Wilberg on Wednesday - The Illness Is The Cure pt 34/46

On Life Doctoring

What is Life Doctoring?

LIFE DOCTORING is therapeutic counselling for serious or chronic illness. It is about ‘treating the patient and not the illness’ – by exploring links between illness and life – in particular the relation between the emergence of symptoms and significant life changes.

“It is changes that are chiefly responsible for disease.” Hippocrates

What is a Life Doctor?

A Life Doctor is a psychotherapist trained in Life Medicine and able to provide Life Doctoring for symptoms of all sorts, both ‘mental’ and ‘physical’.

A Life Doctor is not a conventionally trained biomedical doctor and is not qualified to prescribe any form of conventional medical treatment.

Yet a Life Doctor is not only a medically well-informed counsellor and consultant, but also possesses different types of medical knowledge and understanding of a sort that ordinary doctors do not receive in their training.

The Life Doctor will never seek to prevent a patient seeing or seeking advice from an ordinary doctor or medical specialist, but will instead explore the patient’s experience of orthodox medical practice and practitioners and the meaning this experience holds for them.

The Life Doctor however, will ask questions of a sort very different to those put by ordinary doctors or specialist consultants – whose main role is to come to a biomedical ‘diagnosis’ of a patient’s symptoms and to offer corresponding forms of treatment.

The Life Doctor will also advise the patient about the possible dangers and/or side effects of different forms of biomedical testing and treatment.

What Life Doctoring offers:

Opportunities for you to share your personal experience of illness and of medical services and treatments with a knowledgeable and informed counsellor independent of the medical profession.

Quality listening time – and a different type of listening – of a sort that doctors and consultants have no time for.

Healing of a sort that can only begin with being fully heard as an individual human being – not reduced to a ‘case’ of some hypothetical ‘disease’.

Advice in making informed choices about medical tests and treatments, including their potential dangers and side-effects.

Help in revealing the true story of your illness – its biographical as well as ‘medical’ history – as well as its impact on your current life.

Awareness of possible relational dimensions of your illness – its connection to your personal, family and social relationships, past and present.

The chance to discover significant links between your illness on the one hand and significant changes and events in your past or present life on the other.

Ways to put you more in touch with your body and what it may be telling you – or seeking to tell others.

Greater trust in your body’s own knowing as opposed to any body of medical beliefs.

Help in bringing to light the questions your illness may itself be there to make you ask yourself about your life.

Help in understanding and relating to your illness in ways free of the fears that diagnostic labels so often arouse.

New forms of healing based on meditating our bodies rather than medicating them.

Important knowledge, advice and support in preparing for consultations with doctors, consultants, surgeons or other health professionals. 

Prevention from getting entrapped by standard medical or psychiatric procedures – being reduced to a mere ‘case’ of some clinically diagnosed disease. 

Protection from being persuaded into accepting potentially dangerous, counter-productive or even life-threatening forms of orthodox bio-medical testing and treatment.

The Practice of Life Doctoring (1)

Life Doctoring is therapy for serious and chronic illness. Its focus however, is on the patient’s felt or lived body and not just on the clinical body or the body seen merely as a complex biological machine. The Life Doctor understands the body not as a biological machine but as a living biological language of the human being and symptoms of illness as the ‘speech’ or expression of the patient’s life situation, life world and life history as a whole. The practical starting point of Life Doctoring is therefore precisely the type of questions in my chapter on What Most Doctors Don’t Ask. These relate to what was going on in the patient’s life preceding the onset of symptoms, what they stop or hinder the patient from doing, the thoughts and feelings that accompany their symptoms and how they make the patient feel – that is to say, in what way they alter the patient’s very sense of self – their body identity. At the same time, like any doctor, the Life Doctor must take a complete medical history of the patient – including all forms of testing and treatment they have undergone, what they have been led to believe about their condition and their experience of how they have been handled by doctors and other medical professionals.

The Life Doctor must also be capable of in-depth research and understanding of purely biological and biomedical understandings of the patient’s condition. Like the General Practitioner, the Life Doctor is essentially a ‘generalist’ and not a specialist in these conditions. What distinguishes the Life Doctor however, is their capacity to ‘read’ even the most detailed biological and biomedical accounts of the nature and ‘causes’ of an illness in a very different way from that of a biomedical physician. For often the very language and terminology used in biological medicine itself, and the biological processes they are used to describe, can themselves be highly symbolic. This applies even to the very names given to certain conditions – for example the diagnostic term lupus erythematosus – meaning ‘red wolf’ and associated with dermatological symptoms such as red patches on the skin.

“Systemic lupus erythematosus … often abbreviated to SLE or lupus, is a systemic autoimmune disease (or autoimmune connective tissue disease) that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage. It is a Type III hypersensitivity reaction caused by antibody-immune complex formation. The course of the disease is unpredictable, with periods of illness (called flares) alternating with remissions. The disease occurs nine times more often in women than in men, especially in women in child-bearing years ages 15 to 35, and is also more common in those of non-European descent.”

Wikipedia

Case Example 5

The patient in question first began to experience symptoms of lupus after coming off a treatment course of anti-depressants which lasted many years. The depression had followed the death of her grandmother, with whom she had a highly ambivalent relation. The symptoms of lupus had recently ‘flared’ again when it became a matter of financial importance to consider selling her mother’s house – which she now occupied together with her partner but which the grandmother – a family matriarch – had insisted should always remain in the family.

As a woman, the patient felt responsible and sympathetic to the idea of maintaining a matriarchal line. On the other hand, she harboured deep feelings of anger at the way her mother had always been treated by the grandmother. These unexpressed feelings of anger and rage prevented her from, in any way, mourning the death of the grandmother and led instead to years of affect-less depression – the lack of affect being intensified by the anti-depressants themselves. Even after coming off them however, the patient’s anger itself had never been given an opportunity to fully ‘flare up’.

In consultations with the Life Doctor the patient gave a consistent impression of meek submissiveness – a strong parallel to her mother’s submissive position in relation to the grandmother. At the same time the patient also experienced a sense of guilt at the idea of selling the house passed down by her grandmother. For to do so would be a betrayal, not just of the grandmother herself, but of the patient’s own ‘feminism’, which had long found expression in an interest in Wiccan and other pagan forms of religiosity involving worship of the feminine aspect of divinity (which is sometimes called the ‘great mother’ – itself another term for ‘grandmother’).

The Life Doctor’s analysis of the patient’s illness in the context of her life history was that it was essentially rooted in a conflicted ‘love-hate’ relationship to her grandmother. On the one hand, she identified with what the grandmother symbolised for her (identification being an essential element of ‘love’) whilst on the other hand hating her for the way she had aggressively mistreated her own mother and reduced her to a state of passive servility. This is where the medical terminology itself revealed a new symbolic layer. For from the perspective of Life Medicine, auto-immune disorders – in which the body attacks itself – are an expression of guilt. The patient punishes themselves physiologically for feelings of guilt by directing the anger behind this guilt inwardly (through the body seeing its own cells as foreign or ‘non-self’) rather than this anger being consciously directed outwardly towards its true object – in this case the patient’s grandmother.

“There are several explanations ventured for the term lupus erythematosus. Lupus is Latin for wolf, and erythro is derived from ερυθρός, Greek for ‘red’. All explanations originate with the reddish, butterfly-shaped malar rash that the disease classically exhibits across the nose and cheeks.

1. In various accounts, some doctors thought the rash resembled the pattern of fur on a wolf’s face.
2. In other accounts, doctors thought that the rash, which was often more severe in earlier centuries, created lesions that resembled wolf bites or scratches.
3. Another account claims that the term “lupus ” did not come from Latin directly, but from the term for a French style of mask that women reportedly wore to conceal the rash on their faces. The mask is called a ‘loup’, French for ‘wolf’."

Anger and rage are of course associated with the colour red – and for a biomedical diagnosis of lupus erythematosus (red wolf) the appearance of thick red patches or blisters on the skin is highly significant. So much for the ‘red’ in ‘red wolf’ but what about the wolf – itself an aggressive and predatory creature. The Life Doctor’s interpretation of the patient’s illness came to clearest expression through an intuitive link between the biomedical name and nature of her illness, her life history – and their common relation to the story of ‘Little Red Riding Hood’. To the Life Doctor the patient appeared as ‘Little Red Riding Hood’. The question was then – who ‘ate’ her grandmother? Clearly not a wolf, but perhaps someone who felt aggressive ‘h-ate’ for her i.e. a part of the patient herself. The patient’s inability to mourn her grandmother’s death might also therefore have been due to her feeling that her own suppressed feelings of hate were what killed her grandmother, thus compounding the patient’s guilt. In a nutshell then, the patient developed symptoms of the illness known as ‘red wolf’ by virtue of never allowing herself to affirm, identify with and live out – what the wolf in the story symbolised – not just her blood-red anger towards the grandmother but the aggressive side of herself as a whole.

The key question for the Life Doctor then, was not how to ‘treat’ or ‘cure’ the lupus (it is regarded even in biomedicine as incurable) but rather an entirely different type of question. This was the question of what the illness was seeking to cure in the patient – in what way it was seeking to transform her? In the context of her particular history and the Red Riding Hood fable, it seems this question could be put more specifically: in what ways, besides ‘flares’ of her symptoms and bodily inflammations, did or did not the patient grant herself permission to consciously get ‘inflamed’ or ‘flare up’ with anger – and to fully feel, embody and show the true face of this anger? For this would allow herself to live out the ‘red wolf’ within her – rather than playing the role of ‘little red riding hood’ in relation to that wolf.

The personal significance of the fable for this patient lay in the way that the wolf symbolised both the aggressive side of her grandmother and the patient’s own feelings of anger toward her. In a sense it could be said that the patient, like her mother, had quite simply ‘swallowed’ her grandmother – not in a consciously predatory, hostile or aggressive way but by simply internalising or taking the grandmother inside herself – where she became the object of chronic or recurrent auto-immune attacks by her own body – which simply embodied the patient’s dual and conflicted relation to the grandmother – both identifying with her as a part of herself and at the same time dis-identifying with her – leading the body to identify and attack her own cells as if they were ‘foreign’ or ‘non-self’ bodies.

The unconscious, internal and biologically routed attack on her grandmother no doubt further exacerbated the patient’s chronic psychological guilt – thus creating a vicious cycle which maintained the symptoms of lupus – chronically recurrent symptoms.

The bodily symptoms themselves also corresponded to a specific state of consciousness characterised by a felt sense of weakness and therefore in themselves symbolised a type of recurrent submission to the grandmother – even whilst biologically symbolising an attempt to dis-identify from her on a cellular level – thus rendering her own cells subject to auto-immune ‘attack’.

Yet, as mentioned, the patient came to the Life Doctor in a specific life situation in which her guilt – and the aggressive anger behind it – were exacerbated by the conflict she felt at perhaps having to sell her grandmother’s house, this exacerbation leading to what biomedicine itself terms a ‘flare’ of the lupus. Biomedicine seeks causes for such flares in so-called ‘environment al triggers’ such as allergens, bacteria or viruses. Yet in this way the ‘environment’ in question is in no way connected with the patient’s life world – their social and relational environment as a human being – but instead reduced to a possible source of infections or inflammations affecting the human body. Life Medicine, on the other hand, understands ‘environmental triggers’ as having essentially to do with particular events in the patient’s social and relational environment – precisely because it is emotional triggers coming from this environment that may render an individual more susceptible to ‘environmental triggers’ in the purely biomedical sense.

Biomedical treatment of lupus symptoms takes the form of both anti-malarial and so-called ‘anti-inflammatory’ or ‘immuno-suppressant’ drugs. Both are an attempt to render the patient’s body biologically incapable of expressing – through auto-immune responses and bodily inflammation – deeply buried and inflamed feelings which, in the absence of direct vocal, emotional or behavioural expression, will naturally seek a way of ‘flaring up’ and of literally ‘coming to the surface’ through skin inflammations. Yet if prevented from doing so by biomedical drugs, the danger is that the ‘inflammation’ will progressively begin to damage internal organs too – thus distracting the focus of both doctor and patient even further from the basic question of what the illness is there to ‘cure’ in the patient i.e. what understandings it is offering the patient and how it is seeking to change the patient in a way that would allow them to embody and express their dis-ease in a way other than through bodily illness and its symptoms.

Here again we come to the central question of Life Medicine, both in general and as exemplified in particular through so-called ‘auto-immune’ disorders – namely the potential role of the Life Doctor in acting as a midwife in helping patients feel and give birth to a new bodily sense of self or ‘body identity’ – as opposed to remaining stuck with an over-rigid or internally conflicted body identity that finds expression only biologically and through illness symptoms. In the specific case of the patient referred to here, she came to recognise that the key to turning her illness into a cure lay in finding ways to overcome weak and submissive sides of her identity and instead to embody her anger and rage in ways that avoided the need for aggressive flares of her symptoms – flares which were also accompanied by periods of severe physical weakness. Here she was helped by some of the principal non-verbal methods of Life Doctoring explained and described in more detail in the following chapter on the Practice of Life Doctoring.

In this case the patient was asked to simply feel in her body and show the Life Doctor – silently and face to face – the true face of her feelings; both her un-mourned feelings of sadness but also her anger in relation to her grandmother (or to anyone). The exercise proved strongly cathartic for the patient in first surrendering to her sense of sadness and weakness and then feeling and showing the face of her anger. This was not a face marred by the red patch symptomatic of lupus but did indeed have qualities of aggressive fierceness of a wolf-like character – as opposed to the patient’s previously pale-faced expression and submissive or compliant demeanour. The patient also understood the difference between allowing herself occasional emotional flares or verbal ‘outbursts’ of anger on the one hand, and, on the other hand using continued practice of the exercises she had been taught to silently body that anger through her facial expression and the look in her eyes – knowing from experience that in this way she could be coming to embody a new, less weak, sad or submissive sense of self, feeling it pervading her felt body and transforming her as a whole. It should be emphasised here that in dealing with long-term or chronic conditions, long-term practice of exercises introduced by the Life Doctor are of no less importance than the healing insights and understandings that Life Medicine offers.

The practice of Life Doctoring however, always begins with a search for the ‘hidden story’ behind a patient’s illness in the form of what is called a ‘pathobiography’. And indeed psychoanalysts such as Luis Chiozza have evolved a specific form of medical practice which they call ‘the pathobiographical method’. This involves gathering a detailed biography of the patient which is then analysed by a team which includes not only psychoanalysts but also physicians and biomedical specialists. One important difference between Chiozza ’s method and the practice of Life Doctoring however, lies in the fact that the latter does not rely on any form of elaborate psychoanalytic theory or esoteric terminology to ‘interpret’ the symbol ism of a patient’s illness. Instead it attends purely and simply to what Freud called ‘organ speech ’, and in particular to four distinct ways in which this finds expression:

1. In the language of biomedicine itself – for example by re-linking the purely medical meaning of terms such as ‘inflammation’ or ‘flare’ to their use in describing emotional states (‘flaring up’ or ‘feeling inflamed’ with anger).
2. In the physiological symptoms, functions and processes described in the language of biomedicine (for example the language of immunology and of auto-immune disorders ).
3. In the individual patient’s lived experience of specific symptoms – as described in their own speech and as an expression of their lived or felt body.
4. Through the ways in which the specific life story and context of an individual patient’s illness and its symptoms lends them a highly individual meaning.

In the past, and still in the work of Chiozza himself, psychoanalytic medicine has tended to seek ‘standard’ analyses of particular illnesses. This is not to say that there are no general understandings that can be drawn about the life meaning of particular organic disorders or dysfunctions – but this can be done only through Life Doctoring i.e. through exploration of highly individual cases of them. Life Medicine then, is not just a set of fixed general principles to be applied in and to particular ‘cases’ but is an expanding body of medical knowledge drawn from the very practice of these principles through ‘Life Doctoring’ – which serves also as a form of on-going research into the relation between language, life and illness.


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