Wilberg on Wednesday - The Illness Is The Cure pt 36/46

What can I do if I am a Biomedical Doctor

Study more of the literature on Phenomenological, Existential and Psychoanalytic Medicine (See the list of ‘Further Reading’.)

If you are in private practice, consider extending at least your initial consultations with each patient to up to an hour – to allow time to gather more information about their lives, life world and life history.

If you are working as a GP in the public health system:

Recognise and talk with your colleagues about the counter-productivity of short 7 or 10 minute consultations and emphasise instead the potential of longer consultations to actually reduce the workload of doctors – as well as deepening and enriching doctor-patient communication.

Less medical testing and more talking with your patients!

Ask more questions about the patient’s life and not just the symptoms they present with.

In particular, take opportunities to ask questions of the sort listed in the section of this book called ‘What Most Doctors Don’t Ask’.

For even within a very time-limited consultation it is possible to gather at least some information on the life context of a patient’s symptoms by opening a consultation with a friendly general question such as ‘How are things going?’ – giving time for the patient to offer more than just a superficial answer.

When a patient reports symptoms, ask ‘Had anything been troubling you before the symptoms started?’

Allow yourself to reflect on and share with the patient any possible symbolic or metaphorical dimension to a patient’s symptoms, relating to their current life problems and circumstances.

Example: itching or sensitive skin :

“Anything you’ve been itching to do?” “Anything you’ve been feeling particularly sensitive to recently?”

Example: stomach, digestive or bowel symptoms:

“Anything you’ve found hard to stomach/digest/get out of your system recently?”

Ask for and make notes of dates – not just the patient’s date of birth but the birth and/or death dates of relatives, siblings or spouses. You can do this in the course of asking about diseases in the family such as diabetes, cancer or heart disease.

Be aware of the timing of appointments made by patients – these may coincide with the timing of significant events such as births and deaths of people whom the patient identifies or feels a strong connection with.

Be aware that genetic explanations of illness may disguise something completely different – a strong psychological feeling towards and/or identification with a member of the patient’s family. The fact that illnesses are transmitted across generations does not mean that the mode of transmission is principally genetic.

Always find a way to ask the patient what’s been going on in their mind in relation to their symptoms, for example the question:

“What sort of thoughts and feelings tend to accompany your symptoms and what thoughts do you tend to have about them?”

Menstruation, Migraine and Meaning –
A Short Lesson in ‘Life Doctoring’

The following case offers a further example for biomedical doctors, emphasising the importance of (1) asking the patient different type of questions to those they might normally ask a patient (2) being alert to symbolic dimensions of a patient’s symptoms and (3) seeing symbolic dimensions also to their own medical knowledge of a particular condition and its physiology (both in its typical and atypical manifestations in a given patient).

The aim is to show how taking this Life Medical approach can prove far more effective than simply approaching this condition in a standard way, e.g. by prescribing medications without consideration of either the life-context in which a patient’s symptoms or condition emerged, its life meaning for the patient and the individual significance of both its typical and/or atypical aspects.

Case Example 7

The patient: a married woman in her late thirties who suffered from migraine for almost twenty years, at first irregular and non-menstrual related and then later becoming regular and menstrually related.

Questions to the patient:

When did the symptoms first occur?

The patient experienced her first, non-menstrual migraine during a stay at home from university during the summer holidays.

What were the most important life encounters, events, experiences or dilemmas preceding the onset of symptoms?

In this period she was effectively given the responsibility of ‘head’ of the family by her parents – having to both sort out family affairs and also take care of an elderly relative who she found quite repugnant.

Was there any sort of underlying mood accompanying the symptoms?

Yes, one of general negativity toward the tasks with which she was burdened but also guilt about her own negative feelings.

What did the symptoms force the patient to do, stop her doing or allow her to do?

The first strong migraine made it impossible for the patient to perform the tasks relegated to her by her parents. They forced her to spend days in a darkened room. In this way they also allowed her to take ‘time out’ from her tasks and give time to herself.

At what times do the symptoms tend to recur, intensify or diminish?

The patient’s migraines had continued to recur irregularly for some years after the initial episode. Sometime after she embarked on her chosen career as a university lecturer, she got together with the partner she later married. The couple decided against having children because neither felt a need or wish to have a family. It was around this time that her migraines first began to recur regularly each month, before the onset of menstruation.

What did the patient do in response to her symptoms?

Taking medications in order to alleviate her symptoms sufficiently to able to ‘function’ in her work most of the time.

How did the symptoms, and the thoughts and feelings around them, affect the patient’s life, work and relationships?

At first the patient’s main aim was to use medication in order to not to let her migraines affect her work, which was an important medium of self-actualisation for her. As for her relationship however, though her husband had shared her choice to not have children, with the help of her psychotherapist the patient realised that she harboured some resentment about his seeming emotional indifference to the decision. After being encouraged by the therapist to feel her own feelings about her decision more deeply in her body – and to discuss the decision not to have children once again with her husband – the issue ‘came to a head’. The patient was surprised to find that both she and her husband harboured feelings of sadness and loss at not having a family and that he was prepared to rethink should she change her mind. This removed her resentment toward what she had thought of as her husband’s indifference and brought her closer together with him – whilst at the same time leaving her free to re-affirm her decision to stay childless. In the context of her long-term relationship, this did now constitute a concrete life decision in the true sense i.e. a definite choice between two available options.

What beliefs does the patient hold about their symptoms and the right way to respond to them?

The patient initially appeared to accept the standard socio-cultural beliefs made use of in the advertising propaganda put out by the pharmaceutical industry – beliefs which many doctors themselves are complicit in following. A principle belief is that with the help of the right ‘off the counter’ or prescription pill, patch, tampon, cream or pharmaceutical concoction there is never a need to not go sprightly and cheerfully out of the house and into the world and to stay economically active – whether you suffer from backaches, joint pains, headaches or even cyclical pre-menstrual symptoms. Indeed this applies particularly to menstruating women, who are given a graphic message through advertising that there is no need to not feel full of energy and unencumbered by the monthly ‘curse’. Yet for a woman who is aware of her bodily and emotional needs, menstruation is a time to feel her body more fully and in this way also ‘come back to herself’, listen inwardly to her body and either grieve or rejoice that no child is on the way.

The menstrual cycle of course, follows the lunar cycle i.e. a healthy and natural cycle that all living beings are influenced by: a cycle of waxing and waning. This is one of many natural cycles – the cycle of expansion and contracting that can even be observed in the amoeba, the natural cycle of waking and sleeping, and a no less natural cycle of moving out into the world on the one hand, and withdrawing into one’s self and body on the other.

Without phases of contraction no child would be born naturally. And without ‘coming back to’ or ‘going down into’ ourselves and our bodies we cannot feel ourselves or our bodies fully – and thus go out into the world and relate to others out of a fully re-embodied and authentic sense of self.

Current Westernised societies with their 24/7 culture however, no longer adhere to these cycles or natural rhythms and instead impose a constant ‘forward’ and ‘out-going’ movement as a normative way of living – negating the value of introspection, contraction or withdrawal from the world as unwelcome or even unhealthy and pathological conditions. That is why it is not surprising that both minor ailments such as headaches, colds and flues or even highly painful or discomforting symptoms or illnesses are so often needed as a ‘cure’ for what is effectively a pathological cultural norm – being the only socially acceptable way for individuals to break free of it – even if only by forcing individuals to take time out in which there is nothing to do but feel their bodies and thereby their own selves more fully – to give time to them.

Is there any positive and healthy side to the different mood and sense of self accompanying a patient’s bodily symptoms – or to what their symptoms force or allow them permission to do – or not to do?

Are there any other ways in which the patient could give expression in their life to this positive and healthy side of their symptoms – without needing those symptoms as a spur to do so?

With the help of her psychotherapist – acting in the role of ‘Life Doctor’ – the patient herself quickly realised that she had deprived herself all her life of the benefits of a natural and healthy cycle of expansion and contraction. This was a breakthrough for the patient. It allowed her to recognise that the migraines – particularly when not medicated – forced her to slow down, to spend time with herself without working, reading, talking or distracting herself in other ways. She wondered whether this was what her body was trying to cure her of through her ‘illness’ and decided to see what happened if she started using this cure independently of the illness itself – for example by pacing herself more, allowing herself more time to not ‘do’ and just be, taking breaks instead of hurrying from one task to the other etc. So even though she continued to work very hard she no longer allowed the needs of work to dictate the natural rhythm of her day – and of her body – but began following her own. Even when she had to work 14-hour days she still made time to intersperse tasks with short breaks during which she allowed herself to be more consciously aware of her body and how she was feeling. About 3 weeks after changing her daily habits in this way – and doing so without feeling guilty for no longer following culturally imposed norms – she experienced her first migraine -free onset of menstruation in 15 years. Through her illness and the insights that also ‘came to a head’ through it, she hasn’t had a migraine since – not because it was medically ‘cured’ but because she allowed the illness itself to help her ‘cure’ and overcome unhealthy beliefs and an unhealthy way of living.

What symbolic dimensions can be seen in the patient’s symptoms and their history and what light do they shed on both menstrually and non-menstrually related migraine?

Both the symptoms of menstruation and those of migraine ask people to take ‘time out’ from their regular routines – or rather to take ‘time in’ – time to go into themselves, just be with and feel themselves more fully from within. The typical symptoms of migraine – painful headache, nausea, feeling sick and vomiting, sensitivity to light and noise can be seen as having two principal symbolic dimensions. One is the service they perform in bringing the effects of a culturally normative but essentially unnatural and unhealthy way of living ‘to a head’ – through painful headaches. The other symbolic dimension has to do with how sufferers respond to migraine attacks, which is often by shutting themselves off in a darkened room – as if recreating a womb for themselves shielded from light and sound.

Herein lies a symbolic clue, not only to the frequency of so-called ‘menstrual migraine’ in women, but also to the unmet needs of male sufferers. In the specific context of the patient referred to, it is symbolically interesting to note also that hers was a profession – university lecturer – focussed on use of the head. And in an age in which sedentary ‘service’ professions and mental work dominates over farming or different forms of manual work, there is a far greater tendency for individuals to lose touch with their bodies – and in particular with the so-called ‘gut brain‘ as opposed to the ‘head brain ’. For this, like the uterus, is located in the abdomen – which contains more nerve cells than the brain. Finally it is to be noted again that the patient’s first episode of migraine, albeit non-menstrual, occurred at a time when, though supposedly on holiday, her time was filled with tasks that effectively demanded that she take on the role of parent in relation to her own parents. In this context, her migraine can be seen as serving an important and healthy balancing role by making her withdraw to a darkened room – thus allowing and encouraging her to both avoid and recover from the parental tasks placed on her by placing herself back in the position of a baby in a protective womb.

Though it is a not an uncommon condition, medical literature and practice never attempt to see any symbolic connection between ‘menstrual’ or ‘menstrually related’ migraine on the one hand, and a women’s relation to both her periods and to having or not having children. This is of no small significance in a time and a culture where women are under greater pressure than ever either to manage the highly demanding and stressful role of ‘working mother’ or else to put the interests of their careers and employers ahead of motherhood. Of symbolic note here is also the fact that the use of standard hormonal contraceptives to avoid pregnancy are known to worsen the symptoms of menstrual migraine and are specifically contra-indicated for women over thirty five i.e. precisely those women reaching a critical life phase in terms of deciding whether to stay childless or not.


Please comment at:
https://www.tapatalk.com/groups/smpbiforum/wilberg-on-wednesday-the-illness-is-the-cure-pt-36-t120.html