Appendix 1. Questions & Answers on Life
Medicine –
an Interview with Peter Wilberg
Ben Watt: Visits to the doctor often
leave patients feeling marginalized and ignored. What has gone wrong?
Peter Wilberg:
Doctors are ‘trained’ (indoctrinated in years-long boot camps
might be a more appropriate way of putting it!) to reduce the human
body to a biological machine.
This training predisposes them not
to see the patient’s body as an embodied self,
i.e. as the outer face of a person
– and
one whose ‘inside’ consists just as much of thoughts and feelings
as of tissue and organs. The result is a total separation of biology
from biography, the life of the human body from the life and life
world of the individual human being. The body and its symptoms are
not seen as a symbolic embodiment and expression of a dis-ease
experienced in the patient’s life (for example an experience of
‘heartbreak’ or total ‘loss of heart’ expressed as heart
symptoms –
or of childhood sexual abuse
expressed as vaginal or anal symptoms). Instead of seeing the human
body as an embodiment of the individual human being, it is treated as
a mere ‘thing’ that the patient ‘brings with them’ to the
doctor –
like bringing a car to a garage.
Unfortunately, many patients are already alienated or cut off from
their own bodies, and may treat their own body as a mere thing or
‘It’ in the same way that many doctors do, thus colluding in a
mutual ‘We-It’ relation to their illness.
Alternatively, however, patients will
literally ‘get ill to see a doctor’
– turning
a life problem
into a bodily symptom
just in order to get it at least medically recognised by another
human being –
and, through the specific and
social role of the doctor, by society at large. But if the doctor
fails to even try to see behind the patient’s presenting symptoms
– to
see the life problems or distress they express and embody—the
patient will indeed feel marginalised and ignored as a human being
– as
they will if they sense no authentic human warmth or empathy from
their doctor. Michael Balint wrote of a ‘collusion of anonymity’
whereby patients are passed from one doctor or specialist to another
without anyone taking any
interest in or responsibility
for
the patient as a person –
and one with a real life rather
than just a name or hospital code number. Indeed, one consultant
actually admitted to me that among his fellow professionals in the
hospitals he worked in, patients were
not even referred to by their personal names.
Instead they were identified with their illness and referred to in a
wholly impersonal way as ‘The Emphysema’ or ‘The Liver
Failure’.
This depersonalisation
of the patient and their body is compounded by doctors’ trained
belief in maintaining ‘clinical distance’, i.e. to not show any
human empathy whatsoever for the patient’s lived experience of
illness (for example of acute or chronic pain and the way this
affects their lives. In the past, miners who developed chronic
respiratory or back problems from having to work long shifts in
almost airless tunnels not big enough to stand up straight in used to
be told by their doctors: ‘It’s your work that’s causing it
– so
get used to it’. Yet even today, doctors are still taught than any
expression of subjective emotional empathy
with patients is a threat to their clinical ‘objectivity’, rather
than being central to the patient not feeling ‘marginalised and
ignored’ –
but instead fully taken in as
a unique person with a unique
life (and not just as ‘some-body’).
As regards human empathy or the lack of
it, I myself recall an experience of mentioning an agonising
seven-hour long attack of Trigeminal Neuralgia (known as the ‘suicide
disease’ because it is one of the most painful illnesses known) to
a clinical practitioner. But because for him it was a mere side-issue
unrelated to my principal presenting symptom, there was literally
zero
empathic response –
as if I’d just made some totally
inconsequential remark about the weather or traffic. In fact, so
entrenched are they in their posture of ‘clinical distance’ that
I have yet to hear one doctor whose first
words in response to mine
consisted of such basic, everyday empathic phrases such ‘Sorry to
hear that’ or ‘That sounds very distressing’.
Yet were doctors to truly take time to
listen –
and also ask the right sort of
questions, for example, ‘Is
or has there been anything else bothering you in your life?’,
a clear relation between what is really bothering the patient and
life and their symptoms will often immediately pop out. Thus an
elderly woman suffering from night-time heart pains—that the doctor
initially only sees as possible signs of ‘angina’ requiring
further clinical tests – may share (possibly for the first time)
the continuing heartache
she feels from recently losing her husband – and losing him to a
night-time heart
attack at that. Or else a patient with a chronically aching shoulder
might be found to answer ‘Yeah, since my cousin/brother/business
partner pulled out of our business I feel I’ve had to shoulder
everything – and I mean everything – on my own’. Many more
examples and case studies of symptoms as a type of ‘somatic
metaphor’ for feelings and life problems are given on my site.
Ben Watt: Could you distinguish your
approach to human suffering and illness from that currently prevalent
in healthcare?
Peter Wilberg:
A whole range of sharp differences between conventional biological
medicine on the one hand, and what I call ‘Existential Medicine’
or ‘Life Medicine’ on the other are summarised in a two-column
table on my website. One of the most basic answers to your question
however, as suggested by the very title of my book, lies in its
recognition that illness and suffering have an innately healing or
‘curative’ value and purpose in themselves. In other words,
instead of seeing illness as something to be cured, the Life
Doctoring recognises illness itself as the cure
– our body’s way of
calling upon us and helping to change ourselves, our lives and our
world. Thus simply asking ourselves and recognising what an illness
is stopping
us from doing (for example, overworking) can offer a key to its
healing purpose, as can the recognition of what it may be forcing us
to do (to take more for ourselves for example). But no illness will
have the same meaning
for every individual, and it is this individually curative life
meaning
– and not a more or less
individual ‘cause’ or ‘cure’ of the biological or genetic
sort –
that Life Doctoring serves to help the patient to discover on many
levels –
and in its many, often complex individual aspects.
A central metaphor I employ in my
writings to get over this new approach is the idea of illness as a
form of pregnancy –
in other words, a process of
gestating, giving birth to and learning to embody new and different
aspects of ourselves –
and with them a new and different way of ‘being in the world’ and
of of living our lives. That process
– like pregnancy itself
– can of course require much
time –
whether weeks, months, or, in certain cases of chronic illness, many
years or even a whole lifetime. With this metaphor of ‘illness as
pregnancy’ in mind much medical treatment is really aimed at using
drugs or surgery to terminate the patient’s pregnancy. Which is why
treatments for serious illness, even when successful, are often
followed by the patient developing another illness
– or the same illness again.
One can also compare see illnesses as ‘body dreams’
– or rather as ‘body
nightmares’. Were it possible that medicine had the technology to
scan a patient’s dreams, what would happen if a nightmarish monster
were discovered in them? No doubt this monster would be regard as the
principal ‘cause’ of the patient’s nightmares. Perhaps, then,
the same dream-scanning technology could be used to ‘censor’ the
patient’s dreams and prevent any possibility of the monster
appearing again –
an equivalent to surgically removing a tumour. Yet would doing so in
any way explain or deal with the reasons for the patient’s having
this monstrous nightmare (or tumour) in the first place? Comparing
illnesses to body dreams and nightmares allows us to see just how
backward
modern biological medicine really is
– comparable in its view of
illnesses to the way a lot of people, in particular scientists,
thought of dreams in the era before Freud, i.e. seeing them as
completely meaningless
experiences rather than as having deep personal life meanings.
Ben Watt: What is the wheat and the
chaff of biological medicine
Peter Wilberg:
Another good question –
though behind and in answer to it is the question of what doctors
themselves regard as ‘wheat’
and what as ‘chaff’. If the patient’s life as a whole
– including their life
problems, stresses or dilemmas, current or recent life circumstances
and events, life history and experiences and their most important
life relationships are all regarded as ‘chaff’, then even to
speak of ‘biological’ medicine is a contradiction in terms
– the root Greek meaning of
the modern term ‘biology’ being ‘the speech’ (logos)
of ‘life’ (bios)’.
It is the way in which difficult and often painful
– but at the same time deep
and potentially transformative
– aspects of our
life themselves speak
through our bodies and through illness
– as they also speak through
our dreams—that constitutes what should be the ‘wheat’ of
‘biological medicine ’. Thus if a patient felt or feels ‘stifled’
or ‘unable to breathe’ in their life
– for example, in their home
or place of work, their family or particular relationships, or in
particular places or life circumstances, is it enough to simply
diagnose some disease entity called ‘asthma’ and give them
inhalers for the rest of their life? If another patient feels
subconsciously inflamed
with anger at some person or situation in his or her life, what help
is it to simply diagnose and treat the resulting inflammation of
their skin or another biological organ? If someone finds a situation
or person in their lives ‘a pain in the ass’, is it enough to
perform a rectal examination and look for sensitive haemorrhoids? If
the same children ‘known’ to be reactive to a particular allergen
can be unknowingly
exposed to it in a clinical environments
– and
yet show no allergic reaction to it of the sort they do at home or in
school –
then what is it their bodies are really reacting to through their
‘allergy’? The list of questions such as these is endless, and
the possible answers all highly individual and therefore infinitely
variable. And yet precisely because they cannot be compiled into a
neat set of statistics or pinned down to some particular gene it is
biological medicine itself that discards them as ‘chaff’.
Ben Watt: Many people believe that
biological medicine has proven itself with such achievements as
surgery under anesthesia, antibiotics, vaccines, and genetic
analysis. Do you disagree, and if so, why?
Peter Wilberg:
These ‘achievements’ may
be regarded as another element of the ‘wheat’ in biological
medicine, its ‘good stuff’—although, taking each of the
achievements in turn, one can find many good reasons for
disagreement.
1. Surgery
under anaesthesia. I have
already referred to the principal natural sources, not just of most
modern pain relievers but also anaesthetics. As for surgery as such,
putting aside emergency surgery for war or accident injuries, stroke
or heart attack victims etc., there remains the larger question of
meaning—of how and why people come to require
surgery –
for whatever reason, in the first place. Or rather the question is,
in what ways might a life- and
meaning-based approach to medicine have
prevented or forestalled the need for surgery ever arising?
Conversely, why is it that, even according to the medical research
itself, so much wholly unnecessary and/or damaging and
counter-productive surgery is performed? A principal reason is that
patients’ needs are assessed according to statistical
risk factors and not as those
of individuals. That is why so many women have had a breast removed
only to find there was no cancer there, or that so many men have been
rendered impotent and/or incontinent, not just by surgical treatment
but simply through surgical
testing for prostate cancer
– conducted solely on the
basis of dubious statistical
risks of prostate cancer based on how much of a particular antigen
they have in their blood.
2. Antibiotics.
Five points. Firstly, antibiotics treatments developed grew out of
the accidental discovery of the bacterial effects of a naturally
occurring mould or fungus –
not through some pharmaceutical company designing a molecule unknown
in nature or to the human body. Secondly, the widespread use of
antibiotics did not develop until after major epidemic infections
declined as a result of improved hygiene and sanitation. Thirdly, as
we know, the overuse of antibiotics threatens to render the bacilli
they were designed to treat ever more resistant. Fourthly, though I
have been as grateful for the availability of antibiotics as many
others, their successful use has not in any way explained why the
medical conditions requiring their use arose in the first place
– nor prevented their
repeated use for the same or other conditions. Only a meaning-based
approach to the medical conditions most often treated with
antibiotics can explain this. For fifthly, since we all constantly
carry the bacteria which supposedly ‘cause’ sore throats
– and a host of other
illnesses, including lethal ones
– we should at least all
have sore throats all the time
and be in constant need of
antibiotics to treat them. So
what other factors in our lives and psyches prevent this happening?
3. Vaccines.
Many very big questions about these too
– too many to go into here.
But as with antibiotics some of the questions never fully addressed
are what makes certain people susceptible to a particular bacillus or
virus in the first place, and how come many people come in contact
with them without getting ill at all
– even during plagues and
epidemics? Another question is whether their use might not make the
body less able
to distinguish a potentially threatening virus from a harmless one
contained in a vaccine. Even many doctors argue that better specific
and general immunity is created by actually contracting certain
childhood illnesses than by vaccinating against them. Finally, we
have yet to explain why the incidence of polio, for example, was
already falling before mass vaccination was introduced. Finally,
there are many who would claim, with good reasons, that the multiple
constituents of most vaccines are in themselves highly
toxic.
4. Genetic
medicine. It is one thing to
recognise that, far from being a mere biological machine, the human
body is a living biological language
of the human being—and that illness too is a form of body language
and bodily communication. It is quite
another thing however, to
reduce this language to genetic strings of molecules constituting our
DNA. The huge danger new forms of genetic medicine threatens us with
come from the belief that we can remove or disable genes associated
with a particular disease with
no other effects resulting.
This is rather like thinking we can eliminate the use of ‘bad’
language by simply censoring or removing from our linguistic
vocabulary certain sequences of sounds and letters these ‘bad’
words contain. The claims made by genetic medicine are in some ways
philosophically quite infantile—as if some genius has discovered
that –
WOW! –
the words yuck,
muck,
fuck and
sucks
– all contain the letter sequence u-c-k.
So we’ll just take a sequence like u-c-k
out of your genetic vocabulary
– and good l-u-c-k
to you!
Ben Watt: What thoughts do you have on
alternative medicine and the other practitioners who describe
themselves as holistic?
Peter Wilberg:
Many if not most forms of alternative medicine follow exactly the
same basic model as orthodox medicine, seeing illness and health as
opposites, and seeking causes
and cures for a patient’s
illness, rather than seeking to understand its meaning
and healing value
in the larger context of their lives. It makes no difference whether
you see a patient’s illness as ‘caused’ by an energy block,
evil spirit, virus, mutated cell or gene
– the basic model is the
same.
The only difference is one of language.
Thus a practitioner of New Age ‘energy medicine‘ for example,
might ‘diagnose’ an illness as a result of an ‘energy block’
in one or more of the patient’s ‘chakras’. Similarly,
practitioners of traditional forms of Chinese and Indian Ayurvedic
medicine differ only in employing very different diagnostic and even
anatomical vocabularies
to those of modern Western biological medicine (see my essays and
book chapters on ‘Alternative Medicine’ and ‘Energy Medicine’).
I myself actually avoid the word
‘holistic’ in describing my work, used as it so often is today in
a way that implies that the human being is precisely not
a unitary whole –
inseparable from their life and life world as a whole
– but rather a mere
assemblage of separable parts
labelled ‘Body, Mind, and Spirit’ (and in this sense no different
in essence
from any other assemblage such as a car).
Ben Watt: So, to recapitulate, what
are doctors for?
Peter Wilberg:
A very good question indeed! Indeed, in a recent essay of mine
entitled Automated Diagnosis
and the Future of Biomedicine,
I pose the question of what essentially a doctor is doing
while listening to a patient. I argue that if what the doctor is
doing is essentially going through a sort of calculative ‘algorithm’
or ‘decision tree’ in order to end up with one or more possible
diagnoses, then the doctor could just as well be replaced by
automated diagnostic software
systems –
built on a far larger and more up-to-date databases of symptom
clusters and diseases, and incorporating far more detailed and
integrated patient medical records, than any human doctor could
possibly ‘store’ in their own head. On the other hand, the
availability and increased use of computer assisted diagnosis could
also potentially also free the doctor from the role of serving as a
mere human medical computer
– a ‘black box’ between
the patient’s ‘input’ and some form of mentally computed
‘output’ in the form of prescriptions, further tests, or
referrals to specialists. Instead they could give their full
attention to exploring the symbolic life meaning of a patient’s
symptoms –
and even the very symbolism to be found in the scientific
terminologies used to account for them. For we must not forget that
what is seen as medical ‘science’ is as much based on metaphor as
on ‘facts’ or ‘evidence’ (for example, the military
metaphor of ‘counter-attacks’ by immunological ‘defenses’
against colonising ‘foreign bodies’, in the form of
microorganisms, cancerous cells, etc). And the whole notion of
illnesses –
not least cancer –
as something against which a war must be fought pervades the mindset
of most doctors and their patients, even though not a single form of
expensively researched and ‘aggressive’ hi-tech treatment for
cancer, though a source of huge profits for the health industry, has
been shown to increase the life expectancy of cancer patients (though
such treatments, whether through surgery, chemo- or radiotherapy do
often devastate the patient’s quality
of life). Yet the single word
‘cancer’ has become a symbol of how not just doctors but most
people now understands illness
– as a type of invasion
or colonisation by mutant
cells or ‘foreign’ bodies of all sorts. Indeed, in this sense,
the word ‘cancer’ has become the medical
equivalent of derogatory terms
for Jews and Blacks.
Coming back to the question however, our
notion of what doctors are for
has also come a long way from a time
– only a few centuries ago
– when the use of even
simple measuring instruments such as thermometers was regarded as
quackery, as was the very notion of ‘diagnosing’ some sort of
hidden disease ‘entity’ causing the patients symptoms. At that
time emphasis was still placed on providing both symptomatic
relief to patients
– whether in the form of
human care and comfort, wise
and healing words, or natural
plant remedies such like willow bark or the seeds of the poppy plant
– which still
represent the principal natural raw material for profitable
pharmaceutically-patented pain-relieving drugs such as ‘aspirin’
(a constituent of willow bark), codeine and morphine, as well
anaesthetics such as novocaine.
‘I don’t care what you know unless
I know that you care.’ This
saying offers another answer to the question of why many patients are
unhappy with the sort of treatment they get from doctors—or rather
the way medical treatment has replaced authentically human health
care.
Michael Balint wrote of the ‘drug’ that we call ‘doctor’. It
is the degree and depth of life
experience and empathic life understanding
that the patient feels coming from a particular doctor
– as expressed in his or her
way of listening, words, body language, general demeanour and manner
of communication –
that has the most powerful and immediate effect on the patient’s
sense of well-being –
or the very opposite. In other words it is to the doctor-patient
relationship and the nature of
doctor-patient communication
that we should look in addressing the big question: What
are doctors are for?
Currently, however, it is as if the patient as a human being does not
even figure in medical discourse at all. Thus, one can read literally
thousands of ‘scientific’ and supposedly ‘evidence-based’
medical research papers in none
of which can be found so much as single reference
to the patient’s lived experience of illness, their experience of
the particular form of surgery or treatment described
– or often even to the
symptoms
that it was intended to treat! In general, ‘successful’ treatment
is more and more equated to observed changes in a visual
representation of the
patient’s body, whether through numbers on a chart or images from a
X-ray or scanning device –
and that irrespective of whether the patient actually
experiences any improvement in their symptoms.
The result can be tragi-comic. For as a friend of mine shared with
me, he himself was told –
without even a hint of irony
– that the surgical
procedure conducted on his father had been completely ‘successful’
– aside from the minor
detail that his father had died during the operation. The
side-effects of medical drugs and surgery as actually experienced by
patients are almost never reported in medical journals and papers,
but are just ignored as a form of ‘collateral damage’ that the
patient has to put up with. Reading patient
experience forums on the
Internet however (something it seems doctors never do) tells us quite
a different story –
often offering a host of horror stories recounting the distressing,
often chronic or even permanently life-damaging
effects of different types of medical drug or surgery.
Ben Watt: In the light of your
thinking, how do you help the ill who come to your home?
Peter Wilberg: Like
many counsellors today, I do not only see clients at home but also
engage with them through correspondence and Skype. Nor do I see Life
Doctoring, i.e. counselling for serious illness – as a replacement
for consultations with ordinary doctor, but as a necessary complement
to conventional doctoring – that is until medical training itself
begins to turn out doctors already steeped in the basic philosophy of
‘Life Medicine’. As for the patient, first contact is usually
made by phone or e-mail enquiry. In response I invariably request
that a potential patient writes to me again, but this time attaching
(a) as detailed a medical history as possible, including of course an
account of their current medical condition and its history – along
with any drugs they are or have been on on or any treatments that
they have received or that have been suggested to them (b) as
detailed an account also of their life
history as they are
prepared to offer – including whatever life circumstance, events
and experiences, as well as family and other relationships, they
consider as having been most important.
Finally, I might also suggest that
they begin to
answer in writing also some of the questions listed in my book and on
my site under the title What Most Doctors Don’t Ask. These
questions are then followed up in face to face sessions and/or
through phone or Skype calls and further correspondence – for they
are central in beginning to gain valuable insight into ‘the hidden
story’ behind a patient’s illness, i.e. the ways in which
difficulties in their lives may be symbolised by their symptoms (see
also Brian Broom: Somatic
Illness and the Patient’s Other Story).
For this purpose however, it is of the utmost importance that the
Life Doctor be as medically
informed as possible of
the specific nature of the patient’s condition – whether through
very competent and thorough research skills, by virtue of already
being a doctor, or through consultation with medical professionals
and specialists. Only in this way can they help a patient in all
the many ways that I see
as defining the principal aims of Life Doctoring – both as new and
specialist form of counselling (for serious illness) and as a new
approach to ‘doctoring’ itself. For it must not be forgotten that
though not necessarily a conventionally trained or ‘qualified’
doctor, the Life Doctor not only has additional and very important
skills, to ordinary doctors, but also a different type of
knowledge of illness – and indeed of the nature of the human body
as such – knowledge of a sort most conventional doctors do
not get from their
training.
With this in mind, the overall helping
aims and methods of my work as Life Doctor can be briefly summarised
as follows:
- Giving patients the opportunity to share their experience of illness in all its life dimensions – not least its subjective, social, emotional and relational dimensions. This includes the opportunity to express their experience of medical practitioners and services and/or voice their concerns around specific medical diagnoses, prognoses and treatments.
- Giving patients greater quantity and quality of listening time – not just a rushed seven, ten or even twenty minute consultation but anything from 1 to 4 hours of deep, patient and empathic listening. True healing can only begin with the patient being fully heard and given the time also to be fully ‘heard out’ beyond the confines of what are generally absurdly limited time boundaries.
- Well-researched and individually tailored advice in making informed choices about proposed medical tests and treatments, based on knowledge of their potential dangers and side-effects – and alternatives to them. It is important that the Life Doctor be able to protect patients from being persuaded into accepting potentially dangerous, counter-productive or even life-threatening forms of orthodox biomedical treatment, as well as to advise and support them in preparing for consultations with their doctors, consultants, surgeons or other health professionals.
- Teaching patients ways to more deeply reflect on and meditate their symptoms – including pain – rather than just medicating those symptoms. In this way – and through the Life Doctor’s own highly trained therapeutic and body awareness – helping patients to uncover the life story behind their illness – its biographical as well as ‘medical’ history, its symbolic meaning in the context of their lives and its potentially healing value in transforming their lives.
- This means helping patients to retrace and reverse the process by which they turned particular life relationships, life experiences and life problems into illnesses – and instead begin to approach those life experiences, life problems and life relationships anew, with a fresh awareness and from a fresh perspective, whilst at the same time always offering the patient on-going emotional support in just coping with their illness and suffering on an everyday basis.
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