Anatomy of an Illness as Perceived by the Patient (10 page)

At the same time, the general practitioner has had no way of keeping up with fast-developing new knowledge, let alone the vast array of new technology and techniques. Even as they made allowances for these facts, however, the public felt uncomfortable about the extent to which specialization was changing medical practice. People saw a contradiction between the traditional view of the doctor as a reassuring father figure who took care of all their medical needs, and the pluralization of the doctor-patient relationship brought about by specialists who presided over separate parts of their anatomy. Holistic medicine has tried to counteract this trend by putting emphasis on the integrating factors.

The emergence of specialists was connected to the burgeoning new medical technology, giving many people the impression that the doctor was an auxiliary of the machine. Patients found it difficult to accept the new impersonalization produced by the new technology. Moreover, the machines pronounced verdicts with a finality that seemed to run counter to one of the oldest rules of medical diagnosis: always allow for the fact that certain individuals may have all the signs and symptoms of a particular disease, yet may be atypical or even completely free of that disease. In any case, holistic medicine put its emphasis on human contact and human warmth, regarding medical technology as generally cold and unappealing.

There has been a need in the nation for increasing the number of doctors who would serve rural areas or work in inner-city community clinics; yet the large majority of medical school graduates have been attracted to specialized practice in the big cities. Doctors are criticized for seeking the big incomes that metropolitan centers make possible, but this criticism doesn't take into account the fact that a large number of medical school graduates have to pay off tuition debts that often exceed $50,000. It would be a mistake to doubt the sincerity of students who say they would be far more disposed to work in country clinics if their massive educational debts were not hanging over them. Whatever the justification, the fact remains that people who need doctors the most are least able to get to them, or, if they do manage to get to them, are least able to meet the general level of fees in private practice.

The rapid rise in the educational level of Americans was reflected in the ability of many people to inform themselves to a far greater extent than ever before about health matters. Many millions of Americans got into the habit of following medical developments. In their own relationships with physicians they no longer were disposed to accept medical decisions unquestioningly. They tended to evaluate doctors according to the willingness of the physician to enter into a mutually respectful dialogue with them.

Enough verifiable data have appeared about the ability of the human mind to play a major role in overcoming illness to make this entire field enormously attractive to laymen. It is manifestly true that interest in these matters outruns systematic knowledge; many people eagerly snatch at new findings or speculations having to do with the reach of the mind. And they are disappointed when they discover that their doctors are not equally well-informed or excited about such developments and prospects. With each new popular book on the potentialities of the human mind or on its influence over the autonomic nervous system, the gap has widened between the public and the medical profession. Not all doctors, of course, are disdainful of the new trends. The biochemical manifestations of mental powers are being well documented. Competent observers have written about yogis in India, for example, who were trained to slow down their pulse to a few beats per minute, or who can order their skin to resist burning from hot surfaces. I myself have witnessed such demonstrations in India, so I know them to be true. But systematic scrutiny of such phenomena has lagged behind popular interest, the result being that the entire field has been colored by guesswork and extraordinary claims. Out of it all, however, has emerged the undeniable evidence that the human mind can be trained to play an important part both in preventing disease and in overcoming it when it occurs. The entire biofeedback movement has gained in stature as the result of such new research. In any case, many thousands of Americans are pressing for greater emphasis—by the medical profession—on mind-body interactions and the attack on illness.

To be sure, these are not the only elements involved in the burgeoning growth of the holistic health movement. But they constitute both the main structural props and the rallying points for the growing interest of the educated public. Underlying these ideas, of course, are the traditional essentials of health that have always had a strong place in medical canons—proper nutrition, adequate exercise, enough sleep, good air, moderation in personal habits, and so on.

At the various holistic health conferences I attended, I became aware of a troubling contradiction. A movement based on the concept of wholeness was itself becoming unwhole. Two dozen or more schools or approaches of varying validity, not all of them compatible and some of them competitive, were crowding the center of the holistic stage. Some conferences on holistic health seemed more like a congeries of exhibits and separate theories than the occasion for articulating a cohesive philosophy. Generally included were exhibits or presentations from acupuncture, astrology, graphology, numerology, clairvoyance, biofeedback, homeopathy, naturopathy, nutrition, iridology, pyramidology, psychic surgery, yoga, faith healing, vitamin therapy, apricot kernel therapy, touch encounters, chiropractic, self-massage, negative ionization, and psychocalisthenics, among others.

The inclusion of all these approaches in the same paragraph creates an impression that acupuncture, for example, is on the same level as astrology in the treatment of illness. The same is true when they come together in a conference or exhibit hall. I recognize that many people believe that astrology is a valid guide to treatment of serious illness. I respect their right to that opinion, but I would not want to take the responsibility for advising anyone who is seriously ill to forego the soundest medical advice obtainable. In any case, it is difficult to think of a unifying principle that can tie together nutrition and graphology in a systematic approach to good health. Indeed, the danger of fragmentation and general diffusion in such a coupling is all too real. The parts seem to be at odds with a movement based on the need for an integrated approach to health. One of the dangers is that the movement tends to take on the character of the least workable and reputable of the contending parts.

While it is reasonable, therefore, to expect the physician to take the concept of holistic health seriously, it is unreasonable to expect him to embrace approaches which lack systematic and sustained verifiable data. As evidence is developed, however, it is reasonable to expect the physician to examine it carefully and fully.

Similarly, it is reasonable to expect the physician to maintain an open mind about new developments in diagnosis and treatment even though they may not seem to be in harmony with his own training and experience. But it is not reasonable to expect him to proceed with any treatment in the absence of adequate clinical evidence that it is safe and efficacious. No responsible doctor will experiment with his patients.

It is reasonable to expect the physician to have respect for the powers of mind in overcoming disease, especially in view of the laboratory and clinical evidence that human biochemistry is affected by willpower or emotional states. But it is unreasonable to expect him to give those approaches a monopoly status in his care of patients and to abandon other methods he knows to be efficacious in varying degrees.

It is reasonable to expect the doctor to recognize that science may not have all the answers to problems of health and healing. But it is not reasonable to expect him to give up the scientific method in treating his patients. The most important thing about science is the scientific method—a way of thinking systematically, a way of assembling evidence and appraising it, a way of conducting experiments so as to predict accurately what will happen under given circumstances, a way of ascertaining and recognizing one's own errors, a way of finding the fallacies in long-held ideas. Science itself is constantly changing, largely as the result of the scientific method. It is unreasonable, therefore, to expect the doctor to depart from this method no matter how great the compulsion or persuasion.

It is reasonable to expect the doctor to accord nutrition a high place in the understanding and treatment of illness. It is equally reasonable to expect him to listen to his patient's own developed interest in the subject, even though the doctor may see logical and factual gaps in the patient's articulation. It would be a serious mistake for the physician to allow his superior knowledge of health care in general to lead him to believe that there are no particulars in which laymen may be better informed. The case for good nutrition is exactly the same as the case for good medicine. If medication can make a difference in the internal functions of a human being, so can food. It is a serious error to suppose, therefore, that medication can accomplish a desired purpose despite everything else that is taken into the human body, or that the right foods cannot be used effectively to fight disease, whether in combination with medication or without it, depending on the nature of the problem. In any case, it is reasonable to expect the physician to take a complete nutritional profile of a patient as an essential part of any examination workup.

It is unreasonable, however, to expect a physician to believe that the right foods, however essential, are all that is required to cure any disease. The doctor would be irresponsible if he did not use all the means at his command in cases requiring heroic intervention. To the extent that proper foods are required, they should be fully employed; to the extent that the science of medicine should be fully invoked, the doctor should not be expected to hold back. If a patient has had an attack of bacterial endocarditis, for example, prompt medicinal treatment can represent the difference between life and death. Good food can play an important role in strengthening the heart, but in an emergency situation, it would be folly to abstain from drastic medicinal treatment, taking into account the remarkably high percentage of cases that have recovered swiftly when so treated.

It is reasonable to expect the physician to accept the need for vitamin supplementation where people are under stress or are subjected to environmental strains and hazards. The notion that the average diet supplies all the proper vitamin levels is not very meaningful; the use of the word “average” in such matters is arbitrary and unscientific. Some lifestyles produce a chronic vitamin imbalance. It is possible that more patients would go to doctors for advice concerning these matters if they did not have the feeling that doctors regard vitamin deficiencies as nonsense. Such deficiencies are all too real, especially as the result of the large dependence on processed foods.

It is unreasonable, however, to expect the physician to see all diseases as a manifestation of vitamin deficiency. It is equally unreasonable to expect physicians to encourage their patients to spend large sums of money on vitamins regardless of need and regardless of the possible harm that overloading might cause.

What is needed here—as it is in all matters—is a sense of balance that neither attempts to dismiss vitamins out of hand nor regards them as the only key to good health. Such a balance is possible, given attitudes of reasonableness by both physician and patient.

The holistic health movement can discover its greatest effectiveness by seeking such a balance. It would not be in the interest of the movement to regard the medical profession as the enemy. Talk of enemies does not sit well in a movement in which spiritual factors are no less vital than practical ones. Holism means healing—not just of bodies but of relationships. One of the most useful things the movement can do is to bring public and physician together in mutual respect for the ability of the human body to be fully potentiated in maintaining health and in overcoming disease. The impressive number of medical schools that are represented at various holistic health meetings around the country confirms the fact that holistic health advocates have won their main objective, which is to shift the emphasis from knowledge of the disease to knowledge of human beings in whom the disease exists.

Few things have been more encouraging for the holistic health movement than the 1978 convention of the American Medical Association. At that meeting, the nation's doctors heard talks about the dangers of over-medication and about the need for restraint in writing prescriptions in general; about the importance of psychological factors such as compassion and warmth in the treatment of the ill; about the role of good food in preventing and overcoming illness; and about ascorbic acid therapy. Linus Pauling, who only a few years ago was heavily criticized by the medical profession, made a major presentation at the convention, and provided a step-by-step account of his work with what he called “orthomolecular medicine.” He seemed to have a profound impact on all those who heard him.

The auspicious prospect is that the interest of laymen can be knowledgeably applied in concert with the medical profession's own respect for the layman's responsible involvement in holistic approaches to health.

SIX

W
HAT
I L
EARNED FROM
T
HREE
T
HOUSAND
D
OCTORS

Following the publication in the
New England Journal of Medicine
of the first chapter of this book, I was the recipient of some three thousand letters from doctors in about a dozen countries. What was most remarkable and gratifying about these letters was the evidence of an increasingly open attitude by many doctors to new and even unconventional approaches in the treatment of serious disease. There was encouraging support in these letters for the measures that had figured in my own recovery—a well-developed will to live, laughter, and large intravenous doses of sodium ascorbate. Far from resenting the intrusion of a layman into problems of diagnosis and therapy, the doctors who wrote in response to the article warmly endorsed the idea of a patient's partnership with his physician in the search for a cure.