Wilberg on Wednesday - The Illness Is The Cure pt 17/46

On Life Medicine

Basic Principles of Life Medicine

• Illnesses have life meanings and not just biological ‘causes’.
• People die through illnesses – not ‘because’ of them – and that only if they are ready to die.
• It is not illnesses that are the problem in our lives - but the life problems that express themselves as illnesses.
• The body is not a biological machine or a product of our genes but a living biological language of the human being.
• Health is not merely our capacity to ‘function’ economically in the labour market but an expression of the degree of fulfilment we experience in our lives, work and relationships.

Life Medicine is ‘holistic’ medicine in the truest sense, exploring the relation between the life of our bodies and our lives and life world as a whole. 

Life Medicine challenges the whole separation between what is called ‘physical ’, ‘organic’ or ‘somatic’ illness on the one hand and ‘psychological’ or ‘mental’ illness on the other.

Life Medicine is not merely ‘psychosomatic’ medicine – it does not merely focus on a limited category of so-called ‘psychosomatic’ or ‘stress-related’ illnesses.

Life Medicine recognises that every bodily state is at the same time a ‘psychological’ state or state of consciousness – and that every state of consciousness is at the same time a felt bodily state.

Life Medicine recognises that for many if not most people, illness is the only way they can give expression to and gain recognition of the ways they are ill-at-ease with their lives.

Life Medicine affirms the healing value of illness itself, recognising that the sense of ‘not feeling ourselves’ that marks the onset of symptoms can be the beginning of a journey that leads to ‘feeling another self’ – one that feels more at ease with ourselves and our lives.

Life Medicine understands illness as a form of pregnancy with its own gestation period and labour pains. From this perspective, illness is not just something to ‘bear’ or put up with. Instead its purpose – one that Life Doctoring can help to fulfil – is to help us to give birth to and embody a new bodily sense of self and a new inner bearing toward our lives and life relationships. In this sense, it can be said that the illness is there to cure the patient – to offer them healing insights into themselves and bring about a healing transformation in their lives.

The Healing Value of Illness

“…the body’s symptoms are not necessarily pathological, that is, they are not just sicknesses which must be healed, repressed or cured. Symptoms are potentially meaningful and purposeful conditions. They could be the beginning of fantastic phases of life, or they could bring one amazingly close to the centre of existence. They can also be a trip into another world, as well as a royal road into the development of the personality.” 

Arnold Mindell

“If people become ill, it is quite fashionable to say that the immunity system has temporarily failed – yet the body itself knows that certain ‘dis-eases’ are healthy reactions. The body does not recognise diseases as diseases in usually understood terms. It regards all activity as experience, as a momentary condition of life, as a balancing situation.”

from The Way Toward Health by Jane Roberts (see appendix 6)

In its ‘war’ against disease – a war conducted at whatever cost to the state or to the individual – neither the meaning of illness nor the potentially healing value of illness are acknowledged by biological and genetic medicine. Life Medicine, on the other hand is founded on the recognition that illnesses can themselves serve many different healing purposes:

• Giving bodily expression to a felt ‘dis-ease’ – to ways in which we may feel ill-at-ease with ourselves, other people or different aspects of our lives.
• Forcing us to take ‘time out’ from merely ‘functioning’ in a physically or economically desired way.
• Helping us to feel, focus on and confront painful life problems – even if only through the way in which physical pain can itself focus the mind.
• Bringing us to a necessary ‘crisis’ in the root sense of the word – a decisive ‘turning point’ in our lives.
• Allowing us to fully express and reveal intense emotional pain by feeling and expressing it as a reaction to physical pain. 
• Incapacitating us in a way that allows us to accept real limits to our capacities – limits we might otherwise have sought (or been put under pressure) to deny and overcome.
• Letting us become dependent on others in a socially acceptable way, and in this way to express dependency needs which we might otherwise think are unacceptable.
• Enabling us to indirectly ask for and receive emotional care and attention from others through the care of our bodies and being taken care of as ‘patients’.
• Helping us to give more time and be more patient with ourselves and others by becoming ‘a patient’.
• Providing a temporary respite from life problems by becoming a medical ‘patient’ in need of treatment and care.
• Providing a temporary but coherent organising principle for a person’s life – built around their symptoms or around timetables of rest and treatment.
• Overcoming isolation and offering a medium of human contact through relationships with physicians or through the social environment of a hospital ward.
• Putting us into an altered state of consciousness – one in which we can come to feel ourselves and see our lives in a different way.
• Stopping us from just living in our heads and minds and helping us feel our bodies again – thereby giving us a fuller, more embodied sense of self. 
• Transforming our ‘body identity‘ and ‘body speech‘ – bringing about and giving birth to a new bodily sense of who we are and new bodily ways of relating to others.
• Allowing us to identify with and feel close to an important person in our lives – living or deceased – who may have suffered symptoms of illnesses similar to our own.
• Giving symbolic expression to a subjectively felt dis-ease. For example heart conditions as a metaphorical expression of either ‘loss of heart’ or ‘heartlessness’, ‘cold-heartedness’ or ‘faint-heartedness’ etc.
• Giving birth to a new bodily sense of self or ‘body identity‘ – one more in tune with one’s current life, able to relate in new ways to others and respond in new ways to one’s life world.

Finally, we must not forget the importance of illness as a quite natural way of dying or as a way out of intolerable life circumstances such as extreme poverty or war. The ‘war’ that biological medicine wages on disease on the other hand, is part of a wholly unnatural and wholly unwinnable war against the basic life realities of both aging and death. That is why people seek cosmetic or herbal ‘elixirs’ of youth and science seeks to develop bio-technologies that offer a purely physical form of immortality. What this reveals is a social culture that values quantitative longevity over quality of life, and why biomedicine uses all possible means – even the most toxic – to extend the lives of patients by mere months – at whatever economic cost and at whatever cost to a patient’s quality of life.

Wilberg on Wednesday - The Illness Is The Cure pt 16/46

Illness as Deviance

“In Latin norma means ‘square’, the carpenter’s square. Until the 1830’s the English word normal meant standing at a right angle to the ground. During the 1840s it came to mean conformity to a common type. In 1880s, in America it came to mean the usual state or condition not only of things but of people… [It] was first given a medical connotation around 1840 by August Comte … During the last decade of the nineteenth century, the norms and standards of the hospital became fundamental criteria for diagnosis and therapy. For this to happen … it was sufficient that disease as deviance from a clinical standard make medical intervention legitimate… “

Ivan Illich, Medical Nemesis, the Expropriation of Health

Though they may or may not think very deeply about what is wrong with the social and economic system they live in, most people who suffer from being stuck in poverty, poor housing or boring, low-pay jobs would not think of asking what is wrong with them. Nor do people who suffer from the experience of war, floods or other natural catastrophes, deaths in their family etc. Yet when it comes to suffering experienced in the form of bodily symptoms of ‘illness’, then, unless their condition is clearly related to their immediate environment or living conditions (for example starvation, lack of clean water, radioactive emissions etc.) the first question people tend to ask themselves is ‘What’s wrong with ME?’

The question itself carries several implications. Firstly, the word ‘wrong’ implies that something abnormal and unnatural is going on in their bodies, i.e. a deviation from some norm of ‘healthy’ bodily functioning. Secondly, the question implicitly asks for a ‘cause’ of the body’s deviant behaviour – and usually seeks an answer in the form of some medically diagnosable ‘illness’ or ‘disease’. Indeed the sufferer might already be asking themselves speculative diagnostic questions such as ‘Am I getting a cold?’ or ‘Might I have cancer?’.

A third, even worse implication is suggested by the little word ‘me’ – the implication of it being that not just a person’s ‘mind’ or ‘body’ but they themselves are ‘deviant’ in some way. The belief that illness is a form of deviant bodily state or even deviant behaviour may be reinforced by feelings of shame or anxiety around it – for example, shame or anxiety about calling in sick and taking a day or more off work.

Such feelings are further reinforced if, as was revealed in a recent documentary on working conditions and regulations in Amazon warehouses – employees are actually given a ‘black point’ for simply taking half a day off work due to illness – or even just feeling tired at the end of a gruelling 10- hour night shift – and thus not fulfilling their pre-set performance targets. Worse still, the Amazon rule was ‘three strikes’ (three black points) and you’re out – quite literally out of a job – and that quite irrespective of whether your symptoms (for example a bad or even chronically injured back) might actually be due to the excessive strain placed upon your body by the job itself (for example from having to constantly push heavy trolleys). In the case of Amazon, we must include also the mental stress of having the maximum time in which you are expected to pick up another item for the trolley literally counted down in seconds on a hand-held monitor carried by every employee).

This is but a particularly extreme example of how the very phenomenon that we call ‘illness’ is never itself brought into question. Is a worker’s ‘illness’ merely their bad back, or some other psychological stress or physical strain symptom? Is it enough to have a doctor diagnose the patient’s symptoms (for example as tendonitis or a damaged vertebra ) to know what’s ‘wrong’ – to know what the ‘illness’ is? Or is what is really ‘wrong’ the fact that institutionalised biological medicine limits the very phenomenon of illness to the patient’s body and mind – failing to look for let alone ‘diagnose’ anything fundamentally ‘wrong’, ‘ill’ or ‘sick’ in their life world.

This narrow biomedical concept of ‘illness’ as a phenomenon is particularly obvious in the case of so-called ‘mental illness’ – where a person may for example, be medically labelled as suffering from a ‘psychiatric disorder’ called ‘depression’ – yet without taking into account any of the countless entirely good and valid reasons a person might have for feeling depressed, even severely or ‘clinically’ depressed (for example the actual or looming death of a spouse, loss of a home or job etc.). More broadly still (and though it seems almost a too blindingly obvious question to even ask, though it rarely is asked) what sort of medical ‘mindset’ is it that regards ‘depression’, ‘cancer’ and even ‘Post Traumatic Stress Disorder’ as ‘illnesses’ – but not exploitative wage-slavery or war – not even dropping atom bombs on whole populations or using carcinogenic uranium tipped bullets? Similarly, what sort of medical mindset is it that regards liver cirrhosis as an ‘illness’ – but not the mass marketing of alcoholic drinks or a culture of binge-drinking? The list of possible examples here is endless, yet they all point to a wholly artificial division between the sickness of individuals and that of society as a whole and social relationships in general – including the doctor-patient relationship – a division maintained not just by medical practitioners but all too often by their patients as well.

From the first question (‘What’s wrong with me?’) comes another: ‘What can I do about it?’. This second question too, carries many hidden implications and presuppositions. One major presupposition is that if a person has discomforting symptoms of any sort, then the natural and obvious course of action is to seek to get rid of them – and to do so both as soon as possible and by any medical means available. The idea that an illness may be a natural expression or even a healthy response to fundamentally unhealthy ways of living and relating, to distressing life experiences – or to a fundamentally sick world – does not even enter the medical mindset shared by most doctors and patients alike. Instead it is as if the whole place of medicine in society is simply to eradicate the symptoms of a sick society by ‘privatising’ them – reducing them to a personal condition of individuals and one that can be diagnosed and treated independently of their larger social and relational context of emergence.

What Martin Buber said of so-called ‘mental illness’, namely that “sicknesses of the soul are sicknesses of relation” can therefore just as well be said of so-called ‘physical illnesses’ too – ‘sicknesses of the body’. Indeed it may be argued that ‘sicknesses of the body’ are there precisely to express and make us aware of ‘sicknesses of the soul’. For the human body is not just a more or less well-functioning biological machine but a living relational language of the human being. And just as ‘body language’ constitutes the major component of all human communication and relating, so also is ‘bodily sensing’ (Gendlin) our most important way of staying aware of how we are experiencing our lives and life world as a whole – being a type of sensitive field awareness of that world as opposed to the more focussed awareness we apply to everyday activities in it.

As Carlos Castaneda put it: “The body is an awareness.” This is an understanding central to the very essence of what we call ‘body’ – a word whose oldest etymological meaning is simply ‘to be aware’ or ‘be awake’. Quite simply, the body itself, being itself so intimately connected with the world around us, also is aware of and knows that world more deeply and intimately than the intellect alone. Yet we are faced with medical mindset that, whilst it claims a huge amount of intellectual knowledge about the body, at the same time totally ignores or devalues the body’s own knowing – that sensitive knowing awareness which the body most essentially is.

A second presupposition of the ‘What can I do about it?’ question is (except in emergency situations or where simple remedies suffice) the belief that anything needs to be ‘done’ at all. For more often than not, when patients present physicians with symptoms, their principal motive – beside the basic infantile one of wanting a parent figure who will ‘make it better’ – is simply to seek acknowledgement or ‘registration’ of their discomfort or suffering by another human being and – through the official role of the doctor in society – by society at large. The patient may also, consciously or unconsciously, be seeking someone who will recognise the ways in which they feel not just ill-at-ease with their bodies but ill-at-ease with their lives, i.e. recognition of the existential or life dis-ease that their body is communicating through their symptoms.

This is not the same thing as asking for a medically recognised ‘disease’ to be diagnosed. For though this is something which may be a comfort for some, for most patients diagnostic testing and its results often constitutes a further step on the road of separating their body from their being, their ‘illness’ from their life – including their life history, relationships, circumstances and conditions, dilemmas and ‘dis-ease’. Taking this step may also lead to suggestions for medical treatment which only serve to reinforce this separation of illness and life, and which often also carry with them another presupposition latent in the question ‘What can I do about it?’. This is the presupposition that if nothing is done about it, ‘it’ can or will only get worse.

On one level, we all have a tendency to respond to any form of bodily suffering in a basically infantile way – feeling upset by it, wanting it to go away immediately or seeking someone or something that will ‘make’ it go away – make us ‘better’ as soon as possible. We may also believe that if nothing is done the symptoms will either persist for ever or get worse in ways that are a further source of fear. This belief and the fear associated with it is often actively intensified by physicians (usually out of their own fear of negligence in ignoring the possibility of some serious or even life-threatening disease developing if what may be its first signs are not looked at more closely or its still harmless first stages not treated promptly). Indeed we could go so far as to say that the mindset of biological medicine is based on a fundamentally paranoid relation to the human body and bodily states. Thus the often amorphous sense of ‘not feeling ourselves’ that is often taken as the first sign of ‘illness’ may already alienate us from our bodies – leading us to experience them in a paranoid way as alien or persecutory bodies, altering and threatening the usual bodily sense of self we take for granted.

In today’s medicalised world however, any suggestion that we might overcome this sense of alienation from our bodies in the way that human beings used to do for millennia – by accepting and patiently bearing the discomforts, pain or incapacity we are suffering – is regarded as a dangerous form of defeatism in the on-going medical ‘war’ against disease, i.e. against whatever genes, cells or microorganisms are currently held by medical ‘science’ to be the alien disease ‘entities’ responsible for that suffering. The role of the physician then, is reduced to one of merely identifying this alien entity as precisely as possible in medical terms, and then medically exterminating or surgically excising it. Hence instead of exercising the art of patience in the face of suffering people become willing ‘patients’, often colluding with physicians in a common war against the supposedly alien entities inhabiting their bodies. The biological fact that there are, all the time, millions of times more bacteria than cells in a ‘healthy’ human body (including pathogenic ones) is quietly ignored – as are many proven medical and biological facts that fly in the face of biological medicine.

The fact of the matter is also that in industrialised societies billions of people – even if not ‘ill’ in medical terms – are already unhealthily alienated from their bodies. They are so simply by virtue of having to sell their bodies’ physical and mental capacities to an employer – for them to use or abuse at will for in the pursuit of commercial and corporate profit. Yet instead of this fact – this ‘sickness of relation’ – being taken as an illness in itself it is meekly accepted as an unalterable economic ‘given’.

After all, we all have to ‘earn a living’, even if we have no option but to do so through what Marx described so well as “the alienation of labour” – a big part of which was the alienation of the labourer from his or her own body. The result is that ‘health’ as such has increasingly come to be defined as mere ‘fitness for work’, i.e. the capacity to ‘function’ economically and in this way conform to and sustain an economic system based on wage-slavery.

That the human body should rebel against this type of alienation and slavery through symptoms of ‘illness’ – even and particularly if as human beings we do not ourselves rebel – is surely a healthy response (and that even and particularly if it incapacitates or disables the individual’s capacity to merely function economically as a ‘healthy’ corporate wage-slave).

And yet the pseudo-religious dogma and moralistic judgement that illness implies something ‘wrong’ with the body – or even with the person who is deemed ‘ill’ – stubbornly persists, thereby providing an on-going justification for the increasing medicalisation – and commercially highly lucrative medication – of almost every form of human suffering. Thus despite the no less commercialised proliferation of ‘alternative’ forms of medicine the true alternative to biological medicine finds almost no voice in our society. This is the alternative of understanding the very phenomenon of ‘illness’ in a way that transcends the boundaries of the body, of seeking and finding meaning in illness rather than seeking medical cures for it. By this I mean understanding what we call illness as something with an innately healing function – not something in need of cure or elimination but there to cure us – to free us from intrinsically unhealthy ways of thinking, relating, living and ‘making a living’. Hence the provocative title of my book – ‘The Illness is the Cure’.

One fundamental way in which each of us can therefore begin to alter our whole understanding of and relation to illness from this new and radical perspective is therefore precisely not to ask ourselves the sort of questions referred to at the beginning of this essay- questions such as what is ‘wrong’ with us or with our bodies. Instead we can ask ourselves what it is that our bodies are telling us is wrong with our lives. Similarly, instead of asking ourselves what we can ‘do’ to cure our symptoms we can ask ourselves what our bodies themselves are urging – or even forcing us – to start or stop doing in and with those lives (by which I do not mean things like stopping smoking or starting on the latest health tips and fads).

It is the reduction of life as such (Greek bios) in all its dimensions to the life of the body, and the reduction too of life’s own meaningful ‘speech’ (bios logos) to a single science called ‘biology’ that together constitute the most basic falsehoods on which modern ‘biological’ medicine is built – preying on our need for instant fixes for any form of suffering.

Therefore a second way of fundamentally changing our relationship to illness is, like the Stoics and Pyrrhronian skeptics of ancient Greece, to refuse to judge any particular way of experiencing our body – and with it our minds – as ‘better’ than any other. This means also breaking with the conventional association of health with happiness. For it might well be that by fully accepting a bodily state of suffering associated with ‘illness’, not only do we not cease to be capable of happiness, but might actually experience a new and deeper state of ‘happiness’ or ‘well-being’ – one wholly independent of the presence or absence of ‘illness’ or suffering in our lives.

What we are speaking of is a depth of contact with our own innermost being (Greek daimon) that in and of itself constitutes a state of ‘well-being’ – one that the Greeks called eudaimonia.

Wilberg on Wednesday - The Illness Is The Cure pt 15/46

Biomedicine as a Religion
of Salvation from Sickness

“Science is the new religion.” Nowhere, outside perhaps cosmology, is this saying by Martin Heidegger more evident than in the field of biomedical science, which, like a religion, claims an absolute monopoly on true ‘knowledge’ in matters relating to illness and the human body – regarding all other or earlier forms of medicine as based on primitive or pre-scientific ‘beliefs’ in contrast to true biological ‘knowledge’ in the form of biomedical ‘science’ – the ‘one true faith’.

The cultural kinship between biological medicine and religion goes even further and deeper however. To begin with, the words ‘whole’, ‘hail’, ‘hale’, ‘heal’ and ‘holy’ share a common origin. Hence the unhealthy is also the ‘unholy’, as echoed in the German word ‘Unheil’. It is not surprising then, that some religions have therefore traditionally associated sickness with sin, not least Christianity – which also laid emphasis on the healing powers of Christ as part of his salvational role.

The theme of this chapter is that biomedicine effectively offers the same type of salvation as a religion, so that even whilst its emphasis is on salvation from sickness rather than from sin, nevertheless in today’s health-obsessed culture, health as such has become a synonym of what is ‘good’ whereas illness is regarded as something not only intrinsically ‘bad’ but also associated with ‘unhealthy’ (read ‘sinful’) activities such as ‘bad’ foods, smoking, overeating, not taking enough exercise etc.

Thus it was only a small step from the demonization of smoking to the demonization and ostracization of smokers – who are constantly reminded by medical propaganda and gruesome images on cigarette packets that they will pay the price for their filthy habit or ‘sin’ – for example through eventually contracting one or another form of serious lung or heart disease as a form of punishment.

Biomedical science is not only a religion of salvation from the implicit ‘evil’ of illness but also and in this way a search for salvation from death itself. Indeed through advances in genetics, biomedical science holds out the ultimate prospect of overcoming death itself – through a form of physical immortality.

“Through the medicalization of death, healthcare has become a monolithic world religion.” Ivan Illich

The new religion has evolved to the point of having its own Bible and Book of Genesis – namely the human genome – a bible which is understood by the medical-scientific high priests of this religion as literally holding all the keys to life and death, sickness and health – yet which only those high priests can decode and master.

Through this new bible the long-standing quasi-religious quest for ‘miracle cures’ on the part of biomedical science continues. For though medical researchers regularly complain about the exaggeration of such cures on the part of the media, pharmaceutical companies still promote their pills as ‘magic bullets’ with miraculous powers – and that however negligible their effectiveness in comparison to placebos, or however mysterious their mechanism of action is to biomedical science itself.

Nevertheless, as Illich also points out: “Public fascination with high-technology care and death…” continues, and can be understood, as the expression “…of a deep-seated need for the engineering of miracles.”

A case in point is ‘intensive care’, which Illich describes “…as but the culmination of public worship organised around a medical priesthood struggling against death.”

On the other hand, he also points out significant differences between the religion of biomedicine and the approach of traditional religions to illness and suffering.

“The major religions reinforce resignation to misfortune and offer a rationale, a style and a community setting in which suffering can become a dignified performance.” The difference also lies in the different modes of interpretation of illness that these religions offer, whether “…as karma accumulated through past incarnations, as an invitation to Islam, the surrender to God; or as an opportunity for closer association with the Saviour on the Cross.”

In contrast:

“Medical procedures turn into black magic when, instead of mobilising his self-healing powers, they transform the sick man into a limp and mystified voyeur of his own treatment.” They also “turn into sick religion when they are performed as rituals that focus the entire expectation of the sick on science and its functionaries instead of encouraging them to seek a poetic interpretation of their predicament or find an admirable example in some person – long dead or next door – who learned to suffer.”

Illich himself became a supreme embodiment of such an “admirable example” during the last ten years of his life, during which he refused hi-tech biomedical treatment for a painful and disfiguring facial cancer on the grounds that it would prevent him from engaging in the most innately fulfilling and therefore most essentially healthy dimension of his life – namely his work.

Yet as he also observed, the religious dimension of biomedicine is nowhere better exemplified than by the money poured into hi-tech cancer research and treatment, which increases in direct proportion to the ineffectiveness of such treatment – or its iatrogenic effects in either triggering or worsening cancer conditions as well as severely damaging the patient’s quality of life (for example through carcinogenic chemo- or radiotherapy) and all this on the pretext of saving that life.

This paradox can only be accounted for by recognising that “Paradoxically, the more attention is focussed on the technical mastery of disease, the larger becomes the symbolic and non-technical function performed by medical technology … Not only white coats, masks, antiseptics, and ambulance sirens but entire branches of medicine continue to be financed because they have been invested with non-technical, usually symbolic power.”

This would also explain why entirely fake operations relying only on the symbolically suggestive power of mysterious forms of technology and belief in the god-like power of clinicians or surgeons have been shown, like placebos, to be capable of producing exactly the same results as real operations – with operating theatres serving as the innermost holy sanctum of hospitals – the temples of biomedicine.

This is not to say that emergency-room operating theatres and intensive care units do not and have not saved lives or that they should be abolished. But intensive hospital care for the ‘terminally ill’ is a different matter entirely – for as Illich notes, evidence suggests it does not increase life expectancy at all and in many cases it actually reduces it in comparison with home care – which allows the patient to “avoid the exile, loneliness and indignities which, in all but exceptional hospitals, await them.” Thus “…patients who have suffered cardiac infarction themselves tend to express a preference for home care; they are frightened by the hospital, and in a crisis would rather be close to people they know. Careful statistical findings have confirmed their intuition: the higher mortality rate of those benefited by mechanical care in the hospitals is usually ascribed to fright.”

‘Putting the fear of God’ – and of death – into patients is a more recent and one of the most perversely religious dimensions of biomedicine. Thus the current standard of what is bizarrely understood as ‘ethical’ practice on the part of biomedical clinicians is to present patients diagnosed with terminal illness with a worst case scenario as regards their maximum life-expectancy.

Thus a patient may be told that he or she has at most one year or less to live, even though the clinician well knows from experience and empirical evidence that though this may be the case, there can be absolutely no ‘scientific’ certainty in this respect – and that the patient may in fact live on for anything up for an indefinite number of years – or even, as also happen, go into remission.

The profound and stressful psychological impact of such prognoses – and that not just on the patient’s state of mind but on their body – goes without saying. As a result it can prove tantamount to a self-fulfilling prophecy – a form of ‘death by prognosis’ – akin to a doomsaying religious prophecy or a witchdoctor’s curse.

Just as religion has its own temples so does biomedicine – the hospital or clinical surgery. These are truly clinical temples, unadorned, like Lutheran churches, and replacing uncomfortable pews with cheap plastic chairs. Stands or shelves abound in every waiting room, replete with glossy printed religious tracts warning of the evils of this or that disease and/or of the price to be paid by unhealthy (read ‘sinful’) lifestyles.

The institutional hierarchy of biomedicine is also like that of a church, except that its bishops are managerial bureaucrats who preach the gospel of cost-cutting and the sanctity of efficiency. Consultation with the patients are ritualised time-limited ‘procedures’ which severely restrict the patient’s ability to share their own lived experience of illness and its effects on their lives – something which anyway counts for nothing to the clinician unless the patient’s own words can be immediately translated into the dry liturgical language and terminology of biomedical science.

The physician is not there to listen, understand and empathise but, like the dogmatic mouthpiece of a religious belief system – simply to prescribe what the patient must do – whether this means taking a pill or undergoing a further standardised ‘procedure’ whether in the form of a blood test, a scan, an operation or a further tightly time controlled consultation with a ‘specialist’ in one or other area of biomedical theory and practice. All such procedures are of course documented in the form of medical records, reports, test results and communications. The result is that the patient is ultimately reduced to a set of documented, biomedically framed accounts of their illness in which all traces of the patient’s experience of illness have been purged.

As for the written ‘prescriptions’ with which patients regularly leave their clinic or hospital, these are comparable to the so-called ‘indulgences’ granted (or even sold) by the Catholic church, “proving relief from the temporal punishment resulting from the effect of sin” – or in this case sickness.

Finally, we should not forget also the religious and globally ‘crusading’ role of biomedicine in seeking to displace local, culturally and ethnically rooted understandings of illness – which, again, are seen as mere systems of ‘beliefs’ in contrast to the supposedly universal truth of biomedical ‘knowledge’. Here we see something akin to the historical appropriation of local ‘pagan’ gods and symbols by Christianity. Yet if traditional local remedies can be displaced by – or, as is increasingly the case – modified and repackaged as patented pharmaceutical products, then of course this crusade also reaps big profits for Big Pharma – just as the Crusades were as much about bringing home booty as imposing new belie

Wilberg on Wednesday - The Illness Is The Cure pt 14/46

The Failure of Biomedicine
to Explain Pain

One of the most common and important aspects of illness that biological medicine can’t explain is pain. The standard biomedical model of pain is called nociception and deals with the neurons that ‘detect’ pain, which are termed ‘nociceptors’. This term is relatively new – in the past one spoke of ‘pain receptors’. This term was abandoned because of its all too obvious questionability. For how can neurons ‘receive’ or respond to pain ‘signals’, when pain as such is essentially a subjective experience. So instead of pain receptors neurologists speak now of nociceptors, a term derived from the Latin noci (meaning ‘hurt’) and emphasise that what these receptors ‘detect’ is not actually pain as we experience it in real life, i.e. subjectively, but actual or potential injury or damage to external or internal tissue and organs.

As for how the actual subjective experience of pain comes about, this is explained by the nociceptors transmitting signals to the brain via the spinal column. The brain then responds by ‘allowing’ or ‘producing’ a subjective experience of pain. Yet how the brain can ‘produce’ a subjective experience of any sort – in this case pain – is left unexplained by this ‘explanation’. Instead, the pseudo-explanation implicit in the old idea of ‘pain receptors’ is simply reversed, i.e. rather than having to explain how a neuron can detect a subjective experience such as pain, what is now left unexplained is how it can create such an experience as a result of tissue damage - particularly given that biology regards bodily tissue itself as basically insentient. The result is that biomedicine now claims that the true ‘source’ of pain is neither localised nerve receptors – nor is it wherever you actually feel pain in your body – but lies precisely where you don’t and cannot feel it – in the brain. Thus the pain you actually feel in your toe after stubbing it, for example, is, according to this model, nothing but a subjective illusion or sensory hallucination created by the brain through a neural mechanism. This standard biomedical ‘explanation’ of pain is maintained despite the fact that:

• 1.  It is counter-intuitive, running contrary to our lived experience of the source and site of pain.
• 2. It offers no explanation at all of how the brain can produce a subjective experience of pain.
• 3. It is premised on the idea that pain is a consequence of physical injury or damage, and so cannot explain why, for example: “…about 65% of soldiers who are severely wounded in battle and 20% … report feeling little or no pain for hours or days.”
• 4. It does not explain why “…no apparent injury can be detected in 70% of people who suffer from chronic low back pain...”¹.
• 5. It does not explain why even the most acute of pains can spontaneously arise and then subside without any identifiable physiological change occurring.
• 6. It does not explain why hypnosis and acupuncture can alleviate or even completely eliminate pain without any pharmaceutical or surgical intervention – even to the point of facilitating entirely pain-free surgery without any use of anaesthetics.
• 7. It does not explain acute, chronic or recurring symptoms of muscle pain (myalgia) or nerve pain (neuralgia) for example in the form of fibromyalgia, or of facial and trigeminal neuralgia – where there is often no evidence of damage to muscle tissue or to the nerves or nerve sheaths.
• 8. It does not explain many forms of common pain – for example particular types of headache with no clearly identifiable physical cause. Seeing them as a result of ‘stress’ does not explain why someone leading a generally stressfully life should experience just one particular type of pain (or any other illness symptom) or why they do so at a particular time or times and not others
• 9. It does not explain the experience of ‘phantom pain’ – pain experienced in the region of amputated limbs where there are no longer any neural pain ‘receptors’ or ‘nociceptors’.

Points 3 and 7 present just a few of many examples in which – contrary to and in a way wholly unexplained by the standard neurological theories of pain – either injury occurs without pain or pain is experienced without injury.

Just as biomedicine seeks to ‘explain’ illness without first of all asking or seeking to ‘explicate’ what ‘illness’ or ‘disease’ essentially is, so also does it seek to ‘explain’ pain without first of all asking the most basic question of all – what essentially is ‘pain’? Yet as Martin Heidegger points out:

“All explanation reaches only so far as the explication of that which is to be explained…” [my stress]

So: “What good is all explaining if what has to be explained remains unclear?”²

Pain is a perfect example of the basic philosophical quandary of biomedicine as such – namely the failure of all its explanations of illness to address and incorporate its lived, subjective dimension, and the chicken-egg question this gives rise to: namely is the felt subjective experience of ‘dis-ease’ (of ‘feeling ill’) a mere effect of ‘being ill’ – of having some ‘objective’ physiological disease or disorder? Or could it be that it is the other way round? This is the essential question that is avoided in biomedical explanations of pain. For whereas in ordinary language we speak of ‘painful’ life experiences or of feeling emotionally ‘pained’, ‘wounded’ or ‘hurt’, biomedical science discards this everyday language of life for neurological terminologies and explanations which seek to reduce pain to an effect of purely ‘physical’ or ‘physiological’ phenomena – yet without any explanation of how the subjective experience of pain arises from them. Indeed simply by turning the pain into an object of scientific or medical explanations, biomedicine implicitly rules out in advance any attempt to explicate the essentially subjective character of pain and instead turns this into a mere ‘secondary’ phenomenon arising from purely ‘objective’ neurological mechanisms.

“The idea of one basis for science and another for life is from the very outset a lie.” Karl Marx

By simply shunting off both painful life experiences and ‘emotional pain’ into a second and entirely separate life domain from bodily pain, the biomedical explanation of pain is classically dualistic – not just separating ‘mind and body’, the ‘psychic’ and the ‘physical’, but also and above all separating life itself from what is claimed to be a true account (logos) or ‘science’ of life (Greek bios) – namely what is called ‘biology’. Then again, by turning pain into an object of biological and neurological explanation however, not only does biomedicine entirely fail to explain its subjective essence, it also ‘shoots itself in the foot’ when it comes to treating pain – so-called ‘pain control’ or ‘pain management’. For not only doctors but also patients tend to turn their own subjective pain into an object – into something they ‘have’. This is unfortunate for the patient, because the bearability of pain and our capacity to live with it depends principally on our capacity to be the pain we experience rather than experiencing as some thing or ‘object’ affecting us.

‘Being the pain’ – becoming it – is the most effective way to stop experiencing it as some sort of bodily entity or object separate from our self and therefore ‘causing’ us to suffer in a way over which we actually have no control at all except through medication. Instead it allows us to identify with the pure awareness of pain – an awareness which is not itself anything painful. Indeed, actively choosing to intensify our awareness of pain – even the most acute pain – can, paradoxically, alleviate pain suffering – as well as releasing insights into its source in our lives (see Case Example 1).

From the perspective of Life Medicine, pain is first and foremost an experience of the subjectively experienced or ‘lived’ body and not the so-called ‘physical’ body or any of its organs, not least the brain. For if the assumptions of ‘brain science’ itself are followed to their logical conclusion, what we perceive from the outside as the human physical body and its internal organs – including the shape and form of the brain itself – is ultimately but a subjective perceptual ‘phantasm’ constructed and projected outwards by the brain. This is the sort of philosophical reductio ad absurdum to which, as Heidegger indicated, ‘reductionist’ brain science ultimately leads – both in general and in relation to pain. For taken to its ultimate conclusion we end up with a worldview in which there is nothing we perceive or experience that can count as real except the brain, even though, paradoxically, our very perception of that organ we call ‘the brain’ is, according to neurological models of perception itself, nothing but a construction of the brain. Despite these philosophical paradoxes we see an increasing flood of media propaganda for so-called ‘brain science’ – a science that identifies who we are as human beings with our brains is evidence for this – and a useful prop for manufacturers of brain-altering drugs, including what can be highly addictive analgesics or ‘pain killers’. The term itself is an interesting one – akin to the term ‘killer cells’ or the notion of ‘fighting illness’. In contrast we have the following words of Seth and of Ivan Illich taken from the appendices of this book.

“… pain and suffering are also obviously vital, living sensations – and therefore are a part of the body’s repertoire of possible feelings and sensual experience. They are also a sign, therefore, of life’s vitality, and are in themselves often responsible for a return to health when they act as learning communications.” Seth (see appendix 6)

“A myriad virtues express the different aspects of fortitude that traditionally enabled people to recognize painful sensations as a challenge and to shape their own experience accordingly. Patience, forbearance, courage, resignation, self-control, perseverance, and meekness each express a different colouring of the responses with which pain sensations were accepted, transformed into the experience of suffering and endured. Duty, love, fascination, routines, prayer, and compassion were some of the means that enabled pain to be borne with dignity.”

“The pupils of Hippocrates distinguished many kinds of disharmony, each of which caused its own type of pain…Pain might disappear in the process of healing, but this was certainly not the primary object of the … treatment. The Greeks did not even think about enjoying happiness without taking pain in their stride … The body had not yet been divorced from the soul, nor had sickness been divorced from pain. All words that indicated bodily pain were equally applicable to the suffering of the soul.” Illich (see appendix 7)

To be sure, the use of ‘pain-relieving’, ‘pain-killing’ or analgesic drugs is a godsend for many people, though most of these (for example aspirin and opiate based drugs such as codeine or morphine) are not modern pharmaceutical inventions but based on natural plant remedies (willow bark or the poppy plant) which have been known about for millennia. Yet the effectiveness of such drugs in itself tells us nothing about the experience of pain, its effect on patients’ lives – or its source in their lives. Pain may, of course, be a direct result of tissue and nerve damage, whether through inflammation, injury or surgery. Yet this does not explain the immense subjective variation in individual pain sensitivity and tolerance.

On the other hand, in the case of headache for example, pain, experienced bodily, may serve to quite literally ‘bring to a head’ painful emotional states and experiences. From the perspective of Life Medicine bodily pain in general almost invariably serves to localise in a more or less acute or chronic way what might otherwise be experienced as a more or less amorphous, unconscious and non-local sense of dis-ease connected with painful life events or experiences. Yet to suggest, as biomedicine does, that some experiences of pain are purely ‘psychogenic’ – implying that they are somehow subjectively ‘imagined’ by the patient just because they have no identifiable anatomical ‘cause’ – is to deny the essentially subjective nature of all sensations of bodily pain, whether we ‘explain’ them biomedically – as produced by the brain – or not.

The complete failure of biomedicine to explain the nature of pain is perhaps one reason why, apart from pain specialists, physicians in general tend to be rather disinterested in the patient’s subjective experience of pain – except as a sign or symptom of disease they can objectively identify or diagnose. It also explains why in medical literature relating to different forms of surgical procedure, one almost never finds so much as a single mention of how patients themselves actually feel after their surgery – even on such a basic level of how much pain they experience and for how long. Thus an operative procedure may, in biomedical terms, be deemed entirely ‘successful’ even if a patient experiences intense pain for weeks, months or even years following surgery – thus totally ignoring the damage that pain itself (and other side effects of biomedical intervention) can inflict on a patient’s life. That is not to say that pain killers will not be liberally prescribed – yet this too is often done without a thought for or mention of their own side effects or addictive properties.

All this fits uneasily with the Hippocratic oath of ‘Do no harm’. In all too many cases, this harm actually begins with the very first consultation with a biomedical physician, if, as is so often the case, the physician completely fails to hear and empathise with the emotional pain which the patient is, in so many cases, simply seeking an attentive and empathic ear for. To find that a physician has ‘no time’ – in all senses of this term – for any subjective or emotional dimension of the patient’s communication having to do with their life outside the consulting room is a form of empathic failure the experience of which is in itself a painful and harmful one. Yet it was only thanks to the pioneering work of Michael Balint ³ – now rarely recalled, recognised or applied – that doctors were introduced to the idea that not only their own clinical training but also their own personal psychological defences may play a crucial role in leading them to completely block or filter out any element of a patient’s communication that might touch a raw or painful emotional ‘nerve’ in their own life and psyche.

Such expressions as ‘touching a raw nerve’, ‘feeling hurt’, or speaking, for example, of a life event or experience as having been ‘painful’ or ‘excruciating’ – far from being merely metaphorical, show us how the everyday language of life offers us a better guide to the essence of pain as such – as pain – than any biomedical ‘explanations’ of it as some purely bodily and neurological process. For such explanations, as we have seen, actually explain nothing about the experience of pain – and in effect reduce it to a sensory hallucination conjured up by the brain – thus making nonsense of ‘scientific’ distinctions between ‘real’ pain on the one hand and so-called ‘phantom’ pain or ‘psychogenic’ pain on the other. Nor do such explanations help us understand many cultural and religious phenomenon, for example how a torturer may be compensating for an inability to feel their own emotional pain by inflicting physical pain on another, or why in certain cultures, ritually self-inflicted pain is not seen merely as some of form of penitential act or ‘self-harm’ but is understood instead as a medium of mystical religious experiencing – connecting the worshipper to the pain of a revered martyr or even that of God himself. Finally current explanations of pain fail to explain the well-attested ability of yogins and fakirs to experience neither bleeding nor any pain at all even whilst piercing their own flesh – or how the use of acupuncture has been proved capable of preventing any experience of pain during surgery, thus eliminating the need for either local or general anaesthetics.

More importantly however, biomedical and physiological approaches to bodily pain deny it any intrinsic meaning or healing purpose. Yet pain can serve many important healing purposes besides ‘nociception’ – registering actual or potential tissue damage.

Examples:

• Allowing painful life experiences and emotional pain – ‘inner pain’ – to be experienced in a more intense bodily way and brought to a focus through painful bodily sensations.
• Allowing an otherwise only vague or dimly experienced sense of dis-ease in one’s life to become more sharply and more acutely felt through the experience of bodily pain.
• Allowing the individual to express and elicit an indirect empathic response to their otherwise unrecognised or unfelt inner pain – their ‘inner scream’ – through such expressions of physical pain as grimacing and groaning, writhing of the body or ‘screaming with pain’.
• Allowing the individual to obtain temporary relief from their inner pain through conventional forms of bodily pain relief.

All these purposes of pain serve to prevent not just the human body but the human being from suffering on-going or further ‘damage’. Conversely, even where pain is related to actual tissue damage, this may be because it is the only way the individual is currently able to more fully experience, express and communicate their inner emotional or existential pain. This is also the reason why some individuals do engage in intentional and conscious self-harm – seeking a temporary sense of release from their inner pain through creating sensations of physical pain. On the other hand, a period of acute physical pain may also occur after the painful life issues behind it have been resolved – offering a sense of final cathartic release from them.

As a result of its failure to explain pain, the most important question never asked by biomedicine is whether the experience of pain can be approached as a form of healing meditation – rather than simply just as a sign of something ‘wrong’ or an object of pharmaceutical medication. So the idea that a form of ‘pain therapy’ may lie in consciously choosing to identify with or even intensify sensations of bodily pain – to give them more attention and awareness rather than less – is never for a moment considered – even though it is in this way alone that we may come to deeper insights into those painful aspects of our lives (and not just our bodies) the experience of bodily pain may itself be an awareness of.

Worse still, if there is no recognition on the part of biomedical physicians for the emotional pain people experience in their lives, who knows just how many times morphine eventually becomes necessary as a substitute for the empathy that is both craved by and denied to patients – and that long before their inner, emotional pain or ‘life pain’ finds expression as bodily pain.

References:

1. Melzack and Wall, The Challenge of Pain, Hardmondsworth: Penguin Books, 1982
2. Heidegger, Martin Zollikon Seminars,
   Northwestern University Press, 2001
3. Balint, Michael The Doctor, His Patient and the Illness Churchill Livingstone, 1957.

Example: a brief case of headache

A patient complained about having a bad headache at the beginning of a session with her therapist and just before she was about to go on holiday with her partner. Asked when the headache had started she reported having woken up feeling fine but then worrying about the holiday. This was because she had promised her partner not to take any work-related books with her, knowing he was afraid that reading them would preoccupy her for too much of their time together.

However, whilst packing before the session she had realised that she really would like to take at least a couple of her books along with her – but also felt bound by the promise she had made to her partner not to do so. In other words it was the inner pain, fear and guilt about a desire whose result might be to hurt her partner that triggered the headache.

When her therapist suggested that she might resolve this relational dilemma by indeed taking a couple of books with her – but at the same time resolving not to get lost in reading them at the expense of spending time with her partner – she immediately realised that this could indeed offer a practical way of reconciling her desire not to hurt or cause pain to her partner with her equally sincere wish to enjoy at least some time reading her books. When she came to a decision in the session to follow this suggestion and to also share and negotiate a new compromise and new promise with her partner she became aware that her headache had totally disappeared.