Healing and Cultural Reality

Healing, of course, is a much broader cultural phenomenon than that encompassed by Western scientific medicine. Admittedly, the success of Western medicine at curing has helped justify its claim to be the model for healing in the world today. Yet, as Eric Cassell notes, "the success of medicine has created a strain: the doctor sees his role as the curer of disease and 'forgets' his role as healer of the sick, and patients wander disabled but without a culturally acceptable mantle of disease with which to clothe the nakedness of their pain" (Cassell, 1976, p. 51). This strain also appears in the way patients perceive their physicians. Western culture has conferred upon doctors the role of the care of the sick; but although doctors' role as the curers of disease is clear, their role as healers remains obscure. The latter role, Cassell adds, depends less on their ability to provide a scientifically accurate explanation of their patient's illness than to provide an explanation consistent with the culture of the patient. The reality that counts is cultural reality, and the system used by the healer or doctor need be accurate only in terms of the culture in which it is being used, for it serves to explain illness. The importance of the healer's explanation, Cassell insists, cannot be overemphasized.

THE HEALING RELATIONSHIP. As Cassell sees it, the healer's knowledge, imparted to the patient, helps move the world of illness from the unknown to the rational world. This knowledge allows the patient to "work on" the illness and to make an essential link between conscious process and body process that, Cassell says, marks the "educated" patient. Such healing is not cognitive alone. In addition to educating the patient, healers also play an active physical part in providing a link between symbolic reason and the body: They use their hands. Cassell calls this the "tenderness phenomenon," as important as education in the process of healing. He associates this phenomenon with parenting, and, in this sense, healers serve as parents. In addition to other aspects of the parental role, we transfer to them the right to lay hands on us, to be tender to us, and to pass through our territorial defenses.

The connectedness that underlies the tenderness phenomenon works in both directions. Healer and sufferer become exquisitely sensitive to one another; each can sense the feelings of the other. If healers can accept that the feelings they have can come from the patient, they can use their own feelings in the presence of the patient to provide a vital link with the patient's interior emotional state that is otherwise closed to the clinical observer. Cassell emphasizes that the ability of healers to establish this connectedness with the patient is not an exception to the role of healer but is rather an integral part of the healing function. It shatters the silence of which Katz writes, and substitutes for clinical detachment the "constant will of one trying to recognize" (Brody, 1992, p. 263).

Establishing this connectedness does not make of the healer a great person but does place both healer and patient in the presence of a deep human mystery that is greater than both of them. It is to be present at a creation that Elaine Scarry likens to the rediscovery of language: "Physical pain is not only itself resistant to language but also actively destroys language, deconstructing it into the pre-language of cries and groans. To hear those cries is to witness the shattering of language. Conversely, to be present when the person in pain rediscovers speech and so regains his powers of self-objectification is almost to be present at the birth, or rebirth, of language" (p. 172).

Explanation, education, and connectedness form the core of Cassell's understanding of the healing relationship. The problem with the scientific explanation of illness is not that it is incorrect, since, as Cassell notes, "we know that it need not be correct, since for most of the history of medicine it has not been correct" (1976, p. 128). Put differently, the virtue of scientifically accurate diagnosis and treatment does not lie in its correctness. The fact that it seems correct does not entitle it to stand as the only and sufficient explanation of illness. Although science has been empowered by Western culture to dictate diagnosis and disease categories, Cassell notes that it has little or nothing to say about sick persons, their behavior, patient-healer communication, and so on. "If the whole point of the clinical encounter is to decide what is the right and the good thing to do for a specific patient, then traditional medical theory is sorely lacking" (1991, p. 6).

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