Medical Treatment and Healing

Taken seriously, the experience of illness leads to the question of what impact the medical profession has upon the sufferer (Toombs, 1992b). When illness results from an easily curable disease, medical treatment surely plays a powerful role in restoring the individual to wholeness. Such a remedy is not always possible or immediate, however, nor are the experiential impacts of healthcare always benign.

While the concept of iatrogenic disease (disease caused by medical intervention) is well known, there is also the possibility of iatrogenic illness. Many of the experiential disintegrations associated with illness can also be brought about or exacerbated by the process of medical treatment. When illness fragments the body into problematic parts and functions, and renders it alien to the self, the process is often intensified in the doctor's office. The physician has the patient disrobe, probes and palpates different organs, investigating the body as if it were a malfunctioning machine, and the patient learns to internalize an objectifying gaze on the body.

Similarly, treatment can exacerbate the disruption of space, time, and social relations. Hospitalization provides a vivid example. One's clothes, a mark of personal identity, are replaced by a hospital gown embarrassingly open at the back. One is dislocated from the routines of everyday life, leaving friends, family, home, and community for a world of strange rules and protocols, frightening technologies, and authorities who loom and disappear. Just when one's world most needs shoring up, it is further fragmented.

Medical language also effects subtle but pervasive displacements. Struggling to make existential sense of what is happening and why, the patient may find little help in diagnostic labels. In Tolstoy's story "The Death of Ivan Ilych," Ivan grapples with the profound issue of his life and death, but for the doctor, "the real question was to decide between a floating kidney, chronic catarrh, or appendicitis" (Tolstoy, p. 121). This exclusive focus on disease leaves the illness unaddressed. Loneliness is intensified when one most needs communion; the search for meaning is truncated by a heap of scientific words.

Some of these deficiencies so characteristic of contemporary medicine emerge from its basis in a mechanistic worldview. The seventeenth-century philosopher René Descartes, who helped lay the groundwork of modern science and medicine, took a dualist position. The human being, he argued, is a conjunction of two very different parts—the mind, imbued with rationality and free will, and the body, a mechanism governed by the same physical laws as the rest of nature. In this view, bodily disease can be understood according to the model of machine breakdown. Doctors become scientists or technicians who fix or replace broken parts. This Cartesian paradigm has generated the search for precision drugs and surgical procedures, the emphasis on scientific (rather than humanistic) training for the physician, and the hospital conceived as a temple to technology. Much of the efficacy of modern medicine rests on its dualist and mechanist foundations. But this focus on the body-as-machine has also led to a neglect of the ill person struggling with profound existential dislocations (Leder, 1992).

Nonetheless, many sensitive clinicians do seek to be healers of illness. To "heal" is to begin reweaving into wholeness the tapestry of life shredded by illness. Even when disease is not curable, the practitioner can try to relieve pain and preserve physical function, explain what is happening within the patient's body, and encourage the patient to be an active participant in treatment. Thus, the ill person regains a measure of knowledge and control.

Cut off from others by the privacy of pain and the loss of function, the sick person may reach out to the provider with the longing of a shipwrecked castaway who spies a sail on the horizon. When the patient is permitted to tell his or her story—to voice fears, ask questions, and hear genuine responses—a social reconnection is forged. The practitioner furthers this process by informing and mobilizing the patient's support system. The participation of family and friends is welcomed, and isolating modes of treatment such as hospitalization can, when possible, be avoided.

Just as the body seeks to heal itself, so individuals seek an interpretive healing by trying to make sense of what has occurred (Kleinman) and telling stories about it (Frank, 1995). Anne Hawkins has studied written accounts of illness and charted out the mythic motifs the sick often use. People suffering from disease may see themselves in an heroic struggle against a dangerous foe, or as journeying to the underworld to retrieve a great prize. These myths can sometimes turn disabling, however. For example, the battle metaphor provides little guidance or solace when the disease finally emerges as the victor. Susan Sontag, in Illness as Metaphor (1990) focuses on such dangers of understanding disease metaphorically, suggesting that the practitioner may need to challenge a patient's unhelpful fantasy. But these mythic interpretations can also play a healing role, helping the ill person to render events coherent, to rise to the occasion, and to work creatively with the challenges faced (Hawkins). The practitioner who resists the temptation to rely on reductionist "medicalese" or on metaphors foreign to the needs of the patient can support the patient's own healing narrative.

Ultimately, healing is not just a reconstruction of a prior life, but the building of something new. Through illness people often develop a deeper compassion for others, a greater intimacy with loved ones, an attentiveness to the joys of ordinary living, or a reordering of lifestyle and priorities. It is not unusual to hear a patient say "This cancer [or heart attack, etc.] is the best thing that could have happened to me." For such people, illness is not the diametrical opposite of health. Rather, it is the first stage on a healing journey, summoning the person to needed changes, whether physical, emotional, social, or spiritual.

The suggestion that illness can be a grace is not a license to grow callous to the suffering involved, however. Few seriously ill people wish to be told, "Cheer up, this disease is great for you." But the patient and practitioner alike can remain open to the healing gifts that illness may bring, albeit wrapped in a dark package.

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