The new mind-body paradigm
“Wherever a thought goes, a chemist goes with it.” –Deepak Chopra
Life-threatening illness is more than a crisis of the body; it is a crisis of the soul. During thirty-five years as a cardiologist in a hospital, I have seen countless ways patients react to a medical catastrophe. Initially, most feel overwhelmed and feel as if they have been attacked by an alien force, as if body, mind and spirit are under siege.
Many patients are paralyzed by fear. All resistance collapses, replaced by passivity and resignation. Some go into denial, unwillingly or unable to face the enormity of what is happening. However, others face the crisis by challenging it head-on and, in the process, discover within themselves the resources to confront and overcome the most dire circumstances. Sometimes these patients succeed not because of the medical care they receive, but in spite of it.
There is in all of us, a life force: the foundation of organic existence. In some, this drive is powerful and passionate. In others, there is ambivalence about continuing with the burdensome task of living. When the disease strikes, many are all too prepared and even willing for their lives to end. But passivity or resignation are not immutable reactions to life-threatening illness. My patients have taught me that the will to live can be awakened at any point in its course.
Medical science has been largely blind to the power of a patient’s mind to determine the outcome of a disease. Physicians are taught to see patients as the sum of their body parts and to treat disease by relying almost exclusively on the wonders of medical technology. His unspoken communication with patients is unmistakable: we will mobilize our array of wonder procedures and medications to save you. If they don’t work, you are beyond help.
Having spent much of my career as an academic physician directing medical research programs, I have been involved in the development of technological advances that have led to this new paradigm of patient care. While today’s medical arsenal is invaluable in the fight against life-threatening illnesses, it has brought about a major side effect: far-reaching changes in the time-honored doctor-patient relationship.
That bond, once an invaluable component of the healing process, has weakened. In teaching rounds, I have always found it important to point out the ways in which clinicians inadvertently discourage patients from mobilizing their inner resources to overcome an illness by implying that these elements play no role in the outcome. . I emphasize how powerful these resources can be. Experience has taught me that they are comparable to any cutting-edge pill or procedure.
This was dramatically demonstrated to me many years ago by a patient named Vivian, who suffered from progressive heart failure. Cumulative heart damage from several previous heart attacks had forced me to admit Vivian to the hospital three times in four months. Her heart had weakened to the point where she was no longer responsive to maximum doses of intravenous diuretics and other powerful medications. Edema fluid had accumulated both in her lungs and in her legs.
In the previous twenty-four hours, Vivian’s kidneys had begun to fail, making it impossible to treat the massive accumulations of water in her body. Her liver and other organ systems were also being affected. All therapeutic options had been exhausted. Vivian’s chances of survival were slim to none.
After suffering for ten days in the Intensive Care Unit, Vivian grew tired. “Look, doctor,” she said, “I’m seventy-two years old. My husband died fifteen years ago and my daughter hasn’t spoken to me since the day he died. I’m in constant pain and I have nothing to live for. Please let me go.” “.
Despite their estrangement, Vivian had listed her daughter Janet as the person to be notified in the event of her death. When I asked if Janet knew how sick she had been, she Vivian shook her head.
“My daughter doesn’t know, and I’m sure she doesn’t care.”
“If you don’t mind, I’d like to call her.”
“I don’t see the point. What good would that do?”
“It may not do any good, but I think your daughter should know what’s going on with her mother.”
“Frankly, I think it’s a waste of time.”
Two nights later, Janet arrived at the Unit accompanied by her ten-year-old son, whom Vivian did not know.
The next morning, a different woman greeted me at the Unit. Vivian looked at me with sparkling eyes and said, “My daughter is getting married in three weeks. She wants me to walk down the aisle with her.” Tears welling up in Vivian’s eyes, she took my hand and whispered, “I want to be there, doctor.”
Within days, Vivian’s kidneys began to open up. The same dose of intravenous medication that had been ineffective now caused a substantial decrease in Vivian’s edema fluid. After a week, her lungs were clear. At the end of the second week, we were able to switch from intravenous to oral medications and get Vivian out of the ICU.
Three days before discharge, Vivian began to walk gingerly down the hospital hallway with the help of a walker, the same one she used to walk down the aisle with Janet at her wedding.
Vivian not only attended her daughter’s wedding, she also lived to attend her grandson’s bar mitzvah three years later.
Every doctor has seen patients with a life-threatening illness make a miraculous recovery after they were thought to be hopeless. But because medical science is unable to explain these extraordinary events, their importance is often ignored. Medicine is so enamored with the apparent infallibility of science that it has become blind to other possibilities. But remarkable recoveries like Vivian’s are possible for all of us. As Emily Dickinson wrote: “We never know how tall we can get until we are asked to stand up.”