Archive for March, 2011
This blog was written by a friend and writer, Jared Egol. He writes eloquently about the patient’s history as “story” and the concept of “narrative medicine,” i.e. seeing the patient’s story as critical to healing. When the person with Mind Body Syndrome sees that they are, in fact, the “hero” of the story, they will be much farther on the road to recovery.
To your health, Howard Schubiner, MD
The Hero’s Journey as Story: The Irreducible Diagnostic Criterion
by Jared Egol
The patient, in present times, faces chronic, painful and dismissively mistreated and misappropriated syndromes of stalled emotional progress. Despite seeking to function at our service against pain and a variety of illness, medicine is traipsing feet-first into a biologic-centric approach to the treatment of our stories. Stories are completed, edited, examined, shared and propagated. And, most importantly, they are added to. They are not treated. Any treatment becomes a subscript to the through-line of how our life proceeds postscript. Health, like being human, is raconteurism. It wishes to be resolved and triumphant.
While the scientific community begins to trumpet the mind-body connection as a wellspring for treatment possibility, it seems to passively disconfirm the blunt fullness of what mind-body awareness can be, greater than the sum of its words on paper: that the qualitative first step to treatment starts pre-diagnosis and pre-medicine, at the human condition, which in and of itself is idiopathic. If the mind-body paradigm is to someday be championed as a keystone of accepted treatment in the 32nd century, it must concede that the human condition’s only unit of perceivable measure by outside meters can be its stories, just as atmospheric pressure cannot be interpreted in kilojoules. By dimensional analysis, if spoken words are the sub-units of those stories, then the feelings evoked, hugs had, nods afforded and change experienced by the recipients of them are the units of their transfer: lessons.
I believe that the doctors who rise above the ranks will be those identified as narratorial asides in the stories of the hero –the patient– who takes and imparts lessons in equal measure to the physician. Even the word-bare, thought and action-heavy field of intensive care, which my father occupied himself with for almost three decades, will one day evolve to contain the parameters of narrative in its protocol, even if I don’t know how it will look.
If you’ve seen the Black Swan, you will probably recognize many aspects of Mind Body Syndrome in the protagonist, Nina. She lived in a world where she denied herself pleasure because she had placed too many demands upon herself and her body. Her’s was the world of ballet, but it is truly a metaphor for the millions of women who are trapped in a world of work, child and parent care, financial issues, difficult marriages, and troubled relationships with parents, children or siblings. A common thread often seen in the development of chronic pain or other mind body syndromes (such as fibromyalgia, neck or back pain, irritable bowel or bladder syndrome, pelvic pain, headaches and migraine, chronic fatigue, and insomnia) is the pursuit of perfectionism. People who grew up with emotionally, physically, or sexually abusive events or with love being given primarily for performance tend to have low self-esteem. They tend to try extra hard to please and to prove that they are worthy, good, and lovable. Unfortunately, their quest often becomes never ending as they may seek love from those who have criticized or abused them or from people who act in similar ways. They frequently repeat their childhood experiences and continue to feel even more unworthy and unlovable.
The only way out of this horrible cycle is to recognize this whole pattern and take control over it. There is no such thing as someone who is unworthy of self-respect and of love. We all have those things as part of our birthright. The most important thing that I teach in my Mind Body Syndrome program is “be kind to yourself.” Cultivating kindness to self, acceptance of self and forgiveness to self are key aspects of healing. Without this, we are often stuck in an endless search for relief from pain and suffering. There are several exercises in the program (see Unlearn Your Pain) that help to create these qualities. When people are kind and accepting to themselves, they feel so much better about everything in their lives. Research confirms this as work by Dr. Kristin Neff at the University of Texas shows that self-compassion improves motivation and happiness, while decreasing anxiety and depression. There are a couple of excellent books that I recommend. The Spirituality of Imperfection by Ernest Kurtz and The Mindful Path to Self-Compassion by Chris Germer offer great insight and exercises to help those who tend to “beat themselves up.” Dr. Neff is publishing a book entitled, Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind.
In The Black Swan, Nina sacrificed herself for her art and plunged into the depths of insanity. I have seen people who were so consumed with guilt, shame or fear that they were held hostage by these powerful emotions, stuck in chronic pain, fatigue, anxiety, and/or depression. Developing a healthy sense of self, giving oneself the benefit of the doubt, taking time for oneself, and accepting our faults are all critical steps in the process of healing. Do yourself a favor by doing yourself a favor!
To your health,
Howard Schubiner, MD