Recently, I was explaining to a patient the difference between her diagnosis from a western mainstream doctor, and the diagnosis I had just given her, which emerged from an examination based in Traditional Chinese Medicine (TCM).
"Diseases are cultural concepts," I said. In mainstream Western medicine, certain symptoms, signs, and laboratory tests are grouped together because it makes sense to congregate them given that view of the body. We clump that fact pattern together, call it a disease, and give it a name. Eastern medicine may likely have no analogue, not because the disease had not been "discovered" by TCM doctors, but because when looking at a person from an Eastern perspective, it makes no sense to clump those findings all in one pile; in TCM, some go in one pile, and some in another, and neither fully replicates the Western diagnosis.
Which is a good thing. One of the greatest failures of western medicine (aside from its obeisance at the altar of Mammon) has been its failure to recognize that a disease is not a creation of biology -- it is a creation of culture.
On the personal level, a disease is, in fact, a story we tell ourselves about ourselves. It is one of the many myths we use to make sense of our lives, to collate and correlate all of the data we collect into a coherent whole, a narrative that relates ourselves to our world sequentially in time and which gives meaning to our lives.
From this perspective, then, it is the doctor's job to provide the story in which the patient immerses themselves. Our important knowledge base is less one of laboratory values and abstruse structures on x-ray than it is the particular narrative in which which each patient can find association.
For example: If I tell a patient that they have arthritis, without any qualifiers, their reaction can vary tremendously. This is because of the associations which that word has in their mind. One patient may immediately think of rheumatoid arthritis, which erodes joints and may leave its victims disabled and wheelchair-bound, fighting constant pain. Another patient may assume I'm referring to osteoarthritis, the wear and tear of joints which eventually effects us all, and may only display as some stiffness and a mild loss of range of motion. I can watch, physically, as they respond to their interpretation, sinking into themselves in resigned defeat or shrugging their shoulders as if to unburden themselves of a fly. Each patient is telling themselves the story which they will be living, and reacting accordingly.
Most people these days are familiar with the concept of a placebo -- a physiologically inactive intervention, such as a sugar pill, that a patient takes and it miraculously begins to heal them. Placebos can be extraordinarily powerful interventions, to the extent of curing people of cancer. The key aspect of the placebo effect, though, is that the patient cannot know that they are taking a placebo.
The cause of the placebo effect is that it is an item that a person can use to change the sequence of their narrative. To understand how that can be so, we must first take a shallow dive into Jungian psychology and the realm of mythology. Joseph Campbell, in his book The Hero With A Thousand Faces, describes what he calls the "monomyth." This is the tale of the hero, who leaves his safe home, fights monsters and giants, faces death (and dies), and then returns to his world and his home as a more complete (healthier) individual. This is a story that exists or has existed in virtually every culture over mankind's history, and regardless of the time, culture or language, all of these heros' journeys have common elements.
This is the journey of individuation that we all undertake during the course of our lives, and it may be a trip that we take several times in several ways. The hero's journey is also the path that many people follow when faced with a disease. I have seen patients replicate this journey many times over the past 20 years, and the pattern I have observed hews closely to the Campbellian outline.
There are several stages in the monomyth. The first is the "call to adventure," which in a clinical setting is best seen as the time of diagnosis. The hero (patient) often resists this call (denies the diagnosis), but after rising to begin his or her journey, one of the first encounters that our hero has is with a supernatural or magical helper, who often gives the hero a talisman or artifact that will aid him in his quest. Again, in the clinical context, the supernatural helper is the doctor (or magician, shaman or priest in other cultures), and the talisman in this culture is most likely to be a pill, herb, or chiropractic adjustment.
The exact nature of the talisman is unimportant, as is the factual existence of the powers that it is claimed to possess. What is most important for the hero (patient) is that "protective power is always and ever present within or just behind the unfamiliar features of the world. One has only to know and trust, and the ageless guardians will appear," Campbell states.
This is the power of placebo, and indeed, this is part of the power of every therapeutic intervention, regardless of its physiological properties. In fact, in the case of many interventions, the physiological properties are far weaker than the magnitude of its therapeutic effects. But because these are talismans imbued with protective properties, given to the patient by a figure representing a force stronger than their own, their power is magnified.
What the drug/herb/adjustment is really doing, far more important than chemical or mechanical changes, is giving the patient the power to change the outcome of their narrative. The feared enemy is no longer stronger than the hero and their playing field is now levelled.
Thus, the outcome can be changed, literally, in the patient's mind.
This approach -- seeing the disease process as a story we create, or co-create with our environment, is hardly a novel or new one. It is, however, a largely forgotten one, in a day and age when diagnosis is based primarily on laboratory testing rather than observation and interaction with the patient.
For patients, this realization that our diseases stem, to a great degree, from how we interact with our internal and external worlds can be an initially frightening revelation. One might accuse me of cruelty to suggest that a person with cancer, or heart disease, or even MS, is in some way, responsible for their disease. My words, though, are less the whip of admonishment than they are a call to hope.
Taking responsibility for something is the first step in being able to manage and control it. If a disease is declared genetic (the scientific version of "an act of God"), it becomes something impossible for the patient to overcome, because, who, after all, can defy the almighty Gene? (This approach, by the way, is also a very good way to deify the doctor for his own benefit, but that's a tangent for another day).
If you can claim ownership and responsibility for a disease, then you are simultaneously reclaiming the capacity to change it's course. You are changing the narrative of your disease. You are changing from victim to hero.
Of course, that alone isn't enough. You have to change whatever needs to be changed, behaviorally, mentally, emotionally, in order to change the actual course of your disease, and the talisman given to you by your doctor will only help you so much. The rest you must do yourself.
Any disease, your disease, is just a story you are telling yourself. And whether the outcome is tragic or triumphant is entirely up to you.