INSIDE-OUT MEDICINE: SEEKING THE STRENGTH IN ILLNESS

by Steven Goldsmith MD

INSIDE-OUT MEDICINE: SEEKING THE STRENGTH IN ILLNESS

by Steven Goldsmith MD

“What are you best at?” I ask patients that at our initial consultation, after they have detailed their problems. This question stops most in their tracks, baffles, even stuns them. Many request clarification: “How do you mean? . . . Best, in what way?” Most respond after lengthy reflection with a vague,“I’m good with people”; or “I try to be a good person” and the like. Sadly, a substantial percentage can think of nothing. I cannot generalize about the public at large, for psychiatric/psychotherapy patients may not serve as a representative sample. But contrast their perplexity when I pose that question with the readiness with which they recount their symptoms and relationship woes.

It is not that they really are good at nothing. After all, if they have navigated life for decades to the point that they sit in my office sentient and fully mobile, fluent in English, reasonably well nourished, clothed, and groomed, financially covered for my services either by health insurance or their ability to self-pay, they must be good at something to make it this far. The problem is that absorption with their problems obscures their awareness of personal strengths, which pale by comparison. Yet it is a truism that a problem cannot solve itself but requires for its solution something outside itself,. That something can be a piece of information, a helping hand, sage advice, a proper tool, a pat on the back, a healthier diet, the hand of God, an epiphany, what have you.

Unfortunately, psychiatry and mainstream medicine similarly disregard personal strengths and their role in the healing of any health problem—psychological, physical, or relational. None of the iterations of the Diagnostic and Statistical Manual of Mental Disorders has mentioned patient strengths as a consideration in treatment. An account follows of the utility of deploying personal strengths to achieve psychotherapeutic success.

I once treated an electrician with recurrent anxiety-related vomiting that had not responded to conventional psychotherapy or medications. He seemed to have little going for him in his life that I could utilize to help him—no relationships, hobbies, or memberships in organizations; minimal educational attainments. His one source of pride was the excellence of his work. And so, after I guided him into a hypnotic trance, I suggested that he design in his mind’s eye electrical circuitry—cables, junction boxes, toggle switches, etc.—that he could mentally operate to stop his vomiting. True to his word, he did that and his symptoms instantly vanished.

Neglect of patients’ strengths should not surprise us, for conventional physicians target the signs and symptoms of disease in order to control them with pharmaceuticals. After all, who needs to know about airy-fairy concepts like strengths when we have Prozac to kick depression to the gutter or amlodipine to punch the lights out of hypertension. However, in ignoring strengths, MDs erase much of their patients’ individuality. Because patterns of pathology from one person to the next can appear with only so many variations, patients become transformed in doctors’ minds from three-dimensional people to mere cases of this or that diagnostic label, each one treated similarly to the next.

Psychiatry/medicine ignores two truths I examined in previous posts. The first, enunciated by Dr. Albert Schweitzer, is that “all healing is self-healing.” Health practitioners can heal nothing and no one by themselves. All they can do—and here is the corollary—is facilitate/strengthen the innate self-healing resources of the patient. Mainstream psychiatry and medicine fail to do that; because of their professional indoctrination they don’t know how or even why they should.

Take infectious disease. Most PCPs and internists understand the nature of this problem to be the invasion of microorganisms that produce disease. With more sophistication they recognize that germs will invade and proliferate only in hospitable environments. Hospitable because of congenitally defective immune systems, dietary or environmental toxins, emotional stress, pharmaceuticals and vaccines, etc. So people with lower resistance, i.e. those who offer hospitable lodgings for germs, are most prone to illness. This proposition, while on the right track, perpetuates a pathology-based view of illness: if only we can boost their Vitamin D levels, promote exercise, green tea, and meditation, we can reduce their vulnerability to microbes. Fine, so far as that goes.

This pathology-based view of illness (as tautological as that phrase seems) may explain why some people fall ill to influenza, meningococcal meningitis, peptic ulcers, etc. But it fails to explain why many, even most of us do not. It also fails to explain why a sizeable number of us carry microbes that can kill or incapacitate others while not laying a glove upon us.

According to the National Institutes of Health, 5-10 percent of the general population carry the bacterium Neisseria meningitidis, the “cause” of lethal meningitis, in their nose and throat with impunity. But the prevalence of such asymptomatic carriers can rise as high as 90 percent among those living in close quarters like military recruits. About 16 percent of schoolchildren carry Group A streptococcus, the reputed cause of strep throat and its complications. The bacterium Helicobacter pylori has attained notoriety as the putative cause of peptic ulcers only because of medicine’s myopia; most people who carry it experience no symptoms, so clearly something else is culpable. At this moment, a rogue’s gallery of potentially lethal microbes swarms about all readers of this post. We live within a sea of them. All this suggests the following: what determines whether someone sickens with an infection is not the microbe but the individual’s resistance. This is true of almost all infections. Yet mainstream medicine, oriented to pathology, evinces little interest in how we remain well, aka our self-healing resources.

So where do we find these resources? One of the best places to look is in our symptoms. The conventional understanding of symptoms is that they are bad, signifying as they do disease, which is bad. Wrong. Symptoms are disguised strengths.

Marta, a 24-year-old philosophy grad student, saw me for help with disturbing out-of-body sensations and perceptions that nothing was real, including herself. The triggers for these dissociative symptoms? Intense anxiety about the anticipated ordeal of her doctoral thesis and her fears of unemployment after school. A psychiatrist would have diagnosed a dissociative/derealization syndrome or DDS, ICD-10 code F48.1, plus generalized anxiety disorder, and probably have shoveled anti-anxiety or antidepressant pills her way.

But what if we invert Marta’s DDS, turn it inside out like socks, view it not as a flaw to be chemically nuked but as a potential asset. Dissociation is after all a psychological defense that some employ to ward off even greater psychic distress, which is what all such defenses attempt with varying degrees of success. In fact, all psychiatric symptoms reflect our attempts to solve psychic problems, however unsatisfactory the resulting solutions may be. They are unappreciated strengths, efforts to restore our minds to healthier equilibria. Think of them as skills, techniques at which some people are especially adapt, like Marta. Without her ability to dissociate, the distress would have been greater.

Accordingly, I taught her to deliberately dissociate through self-hypnosis (a therapeutic form of dissociation). Then, rather than being at the mercy of unpredictable symptom flareups, she could control when and where she summoned this skill to assuage her anxiety and achieve relaxation, usually by visualizing in trance comforting scenes from childhood. We did other hypnotherapeutic work as well regarding her perfectionism and self-esteem. Her ability to harness her dissociation delighted her, and she proceeded with graduate work with greater comfort and confidence.

Is it possible that like Marta’s DDS, all symptoms, mental or physical, reflect our systems’ attempts to react against noxious influences—emotional stresses, microbial invasions, internal biochemical derangements, environmental toxins—and thereby to restore our systems to healthier equilibria, however unsuccessful these attempts prove to be? Joint pain and swelling, for example, could represent the body’s attempt to wall off a more generalized inflammatory process caused by harmful diet. In essence our symptoms, like Marta’s DDS, would be the good guys, warning us of problems they are trying, perhaps unsuccessfully, to fix. If they are, instead of bombing them with drugs we should ally with them and try to help sick systems do even more effectively what they are already trying to do to restore health. This is a key principle of homeopathy, in which medicines are prescribed that mirror the pattern of symptoms in order to heal.

Those who consider homeopathy the medical equivalent of woolly mammoths pirouetting across the Golden Gate Bridge in tutus will nevertheless do well to bear in mind that all symptoms are in some sense your allies, trying to tell you something about yourselves that needs attention, including hidden strengths.

Be well.