In the last post we saw how medical systems are responses to fear but also generate it. This is particularly true of today’s biomedicine, but is also a feature shamanic systems of care—which date to prehistory—induce fright as a side effect. Only if the patient believes in the evil spirits the Shaman exorcises will she feel better after the exorcism, but belief in invisible attackers is inherently frightening. Our scientific knowledge has replaced supernatural forces with biological ones, but our belief in deadly bacteria and marauding cancer cells is likewise terrifying.
Modern health care has gone one step beyond shamanism in its induction of fear, because it places the fault within the physical body. If one believes illness is due to the work of evil spirits, one isn’t inclined to fear the body, which is innocent. But if one believes it the result of bodily failings (such as a failure of immune surveillance), and if one worries that these can happen at any moment, one learns to feel uneasy, as if driving down the freeway on threadbare tires.
This is all unfortunate, but it may be unavoidable. I’ve suggested we could rebuild faith in the body by concentrating on everything it does well, even in times of illness, in order to keep us alive. But that counterargument doesn’t erase the fact that the body is prone to immune dysfunction, neurologic degeneration, joint deterioration, etc. We can forgive the body its vulnerabilities, but we cannot forget them. The best we can do is remain aware that—on balance—every living body is doing a remarkable job.
There is another way in which biomedicine instills fear that is likewise only partly correctable: its healing power comes at the cost of uncomfortable, humiliating, and painful treatments. A couple of years ago I underwent major surgery to bypass an artery that was being compressed by my diaphragm. The entire experience was dreadful, starting with inadequate preparation (the surgeon didn’t tell me the incision would be ten inches long until the day of the operation), continuing through failed pain management (the epidural catheter meant to control my pain immediately after surgery was placed at the wrong level), and ending with a post-operative infection that led to excessive scarring. What’s worse, although I am a physician and know a great deal about health care, I found it almost impossible to get the medical staff to take my concerns seriously. The lack of respect and loss of control felt humiliating. Having gone through this, the prospect of someday needing more ‘care’ feels dreadful.
Fortunately, many people undergo major procedures without such disappointment and needless trauma. But the process of being rolled into a glaring, aseptic operating room crowded with electronics and stainless steel gear is terrifying, no matter how compassionate and careful the operative team. The impact could be lessened by establishing specialized induction rooms decorated to look less intimidating, with soft music and artwork, then rolling into the operating theater only after the patient is fully unconscious. Of course, that would take extra time and staff, and these days efficiency counts far more than comfort and esthetics.
It isn’t just surgical departments that instill fear. Huge scanners, imposing radiation therapy machines, and toxic chemotherapy cocktails fill us with dread. Modern medicine works by treating the body like a machine, but there is a human being inside each body, and that person finds such dehumanization terrifying. Indeed, it doesn’t take a human mind to feel fear; my dogs tremble and try to escape whenever we approach the veterinary hospital. Modern clinical care scares us all.
Like I’ve said, the fear generated by biomedicine is partly unavoidable. We shouldn’t deny the fact that bodily systems sometimes go awry, and many interventions simply can’t be made pleasant. But the way things are currently done, almost no effort is made to soften the blow.
Imagine sitting in a waiting room and watching beautiful videos of inner bodily functions. These are easy to find on YouTube, but TV screens in clinics are usually tuned to news channels: hardly comforting. Imagine if doctors sent us home with a list of all the systems that are functioning well in addition to instructions for how to manage hypertension or diabetes. Imagine if MR scanners were screened by murals painted by local children, so that the patient felt like he was being slid into a field of whimsical daisies rather than a giant mechanical maw. These steps would take only a bit of extra time or energy, but they would require a radical reorientation. Medical systems would need to acknowledge that the person’s state of mind matters as much as her state of body.
That acknowledgment is crucial, because we suffer far more from dread and grief than we do from the physical facts of illness and dying. I’ve felt searing bodily pain, and I’ve also endured crushing psychological distress. Although both are unpleasant, the latter is far worse. What’s more, physical pain gets amplified when emotions become riotous. The surest way to reduce suffering is to attend to the person’s tender experience of vulnerability, and to strive as much to reduce fear as we do to reduce pain.
Some fear is unavoidable. A major diagnosis raises the specter of discomfort, disability, wasting, and death. That’s frightening. But how much worse it is to receive that diagnosis in a setting that feels impersonal, industrial, and uncaring!
Fear is a side effect of modern medicine, and we need to address that fact. Medical providers routinely treat side effects—whether from medications or procedures—and they could do the same with iatrogenic fear. Medical centers could be redecorated, patient education could be reenvisioned, and clinic practices restructured. With compassionate design, medical visits could encourage trust in the body’s capacity to heal and recover.
The operation I mentioned earlier took about four hours. The surgeon worked diligently during that time, and his skill is to be celebrated. But the healing process took months; the final stages of it stretched out for one or two years. My body did the amazing work of knitting together the wound, solidifying around the artificial vascular graft, and keeping me alive. That deserves celebration, too!
Unless the immune system and other restorative functions are operating, no amount of medical care can keep a patient alive. This message is both uplifting (the body takes care of itself) and healing (trusting the body reduces stress, and stress reduction improves immune function). It should become an integral part of patient education.