Clinical Shamanism?

While applying to medical school in my early twenties, I read an article by a plastic surgeon. He said modern cosmetic surgery is much the same as tribal scarification, because they both carve skin to match a society’s ideas about beauty. 

I rejected the comparison. I imagined modern medicine to be informed by science, while tribal practices seemed based on superstition. The two had little in common—or so I thought. 

After I began medical training and then entered surgical practice, I began noticing ritual elements in clinical settings. There were steps taken in sequence. For instance, prior to entering the OR, surgeons wash their hands in a large sink outside the door. Then, with hands held up to avoid contemplation, they enter the OR by pushing the door open with their backs. A nurse holds out a sterile gown, and the surgeon slides both arms into it. Finally, sterile gloves are presented and the hands slide in. The surgeon is now ready to begin prepping the patient.

Or consider how clinicians speak an esoteric language that might sound—to the naive ear—like incantations. Even the background beep and hum of medical machinery can seem potent. In the best case, the noise reassures patients that technology is coming to their aid; in the worst, it frightens them.

These ritual undertones seemed interesting but also minor. They had no direct bearing on patient care. As a novice surgeon, I didn't think them relevant to my practice or my life.

That changed in my forties, when health problems transformed me from physician to patient, and I groped for meaning during storms of illness. As years passed, I underwent a series of invasive procedures. At first, these clinical ordeals felt stressful and frightening. Strapped atop procedure tables, my view of clinical interventions differed from the one I’d known standing over them. I felt vulnerable and powerless, as is natural when our lives are entrusted to strangers’ care. The doctors, nurses, aides, and technicians involved seemed barely aware of the psychological power they wielded, and as near as I could tell, they never used it consciously to aid my healing. 

With more and more time as a patient, I saw ever more clearly how an unacknowledged shamanism lurks behind modern medicine, just as the plastic surgeon had suggested. Yet precisely because clinicians don't see or understand this hidden power, it more often harms than helps. 

I don't mean to single out the clinicians who treated me. After all, I was just as obtuse during my time as a surgeon. Clinical training does not cultivate the mindset and skills needed to use ritual power with conscious intent, and professional norms would discourage the use of them. Everything is supposed to be objective, scientific, and antiseptic. But couldn't medicine’s primal underbelly be made as helpful to healing as its bright technological face? My experiences as a patient soon helped me realize it could. At first, this wasn't something I wanted or planned. Yet because of the intensity of my clinical experiences, plus an innate tendency to slip into non-ordinary states of consciousness, some of my times in hospitals and operating rooms led to powerful feelings of awe, oneness, and love. These felt very healing, and sometimes seemed more beneficial than the material medical treatment that brought me into these settings. At first, I wasn't doing anything besides trying to survive these ordeals. But because the spiritual effect seemed so obvious, I started to pay more attention to it.

One obvious fact about the effect was that it seemed random. Not every procedure uplifted my soul; some merely discouraged and depleted me. Rather than leaving things to chance, I began to think of how I could heighten the spiritual benefit. Of course, few of biomedical clinicians can be enlisted to help with that, so it was on me to support my own soul before, during, and after subsequent procedures. Using a mix of medical background, meditative training, spiritual insight, and playfulness, began to take steps to ensure my clinical experiences felt mysterious and enriching, rather than harsh and depleting. My health cooperated by providing opportunities to try out my techniques, and I gradually gained confident in them. 

Then, in 2019, I was diagnosed with atrial fibrillation, an irregular heart rhythm that causes fatigue and can occasion strokes. For months it had limited my lifestyle, so I decided to give the recommended cardiac ablation procedure a try. I simultaneously resolved to do everything I could to ensure that this intervention would do as much to heal my emotional and spiritual heart as my anatomical and medical one.

As my date with the interventional cardiologist approached, I contemplated my history of trauma and stress. I thought about my lifelong tendency toward negativity, chronic muscle tension, and self-defeating behavior. I contemplated the times I’d pursued life paths that didn’t suit while neglecting interests that fulfilled. It struck me that although atrial fibrillation is common and might have happened anyway, my trauma history, emotional style, and personal choices likely played a role. Perhaps this heart affliction was telling me to take my wellbeing more seriously.

To avoid a ninety mile drive through rush hour traffic on the morning of the procedure, my wife and I spent the night before near the hospital. Though I awoke cranky and Mandy had slept poorly, we stuck to our plan and went to church together the next morning. Two decades earlier, when my health problems began to intrude on our life, we’d found solace in the Catholic Church, the religion of Mandy’s youth. Back then, as we grappled with the disabilities that ended my surgical career, Christian liturgies felt stabilizing. We’d long since transitioned to Buddhist meditation and yoga, but in the unfamiliar neighborhood near the hospital, attending a Catholic mass was easier than finding a suitable yoga class.

We stopped at a church halfway between our lodging and the hospital. The procedure wouldn’t begin for a couple of hours, but I was already feeling stressed and dazed. The service is a blur in my memory, but I remember feeling soothed by it. I’m not a staunch believer in the power of prayer, but the ritual of mass helped me emotionally prepare for a potentially lethal procedure. I’d been told the risk of life-threatening complication was only about one percent, so perhaps I needn’t have bothered with church. Yet despite the low risk and my limited buy-in, attending mass helped me feel a little more supported—and a little more open-hearted—as we drove the final distance to the hospital.

After checking in, changing into a hospital gown, and lying down on a gurney, I did my best to relax and breathe deeply while being prepared for the procedure. The prep involved placing monitoring leads, setting an intravenous line, and shaving my lower belly, upper thighs, and genital region. The sense of vulnerability was undeniable as one nurse shaved me while another placed the leads and IV. The two chatted amiably as they worked on my aging, ailing body, while I continued to breathe, relax, and feel into my interior. From a conventional perspective, ministrations like these are routine care, but I choose to experience them as a ritual cleansing. The sacred flavor would have been heightened by music and spiced oil, but I tasted it even with the utilitarian delivery.

After the prep, Mandy returned to sit with me, but I soon shooed her away. Two of her friends who lived in the area were at the hospital to support her. She seldom sees these women and was happy to spend time with them. After she left, I closed my eyes and began to focus ever more deeply inward.

I spent the next two hours in meditation, awaiting my turn in the procedure room. I did my best to remain present for my body, breathe slowly and deeply, and invite relaxation. This wasn’t easy given the busyness of the ward, where a dozen other patients were being prepped before procedures or monitored afterward. Still, I grew calmer and more grounded than I would have otherwise. I also grew more aware of rippling fear and poignant sadness in the face of the real (however remote) risk of death. I’d have felt less emotional if I’d simply watched TV or listened to an audiobook during those hours, but I’d have missed an opportunity to honor the impact of what was happening.

At last the staff rolled me down a corridor and into a room overflowing with technology. A bank of monitors towered over the procedure table to which I was soon fastened, swaddled like a giant infant in a papoose of white linen. A rack of servers loomed in the background, the broad saucers of OR lights hovered above, and assorted medical devices stood in the corners, like dormant robots. When the anesthetist told me sedative medications would soon start flowing, I asked him to use little or no midazolam, a commonly used sedative. Because it blocks memory formation, it offers an advantage to patients who'd rather not remember the procedure. But I wanted to remember, and I felt pretty calm after all that meditating. So I asked the anesthesiologist to avoid midazolam. He agreed to provide opioid medications only, unless I changed my mind or grew agitated. 

I gradually settled into an opiated haze as the staff verified my ID and the planned procedure. Cool wetness spread across my belly, groin and thighs as they swabbed the shaved area with antiseptic. A drape of blue paper settled over my body, leaving only my groin and face exposed. The team gathered close, until a half dozen clinicians loomed above me in gowns and masks. 

The main work of the four-hour procedure began. Awash in mind-softening drugs, the experience took on a dreamy quality. From the outside, I must have looked like a specimen undergoing dissection. But on the inside, I was floating in a broad, intoxicated sea of worry, curiosity, submission, and awe. My interior state seemed limitless and contradictory. Part of me watched with intense, vested interest while another felt oddly detached. Part of me wanted to understand what the cardiologist was doing, while another drifted unconcerned in the tides of narcotics. For large blocks of time, I simply slept.

Then the pain kicked in. The procedure had reached the stage where probes cauterized the inside of my heart and then—sometime later—froze it with liquid nitrogen. With every blast of fire or ice, intense aching bloomed in my chest. Each time, the dreaminess vanished, replaced by an unwavering focus on my heart as volcanic and glacial forces sculpted its conduction pathways. But eventually the pain ended, and I drifted off to sleep.

I awoke where I’d started, in the ward filled with gurneys occupied by heart patients awaiting or recovering from procedures. The staff kept me overnight in the hospital, where I spent sleepless hours meditating as waves of physical and emotional pain washed over me.

Before the procedure, the cardiologist’s assistant had warned me I’d feel battered after it was over. She was right. My groin felt and looked traumatized, throbbing and swollen with dark purple stripes that ran down my upper thighs. My chest felt sore, as if it had been punched, hard. Walking out of the hospital, I felt shaky and depleted. For the next two weeks, and especially during the first few days, I labored with exhaustion and a strong but tender ache in my chest. I modified my mindfulness practice, spending twenty minutes twice a day in recumbent meditation with warm packs atop my chest and groin. I felt raw, sensitive, and prone to tears. Drained and humbled, I lost all inclination to argue with people or circumstances. Life flowed easily, and I moved through it gently, grateful for its loveliness and aware of its fragility.

My heart’s rhythm had returned to normal, yielding a sense of bodily rejuvenation. But I also felt more open-hearted, less trapped by my defenses. It seemed that the ablation had improved both the medical and metaphorical functions of my heart.

A month to the day after the cardiac intervention, I woke from a dream I knew well, one that had recurred often over many years. The setting was an old house Mandy and I once owned. As I wander through, I discover rot along the foundation and gaps in the roofing. The more I look, the more trouble I see. I feel overwhelmed, unable to imagine how all these defects could ever be repaired.

In the past, I’d always awoken at this point, as if defeated by dread. But now, on the one month anniversary of the procedure, the dream went further. Workmen arrived and stripped the house to its framing, revealing a huge but dying tree upholding the entire building. I expected them to build scaffolds to reinforce it, but instead they cut it down. Bereft of walls and without central support, the house almost vanished, open on all sides and spacious in the middle. To my surprise, I didn’t feel sad; I felt relieved of a great burden. I awoke with a sense of profound fulfillment.

I thought about the dream for days afterward, thinking how it's sometimes said that to dream about a house is to dream about one's self. The interpretation seemed to fit, since my identity felt softened and opened by the work inside my heart. Then one morning I awoke remembering words the Buddha is said to have spoken upon his enlightenment:

Oh house builder, thou art seen at last!

Smashed is the ridge pole, broken the rafters.

Open to the freedom of the world,

no longer imprisoned by sorrow am I.

After the procedure and the dream, the words meant more to me than before. It was as if the work inside my heart had implanted them deep within my soul. 

No more proof was needed. I felt wholly convinced of the subterranean connections between modern procedures and tribal rituals, which the plastic surgeon had spotlighted decades before.

This was reassuring, but there was an obvious problem. If I hadn’t cultivated the potent shamanic qualities of my medical ordeal, its psychospiritual potential would have been squandered. And that would not have been unusual; it is the standard of care. 

It doesn't need to be. We can and should consider new standards.

CONCLUSION

Medical interventions transport us to depths both terrifying and transformative. They summon the same psychological energies as shamanic healers. True, medical technology bears little outward resemblance to masks, chants, drums, and dances. Yet within a patient’s psychology, it’s at least as evocative.

Because these energies are summoned incidentally and aren’t considered therapeutic, they seldom have beneficial effects. Often, they simply leave people feeling battered, traumatized. Every day, in hospitals everywhere, opportunities for growth and healing remain overlooked.

Of course, there are important differences between biomedical and shamanic practices. The former are for more likely to cure illness. Infections can be eliminated. Major injuries can be repaired. Intense pain can be reduced. Even cancers can be cured, in more and more cases. And where medicine faces limits, as in the treatment of many chronic illnesses, research is making inroads.

But for all the power of modern medicine, traditional healers are better at reaching patients where they live: in their complex, emotionally responsive body-minds. They are better able to engage the human psyche in the healing process, embed illness in a communal and global context, and help patients find meaning in their experiences.

Someday, perhaps, hospitals will hire greeters to offer a selection of rituals as we’re admitted, and train surgical personal to pray or chant during induction of anesthesia, according to patient preference. Until then, we can devise our own methods for recruiting the emotional power of biomedical interventions. Rather than letting them deplete the human soul, we can enlist them to enlarge and strengthen it.