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May 2010
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Healing Guidance

Medicine, Caring,
Service to Humanity

Thomas Moore is author of the classic best-seller Care of the Soul and its companion volume Soul Mates. The following excerpt is taken from his just-released book, Care of the Soul in Medicine: Healing Guidance for Patients, Families, and the People Who Care for Them by Thomas Moore. This selection was titled “Service to Humanity.” Published by Hay House (April 2010), his new book is available at all bookstores or online at: Moore will be in San Diego in May, and will be doing workshops at the Hay House “I Can Do It” Retreat (see News section) and at the Vision Center for Spiritual Living May 16 (see page 16).

I have already referred to Albert Schweitzer’s three-word statement that guided all of his work: reverence for life. I would like to offer another three-word philosophy that could lie at the base of medical practice: service to humanity.

Most doctors and nurses say that they would do the work even if they weren’t paid for it. They are indeed concerned, as they should be, to be paid a good wage for their work. They mean, rather, that their job in medicine represents their desire to be of service to humanity. When you ask people in the medical professions what brought them to the work, they will often say, “I wanted to help people.”

It’s a basic, perhaps obvious idea: Medical people want to be of service. That desire is at the very root of their existence and their getting up to go to work every day. But almost everyone in medicine I interviewed said that today it isn’t easy to live by such a simple principle. The complexities of medical education, insurance, and malpractice pressures get in the way.

When a professional is dedicated to giving service, he knows what work has to be done, but today many feel that the bureaucracy makes this kind of service difficult. You have to compromise with requirements, and you have to arrange your work so that you are paid enough to cover the steep prices of malpractice insurance, office space, and other professional expenses.

At one level, then, the doctor or other professional has to deal with the endless demands on time and money, and at another level he has to try to keep the soul in the work. Many, of course, just succumb to necessity and forget about their ideals and their calling. Others feel burned out by the process and look for a way out.

An Expanded Medical Vision

Books on the history of medicine are often dismissive of the past. They present Western medicine as an evolution toward science and machinery and celebrate each advance over what they judge to be ignorance. The history books rarely take a lesson from the past or challenge modern approaches by comparing them to past methods. They can’t see beyond technical backwardness to the philosophical and spiritual riches in medicine of the pre-technological age.

It is possible to read old medical books with an eye toward their wisdom. Of course, we have made a multitude of dazzling discoveries in recent decades, but we haven’t advanced the philosophical and spiritual aspects very far. In this, the ancients are still ahead of us.

A good example is the writing of Paracelsus, whose work with alchemy and astrology would cause eyes to roll today. His philosophy of medicine is inspiring and rich and could well address some of the emotional and spiritual issues that are problematic in contemporary medical practice.

Consider the following passage, which I have reflected on for years: “In medicine we should never lose heart, and never despair. For each ill there is a remedy that combats it. Thus there is no disease that is inevitably mortal. All diseases can be cured, without exception. Only because we do not know how to deal with them properly, because we are unable to understand life and death in their essence, can we not defend ourselves against them.”23 Paracelsus was born in 1493.

Cross-cultural studies in medicine also offer new, creative ideas that could complement and enrich modern medical practice. Traditional healing methods are quite different from Western approaches, yet they, too, usually work from a larger picture of what a human being is. Shamanic healers, for example, take into account both psychological and spiritual aspects of a person’s experience and respond to them accordingly, with rituals and potent images.

A modern doctor could study a shaman’s way of healing and deepen his own practice without literally adopting shamanic techniques, or he could become shamanic in his own way. He could learn to meditate in such a way that he discovered a layered universe and could get to know realms of imagination that might enrich his practice. We live in one world, where it is possible to combine universes of meaning and method.

A doctor might learn from a shaman how to evoke levels of awareness through music or other types of sound. He could learn to stop and look at images in his dreams and waking fantasy life that otherwise he would pass by. He could learn that to be a real healer you discover how to be a conduit of healing power. All of this could be adopted in a subtle way within modern practice.

Many years ago I did a preliminary study, a sort of test case, on asthma. I looked into the history of the word and the way the illness has been treated over the centuries. I was looking for insights into the soul and spirit of the disease. I found that the word asthma is related to the word aesthetics, both having to do with taking the world in. I found the word used in ancient Greek literature for the last dying gasp of warriors and later as a suffocating feeling from being dominated by another person. Psychoanalytic literature placed asthma in the context of maternal pressures. I read a biography of the French writer Marcel Proust, who said that his writing emerged in part from his asthma, in particular to his extreme sensitivity to the world around him.

None of these ideas offered a “cure” for the disease, and my approach certainly moved in a direction far different from clinical studies of asthma, but this kind of research did address the human dimension of the experience of asthma. I believe it did offer insight that could, if developed and extended, help deal with the disease in a holistic manner.

I am speaking here of the “humanity” part of the life philosophy “service to humanity.” We doctors, nurses, and therapists want to help people—the accent on people, not just bodies. We want to help people go through their illnesses and live happy and creative lives. I would like to help people deepen as persons because of their illness, treating it as a rite of passage rather than the mere failure of a physical system. But it isn’t easy to advocate a holistic viewpoint when the spirit of the times moves strongly in a different direction, toward specialization, literalism, and the enthronement of science.

Today you see this last idea in a catchword common in medicine—evidence. Researchers and practitioners are proud of what they call evidence-based medicine. The gist of this approach is to select treatment for a given patient based on reliable studies that have been carried out on various possible treatments and issues related to the problem, linked to the clinician’s decision-making in the face of a patient’s situation. Using this approach, healthcare professionals make “conscientious, explicit, and judicious use of current best evidence” in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

Guidelines for this approach rank various kinds of research studies for their appropriateness as standards of evidence. They also suggest that the clinician should not lose sight of his or her own experience but should nevertheless put more weight by far on evidential studies. Furthermore, this approach works on two levels: in an organization, such as a hospital or clinic that evaluates its effectiveness based on evidential studies, and with the individual caregiver, who conscientiously researches the evidence when making a choice about treatment.

You can see the value of consulting studies about treating medical issues that have been dealt with thousands of times. The physician or nurse doesn’t have to invent the wheel every time he or she faces a knotty medical problem. On the other hand, many worry about this approach, fearing that it will override a physician’s medical experience and intuition, cause insurance companies to approve only those protocols supported by evidence, and disregard important issues in illness and treatment that are not covered by evidence. My concern is that evidence-based medicine may become yet another form of impersonal, science-dominated health care. It’s a kind of standardization of care that looks reasonable on the surface but could create even more distance between the practitioner and the patient. Where is the soul in evidence-based medicine?

The Meaning of Service

Taking “service to humanity” as our mantra, exactly how do we offer service when we’re getting paid? How do we see our work as service when we are applying ideas and techniques that we have learned through study and practice in higher education? Can we really be offering service when we’re doing our jobs rather than volunteering?

Service is related to the words servant and servile, all of which go back to the Latin word, servus, for slave. Service is not slavery, but it does have the connotation of emptying oneself for the benefit of another. Preparing for this book, I talked to a great number of people in the health services, people in every imaginable job related to medicine and in many different institutions and countries. Most of them understood that their calling was to serve, and they found rewards in doing so.

The service aspect might appear in their attitude toward their work and toward their patients. They felt that they were serving when they went even a short distance past what was required of them: spending more time at work on behalf of a patient, spending more time in the patient’s presence, being more available by talking freely or sitting rather than standing. That is an interesting notion—service through sitting with a patient, showing her that you are not ready to run off to the next chore or assignment.

The key of service in these examples is going slightly beyond the requirements of the job on behalf of a patient. Dr. Baxter’s stories of his AIDS patients in New York show that service is not only an offering of time, but also personal, emotional effort to do what is necessary for the complete healing of the patient. Dr. Baxter worked for the entire welfare of his patients, attending them not only so that they would have the best medical treatment available but also that they might have a meaningful death. He gave his attention to their families and to the aftermath of the suffering and death of a loved one. He had his limits, of course, but they extended beyond what most would consider his duties as a physician.

Albert Schweitzer not only practiced medicine, he moved to a poor area of Africa and treated needy patients. My plastic surgeon not only did excellent work for his paying patients at home, he traveled to remote areas to offer his skills to children with cleft palates, places where, without his intervention, they would suffer their scars for their entire lives. My friend Mark McKinney goes out of his way to embrace the people of his city, including gang members, who might otherwise lie outside the sphere of concern of a busy hospital. At the University of Tennessee, George Doebler picks up all the pieces of humanity in need, wherever he sees them. Dr. Balfour Mount goes far beyond the expertise of his medical training to create inventive programs for the souls of the citizens of Montreal. The list is endless of medical professionals who indeed feel a calling to service and accomplish it by extending the limits of their creative work. Here we see the soul of medicine: a deep feeling for humanity showing itself in many compassionate and creative modes of service.

There is also a psychological side to service. When you truly serve people, instead of merely doing a job for them, you connect with them. You meet them at a common level or point of interest. One of the chief psychological blocks to service on the part of doctors is the arrogance patients run up against time after time. Arrogance lies at the opposite end of the spectrum from an attitude of service, so one wonders if arrogance in the medical profession is an active avoidance of service.

One form of arrogance is the doctor who doesn’t want you, the patient, to think for yourself or do any study of your problem or go beyond the boundaries of strict Western medical science. A renowned doctor who writes in a major magazine warned people against scouring the Internet for information on their diseases. The best patients, he said, are those who do as he says and come to him as the expert.

A savvy public health official told me that, in contrast, young doctors, raised on video games and skilled at computers, welcome patients who educate themselves on their diseases and treatments. There is a significant generational gap, she said, that separates the hot young democratic doctors from the remote, autocratic old physicians who want their patients to obey them to the letter.

People who are used to going online for most of their needs would find it natural to study their illness in that way. I suspect that it’s a neurotic need for authority and control that keeps some doctors from joining their patients in studying their medical issues online.

Another form of arrogant healer is the doctor who is too busy to bother answering naive questions or getting involved with the families of patients, who are always asking about something. This is a kind of class arrogance, a professional who won’t stoop to the level of lay ignorance that his patients and their families, in his mind, display.

Some forms of arrogance you can see in dress and comportment, the “bedside manner” of the doctor. Even friendly, laughing, joking doctors can be arrogant in their low esteem of anyone not in their profession.

One day I sat with a group of nurses in the birthing unit of an East Coast hospital. They loved their work so much that they said that if they went a short while without attending a birth, they felt empty and yearned to get back to duty. They e-mailed and phoned from home to see how their patients were doing. Their involvement, they said, was 24/7.

And yet their devotion to their chosen work was overshadowed by an insensitive hospital hierarchy that expected more from them than they could deliver and refused to give them the space and personnel they needed. I could feel both the strength of their dedication and the depth of their disgust with the top-heavy hierarchy that didn’t yet understand the professional status of the ob-gyn nurse.

Studies on doctor arrogance raise some interesting points: Doctors are often unconscious of their arrogance. They may not recognize it until a patient’s lawyer points it out to them. Doctors excuse arrogance, blaming it on a tough training program and the impossible job of treating people in life-and-death situations. Some doctors confuse arrogance with courage and risk-taking, positive and needed attitudes in a field full of new adventures and experiments.

One of the best explanations for professional arrogance I have found is one offered by the Swiss Jungian analyst Adolf Guggenbuhl-Craig. He talks about a split archetype, a problem we have already noted. In the best of situations, a doctor treats a patient as a fellow human being, both of them susceptible to mistakes and illness, both having intelligence and good intuitions. But usually this archetype of healing, which has two sides—healer and patient—gets literalized and split up between the two people. The doctor is the healer and the patient the one to be healed. The doctor forgets that he is human, too, and is sometimes a patient. The patient forgets, or may not even realize, that she plays a positive role in the healing and can make good judgments and have helpful intuitions as well. This is fertile ground for the dangerous and disrupting condition of doctor arrogance.

Guggenbuhl-Craig describes the situation perfectly. “The doctor is no longer able to see his own wounds, his own potential for illness; he sees sickness only in the other. He objectifies illness, distances himself from his own weakness, elevates himself and degrades the patient.”

The solution to this split archetype is to face yourself, acknowledge your arrogance, and make a genuine effort to do something about it. Notice your defensiveness when people give you hints about it. Face your anxieties, your attitude toward your work, and your fears.

When I first began practicing psychotherapy, I realized that I wasn’t fully prepared for the work. I didn’t know some things I should know because I hadn’t faced them in my own life. My first years in this work were effective—I had a good education and good training—but they were difficult because of the personal work on my own soul I knew I had to do. I went into therapy myself, I kept a full and intense diary of my inner conflicts and my dreams, and I consulted with many professional and nonprofessional friends. I reached a point where I finally felt more secure in myself as a healer. I saw some good work I had done, but because of my self-confrontations I didn’t gloat over it.

This experience of mine leads me to think that self-confrontation is an important step in becoming a healer. Like the aspiring Plains healer who didn’t become a shaman because of his fear of rattlesnakes, many physicians fail to evoke the healer in their work because of their fears, and they won’t deal with those fears until they face up to them.

A physician doesn’t have to be afraid as long as his patient bears all the weight of anxiety around his illness. But in the best situation, the two share their fears and enjoy the genius for healing that they also share. The cure for doctors’ arrogance is to appreciate the wisdom and capability that ordinary people bring to their illnesses, and even the insights and deep intelligence in their families. The cure lies in the shared experience of suffering and doctoring, the evocation of healing rather than one person working on another. We are brought back to our mantra, service to humanity. The realization of our common humanity keeps the doctor from being arrogant and the patient from being passive.

Of course, some people live by superstition and unfounded fears and truisms that they have picked up in their families. Some get erroneous information from the Internet. Some have psychological problems that make them poor candidates for sharing healing power with their doctors. But Dr. Baxter’s examples show how even the slightest participation in the healing process might be useful.

The psychology of service could be one of those human issues that find their way into the soulful education of a healthcare worker. It isn’t enough to encourage, inspire, or cajole a person to show some etiquette with patients. Each worker has to do some work on or with himself, dealing with emotional issues that any of us might have that may interfere with good community relationships. The soul exists in the rich, sometimes tense space between people, and how you handle that space can make all the difference in creating a healing environment.