This past weekend I had the opportunity to co-facilitate a workshop with my friend, Peter Blum, in Woodstock, New York. Our topic was Coyote Magic: Blending energy medicine with hypnosis and storytelling. One of our attendees was suffering from lung cancer. She told us about the many medical procedures and chemotherapies she had endured. Because her course sounded so difficult and arduous, we thought she would be ideal for our daily demonstration. I asked Sarah, and she agreed to be the subject for my demonstration of narrative-style interviewing.
The philosophy of narrative medicine sees our illnesses and our stories as embedded in the same life processes, which are not readily decipherable, and sometimes are even difficult to recognize. We catch glimpses into these processes through metaphors and stories. Our illnesses make sense within the overall contexts of our lives. Often we understand this intuitively without being able to articulate why. These processes are not linear or simple cause and effect. They are quite complex. And because they are processes, they are more like movies than still photographs. Reductionist science proceeds to understand movies by cutting small still scenes out and ignoring how they fit together.
The usual models for mind-body medicine are those of the dominant biomedical paradigm simple, linear, cause-and-effect, useful probably for pharmaceutical research in which all things can be equal in comparing two drugs, but not so much for healing, in which all things are not equal or controllable. In the biomedical paradigm, cancer is caused by faulty genetics, by environmental toxins, by viruses, and the like. Treatment aims to kill the bad cells, not unlike other simplistic militaristic metaphors in which police aim to lock up all the bad people or soldiers aim to kill all the terrorists, the assumption being that there is a finite supply and that once they are all killed (or locked up), no more will appear. This represents the bad cells/bad people hypothesis, and doesn't seem to work in medicine or in criminal justice. In both areas and in the prevention of terrorism, we must look to the conditions in which "abnormal" behaviors appear. Within those contexts, these abnormal behaviors appear "normal". Thus, we need to look to the conditions in which normal cells transform to cancerous cells. We know the conditions that facilitate criminal behavior, just as we know the conditions that breed terrorism.
The biomedical, materialist paradigm has little use for the psychological or the spiritual. These aspects of life are relevant to quality of life, but not length of life. Mindbody theorists who wish to add psychospiritual concerns tend to make the same assumptions. They create variables and test them. "X" causes "Y" in all (or at least in a statistically significant number of) cases. Thus, "fighting spirit" (an arbitrary construct) should be associated with longer survival in most or all cases. This is a linear model. Increase fighting spirit and survival increases proportionately. Or, consider Lydia Temoshak's Type C personality, which she claimed was statistically significantly associated with a higher likelihood of having cancer. A narrative theorist would argue that it's not that simple and everyone is different in accordance with their stories.
I asked, as I usually do, if Sarah had any theories to explain why she got cancer at this time in her life. With some discussion, it emerged that she believed that betrayal and unrequited love had set the stage for her cancer. A man whom she thought was her soul-mate had not reciprocated her feelings. She had apparently misread his cues. She was crushed. In addition, her psychoanalyst of 17 years had turned on her. She believed that this had occurred as the result of a personal illness altering his capacity for empathy and rapport. He became cold, distant, and critical. Two years previously, her brother had tragically died of cancer. Two years before that, her father had died from a heart attack (myocardial infarction). She felt that all the important men in her life had abandoned her and betrayed her. This had weakened her immune system and had allowed her family genetic tendency to emerge.
If this were a truth in the scientific sense, then all people with the same level of betrayal should have cancer. We could make it more complex by saying that the same level of betrayal with the same genetic susceptibility would be associated with more cancer. Now we're moving closer toward non-linearity, but in a more multiple linear way. What if the story and her view of the story is more important than the details of the story? What if her belief that betrayal and unrequited love activate her genetic tendency to cancer is more important than her level of betrayal or the level of genetic risk? What if her commitment to the story is as important as the elements of the story? This introduces a non-linearity worthy of the complexity of life.
As we continued, more elements of Sarah's story emerged in response to my question about how she thought she could get well. She said, "If I could only think all the right thoughts, I will get well." In addition, she had to eat all the right foods, avoid environmental toxins and non-green products, and do her yoga and other healing activities. She had visited numerous healers, some of whom gave her contradictory advice, had visited the "best" oncologists, had taken the most intense chemotherapies, had taken many supplement combinations, herbal products, Chinese medicines, and on, and on. Now her quandary was to decide what combination of therapies to do next.
I've seen this many times before that belief (story) that a formula exists for getting well. All you have to do is follow it. We all want that kind of certainty. Unfortunately, it seems illusionary to me. Doctors can't predict which patients will respond to particular medications yet. We can't predict who will live or die. Pharmacogenetics is beginning to explore how to pick drugs more compatible with the patient's genetic make-up, but this is an early science.
Certainty is currently unattainable and over-rated according to Professor Taleb of the University of Massachusetts at Amherst (Professor of the Science of Uncertainty), and author of The Black Swan. Progress and transformation arise in the midst of uncertainty.
Healing is transformation and does arise uncertainly from this zone of indeterminacy. Sarah was tormenting herself in her quest for certainty.
"What if healing is random?" I asked. Sarah was shocked. How could I say such a thing!
"What if angels are like traffic cops who have quotas of tickets to write. Sometimes they break for coffee and they miss your speeding by. Sometimes they're on lunch break. Sometimes it's getting late in the day and they have to liberally bestow healing on anyone in sight. What if it has nothing to do with whether you do what's right or wrong? What if it's all seemingly random, at least from your perspective? Maybe it has nothing to do with you, and everything to do with their whims.
Sarah squirmed. She didn't expect me to say this and didn't like it. I meant to make her uncomfortable because I wanted to challenge her story, which I believed to be furthering her suffering. Random would be better than the sense that her "failure" to heal was due to a "failure" to think the right thoughts and do all the "right" things.
This led to a discussion of grace. What if healing involved acts of grace, gifts from the spirits or the angels? Grace, by definition, is undeserved and unearned. It can't be achieved by doing all the right things. Here is where spirit enters. Now I am stepping beyond narrative medicine into my own spiritual beliefs which are largely derived from my indigenous families of origin (Cherokee and Oglala).
In my preferred story, who lives and who dies is more complex than we little people can imagine. In the Oglala concept of wo'onshila, we acknowledge that we are pitiful, little people, relatively insignificant to the grandeur and size of the Universe, thrown into a world beyond understanding and buffeted about by Forces far greater than us, who mostly could care less about us. This pretty much sums it up for me indigenous existentialism! Despite that, we create meaning and purpose by proceeding as if we had meaning and purpose in the midst of this chaos. We do this by co-inventing stories with all our relatives (spirits, ancestors, nature, and other humans) about the purpose of life, what constitutes a good life, what qualifies as virtue, and the like. We co-create a world of simple meaning within the greater chaos. We can live in this world.
However, when we fall into imbalance (towa cowpta) and disharmony and disease like cancer arises, we need big-time help from these supernatural powers that are so much greater than us. That is when prayer arises. We cry out to these Powers for help. The spirits who are close to us lend their voices to our pleas. How these Powerful Beings decide whether or not to help us is a mystery that we can't solve. It's beyond our level of comprehension. All we can do is ask in a humble way with respect, and hope for the best, realizing it might not come. This is my story that I told to Sarah to challenge her story. I'm not claiming truth for my story, just saying I prefer it. I hoped it's telling would influence Sarah to lighten up her negative self-judgment.
