By Michael Specter The New Yorker December 12, 2011, p. 30

Could studying the placebo effect change the way we think about medicine?

In 2011, Harvard created an institute at the Beth Israel Deaconess Medical Center under the direction of Ted Kaptchuk: its sole purpose being Placebo Studies and the Therapeutic Encounter. Can placebos when given deliberately, be employed in clinical practice; could placebos possibly replace medicine?

Something has to change the chain from illness to pill – the simple solution to a single problem.  Somewhere we have to acknowledge the healing power of being witnessed and held in relationship by our doctors: honest words, a pat on the back, encouraging, empathetic resonance. At some point, we have to question the unquestionable: can our expectations have a profound impact on our ability to heal and, if left to its own healing, can the brain produce its own pharmacy? -Sdukes

Image: Tdukes, 2011

Chris, a doctor, was very handsome in the way boys are. Even though he was in his late thirties, he energized his world with the flirtatious charm of an adolescent. He was successful in his profession largely because of the efficiency of the caretakers he had placed around him. His receptionist, a second wife if you will, scheduled and managed the constant flow of mostly women clients. Suffering did not reach him.

If you wanted to deal with only the positive, then Chris was your perfect match. However, as his client, if you knew suffering and needed help understanding the lessons contained in your pain, what to do differently in order to change the patterns that perpetuated your discomfort, Chris was not the guy for you.

Chris was not the guy for Mary, his wife. She tried to make it better. She even spent years as his assistant, putting her own medical career on hold. It wasn’t until she started having children that she felt compelled to recover her own path and, in time, develop a psychological understanding of Chris.

Christmas Eve in New York is a timeless event. The three children and Chris and Mary had spent several days with family shopping, tea in the afternoon and of course the Nutcracker in the evening. Mid-afternoon Chris had scheduled their trip from the city to The Vineyard where they intended to spend their Christmas morning. Upon take-off, Mary began to question Chris’s judgment. Fog was setting in around the city and the weather report called for heavy snows and winds along the coast. It was early afternoon, and as they emerged above the fog the skies were already blackening. The flight time in good weather would have them landing on the island just before dark. Chris’s single engine plane did not have instruments. Chris was licensed to fly using vision only.

After registering her concern, Mary was made to feel as though she didn’t know what she was talking about. In a very real way she “died” to her concerns. Or, better put, Mary’s concerns were killed off by Chris. He was in control, he knew what he was doing and no measure of reality would cloud his vision, including blackening skies, hours of heavy snow, high cabin-shuddering winds, Mary’s expressed concerns, and finally the tears and screams of his frightened children.

This story opened a floodgate of other equally disconcerting stories about the risks Chris would take to maintain the world of his own making. There was the time he and Mary and their newborn weathered a storm in an old, family cabin that Chris heated with a makeshift, wood-burning stove. Not mechanically inclined, Chris would solve problems in ways that put others at risk. For various reasons known only to him, Chris wanted the wood stove at one end of the cabin but the chimney was completely at the other end, more than 30 feet away. To solve this dilemma, Chris simply piped the flue with a horizontal run of metal pipe suspended from the joists with coat hangers, the seams duct taped. Through the subzero nights, Mary would watch as the pipe above the stove glowed red with excessive temperatures and shuddered as the exhaust cooled during the long, horizontal run of the pipe. When she expressed her concern, Mary was diminished as Chris relentlessly maintained his fabricated world of falsely manufactured self-perfection.

Chris’s psychological damage accounts for much of this destructive behavior. However, his denial of this damage and the maniacal drive to continuously create and preserve a world of his own making displaced the need to “die” into those around him. In avoidance of finding his way into the natural life cycle of birth and death, Chris continuously drove into a world of perfection by creating and preserving a world that only mirrored who and how he needed to experience himself. In other words, Chris constructed his own reality. This manufactured world completely and universally disallowed the simplest acceptance that life is impermanent: things change, and in order to be conscious of this, one must naturally suffer. We all suffer. In Chris’s case, others suffered in extraordinary ways so that he would not.

Reflections

Suffering is an innate component of the cycles of change that naturally occur in life, and life continuously invites us to change right along with it. It is when we, for a variety of reasons, refuse to cooperate with this organic ebb and flow that problems emerge.

The theological definition of inspiration is “a special or immediate action or influence of the spirit of God (or of some divinity or supernatural being) upon the human mind or soul,” (OED).

I experience inspiration as something that is reaching out, compelling me to listen while at the same time encouraging me to find a means for expression.

 However, it is not entirely correct to say, “it reaches out to me,” because I have to actively work to receive it, to allow it into me, and to then discern what is actually being offered.

 To receive inspiration, I need to act upon “that which is seeking my attention.” In a very real sense, I have to give this inspiration a body so that it can then begin to live within me.

During a period of research in mind-body systems, I traveled to India to further my study of Buddhist meditation. I landed in Varanasi, the spiritual capital of India, and spent my days wandering the banks of the holy Ganges. Day after day, I noticed a fellow traveler and Hindu Brahmin practicing pre-dawn yoga and meditation on the sun as it peaked over the horizon moving from red, to orange, to yellow and finally resting as white in the haze-laden sky. As the heat of the day dissipated, I would again see the two having lengthy, evening discussions over meals that lingered long into the night. I often watched transfixed from a distance; using only the index finger or the entire right hand, their conversations were held in an abbreviated sign language. I later learned that the Holy Man had lost his hearing to Small Pox at an early age and that the traveler had only just recently arrived in town. Observing the depth and intensity of their conversation and the dynamic nature of their early morning teachings, I determined that their communication could not possibly have been conveyed through the lexicon of this mutual sign. What occurred and re-occurred was a subtle and direct transmission of knowledge somewhere beyond the standard reality of daily discourse. The sign seemed only to hold their attention while meaning was transferred and received through less-dominate senses, like the warmth of the morning sun heating the muscles of a chilled body. Trust, mutual regard, strong concentration, and a willingness to suspend disbelief held their shared, phenomenal world together.

The master’s gone alone

Herb-picking, somewhere on the mount,

Cloud-hidden, whereabouts unknown.

Chia Tao

image: http://www.enuui.org/tag/varanasi

She died in a swimming pool; she was only 23, Irish, and she never saw the ocean until she came to Florida to be a nanny. The children were playing; the father was watching them when his phone rang. He was waiting to find out about his new car, and it was now ready for delivery. He left Martha in charge only days after her arrival. He left abruptly, with little instruction, and when he returned, he found her floating in the pool. His son and his two daughters were fine; they weren’t really drowning, but Martha didn’t know this. Hearing their screams, she jumped into the water to “save” them. She did not know they were playing. She could not save herself. She had never learned to swim.

When Bill was around, the children lived in an environment that had so much less to do with them and everything to do with their father. I have reflected on the tragic death of Martha. The children were just being children, I imagine. Playing in the pool, enacting in play what they knew to be true, that dying had everything to do with living. Martha could not have known this. She, new to this type of work, new to this country, and wanting to please, assumed she was dealing with “reality.” The children were playing, mind you, calling for help and sinking to the bottom. Instinctually, she did what she was supposed to do; she went to their rescue. Bill blamed Martha for her own death. After all, he was on an important telephone call.

Ending is permanent and often avoided by certain personality types. The father, Bill, was one of those types. To spend any time with Bill was like suffering “the death of a thousand cuts.” He didn’t really do anything that was wrong; he simply made every conversation and situation about himself. To be with him, one had to simply “die.” If you had a thought and wanted to express it, Bill found a way to drift away and abandon you to your tome. Or, he would dynamically and intelligently explain to you, in better language and more richly informed connections, exactly why he knew more about your thought and your understanding than you did.

Bill had difficulty letting go, being in the wrong, or even feeling the least bit vulnerable. He was afraid of dying to the moment, any moment for fear of what it would mean to be reborn.

“As long as you do not know how to die

and come to life again,

you are but a sorry traveler on this dark earth.”

Goethe

“There have been times when I think we do not desire heaven but more often I find myself wondering whether, in our heart of hearts, we have ever desired anything else. You may have noticed that the books you really love are bound together by a secret thread. You know very well what is the common quality that makes you love them, though you cannot put it into words: but most of your friends do not see it at all, and often wonder why, liking this, you should also like that. Again, you have stood before some landscape, which seems to embody what you’ve been looking for all your life; and then turned to the friend at your side who appears to be seeing what you saw – but at the first words a gulf yawns between you, and you realize that this landscape means something totally different to him, that he is pursuing an alien vision and cares nothing for the ineffable suggestion by which you were transported. Even in your hobbies, has there not always been some secret attraction which the others are curiously ignorant of – something, not to be identified with, but always on the verge of breaking through, the smell of cut wood in the workshop or the clap-clap of water against the boat’s side? Are not all lifelong friendships born at the moment when at last you meet another human being who has some inkling (but faint and uncertain even in the best) of that something which you were born desiring, and which, beneath the flux of other desires and in all the momentary silences between the louder passions, night and day, year by year, from childhood to old age, you are looking for, watching for, listening for? You have never had it. All the things that have ever deeply possessed your soul have been but hints of it – tantalizing glimpses, promises never quite fulfilled, echoes that died away just as they caught your ear. But if it should really become manifest – if there ever came an echo that did not die away but swelled into the sound itself – you would know it. Beyond all possibility of doubt you would say ‘Here at last is the thing I was made for.’ We cannot tell each other about it. It is the secret signature of each soul, the incommunicable and unappeasable want, the thing we desired before we met our wives or made our friends or chose our work, and which we shall still desire on our deathbeds, when the mind no longer knows wife or friend or work. While we are, this is. If we lose this, we lose all.”
- C. S. Lewis
The Problem of Pain

(Courtesy of  Whiskey River)

When I think of courage, I often think of my mother – as she sat patiently attempting to thread her sewing needle in a dimly lit room, ceiling light beckoning for a new and brighter bulb. My sister or I would take over the task after so many utterances of; “oh dear, what is happening to my eyesight?” This woman, as a teenager, raised four siblings in the late 1930’s after her father died and faced endless days of caring for others. Her mother worked as a nanny. My mother finished high school, had a brief stint as a newspaper reporter in a small lakeside Michigan town and then, after marrying my father, began her own family of four children.

She got by, through the years of economic challenge, making sure that all of her children ate well and wore clean and pressed clothing. Socks were darned and torn shirts mended. There were other challenges, of course, but the central one was that she lived a life for others while she grieved a life she imagined was not hers to have. You know, the luxury to be able to wake up in the morning and ask; “what do I want to do today.” I know she is not unlike many men and women who face a life that demands more than they have to give, who somehow preserver.

I don’t know how any of us do it, sometimes, -waking up and facing a life that is filled with so much demand surrounded by so much uncertainty. Do we really know if we will live through this day? Whatever we focus on – our jobs, family, health – all of life will change and we will have to find a way to deal with it.

I often wonder; “how do we do it?” How do we live a life of joy and happiness when the inevitable is so close at hand? I think it takes courage. A soft and quiet courage to find a way to release our fears and to embrace the life that we do have as it unfolds right in front of us.