Barriers to wellness in medicine – 1. Identity Crisis
I am the Sick resident this month.
Instead of seeing check-ups and doing physicals, I see walk-in patients and triage same-day appointments. When my desk phone rings, the standard greeting in clinic is “This is Amy – Sick.”
After a few days, I started joking that I am to be called the Well resident from now on. Some people laughed, and many said “what would that mean?” Somewhere between the 50th and 100th child with fever + cough +/- diarrhea, I realized the truth in jest.
Modern medicine only knows the curing of sickness rather than the implementation of wellness because we don’t understand what wellness is.
Wellness is not simply the absence of physical disease, but a state of balance between health of the mind, body, and spirit. For the mind, we have a few categories of disease, some formulas for counseling, and a handful of poorly understood drugs to play with neurotransmitters. For the spirit…well, there’s no official party line regarding its existence yet, and please direct all inquiries to the hospital’s non-denominational pastoral staff.
It’s not our fault. Rather, it’s not medicine’s fault. We trace our ancestry to empirical science, whose pioneers were rather brutally persecuted by the spiritual leaders of their day. In those dark ages, science fought the battle for faithful observation of the truth, free from bias and dogma. We owe a great deal to this battle. Without it, not only would we continue to easily die without penicillin and a tetanus shot, modernity would not exist.
Medicine inherited the scientific fervor for objectivity. Unfortunately, the practice of medicine also inherited a rejection, or maybe even a phobia, of anything that is not tangible, quantifiable, and blessed by a double blind trial.
Science and spirituality are not fundamentally contradictory. In fact, some of the greatest scientific minds in history were also intensely spiritual beings. In the words of someone who is good at explaining the universe:
Light appears as a wave if you ask it “a wavelike question” and it appears as a particle if you ask it “a particle-like question. This is a template for understanding how contradictory explanations of reality can simultaneously be true.
And it’s not so much true, as our cultural debates presume, that science and religion reach contradictory answers to the same particular questions of human life. Far more often, they simply ask different kinds of questions altogether, probing and illuminating in ways neither could alone.
- Albert Einstein
Why, then, is the practice of medicine so uncomfortable with, and so unwilling to share its powers with anything that does not speak its peer-reviewed language? I believe it is because of the ego of medicine.
The ego is conferred by society and its expectation for medicine to be the Great Healer. It is nurtured by the pressure our discipline puts on itself to have the final answer. Even though health is the intersection of three dimensions, our “health” insurance mainly covers services to the body. We make the effort to encourage mental health practices and offer spiritual services in the hospital, but they are treated as extras – the stuffing, not the turkey. At the end of the day, we are a society of science (which is not, as medical anthropology will point out, an unbiased culture-less institution) and expect the crowning jewels of scientific knowledge to end our suffering.
But medicine is an empirical study of the physical body, and it does not have the tools to study, much less treat, the unquantifiable dimensions of personhood and life. It is akin to asking a “wave-like question” to a community that sees light only as particles. As a result of this lack of ability, the ego expands to compensate.
Every time I work in the intensive care unit, there always comes a moment when I am struck by our ability to keep a body functioning. We have tools to assist or emulate the jobs of almost every vital organ. Even if this is not a permanent solution and can hardly be called living, often it gives the patient a vital window of time to recover and return to being alive again.
And then there always comes another moment when I am struck by how helpless we (patients, families, doctors, nurses, technicians, cafeteria workers) all are at being well in our different roles.
Let’s lay down this heavy ego and be emphatic about what we don’t know. This would not diminish the marvel of modern medicine – and the intensive care unit is a thing to be marveled at. But how many times have we all had patients who were hospitalized for a suffering we cannot identify or cure with medicine? As complex as the body is, surely the mental and spiritual dimensions of being deserve acknowledgement of the same complexity and same need for care. Let’s not belittle the idea of wellness by checking off the box with a few lunch-time seminars for physicians and thinking the task is done.
We are the killers of bacteria, the transplanters of organs, and the army against cancer cells. But we don’t know all the dimensions of pain, and pretending we do by using big words like somatic vs. Munchausen is doing our patients a disservice in the end.
Let’s take a step back, create an open space to “ask different kinds of questions altogether,” and start with wellness in ourselves.