This article appears in the February 2003 edition of the Catholic Medical Quarterly
The Practice of Holistic Medicine
Talk given at the Guild�s 2002 Symposium
I should like to tell you something about the Helios Medical Centre in Bristol (NHS). As harassed GPs, we are under pressure to produce immediate solutions to all our patients� ills, which usually means some form of medication. However, there is much the patient can do for themselves, thus reducing the need for pills and sometimes preventing their use altogether.
When depressed, patients are plagued by negative thoughts of self-worthlessness, hopelessness and even ideas of suicide. Feelings are grey and un changing; there is virtually no motivation. These patients can often be helped to help themselves through painting therapy. However their immediate response to such a suggestion is "I was always hopeless at painting at school". The doctor needs to explain to them that the end result of the picture they produce is of secondary importance. It is the creative process that is significant, for this is therapeutic. Usually one can persuade patients to give painting therapy a try. When the day arrives and they meet the painting therapist, they sit in front of a white sheet of paper, a terrifying experience. The following is a description of how someone coped with this:
'I had long hours of utterly unwonted leisure in which to contemplate the frightful unfolding of the war. At a moment when every fibre of my being was inflamed to action, I was forced to remain a spectator of the tragedy, placed cruelly in a front seat. And then it was that Muse of Painting came to my rescue out of charity and out of chivalry, because after all she had nothing to do with me - and said, "Are these toys any good to you? They amuse some people."
Very gingerly I mixed a little blue paint on the palette with a very small brush, and then with infinite precaution made a mark about as big as a bean upon the affronted snow-white shield. It was a challenge, a deliberate challenge, but so subdued, so halting, indeed so cataleptic, that it deserved no response. At that moment the loud approaching sound of a motor-car was heard in the drive. From this chariot there stepped swiftly and lightly none other than the gifted wife of Sir John Lavery. "Painting! But what are you hesitating about? Let me have a brush - the big one." Splash into the turpentine, wallop into the blue and the white, frantic flourish on the palette - clean no longer and then several large, fierce strokes and slashes of blue on the absolutely cowering canvas. Anyone could see that it could not hit back. No evil fate avenged the jaunty violence. The canvas grinned in helplessness before me. The spell was broken. The sickly inhibitions rolled away. I seized the largest brush and fell upon my victim with berserk fury. I have never felt any awe of a canvas since.
Not all patients have the guts of a Churchill. How ever this is where the painting therapist comes in, to encourage the patient. After the first fears have been overcome, the patient gets in touch with his or her own feelings and slowly learns to express them on paper. For many patients, to be creative is a new experience. They notice that their painting is quite different from that of other patients, which makes them realise that they have a quite different identity. This self-knowledge can lead to significant insights into the nature of their illness. They experience the blue as calming and soulful, the yellow as joyful, the red as aggressive, etc. They experience the heaviness of rocks, the moral uprightness of a tree trunk and the joy of the sunshine. This helps them to look at the world outside themselves and experience the qualities that are found in colour and form in their environment. A new world opens up for them. In time they may be able to dispense with their medication. Not only do they feel better but they have enriched their inner life to such an extent that they will be able to weather life�s future storms more successfully.
It has been shown that the attitude of the patient to their illness is a significant factor in patients suffering from breast cancer.
Stephen Greer2 published results of a survey of patients from the Royal Marsden Hospital. He divided the breast cancer patients into four groups: those that had a helpless, hopeless attitude to their illness, those that denied it, those that stoically accepted it and those that showed a fighting spirit. The latter group survived the longest. He also showed that many breast cancer patients suffered from suppression of anger. Kissen3 showed that sufferers from bronchial cancer who were smokers had a lower survival rate if they had poor emotional outlets.
Thus psychological factors would appear to play into the survival of cancer patients. Le Shan4, an American cancer psychotherapist, found that 70% of his patients tended to be nice complacent people. When asked what they wanted out of life, they were very unsure. His therapy involved helping his patients to find something that they really wanted to do and then to go for it, i.e. to sing their own song.
One of his patients said that she had always wished to travel but hadn�t the money to do so. He told her to blow all her savings and go abroad, which she did. Some years later he met her again. She had become a travel guide, having never stopped cutting out her life wish - she was cured of her cancer.
Another patient with a cerebral tumour had become a solicitor because his father wished this for him. He had married a girl because this is what his mother wanted of him. He divorced his wife, and Le Shan helped him to take up music which was the love of his life. He did have some chemotherapy, but singing his own song was also a factor in his survival. This is, of course, an extreme case.
In Helios we also use Steiner�s movement therapy, eurhythmy therapy5. This does not just involve passive movement but expresses feeling experience. Each alphabetical sound has a different movement that arises out of the inner experiences of what the sound does to one. Sound sequences are geared specifically to each illness in a therapeutic way. In cancer, not only do the movements help patients to get in touch with their feelings and their identity but they also help to send this healthy impulse into the body.
We all have to try to help our bereaved patients. My initial approach is to ask if they have any church affiliation. If this is the case I tell them to contact their priest or vicar for help in managing their difficult situation. However these days many people do not have any church connections. If this is the case, I lend them a copy of the book by Ronald Moody6 called Life after Life As you may know, this is a collection of near death experiences. With only two exceptions patients have found this book to be a great comfort. To hear that death is not the end of existence and that one will meet one�s dead relatives after death is an enormous relief. As you probably know, these case histories describe experiences after death, where a person has suffered a severe accident or asystole for less than four minutes, and has recovered. With our improved techniques of resuscitation, these experiences have be come increasingly common.
These patients describe first a state of being outside their body, i.e. being on the level of the ceiling and looking down on to their physical body, this is called autoscopy. It has happened during surgery when the patient has listened in to the surgeon talking about his recent golfing experiences etc. Then the subjects describe themselves going through a dark tunnel at the end of which is a wonderful figure of light of high morality, some describe it as an angel. They hear heavenly music and experience a flash back of their whole life existence. Then they meet their relatives who have died. The whole experience is so wonderful that they are disinclined to come back to earth. It is only out of a sense of moral responsibility that they agree to return to earth, to bring up their children, to complete a job of work etc. One feature that all these people experience is loss of the fear of death.
I had a patient who picked up a copy of Moody�s book which I had lent to a bereaved patient. He came into the surgery clutching the book in a state of high excitement saying that he had had a near death experience in his youth but never told anyone about it, not even his wife to whom he had been married for 40 years.
He had not told anyone for fear of being carted off to a mental hospital. He has since died. I recently asked his son whether he had mentioned the experience to him. The answer was negative. Another patient, who was an alcoholic and was depressed, caused me considerable concern. I felt that she might be suicidal and thought I should tell her what she would go through after death. As I started to talk she told me that I was wasting my time. She had already had a near death experience and had met her dead father. This naturally made me feel very sheep ish. The experience is much commoner than is usually supposed. The patient will only talk about it if one has introduced the subject oneself, as they have a fear of ridicule.
As mentioned, nearly all my patients have found this knowledge to be a great comfort. There were two exceptions. One lady blamed herself for her daughter�s death, and the other one told me that one should not meddle with such things.
As you may know, there is an institute in Oxford that researches into near death experiences. Dr Peter Fenwick7, a neuro-psychiatrist at the Maudsley Hospital, has also brought out a collection of descriptions of near death experiences. This is called The Truth in the Light.
We are privileged to live in a time of the most extraordinary advances in medicine, which must be appreciated for the boon they have produced for our suffering patients. However, they are based on a purely physical way of looking at the patient. Underlying this way of looking at patients is the belief that the soul and spirit are merely functions of the physical. One can then ask the question: are my thoughts merely a function of my brain or do I form thoughts myself? Is there more to me than my brain function?
To look at the soul and spiritual aspect of the human being we need a different way of thinking. We may look for guidance to the gospel of St Luke. He is the doctor of the four gospel writers. In the fifth chap ter, he describes how Christ leaves the land and steps into a boat. St Peter has been fishing all night and caught nothing. Christ bids Peter to let down his nets again. Peter overcomes his scepticism and, low and behold, draws up a miraculous draught of fishes, so miraculous that the nets begin to break. How are we to interpret this?
With biblical pictures there are many interpretations. Ido not claim the following to be the only one but just one of many. Lowering one�s nets into the water can be seen as leaving one�s abstract thought process (head) and lowering one�s centre of conscious down to one�s feeling experience (into the heart region). Water has a certain affinity to feeling life. It is a mobile dynamic and has not the crystal clear definition of thoughts (Christ also leaves the land and goes into a boat).
We need to leave all our gathered knowledge be hindus and just experience. Another picture of this gesture is that it is easier for a camel to pass through the eye of a needle than for a rich man to enter the kingdom of heaven (in three of the gospels). To enter the kingdom of heaven we need to leave our accumulated wealth of knowledge behind us and just experience the phenomenon in front of us.
To come back to St Luke, St Peter had not caught any fish in the night. Christ was not present then. When we live just in our feelings (down in the heart region) then we also need a mood of love and reverence (presence of Christ). Only then can we really unite with the phenomena of the world in an objective way. Only then will we be granted new insights (fishes). We need love and reference to come to these insights which are given as an act of grace.
This way of looking at the world Steiner8 called intuition.
One can look at suffering patients in this way.
Let us look at what happens when we suffer from fear and anxiety. We feel that we have the wind up, we feel screwed up, wound up, upset, uptight, etc. Why all this upness we may ask?
What psychosomatic effects do we notice? We come out in a cold sweat. We suffer from cold feet, jelly legs, wobbly knees, butterflies in our stomach, our hearts in our mouths (up word shift) and possibly diarrhoea. There would appear to be an upward shift of forces. Something that normally works in the lower body moves upwards and leaves the lower body in a weakened state. When this organising force withdraws from the bowel, the contents go to pieces and produce diarrhoea. It no longer holds on to the fluid part of us which then also flows out as perspiration.
When we calm down, when our emotions die down, when we wind down, then all these signs and symptoms are reversed, then diarrhoea improves. The reentry of this force into our lower regions causes the diarrhoea to improve. It pulls things together, and the motions become formed again. The fluid is held together, the cold sweat stops, the lower body is again strengthened. Thus we can look at pathology holistically by means of intuition. This can be applied to any aspect of medication though it does require hard work. What one calls these various forces at work is secondary. Steiner has names for them but each person can find their own names. This holistic approach does not supplant the conventional one but complements it.
I have tried to present something of Steiner�s approach to artistic therapy, whereby the patient can be helped to help themselves by becoming creative i.e. using forces that are dormant in everyone. These same forces can also be used as a means of cognition of the non-physical forces of soul and spirit and their interaction with physical.
Churchill s Black Dog, Anthony Storr pp42, Fontana Collins 1990
GreerS., MorrisT., Pettingale KW. Psychological Response to Breast Cancer. Effect of Outcome. Lancet 13.10.79
Kissen D. M. Relationship Between Lung Cancer, Cigarette Smoking, Inhalation and Personality - British Journal of Medical Psychology 1964. 37.203-2 16
Le Shan L. You Can fight For Your Life -Thorsons 1984
Fundamental Principles of Curative Eurythmy, M. Kirchner- Bockholt. Temple Lodge Publishing 1999
Life After Life - Raymond Moody JR MD) Bantam 1977
The Truth in the Light - Peter & Elizabeth Fenwick, Headline 1995
The Science of Knowing - R. Steiner, Ch. 16 Mercury Press, 241 Hungry Hollow Road, Spring Valley, NY 10977 1988.
Dr. Andrew Maendl is a Bristol General Practitioner, semi-retired.