Journal of Sacred Work

The physician should speak of that which is invisible…he becomes a physician only when he
knows that which is unnamed, invisible, and immaterial, yet has its effect.  – Paracelsus (1493-1541)

   Born the year after Columbus discovered America, Paracelsus may have discovered something far more important than a country. He may have been the first to fully appreciate the role of the unchartered land of the invisible in the treatment of human illness. Unfortunately, much of contemporary medicine is delivered with little or no appreciation for Paracelsus’ wise insight. 
   Sometimes, a physician must become a patient to discover something with which he or she may have lost touch. Illness lays bare so many invisible pains not touched by typical medicines. When doctors become patients, they discover that words like "placebo" which they may have disdained are actually quite powerful.
   It is this phenomenon which causes me to wonder that since there is a Placebo Effect, what about something we might call The Placebo Causes – invisible or seemingly benign events which may provoke illness…

   In a day when computers are used increasingly by doctors to help both
diagnosis and treatment plans, it is becoming easier for some
physicians to rely on software to do some of their thinking for
them.
But, as Thomas Moore wrote in his landmark book Care of the Soul in Everyday Life, "Modern medicine trusts the microscope to reveal the roots of illness, but the microscope doesn’t look far enough within."
   The presence of modern technology, including especially CT scanners, MRI
machines and increasingly sophisticated blood tests, may seem to have
carved back the land of the invisible to a smaller and smaller island.
Yet, the more we learn of the physical illness we can see, the more we
discover the impact of emotional and spiritual forces we can’t see.
   For example, I know the exact moment that Crohn’s disease, an auto-immune illness, overwhelmed my body’s defenses and entered my life as a permanent presence. To this day, more than forty years later, it is painful for me to speak all of the truth about the triggering episode.
   The external facts may be less important than was the invisible yet toxic convergence of three stressful events. I was a sophomore at Northwestern University. My girlfriend at the time, the homecoming queen I thought I would marry, had betrayed me for someone else. Second, I was in the middle of a hard campaign to get elected to a student office. And then came the decisive blow. In the middle of exhaustion at the end of the quarter, I was leaving a final exam when I was confronted by another student. She gave me information that made me think I was going to fail the exam and flunk out of college. Although this didn’t come to pass, I didn’t know that at the time. Instead, I absorbed her comment as a sort of fatal blow.
   I remember the pivotal moment with the vividness we attach to any traumatic event in our lives. I was standing at an intersection with other students waiting for the stop light to change so we could cross. The sharp point of my latest personal disaster pierced me as deeply as if an arrow had been fired through my gut. I felt a deep burning sensation. The next day, I was hospitalized.
   When I was finally diagnosed, I asked my doctor, "could this have been caused by stress?"
   "Absolutely not," he responded with a mix of certainty and disdain. "We don’t know the exact cause, but I’m sure stress has nothing to do with it."
   Dr. Etheridge was, of course, seeking a disease factor that might be seen under the microscopes of the times. Instead, the only thing tests could discern was not the cause, but the effect: a disorder in the intestinal wall. Even though Crohn’s disease had been identified more than a hundred years before by Dr. Samuel Wilks, the cause was unknown. From a scientific standpoint, the cause is still described as unknown to this day.
   Yet, I am certain that if I had somehow been connected, back at that defining personal moment, to today’s sophisticated diagnostic machinery, a trained scientist could have seen the cause-effect relationship between those words spoken by my fellow student, my stress reaction and the onset of physical illness.
   So what?
   The implications of cases like these can be profound for both diagnosing and treating illness. Too many physicians throw up their hands when they can’t discern the cause of an illness. Instead, they should probe more deeply into the patient’s history listening for the invisible but powerful factors that may have caused the illness.
   The Placebo Effect, better referred to as The Meaning Effect, has long been recognized as an emotional level of trust that can have a curative effect. Simultaneously, all care givers must recognize that there are a range of placebo causes – seemingly benign events which actually have toxic impacts.
   My own case must have been replicated millions of times in millions of different ways by millions of patients. I experienced what I perceived to be a threat upon my existence. The meaning of my life was challenged so severely that the invisible words from my fellow student entered my blood stream like poison.
   The best physicians in the country, including my own doctor, Paul McNabb, M.D., have learned to pay deep respect to the invisible – the role of so-called psycho-social factors – in both the diagnosis and treatment of chronic illness. Today, they understand that relaxation techniques and cognitive therapy can be of as much value to patients with auto-immune illnesses as are prescription drugs. It is not a case of one or the other, but of the use of both in balance.
   As Paracelsus understood four centuries ago, the best doctors respect the effect of the invisible.  They learn to take it into account as they engage the patient’s history and develop treatment plans. Most important, they appreciate that visible illness may have a range of invisible causes and that effective treatment will engage a panoply of other invisible, yet potentially powerful cures.
   These cures are hard to program into a computer. They require physicians to engage their artistic gifts as well as their scientific skills. These challenges call all care givers to engage one of the most powerful skills any of us has: our gift of listening presence.
   As David Whyte says so well in part of his poem called "The Winter of Listening":

All those years
forgetting
how everything
has its own voice
to make itself heard.

   Each of us lives with our own version of chronic illness. It is made up of all the scars of every hurt inflicted upon us in our lives. To find healing, we may engage the listening ears of someone who will hear us with compassion. We may do the same for someone else who waits out there now, hoping we will be present to their pain.
   And each of us may look within our hearts in a new way – a way that rediscovers the soft joy of our sacred self.

–Erie Chapman