Curing Illness or Curing People?

Illness, physical, emotional or mental, is the most prevalent and obvious form of suffering. Everyone, in any age or social position, experiences it, is vitally concerned about its causes, and anxious to eliminate or reduce it. In this Stauros Notebook, Dr. Michael Wilson, a medical doctor and an Anglican priest, offers important dimensions of illness often overlooked. He practiced medicine in Africa, and presently is the Senior Lecturer in Pastoral Studies at the University of Birmingham. He is the author of The Hospital - A Place of Truth, Health Is For People, and The Church Is Healing.

Why Am I Ill?

Illness carries a message, it may be a personal cri de coeur expressed in body language like a rise in blood pressure: or a symptom of what is wrong in society, like poverty or stress, focused in and through individual victims. This question "Why am I ill?" is far more important to an African than to a European, and because we do not answer it, Africans commonly consult their own native practitioners as well as making use of a Western style hospital. If illness may be regarded as a symptom of disease in personal and social life, then an important aspect of the medical system is the value of the information which it gathers about what is going wrong in society. With this understanding of illness in mind I describe the primary task of a hospital as: to enable patients, their families and staff to learn from the experience or illness and death how to help build a healthy society.

It is possible to ignore the writing on the wall even though in hospitals the truth is written not on a wall but in human flesh. It is possible to read the message of the illness in different ways - as a threat to be eliminated, for example, and sometimes it is. There is a conflict between medical, social and Christian or other religious values which may affect the way we "see" illness, and these differences may be shown by exploring certain concerns in the life of a hospital.

Treatment of Disease or Patients?

Priority is given to the treatment of disease. James Mathers has usefully distinguished between two processes: "When we talk of treatment (or cure) we do not often make it clear whether we mean the treatment of patients or the treatment of diseases. Yet there is a great deal of difference: to treat a disease means to attack, destroy or inhibit it in some way. To treat a patient, on the other hand, means to foster, nurture or care for his capacity for living. These are quite different kinds of activity."

It is to the treatment of disease that we give priority in terms of job status and hard cash. This means that those with illness that is stubborn or less easily cured get pushed to the margins of concern. Services for patients such as the elderly, the chronic psychiatric and the mentally sub-normal, for whom personal nurture may be required without the rewards of clinical recovery, tend to be impoverished.

What is Health?

The model of health implicit in our National Health Service is that health is to be obtained by the diagnosis, treatment and prevention of disease. This medical model of health is based upon an ideal of perfection - the flawless body, if not mind and spirit, too. But the biblical model of perfection is neither idealistic nor static; it is in terms of interpersonal relationship between self, neighbor and God. The biblical notion of health, therefore, is neither a state of biological perfection (though this is valued) nor sinlessness, but harmony (Shalom), a harmony which contains the sorrow of not being whole. Shalom is a social event which has to be worked out in specific local situations by real people. It is not an abstract ideal. It is a part of human health to bear one another's burdens.

A Healthy Nation?

It is somewhere here that Health Service fails, for it has not produced a more healthy nation. It was believed that when we had caught up with the backlog of illness that the Health Service would get smaller and cheaper. In fact, illness cannot now be conceived as so clear cut and reversible. Indeed the Health Service has consistently grown larger and more costly every year as our ability to detect and treat disease has grown. But as one pattern of disease has yielded dramatically to technical advances, another has taken its place. The triumphs of idealism and materialism in Medicine have been notable and world-wide. No one who has doctored in Africa would have any doubts about that. But we have moved into a different era of illness where the tools of hospital medicine have a vital but diminished role to play.

'Holistic' Health

To move into a consideration of what I call a new era of illness, I want to treat "holistic" or whole - "whole person medicine" as we may speak of it in Britain. There are three stages, I think, in a growth of medicine towards wholeness of approach.

First, to affirm that PATIENTS ARE PEOPLE! It seems quite strange that we should ever have reached a stage in the art of healing that it was necessary to write a book of that title - "Patients Are People". If we needed the reminder, let us heed it. So far so good. But there is a second stage which is:

Second, PATIENTS BELONG TO FAMILIES. This statement is not simply pointing to a patient's support group, though that is important. The thrust is much deeper. It is to assert that one's nearest and dearest are part of our own health or sickness situation. When I was a boy, I remember my father (then a hospital chaplain) remarking to my mother that the visitors often seemed more disturbed than the patients. There is a poem which illustrates this well, written by a patient in a psychiatric hospital. She entitled it WARNING TO VISITORS:

• Visitors be advised.
• Pity the mad.
• But gaze not in their eyes.
• Where your image shrinking lies,
• Lest the surmise that dismays.
• Your own soul you there may see.
• Your own to a monstrous certainty.
• We warn you, we, who once were sane.
• But now are madly wise;
• Who laugh, but are not glad,
• Despair but are not sad,
• And hold, each locked within his brain,
• A mirror to the universal pain.

Shared Nature of Illness

Do you believe that a person is limited by their skin? These insights into the shared nature of illness demand a radically different understanding of human nature. Our Western medicine is based upon the image of a human family being rather like a collection of marbles in a box - discrete individuals related by reason of proximity. The woman who wrote the poem sees the human family more like the biblical image of a body - members one of another. This also is the African's image of how people are related. For example, the Shona people greet one another with: "How are you?" - and the reply: "I am well if you are well". There is a Zulu proverb: "When. there is a thorn in the foot the whole body must stoop to pluck it out."

'The Family is the Patient'

This second stage towards a holistic medicine has only just begun. It has made progress in areas such as Family Counseling. But to give an example is to illustrate that the wider development can only take place in cultures which do not share the individualistic emphasis of Western Medicine. It is not surprising that where Western Medicine has been introduced into Africa there has been a clash of values and perceptions related to the family. For some Africans it would be true to say "The family is the patient". But is that how we in the West would see it?

A hospital chaplain was called to the emergency room at 2 A.M. Four teenagers -two girls and two boys - had been mangled in a high-speed automobile accident. The hospital became alive. Its resources of personnel, equipment, skill and know-how were all bent toward one task - that of keeping these persons alive. After four months, all four were released and it was with an understandable sense of satisfaction that the hospital personnel saw these young people apparently well.

When the hospital chaplain, on the night of the accident, contacted the parents of the four victims, the parents were either ignorant of what their children were doing, or did not care. Most of the parents did not know that their son or daughter was out of the house. A few weeks later one of the patients returned to the same hospital with the same symptoms: her body was mangled as a result of a high-speed automobile accident. The cure of the symptoms while constituting a technical repair, was not enough to solve the whole problem.

Health - The Life-style of a Society

The third stage, if we push towards a greater understanding of wholeness in medicine, is that FAMILIES MAKE UP NEIGHBORHOODS. The logical conclusion of widening the circle of involvement is to understand health and illness as rooted in the life style of a society. This is the lesson of the teenagers in Casualty. This lesson has been recognized in Canada where the Ministry of Health's Report - sees the increasing problem of stress among city dwellers as a symptom of something wrong with the Canadian life style.

Medical Service is a source of information about what is going wrong in society, and the importance of learning the lesson of the illness if society is to respond more healthily. If we want to evaluate the cost of unemployment we may not rest content simply with an economic figure. It is from psychiatric hospitals and voluntary societies that we can learn the human cost in terms of depression and despair. But if we only see these breakdowns as problems to be treated privately, then the real cost of unemployment is hidden. If we see them also as symptoms of unemployment, then society and government cannot escape responsibility for policies which damage the health of society.

Change - Urbanization

With the spread of urbanization there is rapid social change. We are a different people from fifty years ago, and a symptom of that difference is a change in the pattern of our disease.

In rural areas or tropical climates it is diseases due to DISHARMONY WITH THE NATURAL ENVIRONMENT that afflict people - malnutrition, infections and parasites - the diseases of poverty. It is the common pattern in underdeveloped countries now. In urban areas all over the world, however, a new pattern of illness is emerging. As new standards of hygiene arrive - improved housing, diet, clean air and water, - many of the old diseases come under control (cholera, diphtheria, smallpox) and new diseases take their place. In Ghana, West Africa, I saw only one African with a duodenal ulcer: and he got it while on scholarship in Britain! Twelve years later, on a return visit, I saw as many Africans with ulcers in the hospital in Accra as you will see in Birmingham.

Urban Stress

These city diseases are due to DISHARMONY IN THE SOCIAL ENVIRONMENT; that is they are inter-personal in origin - diseases due to urban stress (anxiety, nervous breakdown, raised blood pressure, heart attacks), violence (suicide, wife battering)and addiction (alcohol, smoking, tranquilizers and overwork). There is an accompanying rise in the number of old people and geriatric problems.

Our individual health is rooted in the health of our society. SOCIAL STUDIES HAVE HELPED US TO UNDERSTAND THIS OUTWARD AND SHARED ASPECT OF PERSONAL DISEASE. Psycho-social illnesses now dominate the Western world.

Who is Responsible?

In the old pattern of disease we can often speak of an illness as a "thing in itself" (there it is, that: lump there), but in psycho-social illness we are less certain what illness is. People tell us how they feel, but there may be nothing to see or touch - in fact we often cannot speak of disease at all; we must speak of ill people. And whereas a cancer can be treated in one individual, where can we locate and treat the cause of anxiety, an ulcer, a threatened heart attack or a battered child? In the sufferer? the spouse? the foreman at work? the parents? or the competitive society we have made together? These illnesses, like human beings, have fuzzy edges.

The Winter of Materialism

The passing of the first pattern of disease is a triumph. We know that no society will or should tolerate malnutrition and preventable disease. In this technological age all peoples have caught a glimpse of the possibilities of material advancement, and many have actually achieved a high standard of living. This is the 'Autumn of materialism, rich with fruit. But the discovery that when the first pattern of disease has been greatly changed, new kinds of disease take over, and ushered in the Winter of materialism. "Man cannot live by bread alone" is seen to be an iron exactment of life: man can perish amid plenty.