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Disease can be an awakening An interview with Naomi Remen, MD Rachel Naomi Remen, MD, may
have discovered what traditional medicine has long been missing: heart and
soul. Author of the best-selling Kitchen
Table Wisdom: Stories That Heal (Riverhead Books, 1997), Remen has plenty of stories herself. She's a medical
educator, pioneering healer and survivor of a life-threatening illness. And as
one of the pioneers of the mind-body health movement, she's helping people to
learn more about heart and soul in healing.
Remen is a graduate of Cornell Medical School and received her
post-graduate training at Cornell and Stanford. She also holds an honorary PhD
in health psychology from California Institute of Integral Studies and an
honorary PhD in Humane Letters from John F. Kennedy University. Currently,
she's a clinical professor of Family and Community Medicine at the University
of California San Francisco School of Medicine, where she has won numerous
teaching awards and academic recognition for returning humanity to the
practice of medicine. Her newest book, My
Grandfather's Blessing (Riverhead Books, 2001), was released earlier this
year. In this issue, Remen talks to Nexus
publisher Ravi Dykema about heart and soul in medicine, telling our stories
and finding a new definition of healing. RD: You're a medical doctor
with a distinguished career, and you've worked with many populations,
currently with cancer patients. RNR: I
have to laugh when you say a distinguished career. I am a maverick. I became
interested in mind-body health in 1972. There were only about a dozen of who
were interested in it-people like Andrew Weil, Jon Kabat-Zinn, Joan
Borysenko and others. Initially, I became interested because of my own health.
I have Crohn's Disease. I've had major surgery eight times. I no longer have
most of my intestine. And I became ill when I was 15. It changed me
profoundly, the way life-threatening illness changes people.
My own experience in the first 10 years of my illness were intense and
enlightening. I was enraged all the time. And I had a sense that there was
something growing in me, something which had no voice, which I couldn't really
talk about or explain, but which was absolutely whole. Then I began to notice
it growing in my patients as well. And, you know, at that time, there was no
thinking like this, that "Maybe there's a healthy way to have a
disease." Maybe as the body becomes challenged, something in the person
responds and becomes stronger. There were no tools, even, to enable this
process. In fact, nobody thought the process was happening. From my own
experience, I began to wonder if we understood illness at all, or if it was
something completely different than what I had been taught about in medical
school. RD: How had you been taught
about illness in medical school, and how was it different in your discoveries? RNR: In
medical school, illness is basically about the doctor. I was taught that I had
to make the diagnosis, I had to select the treatment. If I was not successful,
you would not have a good outcome. And the only outcome was physical. It was
all about the body, about biological repair. And I took credit-or
blame-for the outcome. I was in the center of the stage.
During all this time, I was a
patient as well. And the experience I had as a patient didn't fit with the
picture of illness I had been given as a doctor. I have been ill for 48 years. RD: Had your doctor
succeeded or failed in your case? RNR: According
to what I was taught about healing, my doctors have failed miserably. It began
to come to me that unless doctors engaged this thing that was growing in sick
people, unless they addressed healing, which is always possible, even when
cure isn't, we were failing people. I started talking about my theory, that we
have been failing our patients for years. It was not very well received. And I had gone to Esalen
Institute. There are times when you're on some straight and narrow path, and
something happens in your life, and you start off in a different direction.
Sometimes we don't even realize it's happened. It may be one tiny little
thing, like a single workshop, and your whole life path will be different. The associate director of the
medical clinic at Stanford came to me one day and put some colored papers on
my desk-I can remember this very clearly because it was an important turning
point in my life-and said "There's a place called Esalen Institute, and
they want a dozen doctors to come down there. They're working on something
called the human potential movement, and there's a woman down there who wants
to see if these ideas have anything to do with health and illness and the
recovery from disease." At the time, Esalen was the center of one of the
largest revolutions in thinking and perspective in the last century, but I'd
never heard of it. That's how insulated medicine is. When he explained what
Esalen Institute is, my first thought was "Oh, what a great way to meet
men," because I had just broken up with my fella. And so I went. If you had asked me at that time what my life
path was, I would have told you: I was going to be the first female head of
the department of pediatrics on the west coast who was a woman. Every move I
had made professionally for 10 years prior to that was towards this single
goal. And I think that if I had understood at that moment that this choice of
going to Esalen Institute would mean giving up pediatrics entirely, resigning
from the prestigious faculty position that I was in and being a medical
outcast for about 12 years, I would never have gone down there. RD: So you weren't
searching for a new course, or a new path. RNR: No,
I wasn't. I was very much on track. But I think the soul takes us by whatever
handle is sticking out, and moves us along in a direction that serves its
purposes. And it may be years before we understand where we're really
going-half that time we think we're going somewhere else. So I went down
there to meet men. But that's not what happened. When I went to Esalen, I met
Sukie and Stewart Miller, who had a residency program in which, once a month,
doctors spent the whole weekend with one of the seminal thinkers of the time,
like Elmer Green, who wrote Beyond
Biofeedback, or George Leonard. These amazing people would sit with us and
talk about the growing edge of their thinking, stuff we had never heard of. We
would practice those new ideas, like biofeedback or Aikido. Then we would come
back to the Bay Area and have meetings to see how either the thing itself, or
the principles behind it, might have something to do with illness, health and
the recovery of health. RD: And you discovered it
did, and that changed the course of your life? RNR: Yes,
it did. The interesting thing is, there were 11 men in this program and me. At
the end of the program, they all went back to their respective practices. And
I quit Stanford and began doing what I do now. There was only one of us who
went on. Isn't that interesting? It seems like the weekend with George
Leonard, when he introduced us to Aikido, gave me a completely different sense
of my own relationship to my illness. In western medicine, the opponent comes
at you, and you either overcome the opponent or you are overcome by it. But in
Aikido, you take your energy and you blend it with the energy of the attack,
and you go off on a vector in a new direction with a new perspective that you
would never have without the attack. And at the end of the encounter, the
Aikido master thanks the opponent for the gift of his energy, which has
allowed the new perspective, the new direction to be born. That's what had happened to me when I became
ill. It was like an Aikido encounter, and I learned that perhaps there's a way
to deal with an illness as an honorable opponent and thank it for the new
perspective, the greater ability to live from the heart and from the soul that
it brought into your life. The minute George described this to us, it was like
it all came together. I understood how all of the experiences in my previous
17 years or so related to this illness, and I saw that everyone around me who
was ill was struggling to find this same way. They were struggling to use
illness as a force for growth in their lives. And it's the nature of suffering
to be a force for growth unless we get stuck in anger or self-pity or
something like that. RD: You said earlier that
even if someone is terminally ill, they can still find healing. RNR: Many
people die more whole than they've ever lived. Anything can be used to bless
the life in others, or anything can be turned into something that blesses your
own life. I've seen people bless the life in others by the way in which they
die. A blessing is not about butterflies and rainbows. It's about the power of
the human spirit. Illness, injury or disease can be an awakening,
rather than a setback. Suppose you suffer what some people may call a
misfortune, and you find yourself thinking, "Now I'm back to the
financial state I was in five years ago," or "Now I'm alone
again," or "Now I can no longer do my sport because I've broken my
ankle." These are opportunities to discover who you are-who you really
are-and what's important to you. They're opportunities to live life more
passionately, more fully than you have ever dreamed. RD: Let's say you have a
chronic pain that you didn't have before. And the pain makes you unable to
hike in the mountains. And you loved hiking. How could that possibly be a rich
opportunity to find your true self?
RNR: It
depends on how a person reacts. For some people, it's an opportunity to be a
victim for the rest of their lives. Other people will look at not just the
activity that they can't do anymore, but why that activity is important.
What's the meaning of it? And they will find other ways to have that meaning
in their lives, usually ways that are much more profound than the way they've
lost. I was thinking about a young man that I saw years ago. He was a football
player, who no longer played football because of a sports injury. He spent
about eight years trying to destroy himself with alcohol and cars and just
about anything you can use. And in the course of our working together, he got
a sense of what football was really about for him. He understood what it meant
to be a part of a team, to have a passionate common goal with other people, to
move past the obstacles to victory as he saw it. He realized he could still do
those things, except he could no longer do them on the football field, and he
became an innovative psychologist, whose name you would know. He has done a
great deal of work with groups-in fact, a lot of what we know about groups
and group process comes from his work. I think he'd probably be a retired
football player living in the past, now that he's about 50. It's really all
about the will to live. I think there's something in people that struggles
towards wholeness. It's very much a part of essential human nature. RD: So it's more than just
a will to live, it's a yearning for wholeness. RNR: Yes-the
will to wholeness. The will to manifest one's dream of oneself. Even though
you may not be able to say in words what that dream is, and it may exist deep
in your unconscious. The Buddhists talk about the Buddha seed in an
individual, that part of us that can become more Buddha-like, more whole.
These are not static things. This is a dynamic thing. And the will to live
manifests itself often as anger. When you wreck your knee, or you get a
diagnosis like Crohn's Disease, anger is usually the first expression of your
will to live. It was for me. I was enraged for 10 or 12 years. I hated all the
well people. I was unfairly a victim, and it was all your fault that I was a
victim. I remember walking down a beach
in the New York City area and feeling that this disease had robbed me of my
youth and so many opportunities. I was thinking that other people my age had
so much energy and power. And suddenly this rage came up in me, and I
recognized it for what it was-that very deep inside me, I loved life. I
wanted to celebrate life. And I had a power in me that wanted to do that. But
I had been expressing it in the form of anger. Some of the esoteric teachings talk about energy
and energy form. The energy is chi, the life force. The energy form is anger,
love, whatever it is. And I realized that I couldn't own my power if I kept
running it through the energy form of anger. I understood that I needed to
experience the will to live, the love of life, directly, and that I could not
live my life as an angry person. I felt liberated, as if I had reclaimed my
power from something that had held me captive, which was my anger. I'm seeing
this happen to many other people now who are in the process of healing from a
disease-not necessarily in the process of curing. Curing is about expertise.
Healing is about a human relationship. We're all healers. It takes years to
learn how to cure. And that's a very limited approach to something like an
illness. RD: Do you think one's
attitude, let's say of shifting from a reaction of anger to one of
appreciation or gratitude, could change a medical condition? RNR: Sometimes.
There is a connection between the mind and the body that works both ways. But
if we look at that relationship and assume that we use the mind to cure the
body, it's a limited view. This is not about a cure. Is there a change in the
medical condition? Sometimes, sometimes not. Is there a change in the person?
Always. Our real power may not be to influence our body. It may be to
influence ourselves, to grow beyond the challenge of an illness and free
yourself from it by living beyond it. There's a funny little story in
my book My Grandfather's Blessings
called "Eggs." It has to do with my grandmother, Rachel, who came
from Russia, a place where she and the family were often hungry. When she got
to America, her kitchen was bursting with food. Even so, nothing was to be
wasted. Even the tea bags were used twice. Her icebox was always filled to the
brim, and if somebody opened the door without caution, an egg might fall out
and break on the kitchen floor. And my grandmother would always have the same
response to this: She would look at the broken egg and say, "Aha! Today
we have a sponge cake!"
When I first became ill, I was about 15 years
old and I was told I would be dead by the time I was 40. I was told there was
no cure, that no one even knew what this disease was about and that I would
have multiple surgeries. My mother was there with me, and I remember turning
towards her for some kind of comfort. But she didn't comfort me. She did
something rather spectacular. She took me by the hand and said "Rachel,
we will make a sponge cake." And you know, it's taken years to find my
own recipe. But in that moment, I had a sense that something was possible that
my doctors had no idea about. RD: I imagine that making
sponge cake in such a situation reduces your suffering a lot, whereas
believing that you are weak or chronically ill or terminally ill involves a
lot of suffering. RNR: It
involves what I would call unnecessary suffering. There's enough suffering
from the illness itself-we don't want to be visiting unnecessary suffering
on people. I think many people feel diminished by their illness, because
they've identified themselves with their body. We have bodies, but we are not
our bodies. It's not who I am. I myself am a person of considerable power,
with the capacity for love, understanding, wisdom and seeing meaning. Even
though I don't have the physical stamina to walk three blocks, I'm a person of
power-probably more power than when I was able to run three blocks. It's
important not to identify with something as impermanent as the body, when
there's something in all of us that is not impermanent. That something is
probably who we really are. One of the things I do is run a
large continuing medical education curriculum, a series of retreats for the
California Medical Association. For the past 10 years, I've run a course at
the medical school called "The Healer's Art." It's a student-initiated
elective, which means it bypasses the curriculum committee. I take a different
approach than what I think is the norm in any medical school. First-year students are on fire
with the spirit of service. They come in filled with gratitude for an
opportunity to use their lives to help others. Four years later, they're
filled up with facts, cynical, depressed, numb. So the first thing I say to
them is, "You are already doctors. You just don't have any facts yet. The
whole trick of your training will be to remember the facts without forgetting
what it feels like to be a real physician, which is the way you feel right
now." I tell them that what they know and who they are is as important as
anything they're going to learn in school, in terms of being able to help
people. We engage them in the preservation of their humanity, and we create a
community which supports a different set of values than the dominant medical
culture supports. It's a way of taking on the shadow of medicine, if you want
to look at it that way. The conventional values are the ones that most
people are aware of: expertise; a certain kind of professionalism, which
involves distance; a certain kind of control; a belief that the heart and soul
are somewhat irrelevant to the task at hand. I've seen it affect doctors like
a disease. We have to heal that, to recover from it, and it can be a long,
slow process. I'm still recovering. RD: What did your
"recovery" look like? RNR: A
lot of it had to do with the writing of my books. When I started to write my
other book, Kitchen Table Wisdom, I
didn't know how to write. I didn't even know what I was writing. But I had
this wonderful editor who said, "We have no outlines, no proposals. Why
don't you just write down 400 pages of what's important to you and we'll sort
it out." I don't know how to write, but I have been telling stories for
years. So I tell the computer a story, and then I tell it another story. And
then I can remember another story, so I tell the computer that story. It's
like a meditation, for 14 months in the end. I told the computer story after
story, until I could remember the stories from my early childhood. They just
kept coming up. At my deadline, I had 400 pages, but it wasn't a book. It was
just a bunch of stories. I sent it off to the editor with an apology, and a
note saying "It will take me another four weeks to write the book, and
I'm starting now." She called me back and said, "Stop writing. It's
done." I was horrified. I said, "I can't write a book of
stories." She said, "Why not?" And I said, "Well, it
doesn't have any footnotes. It won't have any credibility." (These things
die hard, you see!) And she said, very slowly, "Rachel, I think you're
about to discover what real credibility looks like."
RD: What do you mean by
stories?
RNR: Everybody
has stories. In the old days, we'd sit around the kitchen table and share
stories. That's how Kitchen Table Wisdom
got its name. And the stories help us to live better. A story is like a
compass. It points to what's important. And no two people read a story in the
same way. There's a book called Crow and
Weasel by Barry Lopez, in which he talks about the power of story. He says
sometimes people need a story more than food in order to live. That's why we
put these stories in each other's memories. When I first became ill, I needed
a story. I needed a story about the possibility of breaking through an
obstacle, about the life force, about mystery. I think the first book, Kitchen
Table Wisdom, was the book I needed to read when I was 14 or 15 years old,
when I got sick. I think the story is more important than the fact. RD: So you became your own
story, and then you realized it and you told it. RNR: The
story we all need is our own story. Most of us don't know our own story. For
me, both of my books are memoirs. But when you tell your stories without
putting yourself in the middle of them, they become everybody's stories. These
are stories about me, but they're also stories about everybody, which is why I
think people respond. RD: If a person doesn't
plan to write a book, they can still tell their story. How would you suggest
they do that? RNR: I
suggest they do it the way people have done it for thousands of years: by
telling their stories. We have something called "Finding Meaning in
Medicine Circles," which I think of as AA for recovering doctors. Doctors
are being asked to function below their level of excellence by the present
medical system, and so something in them, something that has made medicine
what it is for thousands of years, is eroding and dying. This is a way for
those people to strengthen themselves. Story strengthens us.
I suggest people find three or four friends to meet with once a month.
You meet in someone's living room, and you start with the first topic. The one
we recommend to people is compassion. The price of admission to this group is
to bring a story about compassion from your personal or professional life, or
from literature or a poem. The whole evening is simply about everyone telling
whatever it is they brought. It becomes a community of inquiry, a discovery
process, and it validates compassion as something to be cultivated. Then the
group will choose another topic-for example, suffering. And people bring
their own stories about suffering. And you get to look at all the different
kinds of suffering. Six people telling their stories have enormous power to
show each other the direction of wholeness. Not just personally, but also
professionally. RD: What message would you
like to leave us with? RNR: I'm
not one for messages. I think most messages are the ones that we discover are
written on the reverse side of our own hearts. The only message I have is for
me. But in a general way, I think our whole culture has persuaded us to give
up our power. We don't even know what our real power is. We think it has
something to do with our expertise, our technical skills. And I think the
important thing for people to realize is that expertise does not make you
whole, and it will not make the world whole either. It's going to take our
hearts to do that. It's going to take something different to make the world
whole. You can't talk about a single individual
struggling to become whole without talking about the whole world. It's the
same struggle, and it's the same power that will make us whole. We've turned
away from it, and we need to turn back towards it. What that will look like
for each person is as unique as their own fingerprints. But just knowing that
there is this possibility of living whole is very important, because if you
don't know, then you never search. |
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