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Disease can be an awakening
 

An interview with Naomi Remen, MD
By Ravi Dykema

 

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.

"Healing is always possible, even when cure isn't."  

      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.

"Our real power may not be to influence our body. It may be to influence ourselves."  

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?  

"Curing is about expertise. Healing is about a human relationship. It takes years to learn how to cure. But we're all already healers."  

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!"

"It's important not to identify with something as impermanent as the body, when there's something in all of us that is not at all impermanent."  

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."
      These books have been the final step in the healing of the wounding of my training, which taught me that the intellect is everything, and that nothing else is nearly as significant. These stories are about the heart. They're about the soul. They're about what I think medicine is really about. And the thing that's so interesting, of course, is that Kitchen Table Wisdom is now a textbook in 34 medical schools. Since it was published, I've received close to 10,000 letters. What I've discovered is that the world isn't made up of facts. The world is made up of stories, and it's stories that empower us and change us.

"In medical school, illness is basically about the doctor. The doctor makes the diagnosis and selects the treatment. And the doctor takes credit-or blame-for the outcome."  

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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