by Dawn Garisch
A hypothyroid friend who has been on medication for years postulates that there is something in the modern environment that is knocking off people's thyroids. There does seem to be an epidemic of the condition, and it is very likely that the interactive soup of unnatural chemicals we are exposed to daily – smog, tobacco smoke, preservatives, medication, drugs, colourants, flavourants, pesticides, etc. – has adverse effects that have not yet been documented. This could be one of the prices we pay for poorly monitored and overvalued ‘progress’. It is also possible that hypothyroidism is the shadow aspect or corrective of the Zeitgeist, or spirit of our times, which is fast-paced, instant, driven, gobbling dinner at the drive-thru.
For two days I have sat with this news, feeling vulnerable and afraid. I have not yet taken the medication lying unopened in the package in the bathroom. I am made to understand denial first hand. I am developing sympathy with those patients who are not interested in what I offer them in the consulting room from the other side of the metaphoric desk.
Also, I feel devastated, wanting to go to bed and weep into my pillow. And I want to laugh. To shriek with laughter. How ironic can this get?
This is a strange angel.
For a week or so I have been stuck, not knowing how to broach the next chapter. So, now, here it comes. It seems I cannot write about the body and illness, the psyche and art, from the outside, calmly and retrospectively, as the objective observer taking refuge in a place apart, reflecting back and reporting on what I have experienced and know. Instead, I am required to wade and fall into muddy waters, not knowing exactly where I am going.
I had a dream last night. I woke, and lay still a while, trying to catch hold of it, but it has gone. I need to pay attention now; I need to live the questions of my life and of this book on into the future.
It does feel unfair. It is outrageous that my body gave me no indication, no warning at all. Oh, except for hair falling out, now that I think of it. Long silver strands lying loose on my shoulders, the sofa, the floor. And inexplicable weight gain. And, since the diagnosis, I feel exhausted.
I take the first pill – Eltroxin 50 microgrammes. As I wait for it to take effect, despite knowing that it will take some time before I feel any different, I am very moved that this option is available to me. It is astonishing how humans, by applying their brains, have managed to identify this hormone and what it does in the body, and then discover how to manufacture it to assist those whose inner supply is dwindling. I am grateful to those men and women who go to work every day in laboratories in order to help heal me. It is a miracle: I can swallow this smidgen of substance – a mere 50 microgrammes – and it can save my life.
Acknowledging this medical advance, I am also going to bed to dream. May Psyche reveal herself. May she indicate what it is she wants of me.
***
Body my house my horse my hound what will I do when you are fallen?
May Swenson30
Five days later, and I am still feeling shaky and insecure. With this development in the narrative of my life, the ground has once again shifted under my feet. Fortunately, I am also curious.
So, here I sit with these symptoms, these symbols of the body, this dream, this unfinished story, this corrective we call hypothyroidism, which amongst other things is affecting the long term integrity of my bone strength.
The thing about the unconscious is that it is unconscious. We do not know what we do not know. Wherever we shine the light of understanding, in other places there will be darkness. Darkness contains what Jung called the Shadow, or the repressed aspects of ourselves – those gifts we are terrified to recognise, value and use; also those human traits we dislike and even despise in others, and deny in ourselves.
At the moment, I am afraid. The assumption that I can trust the process of my life has been repeatedly tested and found to be reliable, yet it is never easy to keep trusting. I want to be in control, I want to know where this is going and how it will all turn out.
I have a joke about this book, that when it is published it will be cheaper than a consultation. Embedded in this jest is the message: read this book and you won't have to see a doctor. Everything you need to know about your health and life you will find here. It is the message of the worst kind of self-help book. It is the message of fundamentalism, of arrogance. It says: life is simple. There is one door, and one key, and I have it. Now I am challenged yet again by the complex problem of illness. Also of ageing.
Illness is like a mini-death. It is a premonition of the overwhelming failure of the physical body, and makes us uncomfortably aware of our mortality. The scares surrounding avian and swine flu are reminders of the not too distant past when it was not infrequent for mere influenza to become pneumonia, which could end in respiratory failure or septicaemia.
Patients arrive in the consulting room wanting an antibiotic because they sneezed. They don't have time to fall ill, they say. They can't possibly miss work/an exam/a party on the weekend. They want to fix their bodies before they are even a little bit broken. Those with access to health care no longer have to go to bed with poultices and herbs and wait for the ‘crisis’, after which you either lived or died. But I think our bodies remember. We get fearful when we are incapacitated by illness or injury. Our bodies are part of the great cycle of the compost of life. We are all headed for the grave.
***
I am afraid that life is not as it appears to be. Another tiny shift, and everything again looks different. I cannot cling to this situation either, for this exact set of circumstances too is transitory. I must learn to live a dynamic existence in the midst of my need for permanence. The image of a surfer comes to mind – one who is skilled enough to ride the unexpected wave, who can be dumped without staying under.
I have often thought in life, similarly to when reading a story: I wonder what will happen next? Sometimes I am brave enough to pose it as an open-ended, open-minded question, but mostly I use it as a mantra, a verbal talisman to ward off evil.
So many strategies to fend off the void.
I am worried that my body is failing me. I don't want to be the patient. I want to be the doctor, the one in control, the intact one who dispenses treatment to ailing others.
How long will it take me to integrate what I know very well, that to be fully human encompasses every aspect of what it is to be human. I am a wounded healer, impaired in thought and body and action, blinkered in my attempts to apprehend the truth. It is the only condition possible, however much we aspire to perfection.
***
PART TWO
Fear: The Guardian with Two Faces
6. The Body is a Big Hook
He lived at a little distance from his body, regarding his own acts with doubtful side-glances.
James Joyce31
To be human is to be fearful. Fear is an appropriate warning mechanism that can save your life. When confronted by a real threat or danger, we can take appropriate action to avoid harm. Flight, fight or freeze are the fear-mediated responses of the animal world; in other words, run away, overcome the threat with force, or play dead. But undirected, displaced anxiety can undermine our lives and play havoc with our health. It can impede our capacity to pay attention to what is really happening, and can encourage rash and inappropriate action, directing choices towards outcomes that benefit neither ourselves nor the situation.
In the modern, industrialised world, now that we have dispensed with what, for millennia, were the usual suspects that dealt out death: lions and snakes, smallpox and gastroenteritis; now that we have controlled our environment with fences, air conditioning, and satellite tracking; now that we can easily summon help when we are in trouble with the assistance of cellphones, ambulances and helicopters; now that we have firefighters, third generation antibiotics and surgery, why are we so anxious?
Today I attended to two people who were afraid they were dying. The first was a woman who was very overweight. She said she had a tightness in her chest, pins and needle
s in her fingers and that she was finding it difficult to breathe. She told me she was smoking more than usual due to the stress of the renovations at her home that had hit several snags. She had other risk factors for heart disease – raised cholesterol and hypertension, and her father had died of a heart attack in his fifties. However, the rest of the physical examination, her oxygen saturation, ECG and cardiac enzymes were all normal. The only finding of note was a fast but regular heart rate. Her symptoms subsided when I gave her Ativan, a powerful remedy for anxiety.
When I discharged her, despite my cautionary advice, she said she was going straight off to have a cigarette and a cup of coffee to calm herself down.
The second was a young man who had a feeling of discomfort in his chest. He could feel his heart racing and was finding it hard to breathe. He smoked thirty a day, was very stressed, and only drank coffee. Nothing else but coffee.
Both these people were suffering from panic attacks, exacerbated by large quantities of nicotine and caffeine. Both chemicals are stimulants that increase heart rate. In an already fast-paced society, it is fascinating that we choose to inhale and ingest chemicals that artificially speed up the metabolism. Some patients say they can't get going without a cup of coffee in the morning. Many people can't do without a drink to ‘unwind’ at the end of the day.
The body's needs are often different from our conscious agenda. Every now and then, out of the rushing rapid of our modern lives, our flesh and blood homes send out distress flares in the form of illness or injury. The bodies of these two patients were trying to force them to slow down and to take note.
It is a remarkable trait how alienated we are from our physical needs and stresses, considering the body is the only home we have other than the earth itself, another aspect of home we take utterly for granted.
***
Somewhere in the recesses of our minds we must know that we cannot escape what Lewis Hyde calls The Law Of Appetite.32 Every living thing on this earth must consume in order to stay alive, and will eventually themselves be dined upon. Even though we have largely managed to banish polio and wild dogs, in the end we cannot avoid being eaten by death – by fire in the crematorium, or by worms in the earth.
During a lifetime we are presented with the problems of survival, meaning and limitation. Our attempts to resolve those three are embedded in our health, work, financial, relationships, creative and spiritual difficulties. We wish for our lives to be easy, free of constraint but, as M. Scott Peck reminds us in his book The Road Less Travelled33, life is difficult. It is precisely those difficulties which make for an interesting story. Misfortune can bring out the best in us.
Yet we fear adversity and the unknown and insure on all fronts against disaster. We do not trust our bodies or our lives and we worry about things before they have happened and that will probably never happen. We cannot sleep at night for fear of what tomorrow might bring and we make decisions based on predictions of the worst outcome. We think the unconscious is out to get us or that we are victims of our lives. The human default position appears to be anxiety.
Depression and anxiety are on the increase. We now understand these conditions as part of the same disease. A psychiatrist once told me that this disease will soon be the most prevalent illness of our time.
In my line of work I meet many people who are fundamentally anxious. Their anxiety is often free-floating, and can settle on anything. They constantly and unconsciously seek a hook to hang it on. They seem to think that if they can say, This is why I am anxious, it will validate their fear and give them some relief. The body is a great big hook, with its mysterious inner workings and invisible germs, its twinges and lumps. On several occasions I have had young people with infected throats come to me, concerned about cancer. What's this lump, doctor? they worry, prodding their enlarged cervical lymph glands.
I spend at least half of my time at work educating and reassuring patients. Doctors and other health practitioners are there mostly to make you more comfortable and less anxious while your body does the work of recovery. Occasionally you might need a little more assistance – in the form of an antibiotic, for example – and sometimes symptoms might flag a more serious condition. Mostly you can help yourself recover by taking time out, resting, drinking enough water and eating well.
***
A nurse pushed a woman in a wheelchair into the procedure room. She had difficulty getting from the wheelchair onto the bed, because, she said, everything was spinning. Then she vomited and started to cry. She said it felt as though she was dying. I treated her nausea, then took a history and examined her to confirm my diagnosis. She had labyrinthitis, where the organ of balance in the inner ear sends the wrong information to the brain, and the world wobbles and swerves. Viruses can cause this, as can a loose otolith. She was very alarmed, so I took extra care and time explaining the illness. When I had finished, she looked at me anxiously and said, ‘Yes, but what is wrong with me, doctor? ’
Briefly I was frustrated with her for not listening. Then I realised that it was a good question. Paying attention to her, it was obvious: labyrinthitis was not her biggest problem.
***
7. The Valley of the Shadow
I move through our rooms A somnambulist or deep sea diver With leaden boots, turning off The lights, lowering the blinds, Ensuring that the doors Are locked, the shutters bolted.
Michael Cope34
A South African artist, Zhane Warren, has made a piece entitled ‘My Fears’. It consists of a cardboard box that contains two hundred and seventy-six A4 sized pages of rice paper. On each is printed a sentence, beginning ‘I fear …’ Two hundred and seventy-six different fears on a stack of edible paper!
It is a powerful piece – the volume and weight of fear, the layers and range, the obsession and focus of fear, the compounding of fears with no relief. The time fear consumes, just to wade through the compelling list she has detailed for us all to see and note and recognise. We speak of being consumed by fear, yet her work depicts fears we can consume, take into our bodies – fears becoming flesh and blood. The urge was almost irresistible; once I had read that the paper was edible, I wanted to taste it, chew and lick it, swallow it down along with the fear.
Do fears come from inside or outside? Are they monsters, bogeymen and tokoloshes that hide under the bed with evil intent? Do we feed ourselves a diet of fear laid out like a feast in the daily papers, with an extra big helping on Sundays? Or are our terrors instilled in us from an early age, and now reside within us, ready to take us down at the slightest provocation?
In his book Why Good People Do Bad Things, psychologist James Hollisi35 shows how a child learns to repress aspects of himself that the adults around him do not like. These unmediated inhibitions make him socially acceptable to his parents and community but many of the natural drives that comprise being human – like fear, anger, desire and need – are not allowed appropriate expression, and are driven underground. These split-off features of ourselves form aspects of Jung's concept of the Shadow. Not surprisingly, these very fragments of himself that a child is taught to be afraid of and to deny, are also the parts the adults in charge fear about themselves.
Suppressing these drives does not make them go away. They can return repeatedly as disturbances in our behaviours and relationships, and in physical symptoms. The natural expressions of fear, anger, desire and need can get subverted, even perverted, when they are not permitted normal outlets. Our society is riddled with anxiety, violence, sexual abuse, corruption and addiction.
‘Bad things’ are committed by people who think of themselves as ‘good’. We are all split beings, engaged in an ongoing, internal civil war.
***
Not surprisingly, we want to avoid the sensation of fear. When we are young, we put what Hollis calls anxiety management plans in place. We adopt these strategies in order to feel better. Unfortunately these habits we employ can be a trade-off with long-term disaster. Comfort eating, fixed routines, su
bstance abuse, social withdrawal, belligerence, and being hypercritical or perfectionist are examples that can all provide a measure of security in the short term, but provide poor frameworks for negotiating the complexities of life, health and relationships.
A patient, whose chest was wet with tears, told me she was not coping at work. All she wanted from me was something to help her get back to her desk. Taking time off, she insisted, was out of the question. It turned out that her life partner had left her a year ago. Her anxiety management plan was to throw herself into her work.
Her exhausted body had stopped her in her tracks. From her story, it was clear that she needed to attend to her grief, but she was having none of that. She refused everything I offered -leave, therapy, hospitalisation, antidepressants. All she wanted was quick-fix medication to calm her down and to help her sleep so that she could get back to the deadlines. A telling word: deadline.
I recognised that she was unable to be on her own side, and gave her a short course of medication to help her feel calmer and to sleep, repeating my recommendation that she take time out and go into therapy to reconsider her life. I asked her to come back and see me, but she did not. I have wondered what happened to her. Sometimes people only pay attention when they are so anxious and exhausted that they have a car accident, or other major trauma. They are then forced to stop and face the terror of the void.
***
One interpretation of the story of the Garden of Eden is that before Adam and Eve ate fruit from the tree of the knowledge of good and evil, they had no awareness. They were at one with God. Instead of remaining obedient, however, they were curious, and bit into that irreversible apple. The result was awareness, and with awareness came banishment from the state of at-one-ness, or Eden. With separation comes consciousness, which brings with it apprehension – the word ‘apprehension’ meaning both the faculty of comprehending and understanding, and also anxiety about what could happen in the future.