by Dawn Garisch
Awareness allows us access to a bigger picture. It also forces onto us the contradiction that as individuals and as a species we are on the one hand important and valuable, and on the other we are as nothing, existing for a brief moment in the huge drama of the universe. We live between two darknesses -our lives are brief parabolas into light, out of the void and back into the void, out of the earth and back into the earth, out of spirit and back into spirit.
We tend to see birth as a positive event, the miracle of a new being arriving essentially out of nothing. A whole new and discrete person, made in the image of the parents, grows slowly from a baby who is totally dependent on her caregivers for her survival, into a child aware that she is not at one with her parents. She becomes a separate being, capable of her own independent thoughts and actions. Like God in the Garden of Eden, the parents are not always pleased with this development.
On the other hand, we tend to experience death as a negative event, the tragedy of a well-established character disappearing into nothing. We mourn the loss of our loved one, and struggle to grasp that we can no longer ring him up nor drop in to see him. The dead person has stepped away, back into the void; disintegrating back into the earth, merging back into God.
Those things that give us indescribable pleasure in life are usually felt as brief moments of at-one-ness, a merging into bliss, into another, or into the fullness of life. Boundaries dissolve and we are back in the haven of Eden. Conversely, those times that evoke terror and deep depression are those where we feel as though all support and certainty has fallen away, and we are left unutterably alone and afraid. We strive for at-one-ness, and we try to avoid the void. Yet they exist side by side, like birth and death.
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The neurophysiologist J. Z. Young36 notes that living things are remarkable in that they have developed systems that can withstand the ubiquitous tendency for all substances to merge back into the surroundings. This means that, while we are alive, we have systems in place to stop ourselves from rotting. People, even health consultants, forget that. They mistrust the body's innate healing capacities, and want to rush in and fix something before it has had a chance to fix itself. There is a bad joke amongst back surgeons: Operate soon, before it gets better.
Often enough the body can heal itself of acute conditions – and we can assist this if we are kind and nurturing, as one would be to a child. There are also many conditions that used to cause death which we can now cure or ameliorate. Modern medical practice has come to be synonymous with control of natural processes through medication and surgery.
A short while ago humans had little influence over conception, birth, illness and death. The modern way is to control these events – in part to avoid suffering. The Caesarean section is an operation originally performed to save the life of the child, the mother, or both, and yet some women choose to have Caesarean sections because they say they are afraid of pain. Yet they know that surgery involves pain. On the other hand, labour is unpredictable in terms of the severity of suffering and how long it might take. Cut the baby out, and you can be back in the ward before lunch.
There are patients who take pain killers in case they get a headache, and those who want an antibiotic at the first sign of influenza.
None of us welcomes suffering, but even minor discomfort can trigger disproportionate anxiety. I tell my patients who need to lose weight to expect to feel a little hungry occasionally. People generally prefer to feel over-full than slightly hungry, and over busy than at a loose end.
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A young man was waiting to see me in the procedure room. He suffers from panic attacks, and said he was too afraid to go to sleep because he was worried he would die. It is a common time for anxiety to rear up: the moment one drops off to sleep, there is a letting go of control, a real sense of ‘falling’ asleep. For someone who is very fearful, this sensation can feel unbearable.
I suggested that he try to talk himself down, rather than wind himself up. After examining him, I asked him to do a reality check and confirm what was obvious – that he was a fit and well young man who was not going to die in his sleep. He was unable to do so. Logic is often a frustratingly inadequate tool.
Anxiety can be paralysing, exhausting. Medication can provide respite from unrelenting tension. I tell fearful patients that taking anxiolytics for a short period of time can be helpful if they regard these drugs as crutches while their emotional legs are getting better. The word anxiolytic is derived from the Latin word anxius, related to angere, meaning torment. Lysis comes from the Greek word for loosen. An anxiolytic, poetically, is something that loosens torment.
At the same time as prescribing a pill to loosen torment, I encourage an anxious patient to observe whether his body is drawing urgent attention to unresolved difficulties. The fear of dying, for example, is not necessarily something to take literally. It can be a powerful indicator that something needs to end.
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Many patients avoid asking for help. Their anxiety management plan is a story that says they cannot trust anyone else, and that they can do it on their own.
A tall, thin and attractive man was brought to the clinic by his girlfriend. He sat and stared at the ground for some time without speaking, other than to tell me that he was stressed. I remarked that he looked depressed, and that he appeared to have lost weight, to which he nodded. I told him that we all go through difficult times, and that we all need assistance at some point in our lives. I reassured him that there was plenty of aid available if he was ready to ask for it, from therapy to medication to self-help groups and phone-in counselling. He turned each suggestion down, saying that he needed to work it out by himself. I asked him how long he had been trying to do it on his own, and he admitted that it had been years.
I turned to the girlfriend and asked for her view. She said that her boyfriend had mood swings, and became aggressive, and even hit her on occasion. The man cut in, saying that she provoked him, whereupon I challenged him, saying that nobody can make you get violent – that was his responsibility entirely. For a moment he looked as though he was going to hit me, then he stormed out of the clinic. I encouraged the woman to get help herself, including an interdict. Yet she insisted she was fine – that it was her boyfriend who was the one in trouble.
Asking for help is an act of vulnerability, humility and trust. It requires loosening your grip on the way you have always done things. It means being prepared to relinquish the illusion of control and to allow another in.
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Wherever possible, we have eliminated all bugs, vermin and predators that intrude on civilised life, or we have confined them to nature reserves or zoos. We have managed to render all organisms largely harmless to our way of life, from streptococcus and rats, to snakes and lions. The irony is that once we have managed to get rid of them all, we will have a lot to worry about. Jonas Salk, who pioneered the polio vaccine, pointed out that if all insects disappeared from the earth, within fifty years all plant and animal life on earth would die. But if human beings were eliminated from the earth, within fifty years the planet would have recovered from the devastation we have wrought.37
Fear of nature interleaves with the fear of loss of control and fear of the void. When frontal lobes made an evolutionary appearance, humans benefited from what are termed ‘higher functions’ – faculties of reason, discrimination, restraint and planning, and the capacity to develop culture. Unfortunately by reason of our reason, we have begun to see ourselves as more advanced and therefore more important than animals, which function reflexively in the main. Humans see themselves as superior to, or different from, nature. Even our language reflects that. When we talk with concern about ‘the environment’, we leave ourselves out of the picture.
The biblical injunction that man has dominion over animals and the earth has fed our perception of human sovereignty, or primacy, as has scientific enquiry. Nature, seemingly out of our control, even dangerous to us (as are we, often unknowingly, to na
ture), needs to be conquered and tamed by ownership and agriculture, insecticides and toilet cleaner, medicine and surgery, fences and guns, dissection and analysis, weather forecasts and genetic manipulation, landscape gardening and battery farming.
Julian David likens nature, and the earth, to a feminine principle of a goddess who does not function by the logic of power, but by the binding force of Eros:
When people started to enclose the land It was as If they took a piece of the ancient goddess and dared to call it theirs … Instead of weaving back and forth over the skin of the goddess, hunting her animals, making painted cathedrals in the caves of her womb, gathering her fruits, dependent for every breath on her good will, they were going to take her prisoner, parcel her up, distribute her amongst themselves, make her the sinew and muscle of their lordship. They took her sacredness and … transferred it to a male god, who then transferred it to them… And … It dawned In someone's mind a blasphemous thought – that perhaps one need not worship the goddess any longer, but conquer her. And when they find that it actually works, and that they have the power of the gods in their own hands … and that within a mere ten thousand years the world is transformed and brought also to the brink of its own destruction, ‘what’, they must ask, ‘has gone wrong? ’38
We further embody the split between people and nature by valuing the brain more than our physical selves. We often think of the mind as rational, with the body as nature out of control, with all its urges, smells, reflexes, excretions and secretions, and desires. Our flesh and blood homes are even seen as disgusting, and must be kept in check with a range of products.
Bacteria are everywhere. Right at this moment, there are about four hundred on either one of your hands. It has always been so. It is natural. It is nature. Watch any crawling child, and notice how often he puts his hands and other objects into his mouth. Not only is he learning about his environment by tasting it and examining it with his lips and tongue, he is feeding himself with a huge range of micro-organisms, thereby waking up his immune system. Bugs often live in essential harmony with organisms around them, including us.
Yet advertisers warn us to ‘kill all known germs dead’ by buying their anti-bacterial soaps, cleaners and antiseptics. Understanding how hygiene prevents illness has revolutionised medical care, but our fear of bacteria, paradoxically, can result in disease.
Probiotics were largely unknown a decade ago; now they are the new wonder treatment for many problems, from constipation to diarrhoea to recurrent viral infections. Probiotics are germs. A drug rep told me the other day that there is a new probiotic on the market for babies born by Caesarean section. We have known for some time that certain bacteria are necessary for normal gut health; now researchers have found that being born through the vagina inoculates a newborn with appropriate bacteria which colonise the baby's intestines for good digestive and immune health.
Our consumer culture has pulled off the most incredible scam: sell people household and body disinfectants and antiseptics to sterilise their environment, then sell them bacteria in sachets and capsules as a medicine essential for health.
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Insecurity stems in part from our inability to control and predict the future. There is a lot of money to be made from this kind of fear, from fortune-telling to the unscrupulous ‘Lifescan’. If you are wealthy enough (no medical aid is ever going to pay for this test, and no self-respecting doctor is ever going to order it), you can arrange to have an MRI scan of your whole body at your local private X-ray department. The idea is to pick up abnormalities like plaque in a coronary vessel, or a pre-cancerous polyp of the colon, or cyst in the ovary, or tumour in the brain before it has presented in the body with symptoms.
For the cost of a second-hand car, you have a whole body scan that infers that you are totally free of disease – for that precise moment in time. Until you start worrying again about what new disease has taken root just after the scan was done, and is lurking unseen, unfelt, in the horror chamber of your physical self.
Yet insecurity does not only concern the psychological problems of inner life. To feel secure, we also need to feel that we have good footing in the world.
Our political, economic and sociological arrangements frequently seem counter-intuitive. We must suspend our better judgement in order to accept much of what has become ‘normal’. We spend hours in traffic jams, cut down trees to flood the world with junk mail, drink artificially-flavoured, sucrose-saturated water, wreck our backs wearing high heels, buy cars that cost more than houses, and build houses for cars. We buy into the manipulations of corrupt politicians and bankers, accept the obscene and ever-widening gap between rich and poor, expect new cell phones every year, buy mass-produced clever but trite gimmicks and gadgets which then fall out of fashion and into the rubbish bin, design superfluous packaging that costs more than the food or drink it contains and which we then throw away. We throw away, throw away, throw away as though the earth can endlessly receive our exponential accumulation of waste. Our perceived and transient need for some fad trinket might have meant long hours of hard work for disempowered people in poor working conditions for shockingly low pay.
For our economy to work, we are encouraged to buy into avarice and waste. We know that another pair of shoes or a bigger car is not going to solve the problem. It might even make things worse if we buy the car on credit. We know we are conning ourselves. A friend describes the world economy as the biggest Ponzi scheme ever invented. We are continually borrowing from natural resources without any intention of paying back what we owe. We are being sold an unsustainable, unethical system that results in our soiling our own nest.
The way we live makes for a shaky foundation. We put our full trusting weight on what might turn out to be veneer. Veneer is that thin covering we take for the real thing. Oak veneer is a cheap way to achieve a pleasing finish to furniture in a world where hard woods are no longer abundant. But scratch below the surface, and you will find chipboard. Given a flood, or hard knock, chipboard will break and fail.
We need to agitate for and promote good governance, so that civic life is supported by policies that promote sensible practices in food security, environmental integrity, public health, crime prevention, education, energy, health and welfare.
Yet we are not inclined to scratch too deeply. When a colleague at work asked me what I was writing and I told her, she gave a worried smile. ‘That sounds soul-searching, ’ she exclaimed. ‘Are you sure that's good for you? ’
Our heads are so deep in the sand, it's no wonder we are having difficulty breathing.
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8. Of Detectives and Gardeners
This much is all we have: shadows gathering,
fugitive grace and the deep body as our penumbral space.
Ingrid de Kock39
My back is sore. I have been working – alone and hard – at the computer, and I want somebody's hands on me. What I want is to relax in someone else's care – to give my physical self over to kind hands. It is a gift to my body. So yesterday I went to someone who practises shiatsu and who has a good reputation.
What I keep forgetting is that healers want to fix things. Whenever I go to someone for any kind of therapy and I give them my medical history I can see their eyes light up. They adopt an heroic look. It doesn't help to explain that, having lived with a chronic condition for thirty-three years, and having spent a fortune on various therapies in search of cure, I have come to the point where I want to give up on the goal of healing.
I am fortunate that the eye manifestations of my condition appear to have burnt themselves out. I would rather have backache than lose my central vision.
Now that the consequences of my illness are not so severe, I want to accept myself as I am, with all my flaws. I want to relieve myself of the burden and expectation of having to get better. As a doctor and a patient, I want to embrace the fact that thinking you can fix everything is a denial of the limitations of physical reality, which includes deat
h. But as I listed my physical and physiological imperfections, I could see the shiatsu practitioner rising to the challenge. I felt myself sigh inwardly. It is almost impossible to tell someone in the healing profession that you don't want to be fixed. I would then sound like the worst of my patients. We would stare at each other, each with the same thought-bubble about the other – she's in denial.
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The art and science of healing is like the difference in approach between a gardener and a detective. Good gardeners know that the life force needs tending with respect, patience and care, and that a garden is a dynamic process that cannot be planned entirely in advance. They accept sickness and death as a part of nature. The life force does not favour the rose over the aphid, the arums over the porcupine, the potato over the blight.
Gardeners work slowly in tempo with the seasons, using their knowledge of the soil, plants, insects, birds and disease to foster life. Gardeners know the limits of their capacity to control, and trust natural processes to do a core part of the work.
Detectives use different tools. They have a mystery to solve. They gather clues to track the culprit down. They are quick, efficient, and focused. There is a solution, and time is of the essence. If necessary, the detective will apply pressure to get what she wants.
You don't want to adopt a gardening approach when resuscitating a patient. On the other hand, the attitude of the detective is unhelpful when someone is grieving.