On Doctor's Office Frustration, My Beef with Western Biomedicine, and the True Meaning of Healing
+ My thyroid did NOT understand the assignment
I’m a hypochondriac. And I mean that clinically. So when a strange constellation of symptoms cropped up that seemed intertwined with my mental health, I was not only quick to obsessively spiral, but it was also easy for me to gaslight myself and repeatedly say it was just anxiety and probably all in my head.
Then things got worse.
When I went to the doctor, I explained all of my symptoms to the nurse, and she dutifully wrote every single one of them down in my chart. Then the doctor came in, and she seemed to glaze over all symptoms except for the allergy concerns and recommend I do a nasal spray, decongestant, and an antihistamine. All things I was already doing.
She started to stand.
I was like wait! What about this, this, and this? And what about the fact that one of my thyroid markers was slightly off in January?
The entire appointment felt as though it was not the doctor who was responsible for my health; it was me. And as a hypochondriac, I don’t always trust my judgement. At the same time, I knew something was wrong. Sometimes you just know. And I wish that so many of us didn’t have to feel like fighting to be heard and given time and consideration is so impossible in medical settings. It’s not necessarily doctors’ faults we don’t feel heard—it’s the nature of a bad system, of too many appointments in too little time, and the entirety of western biomedicine operating from an inherently flawed paradigm: that the body can be broken up into parts rather than seen as a whole, intrinsically intertwined system where everything affects everything else, and that symptoms should be treated individually with medication and root causes considered an afterthought, if at all.
This is the nature of the bureaucratic, for-profit (if in America) medical system. However, this philosophy still permeates throughout the homogenized modern world. The patient is not a person. We are bodies composed of parts. Doctors are highly specialized and attuned to a single section of our highly complex, beautifully intelligent, and simultaneously impressively resilient and delicately fragile system. Each specialist does not directly communicate with each other to discuss how each problem connects and each treatment interacts in any meaningful and individualized manner. They don’t have the time, and that’s just not how this system works.
Foucault, a sociology darling of the early 20th century, had a lot harsher words to say about this phenomenon, which he termed the medical gaze. David Misselbrook, in the British Journal of General Practice, paraphrases as follows:
Foucault’s The Birth of the Clinic should be read by all reflective doctors. Foucault develops the concept of ‘the medical gaze’, describing how doctors modify the patient’s story, fitting it into a biomedical paradigm, filtering out non-biomedical material. A ‘gaze’ is an act of selecting what we consider to be the relevant elements of the total data stream available to our senses. Doctors tend to select out the biomedical bits of the patients’ problems and ignore the rest because it suits us best that way.
Foucault’s charge is that doctors are doctor-oriented, not patient-oriented, and thus medicine creates an abusive power structure. Medical school has taught us more about biomedicine than about patients. The medical tribe tends to dominate rather than share. We control, stick people into appointment slots, strand them in waiting rooms, QOF them, and talk above their heads.
My doctor did not ask about my diet or exercise regimen or substance use or social life or mental health or stress. Some doctors ask about some of those things, some of the time. Other times you’re the one who has to remember all the moving parts and self-advocate. More often than not, important pieces of the puzzle are overlooked or flat-out denied as being significant. In fact, I think the vast majority of us have had the experience of feeling dismissed or silly for asking certain questions, especially if we come to an appointment with research we “read on the Internet.” (As if the latest studies and peer-reviewed articles on PubMed aren’t available for free, and that the general public isn’t capable of understanding anything medical or the nature of their own bodies without having attended med school.)
Under the medical gaze, our bodies are not our own. When we step into a doctor’s office, we become a puzzle to be solved through a very culturally-specific, epistemologically narrow lens. Our healthcare system is not collaborative. Me and my doctor are not peers. Sometimes it feels as though medical settings are not in the business of true healing at all.
That is not to say that modern medicine hasn’t come a long way or isn’t useful. Life expectancy in the Western world has risen sharply, and we have come up with ingenious ways to treat infections, ease pain, and fight complex diseases. On the other hand, mental illness, preventable diseases, and disorders that are nearly unheard of in “pre-modern” societies have skyrocketed. We know a great deal about how to keep people alive, but we still haven’t quite grasped how to keep people spiritually, mentally, and physically healthy and balanced.
Perhaps that kind of true health is more of a process of remembering than it is discovering anything new.
It was a good thing I pressed about my thyroid levels, because when my blood work came back the TSH (thyroid stimulating hormone) marker had risen even more beyond the upper threshold than it had been at my January check-up. Nothing too scary, and my other thyroid measure was normal. Which meant I have what is referred to as “subclinical hypothyroidism.” My thyroid isn’t performing as well as it should. A nurse called me to tell me this and say that they called in a prescription and would see me again in a month to check my levels again. That was it. No discussion of possible causes, how it related to the symptoms that still troubled me, important info about which drugs I would need to avoid or best practices for taking what they prescribed. Nothing about diet or lifestyle factors.
The Western scientific community is often slow to catch up to indigenous wisdom: the inherent understanding that everything within and without are connected, that the social body affects the personal body, and that the mind and body are in constant communication and share reciprocal influence on all levels. The mind-body connection was only a recent biomedical “discovery.” So was the body’s inherent healing and regenerative abilities—like the neuroplasticity of our brilliant brains, our ability to heal from both emotional and physical trauma by growing new neural pathways.
We’re only beginning to understand the role of our microbiome, and how our gut health affects both our brain and our skin with a constantly communicating, complex system of beneficial bacteria and microscopic organisms. (Yes, it’s kinda disturbing, but also kinda cool to think we aren’t the only ones to call our bodies home. The tiny creatures that live in your body and on your skin are helping you, I swear.) This is called the gut-brain-skin axis. You may have heard of the gut-brain axis, but surprise! Skin seems to be a huge part of the equation too, and the reason stress leads to increased dermatological symptoms and disorders like psoriasis, eczema, hives, and acne. Emotional pain is communicated throughout the entirety of your body. When one bodily system is affected, the others are too. When you mess with one hormone, all other hormone levels are impacted. When we only focus on treating specific parts and symptoms, we run the risk of throwing the whole system out of whack and failing to ever pull out the problem by its root.
It took a great deal of time and effort to get practices like meditation and breath work to be seen as proven, reliable health tools rather than fringe pseudoscience. Which is disheartening when one considers that up to 60-80% of all doctor visits could have a stress-related causal factor. In medical studies, the placebo effect is seen as a problem, a challenge to overcome. It’s the measure to beat in order for drugs and treatments to be seen as significant and effective. Interestingly, the placebo effect is actually extremely hard for drugs to beat, and it’s a big reason many drugs will never make it through the FDA approval process. Reading about the placebo effect at work in drug trials never fails to amaze me, but what really blew my mind was that the placebo effect was strong even in the case of surgery.
So-called sham surgeries are a kind of extreme placebo, where patients undergo all the rituals and scars of a surgical procedure except for the part meant to help. These patients benefit surprisingly often: In about three-quarters of sham-controlled studies, there’s some improvement, according to a 2014 review. And they actually benefited just as much as those who got the actual intervention a whopping half the time.
It turns out that the amount of faith we have in both the treatment and the doctor prescribing the treatment dramatically impacts health and recovery outcomes. This has been proven over and over in numerous studies. Relationships are inherently healing. The medical gaze often robs us of that healing power, as patients often see doctors and medical settings as cold and detached, lacking in the necessary components for genuine connection, listening, and empathy. (Again, not necessarily doctors’ faults! Lots of amazing doctors out there. It’s the system that’s to blame, as it so often is.)
What all of this tells us is that belief, balance, and harmony are all important healing components. The placebo effect is not an error. It is proof of our bodies insanely powerful self-healing ability, and the inherent connection between our thoughts and our physical reality. When we think, our bodies listen. And not only do we need internal harmony, but also harmony with the outside world in our families and broader communities. I don’t think anyone feels as though the world is currently harmonious and conducive to healing, so it’s no wonder we’re all ill.
Our body is a microcosm of the world. We are a habitat for trillions of tiny, helpful lifeforms. When we kill off bad bacteria with antibiotics, we kill the good guys too. In the same way, when we decimate one species population in a forest, the entirety of that ecosystem is thrown out of balance. There is even evidence that our microbiome emits chemical odor signals that indicate health states. (Ever heard of dogs that can smell malaria or Parkinson’s disease? This is that theory in action.) This could mean that we’re also broadcasting other subconscious messages with each other and the outside world, perhaps about our emotional states. Animals and plants do it, which lends itself to the theory. Like when a male wolf can detect when a female wolf is in heat, or when plants release chemical signals to communicate to each other that they’ve been attacked by a hungry animal. Everything in the natural world communicates with each other in ways we are just beginning to understand.
The whole of the world is a web of influence and interconnection, an incomprehensibly complex global consciousness that spans across every inch of the earth. We are a part of it all, never separate. The inner reality of our bodies is the same. The Navajo conceptualize true health as “Walking in Beauty,” which is the understanding that optimal wellbeing can only be achieved by living in harmony with all components of our life and world. Lori Arviso Alvord, M.D., talks about the discord between indigenous and Western healing modalities in her book The Scalpel and the Silver Bear, where she details her experience as the first female Navajo surgeon in the United States. She writes:
The latest breakthroughs in research and methodology are stunning achievements and should be acknowledged as such, but along the way we have forgotten some of the things that heal us best—our relationships, how we live our lives, our feelings of wholeness and belonging… Everything in life is connected. Learn to understand the bonds between humans, spirit, and nature. Realize that our illness and our healing alike come from maintaining strong and healthy relationships in every aspect of our lives… The Navajo view is a macro view, whereas Western medicine often takes a micro view. As Western society has moved to a focus on the individual rather than the community, the support and sanctions of the community have faded away.
In The Lost Witches of Aradia series, I talk about the pain of alienation and trauma that arises from living in a profoundly imbalanced society where sociocultural institutions and ties have been broken. (If you just yawned, I will also add that there are kinky witches and a sexy evil villain.) A new character in Book 4, The Hunted, says “It is no measure of health to be well adjusted to a profoundly sick society, a wise human once said. Just like on Earth, the mental health and addiction crisis in Aradia today cannot be separated from its broader environment. We don’t suffer alone. We only suffer together.”
In Books 1-3, I was a little more subtle with the Aradia-Earth parallels. Clearly not so much anymore. The Hunted is currently in round two of edits, so everything is on track for its July 5th release. (Yay!)
I’ve had a rough couple of months. After this very long rail against biomedicine, I would like to add that every morning for the past week I have taken my synthetic thyroid hormone pill, and I do so gratefully. I only hope it corrects my own imbalance, and I’ve been adding my own healing recipe to the mix for good measure. It includes morning affirmations that thank my body for what it does for me and promises that I believe in its own healing abilities, cutting back on stress and upping mindfulness practices, and a focus on good sleep and a rainbow of healthy foods. What my blood tests did not tell the doctor was that I had been overworking myself for months on end, that I had been struggling with an extreme bout of anxiety and stress the weeks leading up to my appointment, and that my spiritual and social health had been severely diminished. These factors could be just as important to understanding illness and treatment as a single biomedical marker.
I fought hard against my body when it started to rebel. I said no, you don’t get to be sick or defective right now, we have work to do. It’s what I’ve always done. I’ve waged wars on my body. I’ve starved my body of food, rest, and joy. I’ve fed my body drugs and supplements to attempt to bend its processes and internal states to my will. I’ve stared in the mirror and cried over physical manifestations of illness or imbalance, reaching for anything external to make it better, to make it go away, to cope or cover-up, anything at all except listening, surrendering, and going inward.
On the experience of illness, Virginia Woolf writes, “Short of these, this monster, the body, this miracle, its pain, will soon make us taper into mysticism, or rise, with rapid beats of the wings, into the raptures of transcendentalism.”
Illness can present an opportunity. A lesson to be learned. My lesson is that my soul resides in a flawed, intelligent, beautiful, fragile, intelligent, perplexing vessel of flesh and bones that I will never have complete control over. I opened my copy of the Tao Te Ching during a particularly horrible day this week. For those who don’t know, Tao translates to the way of the universe, and Taoism is all about living in harmony with that natural energy flow. The Tao Te Ching is an ancient collection of short, lyrical philosophy chapters at the core of Taoist religion. The language is poetic, beautiful, and profound in its simplicity. I borrowed a copy at my campus bookstore my freshman year of college for a humanities class, and I ended up never giving it back (and buying it, obviously). Taoism is about surrender, or non-doing—action that flows naturally rather than deliberate choice and conscious will—which is the very opposite of the natural human inclination toward clinging to control and attachment. On the page I opened to, my eyes snagged on this quote:
Your body dies.
There is no danger.”
I repeat this to myself every morning now. I don’t know why it brings me so much peace. Others might find the reminder of their own mortality more of a source of fear than of solace, especially in times of illness. But I like being reminded that I am not at the center of it all. That there is more to the world than what we are capable of perceiving and understanding, that there is more to me than what I feel in my flesh or see in a mirror. I am not very sick right now, but in the future I might be, with who knows what illness or condition. There’s a good chance most of us will be, at some point or another. I have a feeling that what will matter to us then are not the same things as what matter to us now.
Perhaps we should all be making an effort to consider what we will value in our final days. I think we would live a lot differently if we did. We might all be far kinder to ourselves. To each other. Because in the end, it’s love that people report feeling in death. Love, peace, and a connection to that which is greater than all of us, a grand tapestry of all of existence that we will always be a part of. Forever.
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