Reinventing Medicine

Beyond Mind-Body to a New Era of Healing

Larry Dossey

• Publisher: HarperOne
• Year: 2009
• ISBN:
  9780061865701
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Larry Dossey forever changed our understanding of the healing process with his phenomenal New York Times bestseller, Healing Words. Now the man considered on of the pioneers of mind/body medicine provides the scientific and medical proof that the spiritual dimension works in therapeutic treatment, exploding the boundaries of the healing arts with his most powerful book yet.

CHAPTER 1

THE ERAS OF MEDICINE

Man’s perceptions are not bounded by organs of perception: he perceives far more than sense (tho’ ever so acute) can discover.

WILLIAM BLAKE

“snowing and about three inches deep…wind at northeast and mercury at 30…. Continuing snowing till one o’clock and about four it became perfectly clear. Wind in the same place but not hard. Mercury at 28 at night.”¹

These were the last words George Washington, the first president of the United States, wrote.

On the morning of December 13, 1799, at age sixty-seven, Washington had gone on his long daily ride at Mount Vernon. He was an obsessive horseman, and not even foul weather could keep him out of the saddle. When he returned later that day, his greatcoat was soaked through, and snow hung from his white hair. He sat down to dinner without changing his damp clothes, and by evening he had a sore throat. On trying to read parts of the newspaper aloud, he was hampered by hoarseness. When his secretary, Tobias Lear, suggested he take some medicine, Washington declined, saying, “No. You know I never take anything for a cold. Let it go as it came.”

Between two and three in the morning, Washington woke his wife, Martha, and complained that he had a very sore throat and was feeling unwell. He could hardly talk, was shaking with chills, and had trouble breathing. At George’s request, Martha sent for his lifelong friend Dr. William Craik, who had been his companion in the French and Indian War and a fellow explorer of the frontier. In the meantime, Washington asked Rawlins, the overseer who usually took care of sick slaves, to bleed him. He bared his arm, and Rawlins made the incision, but Washington complained that the incision was not wide enough. “More,” he ordered. When Craik arrived he applied Spanish fly to Washington’s throat, to draw blood into a blister, and bled him again. Washington was given sage tea and vinegar to gargle and nearly choked. Craik sent for another doctor and bled him again.

Between three and four in the afternoon, two more physicians, Gustavus Brown and Elisha Cullen Dick, arrived. Craik and Brown agreed on a diagnosis of quinsy, what we today would call acute streptococcal pharyngitis, or strep throat. They decided on more bleedings, blisterings, and purges with laxatives. But Dick, a thirty-seven-year-old graduate of the University of Edinburgh School of Medicine (also Craik’s alma mater), dissented. It was his view that Washington was suffering from “a violent inflammation of the membranes of the throat, which it had almost closed, and which, if not immediately arrested, would result in death.” Dick urged that a radical new surgical procedure be performed that he had learned about in Scotland for cases like this—a tracheotomy below Washington’s infected, swollen throat to allow him to continue to breathe. But this was too much for the senior physicians Craik and Brown, and they would not agree.

Dick took another tack. At the very least, he pleaded, do not bleed Washington again. “He needs all his strength—bleeding will diminish it.” Again Craik and Brown ignored the younger doctor. They asked for and obtained Washington’s consent to bleed him a fourth time. Washington rallied briefly, long enough for Craik to give him calomel and other purgatives.

Shortly thereafter, George asked Martha to come to his bedside. He requested that she bring his two wills and burn the old one, which she did.

Washington continued to defer to the advice of Craik and to refuse the suggestions of the younger man. He had convinced himself early in the day that he was going to die. “I find I am going. My breath cannot continue long,” he whispered to Lear, to whom he gave instructions for the arrangements of all his military papers and accounts. Then Washington smiled and said with perfect resignation that death “is the debt which we must all pay.” To Craik he whispered a little later, “Doctor, I die hard, but I am not afraid to go. My breath cannot last long.” A lifelong stoic, he did not complain, although he must have been in terrific pain.

“’Tis well,” he finally whispered. These were his last words. Five hours later, with his beloved Martha at his side, George Washington died.²

Washington was hard to kill. At a muscular six-four, he was a giant for his day. His ironlike constitution enabled him to survive a volley of illnesses that would have killed weaker men—dysentery, influenza, malaria, mumps, pleurisy, pneumonia, rickets, smallpox, staph infections, tuberculosis, and typhoid fever—not even counting all the lead shot at him. It is ironic that in the end he succumbed to an illness that today is regarded more as a nuisance than a disease and that can be cured by a single injection or a handful of pills: strep throat.³

It is easy to find fault with the way America’s first president was treated in his final hours, but retrospective criticism is unfair. Washington’s physicians were doing the best they could with the knowledge they had. To senior physicians Craik and Brown, young Dick’s suggestion of a tracheotomy probably sounded like assassination. They were unwilling to make Washington, the most revered man in America, an experiment for an unproved, unfamiliar surgical intervention. Washington himself declined Dick’s advice. A true man of his time, he got what he expected and what he wanted—bleeding, blistering, and purging.

THE ERAS OF MEDICINE

Washington’s deathbed therapies show a gruesome side of medicine, which has prevailed for most of our Western history. His final hours reveal both the helplessness of the physicians of his day and the fact that by and large the techniques in use at the time either did not work or were actually harmful. In the early nineteenth century, there was no getting around the fact that doctors were dangerous. It has been proposed that the reason the kings and queens of Europe during this period lived shorter lives than ordinary folk, in spite of having adequate housing and nutrition, is that they had unlimited exposure to one of the greatest health risks of the day—the medical profession.⁴

It is difficult for us to comprehend the health risks people in Washington’s time faced. If you were born in the United States at any time prior to the mid–nineteenth century, you had less than a 50 percent chance of surviving long enough to produce any children. It was particularly hazardous to live in a large city. Because the growth of cities following the Industrial Revolution occurred at a time when there were virtually no minimum standards or restrictions on building, the great cities in the Western world achieved a level of squalor and mortality almost matching that of ancient Rome. In the mid-1800s, one-fifth of all infants born in New York City died before reaching their first birthday, often of infant diarrhea, and even if they reached adulthood they had a one-in-four chance of succumbing between the ages of twenty and thirty. As for life in the country, the semirural districts of England in 1860 had a mortality level not much different from Roman North Africa more than fifteen hundred years earlier.⁵ In the pastoral Tidewater area of Virginia, where Washington lived at Mount Vernon, epidemics of cholera, yellow fever, and smallpox often raged.

We often think that the diseases our predecessors endured came in waves, such as the bubonic plague, which reduced the population of Europe by perhaps two-thirds between 1320 and 1420.⁶ Or the epidemic of yellow fever that killed more than six thousand of Philadelphia’s thirty thousand residents in August 1793, forcing George and Martha Washington to flee the city, which served at the time as the nation’s capital. Yet there were no disease-free intervals between the epidemics. Illnesses such as typhoid and pneumonia killed at a steady rate, year after year. Death stalked everyone, everywhere, all the time.

Although I practiced internal medicine in a large city for more than twenty years, I never saw a case of cholera, smallpox, yellow fever, or polio, and I might have had trouble recognizing them if I had. In contrast, death from infections was so prevalent in America’s large cities in the eighteenth and nineteenth centuries that people became experts in recognizing infectious diseases, and they would have put modern physicians to shame. Nancy Tomes, professor of history at State University of New York at Stony Brook, writes that all the social classes of that time were familiar with “the blue skin and rice-water discharges of cholera and the high fever and rash that signaled typhoid. They could recognize,” she writes, “the characteristic skin eruptions of smallpox, and the sore throat, strawberry tongue, and sunburn-like rash of scarlet fever.” They could even, she says, “differentiate the coughs associated with whooping cough, pneumonia, and consumption. They knew too well the chronic diarrhea and wasting that indicated the ‘summer complaint’ and the labored respiration and blocked airways produced by diphtheria.”⁷

But they could do little about them. In Washington’s time and for decades following, people did not understand that the diseases that carried them away were related to microorganisms. The “germ theory of disease” did not come into use in the English-language medical literature until around 1870. In addition to threats from infectious diseases, people faced broken bones, cancer, metabolic diseases, endocrine disorders, cardiovascular ailments, and on and on. The result was that people were burdened by a sense of mystery, vulnerability, chronic dread, and resignation—the certainty that “this is the way things are and have always been.” And they were right, for in the three million or so years humans have existed, there had not been much change in the pattern of mortality up to their time .⁸ And, following Washington’s demise, things were not to change much in Western medicine for the next half-century.

Then, beginning roughly in the decade of the 1860s, the decade of the American Civil War, medicine began to change radically and dramatically by becoming scientific.

If we begin at that moment in history and move forward to the present day, we can sort out three distinct ways in which health, healing, and the nature of the mind have been viewed. Because these perspectives developed in a historical sequence, they can be called eras. Although these developments are referred to as medical eras, they reflect currents of thought that extend far beyond medicine. Medicine grows out of a culture; it is never isolated and self-contained. The following eras of medicine reflect, therefore, patterns that run deep in our culture.

As we examine these three eras, bear in mind that some of the ideas about the nature of the mind they contain are not new. In fact, the most recent view, that the mind operates outside the body, is, as we saw, quite ancient. But this idea is new to us, because we lost this understanding and are in the process of rediscovering it.

ERA I: MECHANICAL MEDICINE

Era I, the first scientific medical era, began to take shape in the last third of the nineteenth century, beginning in approximately the 1860s. Era I can be called materialistic, mechanistic, or physicalistic medicine. It encompasses the therapies that largely dominate Western medicine today—drugs, surgery, radiation, and so on. The classical laws of matter and energy described in the seventeenth century by Sir Isaac Newton form the foundation of Era I medicine. According to this view, the entire universe is a vast clockwork that functions according to deterministic, causal principles. In Era I, what matters is energy and matter, not mind.

Era I represented a monumental advance in the history of healing. It was fabulously effective, laying the groundwork for what we call conventional or orthodox medicine. In fact, the achievements of mechanical medicine are so significant that many people remain convinced that the future of medicine lies almost exclusively in Era I approaches. While much of this enthusiasm is justified, we have already moved beyond the confines of mechanistic medicine in our quest for health and healing, as we shall see.

I have spent most of my life as a physician working in Era I medicine, and I bow deeply in gratitude to its architects. I am grateful not just for the high-profile discoveries of Era I medicine, such as vaccines and antibiotics, but also for less spectacular measures, such as public health interventions and lifestyle modifications. These latter measures have been largely responsible for the improvement in health and longevity seen around the world in Era I, and they get less credit than they deserve. For example, half the reduction in mortality from diphtheria had already been achieved by public health measures by the time diphtheria immunization was introduced in the 1920s. And by the time antibiotic treatment became widely available in the 1940s, more than 90 percent of the mortality due to tuberculosis had already been prevented by other means.⁹

One of the most significant effects of Era I medicine was a revolution in how people thought about disease. Following the introduction of sulfonamides in the 1930s and penicillin in the 1940s, almost overnight the veil of helplessness began to lift, and victory over illness seemed possible. As John Cairns, formerly of the Harvard School of Public Health, describes the transformation, “Perhaps one of the main consequences…has been the idea that every disease should be treatable, if we could but find its Achilles’ heel.” Thus today we assume there should be a cure for any and every disease that afflicts us. Discovering it depends only on the availability of people, funding, and time. Prior to Era I medicine, people did not expect medicine to deliver cures. “In nineteenth-century London,” Cairns points out, “there were riots about the failure of the government to prevent the spread of cholera but no complaints about the way the disease was being treated; 150 years later there are riots about the lack of any treatment for AIDS…. We are no longer content to endure illness and disease: the maimed and the halt expect to be healed, and healed quickly.”¹⁰

Today most people place their confidence in high-tech solutions to health care. We are mesmerized by the promises of gene therapy, DNA manipulation, organ transplantation, computer-designed drugs, and so on. In this heady atmosphere it is often considered heresy to speak of limits to high-tech medicine. As Cairns says, “Most people, doctors especially, find it hard to believe that the main advances of medicine did not arrive until long after most of the causes of untimely death had come under control.”¹¹ Era I medicine has always been limited and remains so. For example, it continues to be largely ineffective in combating chronic, degenerative, and age-related illnesses.

Acknowledging the limitations of Era I medicine is not disrespectful. Doing so opens us to other possibilities, other approaches.

ERA II: MIND-BODY MEDICINE

Following World War II, another discrete period in the history of Western medicine began to take shape, which I call Era II. This development grew out of research in the field of “psychosomatic disease”—from the Greek words psyche, meaning breath, spirit, or soul, and soma, meaning body.

The foreshadowings of Era II can be traced to antiquity. For fifty thousand years shamans have used expectation and suggestion to help people heal. The Greeks were well aware of the influence of the emotions on the body, and they honored the role of dreams in healing. Era I medicine, which took shape in the second half of the nineteenth century, was not devoid of this understanding, although most doctors left it decidedly in the background. Jean-Martin Charcot, the great nineteenth century French neurologist, studied hysterical reactions and the effect of suggestion on bodily function. Sigmund Freud, a student of Charcot, extended these ideas and emphasized the influence of the unconscious on behavior. The end of World War I lent impetus to the idea that the mind could dramatically affect the body when thousands of soldiers returned home suffering from an emotional derangement called “shell shock,” which was often incapacitating. But although the basic idea of mind-bo...

Table of contents

• Cover
• Title Page
• Dedication
• Epigraph
• Contents
• Acknowledgments
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Postcript
• Notes
• Searchable Terms
• About the Author
• Praise
• Other Books by Larry Dossey, M.D.
• Copyright
• About the Publisher