Put the X Back into Medicine! The Top-Down Approach
“I hope nothing. I fear nothing. I am free.” ― Nikos Kazantzakis
“It’s like I’m cursed!” – she says, stepping in the consultation room with a frail appearance. She came to seek help for insomnia, palpitations, dizzy spells and panic attacks. She is young, beautiful, just graduated and started her nursing career in a well-known New York hospital, and she is getting married soon. But she is not happy. “It’s like something doesn’t allow me to enjoy the happiest moments in my life – actually that’s when all my symptoms get worse!”, she explains. When she first came in last month I’ve diagnosed her with Liver qi stagnation and Heart yin deficiency and treated her with acupuncture, herbal therapy and qi gong. She does feel much better, however, the pattern of anxiety reoccurs days after our weekly meetings. From the moment she reformulates her symptoms giving me key words such as “cursed” and “something doesn’t allow me”, I understand no “medical” approach will yield true healing for this young woman. I once again have to cross over into the field of X.
Life = Body + X – was a fundamental hellenistic idea. There is absolutely nothing human about a corpse, Socrates argued some 300 years BCE. The X, or psyche (Gr. ψυχή), is what gives life to the body. “What is it that, when present in a body, makes it living? — A soul.”, Socrates argues in the last line of Phaedo, explicitly appealing to the idea that it is the soul that animates the body of any living thing, including plants, and the soul is immortal because it has life essentially, the way fire has heat essentially. The vitalist approach, an ancient understanding of the world as alive and interconnected, culminates with Paracelsus, the traveling doctor, who learned about life and medicine by observing the nature, mocking the medical establishment of the sixteenth century while preferring to learn from barbers and folk medicine people. Paracelsus not only argued that the body is a chemical system that needs to be balanced internally and kept in harmony with its environment, but also insisted on the psychosomatic component of any disease, stressing the importance of the patient’s mindset and worldview. He used signs and amulets to help patients form mental images which yielded physical cures. In his work, Von den Krankeiten (1567), Paracelsus writes: "Thus, the cause of the disease(…) is a mere opinion and idea, assumed by imagination, affecting those who believe in such a thing. This opinion and idea are the origin of the disease both in children and adults”. (1)
Paracelsus, born Theophrastus von Hohenheim (1493-1541), a Swiss physician, alchemist, and astrologer of the German Renaissance
Eight months prior to booking the first appointment with me, my patient’s opinion and idea was that what she needed was quick pharma fix. At the time she was going through graduation exams, job search and a heartbreak. She was sent home with two prescriptions by a highly recommended psychiatrist: one for insomnia and an anti-anxiety medication. At the time, the medication seemed to her like the right choice, it brought her relief with her sleep problem and she was able to cope with her life situation. However, after a while she started to experience “a different kind of anxiety”. She described this to me as “anger” and “uncertainty that her life was going in the right direction, in the work environment of a hospital”. “I felt like chocking”, she said. At that point she went online and did some research about the medication she was taking. She was shocked. She was never told by her doctor that she will develop codependency on the anti-anxiety drug. She was never told that she might experience "paradoxical effects," such as shape shifting or worsening of initial symptoms - as this is what happens when suppression of X occurs: the symptom comes around in another form. She was never asked about her lifestyle and her work environment and her core beliefs were never brought on the table. In fact, there was no table. It was just a prescription pad and a pen, and in the blink of an eye the patient’s X was pushed into non-existence. Why bother with X, since the evidence-based approach, which is the current main stream model of medicine, is fast and convenient?
Four month on sleep and anxiety drugs, my patient’s opinion and idea about the quick pharma fix flipped over. All she wanted now was to get rid of the a habit forming medication. She felt trapped and tricked into a temporary fake “normalcy” while in the meantime the real problem was deepening. She was experiencing intense mood swings and a feeling that she has lost the control over her life. She understood that the cause of her symptoms was unresolved, suppressed and ignored. And, the most concerning, she understood that, somewhere on the way she has learned disempowerment. When she initially came to me, her wedding dress was already bought and she felt like time for a real change has come.
Everyone with basic understanding of medicine knows that taking “mood stabilizers” is not a long-term solution. Antidepressants and anti-anxiety medication, as all psychotropic drugs, do not heal or correct any imbalance in the brain. If they would, people would take them for a while and they would be cured. Instead, the brain develops tolerance and the dosage often needs to be increased. On top of this, they are the most habit forming chemicals. To simply come off, once the existential crisis is over, it takes caution and planning. Nevertheless, one in six U.S. adults reported taking a psychiatric drug, such as an antidepressant or a sedative, in 2013 - according to the Medical Expenditure Panel Survey (MEPS).
The vitalist approach to life and health was gradually buried in the West staring in the seventeenth century, when Rene Descartes came up with the idea of a purely mechanical relationship between different parts of the body, with tragic consequences on the concept of X. Later on, Rudolph Virchow (1821- 1902) envisioned the body simply as an assembly of living cells. Cellular pathology emerged as a result. Robert Koch made the transition towards the evidence-based medicine, isolating the tuberculosis bacterium and proposing a model of pathogens transmission. Only in 1975, as the psychoneuroimmunology emerged, from the combined effort of its founding fathers, the psychologist Robert Ader and the immunologist Nicholas Cohen, who investigated the relationship between the nervous and the immune systems, the X was somewhat brought back into the health equation. The emotions – one of the X’s forms of expression - were proven to have a measurable impact on immunity and health, with clinical evidence in wound healing and infectious diseases (finally, a scientific ground for the Asian Medicine model of coughing from the first century BC, postulating that not everyone exposed to cold necessarily gets sick was finally found!). The two researchers found a correlation between positive emotional experiences and immunity markers in the blood (2). Today, X is still underscored in the health equation, and its impact on one’s life configuration, including the health status, remains in discussion. Soft core medical doctors refer patients to psychotherapists, while mainstream medical doctors send them to psychiatrists, as X just doesn’t fit in their practice, according to existing standard of care.
A blunt hard core approach of X was practiced by ancient Chinese doctors. The opening sentence of chapter 8 of the Ling Shu, the Spiritual Pivot is: Fan ci zhi fa, xian bi ben yu shen 凡 刺 之 法 先 必 本 于 神 literally meaning “every needling’s method first must be rooted in Shen” or “All treatment must be based on the Spirit”, with various interpretations of the word "spirit". Most often, this sentence has been interpreted as referring to the “spirit” of the practitioner when needling. For instance, Giovani Maciocia interprets it as: “When needling, one must first concentrate one’s mind [Shen]. If that “Shen” is the Shen of the practitioner, then “Mind” would be a better translation here”(3). Other practitioners associate the word “Shen” to both practitioner and patient. The Daoist teacher Jeffrey Yuen defines the Shen in this context as “ the person’s point of reference at the time they come in to see the practitioner. What are they feeling in terms of their own self? That’s their spirit. Their sense of calm. Their sense of measure – also, their sense of fear” (4). And, according the Sun Si Miao, as a result of this Shen measurement, a practitioner must treat “cultivating the Shen (spirit) through the eyes and stirring down Heart using that piercing-eye Shen as you needle to break through doubt, the fear, the possession that the person might have” (4).
Qing Dynasty illustration of Sun Simiao (center) demonstrating his complete control of the tiger and dragon, symbols of yin and yang, opposite natural processes.
Photo source: itmonline.org
She is starring in a fix spot in front of her. “What happened to my life?”. She is trying to remember how it all started. This disempowerment. This weakness, this loss of X. She came to me to help her figure this out. And yes, as alternative medicine practitioner I will ask her about her diet and digestion, to make sure her body receives and can digest all the precursors of neurotransmitters necessary for a healthy food - mood connection, excluding sugar fluctuations and nutrient deficiencies from the picture. I will exclude any organic disease such and thyroid imbalance or pheochromocytoma and I will use Chinese medicine to address her yin deficient constitution. But I there is more to that. Above anything, I’ll bring back the X into the equation of life.
The first thing I tell my young patient to re-acquaint her with her own X is that there is something in the process itself of coming off medication that will bring her life and power back. For most patients which choose to experience disempowerment and codependency, the decision of a quest for freedom represents the landmark of the upgrade. The upgrade can only be done by acknowledging the X / the soul power/ the spirit/ Shen, and allowing that power to take over and weave a new story, one of liberation. Because that’s what the X naturally does and longs for: freedom. The reclamation of power can only be done by X. We are learning through different experiences, and only when we decide that we are done with a particular type of experience (eg: disempowerment, codependency etc), we can choose to embrace a different experience and weave a new story. The soul, as Socrates put it, is life itself. There is really no limit to life’s adaptive and creative powers. Sometimes, it takes the pain of the ego shattering for the X to start functioning again and take the leading role in life. The story of any memorable upgrade can be helpful here. Rumi, one of the best poets of all times, used to be just another islamic priest, the head of a teaching community in Konya, Turkey, in the 13th century. When he was on the top of his priest career, as religious school leader and community preacher, he met a tramp, a wandering dervish, dressed in rags, who totally shattered his priest identity. He realized that this was the teacher he always wished for, he embraced the shame of deserting teaching his students and preaching to his community members to dedicate himself to the union with something deeper, that he realized was missing from his life. He dedicated all his time to studying with the dervish, Shams al Tabriz, to became what he already was deep inside his heart: a mystic. He ceased preaching about God, choosing instead to be God.
“Let the beauty we love be what we do” - Rumi
I urged my young patient to seize the opportunity of disease and opt for the painful upgrade. It is really the only way towards authentic progress. To dare to ask herself all the hard questions. How did all begin? What is beneath these symptoms? What kind of story am I creating holding on the narrative of codependency? Where is this going to? What kind of words am using? Can I re-program the passive negative markers “I’m cursed” and “something doesn’t allow me” with some active, positive aspects of existence? The good news, I tell her, is that our brains are very good at creating neuronal maps that work well with repetition. This is the secret of “positive thinking”: the more you repeat something, for instance “I want to get off this addictive drug”, the more the brain opens up new neuronal maps that will support the change. And, once started, she has to trust the process itself of power reclamation, which has an X of its own, connected to her own X, that moves her through self healing. I took a piece of paper and a pen. I used the best of my talent to draw a gingerbread man, with smooth, fluid edges, representing her core, and then I added some extra arms to it. “These are your believes that hold you from being who you really are”, I told her indicating the extra arms. You carry some heavy stuff in these arms, that hold you back in your life. You better let them go, just don’t grow them anymore”. That was her decision moment, when she finally understood that the change is ultimately her choice, and by letting go on what she believed her life was about will trace her back into the smooth edges of the gingerbread cookie – the core of her being.
“These are your believes that hold you from being who you really are”, I told her indicating the extra arms. You carry some heavy stuff in these arms, that hold you back in your life. You better let them go, just don’t grow them anymore”.
(1) Ehrenwald, Jan. The History of Psychotherapy: From Healing Magic to Encounter, 1991, p. 200.
(2) Roberts, Thomas B. (2006). "Do Entheogen-induced Mystical Experiences Boost the Immune System?: Psychedelics, Peak Experiences, and Wellness." Chapter 6 in Psychedelic Horizons. Westport, CT: Praeger/Greenwood.
(3) Maciocia, Giovani. The famous Chapter 8 of Ling Shu, http://maciociaonline.blogspot.com/2011/09/famous-chapter-8-of-ling-shu.html, September 18th 2011.
(4) Yuen, Jeffrey. Cultivation for the Practitioner, Daoist Healing Arts.