EXISTENTIAL MEDICINE

Introduction: Illness as an Altered State of Consciousness

From the point of view of Existential Medicine there is no need to scientifically find or prove causal links or relations between ‘body and mind’, ‘body and brain’. Instead it is a matter of recognising that every bodily state is a ‘mental’ state, but in a much broader sense than usually understood – being a subjective state or state of consciousness that is experienced in a bodily way and not just in our heads.

No ‘subjective’ state or ‘state of consciousness’ is merely something enclosed or encapsulated in our heads, brains or minds. Conversely the body as such is not something we merely perceive or are merely aware of ‘mentally’ – as if it were some object we carry around with us. Instead the body itself is but a particular shape and dimension of subjective experiencing – one that completely transcends the whole body-mind, body-brain division. This is why the notion of the ‘felt body’, ‘lived body’ or ‘subjective body’ is so central to Existential Medicine – and to the new understanding of illness it brings. For this new understanding makes it impossible, in principle to separate our lived experience of illness in two separate categories that we call ‘mental’ and ‘physical’.

A basic principle of Existential Medicine is that every bodily state is a state of consciousness and vice versa. That is why the experience of any bodily state or condition, even a minor ailment such as a flu or cold goes together with a new and different state of consciousness – a state of consciousness that is not limited to one’s head or mind but pervades one’s entire body.

Conversely, different type of  ‘mental’ or ‘emotional’ state are also states of consciousness not confined to the head mind  – but felt and experienced in a bodily way, for example as a particular sensation arising from a state of muscular tension in one’s chest, heart, stomach or guts.

“Every feeling is … a mood that embodies in this or that way.”  Martin Heidegger

What we call a ‘mood’ itself is nothing we are simply aware of ‘mentally’ and in our heads, but is rather a particular tone and quality of embodied and feeling awareness – one which embodies itself as different degree and qualities of muscle tone and tension body – which is why no state of ‘mental’ stress or tension is not at the same time a state of muscular tension.

 “A mood makes manifest how one is…” Martin Heidegger

In other words, a mood is not just nothing purely mental but is a  bodily way of feeling ourselves. This is reflected in the fact that the question ‘How do you feel?‘ is synonymous with the question ‘How are you?’.   For way we ‘feel’ is the way we ‘are’ – and vice versa. For this reason however, any alteration or change in how we feel or are is at the same time a change in who we are or feel ourselves to be – a change in our identity or sense of self that is felt in an immediate bodily way. For in a most literal sense the ‘you’ that feels sick or tired is not the same ‘you’ that feels healthy, bright and alert.

Thus not only is every bodily state also a state of consciousness – it could also be described as a ‘self-state’. For the way we feel our bodies cannot be separated from the way we feel ourselves. How we feel in our body affects not just our mind but who we feel ourselves to be – our ‘bodily sense of self’ or ‘body identity’.  That is why, when people begin to feel ill they might speak of ‘not feeling themselves’. This basic  ‘dis-ease’ of ‘not feeling ourselves’ is both the essence and first sign of illness – being not only an altered state of consciousness (how we feel) but also an alteration of our bodily sense of self or  body identity– of who we feel ourselves to be.

The Immune System, Body Identity and Illness as Pregnancy

In the framework of biomedicine ‘body identity’ is connected only with genetic or biological identity and in particular with the immune system – which is seen as ‘defending’ our biological identity against threats and attacks from ‘foreign bodies’ in the form of pathogenic bacteria, viruses or mutant and cancerous cells, or any type of genetic material such as organ transplants that consist of ‘non-self’ cells (a term actually used in immunology).

Today more than ever, much fuss is made about ‘health’ being dependent on maintaining or restoring a strong ‘immune system’ or with strengthening the body’s immune ‘defences’, which is why countless  food products and supplements are advertised that claim to do so. On the other hand even biomedicine acknowledges that most discomforting or painful symptoms of illness (such as a runny nose or swelling and painful joints) arise from the activity of the body’s immune system.  Indeed many illnesses are recognised as resulting from an immune system that is too strongly defensive and as a result is  overactive –  leading to so-called ‘autoimmune’ diseases such as arthritis in which the body’s immune ‘defences’ are used to attack its own cells. Alternatively, the body’s immune system may be at such a high alert and so overactive and ‘strong’ for long periods that it ultimately weakens or collapses. Its very strength and activity therefore may ultimately result in precisely the sort of weakness that makes the body susceptible to infection and other types of illness.

In contrast to biomedicine, Existential Medicine understands the strength of our immune system – the degree of immunity of our bodies – as an embodiment of the degree of immunity of our self or identity. Thus a too rigid or strongly defended identity or sense of self – one completely ‘immune’ to natural and healthy processes of change and adaptation to life – may find biological expression through an over-defensive and over-active immune system, which then actively seeks out threats to our biological identity that would otherwise be ignored or are ignored by the immune systems of other people. An over-rigid or immune self – or one that experiences deep identity conflicts – would explain many auto-immune disorders. A more healthily and naturally ‘strong’ identity or sense of self on the other hand would also explain what biomedical immunology can’t explain – why some people ‘catch’ diseases which are supposed to be highly infectious whilst others don’t – even from spouses or children they live with or during widespread epidemics. Nor can biomedical immunology explain why most of the bacteria, viruses and  even damaged, mutated and ‘cancerous’ cells that biological medicine regards as ‘causes’ of diseases are all in fact constantly present in most healthy bodies.

Biomedicine simply takes it for granted that ‘health’ is the protection of a fixed biological and genetic identity – one ‘immune’ from all change. The problem with this theory is that it prevents biomedicine from coming up with any explanation of why it is that the immune system, though it may launch attacks on transplanted cells and tumours, does not launch attacks on a no less alien or foreign body that can grow within the human body – namely the baby growing in a pregnant mother’s womb? And whilst biomedicine has effectively come to treat pregnancy and birth as something fraught with much dangers as an illness, therefore requiring hospitalisation and the use of hi-tech medical equipment, the body itself clearly does not regard pregnancy as a disease or the baby as an alien or foreign body growing inside it – despite the differences in its DNA to that of the mother. Existential Medicine, on the other hand, understands ‘health’ itself as a capacity to allow our body identity or sense of self to be altered and transformed in response to our life world and life experiences.  That is why, instead of treating pregnancy as if it were a type of illness, Existential Medicine understands Illness itself as a type of pregnancy – the meaning and purpose of which is precisely to allow us to gestate and give birth to a new ‘bodily sense of self’ or ‘body identity’. A key aspect of health, not as a mere state but as an on-going life process is therefore the capacity to pass from a state of ‘not feeling ourselves’ to one of ‘feeling another self’ – and of learning to embody or ‘give birth’ to that self through new and different ways of relating to our lives and life world.

Health and Illness as Life Processes

The different ways in which it is possible to interpret and respond to discomforting alterations in our bodily sense of self – in particular that bodily sense of ‘not feeling ourselves’ that accompanies even the most minor of symptoms such as feeling a cold or flu coming on – take us to the very heart of the contrast between Biomedicine and Existential Medicine. They also enable us to understand both health and illness as self-states and life processes rather than merely as bodily states or biological processes.

A key aspect of both health and illness as life processes is how we interpret and respond to the essential ‘dis-ease’ of ‘not feeling ourselves’ – a dis-ease that may either precede or accompany discomforting symptoms of illness. One option is to feel this dis-ease and its symptoms merely as a sign of some biological disease or disorder – leading to what I call ‘the illness process’. An alternative is to feel our dis-ease as a state or pregnancy and our bodily state as the womb of a new and different sense of self  gestating within us – a self we do not need to ‘defend’ against or ‘fight’ with our body’s immune system. This is what I call ‘the health process’ in contrast to ‘the illness process’, the stages of both of which are described below:

The Health Process

1. ‘feeling ourselves’ in a familiar and ‘normal’ way that we identify with feeling ‘healthy’.
2. ‘not feeling ourselves’ – feeling a change in our bodily sense of self or body identity.
3.  choosing to actively affirm and identify with our altered bodily sense of self or ‘body identity’.
4. Giving ourselves time to meditate our felt-disease in the context of our current lives.
5. Passing from ‘not feeling ourselves’ to ‘feeling another self’ – to experiencing the change in our bodily sense of self not as something that is ‘not me’ or ‘other than self’ but as a distinct self in its own right.
6. Seeking to actively embody and in this way give birth to the new sense self that is pregnant in our dis-ease through new ways of being and relating to others and our life world.

The Illness Process

1. ‘feeling ourselves’ in a familiar and ‘normal’ way that we identify with feeling ‘healthy’.
2. ‘not feeling ourselves’ – and experiencing this both as a felt sense of dis-ease and as the result of some ‘thing’ that is ‘not self’ or ‘other than self’.
3. identifying our felt dis-ease solely with some purely bodily state or illness symptom.
4. Seeing this symptom only as a sign of some ‘thing’ that is ‘wrong’ with us – such as a medically recognised ‘disease’.
5. seeking a medical diagnosis or ‘cause’ for our symptoms in some ‘foreign body’ such as a virus.
6. seeking a ‘cure’ for our symptoms by some means of medically counteracting or cutting out that ‘foreign body’.

The illness process is always culturally and linguistically shaped. Thus, whilst modern medicine might seek the cause of dis-ease in a foreign body such as a ‘malignant’ tumour or ‘pathogenic’ virus or bacterium, a witch-doctor or shaman might blame it on a malign spirit just as earliest Greek physicians blamed illnesses on ‘ill-winds’ or pneuma.  Yet what all historical forms of medicine have tended to share in common is that any sense of ‘not feeling ourselves’ – rather than being taken as an opportunity to begin ‘feeling another self’ – is instead identified with feeling something wholly ‘other than self’ such as a foreign body or spirit, or a ‘non-self’ cell or organism. In this way however, the health process – passing from ‘not feeling ourselves’ to ‘feeling another self’ is foreclosed and gives way instead to the ‘illness process’.

Illness as Pregnancy and the Doctor as Midwife

If we understand  illness in the framework of Existential Medicine, i.e. as a life process comparable to gestation, then all forms of medical treatments or ‘cure’ are equivalent to an attempt to medically ‘terminate’ or ‘abort’ the new bodily sense of self or ‘body identity’ that is pregnant in the patient’s dis-ease. Such premature medical termination or abortion of an illness has the immediate ‘side effect’ of preventing the patient from taking time to explore, understand and identify more clearly  the new sense of self they are gestating and pregnant with – and to find ways of giving birth to it through a new way of living and relating.  Abortive biomedical treatment may and does also frequently ‘miscarry’ in several others ways – not just through other side effects but also through actually intensifying the ‘illness process’ – the process by which a felt dis-ease is ‘somatised’ and as a result may take the form of ever more chronic or acute medical symptoms and diseases.  Finally, even if a disease or its symptoms are cured – whether through conventional medicine, alternative medicine or ‘spiritual’ healing – if the underlying dis-ease behind it is not explored, the result may well be that the patient simply gives expression to this dis-ease through other symptoms or another disease – one that may be worse or more serious than the one supposedly ‘cured’.

The ‘health process’ is a process of giving ourselves time to feel ourselves more deeply into a felt dis-ease with the aim of sensing it as an expression of a different bodily sense of self – rather than simply seeking to counteract or cure, suppress or exorcise  its symptoms. Yet since so few people are able to approach  any felt sense of dis-ease in this way however – through ‘the health process’ – this dis-ease may need to take the form of ever more acute or chronic disease symptoms for them to begin to do so. The illness process therefore, can also provide a spur for the health process. Yet if, through the illness process, an individual’s dis-ease has already reached the point of transforming itself into a serious biological disease, then some form of biomedical intervention may be unavoidable, if only to alleviate its symptoms. Yet this is precisely the point at which what I call Life Doctoring – existential therapy for illness – becomes so vital and relevant – even if conducted in parallel with medical doctoring. For only Life Doctoring can ensure a true ‘healing process’ is set into train. Here the role of the Life Doctor is to serve as midwife for the patient – helping them to give birth to changes in their sense of self or body identity and not just their body, and to changes in their life as a whole and not just their bodily life.  Life Doctoring sessions serve to support this healing and birthing process by offering times and ways for the patient to step back from purely biomedical diagnoses, prognoses and treatments of their illness and by helping them both feel into and come to understand the deeper meaning and purpose of their illness – thus restoring the health process in place of the illness process.  The Life Doctor can also play a vital role in helping the patient to consider more carefully and if necessary reject potentially dangerous or high-risk forms of diagnostic testing, treatment or surgery. For the danger is that these may either miscarry, worsen the patient’s symptoms or hasten the progression of their disease – and in any one of these ways result in their premature death. On the other hand, even if medical treatments for serious or terminal diseases are ‘successful’ in purely biomedical terms, they may massively reduce the patient’s quality of life – merely to extend that life for what is often only a very minimal period.