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On the Nature of Afflictions

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"The affliction is the doorway; it is not the thing itself.   The afflicted one is being asked to make an offering for the community."   Thus, began Deena Metzger this past Saturday in a workshop which I co-facilitated with her in Topanga Canyon, California.   Deena is a writer, a novelist and essayist, perhaps best known for her personal and inspirational writing about her own breast cancer experience.   We sat together with a room full of people on top of a mountain next to the largest "inside city limits" park in the world, the Topanga Canyon Preserve which lies entirely within the city of Los Angeles.   Coyotes intermittently howled their agreements and disagreements with our discourse from close quarters inside the canyon.   Large ground squirrels (as large as our Vermont woodchucks) scampered from boulder to boulder outside the window.   The vast expanse of Los Angeles lay nearby but out of sight from this panoramic vista.


Within contemporary medicine and psychology, we have invented "things" to have.   We have bipolar.   We have attention deficit.   We have PTSD.   People want to know what they have.   Rarely do the come to the consultation room acknowledging that they have been invited to enter a doorway to explore the nature of the universe.   Yesterday I sat in my office with a woman who "had" leukemia.   She had come to the understanding that she had never permitted herself the indulgence of exploring her own life until she was diagnosed with leukemia.   Then she had something sufficiently serious as to justify her adventures into inner space.   As her leukemia improved (co-incident with her inner journey), she wondered if she would reach a time when the severity of her condition no longer justified the indulgence of exploring the world of her mind and relationships to others.   "So," I said, "in order for us to continue our work, will your leukemia have to relapse?"   That comment shocked an awareness in her that she could continue for the sheer joy of exploring without the excuse of having a potentially life-threatening illness.   Leukemia had invited her to open a door, but she could remain in the dimensions of the mind long after the invitation had expired.


In 1976, Deena wrote that "cancer is silence".   She was describing women who went "crazy", had nervous breakdowns, got heavily drugged, and then got cancer.   She was determined to speak whatever had been silenced in her.   Of course, I don't think cancer is always silence, but I do think cancer, as well as other illnesses, emerge interactively as meaning-making opportunities for those who have them.   The meaning of the illness can sometimes be transformed into the meaning of the healing.   Deena was describing an experiential phenomenon of her time -- the silencing of wild and crazy women through drugs and the emergence of that energy in other ways.   She reminded me of the insanity of the changes in our small brook that happened during Hurricane Irene.   So much water fell from the sky that nothing could contain it.   Dams burst.   The rise in water level was measured in meters.   We can appreciate that still when we see refrigerators wrapped around the top of trees or car hoods nestled in branches far too high to reach.   Deena believed that telling her story would be healing.   For her, and for a generation of women, it was.


The radical departure of this brand of narrative medicine from the biomedical model lies in the awareness of the embeddedness of illness in the entire context of a life story, even if the affliction is a mysterious visitor, even if it remains silent and cannot be made to speak.   However shrouded in mystery it remains, it is a being with ontological validity.


Within the medical model, illness is isolated, fragmented, and silenced.   Its existence is denied.   Its presence as a being is avoided.


I believe illness has a story to tell.   Visitor, friend, enemy, obstacle, antagonist, helper, or villain -- whatever it may be (and it can be all simultaneously), our affliction stands before us ready for discourse, no longer silent.


The transition from positivist to narrative medicine gives illness back its voice and is fundamentally reanimating to the world.   In medieval times, illness spoke.   Ingmar Bergman's famous movie, The Seventh Seal, reveals the voice of the Black Plague in the being of Death itself who plays chess with the knight, returning from the crusades, expecting to lose, but with the intent of saving the lives of others with whom he is traveling.


However, assuming that illness necessarily has a message is also positivist.   The message may be the one that interactively arises through the dialogue with affliction.   We co-create the message with the illness.   What emerges may not have been present at the moment of affliction.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)

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