What's Love Got To Do With It?

A conversation with Bernie Siegel, M.D.

• Introduction:
• Siegel:
  • True health
  • The doctor's frustration
  • The experience of illness
  • Doctor as teacher
  • Beliefs and illness
  • Can't force it
  • Pain and learning
  • The meaning of pain
  • Educating doctors to be healers
  • Building a healing health system

Introduction:

Through one lens, Bernie Siegel is a "New Age" doctor with a hip, holistic point of view. Looked at another way, his message is as old as Hippocrates.: we must treat the whole person, not merely the organ, the system, the disease. People are complex. If we expect to heal and care for people, we cannot effectively reduce them to "the liver failure in 127" or "the torn ligament in Examing Room B." We have to deal with people's lives and emotions -- and with our own emotions as healers and caregivers.

For those who dismiss him as too soft and fuzzy, full of nice stuff that doesn't work in the real world, Siegel can refer to the increasing scientific, peer-reviewed literature in psychoneuroimmunology which identifies and quantifies specific therapeutic effects of such warm, fuzzy factors as hugs and touches, colors and smells, the beliefs we hold and the things people tell us.

Siegel's three popular books are Love, Medicine and Miracles (Harper and Row 1986), Peace, Love and Healing (Harper and Row 1989) and How To Live Between Office Visits (Harper Collins 1993). Now retired from his surgery practice, he gives lectures and workshops at Yale University and across the country. Since 1978, a great deal of his energy has gone into the pioneering Exceptional Cancer Patients (ECaP) group, a special type of "carefrontational" therapy designed to awaken each patient's own healing potential (for information, call 1 800 700 8869).

Siegel:

True health

A general practitioner I knew, the father of a friend and former partner of mine, used to say, "True good health is the ability to do without it." That's probably my definition. In a sense, health has nothing to do with one's body, but has more to do with one's attitude towards life. I meet a lot of people who have a variety of afflictions that can't be cured, whom I call really healthy people, because of their attitude towards life. They are a joy to be with.

I read recently of an excellent example. The man had amyotrophic lateral sclerosis, and was slowly losing all his bodily functions. Yet the writer described him as a joy to visit. He said to the man, "You know, it's really a joy to be here with you and your wife." And the man said, "What other options are there?" And the writer said, "You could be moaning, complaining, bitter, and resentful." And the fellow said, "Gee, I've never thought of it that way."

That's the kind of person whose attitude makes me say, "Wow, what a healthy person." They may be prisoners in failing bodies, or in institutions, but they are free people because of what is going on in their minds. Disease has more to do with what's going on in your head then what is going on in your body.

The doctor's frustration

For a doctor, this gets worse as the years go by. Medical students have some sense of this, but they get frustrated by the training, because its all about writing prescriptions or recommending operations, and not really baout dealing with people's life issues. One person told me recently that she never really enjoyed practicing. She felt like all she was doing was putting patches on all the time. I know a man who was was a family doctor and became a psychiatrist because he got frustrated by what he couldn't do as a doctor.

Doctors' expertise is in dosing and cutting, because that's where our training is. Yet studies have shown that the best indicator of the person who will respond well to treatment is the patient who says that "the doctor listened to my story and understood it." So listening to the patient matters -- knowing their experience, and their story, and knowing what you are really treating. Otherwise, you may be treating something mechanical, but that may not be what the patient really needs. We need to listen, so that we can treat the patient's problem, and not only what we are diagnosing.

The experience of illness

Each person experiences an illness differently. You might have a room full of people, all with the same physical diagnosis, but that doesn't mean they are all going through the same thing. So you have to listen. You have to say, "What are you experiencing? And how may I help you?" And they will tell you. One may be feeling isolated, while another may be saying, "This is the best thing that ever happened to me, because I quit my job." Somebody else has another experience, and on and on. If every one of them got the same prescription, you would be making a big mistake.

I knew a woman who was using her chronic disease to manipulate her family. The family looked sicker than she did. They would hire a nurse to help, to be on call in the house at night, and she would let the nurse sleep and wake the family up. I said to her over the phone once, "Come to the office. I'll guarantee you a cure." And she never came into the office after that, just contacted me by phone. My sense was that she didn't want to be cured.

I knew the patient and her family. After she died the family didn't know what to do with themselves. It took them two or three years of floundering around to reestablish a life of their own, because suddenly they had all this time on their hands.

Doctor as teacher

If you get to know families and people, you know what is going on. Doctors need to look at and understand these things. People are grateful, and come back afterwards to thank you for a lot of the things that had nothing to do with the physical problems they came to the office for. Rather they are thanking you for the changes in their life that you opened them up to.

The word "doctor" means "teacher." But I don't think most of us go to a doctor to be taught anything about life anymore. We go for mechanical reasons. My role as a doctor is expressed in the sentence, "How may I help you?" Rather than "What's wrong with you?"

That doesn't mean that I don't operate on people. I'm very much a traditional doctor. It's a matter of utilizing all the resources available. In essence I tell my patients, "This is what I can do for you as a physician. This is what an operation or pills may do to help you. And then here is where you play a part. This is what can you do. This part is about your life, your work, your relationships, your nutrition, your habits."

Sometimes I tell people, "If we just took as good care of ourselves as we do of our pets we would be all right. The world would be a lot healthier place."

Just look at issues like self-esteem and love, and how they relate to self-destructive behavior. Is there anybody who doesn't know that smoking isn't good for you? Or that being 50 pounds overweight isn't good for you? Or that you should exercise, and eat moderately? This is not a secret. Yet why do so many people have these problems? Why are there so many addicts? Why is there so much suicide and violence? We can't separate health from what's in our heads.

Last night on television they were showing something about cats. And they show that if you take kittens and you massage them and rub them and touch them 20 minutes a day, they open their eyes a day sooner and they make better relationships with people and other cats and they are better mothers and so on.

Yet how many nurseries do you know in which, when a child is born, someone talks to the mother and says, "Look, if you stroke and massage your child it will develop sooner, it will be more peaceful, it will have better relationships." Yet we know this is true. If you massage infants they gain weight faster. And it isn't just the weight, it's the deeper effect of the touch, what it's doing to the child. A child who isn't touched, and isn't loved doesn't have self esteem. It's no wonder that we end up with sick teenagers and adults, destroying themselves.

Beliefs and illness

I try to get people back in touch with their true worth and value. Many people wake up to that when they are told they will be dead in six months or a year of some terminal illness. So you have an opportunity to teach them something about themselves, about love and esteem. Some people tell me that their illness, in a sense, was a gift. The irony, of course, is that, when they suddenly have this great joy in living, many of them don't die on schedule.

Studies of the immune system show that it responds to beliefs and emotions. If I ask you to play a role in a play, and then study your immune system as you take on the role, your immune system will respond to your role. If, in the play, your loved ones are killed in an accident, that stress will show up in your body, even though you are just acting the part, if you are a good actor and really involved in the part. You are displaying those emotions and your body is responding to your acting.

This gives us a sense of how we can help people change, by urging them to act like the person they want to be. That's, in fact, what many people do when they're toldthey have six or twelve months to live. They're free. They can quit their job, they can move. They can behave differently, live in the moment, experience joy, say things they never would have said, and -- boom! -- suddenly they are this new person. And their body responds to that.

Now, what if we could learn to do that without having a life threatening disease? That's what I'm telling people. And that's why I think a lot of people come to listen. I say, "Don't wait till you get hit over the head with a mallet." A lot of people thank me for the message. We all deal with difficulties at various times. It may be a divorce, it may be something smaller, but troubles can wake people up and cause them to begin to change.

Can't force it

My job is to love people, not to judge them, or force them to change. If someone comes to my office who doesn't want to talk about their life, I say, "That's okay, I'll do what I can for you." That's all. If I say, "What's happened the last few years in your life?" or whatever else I might ask, and they say, "Nothing," or "I don't want to discuss it," I say, "Okay, then let me tell you what I can do for you." There are people who say that.

I went through a phase trying to save everybody. I think you can offend people. I have learned that if a family member, or another physician, or a nurses calls to say I want to you to call a particular person, I say, "Tell them to call me. Here is my number."

Some patients say, "Don't talk to me like a doctor, tell me how I can help myself." Others say things like, "Don't tell me about what I can do. What can you do for me? Do you have a pill or an operation? I don't want to change my job or my life or eat vegetables or meditate or whatever you have in mind." And I just accept people. What I am there to do is offer them options, and let them choose.

I tell a story of walking into an examining room, seeing a woman with a staph infection, and saying to her, "Why do you have trouble saying no?"She had something of an "Aha!" experience. She said, "Who from my family called you?" If, on the other hand, she had said, "I don't want to get into all of this nonsense, I heard about you," I would say, "Okay, I'll get one of my partners to come in."

Pain and learning

You can't educate people until people hurt. And then they come to you and say, "Help me." That's the sad part, that they need to have some pain. That's why I always argue with God. I didn't create this system. People need to have something come up to make them change their pattern of behavior.

People go to a doctor and say "I am hurting," and the doctor says, "Here is a pill that will stop the pain," instead of saying, "How can we use this? How can we redirect you?"

I call life a labor pain. How can you give birth to yourself? How do we use what comes our way? That changes the whole quality of the pain.

Ask a woman after she gives birth to a child whether it was worth it, and she'll say, "Heck, yes!" That's what each person says: is it worth it? It doesn't happen if the patient feels that "Dr. Siegel made me go through that," or "My family said, `Don't die.'" But when the patient chooses to go through it, they will say, "When I chose it, and gave birth to myself, it was wonderful." They also tell you about all the crap they have to let go of in order to fit out of the birth canal again. Think of the junk you accumulate in your life that really has very little meaning.

The meaning of pain

If you came to me with a headache, I would say, "What is the pain like? Describe your pain." And I would listen to the words of the pain description. And then I would ask, "What else in your life fits under that kind of pain?" If you said it was like being squeezed, or it was knife-like, or like a pressure, I would ask, "What's sticking a knife in you, what's creating pressure, what's squeezing you." People go, "Oh!" and they know why they have a headache. That doesn't mean there's anything wrong with taking an aspirin. But if you get to the root of why you are having that headache, you don't have to have that headache again.

I was training for a marathon and hurt my foot. One person came up to me and said "What are you afraid of? Because if you're limping you don't want to go somewhere." I said, "I'm not afraid of anything." It doesn't work to insist that a particular symptom means a particular thing. Then somebody else said to me, "Do you need to slow down?" I said, "Oh, that makes sense." Here I was doing all this stuff, running miles every morning, fitting everything in.

So this discussion is not about coming up with the answer off of a list in a book -- if you have a toothache it means you've bitten off too much, and if your foot hurts it means you're afraid to go forward, and if your knee hurts it means you're not feeling supported. It's about giving the person the right to find their own answer.

In my work with patients in groups, I work a lot with people's drawings, and this is true of the symbolism they put in their drawings. There are certain symbols where you can make suggestions. If you left the ears off I might say, "You could be deaf. You may not want to hear what's going on. You may not want to listen to the doctor or your family."But you, the patient, have to tell me which of those might apply. Because if you have a pain in your knee, you are the expert in the knee pain, not your wife, your family, or your doctor. It's your knee.

Educating doctors to be healers

Medical education is beginning to change, though not as fast as I would like it. Some schools are doing a very fine job with courses called humanistic medicine, courses in ethical issues, emotional issues, and psychosocial issues. Other schools are still very mechanistic and not doing much about it.

If we hope to educate doctors to be healers, medical education has to change. We have to bring patients into the process early on, literally teaching and talking to doctors about what they need from physicians. We need to teach communication skills. We need to deal with the feelings that doctors go through.

One of the main reasons we build that wall between us and our patients is we can't take the pain we are exposed to. People are dying. There are many things we can't cure. Doctors are sobbing in stairways and empty classrooms where nobody will notice them. We need to say, "Look, it's appropriate to deal with feelings. It isn't a sin to cry in public. Be with families, cry together, share the pain. They'll support you." Instead of de-personalizing people and physicians, we need to humanize both the doctor and the patient, and learn to deal with all these things so we don't have to hide.

One recent study showed that if you interview the other patients of doctors who get sued a lot, the patients will tell you that they don't like how this physician treats them. They'll tell you that he or she doesn't listen. That's why you end up getting sued.

On the other hand, a lot of doctors write to me in incredible pain, afraid that they have made an error in diagnosis, feeling that it's their fault that somebody may die now. If your wife says, "I have a headache," you don't rush her to the doctor and say, "She could have a brain tumor." You say, "Honey, that's too bad, can I get you an aspirin?" What if it turns out that it is a brain tumor? If you were the doctor treating her, then how do you feel at the end of a month or six weeks, saying, "Oh my gosh, I should have done this test a month ago, and maybe she would have been alright." If a hundred people come in with a headache, how many do you think are going to have a tumor versus a migraine or a tension headache? Or some child dies of AIDS or meningitis, and the doctor says, "Why couldn't I have saved that child?" We're human, for god sakes. These doctors didn't perform malpractice. They just were human. It happens to physicians all the time, and they feel awfully guilty.

Building healing environments

Think of the colors, the aromas, the sounds, the sights that make up the medical setting. If I were a healthcare executive, I would do everything I could to humanize the medical setting. In a true healthcare facility, people would already be being treated by the sounds and sights and aromas that surround them when come in. This is scientific: studies in the peer-reviewed literature show that you can affect electroencephalograms and the immune system and a whole host of other physical measurements of the body's ability to be healthy by the surroundings that you place people in, by the proper setting, including nature and plants, including the kinds of windows you use, the paintings on the wall. Studies have been done showing what reduces anxiety, what aromas make you feel relaxed, which colors. People would walk into such a facility and say, "Oh, this is a place of healing." They wouldn't even necessarily know why they were feeling good.

Real estate agents know all this. They know how to sell a house. They know how to make it look and smell good. Just think of smelling apple pie when you walk into a room, like a bakery. You would say, "Wow, it feels good in here." People are more likely to buy the houses that smell good. When I was a kid they were still using ether in hospitals, and we knew a lot less about airborne pollutants and volatile solvents. When you went to a hospital, you walked in and everybody went, "Yech! It smells awful in here!" You got sick when you went in the door. Now hospitals smell a little better. But how about making the environment actually therapeutic?

A friend of ours had AIDS and was in the hospital recently. His room was basically like a closet. There was no room for visitors. There is no room for his computer. He was frustrated that he couldn't work while he was there, which would have helped him to maintain himself as a human being and keep his dignity. I felt, "How can anybody get better in here?" I wrote to the administrator suggesting that he spend a weekend in that room. He never wrote back to me. I find it incredible that they would ever even build a hospital room like that.

Building a healing health system

There are many things that would make our healthcare system so much more humane and useful both to the patients and the people who work in it. Family planning, and healthcare for mothers and children, need to be a part of the health system. It is so important that the children be treated properly so they grow up to be healthy adults, not self-destructive or destructive of others.

We could free up a great deal of healing power simply by relieving physicians of this incredible burden of paperwork. Doctors spend so much time justifying who they are seeing, filling out forms. Most physicians did not choose this career for monetary reasons. But when at some point medicine becomes so unattractive that you can't even enjoy the people anymore, then you begin to look at the compensation and say, "Why am I doing this?"

We need to teach the young people more about health. Children of today are the least healthy group of people in our society. For the health of the children we need to go into the schools, and that includes your executives, too. Go to school. Talk to them. It helps their self-esteem if someone important, someone with a title or a reputation, walks in and says, "I care about you kids." They say to themselves, "Maybe we're worth something -- look at who came to our school."

Most important, we need to understand that wellness is cost effective, that we should be rewarding healthy people, and teaching people how to be healthy. If the people running the major healthcare chains and HMOs had any brains, they would say, "If you want to join our plan, this is our fee. And this is what you have to do." And they would teach me wellness. I wouldn't get sick and they would make a lot of money.

Ultimately what they will find is that people can't afford sickness. If you look at the cost of some of the operations today, compared to the cost of keeping somebody healthy, it would save us a fortune to keep people well. At some point they are going to wake up and say, "This doesn't work. People can't afford us. So if they are going to join our health plan, we had better teach them something about health."