Eloquent Body

Dawn Garisch

• Publisher: Modjaji Books
• Year: 2012
• ISBN:
  9781920590178
• Topic: Medicina
• Subtopic: Biografías médicas

Eloquent Body explores the juxtaposition of healing and creativity both from a personal as well as medical point of view. Dawn Garisch works as a medical doctor and a writer in equal measure and advocates dialogue between our bodies and our creative selves. Her novel Trespass was nominated for the Commonwealth Prize in Africa.

PART ONE
Talking to Myself Across the Table

1. The Science and the Poetry of the Body

The Paradox of Life: A bit beyond perception's reach I sometimes believe I see that Life is two locked boxes, each containing the other's key.

Piet Hein³

The World Health Organisation's definition of health, which has not been amended since 1948, is ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. This is a goal and, as with many goals, it is formulated from good intentions, but is inadequate, even misguided. Life is not a fixed state, but a dynamic process which is taking place on numerous fronts simultaneously.

How do we know whether we are ‘in tune’ with ourselves? How do we know what our bodies and our lives want of us? The ‘sick’ part of ourselves might be the healthy part which is trying to get us to change the way we live. We frequently behave as though our lives, like our bodies, are there for us to do with what we please, like vehicles we drive around in until they are ready for the scrap heap. Instead, we could regard ourselves as caretakers and co-authors of the story of our lives.

Over and above the advice of our health consultants, there is a part of us that knows what is good or right for our wellbeing and our passage. This aspect of body or the unconscious attempts to correct us when we are off course. If we pay respectful attention, the corrective can feel like a compass that guides our ship on its journey, but if we rudely ignore the gentle reminders, we might be rudely coerced to take note.

Our bodies provide information constantly. Fortunately for us, most of that information is picked up and acted on below our radar screens. We don't have to remember to breathe or to adjust our pH level. But some information – like painful joints if we are overweight – needs our attention and engagement in order to correct the situation.

One of the tasks of life is to learn how to care for ourselves. If we treat our physical and emotional selves as machines, or as wayward children or slaves that we have to whip back into place, our bodies are not going to love us for it. Our symptoms, to an extent, provide feedback as to how we are doing – messages that we are sometimes deaf to, or choose to medicate into silence. When the messenger knocks at the door and we ignore her for long enough, she may give up and we become stuck, or she could become furious or frantic, and break the door down, with catastrophic implications for our health.

Illness can be a signpost pointing in a direction we have been avoiding for years.

***

The ophthalmologist told me to rest my chin on the support and press my forehead against the bar to keep my head still. ‘Look at the top of my right ear, ’ he instructed. Then he shone the astonishingly bright light into my eye. It was like looking into the sun – something I had been told as a child never to do. My body wanted to cringe away from this assault, my eyelids wanted to close. It was nauseating. But my will kept me sitting still, staring through the light in the vague direction of the doctor's ear.

‘You know, you may be right, ’ he exclaimed. Those words burned themselves into my memory. I can even remember his tone of voice.

For some weeks I had been visiting the eye outpatient department at Groote Schuur Hospital, complaining about a cloud swirling in my sight. The eye specialist had reassured me that all I had was a couple of floaters, which were not in themselves a symptom of illness, and which are common in the general population. He had smiled at me benignly, noting that I was a medical student. Medical students tend to get all kinds of phantom or sympathetic illnesses as they work their way through the curriculum and the wards. This would happen to me too – an ear infection during the ear, nose and throat section of the curriculum, a urinary tract infection while studying urology, anxiety while participating in the day clinic as part of my psychiatry education.

But that day, concerned about my deteriorating vision, I had returned to be examined again, and the ophthalmologist had believed me. That was what it felt like: I had finally persuaded the expert that I was not making this up.

The ophthalmologist diagnosed an autoimmune disease. As an eighteen-year-old second-year medical student I had never heard of such an illness. It is familial in that it is carried by the HLA-B27 gene down the generations, but all my mother and sister had ever complained about was a bit of arthritis in the lower back. I was a reader, writer and a student studying beautiful histopathology slides through microscopes, and I was in danger of losing my sight.

My own immune cells, whose assignment it is to defend me against invasion by foreign objects and organisms, have somehow muddled their brief. They mistake the cells of my own body as foreign, rally the forces and attack the connective tissues in my eyes and spine. The inflammation that results causes pain and stiffness in my back and damages my vision.

A serious own goal. In fact, a series of ongoing own goals with no intervention from the coach. Why on earth would my immunity do that? Even now, thirty-five years later, we know very little about the autoimmune conditions. An unhelpful offering from my specialist was that a third of people with my illness get better, a third grumble on much the same with patchy vision, and a third deteriorate.

No-one could tell me into which third I would fall. No-one could advise me whether to prepare for a life of seriously impaired sight, or to carry right on as though this was just a minor pothole in an otherwise straight road.

At eighteen, I'd considered life a straight road. Not that it had been easy, but I thought I knew who I was and where I was heading. Born into a family who were not interested in psychology or religion, and who looked to science to provide answers, I had taken for granted that what was concretely in front of me was the raw material I had to work with to construct my life. The intangibles like dreams and soul held no meaning.

Disease provided a window, or rather a trapdoor, into a parallel reality – a reality based on the non-rational, which was nevertheless cohesive and imbued with meaning. If I had developed pneumonia or broken my leg, doctors, backed by science, would have rushed in and fixed me and nothing would need to have changed. But I was suffering from an illness that medicine barely understands. As a result, I was forced to look elsewhere to make sense of what was happening to me.

Initially, I did not do this. I attended the ophthalmology clinic and submitted myself to injections of corticosteroids angled behind my eyeballs and took the prescribed tablets and drops. These were sight-saving measures, although the treatment itself, ironically, can cause cataracts and other unwanted effects which obscure vision.

I carried on studying, evolving into a doctor, learning from tutors both explicitly and covertly how to become a medical practitioner. I studied the body as mechanism and as genetic construct and as chemical cascade. I learnt to take a family, medical and occupational history, to examine the body, to diagnose and to treat. Our class of just under two hundred students was taught that illness and injury are the failures of anatomical and physiological systems. We were steeped in the attitude that death is the enemy.

In those seven years, I learnt about an approach to the body that has had enormous impact on the wellbeing and life span of humans in the latter half of the twentieth century. Yet I could never shake off the feeling that there was something missing.

Over the next few decades after I qualified, afraid for my sight and in pain, I consulted a psychotherapist and a range of alternative therapies. I learnt from these teachers that there are many approaches that view disease as dis-ease, as the means our bodies use to alert us that we are out of kilter; I learnt too that accidents or ‘bad luck’ can be a way the unconscious tries to wake us up. I discovered that there might be something that life wanted from me that was neither ego-driven nor genetic, nor to be found in any rational manual. Wanting to track all sources of my condition, I became open to what I now think of as the poetry of the body – the way story and metaphor reveal themselves in the physical, emotional and spiritual self.

***

It is easy to misconstrue the body as being a machine. The way we fit together and pivot and hinge is awe-inspiring. Watching an orthopaedic surgeon operate with saws, glues and nails, one can be forgiven for thinking that a human body is a very sophisticated robot. Treating someone who has diabetes with insulin can look like supplying oil to an engine that keeps running out of this ingredient essential for proper functioning. Taking a pill to prevent conception can lead us to believe that we are in control of physiological processes that can be entirely understood through logic.

Yet there are aspects of disease and healing processes that we cannot take apart and explain as yet. One example is the placebo effect. We usually regard this either as an indication that the patient is a malingerer – that the symptoms are generated by their psychological state of mind, and that they have responded to a con trick – or as a nuisance, when studying how effective a new drug is. In trials that tested antidepressants,⁴ the placebo worked almost as well as the actual drug. It begs the question why researchers are so keen to eliminate the effects of a placebo.

Another example is that women who have been trying to conceive for years without success, and then adopt a child and stop trying, not uncommonly become pregnant.

The focus of some researchers is shifting away from an approach which views the sick body as one whose systems have failed and which needs an external agent to restore health. They are starting to pay more attention to the innate self-healing capacities of the body and how they are either interrupted or activated, and whether and how this relates to ancient and indigenous practices. For millennia, humans have used story, ritual, talismans, voodoo, laying on of hands, going into trance, hallucinogenic drugs, herbs, ‘energy’, visualisation and vision quests, sacred places, dreams, throwing of bones, music, meditation, prayer, breath work, song, needling and scarification to protect and to heal. We also know that attitude and intention can make a difference in the healing process⁵ -they are aspects of the overt or covert stories we tell ourselves about our illness and lives.

Measured in terms of numbers who consult, the success of alternative and complementary health practices cannot be merely accidental, nor anecdotal. Many mainstream practitioners regard these approaches as bogus as they usually do not stand up to rigorous testing. Indeed, many have not been adequately investigated, largely because companies who sell medicine are the ones who fund research.

I suspect that the popularity and anecdotal efficacy of alternative approaches to healing could lie in the power of symbol and story. Symbol as used in this book refers to anything we attach meaning to beyond what concretely exists: for example, an egg is a means of reproduction, but it symbolises many things – birth, rebirth, perfection, creation, hope, protection, fertility, to name the most common – and is employed in art, such as in Salvador Dali's paintings, and in rituals such as Pesach and Easter. A symbol, unlike a plus sign, cannot be pinned down as to its precise meaning, for we all bring slightly different and even pre- or non-verbal associations to bear. We know this from our dreams, where if we dream of an egg, we might experience a deep resonance, but be unable to express adequately the felt connection.

Even if we were to test alternative approaches to healing through double-blind, randomised, controlled trials – the gold standard of arriving at truth in medicine – this valuable tool might well prove to be inadequate. There is no ruler that can measure symbol, which in its essence can only point towards a constellation of approximate meanings, but can never signify something exactly. My experience, through my own illness, is that the body is both science and poetry, muscle and metaphor, chemistry and psyche.

Even if the mind forgets, the skin remembers: the organs keep a record of their guests.

Phillippa Yaa de Villiers⁶

In the twenty-first century, artists and scientists are working away at opposite ends of the table, observing, investigating, documenting. Both are attempting to find truthful answers using very different tools.

***

The development of the scientific method has shaped our age. It has helped us to differentiate fact from fiction. It can allow us to test our intuition and assumptions to see whether they hold true, and under what conditions they do. In medicine, science has helped us to identify unscrupulous practitioners and bogus treatments. It has provided a means for us to develop inspired strategies and interventions towards assisting the ill and injured and improving quality of life. In its pure form, science is curious and open-minded. In its corrupted form, scientists are in service to commerce, and might be more interested in profits, success and being right than in the truth, the health of individuals, or of the planet.

When serious practitioners of the arts – writers, artists, dancers, and composers – apply themselves to producing a work, they are also attempting to reveal what lies at the core of life. They are concerned with reflecting upon and provoking awareness in service to truth. Yet they employ fictions to do so: stories, representations, illusions.

Can scientists and poets talk to each other? Do these seemingly disparate approaches even speak the same language? The bridges that attempt to connect the lands of measurement and poetry have been rickety at best. Carl Sagan, the scientist and author, stated that he tries not to think with his gut⁷, whereas Yeats, the poet, warns:

God, guard me from those thoughts men think In the mind alone; He that sings a lasting song Thinks In the marrow bone.

W. B. Yeats⁸

One of the many challenges of writing this book is what style of language to use. Poets use one kind of voice and scientists another, and each discipline often has serious difficulties with the style, affect, grammar and vocabulary of the other. Medical researchers tend to use objective, passive tense ways of expressing themselves in articles and books, and avoid words that spin off into multiple associations. Their brief is to be as exact as possible, to use words as scalpels to cut down to the bone of objective, verifiable truth. They go to inordinate lengths to write in such a way to keep themselves out of the picture.

Poets might keep themselves out of the writing, but they approach expression as a subjective enterprise. The words they choose evoke layered images, and through juxtaposing unusual words and phrases in unexpected ways they evoke metaphor and symbol, ...