wCHAP.20b

(10/4/98)

CHAPTER XX. B

HEALTH, MEDICINE AND A SCIENCE OF RELIGION

P. 253: E: "To these people [who fill a city park to practice t'ai chi ch'uan], as to their physicians, the body is a series of energy conduits. Chi, the Chinese name for this energy, flows along systematic meridians, which do not coincide with any known physiologic structures. When a patient is ill, our Western doctors look for physical or chemical abnormalities. Chinese doctors search for hidden forces that are out of balance. Their task, as they describe it, is to restore unseen harmonies. Sticking needles into the body is obviously a physical intervention to Westerners, but not to the Chinese. They see it as intervening in an energy system. The same is true of herbs. For the Chinese, herbs are not a concoction of chemicals that influence other chemicals in the body; herbs help to 'unstick chi' -- to get the energy flowing again. Through pressing needles into specific points in the body, through using herbs, and through massaging pressure points, Chinese doctors, it is said, control the flow of chi."

RESPONSE: Chi is a hypothesis. If one looks at how it is used: "hidden forces out of balance," "restore unseen harmonics," "get energy flowing again," these metaphors are not incompatible with the understanding of Western science. When a disease germ enters the body it causes an upset in the balance of how the body works. Treating it has the goal of returning the body to its "normal" state. The other terms have the same general idea.

The difference is that science produces some falsifiable statements, Chinese medicine does not. However, this doesn't mean that there is nothing of value in studying Chinese medicine. It only means that the studies have to be done. Is there any chi? Are there energy meridians? Is illness caused by hidden forces that are out of balance? Probably all of these things are the product of a cultural myth. However, somewhere in all these ideas there may be a gem that is of crucial importance if we are to understand why people get sick and how best to keep them well. This is a unique opportunity to advance understanding of how the universe really is. And always we must remember that in spite of our current learning, we have barely begun to understand the way things really are.

P. 253: "As we see in the park [the same park as above], they [Chinese doctors] also teach their patients to master the flow of energy in their own bodies through combined mental and physical practice. Chinese sages taught that treating someone who is already ill is like beginning to dig a well after you have become thirsty. The classical Chinese physician received a fee only as long as the patient remained in good health. Payments stopped when sickness began. The task was to teach patients to stay healthy by living correctly; temperament, diet, thoughts, emotions, and exercise were all important in a system in which the patient took primary responsibility for sickness or health. The physician was a role model. Patients went to them to learn about 'energy medicine.'"

RESPONSE: Except for the "energy medicine" the core approach here seems right on, and should be the model for a Wise Community.

P. 266: "...massage is not just a technique for loosening the muscles or relaxing stiff joints. Chinese massage is designed to release the flow of chi."

RESPONSE: Chi, or not chi, massage is a powerful tool to help anyone live a better life. See Chapter IV.

P. 271: M: "At Beijing Medical University, we meet a doctor who operates out of both frames of reference, East and West. Dr. Xie (pronounced 'shee-yeah') never had any intention of learning traditional medicine, having been trained according to Western medical models. But in the fifties, Chairman Mao ordered many Western-trained doctors to study traditional Chinese medicine. Xie says he became profoundly interested and chose to make his life work the integration of both systems. Today he runs an entire department trained in both disciplines and consults on cases where Western medicine has met its limits. We talk to him about two cases of patients diagnosed as having ulcers. In one of these case, Western doctors and Chinese doctors differed in their diagnosis."

P. 274: M: "Dr. Xie, you were trained first in Western medicine, and you then took up the study of traditional Chinese medicine. Why did you change?"

Xie: "In my earlier practice I came across some problematic cases for which Western medicine did not offer any satisfactory cure. After I began to learn about Chinese medicine, I discovered that for these cases, Chinese medicine is more effective. That's when I really began to be interested in Chinese medicine. I then discovered that Chinese medicine had many advantages. For some acute diseases, such as viral infections, Western doctors and medication do not seem to provide a cure -- but Chinese medicine offers some help."

P. 275: M: "Were you skeptical at first about Chinese traditional medicine?"

Xie: "Yes, I was, in part because I had begun my medical studies in Western medicine, and both the theory and practice of Chinese medicine are absolutely different from what I had learned of Western medicine. So I was very skeptical in the beginning. But after I tried the Chinese medicine and herbs, I found that they worked, so I began to change my mind."

M: "What does Chinese medicine tell you about health and medicine that Western medicine can't"

XIE: "In Chinese medicine the mind and emotions are closely related to health and disease. For example, disease can be caused by the intensification of any of the seven human emotions -- joy, anger, melancholy, brooding, sorrow, fear, and shock. An excess of joy will do harm to the heart, anger will do harm to the liver, melancholy to the kidney, brooding and sorrow to the spleen, and fear and shock to the kidney."

M: "And you could feel some of these emotions in the patients with ulcers simply by taking the pulse?"

XIE: "Partially, yes."

RESPONSE: If one is to tie emotion to disease, it is then essential to have a testable theory of emotion. Since Chinese medicine does not have such a theory it seems clear that any hypothesis about a relationship between emotion and disease will turn out to be closer to astrology than medicine; i.e., any value of the process is totally unrelated to the explanation used.

Drawing on Plutchik's work in which he postulates eight feeling states with varying degrees of intensity and numerous combinations (see Chapter XIII) I would say melancholy, brooding and sorrow are all one feeling state (made up of the three named intensity levels: sadness/pensiveness/grief on Plutchik's model). Therefore, three emotion states are not considered (anticipation, adoration, and disgust). Also bringing in Dr. Candace Pert's work on peptides as the agents of emotion ( Moyers' p. 177) would be relevant.

It is very likely that Chinese medicine has a deeper insight than Western medicine on this issue. Western medicine looks to the germ as the cause of disease, and has overlooked why this body at this time has succumbed to the germ after successfully resisting it for years. Or, why others have successfully resisted this same germ.

This whole area if expanded to incorporate current scientific knowledge might lead into very productive and useful areas. Such study must include the areas Moyers explores with David Felten (brain and immune systems), Robert Ader (conditioning immunity), and Margaret Kemeny (emotion and the immune system).

P. 275: M: "Since you practice Western medicine as well as Chinese medicine, would you ever use a drug like Tagamet for treating these patients' ulcers?"

XIE: "Yes, we use it very often here. Western medicine is effective in treating the ulcer, but a combination of both Western and Chinese medicine produces an even better effect. Take these two patients here for example: we gave them totally different Chinese medicines for their ulcers, and in both cases the medicine worked well."

M: "So when you were diagnosing these patients, what did you learn from the pulse?"

XIE: "One patient doesn't have a special emotional problem -- his ulcer had something to do with years of irregular diet. But the second patient is different. His pulse belongs to the 'liver pulse,' which has something to do with emotions. Habitual anger caused his ulcer, little by little."

M: "And how does chi relate to that?"

XIE: "These two cases are opposite. The first patient showed a lack of chi, while the second has excessive chi because of chi blockage in his liver. Chi can't pass through, causing his disease. But his chi excess doesn't mean there is too much chi in his body, just that the flow of chi stops in that particular area and is unable to travel farther."

M: "Is there anything in Western science comparable to chi?"

XIE: "No, I don't think so."

RESPONSE: And these are the kind of things that must be tested to see first if the data supports the conclusions and second if it does, why it does. Of course the hope would be that there truly is something in Chinese medicine beyond the placebo effect. If they have discovered new aspects of body functioning and healing outside the field of understanding of Western medicine that would be very exciting.

P. 276: M: "Your patients can choose either Western treatment of Chinese treatment. How do they make that choice?"

XIE: "Many Chinese patients in fact know when to choose Western medicine and when to choose Chinese medicine. If they need an operation, they'll make sure to find a Western doctor, whereas for chronic diseases they'll prefer Chinese medicine. "

P. 277: M: "But does Chinese medicine cure the illness, or does it just help the patient to live with it?"

XIE: "That depends on the disease. Some can be cured gradually and thoroughly, and some can't. But what I want to emphasize is that the application of Chinese medicine is fundamentally different from what is done in the West. In Chinese medicine, 'disease' is defined as the struggle between human capability to resist disease and the pathogenic factors. Chinese medicine stresses the human capability to resist disease. Therefore, many treatments are designed to motivate this capability -- once it is motivated, some diseases can be cured easily. That's the key point of Chinese treatment."

RESPONSE: And this would seem to be an obvious direction that Western medicine should adopt. However, because Chinese medicine is not based on testable hypotheses with double blind tests all of its conclusions are suspect. But as a scientific approach is applied we should expect to see some vitally important contributions being made.

P. 282: E: "In the Chinese culture....[it is believed that if] you can figure out where your center is and how to concentrate your mind, you're healthy, and once you lose that, you get sick."

RESPONSE: How could one test such a hypothesis? It would seem to lead immediately to circular reasoning. However, at some level the idea seems self-evident as long as we recognize that current understanding does not allow anyone to be centered enough to resist all germs and threats to their health, and perhaps this state could never be achieved.

P. 286: "...Ma Yueh Liang, [is] one of the greatest living practitioners of t'ai chi ch'uan, a Grand Master. He was trained in Western science and ran the clinical laboratories in a prominent Shanghai hospital. But at the same time, for more than seventy years, he has taught and practiced t'ai chi ch'uan. He is now ninety-one years old."

M: ""Did you learn t'ai chi while you were in medical school?"

MA: "Yes, when I was twenty, I began to study t'ai chi from a master. I became not just his student, but his disciple. A student is a learner on a regular basis, but a disciple is committed to the practice and teaching of t'ai chi."

M: "Why did you begin the study of t'ai chi?"

MA: "As a student who studied bacteria, I would easily be infected by disease germs if I didn't keep myself healthy. That's why I learned t'ai chi -- to keep fit. Practicing t'ai chi has many functions. One is that it makes you live longer. I'm ninety-one years old, and I can still take trips abroad by plane and teach t'ai chi to others. Even a young man cannot beat me in a t'ai chi martial arts competition."

"Another function is to help heal chronic diseases. Yet another is to refresh. When you come home from work at the end of the day, if you calm down and practice t'ai chi, you will be refreshed, and your tiredness will disappear."

"T'ai chi works for everybody. Practicing its slow movements is like taking a rest, except that there is movement in t'ai chi. It can also be used as a martial art, like boxing, but it is not designed to attack. Every movement of t'ai chi is designed for defense."

RESPONSE: Sounds worthy of further study.

P. 287: M: "How long did it take you to discover your chi?"

MA: "It took me ten years to discover it. But it took me thirty years to learn how to use it."

M: "That's very discouraging to most of us, who don't have the discipline to do it."

P. 288: M: "You said it would take thirty years for me to discover my own chi."

MA: "When I said it would take thirty years, I was referring to the highest stage of t'ai chi. A person who practices for just three months in order to get rid of an illness is like a person who has only graduated from high school and doesn't go on any further in education. But even if you practice for only three months, you would see results."

P. 290: Eisenberg: "In Chinese theory, once you have learned to relax, to focus on your breathing, and to let go of all the thoughts, then you can actually find a spot in your body where your chi, your vital energy, begins. They call this the 'Dan Tian point.' It's a spot just below your navel. So when they say 'Find this ball at the Dan Tian point,' they are talking about a ball of energy which exists where chi begins in the human body. You concentrate on the ball of energy and learn to move it. That's the skill."

RESPONSE: I would assume that our working hypothesis would be that chi is a metaphor for feeling one's body and concentrating very intensely on its different parts. This would seem to be a useful technique as long as one doesn't confuse technique with reality.

P. 292: M: "Later David takes me to a doctor who was moving his hands in circles around a young man's skull, never touching a hair."

E: "This is the strangest and to me the most unbelievable form of traditional Chinese medicine. It's called 'external chi gong.' The notion here is that at an advanced level, people not only move chi in their own bodies but can emit it at will."

"This idea grows directly out of the basic theory of the body -- that the body is made up of channels through which the energy flows, and that this energy has to be in balance. If you can learn through physical and psychological exercises to control that energy, sooner or later you can learn to move it outside your body. That's what this doctor claims to be doing -- performing external chi gong therapy on this patient, using his energy to help redirect the flow of the patient's energy. There are thousands of doctors all over this country who make the same claim and millions of patients who would claim to have been healed this way. This one is Dr. Lu, the director of the chi gong clinic."

M: "And Dr. Lu is recognized as credible?"

E: "He trained in traditional Chinese medicine for six years in Shanghai, and he also studied Western medicine. So he is trained in all the techniques we've talked about -- acupuncture, herbs, massage, taking the pulse, looking at the tongue. But his specialty is training patients with every disease you can think of to use their minds to affect their conditions -- and also using this own mind, or chi, to affect their condition."

RESPONSE: Without systematic, consistent, extensive study, it is almost impossible to assess the power of suggestion on a human being. Hypnosis shows us that these effects are far greater than most persons realize. Most likely chi is all suggestion. However, controlled studies need to be done in the hope that there is in fact something more here.

P. 293: M: "How many years did you train in order to do this advanced chi gong?

LU: "Our training was for six years, and we studied both Western and Chinese traditional medicine. After graduation I went to the Chi Gong Research Laboratory. At that time our work was different from what we're doing now. Our major task then was to train patients to do chi gong themselves. Ten years later, however, we began to use the external chi gong treatment."

P. 294: M: "Why did you change to that?"

LU: "There was an old doctor named Zhao Guang who was doing massage treatments. A woman patient with cardiorespiratory disease came to him for treatment, and he thought it was impolite to massage the breast of a woman, so he did an external chi gong treatment at her breast. The patient was very happy and said she felt much better, and she was no longer suffering from discomfort of the heart. Since then, we have been studying external chi gong treatment.

M: "Were you skeptical of it at first?"

LU: "I didn't believe it at that time because I had been educated systematically in medicine. But we did a special clinical study, and external chi gong treatment proved to be effective, particularly with cardiovascular diseases, digestive diseases, and neurosis."

M: "But isn't there a placebo effect going on here -- the power of suggestion and the response of belief?"

LU: "This treatment, like any other medical measure, has its psychological effects. In human society, psychology cannot be eliminated from any branch of learning, so in this sense we say that chi gong is also under the influence of psychology. Psychological factors are especially important in the self-imposed exercises. However, our observations indicate that some effects cannot be totally explained by psychology."

"But we should be cautious about external chi gong. Some people don't understand it and want to do away with it. I think we should study it, but at the same time not exaggerate its effects of overestimate its power. It's not a cure-all. We should place it in its proper position -- not hold it too high or too low."

RESPONSE: One of the best ways to recognize when suggestion is a key factor in some phenomena is to change various components and see if the effect changes. When external chi gong proved to be as effective with the woman having cardiorespiratory diseases as regular chi gong that should have been a red flag. To me this indicates that suggestion is the only thing happening here (in regular chi gong as well as external chi gong).

P. 297: E: "Part of the difficulty in looking at Chinese medicine is that it's like going to medical school within the confines of a theological seminary. In the West, we separate religion and medicine. In Chinese medicine, the medical masters, the people who understood material things, were also the spiritual leaders. They never split the two. Imagine if Harvard Medical School were placed inside a large theological seminary, and classes were taught jointly. That's in large part what Chinese medicine is about."

RESPONSE: This would be the exact goal of a Science of Religion. Its aim would be to unite science and religion so that everyone would be working within the same world-view. And, that view is not only internally consistent, but all parts of it are congruent with external reality as it is known. In addition external reality is always under study. When more becomes known everything necessary is altered to maintain that congruency. Medicine as a primary social and individual concern would be impacted in numerous ways by this re-orientation.

P. 297: M: "Are you really talking about a spiritual discipline?"

SHI: "From its name in Chinese, Taoism sounds like a religion. But it's not a religion, it's a philosophy. Chinese culture has grown out of philosophical thinking: from two, there is bound to be three. Look, this is the index finger, and this next one is the middle finger. In between there is a space that is neither the index finger nor the middle finger. What is it? You cannot tell. That's why 'You can talk about the Tao, but it is by no means simple.' It is elusive when you want to define it. I can only say that it is a t'ai chi state, a state of harmony. The reason China is often called 'the Middle Kingdom' is because it has found this truth of the Tao."

M: "How do we learn chi?"

SHI: "By means of the basic training and by learning the way of thinking in the ancient Chinese culture. If you want to learn Chinese medicine, you have to read the I CHING, the book of Changes, which explains Chinese dialectical thinking. Over thousands of years, it has guided the development of Chinese civilization."

RESPONSE: Shi is clearly wrong when he thinks of Taoism as a philosophy rather than a religion. Although philosophy and religion have a great deal in common and one can shade into the other, philosophy is more nearly an intellectual pursuit while religion guides day-to-day living particularly for the common individual, the bulk of society. Taoism in fact guided the lives of the peasants of China as well as the rest of society.

Its reliance on the metaphysics of the I CHING and theories of creation such as Wang discusses below clearly make it a religion. Plus, it was in fact the agent of cohesion in China over thousands of years which as I point out is the essential element provided by a religion.

P. 297: E: "So what you imply is that we foreigners can also learn chi."

SHI: "Certainly. Chairman Mao used to say that Chinese medicine and Western medicine should be combined. China and the Western world should join together."

E: "This is to say that Chinese medicine and Western medicine combined is better than either of the two alone."

M: "China is quite a laboratory."

E: "It's a big laboratory. Millions of people are doing t'ai chi. What if you took the people who did t'ai chi but made the same amount of money and did the same work, and who were the same age and sex? If you studied both groups for ten years, would you find that people who practiced t'ai chi lived longer and got less cancer and had fewer colds? You know, China is a wonderful place to ask questions about mind and body."

RESPONSE: And such open-minded testing is essential. Certainly, the Chinese culture has many ideas and discoveries that a Science of Religion must consider. To the degree that a Science of Religion has value, it has just as much value for Chinese as Americans and every other people.

P. 299: M: "Somewhere along the way, we divided mind and body: they became opposites."

E: "But the Chinese never did that. There was no way to separate mind from body, because what we call the mind was part of the body. It was flowing in the body with the blood, and with the energy of the body."

RESPONSE: Although the Chinese didn't separate mind from body they also didn't separate mind/body from superstition. The ideas they have about how the mind/body works are only the speculations of the shaman enlightened by thousands of years of practice by brilliant, curious individuals.

Because they have taken a totally different path from Western thought they have explored realms we probably never would have. As a result there are gems of infinite value in their approach, even though that approach itself is as off-base as was Western blood-letting, non-sterile surgery, and other early practices.

P. 300: WANG: "The Chinese believe that before there was a heaven and an earth there was a chaos. This is also called the chaos of a light yellow tint. It was like the color of an egg yolk. Then it began to change, becoming left-right, bright-dark, up-down, male-female, yin-yang -- the pairs of opposites. In every part of the universe there are these two opposing forces. They're interdependent -- they can't exist without one another. You can't have one without the other. For instance, if you pick up a stone, the top is yang, or 'male,' and the bottom is yin. Even if you cut the stone in half, you still have a top and a bottom. So, according to this ancient philosophy, the universe is made of these two forces, and the struggle is in maintaining the balance between the two forces."

RESPONSE: These are interesting beliefs, but they have very little to do with how the universe really works. As I point out elsewhere (Chapter XVII, " Fuzzy Logic and a Science of Religion") opposites are not a feature of the universe, rather they are a description imposed on it by virtue of the way the human mind works. It is a limiting interpretation that ends up masking the true "way it is."

P. 302: WANG: "The purpose of our living is not to become famous or to make a lot of money, or to struggle so hard to get something that eventually we lose our lives. [But, rather] to have true health."

RESPONSE: The above would be completely congruent with a Science of Religion since I would define "true health" as a SFLIHM (a Sustainable Feeling that one's LIfe Has Meaning).

P. 306: E: "I think of the millions of people practicing chi gong and t'ai chi -- they have the illnesses I commonly see in my patients in Boston: migraine headaches, abdominal pains, chronic pain, insomnia. The Chinese tell me that these contemplative practices help their symptoms, but I wonder. When I'm asked the question, 'What do you think, Doc? Does it do the job?' I don't know the answer."

RESPONSE: Although I take it as a fact that these activities have a beneficial effect on those who practice them, I also would say that Eisenberg's assessment puts the thing in perspective. Their primary value is probably in providing a cohesive force in society. Any health effects come out of the benefits of practicing techniques to reduce stress, the feeling of intimacy resulting from being joined with others, and the placebo effect.

P. 306: M: "Is there anything here that might be useful to your patients back in Boston?"

E: "You know, I wonder about whether herbs could help reduce side effects for patients getting chemotherapy for cancer, or lessen the effects of steroids for patients with ulcerative colitis? I wonder whether acupuncture could help people who have had strokes to regain some of their function? I wonder whether acupuncture and massage could help people in America with low-back pain get back to work and feel better?"

"But to answer any of these questions, there has to be a marriage of Chinese medicine and Western medicine. Some people would see that as a shotgun wedding. But the two sides have to come together because the Chinese doctors are not trained in science. They don't know about control groups, or randomization and statistics any more than Western-style physicians know about chi. But the two will have to come together and look at hundreds of patients, randomly assigned to different groups, in order to figure out whether these things work predictably, and, if so, how."

M: "Every good marriage is trial and error over many years. So if we want to know whether Chinese medicine tells us anything about health that Western science can't, we have to scientifically test what the Chinese have done just as we would test any new drug before we brought it onto the market."

E: "Yes, if we apply what we know about designing controlled experiments, then someday we can answer that question. And if we don't, then I think the skeptical in the West have every right to say, 'We don't believe this. There's not enough evidence.'"

RESPONSE: This pretty well puts the thing in proper perspective.

P. 308: M: "Although traditional Chinese medicine feels alien to Westerners like me, I can see that it may have something to offer our practice of medicine. On the practical level it may give us treatments for certain diseases -- herbs, or acupuncture therapy for stroke patients, for example. But at another level it also seems to offer a different view of health -- that health is not just an absence of illness, it is a way of living."

E: "The whole Chinese medical system is based on the notion that the way you relate to other people, the way you think, and your emotions govern your health and illness -- what kind of life you'll have and what kind of death you'll have."

M: "Why do the Chinese grasp that in a way we don't? We don't look at our medical system that way. We want a cure."

E: "I think the entire Chinese culture is based on the notion that there is a correct way to live, and that how you live ultimately influences your health. It's not just diet or exercise, it's also a spiritual or emotional balance that comes from the way you treat other people and the way you treat yourself. That has always been the highest goal of living in all the Taoist and Confucian traditions. And since that's the basis of their culture, it spills over into their medicine."

M: "So there is an ethical foundation to Chinese medicine."

E: "Yes, the Chinese medical system is based primarily on Taoism, which claims that it's not just your physical well-being that determines your health, but also your behavior toward others. The doctor was part priest, part martial artist, part scholar, and part empirical scientist. But most of all, they were teachers. And they not only taught you about diet and exercise, but also guided you psychologically and spiritually to become a better person, because that would shape your health. The doctor tried to teach people the best way to live their lives."

RESPONSE: And this model is one a Science of Religion should adopt. A core assumption of a Science of Religion is that there is a correct way to live. The goal is to study individuals and study cultures to clarify what that way is and all the things necessary for its achievement by a given person.

P. 309: M: "Is that ideal [of traditional Chinese medicine] still alive today?"

E: "You know, we are talking about an ideal that developed two thousand years ago and reached its pinnacle probably four or five hundred years ago. Today physicians in Chinese hospitals spend most of their time with the practical applications of Chinese medicine: the herbs, the needles, and the pressure points. So some of the religious objectives are no longer discussed as much."

M: "Did the ancient doctors think that living in this way would contribute to longevity?"

E: "The ultimate objective of Taoism was immortality. Much of Chinese medicine is based on the notion of obtaining immortality -- the wise doctor was said to help you live for one hundred years. Chinese classics written twenty-four centuries ago say that 'in the old days, people lived to be one hundred, but now' -- that is 400 B.C.E. -- 'they are not in control of their spirits, their emotions, or their thoughts. They do not know how to find contentment within. For this reason, when they reach fifty, they begin to deteriorate.'"

"From its very beginning two thousand years ago, Chinese medicine said that what goes on in our minds influences our health. To us this is merely a hypothesis."

M: "You know, I think millions of Americans are ahead of your profession in the practice of mind/body medicine. They often go off into the superficial aspects of it, the pop psychology and all of that. But they're searching for something, and they seem to know that the mind has something to do with health."

E: "Yes, I think people in the West are beginning to pay much more attention to the way they live, the way they eat, and the way they think. Science often lags behind popular experience."

M: "But we are beginning to admit the possibility of a mind/body connection in our own Western medicine."

E: "I think in the last fifty years we have begun to accept the notion that thinking in harmful ways -- being chronically anxious or depressed, for example -- may lead to illness or increase your risk of heart disease. But what about the other side? What about the notion that if you become kinder, more thoughtful, or more relaxed, you can change your body positively?"

"In Chinese medicine, the idea is that your 'will' governs your chi, so that what you decide to do governs the energy in your body. Two thousand years ago, one of the most famous Taoists, Mencius, said, 'Where the will goes, the chi will follow.' Whatever you decide to do, the way you live your life, your convictions -- these will change your physical being and the organs in your body."

P. 310: M: "My goals in life, my intention."

E: "Right, and your desire or lack of desire. The Taoists believe that desiring too much or too little will harm you physically as well as mentally, emotionally, and morally. It's all a matter of balance."

M: "And that effects your body?"

E: "I think it's one of the most interesting questions the West could ask: Does your morality and intention really matter to your health? The Chinese, however, would not be interested in this question because to them, health was not limited just to one's physical health, but also included one's moral health. So, if you were physically strong but morally weak, you could not be considered 'healthy.' To us, this approach is a combination of religion and medicine. But to them, the way you lived your life and your physical health were inseparable."

M: "You're saying these people still see human beings as we were before Western knowledge broke us up into compartments, and separated the study of health into medicine and psychology and religion."

E: "Yes, we invented the notion that 'biology' and 'physics' and 'psychology' and 'psychiatry' are separate. But if we want to deal with health, and we're looking only at the chemistry or the emotional state, we have an imperfect glimpse. The patient sitting before me brings with him or her not only chemistry, but also family, relationships, emotions, and character. The distinctions we bring to a hospital in terms of mind and body are abstractions that we make. The patient is still a whole person, and to help him or her get better, ideally we would deal with all of these aspects -- the balance of a persons's life."

"If you put the focus on health instead of disease, you can begin to understand the Taoist approach. In the West, most medicine is defined from the point that somebody gets sick. Somebody has symptoms, or we find an abnormal laboratory test. We start looking at what's wrong, what's the pathology, what's the disease. We're dealing with a sick person."

"To the Chinese, health was viewed as a continuum. Even if somebody didn't have physical symptoms, the doctor would look at him or her and say, 'You could become healthier if you did the following.' The doctor might recommend herbs or massage or acupuncture or diet or t'ai chi or chi gong simply in order that the patient might go from a disease-free state to even greater health. The doctor's job was not simply to cure you when you were ill, but to help you reach your maximum health by helping you lead a more balanced life, hereby increasing your vital energy, or chi."

P. 311: M: "I wonder if that chi -- which no one has ever seen, or measured, or put in a vial, or held under a microscope to examine -- is anything like adrenaline?"

E: "I think the Chinese would say it's much much more than that. It goes beyond any one chemical. Chi is governed by the way you live and think. Your mind governs your energy. The question is, how do you translate that into Western scientific terms? How do you make people back home open to the possibility that the way you think alters you physically to the point that it can affect disease? And how do we use our modern scientific tools to test this possibility?"

M: "I admire the Chinese way of seeing us as whole human beings, but I have to say that the logic behind Chinese medicine is so complex as to make it inaccessible to Americans."

E: "I think you're right, but Chinese patients don't understand all the theory either. For example, it took a long time for me to learn about chi. In fact, it wasn't until I had been in the Chinese medical college for months that my teacher finally drove it home that the whole system is based on chi energy, and on the balances of yin and yang."

M: "We see that notion of balance in Chinese architecture, The spheres and circles and roofs of the temples come down in a balanced, symmetrical way, They even have names like 'The Temple of Perfect Harmony.'"

E: "The temple is symmetric, and it's supposed to fit into nature perfectly."

M: "Their architecture is based on philosophy and geometry, but is their medicine based on anything more than philosophy? Is it scientific?"

E: "Chinese medicine is scientific up to a point. I guess you could say that the basis is a kind of 'early' protoscience. To do science, you have to watch something, see a pattern, and then experiment with it. We call that empirical science. An observation leads you to a theory, and you test the theory over and over again. I think for the last thousand years Chinese doctors have done that. They have tried herbs, needles, and pressure points and have observed that in some instances those things helped individuals with particular illnesses. They've noticed patterns and used them, and that's empirical science. But that's not science of our standards today. In the last hundred years we've gone from that to a lot more sophisticated science. To satisfy my colleagues back home, you need more than just a few anecdotal case histories. You need to control an experiment. You need to give one group the right medicine and another group sugar pills and see if the medicine worked and the sugar ills didn't. You need to follow hundreds of people over time and use statistics to be certain you're not observing just a chance event."

RESPONSE: Moyers has focused very well in the above discussion that there are really two separate issues. One of them is the social, psychological, religious dimension in which medical treatment is prescribed for individuals within the context of a bigger system. The other is the issue of how beneficial is the treatment in curing the condition?

In the first realm Chinese medicine like all folk medicine does an excellent job. In the other realm of effective cures, the results are less certain. But these issues are critical to a Science of Religion and must be dealt with by it. Medical treatment within a Science of Religion must nest within this total system.

P. 312: M: "How did they come up with this particular geography of the body we saw them using in the hospital? They have meridians and channels of energy. We have nerves and arteries and all of that. Why the difference?"

E: "The simplest answer is that they didn't do any anatomical dissections. They never opened up the body. You see, in Chinese culture the body was viewed as the gift of one's parents and, ultimately, the gift of one's ancestors. To open the body through surgery or autopsy would be to deface the gift of one's ancestors. So their knowledge of anatomy never developed as ours did in the West."

RESPONSE: This explains a lot. And provides another yardstick for evaluating Chinese culture.

P. 314: E: [As a result of studying Chinese medicine], "I have...a deeper appreciation of the possibility that maybe the endpoint of life is not how long you live, but the way you live."

RESPONSE: And a Science of Religion would stress both. The way one lives would be a primary consideration; however, great energy would also be focused on learning everything possible about how to extend this as long as possible.

P. 317: M: "...I read the recent meditations of Arthur W. Frank, a medical sociologist in Canada, who was stricken at age thirty-nine by a heart attack and a year later by cancer. AT THE WILL OF THE BODY: Reflections on Illness describes how Frank and his wife came to see that their struggle was not against cancer but with the nature of life, to preserve the wonder of it against the shambles illness would make of it. 'When a person becomes a patient and learns to talk disease talk, her body is spoken of as a place that is elsewhere, a 'site' where the disease is happening,' Frank writes. 'Illness is the experience of living through the disease....Illness begins where medicine leaves off, where I recognize that what is happening to my body is not some set of measures. What happens to my body happens to my life...to me. Not it, but me.'"

RESPONSE: And this is the kind of orientation that is needed when one considers all aspects of living and their own life. Frank's work should be brought into the domain to be utilized by a Science of Religion.

INTERVIEWEE: "Michael Lerner, Ph.D., is founder and President of Commonweal, a health and environmental research center in Bolinas, California, and is cofounder of the Commonweal Cancer Help Program. Awarded a MacArthur Prize Fellowship in 1983, Dr. Lerner is a Fellow of the Fetzer Institute and a Policy Fellow of the Institute of Health Policy Studies at the School of Medicine, University of California, San Francisco. He served as Special Consultant to the Office of Technology Assessment of the U.S. Congress for the 1991 report UNCONVENTIONAL CANCER TREATMENTS." (P. 323)

P. 324: L: "...everyone with cancer who wants to live, hopes to be cured in some sense. But one of the most fundamental distinctions we start with is the distinction between curing and healing. Curing is what allopathic mainstream medicine has to offer, when it can, and that's what the physician brings to you. Healing is what you bring to the encounter with cancer and with mainstream medicine. Healing comes from inner resources. We make very clear from the beginning that this program is focused not on curing, but on healing."

RESPONSE: And this distinction is important to recognize because we normally focus so completely on being cured that we forget that death is inevitable, only the when is in doubt, and it is the quality of our living regardless of the circumstances that is the prime issue.

P. 325: L: "...the internal healing processes seem to have a tremendously difficult time with metastatic cancer. So we should start with the fact that if we look at all the people using all the different alternative healing methods with cancer, we find relatively few well-documented cases where people have fully reversed a cancer, and it has never returned."

RESPONSE: And at this point in time, society's focus needs to be on achieving a more complete understanding of cancer in all its aspects so that a cure is produced that we understand. At the level of the individual help needs to be focused toward exploring options, drawing on group support, and living the best life one can regardless of how long it is. Achieving a SFLIHM should be that individual's goal.

P. 325: L: "Different people come [to Commonweal] for very different reasons. This program has no ideology. We don't want everybody to leave here at the end of the week doing imagery, or eating a vegetarian diet, or doing yoga, or anything else. We have no agenda. Our essential message to people is that if you come here, we will provide you with a variety of opportunities to explore. Some of these will be cognitive, mental exploration, and some of them will be more experiential, psychological explorations. And we hope that you will find something of benefit to you."

M: "And by benefit, you mean..."

L: "By benefit we mean something that they will feel is useful. By the end of the week people have found things that make a profound difference in their quality of life. That's the most fundamental thing they've found. The words 'quality of life' are not adequate to describe the shifts that many people experience here in terms of their relationship with the cancer. You talked about how difficult it was to understand the distinction between curing and healing. Another important distinction is that between disease and illness. The disease is defined biomedically. But the illness is the human experience of the disease. There's a similar distinction between pain, which is the physiological phenomenon, and suffering, which is the human experience of pain. And, as we said, there's an important distinction between curing, which is the scientific, effort to change what's happening in the body, and healing, which is the human experience of the effort to recover. All of these distinctions can be listed under the difference between biomedicine, which is the scientific effort to cure, and what's called biopsychosocial medicine, or patient-centered medicine. Patient-centered medicine is based on the knowledge that it's not enough just to focus on the scientific facts. You also want to focus on the human experience of the disease, because the human experience may feed back into the biology of the disease in ways that we don't understand yet. That's why this is such an exciting field."

P. 326: M: "If I hear you, you're suggesting that there is a difference between the persons's experience of illness and the physicians's attention to that illness. What's the importance of that difference?"

L: "It's the difference between how you feel going through this experience of cancer and what the biopsy slide looks like to the physician. Now you many have a thousand women, each with an absolutely identical breast cancer biopsy, so that the disease is essentially identical for each one, but there may be a thousand different illnesses, a thousand different human experiences of what that's like, a thousand different relationships to that disease. Biomedicine intervenes entirely on the biological disease that it's making an effort to treat -- but it doesn't address the individual illness. I should say, by the way, that my brother's an oncologist, and that my father's life was saved by a great oncologist. I have enormous respect for biomedicine, and I see it as the great contribution of modern science to the treatment of disease. But what has been lost in that is the human experience of illness, which the ancient traditions of medicine addressed."

RESPONSE: For a Science of Religion it would be particularly important to distinguish between disease and illness, pain and suffering, as well as between curing and healing. These are useful distinctions to help focus on important differences between the human experience and the disease.

P. 328: L: "There's nothing magical about yoga. It's just a useful package of effective stress-reduction practices such as gently stretching exercises, deep-breathing exercise, meditation, and progressive deep relaxation."

M: "What do they have to do with the mind and the body?"

L: "They help quiet both the mind and the body. Doing progressive deep relaxation, tensing the muscles and than sequentially relaxing them, focusing on the breathing, and breathing deeply, watching the breathing, meditation -- those things tend to have a deeply relaxing effect. It doesn't have to be yoga. There are other exercises you could do as well. If you do gentle stretches, or progressive deep relaxation, or if you sit quietly and look inward, that's the equivalent of yoga. Yoga's just a word for a packaging of those things that came together and were refined thousands of years ago in India. Many health-promotion programs use it as a basic framework because it's an efficient way of accomplishing stress reduction. But sometimes the language gets in the way. People hear 'yoga,' and they think of some strange foreign practice. But if the word gets in the way, it should be thrown out and replaced by some other package of ways of relaxing the mind and the body."

RESPONSE: The foregoing interpretation is important because we are used to hearing these things discussed in the same way prayer is discussed in which there is a strong component of magic and unquestioning faith.

P. 329: M: "What do you think the ancients knew about the body that brought yoga into use as a healing instrument?"

L: "I don't know, but I think what is clearly true is that because they didn't have all the technologies, they paid attention to what they had. And what they had was their bodies, the natural world around them, diet, herbs, caring for people, imagery, and belief in God. It's interesting that shamanism, which is the old tradition of healing that comes out of all the great cultures around the world, is remarkably similar in many different parts of the world. Some researchers have suggested that shamanism touched some bedrock of human experience and that the reason it's so similar in different places is that people came to the same conclusions about what was helpful. In all those places you find some combination of ways of quieting the mind, and of going inward. The native healer will try to come into contact with the part of the self that the person is not aware of, and to elicit it, so that there's some possibility of consciousness and growth leading to a new perspective that might help with the illness."

M: "As I understand it, the native healers -- shamans -- had experienced suffering, illness, and pain themselves, and they shared with others what they had learned in those experiences."

P. 330: L: "That's right. They were 'men of sorrows and acquainted with grief,' in the words of the Christian tradition. Almost without exception, the shamans were people who had gone through a life-threatening illness and recovered. It was in that recovery that they found their mission of helping others. And by the way, it's very common for cancer patients to say to themselves, 'If I recover from this cancer, I want to devote the rest of my life to helping other people.'"

RESPONSE: Shamans provided a real service to the societies they served. What they brought has been excluded from Western medicine and must be brought back within the context of a Science of Religion.

P. 330: M: "What about the value of massage? It was obvious in watching the people here that massage was a part of the healing process."

L: "Massage goes back to the very ancient reality of touch. If a child gets hurt, what does the mother do? The mother says, let me kiss it or touch it or rub it and make it better. A lot of people with cancer have been touched only with medical intent for a very long time. Every touch has been a touch for a procedure. And also, very often, their bodies have changed. They've lost breasts or other parts of their bodies. So to receive loving touch, supportive, caring touch as well as the kind of touch that works out all the kinks in the muscles and just relaxes you -- well, again, it's just common sense. You're tense, and you haven't been touched in a caring way for a long time. Most cancer patients just melt at the idea of getting a massage. The massage is nourishing. It reduces the stress of cancer and reinforces that even the scarred body can be touched in a caring way."

M: "But the legacy of Puritan America has been hard to overcome. So many Americans think of touch as sex, and they think of sex as taboo, and then the mind begins to raise barriers to this form of nourishment."

L: "Absolutely."

RESPONSE: One cannot say enough good things about nurturing touch in all its forms. See Chapter IV for more on this topic.

P. 330: M: "What have you learned about the inner mechanism of healing from using meditation, and yoga, and touch? What insights have you gleaned about the connections between the mind and the body?"

L: "Well, there are two pieces to that. One has to do with the science of it, and the other has to do with the experience. Let me speak to the experience first, because that's what we work with here. At the experiential level we take eight people from very varied backgrounds who share in common only that they believe that if they came here for a week, they would benefit from it. We have found that if we do this combination of things intensively for a week, it characteristically produces very important and lasting shifts in people's experience of their illness. They will often say things like 'This is the most important thing that happened to me since I had the diagnosis,' or 'This is one of the most important weeks in my life.' Simply caring for people like that in a very intense way for a week, and providing a safe place for them to get together and share with each other the experience of cancer creates experientially transformative effects."

P. 331: "As to science, we've gleaned nothing about that because we're not doing the science here. But the people who are doing the science have found that many of the pieces that we use here have generally beneficial physiological effects on people, whether these stress-reducing activities have any effect beyond quality of life. Do they extend life? Nobody knows the answer to that yet, because that hasn't been adequately studied."

RESPONSE: And these procedures utilized at Commonweal do obviously have great benefit. It would be great if these graduates could then be incorporated into a CPASR where they would continue to receive loving support and possibly become part of an international effort to master cancer and all other diseases and human traumas. Their whole life would then be devoted to the achievement of a SFLIHM.

P. 332: L: "There's a very interesting scientific study by Lydia Temoshek, who looked at patients with malignant melanoma, which is a serious cancer. Temoshek looked at the difference between patients who expressed their feelings and those who didn't, and discovered that the ones who expressed their feelings had more immune activity at the site of their lesions. They also had thinner lesions than the people who did not express their feelings. Now again, that's only one study, so I don't want to make too much of it. But it suggests that expressing one's feelings and saying how one really is in the world may have a stimulating effect. That's the scientific side. But if we go back to the quality-of-life side, experientially, we all know that to sit on how we're feeling, and to not be able to be who we are in the world, is intrinsically less satisfying than being who we are. In this culture we are trained to suppress a lot of who we are in terms of our work, or our families, or whatever else we do, so that the opportunity to explore who we are is a very important aspect of authenticity."

M: "What do you mean, 'who we are'?"

L: "Well, there's a wonderful line from Goethe that goes something like, 'Whoever said that we have only two beings wrestling within us underestimated the number by a considerable amount.' We all have many, many facets that are jostling about inside us. The process of really coming to grips with all those different aspects of our personalities and beginning to integrate them and bring them forth is a life-long task."

M: "So if I feel deep and unrelieved fear over the diagnosis of cancer, that's who I am, and I need to express that fear. But if I don't express it, although I feel it, I'm pretending to be something other than what I am."

L: "I see what you're saying. If you feel deep fear with the diagnosis of cancer, which is absolutely natural, one of the things you can learn is that you may feel the fear, and it may be an aspect of you, but it is not your core self. But expressing the feeling or emotion that's going on for you right now clears the way for what may be next. You may have noticed how much laughter there is here. There's a lot of lightness and a lot of joy. And the laughter and the joy come mixed in with very intense emotions of pain and sorrow and anger. When you're able to express the fear and pain and the sorrow and the anger, then there's room for the lightness and the joy as well."

RESPONSE: I take Goethe's point to be supportive of the idea of an "I" as a multi-faceted construct. Providing guidelines and organization to integrate and focus all these facets so the interested person can achieve clarity and effectiveness is a core challenge for a Science of Religion.

P. 334: L: "...when you put the feeling out there and express it, there's a release, and the relaxation that goes with that release, and a sense of relief. You have a chance to step back from it and say, 'Ah, yes, I have that feeling, but that is not me. I'm beyond that.' So expressing your feelings is part of that movement inward, toward a core self where one can find some peace."

RESPONSE: And whatever beneficial effects this provides healthwise, it is a key aspect of a Wise Person. In a Wise Community one's feelings must not only be known to the individual, they must be shared and shared with the Community. There are no secrets.

P. 334: L: "People will sit around the room together and say, 'It's crazy that I had to get cancer to learn this stuff.'"

P. 335: L: "In theory, at least, in the East, people used to think deeply on these subjects [different aspects of meaning of life] before they became ill. But in the West, with our less contemplative tradition, it is often only when we become ill that we begin this journey of inner exploration that we might not have undertaken under any other circumstances."

RESPONSE: Hopefully, the efforts of a CPASR as it works to create a Wise Community will make thinking about meaning of life in all possible ways, more and more the norm.

P. 335: M: "I prefer our times to...ancient days, but I do think there is a kind of wisdom we have lost in our information and technology."

L: "The essence of much that we do here is to recover that wisdom and put it in a very commonsense, modern language that is completely accessible to people in our time, so that it can be integrated with first-rate mainstream medicine, which I would not give up for a quarter of a second. We need to bring that old wisdom together with mainstream medicine so that mainstream medicine can become humane and compassionate in the application of its technologies. I think one of the truly great tasks of our time is to make these technologies compassionate. As almost every American knows, sometimes the technologies of mainstream medicine are applied with enormous compassion, and at other times the technologies drive what's happening in a way that forgets what the integrity of the human being is. When that happens, the process is tremendously destructive. So the recovery of that wisdom and compassion, both on the part of the physician or the healer and on the part of the person with the illness, is one of the most important things we can do in medicine."

M: "Yet you're very emphatic that this kind of healing is not to be pursued at the expense of traditional medicine, and that traditional medicine has done some wonderful things in curing disease and extending life and relieving pain, so you don't give it up for this healing process."

L: "I'm profoundly emphatic about that. In fact, I will often find myself suggesting to cancer patients who have overlooked what mainstream medicine has to offer that they're not going to find in these healing approaches the curative potential that exists for many cancers in mainstream medicine. Sometimes I will have an idealistic person who believes that they are going to cure themself as well as heal themself just through diet and imagery and meditation and so forth, without using the mainstream medicine. And I will say to them, 'I've looked for ten years, and if I thought there was a cure for cancer among the adjunctive, complementary approaches, I'd be the first to say so. But I have not seen a cure for cancer there.' Now that does not mean there aren't case histories of spontaneous remissions. But it does mean that the complementary or adjunctive or healing approaches, which may support quality of life, and, potentially, extend life for some people, are not curative in any systematic way. In mainstream medicine you find a series of modalities that are demonstrated to be absolutely curative for some cancers. So to avoid those curative potentials is a very great mistake. I see the two as fitting together."

RESPONSE: And this seems like a key message that has to be understood by the individual if they are to avoid the errors of anecdotal, unsubstantiated stories and claims.

P. 337: L: "If I were to hazard a guess, I would bet that if the research is ever done, it will turn out that sitting on unexpressed emotions is not a good thing. But, on the other hand, I've looked at cancer therapies in Japan, where the expression of emotion is not necessarily a positive thing. So I think that large elements of culture enter into what is a healthy response to these situations."

RESPONSE: Very likely, and in the case of Japan I would guess that the Japanese culture in the form of meditation and similar practices provides a way to deal with these emotions in a relatively healthy way.

P. 337: M: "Do you find that people often blame themselves for their cancer?"

L: "Yes, and I think that's very unfortunate. One of the illnesses of the 'new age' is the view, 'I caused my cancer, I should be able to reverse it.' That's an incredibly simplistic and unfortunate attitude. We live in an age where cancer is essentially an epidemic illness, for reasons that have nothing to do with individual personalities. It may be that psychological factors in an individual life contribute to the multifactorial mix that caused the emergence of a cancer, but to say that you caused your illness because of some set of events or some way that you related to the world ignores all the other things over which you had absolutely no control."

RESPONSE: Plus, "new age" attitudes take ideas that have practically no science to support them and treat them as of higher value than procedures with years of study and supporting empirical data behind them.

P. 341: M: "How would you sum up what that experience [not knowing if he would live or die of a heart condition] was for you?"

L: "I experienced that life was incredibly precious to me, and that the things that mattered most to me were my son and my wife. Driving down a highway at night, just looking at the fog -- moment by moment, life was precious. I had that experience that so many people come here with, that the whole world has shifted and that they're seeing the world in a new way. It's an unfortunate fact that human beings learn through pain and suffering. If you ask yourself, have you learned most from the parts of your life that were easy, or the parts of your life that were painful, I imagine that like the rest of us, you've learned most from the parts of your life that were painful. Well, cancer is an enormous pain. And like every other pain, it has opportunity in it as well as suffering."

RESPONSE: The foregoing insight strikes me as a primary issue that must be confronted in all ideas about a Wise Person and a Wise Community. To attempt to live in a blissful cocoon would probably prevent one from becoming a Wise Person. But certainly pain for the sake of pain cannot be allowed. However, it seems to me being active in the world and dealing with it has adequate opportunities to confront pain, overcome it, and utilize it in rising to a higher level of understanding and living. But the ability to do this requires a foundation of sufficient joy and pleasure so that learning is possible.

INTERVIEWEE: "Rachel Naomi Remen, M.D., is founder and Director of the Institute for the Study of Health and Illness at Commonweal and the cofounder and Medical Director of the Commonweal Cancer Help Program in Bolinas, California. Dr. Remen maintains a private practice in behavioral medicine, specializing in the care of individuals and families with life-threatening illnesses. She has served on the faculty of the Stanford Medical School and on the clinical faculty of the School of Health Sciences, University of California, Berkeley, and the School of Medicine, University of California, San Francisco. Dr. Remen is author of THE HUMAN PATIENT." (P. 343)

P. 320: REMEN: "'One of the greatest gifts you can give another person is your attention.'"

RESPONSE: Definitely. And this point provides some guidance to focus our behavior.

P. 320: M: "I asked about the danger of romanticizing illness. 'There is nothing romantic about illness,' Remen answers, and even as she speaks, I remember that this woman has had major surgery seven times. 'Illness is brutal, cruel, lonely, terrifying. You have to understand that anything positive that emerges out of a real illness experience is not a function or characteristic of the nature of illness but of human nature. People have the natural capacity to affirm and embrace life in the most difficult of circumstances, and to help each other despite their circumstances.'"

RESPONSE: And these two points should always be close to our consciousness. The human capacity for nobility, for magnificence, for meritorious actions and our ability to bring these capacities to any experience so that we come out of it better at some deeper level is critical to what it means to be a Wise Person. And, it is also critical to understand that anything of merit that comes out of illness, pain, suffering could undoubtedly have been achieved in other less painful ways under better circumstances.

P. 344: R: "Healing is different from curing, you know. Healing is a process we're all involved in all the time. It's very close to the process of education. 'Educare,' the root of 'education,' means 'leading forth, wholeness, or integrity.' Healing is also the leading forth of wholeness in people. Sometimes people heal physically, and they don't heal emotionally, or mentally, or spiritually. And sometimes people heal emotionally, and they don't heal physically."

RESPONSE: And the goal of a Wise Community is to find ways that lead to healing in all areas.

P. 344: R: "...it's our woundedness that allows us to trust each other. I can trust another person only if I can sense that they, too, have woundedness, have pain, have fear. Out of that trust we can begin to pay attention to our own wounds and to each other's wounds -- and to heal and be healed."

M: "I've seen that. But despite what happens here, they leave with the same cancer they had when they came."

R: "It doesn't take the cancer away. It takes the fear away. And when the fear is taken away, people are empowered to deal with whatever they need to deal with and to seek and find meaning in the events of their lives. Being here opens up opportunities for people to be listened to, and heard, and validated. They're not stuck anymore. If you ask, 'How does that happen?' I have to say that I'm not sure -- but it does, and I trust that. I think the greatest thing you can ever give someone else is your attention -- not with judgment, but just listening."

M: "But you know, if I had come to you in your life as a medical doctor, and you had told me I had cancer, I think the greatest gift you could have given me would have been to cure me."

R: "It's not always possible, Bill. We don't know how to do that with everybody. For example, for thirty-six years I have had Crohn's disease, which is an autoimmune disease of the intestine and the joints. I was fifteen when I first became ill -- and after several operations, I don't have most of my intestine anymore. I think I would fairly say that without the doctors and nurses who helped me, I would have died. And I'm grateful for that. But if I had had only the surgery and the medications, I would have been an invalid. As a matter of fact, when I was first diagnosed, I was told that I would have multiple surgeries, that there was no cure for this disease, and that I would be dead by the time I was forty."

M: "Do you remember the feelings you had when you learned at the age of fifteen that you had Crohn's disease?"

R: "Yes, I do -- and they're very much the same feelings that many of the people who come here feel. You feel separated from the whole human race. You feel as though you're looking at the world through plate glass. You can see other people, but you feel as if you can't touch them or be with them, because you are different."

M: "That's loneliness."

R: "Yes. And that's what most people who come here talk about. They say that the sense of isolation, of being separated from people who are well, is as painful as chemotherapy, as cancer itself. They feel that other people don't want to listen and don't understand. I think it weakens people to feel isolated."

M: "How did you get rid of your loneliness as a fifteen-year-old girl hearing that you had a devastating disease?"

P. 346: R: "I'm not sure I have gotten rid of my loneliness. I've just invited a lot of people into it, to be there with me. I think, ultimately, being a human being is a very lonely thing. But powerful things happen in the midst of that loneliness. It's not what we do that makes a difference, but what we allow to happen. There is a natural process that moves towards wholeness in me and in every human being. Chris, the woman you were talking to, said that cancer has ultimately healed her sense of loneliness. I think what she means is that the process of being deeply wounded in this way has made her able to open herself to the love that is around her and that was always around her. This disease, in showing her deep vulnerability, has given her the gift of humanness."

M: "But isn't the best thing a doctor can do for people who are ill is fix them?"

R: "If it's possible, yes. We all want somebody to take away our pain. But there are limits to what technology can do. And not everything is fixable."

M: "But what about your own experience? The surgery fixed you."

R: "No, it just gave me another set of problems to live with. We don't fix the people who come here, we simply offer them an experience which allows them to explore who they are as human beings and get in touch with strengths they didn't know they had, and to see themselves and their lives differently."

P. 347: M: "Let's talk about some of those techniques. You use imagery a great deal. Why do you ask people to imagine, to visualize?"

R: "Well, you know, the visual is only one way in which we imagine. We usually trust one of our ways of perceiving and processing the world more than others. Some of us are visual, some auditory, some kinesthetic. For example, I'm not a visual person. My experience of you is not what I see but what I hear or sense about you. And forty percent of people are like me in not being primarily visual. These are the people who come to Commonweal and think they 'can't do imagery' because they can't visualize. And yet imagery, like healing, is part of everybody's birthright as a human being. We all do imagery -- but in our own way. Even worry is a form of imagery."

M: "You mean when we worry, we are imagining?"

R: "Absolutely. Once a man came to my office who had the same disease I have. I asked him, 'How many times have you had surgery?'"

"He said, 'Oh, ninety-three times!'"

"'Ninety-three times!'"

"'Yes,,' he responded, 'but only three of them actually happened.'"

"You see, that's more than just a joke. What we imagine, we experience, and what we imagine affects us. It affects our immune system, and our strength, and our optimism. So we need to take control of our imagination and use it for our well-being."

M: "And that's what imagery helps us to do."

R: "It can. Imagery is the way the mind and body talk to each other. That's why Olympic athletes often have imagery coaches to help them to imagine their optimal performances and thus improve their actual performance."

RESPONSE: Dr. Remen provides many important insights in her above discussion that not only apply to health but to the whole of life. The different kinds of imagery and its proper use -- recognition of how it can produce negative effects as well as positive effects -- is one. Also, the experiences and insights that resulted from her own health problems are very useful.

P. 348: M: "...the poetry writing is about expressing uniqueness?"

R: "Yes. You know, it's ironic that I should have introduced poetry to the program, because I don't like poetry, basically. I hated it in school. It always seemed to me to be pretentious, with references to the Greeks and that sort of thing. I never understood it. And then I came across a certain kind of poetry that was different -- the poetry of Wendell Berry, for example, who is basically a farmer. A lot of his images are from his daily experiences, and they're very powerful. His images are of common, personal experience -- things that are true for him. So we started writing that sort of poetry here as a way of helping people listen to the part of themselves that knows what's true for them and speak that in a simple and real way."

"And when we started writing poetry together as a group, people's first response was that they didn't know what was true for them. What they really meant was, they don't know what was right. Everybody knows what's true. What's true is whatever is happening right now. It comes directly out of our experience of life: it's 'I'm confused,' or 'I'm scared,' or 'There's nothing happening inside.' We do a little relaxation to help people catch a poem. 'Close your eyes, and with each breath in, just begin to move closer inside, to the part of yourself that knows what's true for you, and just listen. And let yourself know something that is true for you about illness or life or death or love, or whatever. Write it down as simply as you can, and then we'll read it to each other.'"

"My sense is that creativity and healing are very close to each other, in some way that I really could not say too much more about. At first most people don't believe they can write poetry. They'll say, 'I can't do this,' or, 'I'm not good at this.' There's some way that our culture has caused us to become alienated from the intuitive and creative in us, perhaps by calling up in us some habit of judgment. We're supposed to produce something perfect or professional. But we help people reclaim this healing, creative part of themselves by having them write poetry. And you know, we've never had anybody who couldn't write it."

M: "So what do you think is happening to them when they're writing poetry? Are they getting out what they really feel inside is true?"

R: "Maybe what they know inside is true. And when people speak their truth in this way, it's highly personal, but it will be true for everybody. It's from the place where we all connect, our common humanity."

"I was thinking about what was for me the absolute high point of this retreat, and I think it is in the many moments in which people show themselves in the beauty of their own humanity. One day, while your crew was filming here, we were reading our poetry to each other, and the cameraman couldn't go on. He put down the camera, and he started to cry. That was a wonderful moment of great healing for everybody because it made clear that there really is only one group. He was as human and as touched and as vulnerable as anybody there. He tried to cover it over, but one of the participants wouldn't let him. She said to him, 'Wait a minute, what happened for you?' She invited him to tell his story, and he started to cry again, and said he just felt very intensely how fragile life was and how precious. He was thinking about his wife and his children and how he loved them."

RESPONSE: Connecting to our common humanity is the first challenge of every human being. Those who do not achieve this step lose their own full humanity and live a rather truncated life. Sharing our true self with others who respond with appreciation and sharing of their own humanness is one of the keys to open the door of a SFLIHM.

P. 351: M: "Zorba the Greek said, 'Life is trouble. Only death is no trouble.'"

P. 353: R: "I once read a dissertation about the dreams of pregnant women. Many of the dreams were terrible nightmares filled with anxiety and fear and loss. But the study showed that the women who had the worst nightmares had the easiest deliveries."

RESPONSE: Research like this when joined together with everything else provides the raw data to put together to develop a congruent understanding of everything. Since we don't understand the role of dreams, and therefore nightmares, it is very difficult to know what to make of them. But recent research and insights provide the possibility that we will soon start to understand what dreaming is really for.

P. 354: R: "Healing may not be so much about getting better as about letting go of everything that isn't you -- all of the expectations, all of the beliefs -- and becoming who you are. Not a better you, but a realer you."

M: "But my expectations, my fears, and my beliefs are all part of me. They are as much me as my hands."

R: "Not true. You were born with your hands. You weren't born with your beliefs. Some of your beliefs may help you to live, and some of them may not. And you need to be able to sort them out, because only the ones that are true, only the ones that can help you to live, are the ones you want to keep."

"Let me give you an image. I bought a little falling-down cabin on the top of a mountain. It was so bad that when Michael Lerner came to see it, he said, 'Oh, Rachel, you bought this?' But with two carpenters, an electrician, and a plumber, in three years we have remodeled the whole thing. We started by just throwing things away -- bathtubs, light fixtures, windows. I kept hearing my father's voice saying, 'That's a perfectly good light fixture, why are you throwing it away?' We kept throwing away more and more things, and with everything we threw away, the building became more whole. It had more integrity. Finally, we had thrown away everything that didn't belong. You know, we may think we need to be more in order to be whole. But in some ways we need to be less. We need to let go, to throw away everything that isn't us in order to be more whole."

M: "I understand you, but at the same time I don't want to throw away more years. If I have an illness that you can treat, I expect you as a doctor to extend my life."

R: "And if I'm lucky, I'm going to be able to do that, too. All doctors feel a very great satisfaction in being able to do that. But you know, extending life isn't the highest goal, because people can live miserable lives for long, long periods of time."

M: "It's true that extending life is not always the highest goal, but there is this will to live. I want to live, and I want to live as long as I can."

P. 355: R: "I think that's too low a goal. Of course you want to live as long as you can, but don't you want to live well?"

M: "Yes, of course."

R: "It's interesting that many of the people here this week have survived a terrible childhood. Now all of us have done certain things in order to survive, and survival is about living longer, right? But I think what has to happen for people at some point in their lives, and what certainly is happening for all the people who were here, is that many of the things we've done in order to survive are different from the things we need to do in order to live and live well. For example, perhaps my childhood taught me that in order to survive I had to become voiceless and invisible so that my alcoholic mother never noticed me. But in order to live, I need to re-own my own voice and its validity. Or, in order to survive, I had to trust no one. But in order to live, I need to trust enough to love and be touched by other people."

"You know, touching is a very old way of healing. We don't touch each other in this culture, and touching is often misunderstood or even sexualized. As a physician, I was taught that you touch people only to diagnose them, and if you touch them in any other way, even in a comforting way, they may misunderstand. And yet, touch is the oldest way of healing. Touch is deeply reassuring and nurturing. It's the first way a mother and child connect with each other. Many people with cancer will tell us that they're often touched as if they were a piece of meat. One woman said, 'Sometimes when I go for my chemotherapy, they touch me as if they don't know anybody's inside this body.' And so we try to touch people with the tenderness of a mother touching a child, because what a mother is saying to her child with that touch is 'Live.'"

M: "And 'I care about you.'"

R: "Yes -- 'Your life matters to me.' That is enormously important. The opposite of love is not hate, but indifference. Many people tell us that they experience being touched with indifference when they go to hospitals. I don't think it's really being touched with indifference when they go to hospitals. I don't think it's really indifference, by the way. A certain percent of the people in my practice are doctors who are burned out. They've seen so much suffering and pain they can't fix, they can't feel anymore. They are numb. And if I'm your doctor, and I feel numb, you may experience me as indifferent. But I've become numb because I care too much. We have to learn how to train people so that they can do this work with their hearts wide open. That's a real challenge."

"But let me go back to the touching issue for a minute. Years ago, when I was associate director of the pediatric clinics at the Stanford Medical School, one of my colleagues, Marshall Klaus, did a study which at the time was extremely innovative. He was chief of the intensive care nursery, where all the babies were these tiny little people you could hold in your hand. Each incubator was surrounded by shifts of people and millions of dollars worth of equipment. Everything was very high-tech. Of course, we didn't touch these infants because we'd get germs on them. But Klaus decided to do an experiment in which half the babies in the nursery would be treated as usual, and the other half would be touched for fifteen minutes every few hours. You'd take your pinky finger and rub it down the little baby's back. And we discovered that the babies that were touched survived better. No one knows why. Maybe there's something about touching that strengthens the will to live. Maybe isolation weakens us."

P. 356: M: "Do you really believe there is a will to live?"

R: "Yes, I do."

M: "Can it be evoked?"

R: "That's the question. I think that's what healing is -- evoking the will to live."

RESPONSE: And certainly that will to live is tied into nurturing touch and caring concern from other people we care about. Learning who we really are is the essence of the process for becoming a Wise Person. Throwing out all the erroneous, destructive, misleading ideas that get in our way and prevent us from growing is necessary. However, we can only do this within the context of a supportive environment of others who share this goal.

P. 358: R: "I really worry about people who get cancer and don't get angry, because I feel that somehow they're not holding to life, they're not engaged with life, or they're not passionate enough about life. When I was working in hospitals, they used to send me around to visit people with ileostomies, because I have an ileostomy, and it helps people to meet somebody else who is living with an ileostomy, when they've just had this surgery. I'd walk into these rooms, and I would feel whether or not the person was angry. And if they were not angry, I would be concerned that somehow they had become resigned too much, in a strange kind of way. Anger is a demand for change. Many people initially experience their strength through anger -- just as I did."

RESPONSE: Remen believes that the proper response to serious disease is anger. This strikes me as far fetched. But research on the matter would be necessary to clarify the matter.

P. 358: M: "We know of many angry people who live and many cheerful people who die."

R: "Yes, and the reverse is also true. There's no formula. I don't believe in positive emotions. I think all emotions can be positive."

P. 359: M: "I don't understand that."

R: "Perhaps positive thinking is not the same as positive emotions. You know, when people first get a diagnosis of cancer, they often run out and buy a hundred dollars worth of books about what you need to do in order to live and what you mustn't do or you won't live. People talk about how love and cheerfulness and optimism are positive emotions, and sadness, fear, and anger are negative emotions, and negative emotions are dangerous. But my experience is that all emotions, to the extent that they engage you with life, are positive. For example, the person who feels sadness at the thought of losing her breast -- well, life is precious to that person. I'm very suspicious of people who say, 'Oh, well, you know, what's a breast?' That doesn't feel real to me. There's almost a tyranny of the emotions now where people are afraid to feel their feelings because they think that if they feel certain 'negative' emotions, their cancer will get worse. People are called upon to edit themselves."

M: "Have you learned anything from your experience, or your own illness, or from the retreat, about who gets sick and who doesn't?"

R: "It's an absolute mystery -- which is very frustrating for those of us who would like to be in control. You know, once a year we invite professionals who work with cancer to come to Commonweal for a little R & R. While they're here, they often talk with each other about the things they really don't understand, even though they've spent years working in this field. What often comes up is that there isn't a simple formula. There's a lot that is mysterious here. People who intensely want to live sometimes don't, while people who seem to be very negative, will. As we do retreat after retreat, we discover that all our cherished beliefs get taken from us by the experience itself."

RESPONSE: Sounds like it would be accurate to say what all the experts are saying, we don't yet understand the underlying factors and mechanisms that cause cancer and are involved in its cure.

P. 359: R: "There's no way to be alive and avoid pain and loss and suffering. It's all part of life."

RESPONSE: And taking pain as part of life and learning how to fully incorporate it into people's lives is the challenge of a Science of Religion. Dealing with pain in a constructive way that allows the individual to maintain a SFLIHM is one goal of a Science of Religion.

P. 361: R: "My sense is that all power comes out of the ability to accept what is. Acceptance is what allows change."

RESPONSE: A Science of Religion is about understanding the universe and dealing with it as it is, not as we would want it to be. However, we also accept our ability to produce change and the goal to understand what change is desirable and what is not.

P. 361: "Several of my patients have had near-death experiences. In one case, the woman told me that she came away from that experience with an awareness that the purpose of life was not about being a doctor or a mother or creative or smart or rich, but to grow in wisdom and to learn to love better. And that's all."

RESPONSE: I can't agree that growing in wisdom and learning to love better is all. The WAYS include other matters. However, I would agree that the foregoing sums up very well what is needed to start on the path toward achieving a Sustainable Feeling that one's LIfe Has Meaning.