This question is about ‘real’ or ‘final’ meanings of illness. Other questions hunt closely behind it. For example, how can a meaning be verified or secured?
What we do see with patients, when we listen to them carefully, is that variants of the same meaning, or theme, keep reappearing. Thus the patient keeps verifying that the meaning that is surfacing is important because it keeps surfacing. More than that, once a clinician becomes adequately aware of a surfacing theme, and reflects it back competently and generously to the patient, the resonance with the patient is often dramatic, because it makes deep sense to the patient. And then if this results in mobilising action in and by the patient, with relief or disappearance of symptoms, we then have further confirmation that this meaning or theme is deeply relevant.
But what we do not say is that it is the exact meaning per se that is crucial. Healing cannot be simply relegated to the expertise of the clinician as a ‘meanings detective’. I know clinicians who pounce on meaning but do not have healing results, though it is probably the pouncing that is the problem! It is of course tempting to take the positivist route and imagine that if we can get hold of the right meaning (like getting hold of the right bacterium) we will be on the fast track to diagnosis and treatment. My experience of trainees is that their natural tendency to get excited about perceiving meaning is not usually matched by an increase in efficacy, if ‘smart’ ascertainment of meaning is the limit of their focus.
Many patients who truthfully examine and acknowledge their own stories around the time of the emergence of their symptoms come to realise that changes of one sort or another, internal or external, do need to be made, and with these changes healing may emerge.
This leads to another important question, whether the emergence in the consultation of meanings that are relevant to the patient, and perceived by the clinician, allow the opening up of a sense of understanding, rapport, and intimate transaction which mobilise healing dynamics. If perception of meaning is accompanied by non-egotistical empathy, willingness to go with the patients to dark places, and shows an ability to hold these elements along with ordinary orthodox instrumental and bodily elements of practice, then ascertainment of meaning becomes remarkably effective in many cases.
On the other hand, healing processes are not easily mobilised when we are inaccurate about meanings. Meanings are deeply personal and constitute person-hood in so many ways. Therefore if we radically fail to understand a person we are in danger of jeopardising any kind of care.
The whole person approach does not allow a reduction of everything to meaning. What the focus on meanings, themes and symbolic manifestations shows is that subjectivity is a crucial element in disease (including the predisposition to, triggering, and development of disease); it does not imply a swing to a new reductionism, or to a new positivism i.e. finally securing the subjective ‘truth’.
There are other ways of considering meaning. The early 20th century iconoclastic German physician George Groddeck, in his book The Meaning of Illness, wrote that patients should consider illness as a warning not to continue living in the manner they had been living. I would not make that into dogma, because as in all things life is too complex for simplistic formulations. But there is an element of truth here. Many patients who truthfully examine and acknowledge their own stories around the time of the emergence of their symptoms come to realise that changes of one sort or another, internal or external, do need to be made, and with these changes healing may emerge.
Brian Broom
