jeudi 11 octobre 2012
The Phenomenology of Perception: The Importance of Context in Clinical Medicine
I minister to poor people with Chronic Diseases in many remote areas, in clinics with good support from colleagues.
On this visit to a remote part of the USA, I was grateful for my Medical Anthropological training, because I could minister them, not as an Allopathic Physician, but as Clinically oriented Medical Anthropologist who understands CONTEXT…
In 1948, the French philosopher, Maurice Merleau-Ponty gave a series of lectures broadcast over French Radio on the World of Perception. (His well-known work is Phenomenology of Perception)
This is how he opened his lecture series”:
The world of perception, or in other words the world which is revealed to us by our senses and in everyday life, seems at first sight to be the one we know best of all. For we need neither to measure nor to calculate in order to gain access to this world and it would seem that we can fathom it simply by opening our eyes and getting on with our lives. Yet this is a delusion.
Most of us were trained in the Cartesian dualistic tradition of Medical Sciences where we look at the body as if it exists in a vacuum, and dysfunction within it can be treated with our bags of goodies as if it is a vehicle in need of repair. This is the mechanistic view of the Body that is held dear by many of the medical practitioners in the west.
We have taken Philosophy out of Medical Practice, and it is a loss for Doctors but more importantly for the patients. What use is your knowledge if it cannot be used to solve the problem as perceived by the patient, as felt in his body?
Every single patient that I saw, I could attribute their situation, better or worse, to a change in the social situation in their lives. None of the “successes” could be attributed to the treatment alone, but of course for an observer who is not aware of the social context, the perception would be that it is the medications that has made them feel better.
A 70 year old, who had endured a bad marriage for 28 years and an abusive relationship for another 18 years, after one comforting session, returns with spectacular results in her laboratory tests denoting her self-perceived sense of wellness. Was there any change in medications? No. Changes in Diet? No. Changes in her activity patterns? No.
Twelve days after our discussion, I decided to move out of the house with a stressful ambience and move into my own trailer. I did that on a Saturday and by Tuesday morning, I was already feeling better.
Another who had been unemployed for one year, has a promise of a job, just that hope had her feel better, better than what she had felt in the past year, the tests showed an improvement of her chronic condition. Once again cannot be attributed to medications.
A young man with Elevated Blood pressure comes in for a chat; he is a friend, an artist and an excellent athlete. His doctor has been trying to control his Blood Pressure by adding medications, some of which he declined to take.
He sat down and as is my custom, I began asking about the family: there flowed the tension his body was under: caretaker to a child that needs full time attention, pain in his knees that made him alter his sociocultural activities, concern about a daughter slightly off course. He needs medications and more of the same is not the answer but a sympathetic ear to his daily struggles.
One after another, they were teaching me, the fallacies about sugar free candies, coffee mate artificial creamer used for coffee, “vegetable” oils, the patchwork medical care offered to the poor in America.
I felt proud to be their physician, grateful that I have the opportunity to learn from them, and remembering what Delacroix had said: relieving the suffering of others…
What you see is not what is present, especially if you view with a pre ordained mind, keeping the eyes open, let the mind absorb the perceived and the reality…
Every one would be better off with it.
What can I do for that young man? an artist, an athlete and with the stress and Hypertension?
I told him that I would tell him more about Pranayama, and teach him some techniques a friend of mine in KL taught me.
and also, as a recent graduate from my alma mater in London reminded me: I will introduce him to Jon Kabat Zinn and Mindfulness Based Stress Reduction.
Now to think of my Little Island and the love and affections waiting for me there..