What medicine can learn from art | Lucie Wilk | TEDxAylesbury


Translator: Linda Anderson
Reviewer: Denise RQ Can imagination and art
bring us closer to truth than science? Well, I studied medicine, so I was raised on a diet
of empiricism, rationalism, and reason, the bedrocks of knowledge,
or so I thought. Until I strayed from science a bit, and had a little fling
with writing fiction. And that fling turned into something
a little more long-term, and I became a novelist. And, in this process,
something shifted in me. And it seemed to me,
and it seems to me now, that science, with its focused beam of objectivity, excludes what’s in the periphery,
the less tangible aspects of life. And art has a wonderful way
of bringing these elements into relief. Let me give you an example of what I mean. I received some feedback on a new novel
I’d been working on recently. And it turns out I’d made
a classic mistake. I had written a passive protagonist. My main character had no agency. Now, readers intuitively know
that this is unrealistic. A character cannot be passive
to the drama unfolding around him, simply because it’s not true to life. And here is where literature
unveils a deeper truth: that agency is an essential ingredient
of the human experience. We need to know that we can take action
and effect change in our lives. If this is missing from a book,
it will lead to loss of interest. If this is missing from a life,
it will lead to despair. But this essential truth
is forgotten in, of all places, the world of healthcare. As a doctor, I work in an environment that is essentially designed
as a really badly written novel. Passive protagonists abound,
thanks to me and my colleagues, who educate patients to give up
their agency and to submit to their care. Whether they’re being asked
to accept a diagnosis, or an intravenous treatment, or to swallow the tablets
placed before them. Patient passivity is a byproduct
of the new healthcare paradigm. And I see this,
the removal of patient agency, as one of the most disturbing
new realities of conventional medicine. Well, it’s clear how we got here. We got here
because medicine is not an art that deals with the soul
of human experience; medicine is a science,
and it deals in the mechanics of illness. And if science were to have
a slogan, it would be, “Science: if it isn’t matter,
it doesn’t matter.” Clearly, in this sort of paradigm, fluffy concepts like personal
agency have no role. At this point in our cultural evolution,
science has become the alpha male. It muscles its worldview around
as the only one worth respecting. For a long time now, science has dominated,
and art pushed to the fringes. And it has left us
with this very lopsided dichotomy, where science is about knowledge, which is more important than art,
which is about imagination. Science studies the physical world,
the world of proof and certainty, more important than art, which plays in the space
of the ephemeral and the uncertain. Science explains the Universe, whereas art
simply experiences the Universe. Now medicine, as a scientific discipline, of course must obey
that matter-based mantra. And of course, it has also
brought us a very long way. It has brought us a clear understanding of the cellular and molecular
mechanisms of the body, and it has enabled life-saving treatments,
both pharmaceutical and surgical. But the hard mechanics of this paradigm continue to push
the soft ephemera to the sidelines. And this has resulted in a separation
between our true sense of self, that nebulous sense of personal identity
that doesn’t have a physical home, and our physical
sense of self, our bodies. And I feel that this separation
is dangerous and disempowering. I met with a new patient the other day:
she came in with her husband and both of them were terrified
of the changes in her body. Illness is, in many ways,
like a random act of violence. It is like returning to find your home
burgled and ransacked. The many personal symbols of your life
either lost or forever changed. Overnight, my patient’s joints
had become swollen, stiff, and painful. She was overwhelmed with fatigue. She struggled to do the things
that she had done without thinking. She struggled to get out of bed,
to get dressed, to cut her food. She had developed rheumatoid arthritis. I explained the diagnosis
and the treatment, which involves strong,
and sometimes toxic medications that she will probably need to take
for the rest of her life. My patient said, “Thank you very much
for all this information. I have just one question. What can I do, what can I do in my life
to get myself better again?” She wanted to know how she could clean up her ransacked home
and make it familiar again. Well, if I followed the dictums
of evidence based medicine, all I can offer her is the advice
of a healthy lifestyle, which she was already undertaking, and the advice to take
the medications I had offered her. The subtext to this conversation is that ultimately,
there is not much she can do. She is a victim of her biology, and she must learn to live
in this new, damaged home. Violated first by illness,
and now by medication. The only potential treatment is through tinkering
with pharmaceutical spanners, something that is entirely in my control,
and entirely out of hers. Her agency has efficiently
and effectively been removed. I feel this is deeply wrong. In doing this, we separate
the person from their body. We drive a stake through their natural
sense of being in this world. We do this justified by scientific truths. But, is this the whole truth? One of the fallacies
of the scientific method is the publication of certain truths
and the casual shelving of others. Is it possible that we are doing this
on a grand scale by focusing on the mechanical
aspects of human nature and ignoring the ephemeral? Are we really just biological machines, that once broken,
can only be fixed by drugs or surgery? Do we really have less control
over our biological homes than we do our brick and mortar homes? And what about that aspect of life
that science continues to ignore because it can’t be quantified? This rich, inner world of ours, the world of imagination,
and belief, hope, and fear? Is world of the mind
truly disconnected from the body? Well, this is what the scientific dogma
would have us believe, but I feel it’s time to challenge this. And I would like to walk us
through a little exercise. Just imagine
that you are waiting in the wings, somewhere over there in the dark,
waiting for your name to be called, so that you can walk out
onto this stage, this red spot here, and speak to an audience. Might this situation provoke
a change in your body? Well, I can attest to the fact that there is quite a vigorous
physical change. A flood of stress hormones are making me feel like my heart
is pumping up in my throat, my hands are cold and clammy,
my mouth is dry, I’m queasy. I think we’ve all been there
in one way or another. But, what provoked this physical change? It was a thought, wasn’t it? It was the thought of speaking in public, a concept living entirely in my mind. The thought of public speaking
is the modern day equivalent of the thought of a saber-toothed tiger
hiding in the bushes. The fear primes the fight-or-flight
stress response which has evolved to increase
our chances of survival if there is an immediate
threat to our safety. But here on this stage, on this red dot, there is no threat
to my safety, I don’t think. There is a threat to my sense of self,
a threat to my fragile ego, a concept that lives entirely in my mind. But my biology,
all these billions of cells, have responded
to this imaginative thought, this complex perception of social risk. Today, here on this stage,
my mind has influenced my matter. So there is a relationship, isn’t there? It seems from this very simple
thought experiment that the mind serves as an intermediary
between the environment and our bodies. And it makes sense, doesn’t it? Something needs to process
the cues from the environment, and then signal our body to act. As a primitive species, this link between environment
and body was quite linear. You might hear a rustle in the bushes, or see a flash of pale color
between leaves, equals risk, equals
be prepared to fight or flee. But now, millennia later,
our nervous systems must process a much more complex world
with a much more complex mind. But our biology still really
can’t tell the difference between a nuanced social fear
like public speaking, and a true physical threat. It’s all processed in the same way,
the same physiologic response, regardless of whether we truly
need to flee the scene, fight for your life, survive on a red spot for some minutes. So, the fear of public speaking
is one on an endless list of modern day equivalents
of tigers hiding in bushes. From the threat of an unstable economy,
perhaps an abusive relationship, fear of job loss, and perhaps fears
and risks that aren’t even rational, thanks to our imaginations. And as we spend each day worrying
about our own unique combination of fears, our bodies obligingly respond,
physically preparing us for the worst. Now, this becomes even more interesting
when you look at the scientific evidence, that shows a clear relationship between psychological stress
and physical illness. We now know that illnesses
such as heart disease, diabetes, autoimmune disease, and infection,
are all linked to stress. There’s also evidence
that your outlook on life matters. Whether you are
a glass half full kind of person, or a glass half empty kind of person,
will have an impact on your health. If you happen to view the world
through rose-colored lenses, you’re actually more likely
to live longer, to be healthier,
and to overcome illness faster. During that conversation
with my patient the other day, she asked me how
she developed her arthritis. And I explained to her this link
between stress and illness. And as I spoke, she and her husband
exchanged looks. She told me that last year, her husband
had been diagnosed with cancer, and her mother had passed away. It had been a very difficult year. And it seemed clear to all of us
there in the room that day, that there is an interplay between the outer world,
the inner world, and our bodies. It is not always separate,
as we have been taught to think. Well, if you look around, some of these ideas have crept
into conventional medicine. The NHS now prescribes
cognitive-behavioral therapy, meditation, and mindfulness training, as part of the treatment paradigm
for mental illness. Leading healthcare institutions
like the Mayo Clinic are recognizing that meditation
may be beneficial not just for mental health,
but for physical health as well. And Harvard University has set up
a center designed to harness the potential therapeutic benefits
of the placebo effect, another piece of that mind-matter puzzle. But despite all these changes, if you use the words ‘mind’ and ‘body’
together in one sentence, you are almost immediately
placed into the camp of the quacks and the charlatans. So this is a conversation I’ve yet to have
with my medical colleagues. Medicine is holding fast
to the matter-based paradigm. And every day, I see the sense
of dislocation my patients feel, as we turn the microscope to the matter,
and ignore their deeper sense of self, and related perceptions,
beliefs, and fears. So, what needs to change?
And how can the healthcare system help? Well, we can’t control
all the sources of stress out there, but we can help patients
modify their response to stress. We can do this by offering
cognitive-behavioral therapy, meditation, and mindfulness training as part of the treatment paradigm
for all chronic illness, regardless of whether it’s perceived
to be above the neck or below it. From a scientific standpoint, we would simply be modifying
a modifiable risk factor. We know that exercise,
and diet, and smoking are risk factors that can be changed. Well, based on the scientific evidence,
stress resilience should be on that list. But if we move our gaze away from the scientific
microscope for a moment and look at the bigger picture, what else would we be doing
if we were to take this step? If we were to recognize this link, this communication
between environment, mind, and body, this connection
between stress and illness, we would be doing something
much bigger than modifying a risk factor: we would be helping medicine
transcend the mechanical. We would be engaging
that part of ourselves that transforms us from biological
machines, to human beings. I would love to be able to tell
my patient with arthritis that there is a lot that she can do. That her perception of,
and response to the world out there, has an impact on her world in here. And, this is something she can change. Responsibility is the ability
to make a response. We would be giving people this ability, and we’d be returning to them
their sense of agency, which we know is a critical ingredient of feeling whole, and uniquely,
and beautifully human in this world. Despite the prevailing world view
that draws a line between the real world of matter and the ephemeral world
of the imagination, all around us is evidence
that life is not so cleanly dissected. And back to our old dichotomies
of science and art, matter and mind, experience and creative potential, well, we all inhabit
these dichotomies all day, every day. So I believe, not necessarily in a world view
but in a basic truth: we are the compilation of an interplay between the known and the unknowable. And that, it is this alchemy
that enables us to live creative lives, to be heroes in our own stories,
both real and imagined. Two worlds that are not
so separate after all. They are, in fact, two facets
of this one beautiful jewel we call life. Thank you. (Applause)

6 Comments

  1. Excellent presentation.  I only wish there were physicians near me that were as enlightened.  That is the first step towards creating a different mentality among patients other than "write me an Rx and I'll feel better".  This holistic approach needs to be introduced and supported by our trusted health care professionals before patients can be expected to adopt it and improve their own wellness.

  2. Really wonderful talk. I so hope that medicine will soon realize how important our mind and emotional health is. I'm so glad that doctors, such as yourself, are finally talking about this. Great job.

  3. Absolutely brilliant! Extremely well delivered!

  4. Thanks for putting it so well. Yes!

  5. Please pray about writing a nonfiction book for patients.  Your topic is not a TedX best seller, but the baby-boomer seniors are in the waiting rooms aching for your message.

  6. Super well said, people view these acts of Ted talks valor and yet fear to express a response. I'm a teacher of art is medicine to people around me. The most often question I receive is….. How are you such a happy person when you have medical issues? I have learned to live threw my problems just like we all figured out at some point in our lives.

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