Book Review

by Dr. Thérèse Madden-Fitzsimons in 1993
Humane Medicine Volume 9 Number 3

In 22 chapters, the authors look at the problems of chronic illness and pain: "chronic" because, by definition, the illness and pain do not respond to usual treatments. In their introduction, the authors suggest that chronically ill patients face the problem of paradox: the existence of something such as an untreatable illness that conflicts with out preconceived notions of what is reasonable or possible. The simplest way to avoid paradox is to deny its existence by denying one-half of its self-contradictory proposition. Thus, denial drives us to avoid the reality that no matter how unpleasant it may be, illness is a real part of us and ultimately must be confronted. In their introduction, and at greater length throughout the book, the authors note that this kind of collective denial is at the root of our medicine and of modern Western society. It is this denial that allows us the conviction that reason is somehow superior to emotion, because feelings are irrational – they do not obey the dictates of logic. This in turn permits the rational to create the world in its own image and thus to dismiss the role of the "irrational" in either the disease process or its treatment. The authors declare that, as practicing doctors, they have come to believe that the denial of our feelings – that "irrational" part of ourselves – will eventually lead to chronic pain and illness.

They conclude that a profound change, one which would embrace the whole being and emphasize transformation over treatment, is needed in our society's approach to medicine. Modern medicine finds it difficult to deal with fear and anxiety – something the holistic approach addresses more readily because it accepts both the rational and irrational in us and thereby faces the paradox. The experience of a renewed sense of being that arises from facing the paradoxical nature of our existence is the process of transformation this approach would facilitate. Since our early history, this paradox has been a motivating force at the centre of many of the ancient myths that have inspired us.

Each chapter opens with a cogent maxim that provides a guide for the chapter content. This is followed by a mythological tale, which the authors explore, analyse, interpret and relate to questions of living – whether to choose "intellect dominant" solutions or "put away our illusions about life and simply get on with living". Then they illustrate the applicability of these metaphors to the dilemma of chronic illness and pain by expanding on the theme that modern "Western" medicine is a discipline of logic and rational intellect, which cannot conceive as important the irrational, emotional factors in the disease process. This attitude further confounds the individual who is suffering from chronic pain and illness, especially when he or she is told that traditional medicine has no cure. The paradox inherent in chronic illness is that at the very time when no cure seems possible and all efforts at treatment have failed the patient has the most renewing choice of all, that of transformation: to "die to our illusions about life", to accept the reality of pain and illness as part of our reality.

In keeping with their mythologic themes, the authors deal with such universal issues as disempowerment, the inability to engage our emotional natures, internalizing our own locus of control and the traumas of abandonment and helplessness. They illustrate points with brief case histories, which further illuminate the rich metaphors. Also, they discuss theories and stances such as systems theory, Cartesian thinking, Gaia theory and "alternative" or, to use their term, "complementary" medicine which includes traditional Chinese medicine, acupuncture, and energetics.

Paradox and Healing is an interesting and thought-provoking book. I recommend it, particularly to those whole life or work includes exposure to chronic pain and illness.

Dr. Thérèse Madden-Fitzsimons: MD, MA, FRCPC Aurora, Ontario, Canada