We Will All take This Journey
Dr. Rachel Naomi Remen on illness, loss and spiritual growth.
Shambhala Sun: What is the distinction between healing and curing?
Rachel Naomi Remen, M.D.: I believe that while curing happens at the level of the body, healing happens at the level of the whole person. Curing is the work of experts but healing is our birthright. We are all healers.
I have experienced healing not only as a physician but as a patient with a forty-four-year history of chronic illness. My own response to illness, my own healing, has been very much like a spiritual journey. Like any spiritual path, it has been necessary to let go of life-long beliefs, ideas and attitudes in order to have a greater wholeness.
Often illness is a powerful evocation of the soul. Thereís something in the nature of illness that can awaken people to experience beyond themselves, the sort of experience that all practice and all religion may evoke in us as well. Suffering is a great awakening.
Shambhala Sun: This journey you describe, illness and death as a spiritual challenge, is one we will all take.
Dr Remen:Yes. Life is about loss, and all growth is based on loss. When weíre not willing to let go of what is a part of our past, what has been used up, what no longer affirms our lives, thatís when we stop growing.
You see, nonattachment is one of the basic capacities which allows spiritual growth. Those people who are capable of nonattachment often are able to live most fully; they have moved beyond fear of loss to be more present in their lives. Therefore, they are able to be more deeply touched by their lives, to grow in wisdom and to learn how to live better. Sixty per cent of the people who have had near death experience report that the fundamental purpose of life is to grow in wisdom and to learn to love better.
Shambhala Sun: Though many people, when they hear the word "nonattachment," would assume that implies a certain passivity, which might not be helpful in conquering a difficult circumstance.
Dr Remen: Actually, nonattachment has little to do with passivity. Itís a very active position. When you are nonattached, it means youíre not attached to a specific outcome; you stand prepared to meet whatever the outcome will be, and therefore you are able to show up for whatever happens.
People who are attached to something fear loss, and itís very hard for them to be fully involved with life, to give themselves to it fully, because theyíre constantly guarding themselves against the possibility of loss. So they lose the very life that they wish to have by trying to hold on to it in that way. A lot of people do that with relationships. They are so anxious not to lose a relationship that they become inauthentic. They say only what they think the other person wants to hear; they do only what will please the other person. They may end up having the form of a relationship, but this is not an authentic relationship. It is an empty form. Often people are lonely in the midst of such relationships.
Shambhala Sun: So youíre saying that in dealing with illness and suffering, you have to engage your full being in the present in order to bring all of your resources to bear on the situation.
Dr Remen: Exactly. I think illness and pain and suffering have the potential to turn us into spiritual warriors.
Shambhala Sun: What would you describe as the attitude, in a broad sense, that best helps people deal with the difficult circumstance of illness?
Dr Remen: My work is with people with cancer and their families, so I work with people in a very extreme circumstance, many of whom are quite young. I think what can help people at such times is a certain kind of openness: letting go of expectation and meeting what is happening in their lives with impeccability.
I remember one of the first patients I had, a lawyer, a very controlling kind of person. She was a person who took charge of everything and everyone around her. Through the experiences of her breast cancer, she became a far larger person than she was before this illness struck her. I asked her during the last of a series of the sessions if she had gotten what she came for in our work together, and she replied, "Oh no, of course not. I didnít get what I came for." I said, "What do you mean?" and she said, "Rachel, when I came here I didnít know that what I have gotten even existed."
Perhaps thatís what itís about. Real growth is always a surprise. Wholeness is a surprise. Itís about emergence, revelation, and a letting go of the ways we have defined ourselves that are too small. It is a recovery of parts of us that we have disavowed and even forgotten, because perhaps the culture disavows them. It is a recognition that our healing may be determined by those very parts that we have disavowed, the heart, the intuition, the soul.
Shambhala Sun: Youíve made a distinction between healing, a spiritual challenge, and curing, a medical process. Is there a relationship between the two, however: does this attitude of openness and acceptance that you call healing also help the process of curing?
Dr Remen: I think this attitude furthers the curing process also. Holding expectations is not often a good way to live. If your expectations are not fulfilled you become like Lotís wife, frozen into a pillar of salt, looking backwards at some place which used to be, unable to take hold of what is real for you now and move forward.
It is hard to make necessary decisions about treatment from such a place. For example, it took me many years to decide to have the surgery that allowed me to live more fully, because I was so attached to having the perfect body I had before I became sick. Attachment can interfere with care too.
Of course, curing can happen without our participation, except as a physiological being. Itís possible to cure people without very much of their participation, but healing requires a very active involvement. Healing is a form of growth, if you want to think of it that way; curing is a form of repair. These are very different things.
Shambhala Sun: Is there a connection between repair and growth?
Dr Remen: Repair may offer us a chance to focus our lives on something beyond our disease, but the nature of repair is different from growth. Repair is external, something I do to you. Growth is a capacity within you that I can collaborate with. Iíve been involved in both sorts of relationships. As a physician I was trained to be a highly technological curing person. Iíve been in curing relationships for many years, and Iíve also been in healing relationships. Itís a very different experience.
Shambhala Sun: The kind of approach youíre describing, which is not aggressive and goal-oriented, sounds very different from the way most people look at the medical process, and indeed from the way our culture views accomplishment entirely.
Dr Remen: Well, in both approaches one might take the same sorts of actions. From the outside it might look quite the same, but the experience of the person taking the action is very different.
A number of years ago I was listening to the radio when a football coach was talking about why his team was on a winning streak. He was saying he had got them into a state of mind where they were just as willing to lose as they were to win, where they loved the game unconditionally. He was basically talking about nonattachment. Nonattachment is what Olympic champions are trained in. They have imagery coaches and meditation coaches because theyíre aware that the physical body can actually achieve better if the mind relinquishes its attachments and gets out of the way. So there are these connections; perhaps we can recover from disease best when we love life unconditionally.
Shambhala Sun: When you work with people who have cancer, how do you help them?
Dr Remen: It depends on who the person is. Each person has cancer in their own way. Each person will heal in ways as unique as their own fingerprints. So itís important for me to listen to the uniqueness in the other person, and to help them to listen to their own uniqueness.
Shambhala Sun: But you have pointed to this theme of nonattachment, of being with what is happening.
Dr Remen: What helps varies from person to person; there is no formula. There are many people today who have never been attached to life, people whoíve never gotten involved in their lives at all. Itís like, "Whatever ..." You know, how teenaged kids say, "Whatever ..."
These people need to commit to life. They need to recognize that they do have preferences, that something matters to them. Nonattachment comes after you know your preferences and then you learn how to be free. Some people start much further back than that: they have no idea of who they are or what they want in life, and they need to experience this first in order to find a sense of meaning in their lives. So itís a spectrum; people are in very different places in this process of being human beings.
I hope I am able to support the people I work with in taking their next step, whatever that is. Often the illness itself will point to it. Thatís the interesting thing. Embedded in the nature of the illness, in what is being demanded of the person by the illness, may be the very next step in their growth, in the refinement of their humanity.
You know, you can view life as a movement toward the soul, that we may be here in these bodies for the education of the soul. Education is a beautiful word; itís a word thatís closely related to healing. Educari means to evoke wholeness, the evoking of a unique, innate wholeness. Perhaps all the events of our lives have this capacity to educate, this potential to evoke our wholeness, to show us ourselves and life in different ways, to make our perspective larger and wiser.
And this event of illness is a particularly pointed one.
Yes, illness gets peopleís attention more powerfully than most other things.
Shambhala Sun: Itís become a cliche, but itís the famous Chinese ideogram, crisis/ opportunity that youíre pointing to.
Dr Remen: Yes, a dangerous opportunity. Crisis is "dangerous opportunity." But thereís danger only if youíre attached. Otherwise, itís an adventure.
Healing is a process: people donít start from a place of nonattachment. I certainly didnít start there. For the first ten years of my illness I was enraged. I was fifteen years old and I had been cut off from the normal life of a fifteen-year-old. My illness was telling me what I could and couldnít do; sometimes it was actually telling me that I didnít have enough energy to walk up a flight of stairs.
I dealt with that with a great deal of rage, which is a very important reaction. Rage is often peopleís first reaction to limitation, and it is an expression of the will to live. It is an expression of the will to resist a distortion, and as such itís quite important as a first step. But it will only take you so far. Eventually you have to feel the will to live in you directly without feeling it as anger. You have to feel it as a love of life, a willingness to take whatever youíve been given and make the most of it. Anger can become a problem if you become wedded to it as a way of life.
Shambhala Sun: Iím reminded by what youíre saying of a phrase that my own teacher used. He described our "sad and tender hearts" as human beings.
Dr Remen: Oh, I love that. Who said that?
Shambhala Sun: Chogyam Trungpa.
Dr Remen: Oh, how exquisite.
Shambhala Sun: Well, we donít find it easy to feel our tenderness and vulnerability and sadness, and it would seem to be even harder when facing difficulty.
Dr Remen: You know, vulnerability is strength. Like many spiritual truths, this is a paradox. My sense is that itís actually easier to feel our tenderness and vulnerability in settings of illness. There are a lot of people who would never otherwise do it. Their attention would be distracted from such things for all their lives. Ultimately illness can reveal our common tenderness and vulnerability; the realization that all suffering is like my suffering and all joy is like my joy is the doorway to genuine compassion.
Illness forces the issue. It basically strips you of all your illusions, your masks and your roles, and eventually you discover something which cannot be stripped away, which is indeed who you are. I write poetry with people with cancer a lot, and the first time I conducted a poetry session with a group of eight people with cancer, I found a poem of my own, which goes like this:
for 41 years,
combined years of training
What seems to happen for people in the process of illness, if theyíre willing not to deny, if theyíre willing to be present, if theyíre willing to show up for their own lives, is that they have this precious opportunity to redefine who they are. They can discover what their strengths are and identify themselves in new ways. Often they move their locus of strength away from that which is impermanent, the body, toward that which is more unchanging. As I watch myself age, I turned sixty yesterday, I find that I seem to be having less difficulty with this than many of the people around me. Unlike me, they are used to running up and down stairs, even running up and down mountains, and they have defined themselves in terms of running up and down mountains. This turns out to be a very vulnerable way to define oneself.
Shambhala Sun: This healing process that you describe, of healing as connection with the soul or the absolute, would usually be conventionally defined as a spiritual task. Is this something that doctors can really address?
Dr Remen: Doctors are intimately involved with this; we are there with people at these times. You see, there is a new population of people who are now living with illnesses that twenty years ago they would have died of. Chronically ill people are one of the most rapidly growing populations, and they are raising new questions with their doctors, and with society in general. These people have very different needs.
The concept of healing, in the sense I have used it here, has moved into the teaching and practice of medicine far more than when I graduated from medical school in 1962. People see their task as doctors very differently than what I was taught to see it as then.
I teach a course at the UCSF medical school called "The Care of the Soul." Every year fifty or sixty students in the first and second year classes sign up for it; so now, after eight years, one out of every three students in the school has been through this course. Courses like this are being taught all over the country. The American Academy of Medical Colleges has just opened a division of spirituality and medicine courses, and American medical educators have submitted more than a hundred papers, each one representing a course or new approach to teaching the doctor-patient relationship.
Complementary medicine, the integration of what might be seen as more alternative approaches with what might be seen as the usual Western approach, is the hottest thing in medicine today. There are clinical and training centers in integrative medicine opening at medical schools all over the country, Arizona, the University of Maryland, Stanford, Harvard, Columbia, the University of California at San Francisco, to name just a few.
Shambhala Sun: Previously, much of what weíve been talking about would have been considered the province of religion. You would have gone to your minister or rabbi with questions about the soul and the absolute. Why is this now part of medicine?
Dr Remen: Actually it has always been part of medicine; it is the lineage of contemporary medicine. Curing has only very recently become part of the medical enterprise. Itís only in the last hundred or so years that people have actually cured diseases. Traditionally, doctors were healers. That was the original way of thinking of the doctorís role. Until very recently, the sacred occupied the place in medicine which science does today, as the point of referral for cause and cure. Medicine is a calling; for many it is still the opportunity to serve that calls them.
Shambhala Sun: Do you feel the need to reconcile the work you do with the scientific method; that is, to be able to prove the effectiveness of what you do by quantifying and reproducing the results?
Dr Remen: Actually I donít. Many of the things that are most true cannot be quantified, but only known. You canít duplicate a human life. Each one of us is unique. What we are talking about is a path, and each one of us will travel that path in our own way. There is a great deal that is mystery in it.
Shambhala Sun: So what you are saying is that a significant portion of the doctorís task is not scientific.
Dr Remen: Oh, science is only the most recent tool of healing.
Shambhala Sun: But science is now considered a necessary element in all medical work, is it not?
Dr Remen: In all medical work, no. Science has failed us in many instances, and many people have learned that in order to be a physician one has to go well beyond science. People really donít come into this work because of the science. People are drawn to medicine more by service than science. If we were drawn by science alone, weíd all be bench scientists, not physicians.
Letís put it this way: medicine occurs at the interface between science and human suffering. If you want to look at it that way, science is one of the tools of medicine, but it is not medicine itself. It is a tool which can be amazingly effective, but it is not an answer for all of lifeís issues, or even most of them.
Rachel Naomi Remen, M.D. is Associate Clinical
Professor of Family and Community Medicine at U.C.S.F. Medical School and co-founder and
medical director of the Commonweal Cancer Help Program. She is author of the bestseller, Kitchen Table Wisdom: Stories That Heal.