Anatomy of an Illness as Perceived by the Patient by Norman Cousins Page B

juxtapose themselves against the entire medical profession, and I couldn’t sympathize with this approach. While I agreed with the prime tenets of the holistic movement, I saw a need to build bridges across the gap that for so long had separated the physician and the public. Moreover, what to me was most impressive, as I explain more fully in the next chapter, about the thousands of letters I received from doctors in response to the NEJM piece, was the sense of an important new mood in American medicine. I believed that the holistic movement would be gratified by the fast-growing evidence that many doctors were attempting to diagnose and treat the patient in the context of all the factors—work, nutrition, family, personality, emotions, environment—that figure in illness or breakdown.
    In accepting invitations to speak or participate at these meetings, therefore, I sought—and received—permission to talk about the need to avoid a wall of separation between patients and physicians. It was true that the medical profession had allowed itself to become overly mystifying, even authoritarian, in its general relationships with the community-at-large. But there were genuine signs of a desire to inform and educate and not superimpose. Patients were being encouraged by their physicians to know as much as possible about issues involving their health. What was in the making, it seemed to me, was an expanding dialogue between the public and the profession on the proper division of responsibility between the two.
    Such a dialogue, I felt certain, would impress physicians with the seriousness and soundness of intent of millions of people who believe that the primary role of the doctor is to help people to prevent illness, and not just to overcome it. And people in the movement, I felt equally convinced, would be impressed by the large number of doctors whose philosophy and practice were based on the idea that the mind and body are a single organism, and that the treatment of either one should not be undertaken without respect for the totality.
    Great medical teachers have always impressed upon their students the need to make a careful assessment of everything that may interact in the cause and course of a disease. Hippocrates, the first major historical name in medicine, was both a theoretician and a practitioner. He tried to close existing gaps between the understanding of disease and its treatment. He was quintessentially holistic when he insisted that it is natural for the human body to heal itself, and that this process can generally take place even without the intervention of a physician ( vis medicatrix naturae ). He believed that the essential function of the physician—here again Hippocrates was being nothing if not holistic—was to avoid any treatment that might interfere with the healing process or that might do harm ( primum non nocere ).
    Hippocrates put his emphasis on the systematic organization and application of knowledge. He was troubled by the fact that a great deal of dogma and superstition were being dressed up as carefully authenticated principles in the practice of medicine. Lawrence J. Henderson, widely admired among modern teachers of medicine, described the essence of these principles in one of his famous Harvard lectures.
    Hippocrates was no casual ordinary observer, Henderson wrote, but a physician whose “skill depended upon both native capacity and long practice.… His success was great, and the whole history of science goes far to support the view that such a methodical procedure is a necessary step in the development of a science that deals with similarly complex and various phenomena.”
    This holistic principle has been restated many times as a basic guideline for sound medical practice. A half-century ago, Arturo Castiglioni, in his A History of Medicine , wrote that “the physician above all should keep in mind the welfare of the patient, his constantly changing