Well it is hard to not notice the collective stir around love & relationship in February and it prompted me to reflect on the power of relationship to heal. This power is undoubtedly important in any healing dynamic (doctor-patient relationship), but as Dr. Heron so aptly states, perhaps even more so when one suffers from emotional and psychological/psychiatric distress:
“I can easily imagine giving a patient a good (homeopathic) remedy for eczema and placing them on a deserted island fully expecting them to get better. But I do not imagine this to be true of the patient who is suffering from depression or from a compulsive disorder. These patients need to be in relationship, they need the relational field to heal.” 1
In my practice, I place great value on the relationship that I have and foster with my patients, for without a connected, trusting and caring relationship, healing does not occur, no matter how powerful the medicine. I have observed homeopathic treatments to heal through relationship. I see remedies as restoring one’s relationship to oneself and to the external world on multiple levels. In so doing, it changes one’s relationship to one’s ailment. Time and again I have seen someone debilitated by a condition, let’s use a case of eczema as an example. The individual is prescribed a single homeopathic remedy and when they return for a follow-up soon after taking the remedy and are asked how their skin is, though it does not yet look any different, they report that it no longer bothers them?! And then I know that a more complete shift and resolution of their symptoms will soon follow as their relationship to their symptoms has changed and the healing process has begun.
This brings us to a brief examination of illness. Arguably there are pathogenic organisms that afflict us, but many would contend that it is the terrain versus the germ that determines what and if we are affected by an organism or condition.
Florence Nightingale “There are no specific diseases; there are specific disease conditions.”
William Osler “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
I tend to agree with this viewpoint in most cases and link this back to relationship. It is the harmonious relationship between our bodily systems, our mind and our environment that determines health from a naturopathic perspective. When these systems are in right relationship, health is to be had. When these systems are imbalanced, symptoms appear, and ultimately more severe conditions manifest if the imbalances are not addressed.
So what does the modern medical literature have to contribute to this discussion? Evidence comes from studies on the efficacy of psychotherapy and from studies on the placebo effect. Compelling evidence on the efficacy of psychotherapy can be found in a 2010 article by Jonathan Schedler, entitled “The Efficacy of Psychodynamic Psychotherapy”, in which an in-depth review of the literature in the field is presented. Schedler speaks to the importance of the psychotherapeutic relationship:
“The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged….The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.”2
The placebo effect has been widely studied and can be summarized very simply as the effects of treatment that cannot be attributed to the medicine itself. The placebo effect can thus be considered the effect that results from the doctor-patient relationship and the patient’s expectation/hope/belief that the treatment will be helpful. A recent 60 minutes episode interviewing psychologist Irving Kirsch, the associate director of the Placebo Studies Program at Harvard Medical School, says that his research challenges the effectiveness of antidepressants (especially for mild-moderate depression). You can view his interview at: http://www.cbsnews.com/video/watch/?id=7399362n 3 .
Finally to extend this discussion a little farther, the relationship of medicine needs to heal. Our current state of affairs is a fragmented system which often leaves practitioners and patients unsatisfied and unwell. I feel that greater collaboration and integration could bring some healing into the medical sphere.
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1 Heron, K. (2012). Expectations. Simillimum. Journal of the homeopathic academy of naturopathic physicians, 2011/2012(XXIV), 43-45.
2 Schedler, J. (2011). The Efficacy of Psychodynamic Psychotherapy. E-Journal of American Psychologist, 65(2), 98-109. Retrieved from http://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf
3 Stahl, Leslie. (2012, Feb 19.) .Treating Depression: Is there a Placebo Effect. [Interview of Irving Kirsch, PhD. on 60 minutes]. Retrieved from http://www.cbsnews.com/video/watch/?id=7399362n