Abstract
The Nature of Healing: The Modern Practice of Medicine by Eric Cassell, MD, offers effective and strategic ways to practice patient-centered medicine. Cassell asserts there is only one goal of medicine: the well-being of the patient, as the patient themselves define well-being. He writes, “Well-being is separate from ideas of disease; a patient can be diseased and have a sense of well-being. Well-being is multidimensional, it is not just physical or emotional” (p. xiii). Cassell maintains that clinicians must understand the implications of this reality, that though the problems of a patient may be rooted in diseases of the body, they permeate into each one of life's dimensions. His assertion that all therapeutic interventions are exercises in healing dedicated to moving a patient towards well-being serves to drive this book and helps him outline exactly what is needed to achieve healing. Thus, The Nature of Healing offers readers specific ways to reconsider the negative effects of reductionism in medicine, which can manifest as a distancing between clinician and patient as a patient disconnects from the world in descent into illness. After his critique of this phenomenon he offers productive, holistic approaches to clinical medicine. For example, he writes:
“In caring for patients in a state of illness-in healing, you should always be aware that the sick are different from the well. Adapting to the differences changes the way the healer thinks, forms the goals of healing, and also how illness is understood.…Mastery in these diverse elements serves the patient, but also enhances the healer.…Healers must reach within themselves for the resources that they extend to the sick. It is the healer plus the patient that constitute the healing entity” (p. 193).
With an engaging thoroughness, Cassell carefully defines what he means by the terms sickness, personhood, functioning, healing, and listening. He provides the historical background that has shaped our understanding of these concepts and illustrates how medicine has become derailed from its deeper understandings of routine medical approaches. For example, he notes that Western culture has developed towards an individualism which is less aware of “social dimensions of existence,” and asks, “If little is written about these social phenomena, especially in the context of medicine and healing, how is the clinician to know about them?” (p. 12). To address this lack, he suggests that clinicians must listen carefully to what patients say, ask thoughtful questions, and try to understand their experience of illness. He values understanding illness in all of its dimensions by taking the time to uncover the basis of the patient's fears, concerns, and worries about their illness.
In the final chapter Cassell provides ideas about how clinicians can learn to see patients as the persons they actually are. He writes:
“Doing this does not at all diminish the importance of acting on or attending to the disease, body parts or functional impairments; it enlarges the field of view, the clinician's perspective about where action would be most effective. There is a person connected to that body and whatever is done to the body impacts the person and whatever is impacting the person is also happening to the body—meanings, feelings and thoughts—everything” (p. 193).
Cassell feels that in viewing the patient as an illness, not a person, clinicians distance themselves from the healing work they are there to do. Unless one sees the other as a complex, whole person, healing is truncated at best. The view of the multidimensional person can only be achieved when the clinician truly opens him or herself to the sick person.
Cassell concludes that unless we include an emphasis on purposes and goals of care in our definition of sickness, we can never understand the nature of healing. He has offered in this unique and clear book tangible ways to cultivate healing in the patient-clinician interface which allow the complexity of healing to be discovered anew with each encounter. As the relief of suffering remains the fundamental goal of medicine, the more informed we are of the subtle nuances involved in our patients' healing, the greater the possibility of lifting the burden of sickness and returning patients to a state of well-being can be. Cassell informs us that holistic healing has the potential to transform the way medicine is practiced around the globe.