Why, in the most scientifically, economically and socially advanced time in the history of our species, do we seem to be suffering from more depression, anxiety, and psychophysical problems than ever before?
Medicine has defeated most of the infectious diseases that shortened our lives 100 years ago; we are living many more years, with greater access to healthcare. And yet, between 25 per cent and 50 per cent of the problems for which patients now seek help have no evident pathological cause.
Despite the almost daily promises of medical ‘cures’ and ‘breakthroughs’ in the media, the list of ‘functional’ or ‘somatoform’ disorders is long and seems to be growing. At the moment, it includes chronic medically unexplained pain, irritable bowel syndrome, chronic fatigue syndrome, non-ulcer dyspepsia, headaches, premenstrual syndrome, temporomandibular joint disorder (TMJD), a wide range of autoimmune dysfunctions, and environmental illnesses, such as electromagnetic hypersensitivity, and allergies.
Add to that, the ‘emotional’ disorders, such as depression, anxiety, phobias, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and we can see why the health services are in danger of being overwhelmed, health professionals are becoming frustrated, and patient dissatisfaction is growing.
The changing face of disease
Lifestyle diseases—sometimes referred to as ‘diseases of civilization’—have taken over from communicable (infectious) diseases as the greatest health risk in the Western world.
These diseases, ranging from asthma and atherosclerosis, through certain forms of cancer, chronic liver, pulmonary and cardiac disease, to osteoporosis, obesity, stroke, and kidney failure, all have a strong behavioral component. In other words, the way many people are living in the ‘civilized’ world is now a major cause of chronic illness and early death.
A research paper published by The Lancet points to the fact that diets in many Western countries changed dramatically in the second part of the 20th century, with significant increases in the consumption of meat, dairy products, vegetable oils, fruit juices, and alcohol. At the same time, large reductions in physical activity have been matched by a surge in obesity. An increase in many cancers, including colorectal, breast, prostate, endometrial, and lung, correlates strongly with diets high in animal products, sugar, and fat.
The fact that many people who move from one country to another acquire the cancer rates of the new host country suggests that environmental and behavioral factors are more significant than genetics. Furthermore, as increasing numbers of developing countries adopt Western patterns of work, diet and exercise, the incidence of lifestyle diseases is spreading fast.
Smoking, high-calorie fast food, and lack of exercise are expected to cost India an accumulated loss of $236.6-billion within a decade, while the resultant toll of chronic disease—all of long duration and slow progression—will seriously affect people’s earnings.
According to a report jointly prepared by the World Health Organization and the World Economic Forum, income loss to Indians as a result of these diseases, which was already high, at $8.7 billion in 2005, is projected, at the time of writing, to rise to $54 billion in 2015.
Pakistan faces an accumulated loss of $30.7 billion, with income loss increasing by $5.5 billion to $6.7 billion by 2015, and China, the worst of all countries under review, is expected to suffer an accumulated loss of $557.7 billion. Loss of income will reach $131.8 billion, almost eight times what it was in 2005.
According to the report, 60% of all deaths worldwide in 2005—a total of 35 million—resulted from non-communicable (read, avoidable) diseases and accounted for nearly half the number of premature deaths.
Despite growing insight into the cause (and cost) of the mounting scourge of lifestyle disease, mainstream medicine’s response—to tackle the effect, rather than the cause—is proving singularly ineffective.
However, all this means that many of these diseases and a large percentage of deaths can be avoided by relatively simple changes in lifestyle, including dietary changes; increased exercise; stress management; and early detection of, and response to, fluctuations in health and well being. In fact, an extensive Europe-wide study by Cambridge University researchers clearly shows that comparatively minor lifestyle changes can add a decade or more to the average person’s lifespan.
The study, part of the European Prospective Investigation and Nutrition (EPIC) study, involving more than 500,000 people in
10 European countries, reveals that
⦁ adding fruit and vegetables to your daily diet can add three years to your life;
⦁ not smoking turns the clock back by four to five years; and
⦁ even moderate exercise can increase life expectancy by up to three years.
A follow-up study at London’s Imperial College has since confirmed that seven relatively simple changes to diet and lifestyle can reduce the risk of dying from any of the major circulatory or respiratory diseases, including stroke and angina, by up to 34%.
1. Be as lean as possible without becoming underweight and by eating mainly a plant-based diet;
2. Be physically active for at least 30 minutes a day;
3. Limit consumption of energy-dense foods. These are foodstuffs and drinks high in sugar, fat, and refined carbohydrates;
4. Eat a variety of vegetables, fruits, whole grains, and pulses, such as lentils and beans;
5. Limit consumption of red meat to 17.5 oz (500 grams) cooked weight a week, and avoid processed meats, such as bacon, ham, and salami;
6. Limit alcoholic drinks to two for men and one for women a day; and
7. New mothers should breastfeed their infants for up to six months.
Further studies confirm that as little as 15 minutes a day spent exercising can significantly reduce the incidence of both cancer and heart disease.
Physicians are familiar with patients’ resistance to ‘doing the right thing’ (quitting smoking, exercising more, stopping snacking on donuts), however much they are confronted with the challenge to their own mortality. It is therefore understandable that reliance on anti-smoking, fat- and cholesterol-busting drugs, and gastric-band surgery is on the rise, despite the risks and comparative ineffectiveness involved.
Our contention (and, the reason for writing this book) is that human behavior is more easily, and infinitely more safely, altered by the methods outlined in this book than by drugs, surgery, or well-intentioned advice. Our experience is that people’s capacity to program and re-program their beliefs, behavior, and, by extension, possibly even their biology, is far greater than they are usually given credit for.
However, while most sufferers of chronic dysfunctions accept that some kind of change is necessary for their recovery, few, if any, know specifically how to make that change.
Just as importantly, many physicians are equally mystified as to how effectively to help their patients.
Part of the confusion may be simply explained: the reductionist, molecular, biomedical, cause-and-effect model that proved so spectacularly successful in defeating the microbe is failing to address the more complex psychosocial factors responsible for the current rise in chronic disease and early death.
Cartesian Dualism, the separation of ‘mind’ from body, still affects training and research. Although the hunt for ‘causality’ has shifted from germ to gene, and while the prognosis for a number of fairly rare genetic disorders is improving, no gene is likely to be found for each of the scores of medically unexplained dysfunctions with which practitioners and patients wrestle every day of their lives.
Failure to find the cause (what is ‘the’ cause of depression? what is ‘the’ cause of cancer?) means in practice that the focus of treatment falls on the symptom. Therefore, our dependence on the trillion-dollar pharmaceutical industry is growing, and is matched only by the hopes invested in technological innovation as the rescuer of humanity in what is perceived as an ongoing battle with the ‘disease’ of life.
The problem of ‘mind’
The implication of all diagnoses of ‘functional’ or ‘somatoform’ disorders may be that they are all, or partly, ‘in the mind’. And ‘mind’ is not widely considered a matter of concern for the average medical professional.
Current treatment guidelines offer two main options: psychotropic (mind-altering) medication, and outsourcing the problem to a ‘talking cure’ professional (where these are available). Either way, the integrity of the patient-as-a-whole is compromised, or, Cartesian Dualism is reinforced.
Pause here and reflect on which cultures, aside from Westerners, subscribe to the ‘all-in-the-mind’ explanation for chronic conditions for which no obvious organic cause can be found. As it happens, there aren’t many. The reason? Possibly because they have no ‘mind’ in which ‘all’ can skulk.
English, as it happens, is one of the few languages that has a word for, and, therefore, a concept of, ‘mind’. Other health systems might speak of problems with your energy meridia; chi; prana; humors; spells and evil spirits. Or, they might point to environmental or dietary deviations from what is required by your innate prakruti, or body-type—but almost never of your mind. Even René Descartes, at whom holists (including ourselves, we must admit) continue to sneer for single-handedly creating the mind-body split, never actually said the ‘mind’, as such, was irrelevant, or even separate from the body. It just didn’t figure in the way of thinking at the time.
In his most famous works, Descartes spoke about amê and corps (and, sometimes, anima). Corps was easy enough to understand, but the translators ran into trouble with the French word, amê. The closest English equivalent to both amê and the Latin anima (which he also sometimes used), is ‘soul’. Just about everyone who believes in the concept of an eternal soul would be happy to declare it separate from the finite physical body, even though Descartes himself regarded it as anchored during life to the pineal gland. But, the damage to the deep complexities of human thought and feeling had been done. Body 1, Mind 0.
What was missed at the time, and continues to be missed, is that ‘mind’ is not, and cannot be, an entity in the same way a body can. Nor are the thoughts and feelings, the experiences by which people ‘know’ they have a mind, discrete objects that can be isolated, identified, and studied in the same way as an organ, a germ or a gene.
All experience is process. People attach meaning to process. Meaning, in turn, affects biology. Therefore, any physical experience we have must affect, and, in turn, be affected by, both the physical and the mental, in an ongoing, dynamic feed-back loop.
To suggest that a problem is ‘all in the mind’ reduces process, and, therefore, lessens the possibility of change. It is as useless and as semantically skewed as to say ‘the light is all in the wire’.
The delivery problem
Problems increase when we look at the ‘delivery’ of healthcare, as opposed to its application. For various reasons, some of them political, we have entered a period of cost-effectiveness, ‘quality-adjusted life years’, evidence-based medicine, and increasing bureaucracy.
As care becomes increasingly standardized—by the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, and insurance companies in the United States—the personal is giving way to the impersonal, compassion is surrendering to science and practitioners, patients and the economy are all paying the price. Doctors are increasingly required to practice medicine unquestioningly, according to a set of guidelines delivered from sources on high. If they don’t, they can face highly punitive consequences. In our opinion, this is not science; this is theology. Patients’ unhappiness with the care they receive is, in turn, reflected in the growing trend towards litigation.
It should be no surprise, then, that so many physicians retreat behind the barricades of professional detachment, from where they practice an essentially defensive form of medicine that places the effectiveness of the patient’s treatment on the other side of a mountain of bureaucratic obligations, legal concerns, official guidelines, and targets, as well as restrictions on treatment modalities, resources, and time. And no surprise that so many patients are responding negatively towards what they regard as a lack of concern, interest, and sufficient information by emigrating towards ‘alternative’ healthcare, or to the offices of their legal advisors with an intention to sue.
A crisis in the making
In the first edition of this book, we hinted at the possibility of a crisis engulfing Western medicine. Now, and with no sense of satisfaction, we report our belief that today’s healthcare is already in crisis. An estimated one in 10 patients admitted to hospital in the EU is a victim of medical error. A disproportionately large percentage (a further one in 10) of these accidents results in serious injury or death.
Figures from elsewhere are even more worrying. According to a report by Dr. Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, medical errors are now the third leading cause of death in the United States, following cancer and heart disease.
Many researchers believe that the figures for medical errors may be significantly under-reported throughout the world, possibly for fear of litigation. Since no effective, mandatory, official system of registration of medical errors, no mandatory root cause analysis, and no systems to prevent the occurrence of medical errors exist in Europe, the figures may be even higher than one in 10. In contrast, motor vehicle accidents have been for decades routinely and systematically registered along with the recording of deaths and injuries.
Various studies blame a number of factors, including work stress in hospitals, limited consultation time, and reduced financial resources. But one of the recurring problems revealed in successive studies is defective communication—between doctors and nurses and their patients, as well as among health professionals themselves. Effective leadership, as well as effective clinical outcomes, is highly dependent on accurate, targeted and mindful communication.
Health professionals, too, are victims of the situation. A large body of evidence shows many doctors suffer high levels of stress as a result of their work, impairing both their health and their ability to provide quality care to their patients. The main sources of work-related stress and burnout among doctors, in both primary and secondary care, have been identified as: workload; the resultant effect on their personal lives; organizational changes; poor management; insufficient resources; constant exposure to the suffering of their patients; medical errors; complaints and litigation.
We believe both patient and practitioner can benefit from an expanded model of healthcare—the patient by being seen and treated as a ‘whole person’, and the practitioner by having a choice of non-invasive, non-pharmacological tools and principles that, in the consultative partnership, can help to meet that need.
In many ways, this is an idea whose time has come. The Center for Advancement of Health in Washington DC is one of several influential organizations currently lobbying for changes in the approach to healthcare. Those organizations, and a growing number of individual campaigners, are broadly in agreement that:
⦁ Attitudes, thoughts, feelings, and behaviors must be recognized as important aspects of healing and health;
⦁ The mind and body flourish or perish together. Therefore patients should not be sent to one ‘repair shop’ for sick thoughts and feelings and to another for sick bodies;
⦁ Scientific evidence is overwhelming that how and where we live, who we are, and how we think, feel, and cope, can powerfully affect our health and wellbeing. To ignore this is irresponsible; and
⦁ Patient care must shift to treating the whole person. This will result in healthier individuals, healthier communities and healthier nations.
Noble as these sentiments are, it is not enough simply to urge the health professional to begin practicing whole-person healthcare. What exactly is ‘holistic patient management’, and how might it be practically pursued in the context of the medical consultation? Indeed, although we have come to know a lot about disease, what exactly is ‘health’? These are just some of the questions this book seeks to answer.
Health as process
Our first presupposition is that health is more than an absence of disease. Rather, it exists along an ever-changing continuum between order and chaos. Our body-mind system is in a state of constant, dynamic interaction with both the internal and external environment, which itself is changing rapidly. The degree to which we are able to respond to these changes and can restore body-mind systemic balance (see our thoughts about autonomic coherence on pages 25, 253, 254 and 255) reflects both our current health and our ability to heal.
One purpose of this book is to unravel (as far as is possible at this stage in our knowledge) those elusive qualities that make up a ‘positive relationship’ between doctor and patient—and to share with our colleagues in the healthcare professions some of the principles and techniques that we, and many of the doctors and medical students who have undergone our trainings, have found to help facilitate the healing process.
The development of NLP
Neuro-Linguistic Programming, as its name suggests, refers to language (words, as well as other symbol systems, such as physical posture, gestures and related non-verbal forms of communication) as a function of the nervous system and its transformation into ‘subjective experience’.
Put more simply, it focuses on the way we use our five senses to create a ‘map’ of ‘reality’, which we then use to navigate our way through the world. It is a basic premise of NLP that the quality of our maps dictates the quality of our lives. In our opinion, NLP ranks as one of the most significant epistemological developments of our time. It developed—and continues to develop—out of Dr. Richard Bandler’s curiosity about the nature of subjective experience, especially that of individuals whose performance is outstanding in their fields. While most scientific research begins with investigation into how problems and deficiencies develop, Dr. Bandler’s question has always been: how do people achieve excellence?
His first subjects were a group of therapists, unrelated in their approaches, but who were nonetheless achieving results well beyond those of their peers. These included Dr. Milton Erickson, a medical doctor and clinical hypnotist, Virginia Satir, now widely regarded as the founder of family therapy, Gestalt therapist Fritz Perls, and noted body-worker Moshe Feldenkrais. Bandler observed certain commonalities in their work. Interestingly, none of the subjects of his study appeared consciously aware of these patterns, and they had never met each other, and even when they later came together, they were reportedly unimpressed by one another.
Bandler and his colleague, John Grinder, began to experiment. By identifying each sequence of their subjects’ approach, testing it on themselves and other eager volunteers, and refining the processes, they found that the effects could be replicated. Furthermore, these capabilities could easily be taught to others, with similar results.
These experiments led to one of the key presuppositions that have come to underpin NLP: Subjective experience has a structure. Following on from that is the corollary: Change the structure, and the subjective experience will also change.
It was widely believed at that time that, apart from drugs, interpretation and insight were the only means whereby effective emotional and behavioral change could be achieved, and that only with considerable effort and time. But Bandler continued to demonstrate, on a range of patients, including long-stay schizophrenic and psychotic patients, that changing the map could have a dramatic and immediate effect. In the introduction to his first book, The Structure of Magic, published in 1975, he wrote:
The basic principle here is that people end up in pain, not because the world is not rich enough to allow them to satisfy their needs, but because their representation of the world is impoverished.
Two other key principles emerged from Richard Bandler’s essentially pragmatic approach. The first was that human beings act largely out of various permutations of patterned responses, and, the second, that each person has a signature way of ‘coding’ his experience by the use of his five senses.
Medical NLP and health
Medical NLP—the development and application of the principles and techniques of NLP to the specific needs of health professionals and their patients—is an internationally recognized and licensed model that formally integrates non-invasive, non-pharmacological, and clinically effective approaches with the existing principles and techniques of the consultation process. Training and certification by The Society of Medical NLP is recognized and licensed by Dr. Richard Bandler, the co-creator and developer of NLP, and his Society of NLP. It has also been approved for continuing professional development programs in both the United Kingdom and the Netherlands.
Supported by extensive research and clinical experience, it offers, for the first time, explicit principles and techniques applicable to a wide range of complex, chronic conditions that have symptoms, but no readily identifiable cause. In holding, as a goal, the physical and psychological coherence of the patient, and integrating seamlessly with any aspect of healthcare, it functions as a practical and continually evolving ‘salutogenic’ (health promoting and affirming) model of ‘whole-person’ healing and health in the spirit envisioned and advocated by Aaron Antonovsky.
One of the central messages of Magic in Practice is that a fundamental component of an effective consultation is an equal and proactive contract between doctor and patient. The relationship functions as a therapeutic agent in itself.
Many practitioners will admit to being mystified by the fact that two patients with apparently identical symptoms will respond entirely differently to the same treatment. And many patients can recall encountering a physician, who, somehow, by some indefinable means unrelated to any specific treatment, just ‘made me feel better’.
Equally, some patients make unexpected, sometimes dramatic, recoveries against all the predictions of current medical knowledge… although these ‘spontaneous remissions’ still tend to be more of an embarrassment to orthodox science. ‘Anecdotal’ is the label usually attached to these events, which, sadly, tends to preclude any closer examination on the part of those people purportedly committed to unbiased scientific investigation.
If pressed, both patient and physician will agree that some factor, other than conventional medical treatment, is responsible for facilitating healing. The doctor may attribute this to the patient’s ‘attitude’, the patient to the doctor’s ‘bedside manner’.
The underlying dynamic undoubtedly depends on effective communication. To focus our students’ attention on the true process and purpose of communication, we draw attention to the origins of the word. It is derived from the Indo-European collective, Ko, meaning ‘share’, and Mei, meaning ‘change’. Communication in Medical NLP, therefore, is a Ko Mei process—a coming together, a sharing, in order to effect change.
We would like to emphasize, too, that practitioners of NLP and Medical NLP are not de facto ‘therapists’. As Dr. Bandler repeatedly asserts, practitioners don’t strive to ‘cure’ problems, but to help their clients (or patients) re-learn more resourceful physical and/or psychological behaviors that allow them to function more effectively. In Medical Neuro-Linguistic Programming, our cry is: treat the patient, don’t try to cure the disease. Therefore, a knowledge of, or adherence to, a particular school of ‘psychology’ or a specific medical specialization, is not necessary for effective intervention.
What is not in doubt is the fact that the quality of the relationship between practitioner and patient is at least as important as the treatment itself. Historical evidence exists that a number of treatments now discarded as ‘unscientific’ demonstrated a 50–70% cure rate when they were still regarded as mainstream.More recent research, specifically in the area of ‘emotional’ disorders (increasingly falling within the provenance of general medicine), suggests that as little as 15% of effectiveness results from the therapeutic procedure alone.
Physicians who have been in practice for more than a few decades will not be surprised by this. For much of the first part of the 20th century, the relational quality between doctor and patient was emphasized in medical training and explicit in practice, even as science was advancing the knowledge and expertise of the health practitioner. This original commitment to partnering wisdom, human values with technological innovation, and respect for the patient was reflected in the mottos adopted by a number organizations and associations around the world.
In 1952, Britain’s Royal College of General Practitioners adopted the motto Cum Scientia Caritas (Science with Compassionate Care). The Canadian Orthopedic Association’s motto is, Pietate, Arte et Scientia Corrigere (With compassion, skill and knowledge we set right), and the Association of Surgeons of Great Britain and Ireland’s is, Omnes Ab Omnibus Discamus (Let us learn all things from everybody).
We applaud the sentiments, but are unsure, in this age of stringent financial targets and controls and purely ‘evidence-based’ treatment, to what extent they are actually practiced today. Many people, not least patients, hanker after a ‘humanization’ of science—especially medicine.
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