William House, Retired GP; Chair of the BHMA

Published in JHH12.2 – Works that reconnect

My life a wreck you’re making, You know I’m yours for just the taking. I’d gladly surrender myself to you, body and soul. Click To Tweet Since retiring from NHS general practice, I have been exploring how to work with my local community to stem illness at its source. This has involved working less one-to-one with individuals and more with groups; though a difficult transition it has given me new insights into how people tackle life outside the doctor’s surgery. It is frustrating, for instance, when someone with a personal agenda stridently dominates a discussion and is unwilling or unable to hear another view or change their behaviour. On the other hand I am inspired by those who adapt to whatever the moment requires, are curious about the world, and above all listen generously and respond thoughtfully. Openminded often goes with openhearted. Research psychologists have now shown that people with this more flexible mind have better health – both physical and mental. Those who are more stuck in their thinking are less likely to meet their deep human need to be ‘known’. Illness follows.

This ‘being known’ requires, first, the willingness and courage to take the risk of revealing your inner vulnerability; and second, it requires a context where you can do this without humiliation or violence. These are key to developing flexibility of mind. Through my career I became increasingly aware that for many people this trusting context is found only in the consulting room of a doctor practising personal medicine. Surely, this reflects sadly on our Western culture. So what is wrong? In the 1830s French political philosopher Alexis de Tocqueville famously studied the emerging USA when democratic society was becoming established for the first time in the absence of aristocratic hierarchies. He noted the pervasive anxiety, concluding that the ‘dizzying possibilities of freedom were giving rise to a terrifying individualism’. He predicted a final retreat into a ‘great quietude’, a fugue of comfort and bourgeois self-satisfaction. This theme was developed by Erich Fromm in his 1941 classic, Fear of Freedom – a response to the rise of Nazism. We now have consumerism, a gentler but more insidious form of tyranny.

Since the shift to more ‘rampant’ consumerism in the 1980s, the ‘retreat’ behind a cloak of appearances and the sense of futility it brings. It has become a blight on many of our ordinary communities. Some call this ‘status anxiety’. We are stuffed with stuff and entertainment to keep us docile, separate, needy and rigid in our minds. Then we fall ill.

Of course, a few become very rich, through providing us with the stuff and the entertainment, but often fare little better (see JHH 5.3 p35). The recently released documentary film, Amy, follows the glittered but short life of Amy Winehouse. Her plight, and perhaps the plight of our times, is tragically caught in these words from her last recording:

So what can be done? The wonderful little book, The Fortunate Man, by John Berger and photographer Jean Mohr, is reviewed in this issue. It is about one English, singlehanded general practitioner John Sassall. The book describes rural practice in the mid 1960s, which was very different to the present day. I trained as a GP at another rural practice in the mid 1970s and Berger’s descriptions vividly recall these times for me. He writes about the nature of unhappiness and the experience of illness as ‘exacerbating a sense of uniqueness’. He goes on to say, ‘It is a question of failing to find any confirmation of oneself in the outside world. The lack of deep confirmation leads to a sense of futility. And this sense of futility is the essence of loneliness: for… the existence of other men always promises the possibility of purpose’. It follows, says Berger, that: ‘Clearly the task of the doctor [is not to accept illness at face value but] to ‘recognize’ the man’. (pp 74–75, Vintage 1997). This ‘recognition’ is of the human soul, not the possessions we accumulate. The importance of this cannot be overstated. It is the essence of personal holistic medicine and it underlines the essential nature of connection: to be known by another human. It is also very close to a new approach to rigidity of mind called acceptance and commitment therapy (ACT).

Rigidity of mind, known as ‘psychological inflexibility’ to psychologists, may be the Achilles heel of our cultural tyranny. Research is beginning to show that even the most rigid mind can become pliable through ACT. The language is obscure to the non-specialist, but in essence, it is quite simple. The core of it belongs to Buddhist teachings from 500BC. It incorporates mindfulness, and crucially other key elements, some from ancient wisdom, some from modern wisdom akin to John Sassal’s – the desired ‘therapeutic stance’ is a classic description of holistic practice. I will leave you on this cliffhanger until my next column.