Language Matters

Holistic and Love

In our 21st century United Kingdom culture, the word holistic in the context of healthcare often means something to do with natural therapies and even beauty products. This is a misuse of the word. If this word means having a wide and deep understanding of the world and our place in it, perhaps from unfamiliar angles, then many ‘natural’ therapies and products would not be ‘holistic’, whether beneficial or otherwise. 

Holistic shop front-cropped

In order to speak and write with the power to communicate authentically about the complexity of health and suffering, we need a rich language and the word ‘holistic’ is a valuable part of that language. It is much more difficult to speak meaningfully about the human experience than it is to speak about material objects – cars, clothes, houses. This material world lends itself to measurement but we have come to trust numbers beyond their worthiness of trust. They can, and often do, give us a false sense of certainty. Nowhere is this more prevalent than in healthcare. Our holistic response is to rebuild our trust in using language to describe the ineffable. This is our challenge.

photo by Natalia Osiatynska
photo by Natalia Osiatynska

Another word that suffers is love. Like holistic it cannot be defined without loss of meaning, but it is a universal human experience. Both ‘holistic’ and ‘love’ denote a powerful sense of connection and perhaps belonging to, even being part of.  Few human beings can thrive without ‘being part of’. Yet both words have been commodified in our consumerist culture. This cheapens our language and makes communication even more difficult.

“Holism (and its lack) may be easier to recognise than define. It is more readily communicated and perceived by stories, rather than data or abstract formulations. This presents problems: holistic mindsets are now becoming harder to access and maintain,  for our culture is now one that increasingly conceives and conveys in packages – food, fuel, news, entertainment, even thought is all likely to be coded, metered, monitored, measured or packed.”     Dr David Zigmond, Words and Numbers, Servants or Masters? (Caveats for holistic healthcare Part 1). This article is illustrated with stories from his work as a general practitioner.

“World is crazier and more of it than we think,
Incorrigibly plural. I peel and portion
A tangerine and spit the pips and feel
The drunkennes of things being various.”

                                                                                                                 From Snow; Louis MacNeice

breakfast
Look what a good girl I am this morning! … and in only 73 characters!!

Social media as a means of communication seems to be substituting for conversation in many relationships. Communicating complex messages with the 140 characters of a tweet is a big challenge. It needs a fertile mind to capture subtleties of meaning on that scale, though it is possible with wit and imagination. For most of us, reduced text translates into reduced meaning.
We confine ourselves to telling our friends what we had for breakfast with a
photo.

 

This is part of a much wider challenge which is mentioned in the community-minded and the connected dimensions in this website.

In healthcare we need to reclaim a language that helps us to share the richness of human connection. Other (perhaps all) languages have words with similar meanings to the original meaning of holistic. For instance, German has gestalt, and Southern African speakers have ubuntu. The meaning of human life is central to health and suffering. For more on this look at the meaningful dimension in this website.

The crisis of language in healthcare

We are left with a crisis in our shared humanity. Not only do we have difficulty in keeping a healthy balance of our conflicting instincts as both individuals and social animals, but our Western culture is making it hard for us to nurture, through language, the social side of our nature.

Canadian writer and academic, Michael Ignatieff, in his 1984 book, The Needs of Strangers (p138), points to the crucial role of language.

“Needs which lack a language adequate to their expression do not simply pass out of speech: they may cease to be felt….. Of all the needs I have mentioned the one which raises this problem of the adequacy of language in its acutest form is the need for fraternity, social solidarity, for civic belonging.”

And the politicians pretend to wonder why the people do not engage with the public democratic institutions! The result is social fragmentation, dependency and socially determined illness, particularly addiction in all its forms.

Of course, this problem also very much affects the microcosm of the state: the UK National Health Service. Below are two contrasting letters about a patient that could have been written from a hospital psychiatric service to a patient’s GP following the patient’s first attendance at a psychiatric clinic. These are based on a real patient’s story, but the letters are both written by GP, David Zigmond to bring to life two very different ways of understanding the patient’s problems. The text of the letters appear in his article, Language is not just data: it is custodian of our humanity.

 

 

DZ-letter-Gareth-formulaic

 

 

DZ-letter-Gareth-personal

David Zigmond asks this question under the two letters:

“If it were you that was distressed, which doctor would you wish to tend to you?

He ends his article with this paragraph:

Archimedes’ notion of displacement is instructive far beyond the physical world: it often operates in the realms of human culture and language. The overgrowth of the technical and the schematic can all too easily – without malign design – extinguish the organic and the human. Our world of ever-increasing mass-production has many hidden taxes. There are hungry conundrae, too: how do we safeguard literature in our language, art in our (medical) science and heart in our practice?

Zigmond has used his expressive language to clarify the challenge we face. The BHMA aims to meet this challenge through this website. We must find ways of exploiting the wonders of bio-science with our analytic faculties, but without sacrificing the holistic approach that requires our imaginative and creative side. Currently, much of the time we are using only one side of our brain.

One of the conundrae here is that medical practice is reliant on the story told by the patient. Interpreting this story can be done in a narrowly medical way: looking for patterns that match the pattern of a diagnosis carried within the doctor’s mind. Or it can be done like reading a book or a poem. This is a different kind of interpretation in which the ‘reader’ and the ‘text’ co-create meaning. This meaning might include a possible diagnosis, but if the clinician is in interpretive mode, there will be much more besides the disease category or ‘label’.

Doctors Stories front cover

“…a diagnostic label is the goal, and often the price of an interpretive understanding in medicine.”   Kathryn Montgomery Hunter in Doctor’s Stories.

This quotation suggests that needing to arrive at a diagnosis risks diminishing the wider understanding. The category gets in the way of the deeper meaning. It is the balance between these two that we are seeking. Without that balance, we have a reductionist understanding, a poverty of knowing the person and therefore of his or her illness .

If you want good personal healthcare front cover

 

The following quotation from GP, David Zigmond, describes how the healthcare system organises itself around the diagnostic categories:

” ‘Providers’ now spawn ‘treatment packages’. Fascinatingly kaleidoscopic forms of difficulty and distress are speedily designated to ‘mental illnesses’ or ‘disorders’, and hence streamed to the ‘appropriate intervention’. There is no language (or time) here for the ambiguous, the nascent, the naturally evolving; the semiotics of symptoms, the creative possibilities of uncertainty. The language is systolic.

And then the language determines the thinking.

The monoculture language, intended to expedite the functions of system and symptom management, does not merely provide utilitarian thoroughfare. Like tarmac roads, such prevailing or exclusive language destroys other forms of intellectual life or thought. An unmitigated use of psychiatric or organisational language will, for example, lead to reification; an unwittingly obstructive consequence of language. Mental illness becomes a ‘thing’, akin to a Cataract or Inguinal Hernia.” David Zigmond   No Country for Old Men in  If you want good personal healthcare, See a Vet

In the end, we need to decide who should have priority here: the system or the person? (patient and practitioner). The current language strongly suggests that it is not the people who are operating the system for the people’s benefit; but rather the system is operating the people for the system’s benefit. If we think this is the wrong way to run a health service, we are duty-bound to do something about it.

For more on this see ‘Community Health Creation – everyday stories’ in the Community-Minded dimension; also ‘Escape from Loneliness’ in the Connected dimension.

Next … The dimensions of being holistic – why now? – the response