S E L F - C A RE
Self-care and self-cultivation: the necessary foundation to heal Thuli Whitehouse GP; BHMA trustee
Identity has for ever been the vexed puzzle at the centre of philosophers’ worrying. Perhaps humans ever since they evolved the power of speech have told stories about what and why we are. In our time each of us lives in a fog of more or less contradictory stories. Different experts rule over these domains and medicine of course tells its own fragmented story about what we are and why we get ill. Is there a way back into a more direct and wisdom-filled experience of what we are and what we need?
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Before starting medical school I suspected that not all the answers lay on the path I was embarking on, but that I needed to understand what we were doing before I could work out how to change it. These days, alongside my work as a GP, I am a trustee of the British Holistic Medical Association and I teach yoga – running retreats guiding people to reconnect. This article is modified from an essay I wrote as a student of medical anthropology and lays out the theoretical framework of why and how I believe change needs to happen. It is something we must both do as doctors and enable in our patients.
In Western civilisation the person has become an amalgamation of often contradictory facts, an entity divided up by specialists into sections (Dumit 1997). We live compartmentalised lives, each person adopting multiple identities to fit the multiple roles in the multiple sub-cultures we are part of (Mellor and Shilling 1997). This fragmented split off identity and loss of any sense of community may be at the heart of the problems now facing biomedicine and society. For medical science has become part of the problem in that it disconnects people from their bodies, breaking them down into parts, and objectifying illness through imaging and tests. Somehow we as doctors have to combat this sense of disparity and body alienation and begin our own process of change. If, as the phenomenologists tell us, embodiment is the foundation of the self and that healing is a process of embodied change, then our task must be to begin re-embodying our patients and ourselves. Through a process of
self-knowledge, self-care and selfcultivation we must come into the present moment, into our lived rather than our objectified bodies.
Medicine today and the Socratic imperative The march of scientific progress continues with an ever-increasing complexity of medical technologies and an ever-expanding body of evidence based medicine. Despite its successes however, modern medicine is facing problems. Litigation rates are on the rise along with complaints about how the ‘human’ aspect has disappeared from medicine; there is poor compliance with treatment and health promotion advice as trust in doctors declines in an increasingly pressurised environment, where we have less and less time to spend with each patient for meaningful communication or to build a relationship. System specialisation might improve industrial efficiency but it compromises continuity of care;
© Journal of holistic healthcare
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Volume 13 Issue 2 Summer/Autumn 2016
