The Effect of a Diagnosis on Patient Quality of Life

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Hi Steven,

People generally do a very good job of making themselves miserable. My previous discussion of human response to a diagnosis as well as the placebo effect Steven describes may both have a lot to do with attachment which is intimately related to the AQAL approach as I understand it. Spiritual and psychological hierarchical models, and Integral Theory is something of the uber model of this type, deal in large part with the shifting attachments of the individual as they progress and grow throughout their lives.

Attachment is a fundamental concept in spirituality and one of the most difficult for most people to initially bring into their lives. The idea is that what you think you need causes you pain because you need it rather than because of some intrinsic quality of the object or concept. Let me give an example. When I was in college my mom and I went to an antique store and we saw a tiny but very beautiful antique table. It was inlaid with abaloneshells and was just amazing. At the time, I was living the existence of a college student, rudimentary bookshelves, minimal furniture, etc. and a beautiful antique really wouldn't have been practical and besides, neither my mom or I had the money for that table. I, however, mourned that table. I went back and looked at it several times and still remember it. The table, or rather my attachment to it, caused me very real pain because I couldn't have it. Now despite the fact that you are thinking I was very petty when thinking about my dream table, everyone has done this to some degree about something (or someone) and my table was a ridiculous example that few would say was a necessary item for me to have.

So let's progress to a more serious attachment- say to another human being or to youth, beauty or good health. Now these are much more serious attachments and the vast majority of us are still working on these at one level or another.  Attachment, in my understanding, is the immersion of the individual with the object. Think about an old relationship you are well over with and think about how you felt about your former significant other at the most intense time of the relationship. Their every word meant something, you dwelt mentally on them and couldn't really see them or the relationship clearly outside of you emotions and attachment to them and the relationship. Now, at a point in time when you are no longer in the relationship, you can really see the person and the interactions and things look very different even though the events are the same. You have externalized the relationship, dropped many of the attachments and have some perspective on things.

Americans are not very in touch with their physical bodies. I am not referring here to whether one is concerned with looking good or exercising, but rather whether you experience yourself as the merger of a physical and mental being. There are lots of reasons people dis-identify with their physical body with most reasons for disengagement being rooted in fear- fear of not being attractive, fear of not being physically adept, fear of physical pain or illness, fear of death, fear of aging.Please do not confuse disengagement with releasing attachment- you must identify strongly with something before you can release the attachment. This is the root of the confusion between the spiritual condition of the pristine newborn child and the enlightened master. Both theoretically have no attachments (although it is really unclear what attachments a newborn may have), but the master has gone through the attaching and releasing process over and over again (moving through AQAL) until he or she can choose to no longer create attachments. The newborn is at no such level of choice and must progress through the levels to be truly free from attachment. In our culture, our bodies are something akin to our cars. They should perform impressively well, look very good and cause us no cause for worry because if they do we are weak and less than an ideal human. In our youth we identify primarily with our physical attractiveness which is strongly reinforced by our culture and when compared to the ideal in our society most of us fall somewhat short of ideal (unless you are drop-dead gorgeous and have the athletic prowess of a professional athlete). By the time we have reached the age where we have sufficient maturity to potentially move past some of the intensity of the need to be sexually and socially attractive, we are likely to find ourselves becoming less and less "ideal" physically within the context of our culture. We haven't developed a healthy identification with our actual bodies, yet they are subtly beginning to show signs of aging, diminished beauty, etc. Now our bodies are a real object of fear- Oh God, I'm getting old, no longer beautiful, losing my strength, and we recoil from our physical selves, never making the healthy connections that would allow us to push beyond the fears and find salvation in the release of our attachments.

So, when people become ill it initiates all sorts of psychological defenses including stress responses. The assigning of an illness to a condition (giving a diagnosis) strongly reinforces the fears described above. Doctors are among the most highly respected members of our society and their opinions have very real clout. It is important to remember that illnesses are entities that were defined by humans and if you look hard enough most of them could be defined in a number of other ways. For example let's look at emphysema- my mom died of this disease so I have something of an insider's perspective on this illness. OK, it's pretty clearly a disease that is related only to the lungs and probably related to smoking, at least that is the western definition of the illness and from the viewpoint of a person doing an autopsy it is clearly the case. However, if you can look at the disease from an AQAL perspective, you will see something very different. My mom grew up in a culture where smoking was cool. She felt frustrated intellectually and like an outsider as many intelligent youngwomen of her age did in the early 1950's. Even her first cigarettes caused major biochemical changes in her brain that reinforced the desire for cigarettes . As the disease progressed it reduced her oxygen levels, impacting every organ system (the disease does not even have to be very advanced for this to occur). In particular this puts serious stress on the circulatory system and the patient's mental capacity. I could go on, but I think I have shown that in my mother's case her illness had major components in at least three quadrants and in at the very least in the respiratory, circulatory and neurological systems of her body. Redefining this disease as a compilation of these quadrants and systems would be perhaps more accurate in my mothers case but it would still be a human attempt to describe something that is ephemeral because of it's intense complexity. It might work as a model, but no model is intrinsically perfect.

And that is the point, we are assigning diagnoses that are very inflexible, intrinsically imperfect, not able to encompass the complexity of the human condition and modern medicine is stating that they are the gospel truth and patients are buying the whole concept hook, line and sinker. They are becoming attached to the limitations and described possible outcomes of the illness. I believe the placebo effect may represent the natural variability of the human being when released from the expectation that bad things will persist. It may not represent a special healing ability, but rather a reduction in the suppression of normal healing processes by psychological blocks put into place through our interactions with cultural and more specifically medical expectations. Providing a placebo simply says that there is the possibility that the patient will heal and "magically" healing does occur. Shouldn't this be the expectation rather than the exception? More than anything, I believe that this provides support for the need to redefine the diagnostic process. Imagine if, in addition to reducing this negative force on healing we could bring people up to really know their bodies and be able to mentally monitor or even adjust their physical state. This is really all that the enlightened masters who can heal themselves are doing, it is not "magic" after all but rather the natural physical ability of all unhindered humans.

Wishing you all the highest and best,

Jeanne

Hi Mike,

First of all, your doggy is precious. Reminded me of my own sweet little girl.

I agree with you in that people either seem to take a negative life event (such as illness) as either something to work with and overcome or improve, or they choose to make little or no effort on their own behalf and basically take the easy route. So frequently in our society we want a pill or surgery to solve our problems. Even in our daily lives we do this. My favorite example of this was when I was in college. I was not the world's most organized undergraduate and every term I would go spend  money on office supplies and calendars, planners, etc. in order to organize myself- then I would be as disorganized as always. It also occurs frequently in the self-improvement realm where people spend thousands of dollars on a workshop only to never practice what has been taught and this is when they seek out the training. I do a lot of trainings and you can imagine the level of follow through we get when people don't want to attend. I am not clear on the degree this is based on cognitive and self development. I would tend to think (or maybe it is just wishful thinking) that every person can be motivated if approached in the appropriate way and I think basing the approach on where they are using an AQAL model is our best bet for moving them forward. I also believe that every person at every stage (with the exception of the most highly enlightened?) confronts similar emotions around blocks (those things you just can't seem to do even though you want to and know you should). My guess is just that the blocks change in nature, after we conquer one set we move on to a more challenging set- lucky us! These blocks are really the basic problem we face in changing the world for the better. It is somewhat easier to motivate individuals at our same stage of development (for those stages up through green) because we speak the same language and are motivated by similar incentives, however non-integral individuals trying to motivate someone else at another stage are very likely to meet with failure. I think that individuals functioning at integral levels need to be very intentional about how they work with the other levels, being certain to put themselves in the other person's shoes and understanding who and where they are rather than trying to approach them from the integral approach.

I think your approach to looking at the patient's residual energy is absolutely brilliant. If they don't have left over energy they simply can't do the necessary work. I had a psych professor that said that no matter what action a person takes that if you stood in their shoes you would see that they have a good reason for their actions or inactions no matter how illogical they may seem to you. As far as your recommendations for people to go to counselors, the pateints may not have the energy to do the necessary work to free up their energy- endless circle and really sad. It is worth it though if you can help a few people.

I think it is interesting that you work with pain. I had a devastating back injury several years ago. When I sought help from my doctor they treated me very badly- basically I was in extreme pain and it took me nearly 45 minutes to walk to my car in the driveway and as a result I was 10 minutes late to my appointment. They almost wouldn't see me at all and finally made me wait hours until the next appointment. I quite literally begged for their help. I worked as a cytotechnologist earlier in my life and we dealt with patients with cancer and we always showed great compassion. I was horrified at my treatment and decided to heal myself through exercise, yoga, holistic medicine- anything I could find and used ibuprofin to ease my pain. Finally after two years of muscle spasms that involved my entire torso and excruciating pain continuously and amplifying with every movement I went to another doctor who did an MRI of my spine. The MRI tech actually stopped the MRI early because of the severity of my injury (and I thought I was doing much better at that point!) My disk had blown completely into the area where the nerves to my legs and lower body passed through and had completely flattened them. My neurosurgeon did a case study on me because he had never seen anyone before with my stage of problem who wasn't incontinent. He said I had no idea how much pain I was in. There is a happy ending, I had surgery and am just fine.

I was stupid to not pursue western medicine as it was what was indicated in my case. On the other hand, despite the fact that I was in fact absolutely disabled, I never once thought of myself as disabled. I went to the zoo with my kids, laughed and was happy when every moment was mindblowingly agonizing. I never gave up looking for a solution, I searched for ways of dealing with the pain internally. I explored meditation, relaxation and basically my interior self seeking solutions. It is most interesting to have continuous pain that you have the chance to study. Pain is not really what you think it is, when you have the chance to inspect it on an ongoing basis there is a psychological component to it that makes it what it seems to be and if you remove yourself from immersion in the pain you can see the pain for what it is. I'm sorry I cannot explain this better. It is very difficult to do this on an extended basis however. The pain was in fact one of my deepest learning experiences as it removed one of those basic existential fears- the fear of pain. It is unlikely that I will ever have to deal with worse pain than what I had and I know I can live with it if necessary and even have something resembling quality of life. Don't get me wrong, I want to avoid pain if at all possible but I can deal with it if it is unavoidable. I am, however, grateful for the experience I had with disability and pain as I learned a lot.

One thing that is not obvious if you haven't had severe pain for an extended duration is that it absolutely drains your energy. I wonder if some of your patients might have this problem?

As far as our broken medical/cultural/educational system, boy do I agree. I think what may have happened is that the red, amber, orange and green approaches that once worked for specific stages of our cultural development are dead end approaches that are showing serious signs failure in our present world. In other words, they are not on a linear path to an integral approach and we may well have to "back out" of the systems that have been put in place over the centuries in order to progress to an integral, non-dysfunctional approach that works for our newly evolving society. This basically means overhauling (or completely replacing) most or all of our cultural structures in a major way- talk about an overwhelming task! Even beginning to try to understand how to approach the problem is huge.

Again Mike, thank you for your thoughts, it was a pleasure reading your comment.

Have a lovely day,

Jeanne