Treating the Person Instead of the Disease

Harry is a 64-year-old man of African American descent and a war veteran who carries diagnoses of PTSD, alcohol use disorder, and cocaine use disorder, and who comes to Valerie, his new therapist, complaining of feelings of depression, insomnia, having anger outbursts, and experiencing nightmares and flashbacks.

Valerie's first thought was, “Where do I start?” She hasn't ever treated anyone with both a psychiatric condition and a substance use disorder [1]. She began to ask herself a series of questions. Does she treat the psychiatric condition before the substance use disorder or vice versa? Or does she manage both of them together? If she decides to manage one before the other, how can she best ensure that there is no exacerbation in the process? Furthermore, if she manages both at the same time, what's available to help her do that? What is the modality she should use?

Valerie is one of the best therapists Harry could have found. Before Valerie, Harry had been bouncing from provider to provider without much relief. He first went to see his primary care doctor, who referred him to a psychiatrist, who, in turn, referred him to a therapist. Since then, Harry has been going from one therapist to the next and from one specialist to the next—including seeing a neurologist, an addiction psychiatrist, and substance use counselors. These previous clinicians were also doing their best.

But where Valerie stood out is her willingness to ask the types of questions outlined above.

The French philosopher Claude Levi-Strauss [2] once said, “The scientist is not a person who gives the right answers; he is one who asks the right questions.” Valerie is not giving answers. Valerie is asking questions. She is asking these questions because she truly cares about Harry. She is asking these questions because clearly, something must not have been working for Harry to have been with so many therapists and specialists and still being far from reaching an adequate level of functioning.

What's Still Missing From Harry's Treatment?

Yet while Valerie does stand out, she is still missing a key point. Valerie is still looking at Harry through the lens of his symptoms and his conditions. As such, while Valerie may still be able to treat Harry more effectively than his previous clinicians have been able to do, Valerie will still be missing the crucial point: always treat the person instead of the disease.

Sir William Osler is one of the four founding physicians and professors at John Hopkins Hospital. He said, “The good physician treats the disease; the great physician treats the patient who has the disease.”

What does it mean to treat the patient instead of treating the disease? The answer to this question will be addressed in the following series of articles. Meanwhile, here are three pieces of advice from three of the most revered clinicians of all time:

1. “Listen to your patient." —William Osler
2. “If the only tool you have is a hammer, you will start treating all your problems like a nail.” —Abraham Maslow
3. “In my early professional years, I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?” —Carl Rogers [4]

What Patients and Clinicians Should Know

1. If you are a clinician, consider that you will never truly make a difference with your patients until you stop treating the disease and start treating the person.
2. If you are a patient, consider that you can start helping your clinicians or therapists start treating the person instead of diseases each time you interact with them.
3. Let the above be a starting guide toward ending suffering in the world.