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Doctor as Healer:
When one thinks about medical doctors, what comes to mind are years of biology and physics. In fact, these are required courses for all pre-med students.
Yet, what makes a good doctor is larger than the mastery of organic chemistry. When you walk into a doctor’s office, you want more than science; you want someone who can help you heal.
Hard Science vs. Soft Humanities:
The liberal arts are getting trashed these days, as many question whether the skills one learns in anthropology or art history, for instance, translate to the marketplace. Science departments are expanding throughout the country, while the humanities and the soft sciences are holding on by the skin of their teeth.
Times are ‘a changing.
So, why study history?
History and Medicine:
I went to Vassar College, the quintessential liberal arts institution, and majored in history. It has been a great primer for life. Looking back over the last thirty years, my friends have gone on to many things with history as a base. Some went to Law School, others to academics, some became teachers and still others went into business.
- I became a doctor.
The History Department at Vassar taught me the value of getting the whole story, and from many points of view.
Sometimes a great person moves history by virtue of their thought or action, but the time and place has to be right. Giordano Bruno was burned at the stake for his new ideas; a few decades later, Galileo only got house arrest.
And, less than fifty years after that, Isaac Newton was celebrated.
Or, sometimes there’s one or two facts that turn history on its head. A Japanese miscalculation, great intelligence, and a moment of Allied good luck gave the over matched American Naval force victory at Midway.
How would WWII have looked if the Japanese had owned the Pacific?
And, sometimes everything fits into a great general trend, like the way globalization (of commerce and ideas) is now sweeping the globe, making many people worried and unsettled.
History opens the door to the idea that all disciplines, including medicine have their own histories.
- And, history itself is no exception.
History's History:
We start with the study of civilizations and religions, to the great ideas of great men, to the great ideas of great men AND women. And, then there's social history, the history of science, military history, economic history, psychological history, gender history…and of course, the history of medicine.
Many civilizations made important contributions to the history of medicine. Among others, we are indebted to the ancient Egyptian, Greek, Chinese, Indian, Jewish, and Arab worlds. For instance, ancient Egypt had Imhotep. Greece produced Hippocrates and Galen. And, the Renaissance brought us Vesalius and Da Vinci.
Later, with the development of the scientific method and germ theory, medicine emerged from ritual healers, bloodletting and doctors with questionable skills, to double blind placebo controlled trials with better outcomes and more hope.
Today, we're looking outside the western tradition, with an eye towards what truly heals. Diet, exercise, herbals, nutrients, yoga, acupuncture, mindfulness and faith itself, are beginning to poke their noses into normative medicine. It’s part of the evolving history of medicine.
Psychiatry and History:
As a psychiatrist, understanding the value of history makes a huge difference in how I help my patients. Whether I’m working with a patient, a family, a school system, a medication regimen, or writing a blog, understanding history makes all the difference.
History takes in both the big picture - and the small nuance.
And, it reminds us to listen better.
- How did that older sister affect my patient?
- Does this Principal make the staff feel bullied?
- Is there a history of mental illness on the father’s side of the family?
- Has this patient experienced some kind of trauma, either subtle or overt?
- Which medications have worked for my patient and when?
This is all history.
Perhaps the most important application of history in the treatment of a patient is whether what I am doing is truly useful, and if so, how? Often, self evaluation is not done sufficiently in psychological care, with patients continuing in treatments that are not effective enough.
Past, Present and Future:
Without doubt, we are affected by forces and values that form us - for better and for worse. History can teach pessimism, because people are often victims of their past, and tend to reproduce their past pain again and again; something Freud called the Repetition Compulsion.
You are hurt by someone important like a mother or father, and then you get yourself into a relationship with a similar type of person in your adult life, only to get hurt again. We all know these stories. Freud accurately believed that victims do this in the unconscious hope that the relationship will turn out better this time.
It rarely does.
The great American playwright, Eugene O’Neill exposed history’s negative power when he has character say:
- “The past is the present, isn’t it? It’s the future too.”
When someone has a personal narrative of defeat or victimization, it’s often hard to overcome it without therapy or a faith experience. A person who deeply identifies as a victim (usually for very good reasons), may expect others to hurt him or her, and will develop defenses, either hostile or avoidant that can recapitulate that past pain in present circumstances; only to enforce the belief that nothing will ever change.
It’s a tough trap.
And, it’s a form of history.
A Doctor Has a History Too:
We are all subject to history. Forces of the epoch in which we live, of the family we came from, the events that we lived and our own psychological constitutions. In order to do the work of psychotherapy, or even prescribe medication well, it’s important to have done your own work.
Patients can trigger many states in their doctors, and we have an obligation to stay even keeled and helpful. Patients can be overly engaging, or overly off-putting. Some can be passive while others are aggressive. Some may generate a feeling of hopelessness, and others fool us into being overconfident.
- We can’t help anyone if we don’t know ourselves. That’s history too.
From History to Health:
Those of us who are committed to medical practice and particularly, the mental health profession, are truly involved with history; understanding it, interpreting it, and giving the patient an opportunity to write a new kind of history for themselves.
It is an honorable task.
The past does not have to be the present, or the future, but the patient has to change the way they see and experience themselves; this is a great application of history.
Finding a Good Doctor:
Sigmund Freud and Eugene O’Neill are correct; history can be entrapping. Yet, there’s another side to this type of knowing. The past can teach useful lessons if we help ourselves and our patients learn them in all their complexity. The past is seared into our brains and the future is yet to be.
It may be hard work, but history does not have to be an anchor.
As, doctors, we have faith in human potential, because everyone has a shot at making a new history if they understand their own.
Dust off those history books.
You’d be surprised how useful they are.
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Research Assistant, Gabriel Banschick
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