Wounds to the soul
There’s a poem by DH Lawrence called ‘Healing’ from which the first three lines are often quoted:
I am not a mechanism, an assembly of various sections.
And it is not because the mechanism is working wrongly, that I am ill.
I am ill because of wounds to the soul, to the deep emotional self
Often, when this is discussed in a group, there’s a hum of recognition. Most of us are aware that when things go wrong with our bodies, there’s a connection with our emotional life. The idea of a body as a mechanical entity is losing ground as more evidence accrues that emotional states influence our health. The cost of these ‘wounds to the soul’ is increasingly recognised in our cash-strapped times. Yesterday, researching new priorities for NHS commissioning, I came across these statements on the Kings Fund website:
There is a strong association between mental and physical ill health. For example, depression has been associated with a four-fold increase in the risk of heart disease, even when other factors are controlled for (Osborn et al 2007).
Co-morbid mental health problems have a significant impact on the costs related to the management of long-term conditions. For example, the total cost to the health service of each person with diabetes and co-morbid depression is 4.5 times greater than the cost for a person with diabetes alone (Egede et al 2002).
Poets and writers have always known that a broken heart is real and at last scientists are putting numbers to these human stories. Poetry therapy is a way of putting human stories to the numbers. My vision is, for GPs to have the option of prescribing poetry for depression on a routine basis.
A book I greatly admire, and have reviewed on Amazon, ‘Why Do People Get Ill?’ takes the analysis in the opposite direction. Written by psychoanalyst Darian Leader with David Corfield, it explores what might be called ‘narrative medicine’. Answers are very dependent on how questions are phrased, and following Darian Leader’s example, I once asked a group to think of an illness or condition they had, not to disclose it but to say how long they’d had it – a classic GP question when presented with symptoms. Answers included, since childhood, three years, six months. I then asked them to say when it started. Thinking of two illnesses of my own, I would answer, when I had a bully for a boss, when I got married. That question generates stories rather than numbers.
Before modern medicine became enthralled to the randomised control trial, there was an acknowledgement of psychological dimensions to many conditions. In ‘Why Do People Get Ill?’ we learn that dentists and opticians in the 1930s would often refer patients to psychoanalysts. That sounds astonishing but subsequently scientists have shown that the enzymes in saliva that fight tooth decay diminish when we are under stress – a study which is another good example of the narrative and intuitive coming together with the empirical. As someone whose first degree was in biological sciences, I am always heartened by such findings.
I’ll write about the rest of the poem tomorrow.