MY STORY

I – Medical Odyssey

I grew up in a family of physicians. At thirteen, I confided to my grandfather an aspiration to become a famous lawyer, defending “truth” and all that was noble and virtuous.

But “the law is corruptible”, he said. “Winning and money become so important to lawyers that truth gets twisted, virtue tainted. Medicine, on the other hand…” He smiled sublimely.

My grandfather’s smile brown compassionate eyes under crinkly lids won friends instantly, made people feel special. Our talk that day started my medical odyssey.

“Nothing else can come close to the satisfaction you’ll gain from healing”, he had said. And that’s true.

“What is healing:? He’d asked rhetorically. “Healing is a special relationship between you and your patients. To succeed, as a physician is to give health and life, give of yourself without qualification. Whether people are rich or poor doesn’t matter because the mutual interchange enriches both you and the patient. And remember, the body, God’s creation and temple, has its own wisdom, works beautifully until we begin to damage it. Too much of the wrong food, too much alcohol, too little fresh air, bad thoughts and bad habits abuse God’s creation.

“If you help sick people honestly, with sincerity, you will be welcomed and loved by all. Love is better than fame. And the Talmud says “He who saves one life saves the world”.

So at thirteen I chose medicine instead of law. Hindsight reveals the significance I trace here. Later in my teens, I was seduced by visions of the awesome surgical suites in our hospital. Patients lay suspended between sleep and death. Anesthetized by one of my uncles, they were cut open by my uncle Alexander, a surgeon fiercely devoted to medicine and to the care of his patients. Of all the physicians I have ever been exposed to, he most exemplified the consummate doctor. His tenacity and diagnostic acumen were second to none. His concern for patients was uncompromising and his standard was maximum effort. He was a doctor I’m proud to emulate.

Yet while his example of the consummate surgeon was an early beacon for my medical odyssey, it wasn’t my uncle’s specialty that I finally choose. Instead, I emulated my grandfather’s gentle, non-intrusive ways and his capacity for communication.

I took a step in that direction in college. Literature, philosophy, and anthropology stirred my intellectual curiosity. The ideas mattered. The professors challenged, stimulated me to think. Of course, most of the pre-me students found Moby Dick, Critique of Pure Reason, Existentialism, Spinoza, Eskimo culture and dietary practices, etc. a waste of time and wanted simply to get on with the science of medicine.

Over strenuous objections from grandparents, uncles, and parents who wanted me to get on with the science of medicine, I decided to learn more about what they considered “extraneous subjects”. I exchanged cold, gray conservative Canada for sunny, exuberant, and liberal Palo Alto to pursue a degree in anthropology and philosophy at Stanford University before entering medical school in Toronto.

This “detour” was necessary because the humanities seemed related to my grandfather’s marvelous ability to communicate with others. His smile and his visionary words had initiated my dedication to medicine by an image of him as healer. His warm smile was the visible form of his genuine interest in people and their problems, and so he excelled in dialogue, that true give and take of conversation. Literally, I saw him heal by talking.

When my father and three uncles erected their private 350 bed hospital in Toronto, my grandfather took it upon himself to become their medical ambassador of goodwill and hope. Almost daily, he visited dozens of patients, many of whom openly admitted looking forward to his visits more than they did their own doctor’s. Many of these patients attributed their getting better as much to his daily ministrations as to his sons dedicated surgery and medication. Grandfather would laugh, philosophize, and cajole them with stories, Talmudic insights, biblical exhortations, or any other verbal weapons he could use to brighten their day. And he was tenacious. He would sit by their beds until they were cheered and comforted.

As I look back now on what he was rendering, I see that his creating Buber’s “I-thou” relationships was the quintessential healing factor. His little mitzvots, as he called them, were as important to the healing process as their drugs or surgery. His constant flow of dialog, empathy, concern, and humor definitely contributed to these patient’s healing.

My grandfather practiced the wisdom of Talmud, that visiting the sick is a religious duty. Cultural systems throughout the world, whether technologically primitive or sophisticated, repeatedly reflect ancient wisdom that values hope and prayer. A patient’s illness is clearly embedded within the value system of the culture that surrounds him. Family and community along with “healers” and magical potions (often potent local herbs) all interact to provide the healing cure. Stories, songs, dances, special foods, prayers to the spirit world are not seen as outside the process of the patient’s illness, but in fact as essential to restoring health.

I choose to follow his healing manner. And chose the closest specialty that mirrored his personality: psychiatry.

Modern medical research corroborates the Talmudic and folk wisdom that a patient in isolation, cut off from all support intuitively. For him the mind-body unity was a self-evident truth. Today, we know it scientifically. One of the body’s “natural defenses”, the immune system, plays a central role.

In my youth I had observed without understanding. I was naïve, thought Grandfather quaint and generous, but believed healing and was caused by modern medicine – that sophisticated surgery, IV bottles with special drugs, antibiotics, steroids, bronchial dilator, and so on did the healing.

So what, in college, appeared to be delays and detours were opportunities to discover what I had to learn – things that I knew from observing my grandfather, but knew without intellectual control.

II

At Stanford – an exciting campus in the turbulent sixties – Gregory Bateson shaped my thinking as decisively as my grandfather had shaped my feeling. At the time I met him, Gregory Bateson had done extensive work in psychiatry, genetics, biological evolution, system theory, and anthropology. He had been married to Margaret Mead and they had worked together as anthropologists in Bali.

Well-known in academic circles, Gregory Bateson’s impact had not then been felt extensively in the wider community of ideas. Bateson was primarily concerned with nothing less than redefining the nature of reality, which he called the “ecology of mind”. Doublebind theory, family systems, cybernetics, general system theory, general system theory, information theory, ecology, and holistic integration of mind and nature – all learned from this remarkable man – were tools for developing my intellectual control.

From Bateson I learned why the subject/object split was indefensible, leading to a distorted “epistemology” with dangerous implications for our technological world. “Dangerous” he would say in his veddy British accent, “because our theories of the nature of the reality in which we live and our theories of the nature of our knowledge of this reality become the bases for our action. Dangerous because these ways of thinking about thinking are limiting. They do not refer to a whole circumstance, only to observer’s frame of reference and his observational tools. The idea that we have control over observational tools. The idea that we have control over behavioral and environmental problems is absurd. Alas, we think we see the whole when in fact we see only a fragment.”

For Bateson, ideas were not airy abstractions, but the foundation of action. Wrong ideas were lethal. “Take Nazi Germany” he said, “as an example of lethal action based on non-existent racial purity and racial superiority. Those absurd ideas galvanized a people and subjected the world to a massive bloodbath. If we separate the mind from the environment, we are doomed. The unit of evolutionary survival, “he said over and over, turns out to be identical with the units of the mind”. Out conception of the world cannot be separate from the world as it works. Our minds interact with the world, and the world with our minds. If we understand this, we will be able to see our minds as part of a greater mind and our selves as part of a larger system.

Much of what he taught me at that time simply went over my head. But substitute “body” for “world” in the paragraph above and you’ll see its significance for a physician. For example: “Our minds interact with the body and the body with our minds”. Only much later after much, much more learning could I comprehend Bateson’s revolutionary significance and recognize that holistic medicine (a term that has suffered from being trendy, faddist, and overused) was initially the serious attempt to define a new epistemology of healing and deal with many of Bateson’s concepts, attempting to integrate them into a unified whole. I shall be explaining how holistic medicine relates to the immune system in the chapter entitled immunocentrality: focus on healing and wellness.

Given the stimulus of a brilliant teacher, I’m surprised that I did not continue in anthropology. But I expected medical school to teach me the profession my grandfather prized above all others and so returned to medical school and grueling studies in pursuit of the mastery of the ever-expanding field of medical knowledge. In sharp contrast to the intellectual heights I had scaled with Bateson, it felt like bailing the ocean.

Cadavers stiff with formaldehyde, death preserved grotesquely in a stinking anatomy lab where medical students pranked each other by inserting fingers, noses, etc. into their lab partner’s lunches, thousand of hours of lectures, thousands of pages of lecture notes, and tens of thousands of textbook pages, hundreds of patients, very often bedded in long, impersonal hospital wards, innumerable physical examinations and history-takings, an obnoxious chief of the service entourage – all conspired to make me seriously question my choice.

Beset with the chronic anxiety of never knowing enough, feeling guilty of I “stole” some breathing time to play though I knew I could not always be studying. I said over and over to myself, I can’t hack it. I’m sorry Grandfather, but this isn’t how you talked about it. Healing shouldn’t be like this. I was being taught, in Bateson’s terms, “the learning to learn” of medicine.

If not for the vision of healing imparted by my grandfather, medical school would have taught me dehumanization and detachment, treating the body as a machine. Like many of my fellow medical students, I would have considered the humanities extraneous. But I shared a vision, made my “detour” into the humanities and benefited from Bateson’s wisdom. I saw it was not a mechanical body, but a human being I must learn about.

Medical students were taught detachment, dehumanization, taught to treat symptoms: the goiter in bed 45. We learned to specialize, emphasize efficiency. We learned to see being professional as being emotionally neutral, learned to view the body as a machine in bad or good repair. The patient was kept dependent and uniformed. The physician was the authority and always in control. We learned to rely primarily on lab tests, X rays, vaccinations, and biopsies. Prevention, we were told, is mostly a matter of luck. The body and the mind were separate. Any pain that couldn’t be diagnosed as physical was suspect: malingering? Or relegated to wastebasket diagnosis: mental illness. Mind was a second rate method of healing.

Although that’s the kind of thing I was taught in medical school, summers had their lessons, too. Visiting Europe opened me and led me to understand what I had learned at Stanford under Bateson, namely the inseparability of customs, culture, language, terrain and topography and the uniqueness of natural character. My laboratory was a continent itself. I hitchhiked, stayed in hostels, worked in hospitals and on ships plying the Norwegian coast to the Russian border.

Another summer, after the third medical year, in sharp contrast from the cool climes and Nordic personalities of Scandinavia. I worked and travelled in Central America, delivering babies in San Salvador, Quetzaltenango and Guatemala. Working in a mountain hospital emergency room I felt, for the first time, a sense of connection with what medicine was supposed to mean and what it was supposed to do. The enormous gratitude, to genuineness, naivete, hospitality, and generosity I encountered encouraged me and renewed my faith in my choice of a life’s work.

I graduated from medical school feeling that the only humanizing experiences had been my friends and my summers.

The exhilaration of graduation was quickly tempered by the reality of internship in a large general hospital where I applied the knowledge gleaned in medical school. An internship is to medicine what boot camp is to marine. The hours, the crushing hours blurred into days and weeks and merged into months. Hours in the emergency room treating victims of gunshot wounds from Saturday night specials, blur with hours of mending bodies smashed in alcoholic accidents. They blurred into interminable hours in surgery, holding a retractor, frozen in space, not daring to move or to scratch my nose behind a mask. Add the hours of going the rounds of internal medicine to chronic heart patients, stroke victims, cancer patients, those simply aged and discarded. Merge that with pediatrics and the unreal world of the premature nursery incubators – tiny human salamanders, naked and hairless. Add hours of the Intensive Care Unit’s deadly stillness, like a science fiction tale the blinking technological machinery of support systems eerily sustains a brain dead patient. Numbed – I mean numbed, I staggered through the year making life and death decisions, most often in consultation, but sometimes alone responsible. And I survived. Somehow…

Apart from the survival training called my initiation into “the real world of medicine”, two significant events occurred at the hospital. First, I had the opportunity to see family therapy practiced by a gifted psychiatrist who sparkled in his humanity. I was spellbound by Dr. Epstein’s skill at interviewing whole families and utilizing general systems thinking exactly what Bateson’s holistic ecological approach had taught. I never failed to attend Dr. Epstein’s weekly conferences or these rounds. Dr. Epstein’s discussions of the family pathology in front of the family were understanding, humorous, empathic, and nonblaming. He evoked no guilt. After a few such conferences I had no doubts that I would become a family psychiatrist. I saw a way to integrate Bateson’s ideas, my grandfather’s values, and my psychiatry.

The second important event was my friendship with a Brazilian surgeon. At the end of his residency and my internship, fall 1966, we left for Brazil. The experience was exhilarating.

III

Most of adventures are a tale for another time, but along the way I learned something strange. At Belem, the headwaters of the Amazon, I paid a fur trapper (who was eventually killed by the very Indians we visited) to take me with him by dugout canoe on a tributary of the Xingu river to encounter a native Indian tribe that had only been discovered a year before.

Living with this Indian tribe for two months finally realized my dream of first hand anthropological study. With the shaman of the trible I went into the jungle to hunt the wild boar and gather the special herbs for his cures. He showed me their methods of medicine, but I am embarrassed to say that I do not know what he showed me because I believed only “civilized” drugs and surgery could succeed. Nontheless, I left the Amazon for Rio profoundly moved by this primitive culture and its way of coping with life’s problems that we all encounter.

In Bahia, the old capital of Brazil, I was introduced to an anthropologist studying possession states “Candobles” – a West African culture of slaves intermarried with the Indian and Portuguese populations who assimilated into a cult a unique brand of Christianity.

With the anthropologist I witnessed a series of “spirit-healing” sessions conducted in small cramped quarters at the end of twisting alleys. The spiritualist was a black woman whose walls and shelves were filled with West African idols side by side with Catholics saints. The ill were mostly women diagnosed as possessed by an evil force imposed by an enemy. The demons were exorcised by ritualistic dance and drumming that regularly lasted three hours and longer. In an orgiastic display of moaning and writhing, the whole room would be thrown into a mass convulsion of crying, writhing participants. Inevitably, the climax was for the women to be possessed one by one by the holy spirit. At the end of the exorcism, the women rose and, almost to a person, declared their aliments had vanished.

At the time I did not fully understand what I was seeing no more than at thirteen I had understood my grandfather, or at twenty, understood Bateson. I was fascinated, exhilarated, the experience satisfied my curiosity to witness anthropological phenomena, but at the time I missed the connection with modern medicine and the immune system. I suppose that like witnessing the healing of the Indian shaman, I was so imbued with concepts of modern Western medicine that I doubted the validity of what I had seen.

And then, out of the blue, I learned that my name had been mentioned on national television. A family emergency. By phone, my father’s troubled voice from Canada whispered, “your mother is dying of leukemia”. My mother, who had always been vibrant and healthy was lying in a hospital, stomach swollen with ascites and given no more than three months to live. I flew home from Brazil, she was operated on and the diagnosis confirmed.

I understood for the first time how the families of patients feel when they heard, as I did from my uncle, the same phrases I had heard dozens of times, all through medical school and my internship. We opened and closed her. She was filled with secondary metastases. There was nothing more I can do, uncle Alexander said sorrowfully.

That disease rendered my uncle’s surgical scalpel impotent. So we took my mother to Mayo Clinic for sophisticated radiotherapy and chemotherapy. Her cancer was radio-resistant. She did not improve. My mother died six weeks after, aged forty-nine.

Three years later cancer struck the family again. My uncle Alexander, the surgeon who had operated on my mother, died of Hodgkins disease, another cancer of the white cells. Once again, failure of the immune system seemed to be involved.

After my mother’s death I began my first year in psychiatric residency. I went from the heart of the Amazon in Brazil to Mayo Clinic, to the cemetery, to a state mental hospital in Hawaii all in the space of a year. In an emotional fog, I functioned, I learned, I even treated patients, but I was detached. My head was disconnected from my heart.

Hawaii was of supreme importance. There I met my future wife and our two children. I reestablished my ties with Gregory Bateson, who was teaching postgraduate anthropology at the University of Hawaii. Lastly, amid a coral sea of cultural diversity, I became acutely aware of the impact of cultural and genetic factors in mental illness. Hawaiian, Chinese, Japanese, Philippine, Figian, Samoan, Portuguese, Italian, East Indian, Black and Caucasian Americans, either representing their pure ethnic backgrounds or highly intermarried, produced an amazing mixture of cultural influences on the expression and the presentation of emotional and mental illness. These topics I discussed at length and researched with Bateson. I undertook a project to film and to analyze the cultural patterns of early childhood-rearing practices on the personal growth of infants. I filmed the mother-child interactions of a number of ethnic cultures, but concentrated particularly on the Portuguese on Mauai.

A second project in the Azores culminated in a paper: “Deuterol Learning: An Entry Into Pattern”. From this research I learned that the value system of a culture might be transferred to infants through nonverbal communication. These cultural values were actually communicated to the infant by touch during the daily feeding, playing, bathing, diapering, and restraining activities in the mother-child body space. This research prompted Bateson to invite me to a conference in Austria under the auspices of the Wenner-Gren Foundation. At this conference on “The Effects of Conscious Purpose on Human Adaptation” the manifesto of anti-reductionist thinking and the move towards holistic thinking had its inception.

The conference “stirred me up”. Too restless for more residency training, I decided to visit Israel. Less than three months after the Six Day War, it seemed the whole world admired Israel’s brave struggle and victory against great odds. I went to Israel with the clichéd intention of many American Jews to search for my biblical roots, completing another stage in my medical odyssey.

For a year I traveled Israel, living on a Kibbutz and doing family medicine in the commune. Then, one special day, I climbed Masada. Almost one thousand feet above sea level, I looked out over the plain at the cluster of stones marking encampments of the besieging Romans two millenniums ago. Jewish zealots in this mountain stronghold had fought off elite Roman Legions for more than three years until engineers erected a huge ramp of stone and dirt. Roman troops then stormed the walls. Rather than surrender, to be humiliated and enslaved, the Jews of Masada elected mass suicide.

When the Roman Legions finally breached the walls of Masada a morgue lay at their feet. The Masadans had fought valiantly then chosen suicide with the same dignity that they had battled the Romans. Because they refused to be enslaved, the enormous Roman investment had been squandered. Atop Masada, I became aware of a metaphor on a socio-historical lever for a phenomenon psycho-immunological medicine.

Modern sociological parallels to the immune system abound. For example, the distinction between self and nonself led directly to the holocaust, then to the destruction of the Third Reich. In Mein Kampf Hitler calls the Jews a “bacterial scourge” that needs to be expunged from the pure Aryan blood line which determined the health and destiny of German society. And ironically, another example is the state of Israel’s enormous emphasis on defense. Surrounded by hostile Arab nations with overwhelming population advantages, Israel’s almost miraculous victories are based on intelligence gathering and preemptive strikes. Israel is an example of a culture acting like the immune system, which fights off infection by early warning and preemptive strikes.

I returned to America to complete my residency under Daniel X. Freedman, an internationally known bio-psychiatrist. At the University of Chicago I learned the basic principles of neuro chemistry and struggled with orthodox Freudian psychiatry. Continuing my interest in family therapy, I saw the devastating effects of family disintegration from drug abuse. I spent six months living with addicts in a treatment center. Exposure to the complexities of the addict personality and lifestyle forced me to see the relationship between the drug abuser, the effects of the addicting substance on an individual’s biochemistry and first-hand experience forced me to understand Bateson’s idea of the inter-connectedness of “processes”.

Events moved at a furious pace. The following year I married Maryann, the woman I had met in Hawaii, and adopted her two small children. I had known during the year of our courtship that our daughter was gravelly ill. Six months after our marriage, in spite of heroic efforts by University of Chicago physicians, she died of a brain tumor. A child whose brightness lighted every corner of our lives disappeared forever at age seven. Who can understand why children die? No I. No medical explanation could console my wife for the enormity of her loss. So I threw myself into helping my new wife with her grief at inconsolable loss, and work passed the time inexorably.

IV

Because family therapy continued to hold center stage of my professional interest, I moved my family to Philadelphia and began further study with Dr. Minuchen and Jay Haley, experts who applied Bateson’s General systems thinking directly to disordered family systems. The patient’s symptoms were understood to manifest a larger family communication dynamic gone awry.

I learned to change the family system and so ameliorate a patient’s illness. In Philadelphia I also learned that patients with such illnesses as diabetes, asthma, anorexia, and bulimia responded favorably to medical intervention using the family system model, holistic in philosophy and built on the idea that the whole is greater than the sum of its parts.

Using this family model of communication I better understood how family stress influenced an individual’s mental and physical health. Intervention in the family system suffering from disordered communication patterns, a revolutionary concept, attempted to restore physical or bodily health by treating an entire family network. I taught these ideas to staffs in a number of mental health clinics in Pennsylvania. A family systems approach made perfect sense to me. I was finally at home as a professional teaching and using a philosophy that was consistent with my intellectual underpinnings.

Two years later I took these ideas and experience to Connecticut where I founded the Graduate Center for Family Clinical Studies (my own training institute in family therapy) and became the director of a Children’s Mental Health Clinic for the greater Bridgeport area. The family model appeared to work as I achieved success both in executing programs for emotionally disturbed children and their parents as well as teaching and training other professionals to use these ideas in their own practices.

By 1975 I was a well-established and respected member of the psychiatric and academic communities. Family therapy was considered avant-garde in those days; nevertheless, it was an accepted adjunct to the practice of psychiatry and the understanding of mental illness.

My personal and professional experience enabled me to respond to a book outside my field entitled “Mental and Elemental Nutrients”, by Carl Pfiffer, M.D, director of the Brain Biocenter in Princeton, NJ. Reading the book convinced me that, although relevant and important, the family system model didn’t go far enough. It overlooked the effects of trace elements on behavior and subsequent health. Further reading revealed the effects of diet, nutrition and other key environmental variables such as light, air, soil, water, climate, and weather on the human body in health and disease.

It shocked me that an obvious and simple idea had been completely overlooked in my medical residency and post residency training namely, the fact that our food must provide elemental nutrients such as zinc, copper, calcium, magnesium, chromium, and selenium, the lack of which could have direct effects on emotional health and physical well, being of a person. The B and C vitamins as well as folic acid and amino acids such as tyrosine, phenylalanine, and tryptophane could have direct effects on neuro transmitter and endorphin production.

After studying Dr. Pfiffer’s book, I visited the Brain Biocenter in Princeton, spent two days with Dr. Pfiffer in his practice and laboratory, and came away absolutely convinced that psychiatry as well as general medicine was overlooking a fundamental and crucial element in understanding emotional and physical illness. It proved significant to my role as a healer when I realized that thinking about the disease model had to allow for this new information.

In Hawaii and the Azores I had recognized the importance of a mother’s loving care, but specialized research had caused me to overlooked the equally important matter of nutrients passing to the infant from a nursing mother’s milk. I didn’t need a medical degree to understand that hunger makes a child cry, but my medical knowledge enabled me to understand the subtler hunger of trace nutrient deficiencies. And so I began to read as much as I could about the field, to attend conferences, and to talk to other physicians who were following similar instincts.

Concepts such as hypoglycemia, subclinical malabsortion state, biochemical individuality, vitamin dependency, food allergy, cerebral allergy, immune dysfunction syndrome, chronic sensitivity, multiple allergic syndrome, subclinical hypothyroidism, tension fatigue syndrome, immune disregulatation, and ecological/chemical illness became new diagnostic considerations that intruded upon the family system model. It was if I’d opened Pandora’s box and released a thousand gremlins. It permanently affected my orientation to medicine and my patients. New techniques and ideas had to be mastered and synthesized.

V

It was an exciting time. But to my surprise my excitement with orthomolecular medicine was perceived by medical colleagues as a direct threat to their model of medicine. They would have nothing to do with me or my strange ways. As a result solely on the basis that I practiced orthomolecular medicine, I was denied staff privileges at a hospital where I had practiced for more than six years. For the first time I became aware of the repercussions from challenging the entrenched medical model of illness. I had expected my discovery of new ways of preventing and treating illness to be received enthusiastically. After all, we physicians had the same goals. But no. New information threatened the fundamental “business” of healing.

Our new nutritional and immunological methods as opposed to drug therapies were being rejected across the country. Other doctors sometimes found themselves in worse situation than losing hospital privileges. Witch hunts. Licenses revoked. Practices closed. In two cases, the ultimate humiliation: prison. I moved to another part of the state, applied to no other hospitals for admitting privileges, and set up a private practice of P.N.I., more convinced than ever before that what I offered my patients was the best possible response to their symptoms and illnesses.

Whatever it is called, this mode of healing is satisfying and rewarding but can be politically and medically ostracizing. Traditionally, general practitioners refer patients to specialists, and specialists to each other. When I practiced full time in psychiatry I had many such referrals. Nowadays, referrals are word of mouth from patients who benefited from holistic methods after others have failed them.