The 'chessboard of healing strategies': A cardiological application.

RATIONALE: The question of how to adaptively cope with chronic illnesses, aging, and other sources of bodily impairment is crucial for patients and clinicians alike, though sometimes overlooked in the focus on biomedical treatment. AIMS AND OBJECTIVES: To examine the array of strategies available to patients and their practitioners, to employ in the face of bodily breakdown. METHOD: Co-written by a philosopher and cardiologist, this article uses a detailed case study of a patient suffering a myocardial infarction leading to chronic heart failure, with examples of effective or suboptimal care. This enables a discussion of how the clinician or clinical team can best facilitate existential healing, that is, adaptive and creative resilience in the face of chronic impairment. RESULTS AND CONCLUSIONS: We outline a "chessboard of healing," involving the possibility-spaces for dealing constructively with bodily breakdown. This set of strategies is shown to be nonarbitrary, drawn directly from contemporary work on the phenomenology of the lived body. For example, as we both experience the body as that which 'I am', and as that which 'I have', separable from the self, patients can react to illness by moving towards their bodies in modes of listening and befriending, or away from their body, ignoring or detaching themselves from symptoms. Then too, as the body is ever changing in time, one can seek restoration to a previous state, or transformation to new patterns of bodily usage, including passage into a whole new life-narrative.

The Phenomenology of Healing: Eight Ways of Dealing With the Ill and Impaired Body.

Encounters with illness, impairment, and aging can disrupt one's experiential relationship with self, body, others, and world. "Healing" takes place when the individual is able to re-integrate his or her world, even if the condition is not medically curable. Drawing on work in the phenomenology of the body, this article examines a series of eight "healing strategies" individuals employ, each representing a different way of orienting toward the painful or impaired body. One may lean into freeing oneself from the body, through strategies of "refusing," "ignoring," "objectifying," or "transcending" its problems. Conversely, one may choose to embrace the body, through strategies such as "accepting," "listening," "befriending," or "witnessing." It can be beneficial to have a good number of such coping strategies at one's disposal, enhancing flexible response to chronic challenges. They also are often used in synergistic or complementary combinations.

Healing time: the experience of body and temporality when coping with illness and incapacity.

The lived body has structures of ability built up over time through habit. Serious illness, injury, and incapacity can disrupt these capacities, and thereby, one's relationship to the body, and to time itself. This paper focuses attention on a series of healing strategies individuals then employ on the "chessboard" of possibilities intrinsic to lived embodiment. This can include restoring past abilities (pointing to the future to recreate the past); and/or transforming one's bodily structure or use-patterns, or the external environment, to compensate. With many conditions, including progressive aging, no full rehabilitation is possible. Nevertheless, one can also seek consolation, richness, or hope by remembering the past; anticipating the future; or presencing, that is, living fully in the now. Insofar as past, present, and future are interwoven in one's life experience, many also meet adversity by a life-story revision, constructing a new narrative to render events meaningful. Some also access a sense of transpersonal timelessness, whether through anticipation of an afterlife, or a sense of the eternal present. There is a literature on the adaptive coping mechanism used by the chronically ill, but with its diverse patient populations, methodologies, and categories, it has proved difficult to systematize. This article suggests that the structures of lived embodiment, as explored by phenomenology, provide a way to understand the modes of wholeness individuals access over time, and in relation to time-what is here termed chronic healing.

Coping with chronic pain, illness and incarceration: what patients and prisoners have to teach each other (and all of us).

This article proposes the benefits to be had from an unusual conversation: that between those suffering from chronic pain/illness and from long-term incarceration. Taking a phenomenological approach, a series of experiential commonalities are outlined: pain and illness, like incarceration, can cause (1) a constriction of lived space and the range of possible action; (2) a disruption of lived time, such that one is trapped in an aversive 'now', or ever trying to escape it; (3) isolation, as meaningful social contacts diminish or are ripped away; and (4) disempowerment and depersonalisation, especially when the ill person feels caught within a medical system that can be dehumanising in ways that echo prison life. Drawing on pathographies, and my published conversations from teaching philosophy classes in prison, I outline some of the strategies whereby creative individuals help relieve these modes of disruption. These include (1) adaptability, as individuals learn to live differently, but well, within the limits imposed by pain/illness or incarceration; (2) appreciative presence, the ability to find joy in, and richly utilise, the 'now'; (3) mental freedom, which includes the capacity to choose emotional responses, and to expand the intellect and spirit even when the body is confined; and (4) community, surmounting isolation through empathic relation with others. I suggest a conversation between these groups can bring mutual benefit, and teach us all how to live well in extreme circumstances, which we may encounter some time in our life.

The Experiential Paradoxes of Pain.

Pain is far more than an aversive sensation. Chronic pain, in particular, involves the sufferer in a complex experience filled with ambiguity and paradox. The tensions thereby established, the unknowns, pressures, and oscillations, form a significant part of the painfulness of pain. This paper uses a phenomenological method to examine nine such paradoxes. For example, pain can be both immediate sensation and mediated by complex interpretations. It is a certainty for the experiencer, yet highly uncertain in character. It pulls one to the present but also projects one outward to a feared or desired future. Chronic pain can seem located in the body and/or mind; interior to the self, or an alien other; confined to a particular point and/or radiating everywhere. Such fundamental paradoxes, existential and epistemological, can challenge those living with long-term pain.

"Take your pill": the role and fantasy of pills in modern medicine.

The pharmaceutical industry has undergone a vast expansion in the 20th and 21st centuries. This article explores the central role now played by pills in clinical practice, but also in the public imagination. First, this article analyzes four properties that, together, account for many of the promises and perils associated with pills: They are ingestible, potent, reproducible, and miniaturized. This allows them to serve as ideal consumer items for widespread distribution and sale and also as model technological "devices" capable of downloading into the body healing chemicals. As such, they seem to promise a disburdening solution to many of life's ills. In our cultural fantasy, often shared by physician and patient alike, pills can be used not only to treat and prevent disease but also raise energy, lose weight, lessen pain, lift mood, cope with stress, and enhance sexual and athletic performance. This article also explores many adverse effects not only of pills themselves but of this exaggerated cultural fantasy of the pill. It tends to distract us from other, more holistic understandings of the locus of disease and healing. It even fosters misunderstandings of the ways in which pills themselves work, which is to assist bodily processes, and the mind's "meaning response." The intent here is not to demonize all pills-many have great therapeutic potential-but to learn how to better choose and use them wisely. We propose that this process be assisted through recontextualizing the pill as a multidimensional gift. Taken in such a way, with appropriate gratitude and discernment, we may ingest fewer pills, but with greater efficacy.

Toward a more materialistic medicine: the value of authentic materialism within current and future medical practice.

Modern medicine is often accused by diverse critics of being "too materialistic" and therefore insufficiently holistic and effective. Yet, this critique can be misleading, dependent upon the ambiguous meanings of "materialism." The term can refer to the prevalence of financial concerns in driving medical practice. Alternatively, it can refer to "mechanistic materialism," the patient viewed as a body-machine. In each case, this article shows that this represents not authentic "materialism" at play, but a focus upon high-level abstractions. "Bottom-line" financial or diagnostic numbers can distract practitioners from the embodied needs of sick patients. In this sense, medical practice is not materialist enough. Through a series of clinical examples, this article explores how an authentic materialism would look in current and future practice. The article examines the use of prayer/comfort shawls at the bedside; hospitals and nursing homes redesigned as enriched healing environments; and a paradigmatic medical device--the implantable cardioverter defibrillator--as it might be presented to patients, in contrast to current practice.

The touch that heals: the uses and meanings of touch in the clinical encounter.

This paper investigates the healer's touch in contemporary medical practice, with attention to both allopathic and alternative modalities. Healing is understood as the recovery of an integrated relationship between the self and its body, others, and the surrounding world-the relationship that illness has rendered problematic. In this context, touch can play a crucial role in the clinical encounter. Unlike other modes of sensory apprehension, which tend to involve distance and/or objectification, touch unfolds through an impactful, expressive, reciprocity between the toucher and the touched. For the ill person this can serve to reestablish human connection and facilitate healing changes at the prelinguistic level. The healer's touch involves a blending of attention, compassion, and skill. The clinical efficacy of touch is also dependent upon the patient's active receptivity, aspects of which are explored. All too often, modern medical practice is characterized predominately by the "objectifying touch" of the physical examination, or the "absent touch" wherein technological mediation replaces embodied contact. This paper explores the unique properties of touch as a medium of perception, action, and expression that can render touch a healing force within the clinical encounter.

"Spooky actions at a distance": physics, psi, and distant healing.

Over decades, consciousness research has accumulated evidence of the real and measureable existence of "spooky actions at a distance"--modes of telepathy, telekinesis, clairvoyance, and the like. More recently scientists have begun rigorous study of the effects of distant healing intention and prayer vis-a-vis nonhuman living systems and patients in clinical trials. A barrier to taking such work seriously may be the belief that it is fundamentally incompatible with the scientific world view. This article suggests that it need not be; contemporary physics has generated a series of paradigms that can be used to make sense of, interpret, and explore "psi" and distant healing. Four such models are discussed, two drawn from relativity theory and two from quantum mechanics. First is the energetic transmission model, presuming the effects of conscious intention to be mediated by an as-yet unknown energy signal. Second is the model of path facilitation. As gravity, according to general relativity, "warps" space-time, easing certain pathways of movement, so may acts of consciousness have warping and facilitating effects on the fabric of the surrounding world. Third is the model of nonlocal entanglement drawn from quantum mechanics. Perhaps people, like particles, can become entangled so they behave as one system with instantaneous and unmediated correlations across a distance. Last discussed is a model involving actualization of potentials. The act of measurement in quantum mechanics collapses a probabilistic wave function into a single outcome. Perhaps conscious healing intention can act similarly, helping to actualize one of a series of possibilities; for example, recovery from a potentially lethal tumor. Such physics-based models are not presented as explanatory but rather as suggestive. Disjunctions as well as compatibilities between the phenomena of modern physics and those of psi and distant healing are explored.