Dr. Leslie Blackhall, an American physician trained in Tibetan medicine, speaks with some first-year medical students about the concepts of "illness" and "disease," and comments on the value of understanding the differences between medical systems.
传统中医或藏医从宏观的角度认识疾病 疾病(disease) 是从医生的诊断的角度来讲的,而这种疾病对患者所造成的影响及病人的感受为病痛(illness)
- Dr. Leslie BlackhallFirst of all, I mean, there's the whole area, since this is Humanities and Medicine, of, um, the fact that people, um, what you are learning about is disease. Medical anthropologists generally distinguish between disease and illness, Ok?
- And maybe you've heard of this before, but you know, disease is the, sort of, patho-physiologic entity, right? But illness is the experience of the patient.
- So, I could diagnose you with diabetes, right? And, and there's a whole patho-physiology and you could learn about it. But the question is, the impact on you would depend on your context--who you are, if you're mother died of diabetes, right?
- And ended up blind in renal failure with her limbs cut off, you're going to have a different impact of this disease on your whole life, you know? From the time of diagnosis than someone who doesn't have those associations with it.
- And so, and similarly, you know, if you feel, you know, embarassed or shy or your whole culture is one that generally your wife--for example, as is true in many Mexican-American communities--you know, the type of food that's cooked is very high fat and then they come to the doctor and they tell you you have to eat lots of fresh vegetables, and you live in East L.A. where there's actually no fresh vegetables for sale, you know?
- All you have is little package stores where you're lucky if you can get Bird's Eye Frozen Peas. And what you have is canned, you know, or refried beans that people cook in a way that they're asking you to make a huge change in your lifestyle and change everything you do.
- For the sake of this illness, as compared to those of, maybe, who lived in Brentwood, L.A. and who are alredy vegetarians and went running, it's going to be a different type of impact in your life.
- That's the difference between illness and disease. And when you get into clinical practice, one of the things you will see is that you haven't been taught to pay attention to illness.
- Because your model doesn't look at illness. It looks at, it focuses on a more reductionist view of disease, and, you know, in certain ways because there are now Medical Humanities courses and things like that, you know, you have more access to, um, issues relating to the non-strictly medical than I did.
- On the other hand, the medical model, in a certain way, is getting more reductionistic, right? You're now there in genetics and people are looking for genetics of alcoholism and the genetics of accident prone-ness.
- I mean, to look at some piece on the DNA for something like that, you have to admit, is a pretty narrow way of looking at it. If I see a patient is being beaten up by her husband and she's drinking heavily, I mean, how much does it help me to know that she has the genetic marker for alcohol abuse.
- If I can't deal with the whole context that she's getting beaten up and the last time she left, her husband went down the street and beat up her mom, which is true of a patient of mine.
- And if I don't know how to cope with that, and you're not going to be given any skills to cope with that, there's going to be a lot of things you can't do.
- So, in this sort of reductionistic model, there's a whole category of disease / illness that is really not well-perceived and those are diseases that are on the borderline between the mind and the body.
- Chronic Fatigue Syndrome. Is it, I mean, the level of discussion about this entity is such that it's on the level of "Does it exist as a disease? Or is it 'just depression'?"
- Fibromyalgia, I mean, we have never in all the years since I've been a doctor--you know, and that was like centuries ago, when I went to medical school--um, we're still arguing about whether these things even exist.
- Because we're not very good--because of the way our medical model is, because of how it focuses on, you know, sort of breaking things down into pieces--at looking at how those get put together.
- I mean is, psychiatric illness is treated as if it's not a real illness. I mean, we do in this country treat it that way, right? Because we don't pay for it. You can't get anybody to pay for psychiatric treatment, you know?
- All these bills about why should we still be discussing if psychiatric illness is really, sort of, a brain disease parody? You know, why do we still have to wonder if insurance should pay for it?
- But there's that sneaking feeling that it sort of isn't real. Or maybe that schizophrenia is, but depression you should just snap out of it and, you know, smile more of something.
- Right? So, the ways in which that doesn't fit, and what I began to feel was that one of the interesting things about alternative medicine wasn't just to take, you know, zinc here and one, you know, like Chinese herb over there, like, that might work.
- But to look at how they envision what the person was. Do you see what I mean? To look not just at, "Gee they were lucky, and they managed to hit empirically on five herbs that worked, you know, in their stupidity and their ignorance about what the human body was."
- "We should be willing to accept the fact that maybe they found golden seal or, you know, um, ephedra or stuff like that and we can then make it better, we'll just distill it down to its essence and then get rid of those stinky--" I don't know if you took the kind of Chinese medicine where you take the herbs and sticks, and you boil them in a thing and you drink the swamp water, which is the kind that I've taken.
- Or the Tibetan medicine which they make into a little pill, and then you have to chew on it. And, believe me, it's like, you know, doesn't taste good. I think that's the polite way of saying it.
- Um, you know, we're going to take it and we're just going to use our western diagnostic tools and then give whatever the "active ingredient," you know, that we've extracted. That, that doesn't interest me much about Tibetan medicine or any form of medicine as "How are they envisioning what, what the human being is?"
- You know and how are they, from that able to see a disease / illness and make an intervention that helps somebody? And are they, really?