Article for Body Language, Mail & Guardian 16th Nov 2012

Ordinary Madness

Recently an overweight friend announced proudly: ‘I lost two kilogrammes this week, so I celebrated by going to the deli and eating a big piece of chocolate cake.’

The other day I was called to see a patient who was having palpitations and difficulty breathing. Her symptoms were caused by a large intake of caffeine, nicotine and the stress of building renovations. I advised her to reduce drinking coffee and smoking, and to look at how she can manage her situation better. ‘Oh I can’t give up coffee and cigarettes now,’ she objected. ‘I am far too stressed for that.’

These are wonderful examples of ordinary madness. Both these women recognised the irony, and we had a good laugh.

When I started out as a doctor, I thought well-presented arguments would change people’s minds. Here are the facts, I would declare, conjuring up ghastly images of blackened, stiff lungs, and scarred, hardened livers. I would draw graphs, and pull out charts. My patients’ eyes would glaze; they would wait impatiently for me to finish so they could hurry off to the pub to have a double whiskey and a smoke. I could see them laughing with their buddies about the ridiculous GP while hacking up pieces of lung.

My training is in evidence-based medicine - prescribing treatments that have been proven to work. Yet if my patients acted on what researchers know is good for health, I might well be out of a job. Self-inflicted conditions are the doctor’s bread-and-butter.

I confess that I, too, exhibit some worrying trends. I bite my nails. I would rather no-one knows that I tear off bits of my own body with my teeth while reading. Not again, I think. What happened? This has to stop. I work with the public. I put my hands on their bodies, and they look down and see: a self-mutilator. My patients will know I am as mad as they are.

I have painted my nails. I have invested in gloves which remain at the bottom of my sock drawer. I sit on my hands while reading. I have a nail file next to my computer to deal with those irritating little sticky-out bits that tempt me to the point of my undoing. I reassure myself that - unlike eating sugar when you are diabetic – nail-biting is not a life-threatening condition.

In my defense, I never hurt myself. Almost never. I have perfected the art of nibbling down to the verge of hurt.

Rationally, like quitting smoking or resisting the cream cake, I could just stop. Stop it. STOP it. But the groove is so deep, so well-worn, so . . . potentially comforting. If logic is frequently, and surprisingly, unhelpful, instead of trying to get rid of our non-rational ways, we could turn and face them. Bravely, with curiosity.

For thousands of years, humans have understood why we are here and what to do about it by telling stories. Thunder was an angry god. The moon was Mantis’s shoe. Now that science gives us new ways of looking at thunder and the moon, many have ceased to take stories seriously.

Yet we resist being fully known through the tape measure and the set square. We are poetic as well as scientific beings. We respond to holy stones, lotus flowers and sacrifice. These images stimulate the poetic foundation of the mind – which merges and connects.

Mythological narratives inform our decisions. Psychologists and artists know this; their work is to reveal these underlying patterns and motifs.

The bite at my fingertips is also in my back. I have the jaws of a bull mastiff locked into my right thoracic back muscles. I have tried many therapies, but it is determined to hang on forever.

My backache is part of an autoimmune condition. There are scientific ways to describe my intransigent illness. Doctors usually stop at that. Yet the dog also resides there. This is the poetry of the body – the subjective experience. It is another way of understanding, and it is as valuable as medication.

My back talks to me in the only way it can, using symbol / symptoms, making me aware of an embedded story. Since investigating the biting motif through imagination and art, I am not as tensed against the ferocious canine. When I notice the grip, I become aware of a need to get tough, more protective.

The body does not speak English, so it can be difficult to work out what these crazy symptom-poems are saying. I wait, with curiosity, for the ordinary madness of my story to unfold. And sometimes I risk appearing really deranged by suggesting this approach to my intransigent patients.