“I don’t believe in diseases anymore, I treat stories.
“…No other medical system in the world ever believed in diseases. They all treat everybody as if, you know it’s whether it’s the ancestors or meridians–it’s none of this rheumatoid arthritis, strep throat kind of thing. That’s just this construct that we kind of… made up.”
– Dr. Thomas Cowan, MD
Dr. Cowan is admittedly a (deliciously) controversial figure. His statement, I’m sure, is controversial. But that’s why it intrigues me.
In naturopathic medicine, one of our core philosophies, with which I adhere very strongly, is “treat the person, not the disease”.
And, in the words of Sir William Osler, MD, “It is much more important to know what sort of person has a disease, than to know what sort of disease a person has”.
And, I guess it’s relevant to ask, what is disease in the first place?
I see disease as an non-hard end point, a state that our biological body enters into. On the continuum between perfect health (which may be an abstract and theoretical construct) and death, disease I believe is near the far end of the spectrum.
Disease happens when the body’s proteins, cells, tissues, or organs begin to malfunction in a way that threatens our survival and disrupts our ability to function in the world. For example, a collection of cells grows into a tumour, or the immune system attacks the pancreas and causes type I diabetes.
But, of course there is always more to the story.
What causes disease?
I have heard biological disease boiled down to two main causes: nutrient deficiencies and toxicities. And, I’m not sure how strongly I agree with this, but on a certain level I find this idea important to consider.
However, it is definitely not how Western Medicine views the cause of disease!
Diseases, as they are defined, seem to be biological (as opposed to mental or emotional). They have clinical signs and symptoms, certain blood test results, or imaging findings, and they can be observed looking at cells under a microscope.
Medical textbooks have lists of diseases. Medicine is largely about memorizing the characteristics of these diseases, differentiating one from another, diagnosing them, and prescribing the treatment for them.
As a naturopathic doctor, I see a myriad of patients who don’t have a “disease”, even though they feel awful and are having difficulty functioning. These patients seem to be moving along the disease spectrum, but their doctors are unable to diagnose them with anything concrete–they have not yet crossed the threshold between “feeling off” and “disease”.
Their blood tests are “normal” (supposedly), their imaging (x-rays, MRIs, ultrasounds, etc.) are negative or inconclusive, and their symptoms don’t point to any of the diseases in the medical school textbooks.
And yet they feel terrible.
And now they feel invalidated.
Often they are told, “You haven’t crossed the disease threshold yet, but once you reach the point where you’re feeling terrible and our tests pick it up too, come back and we’ll have a drug for you”.
Obviously not in so many words, but often that is the implication.
Our narrow paradigm of disease fails to account for true health.
Even the World Health Organization states that health is not the mere absence of disease.
So if someone does not have health (according to their own personal definition, values, dreams, goals, and responsibilities), but they don’t have disease, what do they have?
They have a story.
And I don’t mean that what they’re dealing with is psychological or mental or emotional instead, and that their issues are just “all in their head”. Many many times these imbalances are very biological, having a physical location in the body.
Subclinical hypothyroidism, insulin resistance, nutrient deficiencies, chronic HPA axis dysfunction, and intestinal dysbiosis are all examples of this. In these cases we can use physical testing, and physical signs to help us identify these patterns.
An aside: I believe the categories of biological, mental, environmental, and emotional, are false.
Can we have minds without biology? Can we have emotions without minds or physical bodies? How do we even interface with an environment out there if we don’t have a body or self in here?
Aren’t they all connected?
Ok, back to the flow of this piece:
Your story matters.
This is why it takes me 90 minutes to get started with a new patient.
It’s why I recommend symptom and lifestyle habit tracking: so that we can start to pay attention.
It’s why I’m curious and combine ancient philosophies, research (because yes, research is useful, there’s no doubt–we should be testing out our hypotheses), and my own intuition and skills for pattern-recognition, and my matching my felt-sense of what might be going on for a patient with their felt sense of what they feel is going on for them.
Attunement.
I write about stories a lot. And I don’t mean “story” in a woo way, like you talk about your problems and they go away.
No. What I mean is that you are an individual with a unique perspective and a body that is interconnected but also uniquely experienced. And my goal is to get a sense of what it’s like to be you. What your current experience is like. What “feeling like something’s wrong” feels like. What “getting better” feels like.
And all of that information is located within story.
Your body tells us a story too. The story shows up in your emotions, in your physical sensations, in your behaviours (that might be performed automatically or unconsciously), in your thoughts, in your energy, and in the palpation of your body.
No two cases of rheumatoid arthritis are the same. They may have similar presentations in some ways (enough to fit the category in the medical textbooks), but the two cases of rheumatoid arthritis in two separate people differ in more way than they are the same.
And that is important.
We’re so used to 15 minute insurance-covered visits where we’re given a quick diagnosis and a simple solution. We’re conditioned to believe that that’s all there is to health and that the doctors and scientists and researchers know pretty much everything there is to know about the human body and human experience.
And that if we don’t know about something, it means that it doesn’t exist.
When we’re told “nothing is wrong” we are taught to accept it. And perhaps conclude that something is wrong with us instead.
When we’re told that we have something wrong and the solution is in a pill, we are taught to accept that too. And perhaps conclude that something is wrong with our bodies.
But, you know what a story does?
It connects the dots.
It locates a relevant beginning, and weaves together the characters, themes, plot lines, conflicts, heroes, and myths that captivate us and teach us about the world.
A story combines your indigestion, mental health, microbiome, and your childhood trauma.
A story tells me about your shame, your skin inflammation, your anxiety, and your divorce.
Maybe you don’t have a disease, even if you’ve been given a diagnosis.
Maybe you have a story instead.
What do you think about that?
