Why Me? The Search for Meaning in Alternative Medicine

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Patients often ask "Why me?" At bottom, this is as much a metaphysical as a medical question. In earlier times disease was often seen as divine retribution for some past misdemeanour: God was punishing the sinner by means of the disease. This idea is out of fashion now even among believers, having gone the way of belief in Hell. At the same time, there is a persisting feeling in many people's minds that the world ought to be fair. If you eat all the right things, exercise regularly, and obey all the fashionable precepts about health you don't deserve to get ill, and if you do it isn't fair.

Cancer and personality

This is probably why explanations for cancer in terms of the patient's personality are so compelling for many people. If you have thought the wrong things or felt the wrong emotions and brought on a cancer you feel guilty; this is the modern secular equivalent of feeling guilty because you have sinned and God is punishing you. In other words, we find a metaphysical justification for disease masquerading as a scientific explanation.

This seems to me to be quite unacceptable. Along with excessive and unjustified optimism, the induction of feelings of guilt in patients is one of the worst failings of alternative medicine. It is bad science and bad metaphysics. Unfortunately, however, orthodox medicine at present can't provide much of an answer either, but help does come from another direction: 'Darwinian medicine'.

Darwinian medicine

This is still very new; if you mention it to most conventional doctors, the chances are that they will look at you with a puzzled expression and ask you what you mean. They are of course familiar in a general way with the ideas of Darwin, but they have not usually made much connection in their minds between those ideas and medicine. It may seem odd to say that Darwinism is new in medicine, but its relevance has been curiously understated until very recently. The extraordinary fact is that although Darwin published The Origin of Species nearly 150 years ago, and in so doing precipitated what many people think is the greatest intellectual revolution of all time, the application of these ideas to medicine in any systematic way began a mere ten years or so ago.

Why has there been this denial? The suggested reasons include hostility to Darwinism in educational circles, at least in the USA, and the fact that the evolutionary ideas with greatest relevance to medicine have been formulated only comparatively recently in biology. And if orthodox medicine has been slow to recognize the importance of Darwinian ideas, alternative medicine has not even begun to think about it.

Darwinian medicine views disease in an evolutionary perspective. This does not of course provide a metaphysical explanation but it does make sense of the existence of many kinds of disease in scientific terms. It says, in effect, that you have become ill because you are a being who has evolved in a certain way, and because you live in a world that has certain characteristics and works in a certain way. This is not necessarily a consoling explanation, in fact it may be rather a stark one. It implies that disease and probably aging will always be part of our experience.

Darwinian implications not necessarily optimistic

As an analogy, consider the light of the sun. If the sun did not exist, obviously we shouldn't exist either. The sun is essential for life on earth; all our energy comes, ultimately from it. Yet the sun is also a source of danger; its radiation is potentially fatal for us, and we can survive exposure to it only because the atmosphere, including the famous ozone layer we are in the process of destroying, filters out most of the rays that are harmful. We can minimise the dangers of exposure to the sun by wearing clothes and not going out at midday but we cannot eliminate them entirely; the harmful effects of solar radiation are simply the obverse of the beneficial effects.

The same kind of reasoning applies to evolution. We have come into existence thanks to natural selection. (So too have bacteria and viruses.) Certain consequences follow from this quite inevitably, and one of these is liability to disease. In many instances, it turns out, disease is merely the reverse side of a mechanism that exists in order to preserve us from disease. For instance, allergies and autoimmune diseases such as rheumatoid arthritis result from excessive or misdirected activity of the immune system; but we can't live without the immune system.

We don't have to give up

The implication we should take from this is not one of fatalism. Even though disease, aging, and death will always be our lot, it doesn't follow that nothing can be done about them. Indeed, a great deal has already been achieved, not just by medicine but by public health -- improved sanitation and water supplies, for example, which historically have contributed more to preventing disease than has medicine. I have little doubt that provided our civilization doesn't destroy itself -- quite a large proviso, clearly -- we can expect to see a remarkable increase in the availability of truly effective treatments for many diseases: viral infections, arthritis, many forms of cancer, perhaps even the diseases of old age such as Alzheimer's disease. But the fact remains that our vulnerability to disease is, in the deepest sense, natural.

The naive optimism of alternative medicine

Contrary to what some enthusiasts for alternative medicine would have you believe, we're all subject to illness by the mere fact that we have been born. It's quite true that diet, exercise, not smoking, and avoiding excessive alcohol intake will make it more likely that you'll be healthy, but there are no guarantees; you may do everything that you ought to do, eat the 'right' foods, and all the rest of it, and still suffer any of the myriad illnesses to which we are all subject. And if you don't die in middle life you will age, and you may then suffer from senile dementia or any of the other degenerative diseases that lie in wait for us.

The idea that these things can be avoided by diet, yoga, and similar things is a sentimentalist's delusion. Keep your wits about you and remember Dr Johnson's lines: "But hope not life from grief or danger free, / Nor think the doom of man reversed for thee."

Why not you?

The reason for this is nothing to do with Original Sin or any other religious or metaphysical notion. It's a consequence of the fact that we are biological organisms, subject to the process of Darwinian selection. Conventional medicine has made amazing advances in diagnosis and treatment but it hasn't abolished disease and aging and no doubt it never will. Alternative medicine enthusiasts often imply that they can prevent cancer and other degenerative diseases by alterations in lifestyle and in other ways, but this simply isn't true. Don't be taken in by the merchants of permanent health and happiness. Remember, there's no free lunch.

Unless we die suddenly in the prime of life, most of us will sooner or later experience the truth of the rather bleak view of life that I've just sketched. If you don't believe me, read a few biographies or, if you are old enough, look around you at the lives of your friends. How many people have you heard of or do you know personally who have lived a long life without major illnesses of any kind and who have finally died at an advanced age with only a few days of preliminary illness? Not many, I'll bet. "Count no man happy until he's dead," the classical aphorism runs.

I often remember a remark in a novel by Vladimir Nabokov: "When we're young, we think these things only happen to other people; as we get older, we realize we are those other people." Quentin Crisp has compared life to a race across open country under fire; an image that appeals to me.

Susan Sontag has written:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.
To the question "Why me?" there can, ultimately, be only one answer: "Why not you?"