As soon as she walks into my office, I feel an almost fatherly urge to fix Lynn’s problem. Her bright smile and sparkling eyes are reminiscent of my own two daughters, and her invincible optimism in the face of persisting discomfort is endearing.
For roughly twenty of her 22 years, Lynn has been troubled by severe abdominal pain after every meal. Her pain begins minutes after eating, pierces the epigastrium and penetrates to the back. Legions of specialists have tested, probed, prodded and retested her. All to no avail. Her diagnosis remains today what it has been since she first presented as a child: “abdominal pain, etiology unknown.”
Fortunately, Lynn is not undiagnosable. Not incurable. She has simply never been asked the right question. The most important question a caregiver can ask once the diagnosis has been established – even if that diagnosis is “etiology unknown.”
Why has she not been asked? I suppose because the question invites an unrecognized part of the patient to participate in their own cure – a part for which today’s austere medical science has neither time nor place. The question is: “Why today? Why now?” And the answer is solicited, as I’ve learned over the years, from the patient’s unconscious mind.
Here is how it’s done. First, this query must be properly couched. It must be encircled with a seemingly blasé unconcern and spoken as if it were the most off-hand and undeliberate of remarks. A sort of “Oh, by the way….” In this way, consciousness drops its guard and resistance is unlikely. Next, the question must be asked like this: “Well, Lynn, you’ve seen some of the best doctors in the world, and they don’t know what you have. And, I confess, I certainly don’t know what you have. And, you must admit, you don’t know what you have either. Nobody knows, and we are not going to know. So, let’s not pretend.” Here, I’m casting all knowledge and consciousness aside. Then: “And yet, this pain you suffer – it could have disappeared two years ago, or two days from now. Yet, it’s still here. So, odd as this may sound, let me ask… if you had to guess, just a wild guess… why is this pain still here? Why today?… Just guess.” Now, I am conjuring her deeper wisdom, for what is this guess if not a whisper from the unconscious?
Silence.
I wait, as I have learned to do.
At length, the answer percolates through and Lynn replies, quizzically: “All I can think of is fear of vomiting.”
“Alright,” I say, “let’s go with that. What’s the worst that can happen if you vomit?”
“Well,” she says, “they say if you are born with the cord around your neck, if you vomit you will die.”
There it is. As a child, Lynn had learned that she was “born with a cord around her neck.” That idea became a part of her identity. Then, she learned that to vomit, for one such as herself, is to die. Never mind the infantile confusion of time and place; what matters is that this jumbled notion persists. She mustn’t vomit; it is a matter of life and death. And so, her unconscious imposes a tense lower esophageal sphincter spasm after every meal.
It is, I know, a hypothesis. But I can test it, easily. “Lynn,” I say, “please understand that if you were ever to find yourself in the birth canal again, with the cord wrapped around your neck, doing everything not to vomit would be a good thing. Do that.” She nods, a bit perplexed. “But once the cord is cut, and it was cut at childbirth, the danger from vomiting is gone.” Her eyes brighten. “Besides, in this adult world you are now in, the best way to avoid vomiting is to allow the food in your stomach to pass through the intestines normally. You understand?”
“Yeah, I do,” she says.
“Just normal intestinal mobility from now on,” I tell her with a smile.
As she leaves our first session, I’m hopeful for Lynn. She dreams of owning a restaurant and creating a local gathering place of joy and comfort. She dreams of painting again, and perhaps decorating the restaurant with her art. How wonderful, I think, if these dreams were to come true. How proud her father would be.
A week later, my hopes are momentarily dashed as Lynn reports having had a “terrible week.” But on closer questioning, it turns out the first two days were pain-free – for the first time in memory. It was on the third day that the pain returned. “No worries, Lynn,” I say reassuringly. “As a wise old man once told me… ‘if someone can have a piece of an experience (as you did), then you will have it all’.” This last sentence I deliver with direct eye contact and a forceful voice. It is meant to work as a waking suggestion. After all, the white coat and stethoscope endow all physicians with some measure of hypnotic influence.
During the following week, I think of Lynn. She is a sweet and deserving young lady. I can feel her struggle and the sadness she hides. I want her to be well, to prosper, to achieve her many dreams. For a moment, I catch myself: “Is this right, I wonder.” My concern is clearly personal. But then, I think, isn’t all caring personal? Isn’t this why I got into medicine in the first place – to care about people as if they were part of my own family?
“So how was the week?” I ask, upon her return. “Best week of my life,” she declares happily. “Really? What made it so good?” She smiles: “I ate 10 meals a day and gained 5 1/2 pounds!” Lynn assures me she will moderate her eating going forward and that last week was simply a celebration. Then, I suggest she take “a humble moment” and allow her own sense of pride and gratitude to suffuse through her. “After all,” I offer, “we should always thank our friends when they are helpful. And your unconscious appears to have been a very helpful friend of late.”
Carl Jung was keen to say, “You have an unconscious mind, and I have an unconscious mind. And I’m not so sure where yours begins and mine ends.” As Lynn leaves the office bound for her new life, I know Jung was right. Somewhere in Lynn’s unconscious mind, a single question (“Why today?… Just guess.”) teased out a cause and enabled a cure. Somewhere in my unconscious mind, the urge to ask that question arose. And so, in my humble moment, I too allow a quiet pride and profound gratitude to be felt. I realize that, from time to time, there will be aspects of my father-self hovering over my ministrations. At other times, there will be aspects of my brother-self or friend-self that augment my hopes to heal. These gentle specters are not a part of physical science. But I’m okay with that. In fact, thinking of Lynn at the end of her long travail, I’m happy to let them haunt my office and inspire my work.
