Health and Medicine: Is there any correlation?

When I was a medical student, I was struck by the fascination doctors had with illness. The grotesque, the disgusting, the horrific seemed to only arouse interest in my mentors, and in many of my fellow students. I remember one of these fellow students coming up to me one day during our internal medicine rotation with a glow of excitement on her face saying, "Did you see Mr. Jones (not his real name). He has sino-orbital aspergillosis (Fungus eating up his eyeball). You should go take a look -- it's pretty cool." Was there something wrong with me for being horrified rather than titillated by the opportunity to witness fungus growing out of a person's eye socket? Or was it the other way around? I soon came to understand that a good case or "fascinoma" was usual the end product of some poor person having some rare difficult to diagnosis and usually quite horrible disease with a terrible prognosis. Why did my colleagues seem to rejoice in such cases, where I found them only depressing? Was I in the wrong field, or was there something wrong with these people?

I came to coin the term "pathophile" -- one who has a love for or abnormal interest in sickness and pathology. It was my way of trying to feel O.K. about not being so happy about discovering dread diseases in people. It's not that I felt these doctors didn't care about people or want to help them with their illnesses, it's just that I seemed to lack this emotional response to their illness. While some may find it easy to make the leap from wanting to relieve suffering and heal the sick to relishing the discovery of serious pathology, I have found it difficult to make this transition myself. I have difficulty getting excited about anything I can not help my patients with, even if it is rare and uncommon. What's to get excited about unless it moves the patient towards health? One of my medical school professors once expressed his regret to me that I had decided to pursue psychiatry rather than surgery. "What would surgery offer that I couldn't find in psychiatry?" I asked him. "You get to see so much pathology," was his unhesitating response. I sat dumbfounded, unable to comprehend his obvious pleasure at viewing diseased organs.

The net result of 4 years of medical school and many many years of residency appears to me to be that doctors have a profound knowledge of illness, but very little or no training about health. In fact, I feel it is safe to say that few doctors would even be able to say what health is, without making some reference to illness (i.e., that it is the absence of illness). Why should doctors have knowledge of health if they are primarily interested in illness anyway? Yet, I would argue that if you do not truly understand health you will be very limited in what you can do to treat illness.
How can one truly move people towards health if one doesn't know what it is? You can not simply move away from a point and know you are moving in the right direction. You must know where you are going.

Homeopaths fancy themselves as knowing something about health, since the homeopathic art is all about strengthening health. Hahnemann gave us one of the most profound and eloquent descriptions of health I know of. It is worthy of study and contemplation, as it reveals much about the author, and raises ontologic and other metaphysical questions about the meaning of health. It goes like this (taken from the Organon of Medicine, Aphorism 9, O'Reilly translation): "In the healthy human state, the spirit-like life force (autocracy) that enlivens the material organism as dynamis, governs without restriction and keeps all parts of the organism in admirable, harmonious vital operation, as regards both feelings and functions, so that our indwelling rational spirit can freely avail itself of this living healthy instrument for the higher purpose of our existence."

This animistic, vitalistic view of health, with a bow towards a teleologic view of human existence, must have rocked the nineteenth century like an IED. Yet, much as we may want a more precise material understanding of health, it is hard to argue that Hahnemann has not, in one tightly packed sentence arrived at a singular and comprehensive definition of health. Hahnemann fills in some of the blanks later on in the Organon, but what is perhaps remarkable about his contribution is that he takes on the question at all. Many would be content with "if it works, just do it." But Hahnemann goes a step beyond this by asking us not to accept the appearance of health for health itself. To truly restore health, we must know something about it, or we will be misled, as he felt many of his generation had been, into taking on treatments that might have the veneer of authenticity, but lacked the deeper and more worthwhile signature of true health. Let us salute Hahnemann, the first "salutophile".

Mark Brody, M.D.