The Missing Chapter
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plines that form medicine's foundation, only physiology tries to units
structure and function into a complete picture of how the body works.
Hence it's often called the queen of the biological sciences, yet even in
this realm the synthesis is made organ by organ. There is, however, one
organ group—the nervous system—that coordinates the activities of all
the others; by receiving, transmitting, and storing information, it unites
all the parts into that transcendence of fragments, the organism. There-
fore the one discipline that comes closest to dealing with a living thing
in its entirety is neurophysiology, which in the 1940s was already so
sophisticated as to be almost a science unto itself.
Even neurophysiology couldn't explain the mystery of healing, how-
ever. My best texts either ignored it completely or shrugged it off in a
few vague paragraphs. Moreover, my experiences at Bellevue during my
internship and early residency convinced me that a physician's success
was largely due, not to technical prowess, but to the concern he or she
displayed toward patients. The patient's faith in the doctor profoundly
affected the outcome of many treatments. Certain remedies, such as pen-
icillin used against bacteria susceptible to it, worked every time. Other
prescriptions weren't so predictable, however. If the patient thought the
remedy would work, it usually did; otherwise it often didn't, no matter
how up-to-date it was. Unfortunately, the importance of the doctor-
patient relationship was being downgraded by the new scientific medi-
cine. The new breed of physicians argued that this power of belief
somehow wasn't real, that the patients only thought they were getting
better—a bit of arrant nonsense that should have been quickly dispelled
by a little open-minded, caring attentiveness on daily rounds. There was
no known anatomical structure or biochemical process that provided the
slightest reason to believe in such a thing, so it came to be dismissed as
a mirage left over from the days of witchcraft. The placebo effect, as it's
now called, wasn't documented until several decades later and still isn't
fully accepted as an integral part of the healing process, but over the
years I became convinced that it was a physiological effect of mind on
body, just as real as the effects of wind on a tree.
Our lack of knowledge about healing in general and its psychological
component in particular sowed seeds of doubt in my mind. I no longer
believed that our science alone was an adequate basis for medical prac-
tice. As a surgeon, I tried to apply the principle of interaction on my
own wards, by spending more time talking with patients, letting them
know that I cared for them as well as taking care of the m. Naturally, as I
became a teacher, I tried to pass on my beliefs to others. As I gained
experience, I grew more and more convinced that all the textbooks were