Michael Lerner Lecture

by AL, September 26, 1996

On Sept 25th, a Wednesday evening, I attended a lecture by Michael Lerner, Director of Commonweil and author of Choices in Healing.

I already knew that Choices in Healing was a most important book for cancer patients. The book is deep in facts and research and a wonderful overview of the state of the battle with cancer worldwide. But, its most valuable information has to do with alternative medicine and the topic of living with cancer.

His talk, like his book, deals with five areas:

• Choices in Healing 
• Standard therapies for cancer 
• Alternative therapies for cancer 
• Pain control 
• Death and dying

Choices in Healing

When I read this book, there was no more important thing I gained that the understanding of the distinction between these two. Curing is the medical goal of getting rid of disease. Sometimes it is achievable; sometimes not. Healing is a psychological/spiritual term and is achievable for everyone regardless of cure. It is the difference between pain and suffering, between the event of the disease and the experience of it.

How you experience the disease is a factor in how well you survive and how long!

Victor Frankel, a physician, interned at Auschwitz observed that those who fared the best in these most extremely challenging circumstance were those who had a deep sense of meaning their lives. Lerner suggests that it is worthwhile to ask yourself why you are alive. It is, he says, a question that it is never too late to ask.

Standard Therapy or conventional medicine.

Only mainstream medicine has demonstrated that it can cure cancer. Nothing in alternative medicine is even close. Any treatment program ought to have mainstream medicine as its centerpiece.

Mainstream medicine is high tech and aggressive and among the developed nations of the world the U.S. approach is the most aggressive. (Although the results are pretty much the same as in other industrialized nations).

Because the techniques are powerful (and easily misapplied) the skillful patient has a better chance of survival. Lerner encourages us to find our personal style of participation and risk and find a doctor that will relate to that.

Furthermore, hospitals and the whole medical industry is a bureaucracy. It is run by humans, and capable of error. Like all bureaucracies it responds to good advocates. Every patient needs to be their own advocate and to have someone who can be their advocate when they are unable to do it for themselves.

Alternative medicine

There is little scientific evidence that alternative medicine offers a cure. Although certain individuals may be cured, there is not a large enough percentage of them to be statistically reliable. There is little evidence that it even adds anything to treatment. However, there is much reported anecdotal evidence that it helps.

It is a myth that alternative medicine is generally practiced by quacks and charlatans on a population of the desperate and ignorant. In fact studies show that the more educated are more likely add alternative medicine to their treatment by standard medicine.

Alternative medicine may be divided into a dozen categories:

• Spiritual -- prayer
• Psychological -- visualization, guided imagery
• Nutritional
• Physical -- exercise, yoga, tai chi
• Traditional medicine -- Chinese, aryuvedic etc
• Herbal -- Essiac
• Pharmacological -- shark cartilage
• Electromagnetic
• Unconventional uses of conventional therapies
• Esoteric -- psychic
• Humane

Lerner asked, "what happens to people who practice the first four?"

They get healthier. And if they have cancer, they get to be healthier people with cancer. They have better quality of life and better survival.

Doctors prefer fighters for cancer patients. People who will engage their cancer. David Spiegal, a Stanford psychologist did a study in 1980 of women with metastatic breast cancer. He divided them into two groups: those who received ordinary treatment and those who addtionally belonged to a support group and got a weekly session of hypnotherapy. Contrary to Spiegals' expectations, those in the support group fared better and had increased longevity.

He did a follow-up study on the same group ten years later and learned the longevity of the support group people was double that of the non support group.

Lerner believes the support group does not have to be all that formal. Being cared about is what matters. (I believe the more formal support group can add another dimension. There is the greater collective knowledge, awareness of resources, and networking that goes on as the experience is pluralized. And there is the prodding and urging to action to members who may be stalled out or overwhelmed or in denial. To the extent you believe that prayer is a substantive weapon, the group multiples its power).

We are educating the oncologists that alternative medicine is helpful. And it is much cheaper than standard medicine. Hospitals, which are businesses are recognizing they can increase market share of educated high income patients by offering alternative medicine.

Pain control

Cancer pain is 90% controllable and it is a national scandal that many people's pain control treatment is inadequate.

Pain control is high art. And not well taught. Pain control is best understood by specialized pain clinics and hospice. A cancer patient would do well to educate themselves about these resources well before the onset of pain.

There are also some non-pharmacological approaches to pain. Most notably acupuncture but also an electrical device known as a TENS (theraputic electrical nerve stimulation) machine.

Lerner spoke of the meaning of pain. He told an anecdote about the expectation of pain. Wounded battlefield soldiers whose wounds were small and who would be returned to the battlefield after treatment seemed to experience greater pain than those with more severe wounds who would be sent home after treatment. The psychological expression of pain can differ greatly from its somatic expression.

Lerner concluded his discussion of pain by encouraging that pain be used. After all it is the painful moments in life that are the ones we learn from.

Choices in Dying

We have hidden death in our culture and therefore made it more terrifying. The fear has made us cling more desperately. In fact those high tech skills of life extension create more difficult deaths.

Lerner urges us to explore the spiritual aspects of dying. We should study what we fear. He asked the room of 300+ people who believe that death was the end. Only one person (me) raised his hand. He then asked who thought that death was *maybe* not the end. Most of the room raised their hand. (It was a trick question. He never asked if death was *maybe* the end.) But, he easily made the point that death ought to be viewed as a mystery.

He believes -- as I do -- that dying is much more to be feared than death. There is the fear of being caught in suffering: the loss of control of the body, the mind, of aloneness.

And he points at the biggest fear of all: in the face of time running out, the fear of never having lived.

He went onto to discuss the practical issue of dying. Where to do it. He lauded the home health care workers associated with Hospice as "midwives of the dying process". Who the best ones are known to the doctors and nurses who are associated with Hospice (although they may not be available enough or experienced enough in the midwifery process)

Michael Lerner fielded some questions, signed a few books and a very provocative evening ended.