In Sickness and in Health is adapted from a commencement speech for Acupuncture and Integrative Medicine College, Berkeley.
"Everything shines by perishing."—preacher, Albany, GA
We are all going to die. Death is my most intimate companion. This is the only way in which my love life has been truly successful. What began as an arranged marriage has blossomed into a beautiful and thrilling relationship that I have only grown more certain will see me through to my very last breath.
In some ways birth is the only true cause of death, and death is the only cure for being born. But there’s this middle ground, which is everything that happens in between. It looks like the people I see in my clinic. It looks like myself and my loved ones. It looks like you. I have noticed in my short time as a clinician and in my much longer time as a patient, that we inhabit a rather limited view of this middle ground, and of ourselves.
Sometimes we equate health with a prize for the merits of our own behavior, or sickness with personal failure. Sometimes we are so invested in making meaning from pain that we can’t just let a cough be a cough. Sometimes we insult people by making their disease into a metaphor for some hypothetical, unresolved issue.
I want to talk about these things because I see them happen over and over in my clinic, and in myself, and in the people around me. I’ve seen people break down and cry when I tell them being sick isn’t their fault. I myself have broken down and cried looking for reasons why I have had so many health issues. By the way, I am living proof that thinness is not a proxy for health.
We’re not just inedible meat compartments. We would all die quite suddenly if the room was filled with CO2 instead of mostly nitrogen. Or if the temperature went up or down by just a hundred degrees. Or if the atmospheric pressure changed by just a little. But, if we’re in an ideal environment—and maybe for you it’s the beach, and maybe for me it’s the forest—we flourish. We experience health. And this is how Chinese medicine sees the world, too—as holistic. Where do we end and our environments begin? (Incidentally, this is what makes feng shui a logical treatment principle.)
It is unscientific to deny the intimacy of our surroundings, whether oxygen, or temperature, or the way a piano sings our own musicality back to us. Why do we create this imaginary point at which we cease to exist, and become something Other? Our body is unimaginably vast. We co-evolved with all of this, even the stars—which by the way, are also going to die.
We have this platitude that we create our own reality. But who are we? And again, we’re this giant state of flux, a big old writhing mass of meat and miracle, and there are tropical storms and institutionalized racism and mass murderers involved, and we’re creating that, too. We’re creating our reality, but it’s more than just our singular input. If we’re really in touch with what we’re creating, it is as awful as it is exhilarating. Saying “we create our own reality” is like saying we control the vast and unpredictable sea by steering the rudder of our tiny boat. Of course, we can’t deny the rudder, but we can’t disavow the ocean, either.
Sometimes we just get sick, and we don’t know why. It is ok to stop looking for a reason. We can dig for meaning, and at a certain point it is the digging for meaning that becomes the pathology. “I don’t know” is hard, and it is honest. Understanding causality can be like unraveling the wind, invisible and indivisible.
So I am here to tell you that illness is not your fault. It is no one’s fault. If you are healthy, you have not won. If you are sick, you have not failed. To take credit for our health or to take blame for it is, at a certain point, absurd. Like giving a prize to “a single cell” when the body performs well, or blaming the same cell when we get cancer.
We also do this thing where we make illness into metaphors. For example, if you had a kidney stone, someone might ask, “What are you holding onto so tightly? What beliefs are obstructing you? What isn’t going with the flow?” By the way, I dare you to ask this to someone who’s passing a kidney stone.
At best, these questions acknowledge a fuller range of factors that lead to or away from health. At worst, they are accusations: "You got a kidney stone because you’re not going with the flow.” Dear reader, let us discontinue this commonplace offense, of which I am certainly guilty.
Or take the question, “How’s your diet?” which is a great question, obviously, but I want to look at why we’re asking it. Just think about when we see people on the news who make it to 106 years old, and the news anchor asks, “What’s your secret?”, and the answer is inevitably something like, “Bacon and cigars.” A thousand people can have a terrible diet, and maybe just one or two of them get cancer. On the other hand, a person with a terrific diet who hears this question might start looking at her lifestyle in terms of infractions. She might blame herself for having cancer because she ate a wheat cracker last Wednesday.
We assume that if we understand the mental, emotional, and dietary “causes” for disease, and just stop doing those things, we’ll be well. We’ll be absolved. And sometimes this is the case. But very often, it is not.
Health is not a binary to begin with. Healthy or not healthy. Health can look proud as a personal trainer, or it can look like a woman who’s about to die from cancer, like my friend, teacher, and colleague Suzanne Friedman. In the days leading up to her death, we can say with certainty that though cancer had consumed her body, she was completely healed. She was so lucid and so alive in her last hours that she told her community she was giving us her death as a gift. She told us to study it and to learn from it. Thank you, Suzanne.
Suzanne checked all the metaphors. She knew all the right herbs, all the cutting edge western drugs and therapies. She ate whole foods, exercised every day, didn’t drink or smoke. She had a positive outlook on life, a wonderfully supportive spouse and community, and all the best doctors. She did all this in a relaxed, undogmatic manner, her signature hilarity always intact.
At a certain point, people may encounter this unspoken implication that if we fail to defeat an illness, it must be from a weak will, or a wish to be sick, or even a desire die. Because in this storyline, which sees illness as a failure of our own efforts or maybe even of our own creation, we might conclude that sick people are asking for it in some way.
But I’m saying that people with all manner of health concerns — and that includes all of us — are expressions of normalcy, given the condition of our larger body. We are responding naturally to what we are creating. We can’t blame GMOs or corporations or pollution, because we are these things, too. Acknowledging this frees us from taking pain and sickness personally, and it also safeguards our relationships by making us more mindful of them.
It’s ridiculous to think it’s just about us, the inedible meat compartment. That eons of forgetfulness, war, famine, poverty, pollution, oppression, colonization are all happening right now in the continuous process of our body, and we think there’s something wrong with us when we get sick, or if we feel sad. When we do not feel sad is perhaps when we are the sickest. And I’ll say it again, we can’t blame a person on Wallstreet any more than we can blame a person in a hospital bed.
But when we are aware of the ocean, and when we are aware of our mortality, we are living a life that is already healed no matter how we find ourselves. In happiness or despair, in sickness or in health. This invokes enormous inspiration. It also involves a lot of “I don’t know,” a lot of tolerating discomfort and embracing ambiguity, a lot of relinquishing dogma and forsaking the need for self-improvement. We have already arrived.
Right now a thousand stars are being born. The scent of flowers rides the wind. A million new mothers are nursing their babies. A man is speaking on behalf of those with less power. Someone, somewhere is writing a symphony. Young people are falling in love for the first time. A woman has just received a clean bill of health after her last chemo treatment. On every continent, we smile. We do not need to take happiness and health so personally, either, but simply share in it when it arises.
My wish for all of us is that we live a life that is already healed. That we recognize our terminal diagnosis without literally receiving one. That we see ourselves in the ocean so that our deeply-natural self-centeredness assumes value. There is nothing to lose, except the things that took up too much space anyway. Until death gives us his fond wave of equanimity and the only true cure, we share this body. This astounding feat of biology, this writhing mass of meat and miracle. This is who we are, absolutely replete and undeniably whole, in sickness and in health, till death do us part.