Of Union and Disunion
Taken from the Chapter entitled: A Personal Perspective of Integrative Medicine
Integrative Nutritional Medicine: Volume 5 of the Principles and Practice of Integrative Medicine

I have been a student of medicine for forty-six years. In 1958, I joined King Edward Medical College, Lahore, Pakistan. In 1963, I began my training in surgery at Mayo Hospital, Lahore. In 1965, I traveled to England for further training in orthopedics and general surgery. In 1966, I came to the United States to continue my surgical training. In 1968, I passed the examination given by the Royal College of Surgeons of England and was awarded the diploma of FRCS. Later that year I began residency training in pathology. In 1972, I received certification from the American Boards of Anatomic and Clinical Pathology. From 1974 to 1996, I served as chairman of the Department of Pathology and Laboratories, Holy Name Hospital, Teaneck, New Jersey. From 1972 to 1997, I also served on the faculty of the College of Physicians and Surgeons of Columbia University, New York.

In 1996, I accepted the presidency of Capital University of Integrative Medicine, in Washington, D.C., and proposed that integrative medicine be defined as a philosophy of medicine that requires physicians to offer their patients all that is safe and effective without subservience to one or more schools of medical thought. The Capital 'tribe' gave me a treasured gift of close links with many of the most intuitive and incisive minds in medicine in the United States and other countries.

Unlearning is harder than learning. That is easy to understand. Learning, at its core, is forming unions with one's beliefs and thoughts about the meaning of what is 'learned.' Unlearning is rupturing that union — a "disunion" that is as traumatic to the person as it is to a plant uprooted from the soil it is embedded in. At one level, that is the struggle that physicians face during for their life time. In this personal perspective on integrative medicine, I include some reflections on the subject of unions and disunions.

We physicians do not remain aloof to unions and disunions of the persons we attend to for long, nor to our own unions and disunions. The past imprints the present. The clinical consequences of that imprinting are often profound, as significant for physicians as those are for their patients. My main point in The Cortical Monkey and Healing was this: The Monkey in the Man forever recycles past misery and, when that is not sufficient, precycles feared future misery. And that Monkey cannot be banished with clever thinking. The past cannot be returned, but there is choice in how it may be revisited.

Here, I briefly recount my personal struggle with unions and disunions. As a child, unions came easy to me and in profusion. Disunions also came in equal profusion, but each was difficult in its own way. Early in my childhood, that profusion created a secret place to which I escaped with regularity, though then I did not know what it meant to escape to one's own secret place of life. Nor that it was a place of private unions and disunions. With time, the place grew into an enormous space of happenings that fascinated me. There were also happenings that were not good. I did not know then what happiness was, nor what the absence of happiness might be. More years passed and my private place grew and teemed with things, people, and events. I began to have a sense of things — of why I liked some happenings but not others. I had not yet learned that grown-ups had a word for it: daydreaming. (The word daydreaming—it seems to me — is not quite the right word for all those happenings.)

Also in my early years, I did not know about the problem of thinking too much, nor about how not to think. (It would be decades before I understood the problems caused by too much thinking and began to wonder how to "unthink.") Some more years passed. I learned that grown-ups had a name for the happenings which I did not like: unhappy. My moments of not being happy turned into something more unwanted, deeper, troublesome. Another word was added to my vocabulary: sad. Vague notions of unexplained sadness began to evolve in my developing mind. I did not share that notion with anyone. How could I? I did not even know what any of that meant. I went to high school, then to college, then to medical school. My teachers always lost me within minutes of beginning instruction — or, I lost them, transported back to my place, which had grown much larger and richer by then. Sometimes during those years the voice I heard became louder and I began to put words together just to cope. But the periods of heaviness persisted and the notion of ugliness that made no sense took hold in my mind. Later, I recognized that as unexplained sadness. It would be many years before I learned that psychologists had a name for all those happenings: ADHD (attention deficit and hyperactivity disorder)

My earliest unions—memories, I suppose, might be a better word—were of tracking with my mother. Those unions started when I began to tag along with her. Those unions were the simplest and purest of all I would ever experience, though I did not know that then. Tracking in the market occurred when I was big enough to accompany my with mother when she went out for shopping. That was a wide world of new unions — a bustling world of women in burqas and men in broken sandals, of open sewage ditches running through narrow alleys, of rotting vegetables tossed away from vendor's carts. There was many things there for a boy to observe — accidental palpations of women's bodies by bearded holy men when they took measurements for sewing dresses, and the like. There were with g ls (loudly delivered obscenities), brown ghuur (sugarcane candy) blackened by flies, and khotaas (donkeys) with fungus-eaten hides who seemed ever so ready to relieve themselves in public with loud noises. Whatever I saw in the market inhabited my space. The place blossomed.

Then one day I suddenly found my mother wrapped in a white shroud overlaid with bright red flowers. I was eight years old then. There was much crying in the house. (Many years later, looking at my mother's only photograph in the family album, I realized that the eyes of my father and all of my siblings were swollen from crying. Mine were not. The picture showed me staring into the space before me.) Then, my mother simply faded away. She would return many years later to inhabit my private world again.

Then followed unions from tracking to and within the mosque — a blessed place, so I was told. That was a colorful world of shait n (Satan) and farishates (angels) —of people burning in enormous fires of hell, and of hooris bathing in riverlets of honey and milk in heaven, ready to receive holy men of Islam. What is a virgin? I wondered. Later I learned who a virgin was. Why would any man want so many virgins?, the thought crossed my mind sometimes. I thought of shait n much more often than of farishates, who seemed to flutter around, aimlessly, doing nothing. It was obvious to me that shait n was always busy and successful. Farishates, in contrast, seemed useless. They never seemed eager to stop bad people from doing bad things. The mosque was also where my earliest unions with the evils of Hindus, Jews, Christians — even Sunni and Shia Muslims — formed. How could all of them remain blind to the only truth of Ahmadiyyat in Islam? In India and in Europe? And in America? And for centuries?, I often wondered. But there was something reassuring there. I was a follower of the true Promised Messiah. My very dear father was an Ahmadi Muslim, and so were others in the family. After all, wasn't being an Ahmadi the only thing that mattered? The Hindus had their own hells to pay for. The Christians and the Jews, they were going to be held accountable for their transgressions. Of that, there could not be any doubt.

More unions came my way while tracking in medical wards in Lahore. That was a world of great men in white coats. There were scalpels and sutures, and, of course, much blood. There was high drama of suffering and even higher drama of arrogance. The professors were always right, even when they contradicted themselves. The seeds of union with the medical dogma were sown deep into the mind of the young medical student. Everything was made out to be either black or white. There are educated doctors and there are quacks, I was told. And the educated doctors were not to have nothing to do with the charlatans who called themselves hakims (naturopaths) and homeopaths in Pakistan then. I was told to shun all those imposters. Of course, we students ate that up. We were also told that real doctors never let their patients influence their judgment. We took that as gospel truth. (It would be decades before I realized how stupid that advice was. Whose life were we talking about anyway?) Those medical school years gave me deep convictions — or so it seemed then. Those unions grew deep roots into my private space as well. Medical students are too busy cramming to think about "uncramming." One has only so many functioning neurons. The idea of disunion was years away in the future.

Then came tracking in deeper recesses of the mind. New alleys formed in my space. A dark world of
doubt and uncertainty opened up. What is real? What is true? Who knows the truth? Who may be trusted? The awkward questions came from nowhere. In England and later in the United States, I met Christians and Jews, and they seemed no less decent — or more evil — than the holy men in the mosque of my unions. I moonlighted with Hindu interns and residents. They were gentle, kind, and caring young women and men. Cracks began to appear in the armour of my Islamic convictions. Yet more ugly questions appeared. We doctors are supposed to heal the sick. Instead, I saw the sick getting sicker. During pathology residency, every week I processed so many uterus specimens that I began to look at women in shopping malls and wonder which ones had been hysterectomized. Who gained? Who lost? More ugly questions. Men making money by mutilating women? Oh God! No. Not in my chosen profession. No, it couldn't be, my mind would recoil. Well, yes! It is so! Why deny? The questions were endless. Others also raised those questions. In the end we merely gave each other knowing smiles. Antibiotics and other drugs saved many lives. Those drugs also hurt many people. I began to wonder if those hurt by drugs outnumbered those helped by them. I heard some friends ask that question as well. We physycians saw that happening but kept quiet. Speaking against drugs, we all knew, was bad for our business. Yes, medical practice was enriching, but it was also depleting. Toeing the party line of organized medicine became irksome. Conflicts — beginnings of disunions — multiplied.

Then came tracking in mines of toxicities— of the body tissues, of emotions, of intellect, of environment. The New England Journal of Medicine (NEJM) pronounced dioxin to be the most potent known carcinogen in rats. It then reassured its readers that a large study in New Jersey had found no evidence of toxicity in people exposed to the chemical. The U.S. Department of Defense declared that its soldiers who claimed to have been made sick by dioxin — and other chemicals used for defoliation — had been delusional. JAMA reassured mothers that there was no evidence sugar was bad for their children. NEJM claimed that ear tubes were good for little children. One of the participants of that study cried foul, insisting that the reported data was fudged. NEJM refused to publish that letter. We would not have known that except that JAMA published that letter four years later. Many prestigious journals published editorials under the names of esteemed professors. Later, it became known that those editorials were actually written by drug companies. (See RDA: Rats, Drugs and Assumptions for specific citations of those and many other deliberate statistical deceptions in medical literature.)

Blatant lies in medical literature accumulated at a much faster rate than I could cope with.

The editors of prestigious medical journals began to appear as villains, brazenly safeguarding the interests of their paymasters at drug companies, relentlessly insulting holistic physicians, forever declaring natural therapies — of which they knew nothing — dangerous. Conflict and distrust grew. Old unions of ideology ruptured. Disunions became larger, deeper.

Many patients related the circumstances of their healing that defied the prevailing medical dogma. It would have been easier to simply dismiss their accounts as apocryphal. But I could not. Instead I began trafficking in the mysteries of healing — of belief in the possibilities of injured tissues recovering, following some internal cues. Of healing by helping others to heal. Of healing with giving and love. That brought me newer unions. I recognized that what is given, stays; what is received, well, that lasts for moments. And that love that is given, sustains; love that is demanded, depletes. A physician's true work, I realized, is not about curing. It is about giving and love. In that, a physician's life is, in reality, climbing a mountain, knowing full well that the top shall not be reached, nor that the climb may be discontinued. He does have the option: He can see the sick as wild flowers on the climb, or as thorns on his sides. In the corrupted world of healing arts, a physician has to make some attempts at decency, no matter how feeble however ineffectual. A notion of a civilized medicine arose. I began to see that there were no controversies in medicine, only levels of understanding and enlightenment.

From my simple rural Islamic roots I had wandered into the dizzyingly fabulous worlds of merchants of medicine and of dealers of religion in New York and Washington. I recognized a new medicine — Star Wars medicine, I thought, was an appropriate name for it — which saw sick women and men merely as substrates for it machines. I saw the high priests of that Star Wars medicine sitting on their lofty perches, doling out wisdom about the sick whom they never saw.

They happily sacrificed caring and compassion for the sick on the alter of the 'science' of medicine. Those high priests had little patience for the words of the ill, which they dismissed as 'soft and subjective' trivia. They had nothing but disdain for holistic physicians who offered nutrient, herbal, and self-regulatory therapies. High priests of religion were no different. Their "cyber-spirituality' had enriched them beyond their wildest dreams. They knew their cyber-spirituality did not mix well with anguish of the suffering humans. But they 'healed' millions through their telecasts.

Finally, it occurred to me that I had come full circle. All my unions had turned into disunions, except those I had formed with my mother — and later with my father and some others. I recognized then what was common among all the lasting unions — those immune to disunions — was kidness, giving, and love. My unions of the market, of the mosque, of the medical ward, of dogmas of medicine, of the high priests on editorial boards, and of my own sense of my intellect had been tricks played on me by my cortical monkey. There had been no giving in them, nor love. I also saw clearly for the first time that for any union to be true, it had to be immune to disunion. It had to be a union of giving and love. And that is the true nature of knowledge.

One Can Know Only as Much Divinity as Exists Within Oneself

The mystery of the healing phenomena has deepened for me over the decades. The longer I work with my patients, the more aware I become of the fundamentality of the spiritual in health and disease. How does one define the spiritual? In 1994, in The Canary and Chronic Fatigue I could not resist walking that definitional tightrope with the following words:

The spiritual to the early Man was unknowable. So we sort through our intellectual assertions and return to where we started from: The spiritual is being outside the capacity of our bodily senses and the reach of the mind. Spirituality lies outside the needs of the body or the demands of the mind. Good teachers of spirituality may take us to the limits of our bodily and mental experiences—to the gates of spirituality—but they cannot lead us into it. No one can show anyone else what is the spiritual, no one can make anyone else spiritual. This is what the early Man must have known—through some spiritual journey—when he conceived the mind-body-spirit dimensions.

In 2003, in Integrative Cardiology, the fourth volume of The Principles and Practice of Integrative Medicine, I made a second feeble attempt to put my notion of the spiritual in words as quoted below:

My working definition of the spiritual, which I have used for several years, is this: It is a state of surrender to the larger unknowable Presence that one recognizes only by the way one changes through the light and love of that Presence.

One can know only as much divinity — it seems to me — as exists within one's self. One sees that vividly only when in throes of pain and suffering. We physicians, by and large, insist on the 'hard' evidence of blinded studies. We are uncomfortable with notions of healing with spirituality and one's own divinity. I once read somewhere that it is better to keep quiet and be considered a fool than to speak out and prove that. That has never kept me from speaking out about my personal quarrel with the mysteries of healing. I seldom have had difficulty seeing the fool in me. But the fools do have wonderful insights sometimes. So I persist.