Too many books are forgotten as soon as they're published—that doesn't mean they're not worth reading, writing, or talking about. My reading list is generated by interest, whim, and chance—and by what's available at the Brooklyn Public Library.
When writing my reviews, I don’t Google anything about the book or author. To draw my impressions, I rely only on the book itself.
In the late ‘90s, I had my first fulltime job with health benefits. I picked a provider randomly out of a huge directory because the office was near where I lived. Dr. Lowen’s dingy waiting room was packed with stacks of old magazines and lit by a terra cotta jack o’lantern. If another patient arrived while I was waiting and rang the bell, the harried receptionist would tuck the phone under her chin and wave frantically—I would get up and answer the door.
Despite the chaos up front, the care I got from Dr. Lowen was the best I’ve received in my life. During my initial visit, I filled out a long intake form to which Dr. Lowen added his own comments. He spoke the answers aloud as he wrote. “Appearance,” he queried, then studied me over the top of his glasses. “Menacing,” he answered. Subsequent appointments were never rushed. We spoke for a long time before and after the examinations in which he looked at, listened to, touched, poked and prodded every inch of my body. It was like a laying on of hands.
In the years since Dr. Lowen retired, I’ve had more jobs than I can count, each with a change of insurance, each with a new primary care physician I see for maybe ten minutes once a year. The doctor weighs me, measures my height, listens to my heart, looks in my throat, eyes, and ears, and arranges for me to have “blood work.” If I have a complaint, I might be given a referral for a specialist to investigate.
Dr. Jonas is a research scientist, physician, and professor (at Georgetown University and at the Uniformed Services University of the Health Sciences). From 1995-1999, he directed the Office of Alternative Medicine at the National Institutes of Health. He advocates for a total rehaul of how medicine is practiced. “Health care needs a new way of thinking and a new design. It needs to shift its economic incentives toward prevention and whole person care, even as the industry profits from doing the opposite.”
In the introduction, Dr. Jonas sets down the book’s main conceit: “Only 20% of healing comes from the ‘treatment agent’ that the doctor applies to you…a full 80% of healing comes from constructing a meaningful healing response, unique to you, which is internal and highly personal, using simple principles and components.”
“No single approach works for everyone or even for the same conditions in different people,” Dr. Jonas warns. What he does propose for everyone is an integrative, whole-system approach which links the physical body to the spiritual, the individual to the community he lives in. “Meaning is not simply held in the mind; it is constructed in our body by our culture,” he writes.
Much of the book is made up of case studies. They include Dr. Jonas’ wife, Susan, who has suffered multiple bouts of breast cancer. It is here that he gives us his most unique vantage point: as a doctor who understands “the system” and as a loved one of a person trying to negotiate that system. “Once you have been labeled with a disease and have crossed the diagnostic threshold to enter the world of acute care, an entire industry awaits you,” he writes.
Dr. Jonas is well-aware of the risks Susan faces—not only from the disease, but from the treatment. “None of the physicians asked [Susan] what her main goals from treatment were. They assumed she would follow their recommendations to increase survival, even by a small margin, at almost any cost.”
Susan’s experience isn’t unique. “Rarely are the details of the full risks and benefits of a treatment discussed with patients,” Dr. Jonas writes. The problem is in “the science of the small and particular.” Dr. Jonas argues that “the way we do science—seeking specific effects for particular biological targets…then using this information to treat complex, whole people who respond only partially in ways we want, and frequently in ways we don’t want,” is what harms people when they are treated for chronic disease.
This isn’t a book simply offering a critique of the system from someone on the inside. Dr. Jonas certainly empathizes with the burdens our healthcare system puts on the people who work within it. But as someone who practices medicine, he questions his own approach within the confines of that system. If only a small part of healing comes from the treatments he provides, and many patients suffer from side effects of those treatments, “then was I throwing out most of the healing…by always looking for the small and particular effects?” Unfortunately, this approach is not only common, it is “also being reinforced with money…Drugs get FDA-approval when they show their benefits go beyond placebo even by a small amount…A ‘real’ treatment must separate itself from the daily process of healing.”
Dr. Jonas points out, “Whether a treatment is labeled as a placebo or not is more of an academic or economic question than the primary concern of the clinician and patient. The question for a patient was not whether a treatment was better than placebo, but the likelihood that a patient would get better after the treatment.” As he observed with a patient who had remarkable results from a placebo, “Her healing was not from the agent she took; it was from the agency she found.”
I think what made the care I received from Dr. Lowen exceptional was the relationship he fostered. I really felt he cared about me. Once I came to him concerned about a dark mole. He looked, and then quickly dismissed it. “Why do I have it then?” I challenged. Dr. Lowen stared at me, pointed to the ceiling and said, “God.”
As Dr. Jonas writes, “If we deal with only one aspect of a person—say, the body or the mind parts—we get only partial results, and we produce reverberations (often unwanted) throughout the rest of the person. To fully heal and be well, we need to enhance connections across all four dimensions of a human—body, behavior, social, and spiritual. Healing works by making these connections stronger and inducing us to become more whole and responsive in the world.”
Dr. Jonas has learned the value of not only talking to his patients, but to listening to them—and encouraging them to listen to themselves. “My job,” he writes, “is to see if I can match what comes from their intuition with reasonable scientific evidence that might be used to enhance the patient’s healing.”
Dr. Jonas writes with compassion and humility that convey his authority and conviction. He takes you through his methods of scientific inquiry and shares his surprises and conclusions. This book is remarkable for its tone, and for the connections it shows between meaning and healing. “Mindset influences mortality,” Dr. Jonas writes. Reading this book might extend your life.