The Trickster: Medicine's forgotten character

Therapy in all its forms can be confusingly capricious and unpredictable. We should not try to deny this, but learn to accept it, says Larry Dossey MD.

MOST physicians are trained to be thinkers, analysts, logicians. When we encounter clinical problems such as cancer, heart disease, or AIDS, our search for solutions begins with the assumption that we need more facts and information, which form the substrate upon which reason can operate. Only an approach anchored in analysis and reason, we say, stands a chance of working.

In contrast, many cultures have recognised that an intellectual approach to life's problems can be carried to excess. They have accorded great respect for irrationality and foolishness in its many forms — play, humour, nonsense, light heartedness. One of the most universal expressions of this point of view is the Trickster figure, which has appeared in the mythology and folklore of perhaps every culture on earth[1].

In modern psychology 'Trickster' is often used to refer to a universal force or pattern within the mind — what Jung called an archetype — that represents the irrational, chaotic, and unpredictable side of human thought and behaviour. [2] This aspect of the mind is contrasted with the logical, analytical, and intellectual side that values order, precision, and control. According to the tenets of depth psychology, a balance between these two vectors of the psyche is required for optimal mental heath. When either the rational or irrational side dominates, self correcting forces come into play to restore some semblance of harmony between the two. The countless Trickster tales describe how this process plays itself out in everyday life.

The Trickster operates largely outside conscious awareness but always from within the human mind. We are the Trickster; and when we describe Trickster phenomena we are always describing aspects of ourselves. Thus the Trickster has been called a speculum mentis: a mirror into the mind.

The Trickster in different cultures

Trickster lore flowered in the mythology of native North America, as well as in traditional cultures throughout the world. Not only does the Trickster exhibit trickery, buffoonery, and crude behaviour in indigenous tales, he also appears as a creator, cultural hero, and teacher. He is partly divine, partly human, and partly animal, and is an amoral and comic troublemaker. (I say 'he' because the Trickster is usually male, although occasionally female or disguised in female form.) Although he appears most frequently as the coyote in cultures in the south west of the USA, many other creatures are also represented. including the raven, crow, blue jay, mink, rabbit, spider, racoon, mud hen, opossum, and bear. Trickster figures also appeared in ancient Greece, where they were known as Prometheus, Epimetheus, and Hermes. In the European Middle Ages, the court jester or fool served the Trickster function. In our time clowns, comedians, movie actors, and cartoon characters often fulfil the role.

The Trickster and modern medicine

Probably everyone involved in healthcare sooner or later confronts the fact that all medical therapies, for all their power and popularity, can be frustratingly capricious, unpredictable, and sometimes harmful. This is true not only for drugs and surgical procedures but also for the alternative/ complementary and consciousness-based methods that are becoming increasingly popular. All therapies work only some of the time; they work sensationally for some people and not for others; they sometimes kill as well as cure. Moreover, scientific studies demonstrating efficacy often give conflicting results. They sometimes show that a therapy that was previously thought to be helpful is actually harmful, and vice versa.

The Trickster perspective suggests that some of these problems and paradoxes may result from too much, not too little, reliance on logic, analysis, and reason — the very bedrocks of modern science. Is the Trickster afoot in medicine? Evidence for Trickster effects is subjective but, in spite of this limitation, we can look at some specific areas in contemporary medicine where the Trickster may be leaving his tracks: areas where confusion and chaos arise in frustrating degrees. We shall notice that the confusion often takes the form of paradox.

• Nearly three and a half thousand Swedish business executives were given maximum attention to reduce their risk factors for cardiovascular disease. After five years of intervention and a total of 11 years of follow-up, even though they succeeded in reducing their risk factors by 46 per cent they had a higher mortality rate than control subjects.[3]

• In the highly publicised 'Mr Fit' (Multiple Risk Factor Intervention Trial) study, researchers at 22 medical research centres in the USA studied almost 13,000 men. Half of them received an all-out push by physicians to reduce their risk factors for heart disease. But at the end of seven years, even though they were successful in lowering their risk factors, their death rate was higher than that of the control group, for reasons that are still being debated. [4]

• According to a CNN report, air bags may be contributing to auto accidents by making drivers feel invincible. [5]

• "There is considerable inter-observer variability in the radiographic diagnosis of pneumonia. This variability does not improve with increasing experience."[6]

• Because most kidney stones are made of calcium, physicians often recommend that patients who have already suffered from stones reduce their calcium intake. A research team from the Harvard School of Public Health reports that men who ate a diet rich in calcium faced a 34 per cent lower risk of developing kidney stones than did men who consumed a restricted calcium diet. "This goes against everything we had been taught," says kidney specialist Gary Curhan, who led the calcium investigation.[7]

• Although the periodic health examination was introduced over 80 years ago, it remains a controversy in internal medicine. There have been few data from controlled studies to document the examination's efficacy for adults; nevertheless, its popularity has become a multi-million dollar industry in the United States. [8]

• A new study suggests that doctors and nurses should offer this seemingly paradoxical advice to patients awaiting surgery: "Don't relax, be worried." Although relaxation training before surgery helps people feel less tense, the investigators found that the greatest post-surgical increases in adrenaline and cortisol, two hormones associated with the body's reaction to stress and danger, were significantly higher among patients given relaxation training prior to their surgical procedure, compared to control subjects. [9]

• New evidence indicate that elderly men boasting low cholesterol levels also suffer markedly more symptoms of depression than peers with moderate or high cholesterol levels … Several cholesterol-reduction trials have found unexpected jumps in suicide and other violent deaths … Neither weight loss (which often lowers cholesterol) nor the presence of various medical problems accounted for the link between cholesterol and depression. [10]

• New data challenge the widely held assumption that US women, who usually enjoy higher levels of education, employment, and income, have healthier infants than immigrants. According to statistics from San Diego County from 1978 to 1985, the lowest infant mortality rates were seen in Southeast Asian and Hispanic women, most of whom were foreign born; highest rates were seen in white and African American women, most of whom were US born. [11]

• Professional working women enjoy lower blood pressure than women who stay at home. "Basically, the theory that job stress will make women as susceptible as men (to high blood pressure) doesn't bear out." [12]

Our usual approach to paradoxes such as these is to design more and better studies to clear up the ambiguities. The problems, we say, are not a failure of reason but a lack of sufficient information to which reason can apply itself. Can we eradicate all the confusion with good studies? It would be foolish not to employ our intellect as skilfully as possible. But how fully can reason serve us without becoming susceptible to the self-correcting, intra-psychic forces of irrationality and unpredictability?

Alternative medicine and the trickster

Alternative/ complementary medicine also generally follows a rational, causal framework: If you do X, Y will follow — whether X means taking vitamins or herbs, using a homoeopathic remedy, or praying, imaging, or meditating. In alternative circles, as in orthodox medicine, heroic vigour and assertiveness are also routinely emphasised, epitomised by the frequent advice that patients "take charge," "assume responsibility," and "fight" their illness. As complementary medicine attempts to match the intellectual rigour of orthodox medicine, there is a risk that it, too, may ignore the Trickster forces in the psyche.

Many researchers and clinicians in alternative medicine realise that it may be impossible to subject some healing methods to the rational strategies favoured in contemporary biomedical research, such as double-blind methodology. Consider, for example, studies involving the effect of prayer among patients who are seriously ill. [13] How can one establish a control group that, by definition, should receive no prayer? People facing serious illness routinely pray for themselves, whether or not they belong to a control group. Even if they did not, their loved ones pray for them. No one has yet devised a way of annulling the 'problem of extraneous prayer'. An alternative research approach has been to study the effects of prayer not on humans but on non-humans — assessing, for example, the effects of prayer on growth rates of bacteria [14] or fungi [15,16] or on the healing rates of surgical wounds in rats or mice. [17,18] Presumably the bacteria or mice in the control group do not pray for themselves, nor are they being prayed for by their fellow creatures.

In spite of these difficulties, however, we should not abandon the customary forms of investigation that are based in reason in favour of an 'anything goes' policy, for this approach would lead to the opposite excess in which too little, not too much, reason is employed.

The Trickster and the creative process

The Trickster, therefore, suggests not that we abandon our rational faculties altogether, but that reason must be complemented by unreason if it is to achieve full flowering. Nowhere is this lesson clearer than in the creative process of great scientists.

When Jonas Salk was researching the polio vaccine that would bear his name, he decided to distance himself from his work for a short period by going to the monastery of Assisi in Italy. Salk had a keen interest in architecture, and his encounter with the shapes and spaces, light, materials, colours, and the history of this monastery had a profound impact on his mind and spirit. Salk became highly energised. "Under the influence," he later recalled, "I intuitively designed the research that I felt would result in the desired vaccine. I returned to my laboratory in Pittsburgh to validate my concepts and found that they were indeed correct!"[19]
Salk's experience is not unique. Throughout history researchers often have achieved success only when they allowed play and other distractions to mingle with the intellect — in other words, when they have invited the Trickster to come out to play.

Arthur Koestler observes in his landmark book, The Act of Creation: "The creative act, in so far as it depends on unconscious resources, presupposes a relaxing of the controls and a regression to modes of ideation which are indifferent to the rules of verbal logic, unperturbed by contradiction, untouched by the dogmas and taboos of so-called common sense. At the

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References

human givens journal

This article first appeared in Volume 3, No, 4 (1996) of the Human Givens journal.

LARRY DOSSEY, MD., is the author of a number of books and an international lecturer on mind-body medicine. He is co-chairman of the Panel of Mind/Body Interventions within the Office of Alternative Medicine at the American Institute of Health, and executive editor of Alternative Therapies. His books include Healing Breakthroughs, Piatkus, London; Healing Words, Harpers, San Francisco; Space, Time and Medicine, Shambala, New York and Beyond Illness, New Science Library, New York