Organization Affiliations

The Institute for the Study of Health & Illness (ISHI) is a professional training institute founded in 1990 at Commonweal by Rachel Naomi Remen MD. The Institute offers discovery model education and support for health professionals at all levels of training who wish to explore the deep meaning of their calling and express it daily in their work. The national programs ISHI has patiently grown from seed have reached deep into the lives of many thousands of physicians, medical educators, medical students, nursing students, nurses and others in the healing professions —enabling them to hold to their values, their common humanity, and their professional excellence, renewing their commitment to themselves, to their patients and to medicine. [Learn more]
Commonweal is a nonprofit health and environmental research institute in Bolinas, California, founded in 1976. Commonweal conducts programs that contribute to healing ourselves and healing the earth – to a safer world for people and for all life. Commonweal does that through ten major program initiatives, including the Commonweal Cancer Help Program, founded by Dr. Rachel Naomi Remen and Michael Lerner, PhD, and featured by Bill Moyers in his award-winning PBS series Healing and the Mind,  [Learn more]
The Healer’s Art (HART) is ISHI’s national curriculum and a response to the deformative power of medical training and enables student to embody the deep values that caused them to choose medicine as a profession. Developed by Rachel Naomi Remen in 1992 at UCSF school of Medicine, The Healer’s Art is taught annually at more than 70 medical schools in the U.S. and 7 schools abroad  (Brazil, India, Taiwan, Australia, Israel, Slovenia and Canada – Full list of Universities can be found here). The course is based on a highly innovative discovery model and offers a safe and respectful learning environment in which medical students and faculty can personally explore and strengthen their individual relationship to service, compassion, healing, loss, holism, awe and mystery—vital dimensions of medicine rarely discussed in medical training.
In an environment of genuine colleagueship, students and faculty strengthen altruistic values, compassion, empathy, and intention to serve in each other, values they wish to embody despite the challenging demands of contemporary medical training and practice. Twenty-two years of standardized course evaluations document the transformational power of The Healer’s Art for students nationally despite wide differences in regional and academic cultures across medical schools. Students at all participating schools report the curriculum fills an existing gap in their professional training and has helped them be the sort of doctors that they wish to become. The course has had a profound effect on faculty as well as on students, revitalizing their enthusiasm for their teaching and offering them new and innovative approaches to their relationships with students and patients.  Outcome research has been published in peer-reviewed professional education journals including Academic Medicine,  Annals of Family Medicine , Journal of General Internal Medicine , and most recently the international medical journal, Teaching and Learning in Medicine (in press).
Rachel Remen laughing

Rachel on Healing: An Interview

Basically curing is about repair and healing is about growth. So curing is something we do to others and healing something we evoke in others. Curing happens at the level of the body and leads to a re-normalization of physiology. Healing happens at the level of the person and involves an evolution and refinement of the individual, a deepening of the capacity for emotional life, mental life and spiritual life¾the furthering of personal wholeness and not physical health. Healing promotes the quality of life and the capacity to engage with life.
I am concerned with physical health as a prime outcome, but it is not the only outcome that concerns me and not necessarily the only successful outcome of my relationship with a patient. I see physical health not as a goal but as a means. It allows people an opportunity to follow what has meaning and value in life. But one can do this whether one is physically healthy or not. After 30 years of caring for people with cancer it seems to me that many people may begin to do this only after an experience of profound illness. The paradox here is that illness often initiates growth and healing…

So there is a point when curing is considered complete but healing is a lifelong process that we are involved with all of the time.  It is possible for people to be cured and not heal and to heal in the absence of definitive cure. Sometimes people recover physical integrity but they do not heal emotionally or mentally or spiritually; they live their lives in fear of recurrence or in bitterness over their past losses. Others never recover their physical integrity but live with a greater passion and authenticity than before.

Yes, it is possible and even common to heal in the presence of disease and even to die healed.  Healing is less limited than curing.  After years in medicine most of us have discovered that we can heal with our humanity things that we cannot cure with our science. Curing is not always possible but healing is a potential in all relationships and at all times.

In the presence of chronic illness and even because of it, people are often able to grow as persons in their capacity to love and feel compassion, their sensitivity and understandings, their courage and wisdom. Because of this capacity for growth it is possible for people to lead a full life despite ongoing illness, to lead a meaningful life even though it is not an easy life or even a long life.

We heal with our presence. In order to help others to heal we need to bring our wholeness into the examining room with us, our strengths, our courage, our caring, and even our anger and fears and doubts.  This may give our patients permission to be genuine and whole as well and enable them to find the inner strength to deal with their issues and to grow from them. In the presence of another whole person no one need be ashamed of their pain or their weakness¾no one need feel alone. Everyone alive has suffered. It is the wisdom gained from our wounds and our own experiences of suffering that make us able to trust the process of healing and accompany other people as they heal. Wounded people are usually healed by other wounded people. Only other wounded people can understand what is needed for the healing of suffering is compassion, not expertise. Becoming an expert has turned out to be less important in the long run than becoming genuine and remembering and trusting the hidden capacity for wholeness in myself and everyone else.

It is hard to believe that we can heal others when we know we are wounded ourselves. But often our own wounds make us trustworthy and give us the wisdom and power to heal. Our wounds enable us to trust the healing process. Our hurts can move us beyond judgment and teach us compassion for the hurts of other people. Our loneliness enables us to recognize the hidden loneliness in others despite the masks that we all wear and to find them when they are lost in the dark. It has been humbling to discover that often my medical expertise is not what makes the most difference to someone, but that they have been able to access their strength and transcend their suffering because of something I learned from my Russian grandmother or from my own fifty-three year personal experience with Crohn’s disease.

Yes, we cure with our expertise but we heal with our life experience and our attention. We heal most often with our presence and perhaps the most common tool of healing is just listening¾ not in the way we usually listen or the way in which many of us have been trained to listen. Most of us are thinking when we listen. Do we agree or disagree?  Is what is being said accurate or not? Or we listen competitively: Is the speaker better educated than we are?  Smarter or not as smart? More articulate or less articulate?  We become very busy with all of these concerns. But this is not the sort of listening that heals others and enables them to hear the truth in themselves.

When we heal we abandon all such concerns and simply listen generously to someone¾not in order to position ourselves or even to understand what is being said. We listen just to know what is true for this person at this moment in time¾to witness it and validate it¾and accept it. The paradox being that the things we accept as true about ourselves lose their hold on us and we begin to change.  In order to heal my pain, I must accept that I am in pain¾difficult as that is¾and someone else must acknowledge that I am in pain. Then we can begin to make change. Listening is the oldest and perhaps the most powerful tool of healing.

 Another healing tool is simple touch. In this culture many people are afraid to touch others.  I was trained that it is only permissible to touch people in order to diagnose them.   We may need to find acceptable ways to touch more. Touch is deeply reassuring and nurturing and one of the oldest and perhaps most powerful tools of healing.  There is considerable scientific evidence that touch may strengthen the will to live in people. Years ago a groundbreaking study at the Karolinska Institute demonstrated that tiny premature infants carried in a little “kangaroo” pouch against their mothers skin had a higher survival rate that those kept in incubators surrounded by state of the art technology. There may more to affecting a positive outcome than we may at present understand.
One of the great challenges of our times is to make technology and science humanly relevant, not only in medicine but also generally in our culture: To become both healers as well as curers and to lay claim to our full power to make a needed difference.

 
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