A Country Doctor Writes:

“So when did you get hooked on opiates?” I asked matter-of-factly.

The young man’s low-hanging black jeans were frayed at the bottom. He wore a black hooded sweatshirt – lightweight, but still out of place in the hot weather. His earlobes were pierced and stretched out with black hollow cylinders big enough for me to look through and out the window behind him.

I had seen dozens of his kind before, in my son’s junior high school class, at the skateboarding rink and around town. I figured I knew what kind of music he used to listen to and how he had acted toward his parents and teachers. I wondered if he had dropped out of school.

His clothing style seemed a little young for being at the opiate replacement clinic, where most of the patients were in their mid-twenties or older and weren’t rebelling against anything anymore. Had he arrested in teenage rage somehow?

“I started in high school”, he began. “I was angry at everything and everybody. I grew up having all kinds of skin infections, and then I was diagnosed with Chronic Granulomatous Disease. I had all these painful abscesses, and the doctors gave me hydrocodone. But it was in college I became addicted. I started my own software company and made lots of money. We partied a lot.”

He was bright, articulate, ambitious and successful, except when it came to conquering his drug habit. I realized I had typecast him because of his appearance.

At the end of our visit he paused on his way to the door.

“May I ask where you are from?” he said.

“Sweden”, I answered.

“Oh. You look exactly like my great-uncle Dieter from Germany. You’re an absolute Doppelgänger, but you are a lot nicer to deal with!”

“Definitely not your average kid”, I thought to myself as he described his great-uncle, a stern and meticulous clergyman, who sounded like a character in an Ingmar Bergman movie.

The young man had misjudged me just as much as I had misjudged him when we first met.

It got me thinking about how we instinctively and automatically form opinions of others based on general appearance or similarities with people we know. We need to be aware of this tendency that we all have and careful not to let it go too far, but I don’t think it is altogether useless or undesirable.

The “types” we recognize when we “typecast” each other often represent ancient and fundamental life-roles, or archetypes. Just like the characters in classic fairy tales remind us of people we know and tell us something about ourselves and our own time, we can sometimes understand our fellow human beings better if we look for similarities between them and the archetypes we all carry in our collective consciousness.

Jungian psychology uses archetypes to make sense of human behavior and emotions. Archetypal medicine goes further, by viewing symptoms as physical manifestations of emotions and the archetypes they represent. In archetypal medicine there is no difference between symptoms of the mind and symptoms of the body. A gut-wrenching experience and an intestinal blockage are one and the same process, the ultimate form of psychosomatic medicine.

Jung challenges us as physicians to see the epic drama behind the everyday internal and external conflicts our patients grapple with. The young man dressed in black in his revolt against a family of white-clad clergymen could be a character from Shakespeare or an even older literary master. Jung’s picture of health is a balance between conflicting subconscious forces, as when the young man can finally wear both black and white, and even gray.

Archetypal medicine would ask what the painful boils represent in the tragedy of the talented young man with his opiate addiction. “Illness as Metaphor” has long been the purview of alternative health practitioners. We allopaths aren’t usually willing to go that far, but I have read some thought-provoking treatises about common diseases like asthma viewed in such a way.

Archetypes, in everyday medicine, can offer glimpses into possible causes for behaviors and emotions. In a fifteen-minute visit for anxiety, headache, heartburn or opiate addiction they sometimes offer a deeper understanding than the typical questions we now ask. Does it really matter if a patient has generalized anxiety or panic disorder? Migraine or tension headache? Hiatal hernia or poor dietary habits? Or would we be better served by getting a thumbnail sketch of what the basic issues are that drive a fellow human being toward poor health or dis-ease?