A few weeks ago, a new book was published, compiled by Jan Hnízdil and editor Klára Mandausová together with several of Honza’s friends and enemies, titled Stories of an Ordinary Healing (published by Lidové noviny, Prague). I had the pleasure of contributing a short article to it about how I see psychosomatics, so I have a slightly warmer relationship with it and I was present at its very pleasant introduction to the public.
If you know Hnízdil’s works that appear periodically in print, on the blog (http://blog.aktualne.cz/blogy/jan-hnizdil.php), or in his previous book publications, you will find yourself in familiar territory: quality case reports with a good and a bad ending, reflections on the (un)health of contemporary society, and this time, in addition, reactions to the granting of a ridiculous boulder and finally comments from his friends and enemies.
The following digression is not a sign of sclerosis, but an analogy that allows me to show how I perceive Honza in his theory and practice: in the best sense as a leftist radical that every movement needs, even though it is already far beyond the edge of a paradigm that by itself is difficult for the mind of our era to swallow. In Moor’s sci-fi, Lamb: The Gospel According to Biff, Christ's Childhood Pal, the author describes the ferocious activities of John the Baptist, who managed to drown several people in the Jordan during baptisms. Still, it cannot be denied that he “prepared the pathways.”
I understand that a community calling itself biopsychosocial cannot include Hnízdil among them when he advocates psychogenesis as the main, if not the only, etiopathogenetic route into a diseased state. So far, is he fortunate that just this kind of people follows him? Or do the others, those who do not correspond to that, simply not get published? Nevertheless, from a purely theoretical point of view (apart from the fact that Franz Alexander also walked this route for some time) there is an urgent question raised here concerning the self-healing mechanisms of the human organism. After all, in history, medical interventions were sometimes lethal, and humankind survived. So far, there is no more comprehensive information in either undergraduate or postgraduate education about this indisputably existing capacity of ours. Would it not be worth it for medicine to introduce a subject called “spontaneous healing,” somewhere between physiology and pathophysiology.
The second shortcut, which appears to be outdated, although therapists who were certainly not mentally impaired—such as Eric Berne—held it half a century ago, is the idea that one hammer blow to the right screw is enough and everything suddenly becomes clear. Unfortunately, time has not really been kind to this optimistic notion. The aha-moment, even in the form of a vivid hallucination of a key experience after LSD, usually did not by itself keep the initiated change going, because both the inertia of our own program and pressure from the environment automatically return our behavior to the old tracks. In this respect, support offered over a period of at least several weeks appears to be very useful. However, information about the correct direction of life’s path is truly crucial, especially if the one conveying it is convinced of its quality.
Undoubtedly, reputation, the halo effect, and the communication gift that Hnízdil has also contribute to this. Perhaps even that simplification—“you have that because you run around like an idiot”—has therapeutic value. Both placebo and nocebo effects rise with brand fame and product price, as shown by both an experiment with strongly analgesic (though non-existent in the experiment) fentanyl1 and by an expensive versus cheap nocebo increasing algic experience2, the more expensive one doing so even more. As Professor Komárek writes in his contribution: The world is not problematic in itself; the world is problematic in the way we interpret it. Simplicity can sometimes take the shape of a miracle.
I think we should not ignore the Hnízdil phenomenon only because it really does not fit into our paradigm, and because it appears, at first glance, too reductionist and, on second glance, somewhat quackish. Already for this reason, since it leads to improved health in some suffering people. One cannot agree with what one of his critics took seriously, failing to understand Honza’s subtle irony—that (Hnízdil) does nothing for patients and merely takes money for it. It would certainly be worth looking at what he does and how it works. And while we are on the topic of corrections, I doubt (with a smile) that Jiří Šavlík was the first Czech psychosomatic practitioner. Unless he modestly concealed that he created heaven and earth the day before.
Author: MUDr. Radkin Honzák, CSc.
1 Gracely RH,et al.: Clinicians' expectations influence placebo analgesia. Lancet. 1985, Jan 5;1(8419):43 2 Tinnermann A, et al.: Interactions between brain and spinal cord mediate value effects in nocebo hyperalgesia. Science. 2017 Oct 6;358(6359):105-108