Sala Horowitz, Ph.D. Sala Horowitz: In your books and lec-tures, you rather intriguingly describeyourself as a “recovering physician.”Would you please elaborate on what youmean by viewing yourself as such in thecontext of your conventional Westernmedical training as detailed in yourbooks?

Rachel Naomi Remen: A professionaltraining often wounds us. It encourages usto repress certain parts of our humanwholeness and focus ourselves more nar-rowly and cognitively on the grounds thatthis will make us more useful and effec-tive. I have come to really question this.Often parts we have repressed in ourtraining are human strengths—the heart,the soul, the intuition, aspects of ourselvesthat are our resources in times of stressand crisis and enable us to understandand strengthen others. Few people realizehow repressive a medical training can be.

Over the 10 years that I have been run-ning ISHI, I have heard some amazingstories about this from doctors trained inschools all over the country and havebeen deeply moved by the effort manydoctors have made to fit themselves intoa professional model. When I was about12 years old, I visited Canada. During thistour, we visited a historic graveyard, inQuebec. I still remember one of the tomb-stones. It said something like: “Here liesGeorge Brown. Born a man, died a gas-troenterologist.” There are nine doctors intwo generations of my family, and I wasinspired by this. I no longer am.

SH: Can you give me some examplesof how conventional training can wounddoctors?

RNR: There are several stories in bothKitchen Table Wisdom and My Grandfa-ther’s Blessings about this. . .but every doc-tor can give you many examples of thissort of falling away from wholeness.

One of mine happened in the pediatricemergency room of my training hospitalwhen I had been a doctor for only 2 days.My senior resident asked me to go withhim to tell some young parents that theautomobile accident they had escapedfrom unharmed had killed their onlychild. Very new to this doctor thing,when they broke down and cried, myown eyes had filled with tears.

After it was over, the senior residenttook me aside and told me that I hadbehaved very unprofessionally. “Thesepeople were counting on our strength andyou let them down,” he said. I took thiscrit icism very hard. As one of the fewwomen in the internship program I felt itwas very important to get things right.Three years later, when I myself wassenior resident, I hadn’t cried in years.

During that year, a 2-year-old boy, leftalone for only a moment, drowned in hisbathtub. I ran down to the emergencyroom to supervise the resuscitation teambut, a ft er an hour , we had to admitdefeat. When I told these parents thattheir child had died they put their armsaround each other and began to sob. Aftera few minutes, the father looked up andsaw me standing there, strong and silentin my white coat with a shaken intern bymy side. “I’m so sorry doctor,” he toldme. “I’ll get a hold of myself in a minute.”

You know, I remember this man, hisface wet with a father’s tears, and I stillfeel ashamed. Convinced by then thatmy fe e l i ngs wer e i r re levant to mywork, I had allowed myself to becomethe sort of person a man could apolo-gize to for the pain he felt at his littleson’s death. In the presence of a whole

149

Healing Patients and Physicians An Interview with Rachel Naomi Remen, M.D.,

Pioneer in Mind-Body-Spirit Medicine

Rachel Naomi Remen, M.D., works withpeople with cancer in both her private psy-cho-oncology practice in Northern Califor-nia and at the Commonweal Cancer HelpProgram in Bolinas, California, which wasfeatured in Bill Moyers’ award-winning1993 Public Broadcasting series and subse-quent book, Healing and the Mind.* Dr.Remen is the cofounder and medical directorof The Commonweal Cancer Help Programand the founder and director of Common-weal’s Institute for the Study of Health andIllness (ISHI), which pioneered programs inCategory I continuing medical education(CME) for postgraduate physicians whowish to recover the meaning of their workand live the Hippocratic oath as a way oflife. Dr. Remen is also a clinical professor offamily and community medicine at the Uni-ver s i ty o f Ca li f o rn ia , San F ranc i sc o(UCSF), School of Medicine. For the past 10years, she has taught a course called theHealer’s Art to first- and second-year medi-cal students. Currently, she is on the steer-ing committee of the UCSF Osher Centerfor Integrat ive Medic ine. She has alsoserved on the faculty of Stanford UniversityMedical School; the University of Califor-nia, Berkeley, School of Health Sciences; andSaybrook Institute Graduate School andResearch Center in San Francisco.Dr. Remen has had Crohn’s disease for 47

years and her work is a unique synthesis ofthe perspectives of patient and professional.Both of these experiences are reflected in herbooks, Kitchen Table Wisdom: StoriesThat Heal,* winner of the 1996 WilburAward for best work of spiritual nonfictionand the 2000 Friends of the Library USAnonfiction reader’s award, and My Grand-father’s Blessings: Stories of Strength,Refuge and Belonging.* *All books are noted in boxes within the article,

with publication information.

person, no one needs to apologize forbeing in pain. No one is that a lone .There are many ways to abandon ourpatients. All of them involve abandon-ing ourselves, our wholeness. Most ofus are so accustomed to the ways thatthings are done that we may not realizethat medical training can actually bediminishing, belittling, or even abusive

to the student or resident doctor—orthat we ourselves have been dimin-ished and abused.

Many articles have been written aboutthis but one of the earliest “Medical Edu-cation, A Neglectful and Abusive FamilySystem” was written by Catherine McK-egney in 1989 and published in FamilyMedicine , Volume 21, Number 6. This

recognition is important because thosewho have been abused may unconscious-ly relate to others in abusive ways.

SH: Do you see your ISHI-type profes-sional development courses at Common-weal being replicated elsewhere forphysic i an s who a re working wi thpatients with life-threatening illnesses?

RNR: My interests go beyond helpingphysic ians to work with patients withlife-threatening illnesses and so do theISHI CME courses. I guess I am really a“change agent . ” The re is a need torestore the health care system itself to agreater wholeness. Helping a system to

150 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2001

“There are many ways to abandon our patients.”

ResourcesCommonweal Cancer Help Program

P.O. Box 316Bolinas, CA 94924(415) 868-0970Web site: www.commonweal.orgThis project, founded in 1985, supports patients with cancer and their significant others in

making informed choices about mainstream and complementary cancer therapies throughweek-long residential workshops. Activities include support groups, gentle bodywork,progressive relaxation, meditation, imagery, poetry, and discussions. Also included is groupsandtray, a technique devised at Commonweal by Marion Weber, an artist who is Director ofExperimental Learning at The Institute for the Study of Health and Illness. Via sandtray, agroup of people choose figures and objects and place them in their own sections of a sand-filled table to uncover the meaning in their personal stories and to gain deeper wisdom butthemselves, their relationships, or their collective work.

Institute for the Study of Health and Illness (ISHI) at CommonwealthISHI is at the same address and Web site as above(415) 868-2642e-mail: ishi@igc.org This is a professional development institute that offers weekend workshops for physicians

who wish to examine their professional roles in depth and to learn innovative ways of mobiliz-ing patients’ mental, emotional, and spiritual resources in support of healing. ISHI, directed byDr. Remen, also offers a course for medical students at the University of California, San Fran-cisco, School of Medicine, and an outreach program for physicians, called Finding Meaning inMedicine.

rachelremen.comThis Web site offers excerpts of Dr. Remen’s writings and information on her speaking

schedule.

Recommended ReadingBooks

Choices in Healing: Integrating the Best ofConventional and ComplementaryApproaches to CancerBy Michael LernerCambridge, MA: Massachusetts Instituteof Technology Press, 1994

Healing and the MindBy Bill Moyers (contains a chapter, enti-tled “Wholeness,” with an interviewwith Rachel Naomi Remen, M.D.) New York: Doubleday, 1993

Related Articles by Sala Horowitz inPast Issues of Alternative & Complementary TherapiesWriting: A prescription for health.6(1):28–31, 2000.The Power of more than one: The roleof support groups in mind–body healing.4(2):84–88, 1998

heal is not too different from helping aperson to heal. And the most effectiveway to make change throughout a sys-tem is not to encourage people to repli-cate what you are doing but to supportthem as they make changes in their ownunique ways that are congruent withtheir gifts and visions and to their work-places. In the past 10 years, ISHI hashelped a great many people make need-ed changes within the medical system allover the country.

SH: A central feature of your programis the application of self-awareness andshar ing in the heal ing a r t s . Wha tchanges for the better have you wit-nessed—or would you like to see—inmainstream medical school educationand training since your own?

RNR: Actually self-awareness is notmy main interest; enabling physiciansto reclaim their wholeness is. I wouldlike to see the present medical trainingtransform itself into a medical educa-tion. “Educare,” the root word of educa-t ion means “to lead for th the innatewholeness of a student.” Conventional-ly, we do not educate whole people, wetrain experts. This is a very differentth ing . Although posi t ive change isoccurring in medical school curricula allover the country, there is still a hiddenor unspoken curriculum that may con-vey to a student that being a wholehuman being is somehow unprofession-al. I would like to see medical educationsupport and strengthen the wholenessin students so that they can recla imtheir role as healers.

Reclaiming wholeness is not a questionof any one technique or approach. . .thereare expert acupuncturists who diminishtheir patients as profoundly as expertinternists do. Neither really fully serves thelife in another. Frankly, I would like to seeserving life become the central goal ofmedicine. At the moment, we do not servelife; we are trained to fix life, manipulatelife—to control it, or to gain mastery over it.I do not think this is what service is reallyabout. We serve life not because we see it asbroken but because we see it as holy. Ofcourse, service itself is not a technique; it isa relationship—not a relationship betweenan expert and a problem but between twowhole human beings who bring the fullpower of their combined humanity to a sit-uation. When that happens, many thingsthat cannot be fixed can still be healed.

SH: Considering your long personalhistory with Crohn’s disease, how didyour career path lead to working pre-dominantly with cancer patients ratherthan with people with other chronic dis-eases?

RNR: While I am trained in severaltranspersonal therapies and contempla-tive approaches and am a physician, I amnot a psychiatrist or a psychologist. WhenI opened my private practice in 1980, Ica l led i t “medi ca l counsel i ng” andintended to help those who had signifi-cant physical issues and bodily changestoward a greater a sense of wholenessand personal integrity despite bodilychange. . .At the time, this was a ratherunique practice focus and there was agreat deal of unmet need among people

who were surviving with diseases thatwould have killed them only a short timebefore. Conventionally trained counselorswere unfamiliar with the unique needs ofsuch people and uncomfortable withthem and so I got many referrals fromother doctors and therapists. Almost all ofthese referrals were people with cancer—often young people. After I had been inpractice for 5 years or so, I met MichaelLerner , the president of Commonwealand we cofounded the CommonwealCancer Help Retreat, originally drawingpeople from my practice. Now, of course,we have retreat participants of all agesfrom all over the country.

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2001 151

“Helping a system to heal is not too different from helping a person to heal.”

Rachel Naomi Remen, M.D., Institute for theStudy of Health and Illness, CommonwealCancer Help Program.

SH: What have you learned from liv-ing with a serious chronic illness?

RNR: [Laughs] A great many things,Sala. Perhaps the most important is that iti s poss ib le to have a good l i f e eventhough it is not an easy life.

SH: What have you learned from yourpatients that is relevant to improvinghealth care practice?

RNR: [Still laughing)] Well, I have writ-ten two books about this. . .how muchtime do you have? Seriously, I havelearned that medical science may havedefined life in a way that is too small. Lifeis larger than science; things happen thatscience can never explain. Over time, peo-ple deal with situations that can never befixed by simply living beyond them inways that are deeper and far more pro-found than one might have ever imag-ined. I have learned that recovery fromi l l ne ss i s a lmos t neve r l i near . Anyapproach or relationship that does notcreate a safe space for something com-pletely new to emerge may l imit thecapacity of a person to recover. I supposeyou might say that I have learned frommy patients to trust life and to be awedby human strength and the infinite vari-ety of its manifestations. We may need tohelp health practitioners know less andwonder more.

SH: When I read Bill Moyers’ inter-view with you in Healing and the Mind, Iwas struck by what you said you learnedabout the value of your patients writingpoetry even though you had initially notbeen a fan of poetry—at least not the clas-sical variety imposed on you in school.Please comment on writing’s role in theprocess of patients’ healing at Common-weal and in your private practice.

RNR: It seems to me that all that poetryis, is speaking truth. I begin each 3-hoursession of our 4-day CME retreats with ashort, silent meditation that concludeswith a poem. About 10 years ago, westarted writing poetry with the cancerretreat groups and I have been writingpoetry with groups of doctors in our CMEretreat programs and medical students inmy UCSF medica l school course for

almost as long. I usually do not call thesesessions “poetry” sessions as I find thatthe idea of writing poetry often stiflespeople. I see poetry as simply a way tostate a personal truth.

I use a very simple reflective approachto enabl e peopl e to gathe r up theirthoughts, and people write and are thenusually deeply moved to discover thattheir statements of personal truth areactually poetry. With the doctors andmedical students, these poetry sessionsoften take the form of rewriting the Hip-pocratic oath for themselves. One of themost beautiful of these, written a fewyears ago by a first-year medical studentat UCSF at the time, goes like this:

I dedicate this to my future patients:May you find in me the Mother of theworld.May my hands be a mother’s hands,My heart be a mother’s heart.May my response to your sufferingbe a mother’s response to your suffering.May I sit with you in the darkas a mother sits in the dark.May you know, through our relationship,That there is something in this world thatcan be trusted.

SH: I’m very interested in the groupsupport components of the Common-weal program for cancer patients and fordoctors. Do you see a qualitative differ-ence in healing between this group envi-r o nmen t v e r s us yo u r i n d i v id ua ltherapeutic settings?

RNR: Actually, the depth of healingo f ten has ve ry l i t t le to do wi th thenature o f the hea l ing int ervention .Sometimes a single word or a tiny eventmay lead to a pro found hea l ing . I tseems more a question of readiness than

152 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2001

“Medical science may have defined life in a way that is too small.”

Books and Tapes by Dr. Rachel Naomi RemenBooks

Kitchen Table Wisdom: Stories That HealNew York: Riverhead Books, 1996

My Grandfather’s Blessings: Stories ofStrength, Refuge and BelongingNew York: Riverhead Books, 2000

Edited BooksWounded Healers: Poems By People With

Cancer and Those Who Love ThemBolinas, CA: Wounded Healer Press,1994

TapesKitchen Table Wisdom: Stories That Heal

(abridged)San Bruno, CA: Audio Literature, 1996

My Grandfather’s Blessings: Stories ofStrength, Refuge and Belonging(abridged)New York: Simon and Schuster Audio,2000

Final Wisdom: What The Dying Can TeachUs About Living Louisville, CO: Sounds True, l998

The Will to Live and Other MysteriesLouisville, CO: Sounds True, 2001

of technique. Group approaches oftengive people the opportunity to offerhealing to each other, to recognize theirpower to heal others, which is a dimen-sion which is not usually available dur-ing one on one therapy. Both peoplewith cancer and physicians are actuallymarginalized groups, groups whose lifeexperiences are quite different from theaverage. Sometimes the shared experi-ence of wounding, be it cancer or medi-cal training, will enable people to offereach other a powerful sort of healingthat could never be offered by anyonewho has not experienced the woundpersonally. Alcoholics Anonymous is astunning example of this, I think.

SH: Are you or others at Commonwealconducting any formal research on thisquestion?

RNR: I am trained as a researcher. I dono research projects. Commonweal hasdeliberately chosen to be a service andeducational organization rather than tak-ing a research focus. Early on, it was feltthat we would compromise our capacityto serve each individual by adding a sec-ondary research agenda to our pro -grams. We do outcome interviews withthe participants at the close of the CancerHelp Program and more extensive out-come evaluations on our CME programsas required by the California MedicalAssociation in order to keep the CMEcurriculum relevant but we do not doformal research.

SH: In your pioneering holisticallyoriented books and interviews, I havenot encountered your opinion of theescalating trend in using such alterna-tive and complementary modalities ashe rbal medic ines or acupuncture ,

although I am aware that gentle yoga,o ther bodywork, med i ta t i on , andimagery are used at Commonweal .Please comment.

RNR: The Commonweal Cancer HelpProgram is an educational program.While we offer participants a great deal ofinformation about conventional and alter-native programs, we do not offer anytreatments for cancer. As both The Com-monweal Cancer Help program and thephysicians’ program are personal discov-ery models, such approaches as yoga withits accompanying imagery; massage; andbrief meditation, which can lead to relax-ation and greater self-knowledge, havebeen a par t of the program since thebeginning.

SH: I don’t know how you would havethe time to do so, but do you have anynew projects or books in the works?

RNR: I am preparing to write anotherbook. And the newest project at ISHI,for recovering doctors, which began inOctober 2000, is a nationwide outreachs y s t em o f l e ad e r l e s s s to r y t e l l i n ggroups—cal led Finding Meaning inMedicine. For the past 2 years, in theBay area, we have piloted this simpleapproach that enables doctors to uncov-er the deep meaning that underlies theirda i ly rout ine and draw upon i t fo rs t reng th . Of cour se , th is approa chwould work equally well for groups ofother professionals or mixed groups ofprofessionals. These small leaderlessgroups meet once a month for a fewhours share stories about a chosen topic.The price of admission, as it were, is tobring a story from [one’s] personal orprofessional life, or from the world liter-ature, or a poem, or even an exercise, ora piece of art , which will enable the

group to explore the topic in greaterdepth. There is no preparation necessaryand the only skill needed by the personwho organizes a group is the ability torun a meeting in such a way that every-one’s voice is heard. The discussion top-ics that have been selected by the BayArea physician groups are relevant tothe soul of medicine and include heal-ing, mystery, loss, integri ty, suffering,covenant, compass ion, and the like.These groups have proven to be success-ful beyond our wildest dreams and havehad a profound impact on the way thatparticipating physicians experience theirwork. At present, we are inviting inter-ested doctors to set up their own groupswhere they work and live . We havedeveloped informational packets onhow to do this and are available to sup-port anyone who is interested. Peoplewho ar e in t er es t ed c an r ea ch us atishi@igc.org or by calling ISHI at (415)868-2642.

SH: There is a great deal that may beconsidered spiritual in what you do. Doyou have a spiritual practice?

RNR: Over the years I have had sev-eral spiritual practices but now I thinkthat I would have to say that I practicemedicine. I see medicine itself as a spir-itual path, a way of life characterizedby compassion, harmlessness, altruism,service, awe, and reverence for life. Ithas been my spiri tual path for almost40 years.

To order reprints of this article, write to or call:Karen Ballen, ALTERNATIVE & COMPLE-MENTARY THERAPIES, Mary Ann Liebert,Inc., 2 Madison Avenue, Larchmont, NY 10538-1961, (914) 834-3100.

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2001 153

“Actually, the depth of healing often has very little to do with the nature of the healing intervention.”