Rachel Naomi Remen M.D.
(an edited version of this interview first appeared in Parabola
magazine, Vol. 44 #4)
The name resonated in an undefined, positive way - Rachel Naomi Remen; “Have you heard of her?” I asked my wife. “Isn’t she the author of Kitchen Table Wisdom
?” my wife replied. Indeed. And I’d heard of the book, a bestseller—as was My Grandfather’s Blessing
. I’d read neither and yet somehow, I’d absorbed the sense of these books, like the sound of a bell in the distance, as a new influence appearing in Western Medicine that came out of work done at the Esalen Institute almost fifty years ago, and which led to the founding of The Institute for the Study of Humanistic Medicine. Being part of that was a deeply transformative experience for Remen, so much so that she left her position as Associate Director of the Pediatrics Clinic at the Stanford Medical School to strike out in a new and, at the time, revolutionary direction. From what followed from her radical decision, one can only say she was listening to a call from destiny.
I met Dr. Remen for the first time as part of a small group of admirers who gathered at her home near Walnut Creek, California. We were all mesmerized by her stories. In one of the most striking, she tells about an encounter with a small porcelain figure of Quan Yin. It was in order to hear the story again and to learn more about its context, that I asked Remen if she’d be willing to be interviewed.
On the day of the interview we were seated at a table in her living room chatting before I turned on my recorder when one of Remen’s much loved cats silently jumped up on the table and settled there a foot away from us. Dr. Remen remarked. “He knows where the energy in the house is and he’ll be there.” (The cat remained there for the entire interview.)
As we chatted we discovered we shared some friends, Jacob Needleman,
for instance. I soon found myself sharing a question Jacob and I had talked about a lot; with the advent of machine intelligence and the extraordinary technical advances linked with biology – from both a philosophical and practical perspective - he considered this question newly relevant in profound and disorienting ways. Our conversation took off from there….
The question Jacob put to me, one that has new and confusing aspects, is what is a human being
Dr. Rachel Naomi Remen:
And the other question, of course, is why
are there human beings? Is there any kind of purpose behind this extreme difference in the evolution of the development of life that is humanity?
And would you agree that contemporary science doesn’t consider that a question that has any legitimacy?
It’s not a scientific question. Science describes life, but it does not define life, or even attempt to. It just describes the manifestation of life.
Strangely enough, I was thinking about this on the drive over here.
It’s seductive stuff.
Yes. Science and technology are dazzlingly powerful. They keep pushing into new territories and lead the way on the material plane, let’s say. But science also lags behind in the world of sentience, let’s say. In that realm there are things that have been known for ages, and that continue to be experienced, but that science tends not to take seriously.
Boy! I sure wish I could reason about that. The brain isn’t the highest human function. The highest human function is shrouded in mystery. It’s the soul. I think the development of the human race was not about the ability to think and reason. I think it was the ability to perceive spiritual reality and to align oneself with it in some way. I don’t think the brain is going to be the factor in the survival of the human race, frankly, unless we can figure out how to get another planet, having trashed this one.
It’s a horrible thought, isn’t it?
a horrible thought. I think the survival of human races goes back to a much deeper level of our humanity, which we have yet to fully realize. And compassion is part of that. Compassion. Science is very seductive. It offers us the dream of mastery. But we’ve traded mystery for mastery, and we’ve gotten a very bad deal from this. What it has done is put the entire planet in peril and every life form on it. And you know, there’s a lot that’s connected to the Quan Yin in this because mystery is not part of the yang
. Mastery is the yang modality of understanding and action, really. Mystery is part of the yin
And with that comes a whole other definition of what is a good life. What does it mean to be a human being
? To what larger and unknowable thing are we connected? And what do we manifest of that in our daily life and our relationships with each other? It’s a whole other perspective and a different way of seeing.
They had just invented telephones when I was born. [laughs] The whole emergence of the scientific capacity to direct our own destiny and to make things happen and to “understand” things has led us into a very dangerous situation, collectively. We don’t even realize the danger we’re in.
I can’t even put it into words. It’s a whole other way of seeing. And it’s a very old way of seeing. It’s involved in a lot of the wisdom stories that have been passed down to us—stories that direct our attention to questions of what is it going to take for us to live, to survive and live well? Some of the old, old stories are so relevant to today’s situation. Yet the wisdom in these stories is not always positively recognized. But it’s intuitively understood, and that’s why these stories have been passed along. Let’s go to the story of the Lamed Vav Tzadikim
– The 36 Righteous Ones.
First, let me say that my grandfather was an orthodox rabbi. All of his children were doctors and nurses and professors and deans of this and that. But he himself was a student of the Kabbalah, which was a great embarrassment, especially to his sons. Grandpa was sitting in his study reading about magic. And I was a very mystical child in a cognitively-oriented, high achieving family. So he was a refuge for me.
He would sit at his library table reading Kabbalah and I’d sit under the table playing with his velvet slippers. I spent a lot of time like that. There were certain stories he told me that I didn’t understand, but he made me learn them. I’d say, “But grandpa, what does it mean?”
He’d say, “Don’t worry. Someday if you need to know what it means, it will come back to you.”
And this was true. One of these stories was the Lamed Vav
. The story basically says that God will only allow the world to continue as long as there is a minimum of 36 people in the human race who are able to respond to the suffering of total strangers. And should, at any time in the human race, there be fewer than 36 such people the world comes to an end and the human race experiment has failed.
I remember hearing this story and thinking, who are they
? I was four and had just learned about movie stars. So I was sure that these were the ones. But I asked, “Who are they grandpa?”
He said, “Ah, Neshumelah
. Nobody knows who they are. They themselves don’t even know
. Even you. You
might be a member of the thirty-six so you must behave as though you are.”
Then I began thinking about these people. These people had to respond to suffering. I mean, what if it was too much for them? What would happen? Then the world would be gone
—even my little kitten and me
. I became really frightened. I was a timid little girl. So I said, “Grandpa. What is it that they have to do
? Is it very hard
? What would happen if they couldn’t do it, the thirty-six people?
He laughed and said, “Neshumelah
, they don’t have to do
anything. They just have to have the capacity to feel compassion for the suffering of people, people they don’t even know
—people whose language is different, whose faces are different, whose lives are different. They just have to have the capacity to feel compassion for their suffering as if it were their own.”
And this is an extraordinary story because if we think about the happenings in the world today, the amount of suffering—even in our own country… we read about it, we hear about it, then we go on. A whole bunch of children are gunned down in a school. How many people even think about it anymore? That was a couple of years ago and now we’ve had a lot more.
Basically, it’s the capacity to respond to the suffering of others simply because they are fellow beings. That entitles them to our response. That capacity is, perhaps, what the future of the world is based on. Without it, we’ll destroy our planet and everything in it. And this story is from the 14th Century. If I were to choose a single one of the old wisdom stories relevant to us, this one is the key to survival, I believe.
That story, and the worry that we might be close to not having 36 such people, one has to wonder what is that keeps people’s hearts so closed that they can’t feel this compassion for other people, people they don’t know. What are the forces?
You realize that’s a very male question, yes?
Maybe I don’t, but I can see what you’re saying.
It implies that if we knew we could fix it. And my sense is—I think we’re born with the capacity. How did we forget it? How can we remember it again? How do we experience that I, as a mother or a father—and any other mother or father in the world—have this same experience and this same set of values, if you want to think of it that way. We are a single event, we human beings. We are not Arabs and Jews and Americans and Russians. That is a construct. If you take our clothes off and stand us up, you can’t tell who’s a Russian or who’s an American.
Yes. And your story of the Quan Yin is related to your being under the influence of the yang
forces as a young doctor—which in those days was a world of men—and of course, wanting to fit in with the values you were surrounded by in order to succeed. It’s interesting how the Quan Yin figure appeared out of all that.
I think we learn what it is that we need. Approval is a very important thing in our culture, and in every culture—the approval of others. And approval is a form of judgment. It basically rewards us for being a certain way and withdraws attention from us, or even love from us, if we are another way. This has become enormously important to people in today’s world, to have the approval of other people. Our whole culture is based on judgment.
I’m reminded of a story you told earlier about how a child had been pulled out of a swimming pool and brought into the emergency room. You didn’t just stay there “in control” and not show any feeling in front of the parents who were weeping over their drowned child. You, too, cried. This was in the very yang world you describe, but this buried feminine in you was still alive.
But that was a mistake. It was such a significant mistake that I swore I was never going to make it again. It was wrong to cry
. And I was very invested in being successful, and being right. I really systematically repressed all of my feminine perceptions, all of my intuitions, all of my sense of tenderness, compassion, kindness. Because I was going to succeed
. This was about sixty years ago now. And the contempt with which any manifestation of feminine principle was greeted… I mean when that doctor said to me afterwards, “They were counting on our strength, not your tears
.” And it was in that
tone of voice. I was humiliated.
That’s such a powerful story.
See I was a philosophy major. And it had been made clear to me when I was interviewing to be accepted in medical school, that I’d made a terrific mistake taking something so irrelevant to medicine. Nothing could be more relevant to medicine than to be a philosophy major. But I was getting that I was wrong—not only because I was a woman—but because I was a philosophy major, too. And for me to succeed all that was going to require being changed, eradicated, or hidden at the very least.
It’s kind of shocking to hear the story of how the doctor asked for your “strength” in not allowing any tears…
Normal! Yeah. And things have changed, and for a number of reasons. At the very moment we’re sitting here more than half of the American medical students are young women. This is becoming a woman’s profession, which is not to say these women are not cognitively brilliant and analytical and decisive and competent and all of these things. But they were also once little girls [laughs]. They were permitted, as little girls, a certain bandwidth of response to the world that little boys are generally not permitted.
The Quan Yin is a symbolic representation of the realm of compassion and the feminine values as you’re describing them.
You know, what I was saying, Richard, is that there’s a path through all of this, which is something a little more mysterious. I was always doing the right things for the wrong reasons. It was as if some interest was leading me and I went towards it, but then discovered that the thing I’d gone toward was something very different and much more
important than what I’d first been interested in.
The invitation to the Esalen Institute when my opposite number, the director of the internal medicine clinic (I was the director of the pediatric clinic) came to me…
And this was at Stanford?
Yes. And I was in my very own
office. I mean, I was succeeding
by God! [laughs] He came in and put down these mimeographed sheets in front of me and said, “Look at this! This place is inviting us to be part of a research project. They’re doing an exploration of whether or not healing has anything to do with medicine. [laughs] And “Is there such a thing as the will to live?” [laughs again] And I said, “Tell me more!”
He says, “They’ve invited us for a weekend a month.”
I said, “Where is it?”
He says, “It’s an hour south of us on a cliff over the ocean. There are a whole bunch of thinkers there, like philosophy people, and they’re thinking about what it means to be a human being and all of this. Really, it’s kind of a far out place! People don’t wear clothes sometimes.”
He went on and on and was very excited. He said, “We get free weekends
at this beautiful place and all we have to do is talk about healing and things like that.”
I’d just recently broken up with my boyfriend who couldn’t stand the lifestyle I was living. So I was lonely. And as this doctor was describing all this remarkable stuff (Esalen was ground zero for a change in consciousness that was unparalleled, almost like in the middle ages.) suddenly I realized that this was wonderful. This was the best way I could imagine to meet men
. So I went.
If I’d known that by doing this I would give up my life-long dream of being the head of a department of Pediatrics or being the dean of a medical school as a woman, that ultimately I would give up all clinical medicine and do something else, I would never have gone.
I’m reminded of another story. This was when I left Stanford. It was my last day in the pediatric clinic and I was seeing my last patients. There was a young black woman who I’d met when her child was just a few weeks old. She’d brought him into the emergency room. He was losing weight and crying. In the emergency room they had examined him. They had turned him over and there were these marks on his back that looked like bruises. They weren’t. They were birthmarks that often appear in the first few months in a baby whose skin is highly pigmented.
In the emergency room they didn’t know that and they thought, “She’s beating her baby and starving it.” This young woman was only sixteen years old and unmarried. So they called the cops.
The cops arrived just about the time I arrived since they’d called me, too. And I knew what these spots were. I negotiated with the cops and told them I’d keep an eye on the baby. Then I said, “Let me examine the baby, because no one had done that. When I examined him I felt a thickening, like an olive, right where the exit of the stomach would be. He had pyloric stenosis, a thickening of the muscle that connects the stomach to the intestine, and was vomiting and couldn’t eat. That was why he’d become emaciated.
So we rushed him upstairs to the operating room. We opened the stenosis and it was fine. Then she took him home. She lived in various places in following months and had a whole community of different people who helped her. She was doing just fine. And it turned out that her beautiful, now 18-month-old child, was my last patient.
At this point the mother was in school studying to be a beautician. I looked at her and realized she would be my last patient
. It just hit me. I was leaving and was going to do something totally different, something about reclaiming the soul of medicine. It was not even formulated then, but I knew that I had to do something different. I got tears in my eyes, and this young woman asked, “Why are you crying?”
I said, “You know, your child is going to be my last patient.” And I told her a little bit about Esalen Institute and how medicine had drifted from its purpose, and all of that.
She said, “Oh, you not worry. This system
is sick. I bring my baby into the hospital and they tell me I beating my baby. They don’t believe me. They don’t help me. They call the police. This system is sick
. You have a patient now. It’s not a little patient like my baby. It’s a great big
Then she says to me, “You work for the Man. You have always worked for the Man. Not to worry. He lead you to where you ought to go. And she had a single piece of jewelry, a tiny gold cross; she took it off and put it around my neck.
I think of her as perhaps an angel. She delivered the right message to me at the right moment. It’s a little mysterious.
It’s very mysterious.
Rachel: You got a great big patient now.
Isn’t that amazing?
That’s a very, very beautiful story. It’s so interesting how things can appear when one is in this place of not knowing.
There’s a lot we don’t know, cognitively. You know, we’ve done everything possible to make this a world that runs on cognition and mastery. We’re here to fix
the world. The world is broken
and we are here to fix it. That’s not exactly right.
This, I take it, was after the whole…
I’d quit. I’d been going to Esalen once a month on weekends. It was intense. I had the experience of knowing people like Abraham Maslow, people like Jerry [Jacob Needleman]. I met people like this. They were down there. As a Wittgenstein scholar, I’d been in the intellectual environment, but not in this other environment.
So how did that happen that you quit your position at the Stanford Pediatric Clinic?
They promoted me. They offered me an associate professorship at Stanford, and the next day I quit. And what led me to quit was my experience at Esalen.
Okay. And how does the Quan Yin story fit into this?
That was before I went to Esalen. What happened was this. In order to succeed, I kept repressing a whole part of my nature. I was accepted and rewarded for this and got my first position of authority when I was made the associate director of the pediatric clinic. I got an office with my name on the door and was fully acknowledged for the first time as a leader—all really important things for me. I was given a little stipend, a hundred dollars, to get a new chair and a lamp for my office. I’d gone to the Stanford Shopping Center to get a chair and a lamp. I walked into the store and there was this statue. It was on one of the side tables.
And you were immediately attracted to it.
It was even attraction. It was mine
(Quan Yin by Jim Barton)
That kind of knowing, out of the blue, it’s so interesting.
It isn’t out of the blue. It has to do with a resonance between the symbol— even though you don’t know what the symbol is cognitively—and some inner construct inside yourself. She was mine!
I remember picking her up and seeing that she was a hundred dollars. That’s what I had for the chair and the lamp. Finally, I went ahead and bought a chair and a lamp and left the statue behind. That’s when the nightmares began. It was maybe a year after this, when my opposite number shows up and says, “Hey, there’s this thing happening at the Esalan Institute!”
What happened when the nightmares started?
You know what a night terror is? You’re not a pediatrician. There’s a difference between a nightmare and a night terror. A night terror is extreme. It’s probably when something very deep in the unconscious arises. The experience is of imminent death. Dread. It’s an extreme nightmare. Children have this sometimes. And I had this extreme nightmare.
That was the first night after you left the Quan Yin behind?
Yes. And then the next night, I had it again. Then the third night, I had it yet again. I thought, I don’t know what this is, but obviously I need to buy this thing
. Right? [laughs] I needed to take this into my life. So I took all my lunch money and bought it. Then I knew it had to be in my office. Not in my home, but in my office. It just seemed obvious to me.
When I got to the office—and again, everything has a double meaning—there was no place to put it
. The shelves were full of medical tomes. There was no place to put her down in this tiny office except right on my desk
. She was there in my field of vision every day; sometimes I’d handle her as I talked on the phone. This went on until one day Dr. Barber shows up with the mimeographed papers saying, “Esalen!” and I say, “Great way to meet men! I’ll do it.” And what I met was my whole life purpose.
It presented itself to me exactly the way it had to for me to act. So I went. And I met Maslow! [laughs] And folks like him.
What constellated in you that brought you to the point of leaving that world and quitting your job?
Remember, when I put away the feminine, I put away all my philosophy work as well. And at Esalen people were talking about things they did not talk about at Stanford.
Are you saying that the philosophy part is a natural feminine thing?
I’m saying it’s something that can’t be measured. It’s soft stuff. Except that medicine is a philosophy
. And at some level, I connected with it as only a philosophy major can connect with it. It’s a lineage. It’s a way of life. It’s very old.
When you think of the story of the Lamen Vav
, in a funny way, doctors are
the Lamen Vav. If you think of the human tapestry, there’s a single thread through it of people who respond to the suffering of people they don’t even know. That’s what we do. We may respond in very limited ways, in the sense that we respond only technically, only in terms of diagnosis and treatment and what have you. But we respond. People are willing to compromise their own values, they’re willing to talk to a person who has a serious illness, who is frightened, in the fifteen-minute slot that you are allowed to talk with that person. We’re putting up with a system like this because the suffering of people, whose names we don’t even know, has never lost
Doctors see forty people a day. I don’t know how to even say hello to forty people a day. But they stay with it. And the reason they stay with it is that the lineage holds them to do whatever they can.
If you go back in time in this lineage, the doctor was to take care not only of the patient’s body, but the soul, too—isn’t that the case?
Rachel: The whole patient
—including the heart, which is a way of seeing. The heart is an organ of seeing, basically. The heart has had a very central role in medicine. Aristotle describes the temples of Asclepius, which was the first medical center. He described this as a group of buildings with courtyards and, in one of the courtyards of the temples of Asclepius—which were gone a hundred years before Aristotle was born—there was a statue of Venus, the goddess of love. What that’s about is that the perspective of the heart is central to the practice of medicine.
That’s what we need, don't we? The perspective of the heart
. Maybe that’s simplifying the matter too much.
Let me just think about that a minute. You know, it goes back throughout. It’s part of the lineage. Now, when a person becomes a doctor, there’s the prayer of Maimonides and the oath of Hippocrates. When they confer the degree, all over the world now, the very next thing is that you swear the oath. And you swear it in the old language, the oath of Hippocrates. Some institutions use the oath of Maimonides. It’s not as old.
I remember reading this when I was fourteen. He’s asking for the strength to be able to continue living a life surrounded by human suffering, and it’s in a prayer format. It goes, “Inspire me with love for all thy creatures. May I see in all those who suffer only the human being.” [she points to the figure of the Quan Yin]
It’s Quan Yin, too.
This lineage is the work of responding to the suffering of fellow human beings. A great deal in our culture today makes it hard to realize that we are fellow human beings. We’re focused on the differences.
What happened to you at Esalen came to a point, and afterwards you spent your career in medicine…
I became part of something, a subgroup of people—actually the people who were running the experiment at Esalen. Sukie Miller and her husband Stuart Miller were part of that and they formed something called the Institute for the Study of Humanistic Medicine. The concept of humanistic medicine didn’t even exist then. The little group of doctors who were involved actually went on and began to write and teach in a very different way.
Some of the things I did more recently—in 1991 at UCSF, I started a student elective called “The Healer’s Art.” That’s a story in itself. It’s about medicine as a way of life. It’s about all the things we’re talking about. This course is for first year medical students before they encounter what I think of as the shadow of medicine, the part that says, “Shut down everything. What you can fix is what’s important.”
Thirty thousand medical students have taken this course now in a hundred medical schools across the country. That’s something I’ve done. And medicine itself has changed quite a bit. I mean, just the presence of the young women as students has made a change. It’s not the draconian system it was when I entered, for sure.
Today burnout among first responders in the health care system is a major public health issue. Burnout is loss of meaning. The meaning of medicine is not science. It’s service. And service is a way of life.
I remember the story you told the group of us who visited you earlier. You talked about the question you posed to students…
“How old were you when you first realized that the needs of a living thing mattered to you?” That’s what all of these students have experienced. And they were shocked to discover that this happened when they were very young, and that their work is not just a cognitive satisfaction, but a calling.
I suppose that’s really what my work has been about, to enable people to think of medicine not by its tools—science is just a tool; it’s the most recent tool of service, but it’s not medicine. Medicine is much larger than science. And older—much, much older than science.
Medicine is larger than science. I like that statement. It’s really kind of shocking if you stop to think about it in the context of today’s science and technology.
It’s not the power of medicine. I myself have a chronic illness that’s never been cured. I live with it. I have pretty severe Crohn’s disease. I’ve had major surgery nine times. Without the scientific power of these surgeons to make these interventions, I wouldn’t be here. It’s as simple as that. But with only that, I’d be a cripple and an invalid.
And you’re not. You’re fully living and vibrant.
Not just that, but I think it’s possible to use sixty years of experience with a chronic illness to empower your medicine. It’s one of the things I bring to my medicine—the human awareness of what illness is.
Would you say more about that?
I say we use everything we are, and everything we have, to enable people to find a way to live. The restoration of physical perfection does not necessarily mean that a person has a good life. The experience of illness itself is a powerful tool to connect to others and to enable them to recognize the possibilities in their own situation, if you will.
My mother did something very funny for me. When I first became ill, I was a student at Cornell University. My disease had a very powerful onset. I became unconscious in my dorm room and was rushed to New York City where I remained in a coma for a year. When I woke up from this, my father said to me, “Well, obviously, you can’t go back to school.”
My mother, who had always been very docile and obedient to her husband, even though she had quite a career of her own, told me that she had a secret bank account. She paid my tuition so I could go back to school. But when I got out of the hospital I was laying on my parent’s couch. I weighed 80 pounds. My normal weight was 130. I looked like an anorexic person, and I was whining. I was a victim, you know?
Two weeks into this my mother says. “Come with me. We’re going somewhere.”
I asked “Where are we going?”
She said, “You’ll find out when we get there.”
At first, I didn’t want to go, but she made me get in the car with her. We drove down to the raceway where they raced cars. My mother had me given lessons in competitive driving
. At the time I couldn’t walk two blocks. But I could drive a car at 110 miles an hour. She wanted me to know that.
That’s something amazing.