Rachel Naomi Remen, MD is one of the earliest pioneers of integrative medicine. She is Clinical Professor of Family and Community Medicine at the UCSF School of Medicine. She is Director of the innovative UCSF course,The Healer’s Art, presently taught in 21 medical schools nationwide. She is Co-Founder and Medical Director of the Commonweal Cancer Help Program featured in the groundbreaking 1993 Bill Moyers PBS series, Healing and the Mind. She is Founder and Director of the Institute for the Study of Health and Illness at Commonweal, a post-graduate and undergraduate program for physicians who wish to reclaim their calling and integrate holistic approaches into their work. Dr. Remen has a 50-year personal history of Crohn’s disease and her work is a unique blend of the viewpoint of physician and patient. Dr. Remen wrote one of the first books on complementary and integrative medicine, The Human Patient (Doubleday, 1981). She is the author of The New York Times bestseller, Kitchen Table Wisdom: Stories That Heal( Riverhead Books, 1996), and the national bestseller, My Grandfather’s Blessings: Stories of Strength, Refuge and Belonging (Riverhead Books, 2000). She is the author of over 50 papers and articles on integrative medicine, and her books are used as teaching texts in medical and nursing schools nationwide. Dr. Remen has been the invited speaker at several medical school graduations and holds three honorary degrees.
I have been with many people in times of critical illness, when a door opens and the familiar falls away, to be replaced by something the person has never seen before but can recognize as their own. These are moments of profound and enduring change. For me as witness, they seem to be moments when the personality recognizes what the soul has always known.
At such times something familiar is lost, but something of great value is found. Our true life is offered to us-a life more transparent to our deeper values. I have seen people let go of many previously treasured, hard-earned things and begin to follow an inner compass rather than an old blueprint, no matter how respected that blueprint is by others. Often they take risks that were unthinkable before their illness. They seem, despite their loss and suffering, to have a greater trust in life than before-a greater sense of who they are and what matters.
Seen from this perspective, illness is part of a larger human tradition of initiation, an opportunity in life which is present for us all. As I understand it, initiation is a time when a shift in consciousness occurs and a new path opens for us. And while nothing has changed, everything is different. We see the same world differently. It is a profound personal transformation of experience.
Until recently I had viewed initiation in a more limited way, as a change in lifestyle, usually marked by ritual-joining a sorority, graduating, getting married, having a bar mitzvah-ceremonies that led to greater freedom and responsibility. But thinking back on similar events in my own life, I realized that at the end of such ceremonies I really never felt any different. I seemed, in some basic way, to be the same person that I was before.
To further explore this puzzle, I began to ask people who were not sick about experiences that had changed them irrevocably. People told me stories. This one was told by a physician.
The event took place when he was twenty years old and his brother, who was eighteen, was dying of leukemia. He was in engineering school and did not want to come home, but his parents insisted. About twenty-four hours before his brother died he was sitting in his brother’s room reading to him. His brother lay frail and very, very tired, in his bed. As he was reading he suddenly felt his brother’s hand on his arm. His brother was staring at a blank wall, his face all lit up. He said, “George, look, someone’s there! See? Someone has come for me.”
George put the book down and looked very carefully at the blank wall, but he couldn’t see a thing. However, he could feel it. He said there was a presence in the room, a “radiance” that he described as “profound and ultimately benign.” In that moment he knew he was supposed to become a doctor. And, in fact, after his brother died, he did go back to school and change his major from engineering to medicine.
“Whatever it was that came for my brother, it came for me too,” he told me. He added it wasn’t that he knew he was supposed to become a doctor; what he knew was that he was a doctor. His very nature was a doctor’s nature. It was the reason he had been born. He looked at me and smiled. “In that moment I felt sort of healed,” he said.
When a path of initiation opens, it’s not a path we travel. It’s a path we are. The traveling is not outward, it’s inward, toward our essence, toward our true nature. And because we are able to inhabit that nature more fully our outer life can become more transparent to it, more coherent with it, more true to it. The inner and the outer life become more of one piece, and the result is a sort of healing.
My first thought after hearing this story was “Why has this sort of thing never happened to me?” In thinking about it over the weeks that followed, I realized that I had gone through a major initiation. I had experienced a profound shift in my own way of seeing the world. I had gone from a person who was always fixing a broken world to a person who felt privileged to serve a holy world.
But this hadn’t happened as a single event. It had happened slowly over time through a series of events, and I could see what had happened only by looking back. And so I’ve come to think that experiences of initiation are very common, very ordinary, very subtle. They happen to all of us as a natural part of living.
We might view life as a movement toward the soul, a return to what is most genuine and unique in each of us. And in the trajectory of a lifetime this turning toward personal integrity happens not once but many times. Some of these turnings are small, some are large. All are important.
So an initiation need not be a moment of radical transformation, but rather a movement of return, a turning toward the soul. With each initiation we come closer, we turn more easily, until that final initiation, death, when we turn away from the personality and become the soul. Before then we have many rehearsals, many times when we have the opportunity to turn away from the false self which possesses us the person who we have been taught we are, and who others want us to be, even the person who we ourselves want to be-toward the true person who we are, and more closely follow the path of the soul.
Looking back, I can tell you the very moment my initiation began. At the time I knew with absolute certainty what my path in life was. I had been preparing for it for years, and had made many sacrifices in order to walk it. I was a young academic doctor managing the pediatric clinics at Stanford Medical Center and my life goal was to be the first woman to head a department of pediatrics on the west coast. One morning the man who ran the medical clinics at Stanford came to my office, put three colored xerox papers on my desk and said that a place called Esalen Institute was looking for twelve doctors as part of a research program. The doctors would get a free weekend a month at a beautiful retreat center for two years. They would meet people who had some different ideas about human nature, people who were part of the human potential movement. All they needed to do was to see whether or not they thought their ideas had anything to do with people’s ability to recover from illness, and with the practice of medicine. “I’m going to do it,” he told me. “Do you want to come?”
The year was 1972, almost a decade before the emergence of the field of Holistic Health. In that moment my direction in life, my whole future, was being offered to me, and I must say that I did have a moment of recognition. At a deep instinctive level I knew that this was mine. But what went through my conscious mind was a single thought: “What a great way to meet men.” So I applied.
Life is a movement toward the soul but we ourselves are attached to other things. So the soul has to take us and move us along by whatever handle happens to be sticking out. I had just ended a five-year relationship with a fellow, so I was very available to go and meet men. I believe that if I had seen the opportunity for what it really was, known what I was going to have to surrender, to give up in order to have it, I wouldn’t have gone. My family were Russian immigrants, and we believed that if you let go of anything it left a permanent hole in your life. So anything I had ever let go of at that time had claw marks on it.
This was the first step of my initiation. The second step happened very shortly thereafter, at one of my first weekends at Esalen. At the time I was learning how to make silver jewelry. I had designed and cast my first ring, and wore it that weekend. There were many craftsmen there at Esalen, people of the sort I had never met before, and they accepted me because of this ring. It was a very heady, exciting experience for a young academic physician. Several of them suggested I drive back up the coast to show the ring to the man who ran a gallery next to Route 1. So I did. The man loved the design and wanted to copy the ring and sell it. I was thrilled, so I left my ring with him.
That night a major storm hit the coast, and in the morning I was shocked to discover that we were isolated; a section of Route 1 north of Esalen had fallen into the ocean. The gallery and my ring were gone. I was numb. I could hear the usual inner voices sitting in judgment, my father’s voice the loudest, saying “This is what you get for trusting strangers.” And my mother saying “You always lose things-you can never be trusted.”
In anguish I went to the edge of the cliffs and stood looking at the Pacific, still wild from last night’s storm. Down there somewhere was my ring. Everything in me wanted to go down there and get it back. But this was impossible. As I stood there I slowly began to see in a new way-perhaps what had happened was not my fault. Pieces of the land had been falling into the ocean since the beginning. Perhaps these familiar blaming voices were wrong and there was nothing personal at all in this happening. It was simply part of a larger process, one that was natural. I glanced down at the empty space on my fourth finger where my ring had been just yesterday. What would happen now? What rings would the future hold? For the first time I was able to meet with loss in a new way, with a sense of curiosity, an openness, even a sense of adventure.
Coming into a new relationship with the unknown is a very important step in initiation. The unknown is seen differently, as mystery, something to move toward, not something to avoid, something which increases one’s sense of wonder, one’s sense of aliveness. In every initiation we move closer to mystery. We befriend it. It is what we will be serving for the rest of our lives.
About nine months later the third step of my initiation came about. It began with a series of panic attacks. These were terrible experiences. I would awaken in the night unable to breathe, feeling as if I were dying. I had no idea why this was happening and then I began to notice the pattern-they occurred the week before I was supposed to go to Esalen. I went to Dr Sukie Miller, who was directing the research program, and tried to quit. But Sukie, a master therapist, knew a moment of true freedom when she saw it and asked me if I wasn’t curious why these things were happening. She offered to accompany me as I tried to discover why. We did a very brief imagery exercise. She suggested, “Close your eyes and allow an image to come that is related to your panic.” At that time I was highly skeptical of such methods, but I was also very frightened of the panic. So I did what she suggested.
An image came immediately. It was a thin, flat, white rectangle. Sukie asked me if I knew what it was, and with all the authority with which I made a diagnosis in those days I said, “Of course I know what it is-it’s a business card.” “Are you sure?” she asked. As I looked at it again, I realized I had no idea what it was, and I could feel the start of the dreaded feelings of panic. Quickly I opened my eyes and found Sukie smiling comfortably at me. “Certainly you can leave the program but perhaps it is best to wait until you understand what these things mean,” she said. She told me she was absolutely certain that the meaning of this image would come to me in time, and it would be important. So I went home and waited. Not gracefully. I was very frustrated.
Nothing happened for several weeks. I remember exactly where I was when the mystery unraveled. I was driving up a very steep hill in San Francisco with all my attention focused on not shifting backwards into the car behind me. In the middle of one of the hill’s steepest streets the flat white rectangle came suddenly to mind. But it had begun to change shape. It had become a little shorter and puffed up in the middle. As I watched, it continued to change, and suddenly I was in the midst of a full-blown panic attack. It was so severe that I had to pull the car to the curb and park. I remember thinking, “I believe I am going to die here.”
And then I knew what this was all about. The flat white shape was not a business card at all, it was a marshmallow. This marshmallow had been under a steady external pressure from the moment it was born. The pressure which had flattened it, distorted it out of its natural shape, was now lessening and its shape was changing. The marshmallow was terrified. It felt as if it were dying. But this was not so. It was returning to itself. The shape most familiar to it was not its true shape. Something in it that remembered its own shape was reclaiming it now.
I started to cry then because I realized this was a story about me. I had been born into a medical family, where science and facts and logical thinking were very highly valued, and anything that couldn’t be measured was scorned. My medical colleagues felt the same way, so I had been under a lifelong pressure to conform to this way of being in order to belong. I had learned to be quite rational and analytical. I was even good at it. But by nature I was an intuitive, even a mystic. For the first seven years of my life my closest companion was my grandfather, a scholar of the Kabbalah, a rabbi. He had known me for who I was, and I had known myself then. He had stood between me and the rest of my family. But when I was seven years old he died. There are nine doctors in two generations of my family, and I had forgotten my grandfather and his way of being.
At Esalen, for the first time I had met people like my grandfather, people like Moshe Feldenkreis, Fritz Perls, Michael Murphy, George Leonard, and Elmer Green-people who were willing to wonder, to ask questions larger than the available research tools. People who didn’t know everything. They had reminded me that I was my grandfather’s granddaughter. I wasn’t dying. I was going back to a way of being I had never been able to live before, a way that would fit me perfectly when I got there. I was going home.
The last step of this initiation process happened about a year later. By then the way I saw the world had radically changed but my outer life hadn’t changed at all, except for one small thing. One of Kahlil Gibran’s paintings is a hand with a single compassionate eye in its palm. For some reason I had been drawn to this picture. It had struck me as enormously beautiful even before someone at Esalen had told me it was the “hand of the healer.” I had cut the picture out of Gibran’s book but was too embarrassed to put it in my office at the medical center. So I put it over my desk at home. This was the only external change I had made in the two years. I was still on the faculty at Stanford Medical School, and at about that time I received a faculty promotion. Everyone congratulated me, but somehow I wasn’t happy. It was strange, because all my life this had been my goal, yet now I felt trapped and suffocated.
Shortly afterward I flew to Miami to visit my mother, as I did every year on my birthday. We were sitting in the garden of her hotel, watching a woman playing with her small granddaughter. The woman drew little faces on the child’s fingertips with a felt-tipped pen, and then they held a little puppet show in which these “fingertip people” talked to each other. As we watched, charmed, my mother said, “Some things never change.” Puzzled, I asked her what she meant. She smiled. “You used to draw on your hands when you were a little girl. Don’t you remember?” I said, “No, I have no memory of that at all. Did I draw little faces on my fingertips?” “No, no,” she said. “You would take Daddy’s fountain pen, and draw eyes in the palms of your hands. Then you would hold your palms up on either side of your face, close your eyes and say, ‘Now I can see you!’ Do you remember?”
In that moment I stepped through a doorway into another reality in which all the odd parts and pieces of myself turned toward each other slightly, and for the first time they fit together seamlessly. I who had always felt an outsider, always felt like the wrong person, always covered up how different I was. I did remember, and I knew I belonged.
It had been two years since my colleague put those colored xeroxes announcing the Esalen program on my desk, and only now was I able to take my first step on the path that opened back then. I flew home, went to Stanford, and resigned. We have many rehearsals, many opportunities to get life right.
Much in life distracts us from our true nature, captures the self in bonds of greed, desire, numbness, unconsciousness and drama. These bonds seem strong and unavoidable. Yet every initiation, no matter to whom it occurs, is a witness to the possibility of freedom for us all-the evidence that the soul is stronger than all that, can draw us toward itself, despite all. Every initiation is a message of grace.
Recently I was present at the final step in someone’s initiation. Six weeks before a patient of mine died, I was sitting with him and his wife late one afternoon in his home. He was very sick with widespread cancer, struggling to live. We were awaiting the results of tests that were going to tell us if any further treatment was available for him. In this setting I asked him if he could remember a place of safety, and if he could go there in imagery and tell us about it.
He began talking about rural New Jersey where he had been a small child, and he recalled his earliest memory. At the time he was four or five years old and living in a house which was reached by a long road that ran along a small river. In spring, often the river would flood, and once after a flood he was walking along the road and found a rainbow trout washed up from the river, struggling to live in a drainage ditch beside the road. It seemed to him to be very wrong, this beautiful fish trapped in this small, shallow and muddy place. He was just a little boy and it was a big fish, but somehow he managed to get it up into his arms. He carried it across the road and waded out into the river a little way and put it back. I asked him what he remembered most clearly about this. He said he remembered the moment when the fish realized it was once again part of the river.
There are many stories in every story. On one level this is a beautiful childhood memory shared by a very sick man. On another level it’s a story about a man whose compassion goes back to his very beginnings. But perhaps there are even other readings. Certain practices run through all the branches of Buddhism. One of these is a practice done on those holidays that celebrate enlightenment and the promise of freedom. At such times, in China, Japan, Nepal, Korea, live fish are bought at the market and taken to running bodies of water and set free. These fish are symbols of the promise of return to the great freedom which is our true home.
Over many years of listening to people with cancer, their dreams, their poems, their stories, I’ve come across many images for the soul. I think the rainbow trout is one of the most beautiful. This man was not a Buddhist. He didn’t know any of this consciously. He was a vintner, a fly fisherman, a sailor, but there was something in him that was older than all these things. If you were quiet and listened, sometimes it would speak to you.
And so, as we were waiting together to find out if further treatment was available it spoke to us and told us this story, perhaps so that his wife and I would know where he truly was in his life, but more importantly, so we would know that despite appearances, all was well.
Initiation is a part of the vision quest, the search for new eyes. There is a saying that is very close to my heart: “The voyage of discovery lies not in seeking new vistas but in having new eyes.” I selected the title of this talk, “The Gift of New Eyes,” long before I knew that I was going to have eye surgery last month. In fact, I had a second, emergency surgery after the first one failed. For the last six or seven years I have lost much of my vision to glaucoma, and my one good eye had become covered over with a cataract.
But today I was able to walk through an airport unaccompanied for the first time in years. I was able to read signs, to see people’s eyes, to marvel at the play of light on the carpet. It gave me such a sense of gratitude. If initiation is the experience of having new eyes, perhaps we should think of it in just that way-not as something we’re trying to achieve through our personal ambition, but as a possibility ever-present in life. An occasion of gratitude, a witness to the fact that despite everything that is limited, small, unconscious and trapped in this world “all is well.”
The article “Initiation: The Gift of New Eyes” by Rachel Naomi Remen first appeared in IONS Review, No. 44, Winter, 1997 (pp. 10-17), and is reprinted by permission of the author and the Institute of Noetic Sciences (website: www.noetic.org). Copyright © 1997 by IONS, all rights reserved. This material was also presented by Dr. Remen at the Healing Journeys annual FREE “Cancer as a Turning Point, From Surviving to Thriving” at Stanford University, Palo Alto, California in September, 1996.