The royal road to healing: a bit of a sagaBMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7826 (Published 19 December 2011) Cite this as: BMJ 2011;343:d7826
- Linn Getz, associate professor 12,
- Anna Luise Kirkengen, professor134,
- Halfdan Petursson, research fellow1,
- Johann A Sigurdsson, professor56
- 1General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- 2Landspitali University Hospital, Reykjavik, Iceland
- 3Institute of Community Medicine, University of Tromsø, Tromsø, Norway
- 4Centre for Health Promotion, Akershus University Hospital, Lørenskog, Norway
- 5Department of Family Medicine, University of Iceland, Reykjavik
- 6Centre of Development, Primary Health Care of the Capital Area, Reykjavik
- Correspondence to: Linn Getz
In the face of another person’s suffering, a listener can offer to be a competent, dedicated, and attentive co-thinker—not pretending to know the solution, but trusting the healing power inherent in an empathetic relationship.
In an atmosphere saturated with diagnostic labels, antidepressants, and standardised cognitive therapy schemes, we want to highlight the therapeutic potential of dialogue. We present an anecdote written around the year 1220 in the Icelandic saga Morkinskinna.1 2 3 4 There, we meet the Norwegian king Eysteinn, who ruled in Norway 1103–1123, and an Icelandic skald (highly respected court poet), Ivar Ingimundarson. Ivar has become deeply melancholic and the king seeks to find out what troubles him and how to help. Finally, Ivar’s grief is resolved by daily conversations between the two men.
Morkinskinna—a king’s saga with an unruly touch
Morkinskinna, which means “mouldy parchment,” was originally the name of a book sent from Iceland to Copenhagen’s Royal Library in 1662, where it is still preserved (numbered as 1009 fol⇓). The saga was written in Iceland around the year 1220. It describes the history of the Norwegian kings from 1030 until 1157, when the text ends abruptly, as the last part of the manuscript has been lost. The author is unknown, but Morkinskinna was evidently a central source for the later and far more renowned saga Heimskringla.4 A distinctive feature of Morkinskinna is its numerous inserted anecdotes. Many of these describe the relationship between a Norwegian king and an Icelandic guest or man of court. The literary format of Morkinskinna has long been considered unwieldy and of lesser quality than other more stringent sagas, but literary scholars have recently been captivated by its charm and distinctive human touch.4
To recognise patients as people
We often hear that medicine should be practised according to a “bio-psycho-social model,”5 6 where patients are treated as “whole persons.” However, personhood and subjective experience cannot easily be integrated with biomedical knowledge.7 To engage with the unique suffering person can be demanding, but it is possible —and a privilege,8 9 10 11 as this story shows. Here follows the complete anecdote about King Eysteinn and Ivar.
A timeless account of relational healing
In this part it is noted, as I am about to tell, what a glorious man King Eysteinn was, and how true a friend and how mindful he was in attending to the grief of his beloved followers. There was one man with King Eysteinn called Ívar, the son of Ingimundr, an Icelander by birth and of noble stock, a wise man and a good poet. The king held him in high regard and was affectionate toward him, which is shown in what follows. Ívar’s brother was named Þorfinnr. He also came abroad to meet King Eysteinn and was treated well by many men based on his brother’s reputation. But it weighed heavily on his mind that he enjoyed favour for his brother’s sake and not his own, and he soon grew tired of serving under the king and prepared to return to Iceland. Before the brothers parted, Ívar asked Þorfinnr to carry a message to Oddný Jóansdóttir that she wait for his return and not marry; he estimated her the highest among all women. Then Þorfinnr left and had good voyage, and decided to ask for Oddný’s hand for himself, and they married. Some time later Ívar arrived in Iceland and learned of this and he thought that Þorfinnr had acted badly towards him.
Bound by blood ties and codes of conduct, Ivar cannot publicly accuse his brother or seek revenge.
He [Ívar] was not at all settled and went back to the king thereafter, and was given good favour as before. Ívar now becomes very low spirited. The king noticed it and gathered Ívar to speak with him and asked him why he was so listless—“and when you were with us before we had much amusement from your words. And I did not broach this before because I did not know of anything I had done against you. You are such a wise man that you would not come forth with groundless suspicions, so tell me what it is.”
Ívar answered: “That which is, my lord, I cannot say.”
Although Ivar refuses to tell the reasons for his sadness, the king does not feel rejected.
The king said: “Then I will guess. Are there some men whom you do not like?” “It is not that, my lord,” answered Ívar. The king said: “Do you think that I have given you less honour than you desire?” “That is not the case, my lord,” he answered. “Have you seen some things,” said the king, “in the country that disturb you?” He said “it is not that.” “It is becoming difficult to guess,” said the king, “do you want authority over some property?” He denied it. “Are there any women in your country,” the king said, “that you could be missing?” He answered: “So it is, my lord.”
At first, the king believes he can solve the problem by the use of power.
The king said: “You should not feel miserable about this. When spring comes you will return to Iceland. I will give you money and a letter with my seal for those men who decide these matters, and I do not know of any man that will not yield to either my kind messages or to my threatening words to give this woman in marriage. Ívar answered: “It cannot be so.” The king spoke: “This is impossible,” said the king; “As I further declare: though another man has the woman I can still get her for you, if I want.” Ívar answered: “The case is worse than that, my lord. My brother is now married to the woman.”
The king still cannot see the whole picture because he knows nothing about Ivar’s request to his brother.
Then the king spoke: “Let us abandon this route,” he said; “but I have a suggestion. After the Yule-celebration I will attend feasts, and you will come with me, and there you will see many courteous women; and if they are not of royal blood then I will get one for you.” Ívar answered: “My lord, my case is even more difficult; whenever I see beautiful women then I am reminded of this woman, and my anguish grows even more.”
The king said: “Then I will give you some authority and some property, as I offered you before, for your entertainment.” He answered: “With this I do not feel content.” The king said: “Then I should obtain for you some movable property, and you will go trading to whichever lands you want.” He said he did not want that.
The king has now offered every possible remedy in his armamentarium of royal wealth and influence—but Ivar has still not been able to speak about the rage, shame, and powerlessness that render his distress so malignant.
Then the king said: “It becomes difficult for me now that I have tried my best; and now one last thing remains, insignificant compared to what I have already offered, although I do not know what the best remedy is. You will now each day, while the tables are set and I am not occupied with pressing issues, come and meet with me, and I will chat with you. We shall talk about this woman every way, as you like and may come to mind, and I will give my time to this, because it happens sometimes for a man that his torments are lifted after talking about them. And I will add to it that you will never go away empty handed from our meetings.” Ívar answered: “This suits me, my lord, and thank you for your quest.”
Having accepted that Ivar must find his own way, the king turns to a timeless concept of a therapeutic process. Presenting the patient with a gift after each session, however, is no longer in fashion. Perhaps it symbolises the king’s awareness of being enriched by Ivar’s confidence.
And now they arranged it so that regularly when the king is not dwelling on pressing issues he talks often with Ívar about this woman. This arrangement worked and Ívar’s suffering was now relieved sooner than one could hope for. He became happier after this, returning to his normal self as before, entertaining and merry. And he remains with King Eysteinn.
Talk is medical work
The healing conversations between Ivar and King Eysteinn took place almost 800 years before Sigmund Freud in 1895, together with Joseph Breuer, formally presented the “talking cure.” King Eysteinn’s inquisitive style may not follow current advice regarding open, clinical communication. But it does build an elegant literary plot, which culminates beautifully, as the king abandons the idea that he can find the solution to Ivar’s suffering and reveals his insight into the healing powers of a respectful human relationship.
Had Ivar been an ordinary man who came to see a doctor or psychologist nowadays, would he have been met with the same insistent attempt to understand his suffering?12 The irresolvable conflict troubling Ivar’s mind might have gone unnoticed. But it is this conflict, and not simply a “depression,” that affects Ivar on all existential levels.13 14
Frontline researchers conceptualise depression as a “whole body disease.”15 Physiologically speaking, Ivar experiences allostatic overload. His body’s adaptive, life preserving systems are likely to be damaged if the stress is not resolved.16 The best way to help Ivar is to help him verbalise how deeply humiliated, deceived, and powerless he feels. By integrating the essence of the conflict into his biography, Ivar can reconcile and reorient himself,17 thereby restoring his self respect and self esteem. The best facilitator in this healing process is a person whose reason, integrity, and authority Ivar truly respects.
The experience of care or neglect, trust or treachery, belonging or loneliness, power or powerlessness, fairness or unfairness, can maintain health or engender disease.14 This rapidly emerging evidence sheds new light on Morkinskinna’s old tale of talk as a royal road to healing.
Cite this as: BMJ 2011;343:d7826
The anecdote has been translated from Icelandic to English for this paper by Christopher Crocker in collaboration with the authors. We thank senior lecturer and reader in Old Icelandic literature at the University of Iceland Ármann Jakobsson for assistance.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Not commissioned; externally peer reviewed.