The Doctor as a Mechanic & Gardener.

A concept I learned when I briefly studied Chinese Medicine was the distinction between “The doctor as a mechanic and the doctor as a gardener.” (‘Between Heaven and Earth’; Beinfield & Korngold, 1992).

The conventional Western doctor is a mechanic. They have technical skills and can remove an organ or a joint and even install an artificial replacement. They can “check your fluids”, topping up serotonin or norepinephrine with psychiatric medications. Sometimes a mechanic is absolutely what is necessary to treat an illness that Chinese medicine or other holistic approaches could not address.

Often things get so bad that the mechanic is the only solution and it is important we have “doctor mechanics” in our world.

But what is the doctor as a gardener? The gardener plants seeds that will grow plants that nourish the body. Determining what type of food you should feed yourself for optimal health. Maybe there is an herb or supplement, some fertilizer to nourish the garden. Maybe you need to get out in the garden and put in some back breaking labor (exercise). 

Holistic or integrative medicine practices, yoga, or chiropractic alignment. It’s difficult to say how they “cure” an illness, but they help to get everything in alignment. Allowing the body to heal itself. It may seem like a poor substitute for a doctor as mechanic, but the gardener sits with the garden and tries to figure out how it is all connected. What climate is this garden growing in? What pests or insults are visiting this garden? Can we prevent things from getting worse and reverse the damage? Rather than entirely removing and replacing a tree, nurture the tree to grow and bear fruit.

It’s a metaphor I’ve started to apply to myself. Being a “therapist as a gardener” seems ideal, sit and listen, understand what is going on for this individual in front of me. Recognize all the interrelated causes and effects, how we affect our environment around us and how it impacts us. Watching and nourishing small changes. 

It’s more difficult work because it requires more time and patience. Being present with the client and really seeing and feeling what is happening.

Sometimes the balance of work and life is demanding, to the point that it is difficult to be fully present. To sit in the garden with someone who is very ill, and the garden itself is in disrepair and falling apart. And then to repeat that with 40 people, an hour at a time, every week.

I started to refer to myself as a therapist as mechanic. I’m not going to sit in the garden with you. I’m the mechanic that helps to sharpen your tools (skills). You bring in your shovel or axe and I can sharpen it for you. Maybe teach you how to use it. I’m not going to buy you a shovel. I can tell you where to go to buy one and come back to me when you’re ready. 

I sell a variety of tools and I can tell you what they are all for and how they work together to develop a garden. But you take them back to your garden and put in the work. Check in with me next week if you’re having trouble with the tool (skill). 

It’s been a helpful boundary to set as I figure out what it really means to be a gardener. What is a beautiful garden even supposed to look like? It’s one thing to see a beautiful garden, but harder to imagine how it got to be that way if it started from a state of disrepair. 

Today I was just listening to the new Walled Garden podcast intro and episodes:

“Nourishing the garden of our minds, one conversation at a time.”

When we come to a meeting of The Walled Garden we all bring our internal mental gardens. Like a gardening club, we all get to see a bit of what’s going on in the other gardens. Maybe we start to develop an idea of what the archetypal beautiful garden is. We don’t entirely know what we’re building, or what our garden is supposed to look like, but we get glimpses. Bits and pieces. 

To use the ancient Greek term used by the Stoics, the Hegemonikon, the “governing faculty” as it has been translated; this would be the gardener. Our internal gardener who may or may not be paying attention to the state of the mental garden. Are we allowing weeds to grow? Are we planting or feeding the right ideas that will bear fruit of a fulfilling life? Is the garden so ugly we don’t want to look at it, let alone not knowing where to start?

But we have to start somewhere. Maybe push three quarters of the garden out of mind and focus on one quadrant at a time. Build that section up into something beautiful, but accept that the neighboring plots are going to start overgrowing and spreading false seeds.

Maybe start wandering into the unexplored areas and clear out the weeds. A patch of mostly bare earth is preferable to sit with rather than weeds with thorns.

To be a therapist as a gardener, you certainly have to be tending the garden of your own mind. It is one thing for people to see beautiful gardens, but they also need to watch the process of maintaining a garden. And where do you go to witness a gardener taking a fixer-uper and building back up a garden from scratch? 

I think I really enjoy this metaphor. Be cautious of gardens that look beautiful, but you only see a snapshot. You don’t see what happens when the garden is left untended for a week. Or how much effort is needed to constantly keep self-destruction at bay.

Maybe the place for me to start is moving from a “tool sharpening mechanic”, to a gardening instructor. Come observe what I try in my garden. Maybe I’ll come visit you in your garden. It might take a bit of work to get a garden into a state where it’s acceptable to invite guests in.

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David Alexander

Psychotherapist | Writer

David Alexander is a practising psychotherapist based in New Mexico, USA. He started studying Greek Stoicism in 2020 as part of a journey of self-discovery and searching for answers about how to practically help myself and others endure the challenging times we are living in. He found Stoic Philosophy to be a useful jumping-off point to explore important questions: What is Human Nature? What is your Nature? It is towards this goal, to “know thyself,” that David started studying Carl Jung’s theories regarding the structure of the psyche (soul) and the workings of the unconscious mind. His goal in studying integrative disciplines of psychology, philosophy, and mythology is to better understand the self, thereby learning to better understand others.

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