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In Slow Medicine, physician Victoria Sweet delineates two ways of making sense of the human body. Modern medicine views it as a machine. You just need to find the broken part, repair or replace it, and the job is done. But Sweet, inspired by the writings of the 12th-century abbess Hildegard of Bingen, resuscitates an older model: the body as a garden to be cultivated. When a garden falls out of balance, the gardener’s job is to remove whatever is obstructing growth and provide the organism succour—sunlight, water, nutrients, time. Only then can the intrinsic healing power of what Hildegard called viriditas do its work, reaching a self-regulating level of what we call homeostasis today.

Sweet calls this approach slow medicine. It is not a disavowal of fast medicine, which is necessary in an emergency. But it is an antidote for a different kind of poison: the complex case where a clinician’s focus on what needs immediate treatment overshadows the demand for a deeper investigation into the origins of pain. The practice of medicine requires different speeds for different kinds of suffering.

Two Silos, Two Epistemologies

I know this because complexity is what my own illness warranted, and what it never received.

In December 2016, in the wake of my fourth suicide attempt in nine weeks, I lay in a medically induced coma in a hospital ICU. The intensiveness directed a question to my family that no psychiatrist ever asked: Tell me about Patrick. What is he like as a person? She asked because she was weighing whether to withdraw life-sustaining treatment. My mother sobbed. For 10 minutes, my family recounted who I had been before the collapse. The question that should have opened every psychiatric encounter arose only when my life was ending.

Days later, after I was extubated, a medical fellow greeted my mother with news: a blood test had come back positive for syphilis. A lumbar puncture confirmed neurosyphilis—a spirochete infection that had inflamed the regions of the brain that govern mood regulation, impulse control, and perception. Syphilis has long been called the Great Imitator; it can mimic psychiatric illness with uncanny fidelity. The fellow was excited. This could be the answer, he said.

But the psychiatry team did not share his enthusiasm. What followed was not an integration but a partition. While the internists initiated IV penicillin, the psychiatrists continued treating my depression and anxiety as a distinct problem. Two silos with two consult notes. No one considered whether the psychoneurosis might be intersecting with an underlying bipolar vulnerability. No one connected the manic episode that had preceded the suicidal months of depression to the tiny syphilis bugs now confirmed in my cerebrovascular fluid.

The correct diagnosis—bipolar I disorder—would not arrive for four more years. Four years without lithium. Four years in which every surge of confidence was read as willpower and every crash as moral failure. My cousin texted me suggesting bipolar disorder less than a month after the hospitalisation. She intuited what the professionals could not articulate. But familial prophecy without institutional authority lacks a white coat, a prescription pad, and a billing code.

This is the gap that slow medicine seeks to close. My case is an extreme illustration of a more general problem: symptom management can become its own blinding epistemology. Clinicians can grow so adept at treating symptoms that they stop asking about their source. In Let Me Heal, medical historian Kenneth Lumberer observes how it became easier for psychiatrists to give patients drugs than to engage in counselings and psychotherapy—even with patients who stood to benefit most from such non-pharmacological treatment. Participants at a Harvard conference captured the existential cost: doctors’ struggle to spend quality time with patients has distorted the profession’s understanding of what medicine is even about.

The Question Before the Answer

My mother was the only one asking the right question throughout those years: Where is this suffering coming from? She had no answer. But she had the right question. And in slow medicine, the right question marks the beginning of quality care.

While a master’s-prepared nurse and bioethics, she was not trained in mental health. But she had watched me disintegrate over years and possessed a type of knowledge that was longitudinal and intimate. She could see the pattern of decomposition because she was not seeing me in quarter-hour increments. A gardener does not tend to a plant once, assess its appearance, and never return. Gardening draws on memory, observation, and context—what a 15-minute appointment all too often ignores.

When I was finally diagnosed with bipolar I, the diagnosis was made by a system that was under-resourced and overstretched by a pandemic. My mother had spent years accumulating a meticulous archive of my disturbing behaviour—incidents, emails, intelligence from friends and family who monitored my social media; however, none of it was visible to the treating psychiatrist, who was working from what I alone disclosed during a manic episode. And because my illness involved diagnosis—damage to the brain that prevented me from recognising I was sick—what I chose to disclose was unreliable from the outset. My mother’s knowledge was key collateral history that should have been part of the treatment plan. But the system had no room for it.

To be clear, many of the clinicians who provided me with care were competent and conscientious. But they were part of a deficient culture and practice of fast medicine that could not hold the full ecology of my suffering—the observations my mother could have given the doctors that no one had made the time to hear.

What would slow medicine look like in psychiatry? It would look like time. Time to take a full history—a life story, not just a symptom inventory, one that involved the family. It would look like time to think creatively about how a confirmed brain infection historically known to copy the appearance of psychiatric illness might connect to the psychiatric illness actually presenting in front of them. And it would look like diagnostic humility: a willingness to think outside the pharmacology toolbox when treatment repeatedly fails, when symptoms evolve, and when the story does not cohere. The question was never whether the first diagnosis was foolish, but whether anyone would look for the origin of my suffering. Time to wonder.

Slow medicine cannot promise an answer. It can only promise the conditions under which the right question might finally be asked—the way a gardener kneels beside what is failing and, before reaching for any tool, tries to understand what is happening underneath the soil.