After creating an external change with cosmetic surgery, I have often watched my patients change internally in many ways. I have seen them develop new stances, new ways of holding their bodies, new ways of walking and talking, new ways of relating to the world. New relationships, new jobs, new passions -- they were moving into and realizing their dreams.

Of course there are also patients who don't go through the gateway to a new way of being. They come in asking for an external change, but after the surgery changes the way they look, they are disappointed to find that their life doesn't change. They don't change.

I have found that the wish for life change is usually subconscious in our culture. At their first interview with me, most people speak very literally about changing their bodies surgically, detaching the physical change from any effect on their inner selves -- on their emotional, mental, or spiritual bodies. But this detachment is an illusion -- we cannot separate our physical bodies from our thoughts, our emotions, or our spirituality.

The plastic surgery patients who do not walk through the gate continue to be unhappy. What happens when their lives do not change in the manner in which they desired, consciously or subconsciously? They come back for more surgery or seek other doctors or other disciplines of healing. For a while I thought this plight was specific to plastic surgery, but as time went on I found that it is common in all healing traditions. Whether it is internal medicine, psychotherapy, chiropractic, acupuncture, Reiki, shamanism, or any other kind of healing, some patients gracefully flow into change while others defy change with a resistance so strong that nothing can move them.

And yet they had come asking for change. They wanted change. But they didn't want to change themselves. The old adage "You can't have change without change" is true. If you want to find the way to change your life, you have to change your ways.

If we take the position that there is a connection between our spirituality and our physicality, what is the meaning of disease? I have seen numerous cases, in both allopathic and "alternative" medicine, of "cures" being followed by a relapse of the same disease or the development of another disease -- cancers being cured only to be followed by a different cancer; a shapeshift into a younger, thinner, more beautiful body followed by aging or weight gain; chronic pain relief followed by another chronic disease.

These experiences seem to indicate that without addressing the whole person, permanent "cures" cannot succeed. Could it be that there isn't, as we have long assumed, a separation between our physical, emotional, mental, and spiritual bodies? Could it be that we can adjust the alignment between these bodies, remove blockages, and enhance energy flow? Could it be that in order to effect a long-term shapeshift patients need not only to ask for healing and to clarify what healing means for them, but also to truly want it?

If each of us is a miraculous healing machine, might a lack of balance, a disease, really be a gift? A message? It may be an opportunity to redirect our lives and our dreams or an opportunity simply to take a rest. I began to see that we need to listen to these messages. If we simply remove a disease with treatment but don't listen to the inherent message, another message may be presented to us, one that is perhaps more severe and more difficult to ignore. When a deformity cannot be repaired, the disease cannot be cured, or when we die -- can the disease itself hold a purpose? Can even death be a healing?

One of my workshop participants, Fran, distinctly heard her name being called while journeying. "It was too freaky!" she complained. "But Fran," I responded, "I have heard you ask for a sign from God many times, for a message. This may be the message you have been asking for, and it has reached you clearly and audibly. If this is your response, how long do you think you'll have to wait to get another?"

In shamanic communities, most messages are considered to come in forms far more subtle than spoken voices. As we begin to ask and listen, we can "hear" more and more personal, communal, and global messages. Messages come to us through life's synchronicities, through climate change, even through disease. How many people have had a heart attack only to say that it was a "wake-up call" for them, that they were able to see their lives and their choices more clearly after that? When I hear people saying that they are now able to live life more fully, not taking their lives and relationships for granted any more, I wonder if there might have been more subtle messages, more subtle "wake-up calls," in the years preceding the heart attack, that -- if they had been heard -- would have resulted in the person's turning sooner to a truly healthy life, a life lived more fully, a life lived with more conscious dreams and choices.

In shamanic cultures, the question "why" is always asked when someone becomes ill, or when there is an accident, a change in the climate, or social unrest. I recall the story of an American woman walking in a market place in Bali who fell, twisting her ankle. A passerby stopped to help her. "Why did you fall?" he asked. The woman replied, "I don't know, perhaps I missed my footing." The man took her to a nearby healer. As the healer prepared a paste to rub on her swelling ankle, he asked her, "Why did you fall?" "Well, I don't really know," she said. "Perhaps it was these new shoes; I am not used to them." The next day the swelling was a little better, but not completely. When the taxi driver taking her to visit a nearby village noticed her ankle, she told him that she had fallen in the marketplace. "Why did you fall?" he asked. "I don't know. Perhaps the rocks were laid unevenly on the path, perhaps it was the jostling of the crowd ... why is everyone asking me why I fell?" she questioned, a little puzzled and annoyed.

"It is the most important question," replied the taxi driver. "I can take you to a great healer in my village, but he also will ask you why you fell. Until you are able to hear the message, you will be unable to heal completely. Perhaps your ankle will eventually get better, but another message will come in one form or another."

In our culture we seem to have many answers. When asked why we had an accident or a disease, or in the face of global climate change, we give many answers -- faulty tools, faulty user, genetics, biochemical and anatomic mishaps, pollution, the shrinking ozone layer. Yet these are answers to the question how, not why. "Why" questions lead to a message. What is the message? What is spirit telling us through the language of our physical existence? How can we connect more fully to our physical existence and begin to hear God?

The answers are within ourselves. We need only to ask, open up to the answers, and pay attention.