Anatomy of an Illness as Perceived by the Patient (7 page)

The Bible tells us that a merry heart works like a doctor. Exactly what happens inside the human mind and body as the result of humor is difficult to say. But the evidence that it works has stimulated the speculations not just of physicians but of philosophers and scholars over the centuries. Sir Francis Bacon called attention to the physiological characteristics of mirth. Robert Burton, in his
Anatomy of Melancholy
, almost four hundred years ago, cited authorities for his observation that “humor purges the blood, making the body young, lively, and fit for any manner of employment.” In general, Burton said, mirth is the “principal engine for battering the walls of melancholy … and a sufficient cure in itself.” Hobbes described laughter as a “passion of sudden glory.”

Immanuel Kant, in his
Critique of Pure Reason
, wrote that laughter produces a “feeling of health through the furtherance of the vital bodily processes, the affection that moves the intestines and the diaphragms; in a word, the feeling of health that makes up the gratification felt by us; so that we can thus reach the body through the soul and use the latter as the physician of the former.” If Kant was intimating in these remarks that he never knew a man who possessed the gift of hearty laughter to be burdened by constipation, I can readily agree with him. It has always seemed to me that hearty laughter is a good way to jog internally without having to go outdoors.

Sigmund Freud's fascination with the human mind was not confined to its malfunctioning or its torments. His researches were directed to the supremely mysterious station occupied by the brain in the universe. Wit and humor to him were highly differentiated manifestations of the uniqueness of the mind. He believed that mirth was a highly useful way of counteracting nervous tension, and that humor could be used as effective therapy.

Sir William Osler regarded laughter as the “music of life.” His biographer, Harvey Cushing, quoted Osler as having advised doctors who are spiritually and physically depleted at the end of a long day to find their own medicine in mirth. “There is the happy possibility,” Osler wrote, “that like Lionel in, I think, one of Shelley's poems, he may keep himself young with laughter.”

Current scientific research in the physiological benefits of laughter may not be abundant but is significant nonetheless. William Fry, of Stanford University, has written a highly illuminating paper, “The Respiratory Components of Mirthful Laughter.” I assume he is referring to what is commonly known as belly laughter. Like Immanuel Kant, Fry finds that the entire process of respiration is benevolently engaged by laughter. Another paper worth consulting on the subject is “Effect of Laughter on Muscle Tone,” written by H. Paskind in the
Archives of Neurology and Psychiatry
in 1932.

Some people, in the grip of uncontrollable laughter, say their ribs are hurting. The expression is probably accurate, but it is a delightful “hurt” that leaves the individual relaxed almost to the point of an open sprawl. It is the kind of “pain,” too, that most people would do well to experience every day of their lives. It is as specific and tangible as any other form of physical exercise. Though its biochemical manifestations have yet to be as explicitly charted and understood as the effects of fear or frustration or rage, they are real enough.

Increasingly, in the medical press, articles are being published about the high cost of the negative emotions. Cancer, in particular, has been connected to intensive states of grief or anger or fear. It makes little sense to suppose that emotions exact only penalties and confer no benefits. At any rate, long before my own serious illness, I became convinced that creativity, the will to live, hope, faith, and love have biochemical significance and contribute strongly to healing and to well-being. The positive emotions are life-giving experiences.

Scientific research has established the existence of endorphins in the human brain—a substance very much like morphine in its molecular structure and effects. It is the body's own anesthesia and a relaxant and helps human beings to sustain pain. Exactly how the endorphins are activated and released into the bloodstream is not yet fully known. Nor is it known whether they might be activated by the positive emotions. But enough research has been done to indicate that those individuals with determination to overcome an illness tend to have a greater tolerance to severe pain than those who are morbidly apprehensive. Chinese medical scientists contend that the highly successful use of acupuncture instead of anesthetic is made possible because the insertion of needles in the “meridians” of the body activates the endorphins.

In any case, the human mind has a role to play in the control of pain, just as it has a key role in combating illness. We need look no further than the phenomenon of the placebo to recognize that, both on the conscious and subconscious level, the mind can order the body to react or respond in certain ways. Such response involves body chemistry and not just psychological reactions.

In the first chapter, I wrote about the ability of laughter to reduce the inflammation in my joints, confirmed by a reduction in the sedimentation rate—both sustained and cumulative. Did this mean that laughter stimulated the endorphins? An interesting experiment in this direction was undertaken by a Japanese doctor in Tokyo, who incorporated laughter into the treatment of tuberculous patients. The account of the experiment said that he was able to demonstrate to his own satisfaction that laughter was therapeutic and figured in the improvement of his patients.

Other and more comprehensive research studies and experiments will be designed. As a result we will learn a great deal more than we know about the role of the positive emotions and of creativity and of the will to live. Before long, medical researchers may discover that the human brain has a natural drive to sustain the life process and to potentiate the entire body in the fight against pain and disease. When that knowledge is developed, the art and practice of medicine will ascend to a new and higher plateau.

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Americans are probably the most pain-conscious people on the face of the earth. For years we have had it drummed into us—in print, on radio, over television, in everyday conversation—that any hint of pain is to be banished as though it were the ultimate evil. As a result, we are becoming a nation of pill-grabbers and hypochondriacs, escalating the slightest ache into a searing ordeal.

We know very little about pain and what we don't know makes it hurt all the more. Indeed, no form of illiteracy in the United States is so widespread or costly as ignorance about pain—what it is, what causes it, how to deal with it without panic. Almost everyone can rattle off the names of at least a dozen drugs that can deaden pain from every conceivable cause—all the way from headaches to hemorrhoids. There is far less knowledge about the fact that about 90 percent of pain is self-limiting, that it is not always an indication of poor health, and that, most frequently, it is the result of tension, stress, worry, idleness, boredom, frustration, suppressed rage, insufficient sleep, overeating, poorly balanced diet, smoking, excessive drinking, inadequate exercise, stale air, or any of the other abuses encountered by the human body in modern society.

The most ignored fact of all about pain is that the best way to eliminate it is to eliminate the abuse. Instead, many people reach almost instinctively for the painkillers—aspirins, barbiturates, codeines, tranquilizers, sleeping pills, and dozens of other analgesics or desensitizing drugs.

Most doctors are profoundly troubled over the extent to which the medical profession today is taking on the trappings of a pain-killing industry. Their offices are overloaded with people who are morbidly but mistakenly convinced that something dreadful is about to happen to them. It is all too evident that the campaign to get people to run to a doctor at the first sign of pain has boomeranged. Physicians find it difficult to give adequate attention to patients genuinely in need of expert diagnosis and treatment because their time is soaked up by people who have nothing wrong with them except a temporary indisposition or a psychogenic ache.

Patients tend to feel indignant and insulted if the physician tells them he can find no organic cause for the pain. They tend to interpret the term “psychogenic” to mean that they are complaining of nonexistent symptoms. They need to be educated about the fact that many forms of pain have no underlying physical cause but are the result, as mentioned earlier, of tension, stress, or hostile factors in the general environment. Sometimes a pain may be a manifestation of “conversion hysteria,” as mentioned earlier, the name given by Jean Charcot to physical symptoms that have their origins in emotional disturbances.

Obviously, it is folly for an individual to ignore symptoms that could be a warning of a potentially serious illness. Some people are so terrified of getting bad news from a doctor that they allow their malaise to worsen, sometimes past the point of no return. Total neglect is not the answer to hypochondria. The only answer has to be increased education about the way the human body works, so that more people will be able to steer an intelligent course between promiscuous pill-popping and irresponsible disregard of genuine symptoms.

Of all forms of pain, none is more important for the individual to understand than the “threshold” variety. Almost everyone has a telltale ache that is triggered whenever tension or fatigue reaches a certain point. It can take the form of a migraine-type headache or a squeezing pain deep in the abdomen or cramps or a pain in the lower back or even pain in the joints. The individual who has learned how to make the correlation between such threshold pains and their cause doesn't panic when they occur; he or she does something about relieving the stress and tension. Then, if the pain persists despite the absence of apparent cause, the individual will telephone the doctor.

If ignorance about the nature of pain is widespread, ignorance about the way pain-killing drugs work is even more so. What is not generally understood is that many of the vaunted pain-killing drugs conceal the pain without correcting the underlying condition. They deaden the mechanism in the body that alerts the brain to the fact that something may be wrong. The body can pay a high price for suppression of pain without regard to its basic cause.

Professional athletes are sometimes severely disadvantaged by trainers whose job it is to keep them in action. The more famous the athlete, the greater the risk that he or she may be subjected to extreme medical measures when injury strikes. The star baseball pitcher whose arm is sore because of a torn muscle or tissue damage may need sustained rest more than anything else. But his team is battling for a place in the World Series; so the trainer or team doctor, called upon to work his magic, reaches for a strong dose of butazolidine or other powerful pain suppressants. Presto, the pain disappears! The pitcher takes his place on the mound and does superbly. That could be the last game, however, in which he is able to throw a ball with full strength. The drugs didn't repair the torn muscle or cause the damaged tissue to heal. What they did was to mask the pain, enabling the pitcher to throw hard, further damaging the torn muscle. Little wonder that so many star athletes are cut down in their prime, more the victims of overzealous treatment of their injuries than of the injuries themselves.

The king of all painkillers, of course, is aspirin. The U.S. Food and Drug Administration permits aspirin to be sold without prescription, but the drug, contrary to popular belief, can be dangerous and, in sustained doses, potentially lethal. Aspirin is self-administered by more people than any other drug in the world. Some people are aspirin-poppers, taking ten or more a day. What they don't know is that the smallest dose can cause internal bleeding. Even more serious perhaps is the fact that aspirin is antagonistic to collagen, which has a key role in the formation of connective tissue. Since many forms of arthritis involve disintegration of the connective tissue, the steady use of aspirin can actually intensify the underlying arthritic condition.

The reason why aspirin is prescribed so widely for arthritic patients is that it has an antiinflammatory effect, apart from its pain-deadening characteristics. In recent years, however, medical researchers have suggested that the antiinflammatory value of aspirin may be offset by the harm it causes to the body's vital chemistry. Doctors J. Hirsh, D. Street, J.F. Cade, and H. Amy, in the March 1973 issue of the professional journal
Blood
, showed that aspirin impedes the interaction between “platelet release” and connective tissue. In the
Annals of Rheumatic Diseases
, also in March 1973, Dr. P.N. Sperryn reported a significant blood loss in patients who were on heavy daily doses of aspirin. (It is not unusual for patients suffering from serious rheumatoid arthritis to take as many as twenty-four aspirin tablets a day.)

Again, I call attention to the article in the May 8, 1971, issue of
Lancet
, the English medical journal. Dr. M.A. Sahud and Dr. R.J. Cohen stated that the systematic use of aspirin by rheumatoid patients produces abnormally low plasma-ascorbic-acid levels. The authors reported that aspirin blocks the “uptake of ascorbic acid into the blood platelets.” Since vitamin C is essential in collagen formation, its depletion by aspirin would seem to run directly counter to the body's need to combat connective tissue breakdown in arthritic conditions. The
Lancet
article concludes that, at the very least, ascorbic acid should be administered along with aspirin to counteract its harmful effects.

Aspirin is not the only pain-killing drug, of course, that is known to have dangerous side effects. Dr. Daphne A. Roe, of Cornell University, at a medical meeting in New York City in 1974, presented startling evidence of a wide range of hazards associated with sedatives and other pain suppressants. Some of these drugs seriously interfere with the ability of the body to metabolize food properly, producing malnutrition. In some instances, there is also the danger of bone-marrow depression, interfering with the ability of the body to replenish its blood supply.