Physicians ought to follow the adage, “Assess not only what the disease is but who has the disease”. The same disease may produce varying responses from different persons. The mind may govern the expression of the disease.
We have known about the men of god, saints, being able to remain for hours in suspended animation.
There is the instance of individuals in extreme distress and shock developing acute cardiac disorder, resembling a heart attack. This is described as the “broken heart syndrome” or Takotsubo (stress) cardiomyopathy in Japan.
Headache is a common complaint. Often the label of migraine is applied to it, but careful investigation and the elimination of organic diseases may show it to be tension headache. One sees a disturbed spouse complaining of a headache and crying off from an argument with a headache! The classic example is that of a person with a “sensitive” bowel (irritable bowel) having to go to the toilet when facing a difficult situation.
Allergic asthma is another instance where the mind plays an important role. The textbook description is that of a person allergic to roses developing a wheeze on being shown a paper rose.
Shades of anger
Trousseau, a French physician, was allergic to horse dander (akin to dandruff from the human scalp) arising from the horses’ coat. When he was angry with the postilion (coachman) on the road he didn’t develop asthma as also when he was inside the stable with the postilion but calm. Only when he was inside the stable and was angry with the postilion did he develop asthma!
During the Second World War, instances of bleeding and perforation caused by peptic ulcers increased significantly during air raids in Europe. Obviously, increased tension among the civilian population during air raids and shelling was responsible for this. Earlier, in the Continent two physicians studied the inner lining of the stomach of a solider who had a hole in the abdominal wall and stomach, caused by a bullet.
They could see the stomach lining becoming congested and its motility changing when he was angry. In turn, it appeared pale when he was depressed and normal when his mind was at peace.
In essence, bedside medicine should not be relegated; it should be the first step in managing a patient’s illness. From the history given by a subject who can narrate events of his or her illness clearly, the medical man must “size up” his or her situation.
Often when the patient’s personality is not apparent one could get valuable information about his life situation and so on by requesting him or her to describe himself or herself. You see the floodgates open when a spouse in agony because of the partner’s conduct or anger against a mother-in-law, react. In daily life they may keep a lid on the emotions.
Norman Cousins, the American author, narrates a subject with rheumatoid arthritis who was disappointed with his physician visiting him in his hospital room day after day with his troop of medical staff. The physician would first look at his case chart, speak a word or two and leave. On day the patient told the doctor when he was about to enter the room: “Doctor! Please stop there. You should know I am alone through the day. Your visit is what I look forward to. But there is only a momentary appearance – no words of comfort.”
He got discharged from hospital, got into a comfortable hotel room, had a number of friends with him for pleasant conversation and had music played. The result: there was a remission! The happy mind did the trick.
Of course, not all diseases respond to a mind in pleasure and peace.
(The author was director-in-charge of the National Institute for Research in Tuberculosis, Chennai. He passed away in March 2016)
