In dealing with sick people, the adage, “assess not only what the disease is but who has the disease”, is worth following. The same disease may produce differing emotional responses from different persons; indeed, the expression of the disease may be governed by the mind.
We have known about men of god (saints) being able to remain for hours together in suspended animation. It has been said that the revered Ramana Maharishi offered to have a cancerous growth on his arm removed without anesthesia – by means of the sheer control of the senses and by meditation and will power.
There is the instance of individuals in extreme distress and shock developing an acute cardiac disorder resembling a heart attack – “the broken heart syndrome”, which is described in Japanese as takatsumo .
Headache is a common complaint. Often the label of migraine is applied to it. Careful oral probing and the elimination of organic disease may show it to be ‘tension headache’. You would often see a very disturbed spouse complaining of a headache and crying off from any argument, citing a headache!
The classic example is that of a person with a “sensitive” bowel (irritable bowel is its medical label) who has to go to the toilet when facing a difficult situation. For example, a student going to an examination, or a witness summoned to attend a court for cross-examination.
Allergic asthma is another instance where the mind plays an important role. The classic, textbook description is that of a person who is allergic to roses developing a bout of wheezing upon being shown a paper rose!
Trousseau, a French physician, was allergic to horse dander (like dandruff from the human scalp) arising from the horse’s coat. Whenever he was angry with the postilion (the 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 angry with the postilion did he develop asthma!
During the Second World War, the incidence of air raid bleeding or perforation peptic ulcers in Europe increased significantly. Obviously the tension among the civilian population increased on air raids, shelling and so on. Earlier in the continent of Europe, two physicians studied the inner lining of the stomach of a soldier – whose name was Tom – who had a hole in the abdominal wall and the stomach caused by a bullet. They could see the stomach lining becoming congested and changing its motility whenever Tom was angry. It, pale when depressed and of normal hue when his mind was at peace.
In essence bed-side medicine should not be relegated to a background in managing a patient’s illness – history given by a subject who can narrate events in his illness clearly and the medical man interrogating him must “size up “his or her personality.
Often when the patient’s personality is not apparent, one could get the valuable information about his personality, life situation and so on by a request to him or her to describe himself or herself – when alone with the doctor.
This is surprising how the flood gates are opened when a spouse in mental agony because of her partner’s conduct, or smouldering anger against the mother-in-law. But in day to day life, these subjects may keep a lid on their emotions and may allow disease with physical symptoms like vomiting, headache and so on when the mind reacts strongly.
Norman Cousins, an American author, narrates a subject with rheumatoid arthritis who was disappointed with his physician who was visiting him in the hospital room day after day with his troop of medical staff – the physician looked first at his case chart and spoke a word or two and went on. At last the patient got so vexed and told the doctor when he was about to enter, “Doctor, please stop there. You should know I’m alone in this room through the day. Your visit is what I look forward to. In fact, there is only a momentary appearance and no words of comfort.”
He then got himself discharged from the hospital, checked into a comfortable hotel room, had a number of friends with him and had music played which pleased him – the result was that his disease underwent remission! The happy mind did the trick.
Of course not all diseases respond to a mind in pleasure and peace.
It is said that a good doctor treats the disease but a great doctor treats the patient!
(The author was a Professor of Medicine at Madras Medical College. kvtmalt@hotmail.com)
