Anatomy of an Illness as Perceived by the Patient

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Anatomy of an Illness as Perceived by the Patient

Reflections on Healing and Regeneration

Norman Cousins

For my brother Robert and

my sisters Sophie and Jeanne
.

C
ONTENTS

1. Anatomy of an Illness as Perceived by the Patient

2. The Mysterious Placebo

3. Creativity and Longevity

4. Pain Is Not the Ultimate Enemy

5. Holistic Health and Healing

6. What I Learned from Three Thousand Doctors

B
IBLIOGRAPHY

A
CKNOWLEDGMENTS

A B
IOGRAPHY OF
N
ORMAN
C
OUSINS BY
S
ARAH
C
OUSINS
S
HAPIRO

ONE

A
NATOMY OF AN
I
LLNESS AS
P
ERCEIVED BY THE
P
ATIENT

This book is about a serious illness that occurred in 1964. I was reluctant to write about it for many years because I was fearful of creating false hopes in others who were similarly afflicted. Moreover, I knew that a single case has small standing in the annals of medical research, having little more than “anecdotal” or “testimonial” value. However, references to the illness surfaced from time to time in the general and medical press. People wrote to ask whether it was true that I “laughed” my way out of a crippling disease that doctors believed to be irreversible. In view of those questions, I thought it useful to provide a fuller account than appeared in those early reports.

In August 1964, I flew home from a trip abroad with a slight fever. The malaise, which took the form of a general feeling of achiness, rapidly deepened. Within a week it became difficult to move my neck, arms, hands, fingers, and legs. My sedimentation rate was over 80. Of all the diagnostic tests, the “sed” rate is one of the most useful to the physician. The way it works is beautifully simple. The speed with which red blood cells settle in a test tube—measured in millimeters per hour—is generally proportionate to the severity of an inflammation or infection. A normal illness, such as grippe, might produce a sedimentation reading of, say, 30 or even 40. When the rate goes well beyond 60 or 70, however, the physician knows that he is dealing with more than a casual health problem. I was hospitalized when the sed rate hit 88. Within a week it was up to 115, generally considered to be a sign of a critical condition.

There were other tests, some of which seemed to me to be more an assertion of the clinical capability of the hospital than of concern for the well-being of the patient. I was astounded when four technicians from four different departments took four separate and substantial blood samples on the same day. That the hospital didn't take the trouble to coordinate the tests, using one blood specimen, seemed to me inexplicable and irresponsible. Taking four large slugs of blood the same day even from a healthy person is hardly to be recommended. When the technicians came the second day to fill their containers with blood for processing in separate laboratories, I turned them away and had a sign posted on my door saying that I would give just one specimen every three days and that I expected the different departments to draw from one vial for their individual needs.

I had a fast-growing conviction that a hospital is no place for a person who is seriously ill. The surprising lack of respect for basic sanitation; the rapidity with which staphylococci and other pathogenic organisms can run through an entire hospital; the extensive and sometimes promiscuous use of X-ray equipment; the seemingly indiscriminate administration of tranquilizers and powerful painkillers, sometimes more for the convenience of hospital staff in managing patients than for therapeutic needs; and the regularity with which hospital routine takes precedence over the rest requirements of the patient (slumber, when it comes for an ill person, is an uncommon blessing and is not to be wantonly interrupted)—all these and other practices seemed to me to be critical shortcomings of the modern hospital.

Perhaps the hospital's most serious failure was in the area of nutrition. It was not just that the meals were poorly balanced; what seemed inexcusable to me was the profusion of processed foods, some of which contained preservatives or harmful dyes. White bread, with its chemical softeners and bleached flour, was offered with every meal. Vegetables were often overcooked and thus deprived of much of their nutritional value. No wonder the 1969 White House Conference on Food, Nutrition, and Health made the melancholy observation that a great failure of medical schools is that they pay so little attention to the science of nutrition.

My doctor did not quarrel with my reservations about hospital procedures. I was fortunate to have as a physician a man who was able to put himself in the position of the patient. Dr. William Hitzig supported me in the measures I took to fend off the random sanguinary assaults of the hospital laboratory attendants.

We had been close friends for more than twenty years, and he knew of my own deep interest in medical matters. We had often discussed articles in the medical press, including the
New England Journal of Medicine (NEJM)
, and
Lancet
. He was candid with me about my case. He reviewed the reports of the various specialists he had called in as consultants. He said there was no agreement on a precise diagnosis. There was, however, a consensus that I was suffering from a serious collagen illness—a disease of the connective tissue. All arthritic and rheumatic diseases are in this category. Collagen is the fibrous substance that binds the cells together. In a sense, then, I was coming unstuck. I had considerable difficulty in moving my limbs and even in turning over in bed. Nodules appeared on my body, gravel-like substances under the skin, indicating the systemic nature of the disease. At the low point of my illness, my jaws were almost locked.

Dr. Hitzig called in experts from Dr. Howard Rusk's rehabilitation clinic in New York. They confirmed the general opinion, adding the more particularized diagnosis of ankylosing spondylitis, which would mean that the connective tissue in the spine was disintegrating.

I asked Dr. Hitzig about my chances for full recovery. He leveled with me, admitting that one of the specialists had told him I had one chance in five hundred. The specialist had also stated that he had not personally witnessed a recovery from this comprehensive condition.

All this gave me a great deal to think about. Up to that time, I had been more or less disposed to let the doctors worry about my condition. But now I felt a compulsion to get into the act. It seemed clear to me that if I was to be that one in five hundred I had better be something more than a passive observer.

I asked Dr. Hitzig about the possible origin of my condition. He said that it could have come from any one of a number of causes. It could have come, for example, from heavy-metal poisoning, or it could have been the aftereffect of a streptococcal infection.

I thought as hard as I could about the sequence of events immediately preceding the illness. I had gone to the Soviet Union in July 1964 as chairman of an American delegation to consider the problems of cultural exchange. The conference had been held in Leningrad, after which we went to Moscow for supplementary meetings. Our hotel was in a residential area. My room was on the second floor. Each night a procession of diesel trucks plied back and forth to a nearby housing project in the process of round-the-clock construction. It was summer, and our windows were wide open. I slept uneasily each night and felt somewhat nauseated on arising. On our last day in Moscow, at the airport, I caught the exhaust spew of a large jet at point-blank range as it swung around on the tarmac.

As I thought back on that Moscow experience, I wondered whether the exposure to the hydrocarbons from the diesel exhaust at the hotel and at the airport had anything to do with the underlying cause of the illness. If so, that might account for the speculations of the doctors concerning heavy-metal poisoning. The trouble with this theory, however, was that my wife, who had been with me on the trip, had no ill effects from the same exposure. How likely was it that only one of us would have reacted adversely?

It seemed to me, as I thought about it, that there were two possible explanations for the different reactions. One had to do with individual allergy. The second was that I could have been in a condition of adrenal exhaustion and less apt to tolerate a toxic experience than someone whose immunologic system was fully functional.

Was adrenal exhaustion a factor in my own illness?

Again, I thought carefully. The meetings in Leningrad and Moscow had not been casual. Paperwork had kept me up late nights. I had ceremonial responsibilities. Our last evening in Moscow had been, at least for me, an exercise in almost total frustration. A reception had been arranged by the chairman of the Soviet delegation at his dacha, located thirty-five to forty miles outside the city. I had been asked if I could arrive an hour early so that I might tell the Soviet delegates something about the individual Americans who were coming to dinner. The Russians were eager to make the Americans feel at home, and they had thought such information would help them with the social amenities.

I was told that a car and driver from the government automobile pool in Moscow would pick me up at the hotel at 3:30
P.M.
This would allow ample time for me to drive to the dacha by 5:00, when all our Russian conference colleagues would be gathered for the social briefing. The rest of the American delegation would arrive at the dacha at 6:00
P.M.