MIND AND MEDICINE
WHO TAUGHT YOU ALL THIS DOCTOR?
THE REPLY CAME PROMPTY?
SUFFERING".
---- ALBERT CAMUS, THE PLAGUE
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A VAGUE ACHE IN MY GROIN SENT ME TO MY DOCTOR. NOTHING SEEMED UNUSUAL UNTIL H LOOKED AT THE RESULT OF A URINE TEST. I HAD TRACES OF BLOOD IN MY URINE.
I WANT YOU TO GO TO THE HOSPITAL AND GET SOME TESTS... KIDNEY FUNCTION, CYTOLOGY... HE SAID IN A BUSINESSLIKE TONE.
I HAVE A FOGGY MEMORY OF HIS EXPLAINING TO WHEN AND WHERE TO GO FOR DIAGNOSTIC TESTS. IT WAS THE SIMPLEST INSTRUCTION, BUT I HAD TO ASK HIM TO REPEAT IT THREE OR FOUR TIMES. CYTOLOGY - MY MIND WOULD NOT LEAVE THE WORD. THAT ONE WORD MADE ME FEEL AS THOUGH I HAD JUST MUGGED AT MY OWN FRONT DOOR.
WE SHOULD I HAVE REACTED SO STRONGLY? MY DOCTOR WAS JUST BEING THOROUGH AND COMPETENT, CHECKING THE LIMBS IN A DIAGNOSTIC DECISION TREE. THERE WAS A TINY LIKEHOOD THAT CANCER WAS THE PROBLEM. BUT THIS RATIONAL ANALYSIS WAS IRRELEVANT AT THAT MOMENT. IN THE LAND OF THE SICK, EMOTIONS REIGN SUPREME, FEAR IS A THOUGHT AWAY. WE CAN BE SO EMOTIONALLY FRAGILE WHILE WE ARE AILING BECAUSE OUR MENTAL WELL-BEING IS BASED IN PART ON THE ILLUSION OF INVULNERABILITY . SICKNESS - ESPECIALLY A SEVERE ILLNESS - BURSTS THAT ILLUSION, ATTACKING THE PREMISE THAT OUR PRIVATE WORLD SAFE AND SECURE. SUDDENLY WE FEEL WEAK, HELPLESS, AND VULNERABLE.
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DESPITE SUCH EVIDENCE, MANY OR MOST PHYSICIANS ARE STILL SKEPTICAL THAT EMOTIONS MATTER CLINICALLY. ONE REASONS IS THAT WHILE MANY STUDIES HAVE FOUND STRESS AND NEGATIVE EMOTIONS TO WEAKEN THE EFFECTIVENESS OF VARIOUS IMMUNE CELLS, IT IS NOT ALWAYS CLEAR THAT THE RANGE OF THESE CHANGES IS GREAT ENOUGH TO MAKE A MEDICAL DIFFERENCE.
EVEN SO, AN INCREASING NUMBER OF PHYSICIANS ACKNOWLEDGE THE PLACE OF EMOTIONS IN MEDICINE. FOR INSTANCE, DR.CAMRAN NEZHAT, AN EMINENT GYNECOLOGICAL LAPAROSCOPIC SURGEON AT STANFORD UNIVERSITY, SAYS, "IF SOMEONE SCHEDULED FOR SURGERY TELLS ME SHE'S PANICKED THAT DAY AND DOES NOT WANT TO GO THROUGH WITH IT, I CANCEL THE SURGERY". NEZHAT EXPLAINS, EVERY SURGEON KNOWS THAT PEOPLE WHO ARE EXREMELY SCARED TO TERRIBLY IN SURGERY. THEY BLEED TOO MUCH, THEY HAVE MORE INFECTIONS AND COMPLICATIONS. THEY HAVE A HARDER TIME RECOVERING . IT'S MUCH BETTER IF THEY ARE CALM".
THE REASON IS STRAIGHTFORWARD: PANIC AND ANXIETY HIKE BLOOD PRESSURE, AND VEINS DISTENDED BY PRESSURE BLEED MORE PROFUSELY WHEN CUT BY THE SURGEON'S KNIFE. EXCESS BLEEDING IS ONE OF THE MOST TROUBLESOME SURGICAL COMPLICATIONS, ONE THAT CAN SOMETIMES LEAD TO DEATH.
BEYOND SUCH MEDICAL ANECDOTES, EVIDENCE FOR THE CLINICAL IMPORTANCE OF EMOTIONS HAS BEEN MOUNTING STEADILY. PERHAPS THE MOST COMPELLING DATA ON THE MEDICAL SIGNIFICANCE OF EMOTION COME FROM A MASS ANALYSIS COMBINING RESULTS FROM 101 SMALLER STUDIES INTO A SINGLE LARGER ONE OF SEVERAL THOUSAND MEN AND WOMEN. THE STUDY CONFIRMS THAT PERTURBING EMOTIONS ARE BAD FOR HEALTH - TO A DEGREE. PEOPLE WHO EXPERIENCED CHRONIC ANXIETY, LONG PERIODS OF SADNESS AND PESSIMISM, UNREMITTING TENSION OR INCESSANT HOLSTILITY, RELENTLESS CYNICISM OR SUSPICIOUSNESS, WERE FOUND TO HAVE DOUBLE THE RISK OF DISEASE (EACH REPRESENTATIVE OF MAJOR, BROAD CATAGORIES OF DISEASE). THIS ORDER OF MAGNITUDE MAKES DISTRESSING EMOTIONS AS TOXIC A RISK FACTOR AS, SAY, SMOKING OR HIGH CHOLESTEROL ARE FOR HEART DISEASE - IN OTHER WORDS, A MAJOR THREAT TO HEALTH.
TO BE SURE, THIS IS A BROAD STATISTICAL LINK, AND BY NO MEANS INDICATES THAT EVERYONE WHO HAS SUCH CHRONIC FEELINGS WILL THUS MORE EASILY FALL PREY TO A DISEASE. BUT THE EVIDENCE FOR A POTENT ROLE FOR EMOTION IN DISEASE IS FAR MORE EXTENSIVE THAN THIS ONE STUDY OF STUDIES INDICATES. TAKING A MORE DETAILED LOOK AT THE DATA FOR SPECIFIC EMOTIONS, ESPECIALLY THE BIG THREE-ANGER, ANXIETY, AND DEPRESSION - MAKES CLEARER SOME SPECIFIC WAYS THAT FEELINGS HAVE MEDICAL SIGNIFICANCE, EVEN IF THE BIOLOGICAL MECHANISM BY WHICH SUCH EMOTIONS HAVE THEIR EFFECT ARE YET TO BE FULLY UNDERSTOOD?
