Anatomy of an Illness as Perceived By the Patient Book

From kalireads.com:

Norman Cousins, a journalist and professor, believed in taking massive doses of Vitamin C and laughing to cure illness. Perhaps more important than either one of those specific treatments, he believed in the power of placebo and each person's ability to heal their own illnesses. Cousins' Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration was originally published in 1979 and is now considered an important classic of patient involvement in medical care. Cousins documents his own path to healing from his diagnosis of a serious form of arthritis called ankylosing spondylitis (doctors give him a chance of recovery of 1 in 500): he stops taking his prescribed medications, and he leaves the hospital, which he views as not conducive to his healing. He checks into a hotel, and watches funny movies, laughing bunches. After he laughs, he sleeps. He gets an IV of Vitamin C, a slow drip so his body can absorb the Vitamin C better than if he consumed it all at once. And then he gets better.

Obviously, there is much debate about Cousins healing himself this way. Many doctors speculate that he has experienced a placebo effect, or a perhaps (it is now speculated) a misdiagnosis. Rather than protest the placebo idea, Cousins embraced it. "Many medical scholars believed that the history of medicine is actually the history of the placebo effect," he said. The history of medicine is full of toxic remedies, and we survived these things and even felt better once we took them as cures, perhaps because of placebo. "The placebo is the doctor who resides within," Cousins said, claiming placebo as an amazing part of our own capacity to heal.

While some of the book is outdated, some of it comes across as an almost prescient warning of what will be lacking in medical care in the future. I have been reading Ben Goldacre's Bad Pharma as well. If Cousins' book, written 30 years ago, was a warning shot fired into the air that something was wrong with the way we demand and receive medical care, then Goldacre's book is the summation of that dysfunctional medical train rolling forwards at full speed.

In the chapter called "Pain Is Not the Ultimate Enemy," Cousins speaks to one of the main themes of his book, the overprescription of unneeded drugs. We are overeducated on pills we can take, while being undereducated on usual causes of pain (like stress) and how to solve those problems ourselves. He says, "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." Cousins suggests we could combat this lack of knowledge with education about pain in schools, and "If our broadcasting stations cannot provide equal time for responses to the pain-killing advertisements, they might at least set aside a few minutes each day for common sense remarks on the subject of pain." I do wonder how Cousins would react if he saw the advertisements on television now, not only for over-the-counter pain medication but for prescription drugs tailored towards every ailment you can imagine, side effects crammed into a voice-over while people dance through a field on screen for the last ten seconds of the commercial, like some bizarre bad joke.

In the last chapter, "Three Thousand Doctors," Cousins talks of the importance of touch in the doctor/patient relationship. I have talked about this with so many people, how doctors seem to just read charts and then prescribe medicines without doing much of a physical exam anymore, and how odd that is. A pain doctor recommended facet injections for lower back pain without feeling the area of my lower back that was in pain. Did the doctor know what he was doing? Probably. Am I confident in my doctor, knowing he will shoot a needle in my spine without taking the time to feel what is going on in my lower back? Certainly not. In this chapter Cousins also brings up what seems like a quaint idea to me, that in order to have trust with your physician, they need to be the one to meet you at the Emergency Room during a heart attack. Who has that sort of relationship with a doctor now?

And finally, Cousins encourages laughter. He encourages it for everyone, especially those with serious diseases, morose and in bed. At one point he explains the purpose of laughter to a depressed young woman with a progressive illness:

"What was significant about the laughter, I said, was not just the fact that it provides internal exercise for a person flat on his or her back ' a form of jogging for the innards-but that it creates a mood in which the other positive emotions can be put to work, too. In short, it helps make it possible for good things to happen.
Carole wanted to know how she could find things worth laughing about. I said she would have to work at it, just as she would have to work at anything else worthwhile."

There is some debate about Cousins' actual diagnosis. Thirty years later, it seems that Cousins may have been saving himself from bad medical advice and incorrect diagnoses for much of his life. He was misdiagnosed with tuberculosis when he was young. While in the sanitarium, he stuck with the kids who believed they were healthy until he was released; he was diagnosed with a heart problem and told to stay in bed, he refused (and later he was told that vigorous exercise probably kept him alive), and there are a lot of suggestions on the web that Cousins was suffering from reactive arthritis (from some sort of infection) rather than his more serious diagnosis of ankylosing spondylitis.