Helpful Fright

If a tuberculosis patient is depressed and apathetic, his disease is likely to get worse despite the best of medical care. If a patient is always tense and angry and bucks his necessarily slow treatment he is not apt to improve very fast. But if a depressed patient can be made to snap out of it by sudden fright or sudden anger, he will probably begin to get better right away.

Doctors, who have long known that there is a rough relationship between TB and the emotions, had these facts spelled out for them last week at the Los Angeles meeting of the National Tuberculosis Association. And with the spell-out, came a theory about the body mechanism which governs the relationship.

The mechanism appears to be located in the busy little adrenal glands, which secrete steroid hormones (like cortisone), said Dr. Edmund R. Clarke Jr. of Seattle's Firland Sanatorium. He and his colleagues tested the adrenal output of 109 TB patients. In general, those with abnormally low steroid levels had widespread, active tuberculosis; those with near-normal levels had the commoner, less extensive form of the disease, while others with high levels had localized but stubborn infections.

Then, said Dr. Clarke, it was found that the low steroid levels marked the patients who were depressed, apathetic and withdrawn. The near-normals were alert, cooperative and interested in their surroundings. The above-normals were ridden with conflicts and anxiety and often showed such other signs as fast heartbeat, quick changes in blood pressure and sweating of the palms.

The adrenals pour out extra steroid hormones in times of stress or anger. How this can work to bring the depressed patient's steroid output up to normal was described by Dr. Clarke in case histories:

P:One patient was getting no better, and in fact was being kept alive only by frequent injections of streptomycin. After a while he became so angry at being repeatedly jabbed with the needle that his adrenal output soared back to normal. Now he is recovering.

P:Another, also with underactive adrenals, was about to have a small segment of a lung removed. Fellow patients kidded him into believing that he was going to lose the whole lung. His undue fear sent his adrenal output up. And this helped him through the operation in good shape.

There is no such quick treatment for the resentful patients with chips on their shoulders and excessive adrenal output. But their tensions and hormones can sometimes be reduced gradually with the sympathy-and-understanding treatment from doctors, nurses and family.

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