Mind over Medicine

By Peter Stoler

SOCIAL CAUSES OF ILLNESS by Richard Totman Pantheon; 263 pages; $10

What makes people sick? Medical science believes that little things--parasites, bacteria and viruses--are the villains. Psychiatry suggests that people sometimes make themselves, or, more probably, imagine themselves to be ill Richard Totman, an Oxford University psychologist, offers another explanation He holds society responsible. Drawing upon empirical and anecdotal evidence he argues that many apparently "physical" illnesses--including ulcers, hypertension and heart disease, as well as cancer and the state of mental deterioration known as senility--are the products of an individual's inability to behave as the world expects him to. "The risk of be coming seriously ill," Totman writes in Social Causes of Illness, "is affected more profoundly by social factors than by physical wear and tear."

His conclusions are hardly original. Until a century ago, almost all medicine was based on the theory that illness stemmed from social and spiritual as well as physiological disorders. Even today, holistic medicine tries to cure its patients by restoring their spiritual equilibrium.

Totman believes that the two theories need not lead to exclusive approaches. He recognizes that much of modern medicine ignores the patient and concentrates instead on symptoms or systems. "The present-day practitioner," he writes, "functions more like a pill-dispenser, and the surgeon more like a maintenance mechanic." At the same time, though, Totman warns that an overly spiritual approach can ignore the microbes in favor of the mind.

The prescription: a combination of ingredients. Microbes may and do cause disease, he concedes. But there is increasing evidence that the mind can affect the body in such a way as to make a viral victory more likely. As W.H. Auden tersely observes of cancer.

"Nobody knows what the cause is, Though some pretend they do; It's like some hidden assassin Waiting to strike at you.

"Childless women get it, And men when they retire; It's as if there had to be some outlet For their foiled creative fire. "

Though no serious scientists will speculate too much on the reasons for disease, most do acknowledge that people with social and psychological problems--those who have recently lost spouses, or jobs or moved into new and unsettling work or home situations--seem far more susceptible to certain sicknesses than thos who feel secure about their lives and roles.

Peppered with terms like status in congruity and dissonance and salted with references to Life Change Units and th Social Readjustment Rating Scale, Society Causes of Illness is not easy to read. But it is worthwhile for doctors and patient! Both can be notorious for rushing to the pillbox when alternative methods ar preferable. As Totman points out, any one can tell when he is sick, even a la man. The trick is to determine why, an to treat the nonmicrobial causes of illness as well. -- Peter Stoler

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