A Nation of Hypochondriacs

By Norman Cousins Norman Cousins is on the medical faculty of UCLA.

The main impression growing out of twelve years on the faculty of a medical school is that the No. 1 health problem in the U.S. today, even more than AIDS or cancer, is that we don't know how to think about health and illness. Our reactions are formed on the terror level. We fear the worst, expect the worst, thus invite the worst. The result is that we are becoming a nation of weaklings and hypochondriacs, a self-medicating society incapable of distinguishing between casual, everyday symptoms and those that require professional attention.

Somewhere in our early education we become addicted to the notion that pain means sickness. We fail to learn that pain is the body's way of informing the mind that we are doing something wrong, not necessarily that something is wrong. We don't understand that pain may be telling us that we are eating too much or the wrong things; or that we are smoking too much or drinking too much; or that there is too much emotional congestion in our lives; or that we are being worn down by having to cope daily with overcrowded streets and highways, the pounding noise of garbage grinders, or the cosmic distance between the entrance to the airport and the departure gate. We get the message of pain all wrong. Instead of addressing ourselves to the cause, we become pushovers for pills, driving the pain underground and inviting it to return with increased authority.

Early in life, too, we become seized with the bizarre idea that we are constantly assaulted by invisible monsters called germs, and that we have to be on constant alert to protect ourselves against their fury. Equal emphasis, however, is not given to the presiding fact that our bodies are superbly equipped to deal with the little demons, and that the best way of forestalling an attack is to maintain a sensible life-style.

The most significant single statement about health to appear in the medical journals during the past decade is by Dr. Franz Ingelfinger, the late and former editor of the New England Journal of Medicine. Ingelfinger noted that almost all illnesses are self-limiting. That is, the human body is capable of handling them without outside intervention. The thrust of the article was that we need not feel we are helpless if disease tries to tear away at our bodies, and that we can have greater confidence in the reality of a healing system that is beautifully designed to meet most of its problems. And even when outside help is required, our own resources have something of value to offer in a combined strategy of treatment.

No one gets out of this world alive, and few people come through life without at least one serious illness. If we are given a serious diagnosis, it is useful to try to remain free of panic and depression. Panic can constrict the blood vessels and impose an additional burden on the heart. Depression, as medical researchers all the way back to Galen have observed, can set the stage for other illnesses or intensify existing ones. It is no surprise that so many patients who learn that they have cancer or heart disease -- or any other catastrophic disease -- become worse at the time of diagnosis. The moment they have a label to attach to their symptoms, the illness deepens. All the terrible things they have heard about disease produce the kind of despair that in turn complicates the underlying condition. It is not unnatural to be severely apprehensive about a serious diagnosis, but a reasonable confidence is justified. Cancer today, for example, is largely a treatable disease. A heavily damaged heart can be reconditioned. Even a positive HIV diagnosis does not necessarily mean that the illness will move into the active stage.

One of the interesting things researchers at the UCLA medical center have discovered is that the environment of medical treatment can actually be enhanced if seriously ill patients can be kept free of depression. In a project involving 75 malignant-melanoma patients, it was learned that a direct connection exists between the mental state of the patient and the ability of the immune system to do its job. In a condition of emotional devastation, immune function is impaired. Conversely, liberation from depression and panic is frequently accompanied by an increase in the body's interleukins, vital substances in the immune system that help activate cancer-killing immune cells. The wise physician, therefore, is conscious of both the physical and emotional needs of the patient.

People who have heart attacks are especially prone to despair. After they come through the emergency phase of the episode, they begin to reflect on all the things they think they will be unable to do. They wonder whether they will be able to continue at their jobs, whether they will be able to perform satisfactorily at sex, whether they can play tennis or golf again. In short, + they contemplate an existence drained of usefulness and joy. The spark goes out of their souls. It may help for these people to know that in addition to the miracles that modern medicine can perform, the heart can make its own bypass around the occluded arteries and that collateral circulation can provide a rich supply of oxygen. A heart attack need not be regarded as consignment to a mincing life-style. Under circumstances of good nutrition, a reasonable amount of exercise and a decrease in the wear and tear of stressful events, life expectancy need not be curtailed.

Plainly, the American people need to be re-educated about their health. They need to know that they are the possessors of a remarkably robust mechanism. They need to be de-intimidated about disease. They need to understand the concept of a patient-physician partnership in which the best that medical science has to offer is combined with the magnificent resources of mind and body.

We need not wait, of course, for a catastrophic illness before we develop confidence in our ability to rise to a serious challenge. Confidence is useful on the everyday level. We are stronger than we think. Much stronger.