A Doctor's Journal
The Illness Spiral
By MILES HOWARD The vicious-spiral effect in illness. I thought of this last week when a friend told me of his wife —she has an irregular heartbeat when rattled : the pulse misses a beat, pauses and then the heart `thumps.' This is a common effect of stress : in medical terms, extra-systoles. It can be very alarming indeed. Naturally the patient thinks his heart is going to stop: this secondary fear then feeds into the causal tension state—more missed beats—more fear : and so on, in a downward spiral, until the sufferer is really scared. If the doctor steps in early on and allays the fear, the spiral is checked and the patient recovers balance. I suppose the 'natural' tendency in all living or- ganisms is towards health; left to itself, the body will swing back to its normal adjustments and go on as before. The role of the doctor and the therapist is to free the individual from harmful `feed-backs,' inhibitions that have no useful function, irrational self-criticism and all the other illness-producing forces within the economy. Perhaps all stress disorder is subject to this vicious-spiral rule; certainly the simpler ones are and these are the most readily handled. The key is action early: before the spiral has travelled too far down. Better still, prevention. A hundred times better to avoid a migraine headache than to wait for it and then try to combat the misery; once the explosion in the nervous system has hap- pened it is likely to go on and run itself -out. So long as tension doesn't rise above the critical point, no explosion.
The state of being ill may be depressing : not always, as you can see by looking round. When it is, the depression can lower resistance and prolong the illness; indeed, it can become an ill- ness in itself and require to be treated by special means. This, in theory at any rate, is always pre- ventable. Yet we must strive to see an illness in its personal and social setting and 'in the round': a total view, as someone said the other day at a meeting of family doctors. The family doctor, better than anyone, can take this total view; and he may see that an illness, in one patient at that moment of time, is the best solution of a life- problem that can b econtrived. When that is so he may think : let sleeping dogs lie; don't barge in with the latest tranquilliser or, worse still, with advice and try to 'cure' the patient. This notion of 'curing' patients, though a humane ideal in the abstract, can be most damaging if it stimulates action without insight. Insight in the .doctor and in the patient are both needed; the former must precede the latter. Patients can get better without insight; the beginning therapist may be puzzled by this and fret if he cannot convey to his patient the insight he thinks he has gained. Yet what is the goal? Helping the patient? Or adding to the doctor's store of useful insights? Life and adversity teach people (and doctors) as much or more than therapy. Time alone can be a powerful remedy. How often the wisest course is simply to wait !
One of the several hazards of being a patient is exposure to the unpredictable side-effects of drugs, especially new drugs : for example, bleed- ing from the stomach after taking aspirin, giant urticaria (nettle-rash) after penicillin, swelling of the face—`moon-face'—after cortisone. The latest to be reported is falling of hair after treatment with one of the anti-coagulant drugs. These effects are, by and large, most uncommon and are very seldom grave; but they are a nuisance and up- setting for the patient.
Taking the 'long view, I suppose that over the next hundred years we shall see the area of illness 'covered' by drug treatment gradually shrink. Most of the 'mixtures in a bottle' of even fifty years ago are never heard of now. The medicines of the modern age are the anti-biotic (like penicillin) and the tranquilliser, and in Utopia neither will be needed. No one will be agitated enough to want pills, and infections will be prevented and not merely treated after they begin. A long way ahead? Of course; but it is stimulating and valuable to have some sort epic- lure of where we are moving towards. * * `The old liberal concept that nigness was evil and that smallness had a natural virtue is a lot of nonsense. You can have small tyrants as well as big ones. The question is not: Do we want to escape from a world of bigness; it is, how do we live with bigness and make it responsive to basic human needs? How do we avoid losing the in- dividual in the wilderness of big things?' (wAurnit REUTHER, quoted in the Sunday'Tintes. 22.6.58.)
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