Medicine

How to survive

John Linklater

,"If you can force your heart and nerve and sinew To serve your turn long after they are gone, And so hold on when there is nothing in you Except the will that says to them: "Hold on!"

— Kipling

Most doctors would interpret the tenacity with which 82-year-old General Franco holds on to life, as a good example of the will to live, although this phenomenon is not explained at medical school in terms of any of the known physiological functions.

Christian scientists and followers of the mystical cult of yoga believe that the mind dominates the body completely, and see no problem in the fact that although mental activity is related to brain function some men will, nevertheless, demonstrate dogged determination to survive even when the brain is badly damaged, while others, in apparently much better physical condition, will turn their face to the wall and die.

This common clinical observation, that will power is , an independent quality, not easily located in brain tissue, is denied by humanists who see man as the sick molecular joke — as an accidental pattern of molecules reacting in a predetermined sequence, within an equally predetermined, meaningless universe. They deny free will or the will to survive.

We are, nevertheless, faced with the indisputable facts that men can learn to control their own heart rate, for example, and the size of their pupils by will power, as well as altering, by mental effort, the adrenalin concentration in their bloodstream. The response to chemotherapy is known to depend greatly on the patient himself, and on such abstract factors as the relationship between patient and physician. The mind or body controversy is, therefore, irreconcilable unless we postulate a third entity.

The need to postulate a similar,

non-conceptional entity is well known to the physicist when, for example, he is forced to explain light both as particulate photons, having known mass, and also as an electromagnetic vibration having wavelength. The reality of light can be neither of these, yet it must be

both. The reality of man — his soul or spirit — is, apparently, equally inexpressible in the alternative terms of mind or body.

When a man is startled, a simple nerve reflex releases adrenalin into his bloodstream, as it does in other mammals, and man also feels apprehension, as mammals appear to do after being given an adrenalin injection. Only man can raise his own blood adrenalin level, however, by deliberately conjuring up an imaginary fear.

Man has, in fact, inherited all the drives and reflexes of his animal forebears — including the survival reflexes such as the fight or flight response and the slower, steroid stress response, but he has much more. He has the power of reflection for example, and knows that he exists. Self-awareness leads to self-control which, ultimately, gives man his unique power to survive when all the odds are against him.

Self-awareness raises the need for a philosophy and the best survivor is the man whose philosophy is firmly anchored, and who, therefore, has a stable base. Anchors include religious faith, patriotism, sense of family responsibility or devotion to some consuming socio-political ideal.

These anchors give man a unique sense of purpose and thus enable him to set himself long-term, distant, abstract aims without which the human qualities of optimism, good-natured tolerance, determination, industriousness and application — any or all of which will often characterise the good survivor — would be meaningless.

The basic drive of all living creatures is to survive, at least for long enough to breed; we are therefore pure-bred survivors. Those who did not survive are not our ancestors. Those who happened actually to enjoy the challenge of adversity, furthermore, survived the best. We have therefore, by selective evolution, gradually come to enjoy the piquancy of manageable stress: it puts us on our mettle.

Not only do we enjoy such stress. We also need it to maintain full health and vigour. The Welfare State is on the wrong tack entirely. The cushioned and cossetted domesticated man denies his ancestry and lives a frustrating life, without true fear and, therefore, without joy or exultation, without proper rewards and without proper punishments, gradually losing the very spice of life.

Unless we hunger, we cannot burn up fat stores and we then tend to obesity. Unless we are sometimes stressed by fear and violent exercise we do not release heparin into our blood, to flush out the fibrin and fatty plaques from our arterial walls; and these cause coronary thrombosis. Similar examples are legion.

We no longer actually hunt the sabre-toothed tiger, but the lifestyle of the good survivor will probably reflect the energy and single-minded, atavistic clarity of purpose of those who did. Such a man today will be sanguine self-reliant, courageous and well integrated. He will, above all project his will to live as a sense of purpose and faith in his ultimate destiny.