Anatomy of an Illness

This is such a good book – and scarcely less relevant that when it was first published over twenty years ago – that I thought it needed an updated review, especially as this was the first chance I have had to read it. Many readers will know of the book and its influence. It tells the story of Norman Cousins' recovery from a serious collagen (connective tissue) condition. It is 1964 and he has just returned from a gruelling trip to the Soviet Union in which he has suffered all kinds of stressful situations and comes back exhausted. Within a week he is in a critical condition and is admitted to hospital with a very high sedimentation rate (88 rising to 115) – this measures the rate at which red blood cells settle in a test tube in mm per hour. He is subjected to numerous separate blood tests and the hospital nutritional regime, observing that 'a hospital is no place for a person who is seriously ill'.

His doctor, Dr. William Hitzig, informs him that his chances of recovery are around 1 in 500, prompting him to 'get in on the act'. He reviews the circumstances leading up to his condition – these reflections are most interesting in themselves – and concludes that he is in a state of adrenal exhaustion. Given his knowledge of Hans Selye's work on stress, he wonders what the effect of positive emotions might be on his adrenal glands and endocrine system. He is also concerned about the effects of his medication, especially the pain-killers and speculates about the possible benefits of large doses of Vitamin C. He enlists the help and support of his doctor and begins a combination of laughter therapy (ten minutes of belly laughter give him two hours of pain free sleep) and massive intravenous doses of Vitamin C. It all works and leads him to a number of carefully considered conclusions – he is reticent about making 100% causal connections – including that 'the will to live is not a theoretical abstraction, but a physiologic reality with therapeutic characteristics'.

The next chapters discusses the placebo effect – 'not so much a pill as a process' – discussing the research available at the time, which has of course advanced considerably in the intervening period. At the end of the chapter he recounts an episode with Dr. Albert Scheweitzer when he had taken him to observe the methods of a witch doctor, introduced by the great man as 'one of his colleagues'. On the way back Schweitzer explains that there are three types of condition: first, those with functional disturbances treated successfully with herbs (and placebo); secondly, psychogenic problems treatable with African psychotherapy; and thirdly, serious physical problems that are referred on to Schweitzer himself. He then observes: 'the witch doctor succeeds for the same reason all the rest of us succeed. Each patient carries his own doctor within him. They come to us not knowing that truth. We are at our best when we give the doctor that resides within each patient the chance to go to work'.

This leads on to an inspirational chapter on creativity and longevity, focusing on Pablo Casals and Schweitzer. He met them both when they were in their eighties, still brimming with purpose and will to live. Both were musicians, and both were devoted to Bach, playing his music every day. Music was their medicine, but also humour. Cousins recalls an amusing incident where Schweitzer reports that, 'as everyone knows, there are only two automobiles within seventy-five miles of the hospital. This afternoon the inevitable happened; they collided. We have treated the drivers for their superficial wounds. Anyone who has reverence for machines may treat the cars'.

Cousins now goes on to more general considerations about holistic health and healing, nearly all of which is as relevant today as twenty years ago. What I found especially useful was his discussion of what it is reasonable and unreasonable for a physician to do – for instance reasonable to respect the power of the mind in overcoming disease, but unreasonable to accord those approaches monopoly status; reasonable to accept the need for vitamin supplementation, but unreasonable to take the view that all diseases are a manifestation of vitamin deficiency. In other words, moderation and balance is required, involving reasonableness (and exchange) on the part of physicians, holistic practitioners and patients. Partnership is the key word.

To his astonishment, when the first chapter was published in the New England Journal of Medicine, Cousins received 3,000 responses – mostly favourable – from physicians. They agreed with the basis of his approach and showed an openness to use of the powerful recuperative powers of the body. However he also relates cases of a 'hardening of the categories' where doctors go 'quack quack' when they hear evidence of the therapeutic effects of Vitamin C, and an instance where a lawyer successfully gets her daughter to absorb large quantities disguised as ice cream! And another of his own episodes concerning insurance diagnosis of a heart condition is instructive, leading him to comment that 'some experts don't really know enough to make a pronouncement of doom on a human being'. He hoped that they 'would be careful about what they said to others; they might be believed and that could be the beginning of the end'. This is truly a classic book that should be read by all medical students and physicians, but also by anyone interested in a sound introduction to mind-body medicine.