Anatomy of an Illness as Perceived by the Patient Read Online Free PDF Page A

about in the press.
    Because of the very real dangers associated with powerful new drugs, the prudent modern physician takes full advantage of his freedom of choice, specifying potent drugs when he feels they are absolutely necessary, but disregarding them, prescribing placebos or nothing at all, when they are not.
    A hypothetical illustration of how a placebo works is the case of a young businessman who visits his doctor and complains of severe headaches and abdominal pains. After listening carefully to the patient describe not only his pains but his problems, the physician decides that the businessman is suffering from a common disease of the twentieth century: stress. The fact that stress doesn’t come from germs or viruses doesn’t make its effects any the less serious. Apart from severe illness, it can lead to alcoholism, drug addiction, suicide, family breakdown, joblessness. In extreme form, stress can cause symptoms of conversion hysteria—a malaise described by Jean Charcot, Freud’s teacher. The patient’s worry and fears are converted into genuine physical symptoms that can be terribly painful or even crippling.
    In sympathetic questioning, the doctor learns that the businessman is worried about the ill health of his pregnant wife and about newly hired young people in his office who seem to him to be angling for his job. The doctor recognizes that his first need is to reassure the patient that nothing is fundamentally wrong with his health. But he is careful not to suggest in any way that the man’s pains are unreal or not to be taken seriously. Patients tend to think they have been accused of having imagined their symptoms, of malingering, if their complaint is diagnosed as being psychogenic in origin.
    The doctor knows that his patient, in accordance with convention, would probably be uncomfortable without a prescription. But the doctor also knows the limitations of medication. He is reluctant to prescribe tranquilizers because of what he believes would be adverse effects in this particular case. He knows that aspirin would relieve the headaches but would also complicate the gastro-intestinal problem, since even a single aspirin tablet can cause internal bleeding. He rules out digestive aids because he knows that the stomach pains are induced by emotional problems. So the doctor writes a prescription that, first of all, cannot possibly harm the patient and, secondly, might clear up his symptoms. The doctor tells the businessman that the particular prescription will do a great deal of good and that he will recover completely. Then he takes time to discuss with his patient possible ways of meeting the problems at home and at the office.
    A week later the businessman telephones the doctor to report that the prescription has worked wonders. The headaches have disappeared and the abdominal pains have lessened. He is less apprehensive about his wife’s condition following her visit to the obstetrician, and he seems to be getting along better at the office. How much longer should he take the medicine?
    The doctor says that the prescription will probably not have to be refilled but to be sure to telephone if the symptoms recur.
    The “wonder” pills, of course, were nothing more than placebos. They had no pharmacological properties. But they worked as well as they did for the businessman because they triggered his body’s own ability to right itself, given reasonable conditions of freedom from stress and his complete confidence that the doctor knew what he was doing.
    Studies show that up to 90 percent of patients who reach out for medical help are suffering from self-limiting disorders well within the range of the body’s own healing powers. The most valuable physician—to a patient and to society—knows how to distinguish effectively between the large number of patients who can get well without heroic intervention and the much smaller number who can’t. Such a