Why Do People Get Ill?
by Darian Leader and David Corfield
Hamish Hamilton £16.99, pp376
After collapsing in an art gallery, a man is rushed to hospital. He has palpitations, chest pain and is short of breath. He is certain he is about to die of heart failure. But none of the drugs his worried doctors provide eases his problems. Finally, after months, he tries acupuncture and - eureka! - his symptoms dissipate, as does his anxiety.
Does this prove acupuncture works? Yes and no. As the authors of this fascinating book argue, neither the cause of illness nor its cure is straightforward. A fast diagnosis combined with prescriptions from Big Pharma may sometimes suit and often not. Patients sometimes need a particular illness.
Our heart patient had a story accompanying his collapse. It is this sort of story, like the timing of the onset of an ailment, that few doctors inquire about. He had secretly been seeing a lover and had always done so in a private place, but that week's rendezvous had brought them into the public spotlight of the gallery. Here, in the middle of their embrace, he had glimpsed someone who reminded him of a friend of his wife's. He passed out, struck by heart pain. Nothing helped relieve it until he tried acupuncture. Talking of its efficacy, he repeated excitedly how like torture the treatment was, 'a terrible punishment'.
Whatever the benefit - or lack of it - of acupuncture, in this case it worked because it functioned as a punishment for the patient's clandestine affair and assuaged his guilt. Much successful medicine may work, or not, for the same subterranean reasons. Illness and cure are rarely as simple as the 'single cause' on which much medicine is based.
The evidence, the cases and the statistics that psychoanalyst Darian Leader and science historian David Corfield use add up to a wholesale attack on our medical system and its increasingly 'scientific' bias. This assumes that body and mind are utterly separate entities which never speak to each other. But the dialogue is constant, if necessarily unconscious and, as Leader and Corfield are careful to elaborate, can start at either end. A cancer may make itself evident only after a near one's death, though it has been growing for years, or a child may develop a diabetes that is the sign of her identification with an absent father.
The activity of our immune system turns out to be closely allied to the network of nerves and brain and is markedly influenced by events in our lives. Bereavement can make us susceptible to illness, just as a split with a partner can, indeed, result in a broken heart.
Leader and Corfield's argument seems to point to a need for a resident talk therapist in every practice, who would be alert to all sides of a patient's life and might alleviate some of those intractable symptoms, even though he or she might prove as blind to the body as the harried GP is to the mind. Psychoanalyst Jacques Lacan, who informs some of the thinking here, noted that psychoanalysis had become the last bastion of traditional medicine in which the medic listened carefully to the patient's needs.
But what this compelling volume calls for is a reconsideration of doctors' training. A mid-20th century tradition of psychosomatic medicine pointed the way, as did the brilliant Michael Balint who so influenced the early NHS with his pioneering GPs' meeting groups. Like the country doctor in John Berger's A Fortunate Man, who was intimate with his patient's lives, GPs today might be better shaped by a background in literature and philosophy than one in chemistry and physics. This might more adequately prepare them for their patient not as a replica of the corpse in the pathology unit but as a living being.
One could add that a generous dollop of the liberal arts might serve the talking therapies as well. That endlessly inventive being who is the patient may now be better served by a reading group than a visit to a formula-bound therapist. Come to think of it, though not fictional, the ingenious patients in this book could well serve as subjects for discussion.
