A visitor to the Schweitzer Hospital at Lambarene once remarked during a dinner conversation on the good fortune of the natives then enjoying the administrations of an Albert Schweitzer rather than the traditional witch doctor. To this compliment Schweitzer responded, "The witch doctor succeeds for the same reason all the rest of us succeed. Each patient carries his own doctor inside him. We are at our best when we give the doctor who resides within each patient a chance to go to work.
These two slim volumes are addressed to the doctor within each of us.
"Anatomy of An Illness: As Perceived by the Patient," by Saturday Review editorial board chairman, Norman Cousins, details Cousins' recovery from a mysterious and rapidly progressive illness.
Cousins, who was thoroughly familiar with the known effects of negative emotions on health, began to speculate early in his illness on the possible benefits of positive emotions. "If negative, emotions produce negative chemical changes in the body, wouldn't the positive emotions produce positive chemical changes? Is it possible that love, hope, faith, laughter, confidence and the will to live have therapeutic value?"
To find out, Cousins, with the approval of his doctor, checked into a hotel instead of a hospital and began, under medical supervision, perhaps the most extraordinary series of "treatments" in the annals of medicine.
Along with massive doses of ascorbic acid (Vitamin C) Cousins' "systematic program" included laughing sessions in which he spent hours watching old Marx Brothers films and reruns of "Candid Camera." "I made the joyous discovery that 10 minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep."
After several months of this treatment, Cousins tells us, he was completely off drugs, sleeping well and sufficiently recovered to return to his job at The Saturday Review. The experience leads Cousins to conclude that "the will to live is not a theoretical abstraction but a physiologic reality with therapeutic characteristics."
Whatever else one may think of Cousins' experience, few can argue with the book's basic theme, as Rene Dubos states in his introduction: "Every person must accept a certain measure of responsibility for his or her own recovery from disease or disability." The problem is, of course, how can such a goal be achieved?
Cousins' book is a valuable contribution toward assuaging some of these difficulties, providing an entertaining and instructive example of an inspired participation on the part of a patient in his own treatment.
In "Patienthood: The Art of Being a Responsible Patient," the late Miriam Siegler and psychiatrist Humphry Osmond give specific suggestions on how doctor-patient cooperation can be further improved.
They point out that in all cultures illness unites patient and healer in a relationship wherein each possesses certain rights and duties. Patienthood, the "capacity to cope with the vicissitudes of illness," thrives best, we are told, when the patient accommodates himself to what the authors call the "sick role."
"A sick person without the sick role is rather like the man without a country. He's on his way to becoming what the Anglo-Saxons called a 'nithing,' a person without a role." Other roles described by the authors included the impaired role, the legitimate guinea pig role, the psych role and, finally, the dying role.
Difficulties may arise when a patient is cast in the wrong role. A "troubled, unhappy, conflicted or unfulfilled" person, for instance, should occupy the psych role when in fact such people frequently compose the majority of patients in a doctor's office who are misassigned to the sick role.
Equal injustice results if a person fails to have his condition diagnosed correctly and is labeled a hypochondriac, an opprobrious term that corresponds more closely to the psych role.
Siegler and Osmond's suggestions on improving the patient's lot via the assignment of appropriate roles are valuable and long overdue. But despite their brilliant analysis, there are problems in the role approach to human illness.
For one thing, roles are not always easily assignable. Many illnesses, for instance, go undiscovered for long periods of time and are frequently attributed to emotions (the sick role misdiagnosed as the psych role and vice versa).
Added to this, the assumption of roles is, on occasion, symptomatic of a flight from the reality of illness. A patient who envisions himself in a sick role or dying role does so via a curious emotional distancing process. In fact, the very term "role" implies a fundamental disbelief, a form of bad faith. No actor in his right senses, for instance, leaves the stage still caught up in his role. Implicit in his craft is the knowledge that he's acting the part of somone else. So, too, illness surely requires from a patient learning the craft of patienthood more than just the playing out of a role no matter how intelligently conceived.
Sickness and death demand a transcendence of roles, an existential encounter with whatever we've made of ourselves over the years. Perhaps our difficulty in the face of such a formidable task explains our willingness to conceal our angst within a final series of uncomfortable, limiting and ultimately unconvincing roles.