You know what a roundhouse is, don't you. It's a place where old, broken-down locomotives used to go to get refurbished, inside and out, a sort of assembly-line repair operation. There aren't too many of them in use these days, but Marilyn Pollin thought it was a pretty good concept to apply to people.
Marilyn Pollin has multiple sclerosis -- in fact, has had it for 23 years, although, as is not unusual with this quixotic illness, it was not at first diagnosed.
At one point, the 53-year-old Pollin was bedridden, able only to crawl. She could barely stand up. Her head swam so she could barely communicate. She says, "I didn't have the strength to even scratch my nose. I had no power. I was like a deflated balloon. But I could still think and feel. You're caged with this disease... it's so isolating."
Before, says Pollin, she couldn't button her clothes. Now she cheerily snaps her fingers in the air to demonstrate her coordination. She travels extensively with (or sometimes without) her scientist/psychiatrist husband and recently went rafting with some friends down the Colorado River -- with two canes because she does have some problems in walking. But, says her husband, Dr. William Pollin, who is director of the National Institute of Drug Abuse, "she is the healthiest sick person I've ever known."
Marilyn Pollin is a psychiatric social worker, trained in the philosophy and psychotherapeutic school of Otto Rank, the Austrian pupil of Sigmund Freud who broke with his mentor and developed a therapy shorter than that advocated by Freud and based more on will and individual choice.
Pollin, using her Rankian training and drawing on a number of more recent "holistic" theories, therapies and techniques, has devised a course of support and educational therapy for fellow M.S. victims. She calls it the "M.S. Roundhouse," and believes that these are the techniques that have restored her health and effectively controlled, if not reversed the ravages of her own M.S.
There are many features of Rank's "will therapy" that are not far removed from today's holistic philosophies of taking responsibility for one's own health and of the scientific advances that have identified some of the mechanisms by which the mind is linked to the functioning of the body.
William Pollin admits freely that during the years he was in medical school and Marilyn was studying psychiatric social work, "I started out with feelings of disdainful superiority."
Now, he says, "through quite different pathways, we have ended up surprisingly close to each other."
Briefly and oversimplified, Marilyn Pollin's course of therapy involves:
* Meditation and autogenic techniques for deep relaxation and management of stressful situations.
* Exercises -- yoga, Feldenkrais and others.
* Imaging, based in part on the work of therapists who have been treating even patients with cancer by helping them imagine and picture their illness and then picture it being healed.
* Sketching one's illness and then sketching curative or ameliorative imaginings.
There is a reading list of the best in holistic theory and therapy, from Norman Cousins to diets to sexual options. And there is a program of counseling sessions with Pollin herself. She expects to add a group therapy program at some point in the future.
Pollin, licensed to practice psychiatric social work in Maryland, has other clients with other problems. But her great excitement nowadays is for the Roundhouse. And of course she is her own best advertisement -- enthusiastic, energetic and agile.
She emphasizes that the Roundhouse is not an alternative to established medical treatment, but a useful adjunct.(She herself has taken much more control of her illness, she notes, than she is prepared to advocate for others. But then, as she points out, she has a doctor already in the house.)
Her ideas have provoked genuine interest (tempered with some skepticism) from the Multiple Sclerosis Society and mild interest (but more skepticism) from some neurologists specializing in the treatment of multiple sclerosis.
The relation of stress, they note, to multiple sclerosis is "without scientific evidence." But they add that stress -- even rush-hour traffic stress -- can exacerbate such common M.S. symptoms as numbness, prickling, blurred vision. (Diane Afes, of the National Capital M.S. Society chapter says that a stress-management program is being instituted under the auspices of the chapter.)
Multiple sclerosis is a condition in which inflammation of the nerve sheathing can cause interruption of neural messages, creating and endless list of sometimes bizarre, sometimes crippling symptoms. Its cause is still unknown although it appears to be linked either to a slow-acting virus or an immune system malfunction.
Although there has been work on blood tests, and M.S. patients often show certain common abnormalities, there is still no way to make an absolutely positive diagnosis.
It usually strikes young adults -- Pollin was barely 30 -- and its progress is as uncertain and unpredictable as anything else about it. There are perhaps 130,000 M.S. patients, and about 9,000 new ones each year.
Dr. Dale McFarlin is a neurologist specializing in M.S. at the National Institute of Neurological and Communicative Disorders and Stroke. He sighs and says, "The tough aspect is the tremendous variation as to how the disease manifests and what happens to the patients. At one extreme you have a patient who has one attack and goes straight downhill, has widespread problems and dies in a matter of weeks. At the other end, someone may have one or two problems 20 years apart. There is some evidence that some people have attacks and never know it. In [those] between, the disease becomes chronic. The problem is, how you present all this honestly. Regardless of what you say, you can always find an exception..."
Treatment of acute phases of M.S. is generally done with administration of steroids. Most recently, there has been experimental evidence of the effectiveness of interferon. But, in general, specialists concur that it is incurable and that its crippling effects are not reversible.
Marilyn Pollin does not consider herself an exception, and she gets furious at the words "incurable" or "irreversible."
Her husband agrees.
"We are just beginning to realize the specifics of the powerful relations between positive feelings -- happiness, hopefulness -- and the biological correlates, consequences and bases of these kinds of feelings... This has been very little studied and only indirectly demonstrated in animals where it has been shown that just 10 or 15 minutes of handling in early life had powerful long-range consequences.
"I think that although it is tremendously important to be able to discover the triggering agent of any specific disease so we can develop something as effective as the Salk vaccine is for polio, for example, I am convinced that for a great many disease states, before we reach that point we can still accomplish a great deal even when we don't fully understand (the cause or cure) by maintaining feelings of optimism and hopefulness. I think this is much more than a Pollyanna-ish approach. When those feelings are truly generated, one is changing the mechanism of some as yet unrecognized disease-coping-with mechanism."
As a scientist, Pollin says that "there is no definitive, scientific way to say Marilyn might not have been in as good condition today if she'd had a different attitude. But as her husband and friend, I am personally convinced she would not have been anywhere close.
"Her approach says we don't as yet know the detailed specifics about M.S., its remissions and relapses, but there is every reason to believe that if one is able to maintain feelings of optimism, hopefulness and a sense that one can to a considerable what happens to oneself, my personal conviction is that this is not only more healthy psychologically, but it can and often does have profound physical consequences."
For information on the M.S. Roundhouse, phone Marilyn Pollin, 229-3027.
For general information on M.S. phone the National Capital Multiple Sclerosis Society, 296-5363.