About 10 years ago, an improbable article about an improbable medical recovery launched an improbable second career for Norman Cousins.
Already well known in literary circles as longtime editor of the Saturday Review -- and a legendary perpetrator of April Fool's Day spoofs -- Cousins wrote an article titled "Anatomy of an Illness (As Perceived by the Patient)" in The New England Journal of Medicine.
Cousins' article chronicled his remarkable recovery from a severe and life-threatening disease of the connective tissue called degenerative collagen illness. He was hospitalized in 1964 with severe pain, high fever and near-paralysis of the legs, neck and back.
"Being unable to move my body was all the evidence I needed that the specialists were dealing with real concerns," he wrote. "But deep down, I knew I had a good chance and relished the idea of bucking the odds."
He did.
The key to his recovery, he said, was a powerful drug called laughter.
"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," he wrote.
Flat on his back in a New York hospital, Cousins persuaded the nurses to read him excerpts from the humor columns of E.B. White and Max Eastman and show him "Candid Camera" reruns and old Marx Brothers movies.
It's not often that The New England Journal, must reading for the nation's physicians, prints a six-page article by a layperson extolling the curative virtues of megadoses of laughter and Vitamin C. The article drew some 5,000 letters, more than anything Cousins had ever written, including 31 years worth of signed editorials on the arms race, world affairs, air pollution and other weighty topics in the Saturday Review.
"We launched Cousins' second career," said Dr. Arnold S. Relman, editor of The New England Journal, adding that he has had some "mixed feelings" since then.
In that "second career," Cousins has written two books, including an expanded version of the journal article, "Anatomy of an Illness," and "The Healing Heart," which describes the "healing partnership" with his doctor which helped him recover from the heart attack he suffered in 1980. He also joined the faculty of the University of California at Los Angeles School of Medicine as a researcher in the biochemistry of emotions and professor of medical humanities.
Cousins, 71, is to speak tonight on "New Dimensions in Healing" at a benefit for the St. Francis Center, a nondenominational organization that helps patients and their families cope with death and bereavement. The talk will be at 6 p.m. at the Washington Hebrew Congregation, Massachusetts Avenue and Macomb Street NW.
"It is quite possible that this treatment -- like everything else I did -- was a demonstration of the placebo effect," Cousins wrote. But if so, the placebo -- "the doctor who resides within" -- was a powerful one.
"I was greatly elated by the discovery that there is a physiologic basis for the ancient theory that laughter is good medicine," Cousins wrote.
Not everyone was convinced.
"I'm of two minds about Mr. Cousins," said Relman, who became editor of the journal the year after Cousins' article was published.
"I agree with the basic verities he articulates, but I'm concerned that much of what he says appears to take an anti-scientific, irrational approach to medicine that would seek to turn the clock back.
"There is no doubt that an optimistic and determined patient handles the vicissitudes of illness better than one who is depressed, negative and unhappy and defeatist about his illness. It's also true that physicians who try to be emotionally supportive and deal honestly with patients as human beings are more likely to be successful than those who take an impersonal and distant approach.
"All that is true, and I admire Mr. Cousins for saying so in a persuasive and articulate manner.
"On the other hand, he sometimes appears to be saying that that's all there is to it -- that an upbeat attitude will cure a dread disease. There's no evidence that one's positive frame of mind will cure cancer. All the wishing and hopes and claims to the contrary will not make it so."
Cousins himself knows that his message can be misunderstood and oversimplified.
"We mustn't regard any of this as a substitute for competent medical attention," he said in an interview. "But the doctor can only do half the job. The other half is the patient's response to the illness.
"What we really mean by a patient's responsibility is that we've got vast powers that are rarely used. It's important to avoid defeatism and a sense of panic and despair. But that's not an excuse for not seeking medical help."
Cousins is "troubled" by the term "holistic health" because it polarizes the field into two "armed camps." Actually, he said, the idea of taking into account the whole patient -- both mind and body -- is an ancient medical tradition dating back at least to Hippocrates.
He also said the term "holistic health" is so all-inclusive as to become almost meaningless.
"It tends to become a pretty large tent," he said. "At some of these holistic health meetings, you find booths for palmistry and astrology and pyramidology. I'm not sure that having all those camels in the tent is going to advance the cause of effective treatment."
As for criticism of his book, Cousins said he has no quarrel with scientists who demanded more "hard evidence" to document the link between psychological emotions and physiological symptoms. At UCLA, he is on a research task force -- including immunologists, endocrinologists and psychologists -- looking into these very questions.
The UCLA task force has studied the cases of more than 300 cancer patients, Cousins said. While the research has not been published yet, he said preliminary findings suggest that the symptoms tend to intensify and worsen at the time of diagnosis, because of the fear and panic prompted by the label "cancer."
"I'd much rather take my chances with hope than with despair," he said.
In his "first" career, Cousins was a magazine editor, author of more than a dozen books, eloquent advocate of disarmament and international law, and cochairman of the National Committee for a Sane Nuclear Policy.
And, through it all, a merry prankster who once described himself to The New York Times as "a man who loves to goof off."
"UNFORTUNATE COMPUTER ERROR HAS RESULTED IN 118,000 bra cups in rectangular shape . . ." ran an ad at the top of the personals column of Saturday Review a few years ago during the week before April Fool's Day. "Probably good as cigar ashtrays or for storing playing cards . . . Rounder-than-Round Bra Co."
The year before, several editors had been momentarily dismayed by an authentic-looking notice from the printer that 300,000 copies of the magazine had been accidentally printed upside down. Another time, the publisher ordered a frankfurter from the office vendor, smeared it with mustard and bit into a rubber hot dog. He knew instantly who was behind it.
"Cousins," he muttered. Cousins joined the UCLA faculty in 1978, but it wasn't until "just the other night," he said a little sheepishly, that he discovered he had become a Californian. A devoted Boston Red Sox fan for decades, he suddenly found himself rooting for the California Angels last week in their American League championship series against the Red Sox.
At 71, and more than 20 years after his nearly fatal illness, Cousins said he feels no residual effects. He plays tennis several times a week, and rarely goes a week without a round of golf (handicap: 16).
"I can still drive a golf ball 200 yards, and I still get a big kick out of seeing that ball take off like a homesick angel."
He has nothing against retirement, but regards boredom as the "one of the most dangerous diseases" in our civilization.
"The body has to be used. You have to be needed. Your mind has to be activated. There's got to be something you have to do next Tuesday. We're not machines. We prosper when we have things that light up our minds."
Seriousness and laughter, reading and writing, sports and April Fool's jokes still light up Norman Cousins' mind.
"I enjoy life," he said. "I have complete mobility. The hips move, the legs move, the arms move . . .
"I think I had better stop there."