The Sickening Mind: Brain, Behaviour, Immunity and Disease. Paul Martin

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СКАЧАТЬ punish her by humiliating her at every opportunity and revelling in the spectacle of her suffering:

      … for the last three weeks or so, I had not missed an opportunity to hurt Marguerite. It was making her ill … Marguerite had sent to ask for mercy, informing me that she no longer had either the emotional nor physical strength to endure what I was doing to her.

      As a consequence of her deep unhappiness at their separation and the psychological battering she receives from Armand, the much-wronged Marguerite goes into terminal decline. Her consumption flares up and she expires. Armand realizes his error, but not until too late.⁴ As the narrator sagely concludes: ‘I have learned that one such woman, once in her life, experienced deep love, that she suffered for it and that she died of it.’ Though Marguerite dies from tuberculosis, it is her emotions that have killed her. La Dame aux Camélias was, incidentally, modelled on Dumas’ personal experience following his affair with the courtesan Marie Duplessis. Like the fictional Marguerite, Marie died of consumption not long after the affair ended.⁵

      Until the early part of the twentieth century, popular medical literature was largely in tune with fiction in the way it emphasized the importance of psychological and emotional factors in tuberculosis. To quote one everyman’s guide to medicine from the 1930s:

      Happiness is a mighty important factor in the treatment of tuberculosis … Mental brooding and loss of hope of recovery or of checking tuberculosis tends to drag the unfortunate individual into a deep chasm from which escape is rare.

      So, what happened and why have attitudes changed?

      What happened was that in 1882 the German scientist Robert Koch announced to the world that he had discovered the real cause of tuberculosis – the tubercle bacillus, Mycobacterium tuberculosis. Once it became known that tuberculosis was a bacterial infection, scientific interest in the role of psychological and emotional factors rapidly dwindled. The pendulum swung violently from the psychological to the physical. Open a contemporary medical text on tuberculosis and the chances are you will find little mention of psychology, emotions or the mind.

      A lot of the old ideas about tuberculosis were plain wrong in their assumption that mental forces were sufficient to produce the symptoms by themselves; tuberculosis is undoubtedly a bacterial infection. Moreover, identifying a specific physical cause was immensely beneficial because it enabled medical science to find an effective remedy. Improvements in social conditions in the early twentieth century, followed by the introduction of effective antibiotics after the Second World War, led to an enormous decline in the incidence of tuberculosis in industrialized nations.

      And yet it remains true that psychological and emotional factors do play a role in the disease. Later in this book we shall see how. It is not the nature of the tuberculosis that has changed, but the attitudes and interests of medical science.

CHRONIC FATIGUE SYNDROME

      The misleading distinction between illnesses that are ‘physical’ (in other words, real) and illnesses that are ‘psychological’ (and therefore by implication not real) is starkly illuminated by the furore over chronic fatigue syndrome, otherwise known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome or, if you read the tabloid press, yuppie ’flu.

      It is with some trepidation that I thrust my head into the lion’s den of controversy over the causes of chronic fatigue syndrome. Fierce arguments continue to rage and the medical establishment has yet to reach any consensus. In excess of eight hundred scientific publications have been devoted to the subject and the picture changes almost weekly. Those who suffer from the illness often have passionate views about its origins and anyone who gainsays them is asking for trouble.

      The debate about chronic fatigue syndrome is relevant here because it exemplifies the false dichotomy between ‘psychological’ and ‘physical’ origins of illness. Throughout the controversy runs a seductively misleading vein: the implicit assumption that the illness must be either physical or psychological in origin. But first, what exactly is chronic fatigue syndrome?

      Since 1988 the term chronic fatigue syndrome (CFS) has been used to describe a debilitating illness of unknown origin that has persisted for at least six months. As you probably know (for it is often in the news) CFS is characterized by a dreadful, disabling tiredness that is made worse by any physical exertion. This fatigue is accompanied by a motley assortment of other symptoms, including general malaise, intermittent fevers, pains in the joints, stiffness, night sweats, sore throats, poor co-ordination, visual problems, skin lesions and sleep disorders.

      As if that were not enough, many CFS sufferers also experience psychological problems such as severe depression, forgetfulness, poor attention and lack of concentration. CFS can persist for years and it ruins the lives of those afflicted. Often they will be forced to give up work. Sufferers may show a measure of improvement over time, but the majority remain unwell for several years.

      Cases of CFS have been reported in most industrialized nations including Britain, the USA, Canada, France, Spain, Israel and Australia. Sufferers tend to be young adults between twenty and fifty, though children can also be affected. According to the American Centers For Disease Control and Prevention, more than 80 per cent of CFS sufferers are women, most are white and their average age when the illness develops is thirty. Another common factor is that sufferers usually report having contracted some form of viral infection not long before the syndrome manifested itself.

      As yet, no one has come up with a truly effective remedy for CFS. None of the drugs that have been used to treat the syndrome is of proven effectiveness and some may do more harm than good.

      CFS, as currently defined, is a relatively recent phenomenon. (But then, so is AIDS; the fact that a disorder has only recently been recognized and defined does not detract from its reality.) Records of vaguely CFS-like syndromes, involving severe fatigue, muscle pains and other symptoms, date back at least two centuries. The medical history books, however, contain nothing that can be unequivocally compared with CFS before the second half of the nineteenth century, when neurasthenia became a common diagnosis. Incidentally, cultural stereotypes about the sort of person who was susceptible to neurasthenia were as strong in the nineteenth century as they are now about CFS. Neurasthenia was said to be a disease of affluent middle-class women, in much the same way that CFS has been inaccurately portrayed by the popular media as ‘yuppie ’flu’, a disease of affluent thirtysomething professionals.

      It was not until the first half of the twentieth century that reports of a disorder corresponding to CFS started to accumulate. The first well-documented outbreak of a CFS-like disorder occurred in the 1930s in the USA and was attributed to a mystery virus. A similar mystery ailment afflicted the staff of a London hospital in 1955, in what became known as the Royal Free epidemic. The sufferers experienced persistent muscle pain and fatigue. To begin with the syndrome was referred to as benign myalgic encephalomyelitis. By 1956, however, it had proved to be anything but benign, and so it became known simply as myalgic encephalomyelitis, or ME.

      Since they first appeared on the medical map, CFS-like illnesses have gone by a baffling variety of names including epidemic neuromyasthenia, neurasthenia, Iceland disease, Royal Free disease, atypical poliomyelitis, fibrositis, fibromyalgia, post-infectious neuromyasthenia, post-viral fatigue syndrome and myalgic encephalomyelitis. It is not certain that all these illnesses have been identical with what is now referred to as chronic fatigue syndrome. An analysis of twelve well-documented outbreaks of CFS-like disorders found they differed in various respects, notably with regard to neurological problems.

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