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

‘deviance, clinically or epidemiologically defined, is normal’. This emphasis on positive health, as opposed to the mere absence of disease, is reflected in the explosion of interest in complementary or alternative medicine.

      Huge advances in living conditions and medical knowledge have brought about large increases in life expectancy in many countries during the course of the twentieth century. Yet despite this we are apparently a sick bunch and getting sicker – if, that is, we define sickness in terms of perceptions and behaviour as opposed to objective measures of physical health.¹ Studies conducted in the USA in the late 1920s found an average of eight reported episodes of sickness for every ten people surveyed over a period of several months, whereas in the early 1980s the comparable figure was twenty-one sicknesses: an increase of 160 per cent. If we define sickness as seeking medical attention then the average person nowadays is ‘sick’ more than twice a year, compared with less than once a year in the 1920s. To be sick is normal.

      Of course, what has increased over the decades is not the true incidence of diseases: it is our sensitivity to aches and pains; our tendency to ascribe them to physical diseases; our reluctance to put up with them; and our readiness to seek expert medical care.

      Perish the thought, but just occasionally some of us have been known to concoct a tactical minor illness to get ourselves out of a predicament – perhaps as an excuse to avoid a dire social occasion or, less blatantly, to justify our poor performance in an exam, at work or in our personal relationships. Outright lying need not be involved. Gentle self-delusion is all that is needed. When sickness becomes an escape route from an unpleasant situation or embarrassment it is all too easy to convince ourselves that the symptoms are genuine. The ‘sore throat’ that conveniently gets the anxious child out of having to perform in the school concert can feel like a real sore throat.

      Our minds, like Colin Craven’s, can exaggerate the severity and significance of symptoms, causing us unnecessary distress and wasting doctors’ time. But perceptions can shift in the opposite direction as well. An inert placebo ‘drug’ will often produce startling improvements in a patient’s symptoms – provided the patient believes it to be a real medicine and expects it to have a beneficial effect. (We shall be revisiting the placebo effect later; it is yet another example of why the mind cannot be divorced from bodily health, even when we are dealing with apparently straightforward physical diseases.)

      We all have the capacity unconsciously to blot out things we find too uncomfortable or upsetting to think about. This psychological defence mechanism is known as denial. However, the mind’s ability to belittle or even ignore symptoms is something of a mixed blessing. Being excessively stoical or negligent about your own health is risky.

      When people react to illness by denying the reality of their symptoms they may save themselves the unpleasantness of confronting an unpalatable reality. But their denial can be positively dangerous if it prevents them from seeking timely medical attention. A woman who fails to notice a lump in her breast, for example, or chooses to disregard it until her breast cancer is at an advanced stage, may pay for her insouciance with her life.

      It is an unfortunate fact that people are less likely to seek medical help if it is difficult, inconvenient or embarrassing for them to do so – perhaps because they are too busy, or cannot afford the fees, or because they are simply afraid of calling a doctor out on a false alarm. Heart attacks are notoriously more likely to prove fatal at weekends, when it is inconvenient or potentially embarrassing to seek expert medical help. The lives of countless heart attack victims might have been saved had they not incorrectly attributed their chest pains to indigestion.

      The disastrous consequences of denial are sombrely portrayed in Arnold Bennett’s Riceyman Steps. The tightfisted Clerkenwell bookseller Henry Earlforward has cancer of the stomach but steadfastly denies that he is ill. Earlforward insists that it is merely a temporary indisposition and that he has a constitution of iron.

      For a long time Earlforward’s wife interprets his lack of interest in food as a symptom of his miserliness rather than any medical problem. Even when it becomes obvious that the emaciated bookseller is gravely ill he obstinately refuses to be examined by a doctor, let alone admitted into hospital. His wife rails at him for concealing from her the seriousness of his illness until it is too late to do anything about it. She tries hard to persuade Henry to accept medical help, but is forced to concede for ‘nobody can keep on fighting a cushion for ever’. Faced with Henry’s bland obstinacy, his wife and doctor eventually abandon their attempts to help him and he dies from his cancer – a victim of his own misplaced psychological defences.

      Whether or not an illness has psychological origins it will certainly have psychological consequences. Feeling ill for any length of time is a psychologically debilitating experience. One of the simple but important ideas I hope to convey in this book is that the relationships between mind, body and disease work both ways. The mind affects the body and hence physical health. Conversely, physical health affects the mind and hence our thoughts, emotions and behaviour.

      All but the most trivial of illnesses produce some sort of emotional reaction, whether it be mild irritation, anxiety, anger, denial or depression. Other things being equal, a serious illness should provoke a more intense emotional reaction than a minor illness. But other things seldom are equal. Illness means different things to different people, and just because an illness is not life-threatening this does not mean the sufferer will be emotionally untouched by it. An individual who has never before experienced any significant illness, pain or discomfort may be upset by relatively minor symptoms which would seem insignificant to someone who has suffered a string of serious diseases.

      Our emotional responses to illness can have a crucial bearing on our recovery and future health. If being ill makes us depressed we may become careless about adhering to our doctor’s advice or taking our medicine. This may, in turn, impede recovery. Whether or not a cancer patient adheres strictly to a programme of radiotherapy or chemotherapy can have a major impact on their chances of survival. There are patients who simply give up and sink into decline.

      In extreme cases the emotional reaction to an illness can prove a bigger problem than the illness itself. Severe depression is far more debilitating and intrusive than many physical ailments. As we shall see in the next chapter, severe depression can also have detrimental effects on immune function and subsequent health, creating a spiral of decline. Doctors and patients ignore the psychological and emotional consequences of illness at their peril.

      Finally, please do not go away with the impression that an individual’s perception of their own health is an entirely meaningless or deceptive index, indicating only their degree of hypochondria. On the contrary. Research has shown that in certain respects perception is a good guide to reality. Although our subjective judgement is not always an accurate index of our current state of health, it does provide a reasonably good predictor of our long-term risk of dying prematurely. Depressing though it may be if you are an arch hypochondriac, the research indicates that people who believe they are unhealthy do die younger on average. Moreover, perceptions are clearly important for practical and economic reasons: people’s perceptions of their health, rather than objective measures of health, are what largely determine their initial usage of medical facilities.

      

Bad behaviour

      Sex and drugs and rock and roll

      Is all my brain and body need

      Ian Dury, ‘Sex and Drugs and Rock and Roll’ (1977)

      A cousin of mine who was a casualty surgeon in Manhattan tells me that he and his colleagues had a one-word nickname for bikers: Donors. Rather chilling.

      Stephen Fry, Paperweight (1992)

      Our minds can have a profound impact on the physical health of our bodies by altering the way we behave. Psychological and emotional factors can dispose us to do all manner of unhealthy and self-destructive things. The self-destruction may be absolute