The Meaning of Illness (Jan/Feb 2006)

Friday, 01 April 2011 17:56

Openmind January/February 2006  

It is extraordinary that, at a time when there is less disease and people live longer than at any other time in our history, amongst those who seek medical help, up to forty per cent of them have illnesses which may be given names like irritable bowel syndrome or fibromyalgia (niggling pains and tender areas in the large muscles of the back, neck and shoulders) but for which there is no identifiable cause. 'Literally millions of people are racked by back pain, tormented by abdominal gripes, alarmed by ringing in the ears, tortured by headaches, exhausted by sleep deprivation, frustrated with constipation, debilitated with nausea or faintness or anorexia, overwhelmed by the burden of obesity, terrified by shortness of breath or palpitations or just too sick and too tired to cope.' 

This is how the consultant physician and psychoanalytical psychotherapist Nick Read described what might be called an epidemic of functional illnesses. Doctors divide illnesses into functional and organic. Organic illnesses have a clearly defined pathology, each with a particular set of symptoms and organic changes which can be demonstrated in reliable tests. Functional illnesses have a wide variety of symptoms varying from person to person and in which few organic changes can be reliably demonstrated. People with functional illnesses may be given a many medical tests, and they may try every form of complementary medicine, but no physical cause of their symptoms is discovered and little relief gained. These are the illnesses which  Read studies, and the subject of his new book Sick and Tired: Healing the Illnesses Which Doctors Cannot Cure.  

Early in his work as a physician Dr Read found that many of the patients sent to him not only had a functional illness but that they seemed to suffer more distress in their lives than patients with organic illnesses. Now surveys have confirmed this impression. These surveys 'have shown clearly that patients with functional syndromes score more highly for anxiety and depression than healthy people or people with organic illnesses. They also tend to have experienced more threatening life events. For example, psychological distress is more prevalent in fibromyalgia than rheumatoid arthritis, and in irritable bowel syndrome compared with Crohn's disease or ulcerative colitis.'  

In his examination of how the world has changed since the end of the Second World War Dr Read shows how life is full of uncertainty and anxiety for a great many people. But, if it was just our way of living which led to functional illness, than all of us would be ill. By taking the time to listen to his patients and ask good questions Dr Read uncovered those ways of thinking which lead to suffering. His patients did not value and accept themselves, they viewed the world negatively and always expected the worst. The answer to the question why these ways of thinking led these people to a functional illness lay in the story of each person's life. There had been a crisis and a loss which were hugely significant to the person, yet the person did not want to admit this significance to himself. He felt that if he did so his life and his very being would fall apart. 

In his book Dr Read went to great pains to emphasise that 'in the whole of my medical career, I have yet to meet anybody I thought was imagining their symptoms, or making them up, but I have met thousands upon thousands of ill people who are struggling desperately to protect themselves from the potentially mind-shattering effects of unbearable life situations. These people don't deserve to be dismissed with a diagnosis that cannot be treated. Their illness needs to be understood as a state of disharmony involving the whole person - mind, body, spirit - within their particular social environment. And they need to be helped to uncover its meaning and to find an appropriate resolution for what caused it.' 

 Read illustrated this in his concise re-telling of some of his patients' stories. There was James, the solicitor, whose rumbling guts were reminders of his guilt about his dubious deals and forged accounts; Alison whose illness disappeared after she vented on Dr Read the lifetime of anger she'd kept hidden from her uncaring family; Peter for whom the mere thought of having to meet people made him feel he had to rush to the toilet and who had 'forgotten' a highly embarrassing incident at school involving bullies and an insensitive teacher; and Malcolm whose stomach pain was a defence against and a reminder of his unacknowledged guilt for his sister's death.  

It's been known for some time that loss, grief and depression often precede the organic illnesses of cancer and heart disease. Perhaps what is extraordinary is that many people, including doctors, still don't understand that mind and body are indivisible. 

Nick Read Sick and Tired: Healing the Illnesses That Doctors Can't Cure Weidenfeld and Nicolson, London, 2005.