Anatomy of an Illness (as perceived by the patient)

Ever since the publication of Adam Smith’s much-talked about Powers of the Mind some months ago, people have written to ask whether his account of my recovery from a supposedly incurable illness’ was accurately reported. In particular, readers have been eager to verify Mr. Smith’s statement that I “Iaughed” my way out of a crippling disease that doctors believed to be irreversible.

I have not written until now about my illness, which occurred in 1964, largely because I was fearful of creating false hopes in other persons similarly afflicted. Moreover, I knew that a single case has small standing in the annals of medical research. I had thought that my own episode might have anecdotal value nothing
more. However, since my case has surfaced in the public press, I feel justified in providing a fuller picture than was contained in Mr. Smith’s account.

In August, 1964, I flew home from a trip abroad with a slight fever. The malaise, which took the form of a general feeling of achiness, rapidly deepened. Within a week it became difficult to move my neck, arms, hands, fingers and legs. I was hospitalized when my sedimentation rate hit 80 mm per hour. The sedimentation rate continued to rise until it reached 115.

There were other tests, some of which’ seemed to me to be more of an assertion of the clinical capability of the hospital than of concern for the well-being of the patient. I was astounded when four technicians from four different departments took four separate and substantial blood samples on the same day. That the
hospital didn’t take the trouble to coordinate the tests, using one blood specimen, seemed to me inexplicable and irresponsible. When the technicians came the second day to fill their containers with blood for processing in separate laboratories, I turned them away and had a sign posted on my door saying that I would give just one specimen every three days and that I expected the different departments to draw from it for their individual needs.

I had a fast-growing conviction that a hospital was no place for a person who was seriously ill. The surprising lack of. respect for basic sanitation, the rapidity with which staphylococci and other pathogenic organisms can run through an entire hospital, the extensive and sometimes promiscuous use of x-ray equipment, the seemingly indiscriminate administration of tranquilizers and powerful painkillers, more for the convenience of hospital staff in managing patients than for therapeutic needs, and the regularity with which hospital routine takes precedence over the rest requirements of the patient (slumber, when it comes for an ill person, is an uncommon blessing and is not to be wantonly interrupted) – all these and other practices seemed to me to be critical shortcomings of the modem hospital.

Perhaps the hospital’s most serious failure was in the area of nutrition. It was not just that the meals were poorly balanced; what seemed inexcusable to me was the profusion of processed foods, some of which contained preservatives or harmful dyes. White bread, with its chemical softeners and bleached flour, was offered with every meal. Vegetables were often over-cooked and thus deprived of much of their nutritional value. No wonder the 1969 White House Conference on Food, Nutrition, and Health’ made the melancholy observation that the great failure of medical schools is that they pay so little attention to the science of nutrition.

My doctor did not quarrel with my reservations about hospital procedures. I was fortunate to have as a physician a man who was able to put himself in the position of the patient. Dr. William Hitzig supported me in the measures I took to fend off the random sanguinary assaults of the hospital laboratory attendants.

We had been close friends for more than 20 years, and he knew of my own deep interest in medical matters. We had often discussed articles in the medical press, including the New England Journal of Medicine and Lancet. He felt comfortable about being candid with me about my case. He reviewed the reports of the various specialists he had called in as consultants. He said there was no agreement on a precise diagnosis. There was, however, a general consensus that I was suffering from a serious collagen illness. I had considerable difficulty in moving my limbs and even in turning over in bed. Nodules appeared on my body, gravel-like substances under the skin, indicating the systemic nature of the disease. At the low point of my illness, my jaws were almost locked.

Dr. Hitzig called in experts from Dr. Howard Rusk’s rehabilitation clinic in New York. They confirmed the general opinion, adding the more particularized diagnosis of ankylosing spondylitis.

I asked Dr. Hitzig about my chances for full recovery. He levelled with me, admitting that one of the specialists had told him I had one chance in 500. The specialists had also stated that he had not personally witnessed a recovery from this comprehensive condition. All this gave me a great deal to think about. Up to that time, I had been more or less disposed to let the doctors worry about my condition. But now I felt a compulsion to get into the act. It seemed clear to me that if I was to be that “one case in 500” I had better be something more than a passive observer.

I asked Dr. Hitzig about the possible cause of my condition. He said that it could have come from anyone of a number of causes. It could have come, for example, from heavy-metal poisoning, or it could have been manifested by the aftereffects of a streptococcal infection.

I thought as hard as I could about the sequence of events immediately preceding the illness. I had gone to the Soviet Union in July, 1964, as chairman of an American delegation to consider the problems of cultural exchange. The conference had been held in Leningrad, after which we went to Moscow for supplementary meetings. Our hotel was in a residential area. My room was on the second floor. Each night a procession of diesel trucks plied back and forth to a nearby housing project in the process of round-the-clock construction. It was summer, and our windows were wide open. I slept uneasily each night and felt somewhat nauseated on arising. On our last day in Moscow, at the airport, I caught the exhaust spew of a large jet at point-blank range as it swung around on the tarmac.

As I thought back on that Moscow experience, I wondered whether the exposure to the hydrocarbons from the diesel exhaust at the hotel and at the airport had anything to do with the underlying cause of the illness. If so, that might account for the speculations of the doctors concerning heavy-metal poisoning. The trouble with this theory, however, was that my wife, who had been with me on the trip, had no ill effects from the same exposure. How likely was it that only one of us would have reacted adversely? There were two possible reasons, it seemed to me, for the different responses. One had to do with individual allergy. The second was that I was probably in a condition of adrenal exhaustion and I was less apt to tolerate a toxic experience than someone whose immunologic system was fully functional.

Was adrenal exhaustion a factor in my own illness? Again, I thought carefully. The meetings in Leningrad and Moscow had not been casual. Paper work had kept me up late nights. I had ceremonial responsibilities. Our last evening in Moscow had been, at least for me, an exercise in almost total frustration. A reception had been arranged by the chairman of the Soviet delegation at his dacha, located 50 to 65 km outside the city. I had been asked if I could arrive an hour early so that I might tell the Soviet delegates something about the individual Americans who were coming to dinner. The Russians were eager to make the Americans feel at home, and they had thought such information would help them with the social amenities.

I was told that a car and driver from the government automobile pool in Moscow would pick me up at the hotel at 3:30 p.m. This would allow ample time for me to drive to the dacha by 5:00 p.m., when all our Russian conference colleagues would be gathered for the social briefing. The rest of the American delegation would arrive at the dacha at 6:00. At 6:00, however, I found myself in open country on the wrong side of Moscow. There had been a misunderstanding in the transmission of directions to the driver, the result being that we were some 130 km off course.

We didn’t arrive at the dacha until 9:00 p.m. My host’s wife looked desolate. The soup had been heated and reheated. The veal was dried out. I felt pretty wrung out myself. It was a long flight back to the States the next day. The plane was overcrowded. By the time we arrived in New York, cleared through the packed customs counters, and got rolling back to Connecticut, I could feel an uneasiness deep in my bones. A week later I was hospitalized.

As I thought of my experience abroad, I knew that I was probably on the right track in my search for a cause of the illness. I found myself increasingly convinced. as I said a moment ago, that the reason I was hit hard by the diesel and jet pollutants, whereas my wife was not, was that I had had a case of adrenal exhaustion, lowering my resistance. Assuming this hypothesis was true, I had to get my adrenal glands functioning properly again and to restore what Walter Cannon, in his famous book The Wisdom of the Body,’ called homeostasis.

I knew that the full functioning of my endocrine system – in particular, the adrenal glands – was essential for combating severe arthritis or, for that matter, any other illness. A study I had read in the medical press reported that pregnant women frequently have remissions of arthritic or other rheumatic symptoms. The reason is that the endocrine system is fully activated during pregnancy.

How was I to get my adrenal glands and my endocrine system, in general, working well again – both physically and emotionally? I remembered having read, 10 years or so earlier, Hans Selye’s classic book, The Stress of Life. With great clarity, Selye showed that adrenal exhaustion could be caused by emotional tension, such as frustration or suppressed rage. He detailed the negative effects of the negative emotions on body chemistry. He wrote, for example, about the increase of hydrochloric acid in the stomach. He also traced changes in corticoids and anti-corticoids under conditions of emotional stress.

The inevitable question arose in my mind: What about the positive emotions? If negative emotions produce negative chemical changes in the body, wouldn’t the positive emotions produce positive chemical changes? It is possible that love, hope, faith, laughter, confidence and the will to live have therapeutic value? Do chemical changes occur only on the downside?

Obviously, putting the positive emotions to work is nothing so simple as turning on a garden hose. But even a reasonable degree of control over my emotions might have a salutary physiologic effect. Just replacing anxiety with a fair degree of confidence would be helpful.

A plan began to form in my mind for systematic pursuit of the salutary emotions, and I knew that I would want to discuss it with my doctor.Two preconditions, however, seemed obvious for the experiment. The first concerned my medication. If that medication were toxic to any degree, it was doubtful whether the plan would work. The second precondition concerned the hospital. I knew I would have to find a place somewhat more conducive to a positive outlook on life.

Let’s consider these preconditions separately.

First, the medication. The emphasis had been on painkilling drugs – aspirin, phenylbutazone (Butazolidin), codeine, colchicine, sleeping pills. The aspirin and phenylbutazone were anti-inflammatory and thus were therapeutically justifiable. But I wasn’t sure they weren’t also toxic. With Dr. Hitzig’s support, we took allergy tests and discovered that I was hypersensitive to virtually all the medication I was receiving. The hospital had been giving me maximum dosages: 26 aspirin tablets a day; and 3 phenylbutazone tablets four times a day. No wonder I had hives allover my body and felt as though my skin was being chewed up by millions of red ants.

It was unreasonable to expect positive chemical changes to take place so long as my body was being saturated with, and toxified by, painkilling medications. I had one of my research assistants at the Saturday Review look up the pertinent references in the medical journals and found that drugs like phenylbutazone and even aspirin levy a heavy tax on the adrenal glands. I also learned that phenylbutazone is one of the most powerful drugs being manufactured. It can produce bloody stools, the result of its antagonism to fibrinogen. It can cause intolerable itching and sleeplessness. It can depress bone marrow.

The hazards of phenylbutazone are explicit. Aspirin enjoys a far more auspicious reputation, at least with the general public. The prevailing impression of aspirin is that it is not only the most harmless drug available but also one of the most effective. When I looked into research in the medical journals, however, I found that aspirin is quite powerful in its own right and that it warrants considerable care in its use. The fact that it can be bought in unlimited quantities without prescription or doctor’s guidance seemed indefensible. Even in small amounts, it can cause internal bleeding. Articles in the medical press reported that the chemical composition of aspirin, like that of phenylbutazone, impairs platelet function. Did the relation between platelets and collagen mean that both drugs do more harm than good for some sufferer from arthritis?’

[*I realize. of course, that the implications here are not entirely negative in view of the fact that the same properties of aspirin that prolong bleeding also prevent clotting. Aspirin is therefore useful to some patients with cardiac disease and those for whom dotting is a danger.]

It was a mind-boggling train of thought. Could it be, I asked myself, that aspirin, so universally accepted for so many years, was actually harmful in the treatment of collagen illnesses?’

[The scientific verification that aspirin can be harmful in the treatment of collagen diseases came in 1971 and is discussed later in this article.’]

The history of medicine is replete with instances involving drugs and modes of treatment that were in use for many years before it was recognized that they did more harm than good. For centuries, for example, people believed that drawing blood from patients was essential for rapid recovery from virtually every illness. Then, midway through the nineteenth century. it was discovered that bleeding serves only to weaken the patient. King Charles II’s death is believed to have been caused in large part from administered bleedings. George Washington’s death was also hastened by the severe loss of blood resulting from this treatment. Living in the second half of the twentieth century, I realized, confers no automatic protection against unwise or even dangerous drugs and methods. Each age has had to undergo its own special nostrums.

Fortunately, the human body is a remarkably durable instrument and has been able to withstand all sorts of prescribed assaults over the centuries, from freezing to animal dung. Suppose I stopped taking aspirin and phenylbutazone? What about the pain? The bones in my spine and practically every joint in my body felt as though I had been run over by a truck.

I knew that pain could be affected by attitudes. Most people become panicky about almost any pain. On all sides they have been so bombarded by advertisements about pain that they take this or that analgesic at the slightest sign of an ache. They are largely illiterate about pain and so are seldom able to deal with it rationally. Pain is part of the body’s magic. It is the way the body transmits a sign to the brain that something is wrong. Leprous patients pray for the sensation of pain. What makes leprosy such a terrible disease is that the victim usually feels no pain when his extremities are being injured. He loses his fingers or toes because he receives no warning signal that he is being injured. I could stand pain so long as I knew that progress was being made in meeting the basic need. That need, I felt, was to restore the body’s capacity to halt the continuing breakdown of connective tissue. There was also the problem of the severe inflammation. If we dispensed with the aspirin, how would we combat the inflammation? I recalled having read in the medical journals about the usefulness of ascorbic acid in combating a wide number of illnesses – all the way from bronchitis to some types of heart disease. Couldn’t it also combat inflammation? Did vitamin C act directly, or did it serve as a starter for the body’s endocrine system – in particular, the adrenal glands? Was it possible, I asked myself, that ascorbic acid had a vital role to play in “feeding” the adrenal glands?

I had read in the medical press that vitamin C helps to oxygenate the blood. If inadequate or impaired oxygenation was a factor in collagen breakdown, couldn’t this circumstance be another argument for ascorbic acid? Also, according to some medical reports, people suffering from collagen diseases are deficient in vitamin c. Did this lack mean that the body uses up large amounts of vitamin C in the process of combating collagen breakdown?

I wanted to discuss some of these ruminations with Dr. Hitzig. He listened carefully as I told him of my speculations concerning the cause of the illness, as well as my layman’s ideas for a course of action that might give me a chance to reduce the odds against my recovery. Dr. Hitzig said it was clear to him that there was nothing undersized about my will to live. He said that what was most important was that I continue to believe in everything I had said. He shared my sense of excitement about the possibilities of my recovery and liked the idea of a partnership.

Even before we had completed arrangements for moving out of the hospital. we began the part of the program calling for the full exercise of the affirmative emotions as a factor in enhancing body chemistry. It was easy enough to hope and love and have faith, but what about laughter? Nothing is less funny than being flat on your back with all the bones in your spine and joints hurting. A systematic program was indicated. A good place to begin, I thought. was with amusing movies. Allen Funt, producer of the spoofing television program “Candid Camera,” sent films of some of his “CC” classics, along with a motion-picture projector. The nurse was instructed in its use.

It worked. 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. When the painkilling effect of the laughter wore off, we would switch on the motion picture projector again, and, not infrequently, it would lead to another pain-free sleep interval. Sometimes, the nurse read to me out of a trove of humor books. Especially useful were E.B. and Katherine White’s Subtreasury of American Humor’ and Max Eastman’s The Enjoyment of Laughter.

How scientific was it to believe that laughter – as well as the positive emotions in general – was affecting my body chemistry for the better? If laughter did in fact have a salutary effect on the body’s chemistry, it seemed at least theoretically likely that it would enhance the system’s ability to fight the inflammation. So we took sedimentation rate readings just before as well as several hourS after the laughter episodes. Each time, there was a drop of at least five points. The drop by itself was not substantial, but it held  and was cumulative.

I was greatly elated by the discovery that there is a physiologic basis for the ancient theory Ll,at laughter is good medicine. There was, however, one negative side effect of the laughter from the standpoint of the hospital. I was disturbing other patients. But that objection didn’t last very long, for the arrangements were now complete for me to move my act to a hotel room.

One of the incidental advantages of the hotel room, I was delighted to find, was that it cost only about one-third as much as the hospital. The other benefits were incalculable. I would not be awakened for a bed bath or for meals or for medication or for a change in the bed sheets or for tests or for examinations by hospital interns. The sense of serenity was delicious and would, I felt certain, contribute to a general improvement.

What about ascorbic acid and its place in the general program for recovery? In discussing my speculations about vitamin C with Dr. Hitzig, I found him completely openminded on the subject, although he told me of serious questions that had been raised by scientific studies. He also cautioned me that heavy doses of ascorbic acid carried some risk of renal damage. The main problem right then, however, was not my kidneys: it seemed to me that. on balance, the risk was worth taking. I asked Dr. Hitzig about previous recorded experience with massive doses of vitamin C. He ascertained that at the hospital there had been cases in which patients had received up to 3 g by intramuscular injection. As I thought about the injection procedure, some questions came to mind. Introducing the ascorbic acid directly into the bloodstream might make more efficient use of the vitamin, but I wondered about the body’s ability to utilize a sudden massive infusion. I knew that one of the great advantages of vitamin C is that the body takes only the amount necessary for its purposes and excretes the rest. Again, there came to mind Cannon’s phrase – the wisdom of the body.

Was there a coefficient of time in the utilization of ascorbic acid? The more I thought about it, the more likely it seemed to me that the body would excrete a large quantity of the vitamin because it couldn’t metabolize it that fast. I wondered whether a better procedure than injection would be to administer the ascorbic acid through slow intravenous drip over a period of three or four hours. In this way we could go far beyond the 3 g. My hope was to start at 10 g and then increase the dose daily until we reached 25 g.

Dr. Hitzig’s eyes widened when I mentioned 25 g. This amount was far beyond any recorded dose. He said he had to caution me about the possible effect not just on the kidneys but on the veins in the arms. Moreover, he said he knew of no data to support the assumption that the body could handle 25 g over a four-hour period, other than by excreting it rapidly through the urine.

As before, however, it seemed to me we were playing for bigger stakes: losing some veins was not of major importance alongside the need to combat whatever was eating at my connective tissue.

To know whether we were on the right track, we took a sedimentation lest before the first intravenous administration of 109 of ascorbic acid. Four hours later, we took another sedimentation test. There was a drop of nine full points.

Seldom had I known such elation. The ascorbic acid was working. So was laughter. The combination was cutting heavily into whatever poison was attacking the connective tissue. The fever was receding,and the pulse was no longer racing.

We stepped up the dosage. On the second day we went up to 12.5 g of ascorbic acid, on the third day, 15 g, and so on until the end of the week, when we reached 25 g. Meanwhile, the laughter routine was in full force. 1was completely off drugs and sleeping pills. Sleep – blessed, natural sleep without pain – was becoming increasingly prolonged.

At the end of the eighth day I was able to move my thumbs without pain. By this time, the sedimentation rate was somewhere in the 80’s and dropping fast. I couldn’t be sure, but it seemed to me that the gravel-like nodules on my neck and the backs of my hands were beginning to shrink. There was no doubt in my mind that I was going to make it back all the way.

Two weeks later, my wife took me to Puerto Rico for some sustained sunshine. On the first day, friends helped support me in the breaking surf. Within a few days I was standing up by myself. At first the soles of my feet were so sensitive that I felt as though I were standing on my eyeballs. But walking in the sand was the best possible therapy, and within a week I was able to jog – at least for a minute or two.

The connective tissue in my spine and joints was regenerating. I could function, and the feeling was indescribably beautiful.

I must not make it appear that all my infirmities disappeared overnight. For many months I couldn’t get my arms up far enough to reach a book on a high shelf. My fingers weren’t agile enough to do what I wanted them to do on the organ keyboard. My neck had a limited turning radius. My knees were somewhat wobbly, and, on and off, I had to wear a metal brace.

But I was back at my job at Saturday Review full time again, and this was miracle enough for me.

Is the recovery a total one? Year by year the mobility has improved. During the past year I have become fully pain free, except for my knees, for the first time since I left the hospital. I no longer feel a sharp twinge in my wrists or shoulders when I hit a tennis bailor golf ball, as I did for such a long time. I can ride a horse flat out and hold a camera with a steady hand. I have recaptured my ambition to play the Toccata and Fugue in D minor, though I find the going slower and tougher than I had hoped. My neck has a full turning radius again, despite the statement of specialists as recently as 1971 that the conditionwas degenerative and that I would have to adjust to a quarter turn.

It was seven years after the onset of the illness before I had scientific confirmation about the dangers of using aspirin in the treatment of collagen diseases, which embrace the various forms of arthritis. In its May 8, 1971 issue, Lancet published a study by Drs. M.A. Sahud and R.J. Cohen showing that aspirin could be antagonistic to the retention of vitamin C in the body. The authors said that patients with rheumatoid arthritis should take vitamin C supplements since it has often been noted that they have low levels of the vitamin in their blood. It was no surprise, then, that I had been able to absorb such massive amounts of ascorbic acid without kidney or other complications.

What conclusions do I draw from the entire experience? The first is that the will to live is not a theoretical abstraction, but a physiologic reality with therapeutic characteristics. The second is that I was incredibly fortunate to have as my doctor a man who knew that his biggest job was to encourage to the fullest the patient’s will to live and to mobilize all the natural resources of body and mind to combat disease. Dr. Hitzig was willing to set aside the large and often hazardous armamentarium of powerful drugs available to the modem physician when he became convinced that his patient might have something better to offer. He was also wise enough to know that the art of healing is still a frontier profession. And, though I can’t be sure of this point, I have a hunch he believed that my own total involvement was a major factor in my recovery.

People have asked what I thought when I was told by the specialists that my disease was progressive and incurable. The answer is simple. Since I didn’t accept the verdict, I wasn’t trapped in the cycle of fear, depression and panic that frequently accompanies a supposedly incurable illness. I must not make it seem, however, that I was unmindful of the seriousness of the problem or that I was in a festive mood throughout. Being unable to move my body was all the evidence I needed that the specialists were dealing with reai concerns. But deep down I knew I had a good chance and relished the idea of bucking the odds.

Adam Smith, in Powers of the Mind, says he discussed my recovery with some of his doctor friends, asking them to explain why the combination of laughter and ascorbic acid worked so well. The answer he got was that neither laughter nor ascorbic acid had anything to do with it and that I probably would have recovered if nothing had been done. Maybe so, but that was not the opinion of the specialists at the time. Two or three doctors, reflecting on the Adam Smith account, have commented that I was probably the beneficiary of a mammoth venture in self-administered placebos. Such a hypothesis bothers me not at all.

Respectable names in the history of medicine like Paracelsus, Holmes and Osler have suggested that the history of medication is far more the history of the placebo effect than of intrinsically valuable and relevant drugs. Physicians in the past who favored such modalities as bleeding (in a single year, 1827, France imported 33 million leeches after its domestic supplies had been depleted); purging through emetics; physical contact with unicorn horns, bezoar stones, mandrakes or powdered mummies – the physicians prescribing such treatments no doubt regarded them at the time as specifics with empirical sanction. But today’s medical science recognizes that whatever efficacy these treatments may have had – and the records indicate that the results were often surprisingly in line with expectations was probably related to the power of the placebo.

I have wondered, in fact, about the relative absence of attention given the placebo in contemporary medicine. The literature on the subject is remarkably sparse considering the primacy of the placebo in the history of medicine. The late Henry K. Beecher’ and Arthur K. Shapiro are among the small number of contemporary medical researchers and observers who have done any noteworthy thinking and writing about this phenomenon. In connection with my own experience, I was fascinated by a report citing Dr. Thomas C. Chalmers, of the Mount Sinai Medical Center in New York, which compared two groups that were being used to test the theory that ascorbic acid is a cold preventive. “The group on placebo,” says Dr. Chalmers, “who thought they were on ascorbic acid had fewer colds than the group on ascorbic acid who thought they were on placebo.”

I was absolutely convinced, at the time I was deep in my illness, that intravenous doses of ascorbic acid could be beneficial – and they were. It is quite possible that this treatment – like everything else I did – was a demonstration of the placebo effect. If so, it would be just as important to probe into the nature of this psychosomatic phenomenon as to find out if ascorbic acid is useful in combating a high sedimentation rate.

At this point, of course, we are opening a very wide door, perhaps even a Pandora’s box. The vaunted “miracle cures” that abound in the literature of all the great religions, or the speculations of Charcot and Freud about conversion hysteria, or the Lourdes phenomena – all say something about the ability of the patient, properly motivated or stimulated, to participate actively in extraordinary reversals of disease and disability. It is all too easy, of course, to raise these possibilities and speculations to a monopoly status in which case the entire edifice of modem medicine would be reduced to little more than the hut of an African witch doctor. But we can at least reflect on William Halse Rivers’s statement, as quoted by Shapiro, that “the salient feature of the medicine of today is that these psychical factors are no longer allowed to play their part unwittingly, but are themselves becoming the subject of study, so that the present age is serving the growth of a rational system of psychotherapeutics.”

What we are talking about essentially, I suppose, is the chemistry of the will to live. In Bucharest in 1972, I visited the clinic of Ana AsIan, described to me as one of Rumania’s leading endocrinologists. She spoke of her belief that there is a direct connection between a robust will to live and the chemical balances in the brain. She is convinced that creativity – one aspect of the will to live produces the vital brain impulses that stimulate the pituitary glands, triggering effects on the pineal glands and the whole of the endocrine system. Is it possible that placebos have a key role in this process? Shouldn’t this entire area be worth serious and sustained attention?

If I had to guess, I would say that the principal contribution made by my doctor to the taming;and possibly the conquest, of my illness was that he encouraged me to believe I was a respected partner with him in the total undertaking. He fully engaged my subjective energies. He may not have been able to define or diagnose the process through which self-confidence (wild hunches securely believed) was somehow picked up by the body’s immunologic mechanisms and translated into anti-morbid effects. But he was acting. I believe, in the best tradition of medicine in recognizing that he had to reach out in my case beyond the usual verifiable modalities. In so doing, he was faithful to the first dictum in his medical education: primum non nocere . He knew that what I wanted to do might not help, but it probably would do little harm. Certainly, the threatened harm being risked was less, if anything, than the heroic medication so routinely administered in extreme cases of this kind.

Something else I have learned. I have learned never to underestimate the capacity of the human mind and body to regenerate – even when the prospects seem most wretched. The life-force may be the least understood force on earth. William James said that human beings tend to live too far within self-imposed limits. It is possible that those limits will recede when we respect more fully the natural drive of the human mind and body toward perfectibility and regeneration. Protecting and cherishing that natural drive may well represent the finest exercise of human freedom.


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