Facets of Medicine (4)


By William Wetherall

A Japanese version of this article appeared in
Kokutai, 16(6), July 1995, pages 157-159

"I'm 65 years old. Sickness comes from your qi. If your feelings and disposition are firm, sickness will not enter your body. Physical strength comes with strength of qi."

These were the words of Nakasone Yasuhiro, spoken as Prime Minister on 6 August 1983 before patients at a geriatric hospital for atom bomb survivors in Hiroshima, according to the evening edition of the Mainichi. The Asahi and the Yomiuri carried somewhat shorter and slightly different versions, but with the same implication that your illness will "flee" or be "cured" if only you have the right attitude.

Nakasone was taken to task for his remarks by people who felt that coping with the lack of vigor that is characteristic of "atom bomb lethargy" was more than a matter of how a survivor feels about life. Asked to clarify himself at a press conference afterwards, Nakasone explained: "I said that to encourage them. The most important thing for older people is that they not become depressed. I didn't say that it was okay to neglect medical treatment."

Ironically, Nakasone was himself an example of how the power to will one's own success is limited. He wanted very much to have a great impact on Japanese and global politics, but even his dauntless Yamato spirit failed to ward off the diseases that strike all politicians who overreach or abuse their mandate and intelligence.

Nakasone's delusions of political grandeur were cast from the same mold as is blind faith in medical treatment, whether scientific or traditional. Indiscriminate and unskeptical trust in the efficacies of either tested and proven drugs or customary folk remedies, is as risky as an obsessed belief that good health comes from "positive thinking".

Yet as misleading as the implications of Nakasone's advice may have been, there is considerable truth in his contention that a vigorous spirit is an ally of good physical health. In this sense, at least, there is some merit in what he said about "qi"; and a reminder of the wisdom of the old adage not to throw out the baby with the bath water.

The waiting rooms of most clinics are havens for people who are more afflicted with hypochondria and sympathy-seeking self-pity than they are with an illness that requires a doctor's attention. If more people had more "will power" to tolerate the sort of discomforts that come with common colds and flus, fewer people would bother to frequent clinics with such minor complaints, and so there would be less work for doctors and fewer profits for pharmaceutical companies.

Take two people with a cold. One is willing to tough out the symptoms and let nature takes its course. The other rushes to a doctor at the first scratchiness of the throat. The former will miss less school or work, and may even recover faster, than the latter.

The "tough" type includes a variety of people, from those who simply know from experience that they merely have a cold or the flu, to those who dislike or distrust doctors and hospitals so much that they would deny the implications of the most serious symptoms just to avoid a medical examination. Out of sheer stubbornness, the latter is more likely to succumb to an undetected affliction, or to leave a detected affliction untreated.

The "rush to the doctor" type includes an equally diverse range of people, from those who are simply behaving "normally" by using their health insurance privileges, to those whose complaints are exaggerated, imagined, or even fictional. The former consciously know that they really don't need the intervention of a doctor, but they think "After all, I'm paying for it." The latter include not only hypochondriacs and hysterics, whose need for treatment is partly or entirely illusional, but also malingerers, who consciously know that they are not sick but want others, especially their doctors, to think so.

Such behaviors are products of conditioning by what I would call the "culture" illness and pain. Children quickly learn that they will be pampered when they cut themselves. Mothers and others often make a big fuss over the tiniest scratch, by covering it with a band aid after fretting about infection.

Doctors take over this role when they indulge adult patients who have failed to outgrow their egocentric expectations of attention when feeling even slightly ill. Doctors themselves, from internalists to psychiatrists, are often too busy believing that their charges are really ill or in pain to be able to distinguish truth, figment, and fabrication in the nebulous world of patient complaints.

As biological medicine advances, traditionalist healers continue to believe that there is something more to good health than the physical condition of the body. And more and more practitioners of scientific medicine are endorsing the traditionalist tenet that state of mind (or heart, if you will) is at least a contributing factor, and may even be a deciding factor, in determining the course of an illness.

The purist of traditionalists are reluctant to separate a human being into "physical" and "spiritual" components, and they will use such labels only when maintaining that the two parts are so integrated as to be virtually inseparable. And traditionalists who do recognize the practicality of differentiating the "physical" and the "spiritual" as though they were independent entities are strongly inclined to regard the latter as more important than the former.

Most doctors and other healers, however, would argue that all this is a chicken and egg question. Does depression predispose a person to illness and then exacerbate the symptoms; or does the illness precede and trigger depression? Physicalists, who believe that the primary causes of illness are somatic, will treat bodily symptoms and observe improvements in both physical and mental states.

Many physicalist doctors regard mental symptoms, if they bother to look for or take note of any, as reactions to the physical picture. And if they treat such symptoms, they do so as though they were somatic in origin, as by prescribing an antidepressant for reactive depression. But spiritualists, who view many if not most somatic symptoms as psychogenic, will try to nurture a patient's "fighting spirit" in the belief that if the mind cultivates the forces of life, then the body will have more energy with which to fight the forces of death.

Most doctors and other healers, however, are realists, and as such they work with both the body and the soul, knowing that in life at least the two are fated to share the same host. The soul is deemed emotional. It reacts to pain. It weeps, it rages. Yet the soul needs the body to mediate the content of its consciousness, and it cannot express itself when the body is in a coma.

Bud does vegetation of the body leave its soul irrecoverably speechless? Spiritualists, perhaps more than physicalists, question definitions of brain death because there they cannot be certain that deterioration of brain function below a certain level is tantamount to spiritual emigration. Some even maintain that a healthy soul may be capable of nurturing its dead soma back to life.

All this means is that nobody can be certain as to whether the body is ever really capable of willing its own health. As much as we sometimes wish away sleep, sleep comes. And sometimes more. For the longer we put off our body's demand for sleep, the greater we increase our susceptibility to catching a cold or coming down with the flu. And no amount of utter will to live will keep the Grim Reaper away when our biological clock eventually winds down or suddenly screeches to a halt.