{"id":135630,"date":"2020-12-08T10:51:06","date_gmt":"2020-12-08T18:51:06","guid":{"rendered":"http:\/\/lukeford.net\/blog\/?p=135630"},"modified":"2020-12-08T11:16:39","modified_gmt":"2020-12-08T19:16:39","slug":"from-paralysis-to-fatigue-a-history-of-psychosomatic-illness-in-the-modern-era","status":"publish","type":"post","link":"https:\/\/lukeford.net\/blog\/?p=135630","title":{"rendered":"From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era"},"content":{"rendered":"

Edward Shorter writes in this 1993 book<\/a>:<\/p>\n

This cultural pressure is the crux of the book. The unconscious mind desires to be taken seriously and not be ridiculed. It will therefore strive to present symptoms that always seem, to the surrounding culture, legitimate evidence of organic disease. This striving introduces a historical dimension. As the culture changes its mind about what is legitimate disease and what is not, the pattern of psychosomatic illness changes. For example, a sudden increase in the number of young women who are unable to get out of bed because their legs are \u201cparalyzed\u201d may tell us something about how the surrounding culture views women and how it expects them to perform their roles.<\/p>\n

Psychosomatic illness is any illness in which physical symptoms, produced by the action of the unconscious mind, are defined by the individual as evidence of organic disease and for which medical help is sought. This process of somatization comes in two forms. In one no physical lesion of any kind exists and the symptoms are literally psychogenic; that is to say, they arise in the mind. In the second an organic lesion does exist, but the patient\u2019s response to it\u2014his or her illness behavior\u2014is exaggerated or inappropriate. Culture intervenes in both forms, legislating what is legitimate, and mandating what constitutes an appropriate response to disease. Our late-twentieth-century culture, for example, which values individual dynamism, regards physical paralysis and sudden \u201ccoma\u201d (both common before 1900) as inappropriate responses.<\/p>\n

Psychosomatic illnesses have always existed, because psychogenesis\u2014the conversion of stress or psychological problems into physical symptoms\u2014is one of nature\u2019s basic mechanisms in mobilizing the body to cope with mental distress. People have always tried to achieve some kind of plausible interpretation of their physical sensations. They cast these sensations on the model of well-defined medical symptoms available in a kind of \u201csymptom pool.\u201d Only when an individual\u2019s act of making sense amplifies the sensations, or attributes them to disease when none exists, does psychosomatic illness come into play.<\/p>\n

The two actors in this psychodrama of making sense of one\u2019s sensations are, and always have been, doctors and patients. The interaction between doctors and patients determines how psychosomatic symptoms change over the years. Doctors\u2019 notions of what constitutes \u201cgenuine\u201d organicity may alter, perhaps as a result of increased scientific knowledge or of new cultural preconceptions. Although patients\u2019 notions of disease tend to follow doctors\u2019 ideas\u2014a kind of obedience that has started to break down at the end of the twentieth century\u2014patients may also change their notions of the legitimacy of symptoms for reasons that have little to do with medicine. <\/p>\n

* Given the reluctance of the unconscious mind to be made a fool of, patients have always tended to reject psychological interpretations of physical symptoms. They find this kind of attribution unsettling because it seems to make inaccessible to them the remedies of medicine, conferring upon their symptoms a kind of hopelessness. Patients often think, Who after all can control the action of his or her unconscious mind?<\/p>\n

* This lamentation about the lack of insight in somatizing patients constitutes a steady stream in medical literature. Every decade has its offerings. Here is Herbert Berger in 1956 on the subject of his first few years of medical practice in a small town: \u201cThe certainty that I lived in a belt of inbred neurotics became firmly fixed in my mind. Coming from a large urban center myself, I felt fairly certain that the residents of my community had intermarried \u2026 and that this explained the large number of functionally incompetent individuals whom I met.\u201d Later he realized that this was just a typical general practice. \u201cGradually I have come to recognize that these individuals never wish to be told that they are just nervous. The word \u2018imagination\u2019 is anathema to them for they are certain that they are seriously ill, and they expect and demand that the physician treat their disease with considerable respect. It is often necessary to medicate these people.\u201d Referral to a psychiatrist, said Berger, was impossible. \u201cThe patient is often reluctant to admit even to himself that he is mentally sick, whereas he can continue to believe that he is organically ill as long as he visits the office of a non-psychiatrist.\u201d Berger treated these patients with placebo therapy (giving them injections of a muscle relaxant called mephenesin) plus a kind of Dubois-Dejerine-style psychotherapy.98<\/p>\n

Over the years a kind of informal consensus on the management of the somatizing patient established itself within internal medicine and neurology: Seek out the convenient fiction. \u201cAlmost every one is filled with the belief that he is debilitated,\u201d wrote Baltimore physician Daniel Cathell in 1882. \u201cSay to the average patient, \u2018you are weak and need building up,\u2019 and you will instantly see by his countenance that you have struck his key-note. So much is this the case, that many of the sick, fully impressed with this idea, will want you to treat them with tonics and stimulants, even when their condition is such that these medicines are not at all indicated.\u201d99 In Harley Street it was rather more fashionable to tell patients they had \u201cmalnutrition and dyspepsia producing nervous exhaustion\u201d (rather than the reverse). <\/p>\n

* When the doctors\u2019 idea of \u201clegitimate\u201d disease changes, the patients\u2019 idea changes as well. When the doctors shifted their paradigm from reflex neurosis emphasizing motor hysteria to the central-nervous paradigm of sensory symptoms, the patients shifted accordingly: Symptoms of psychosomatic illness passed from the motor side of the nervous system to the sensory. Anxious to present legitimate disease, somatizing patients in the last quarter of the nineteenth century and the first quarter of the twentieth abandoned the classic hysteria of the past and adopted sensory symptoms that would correspond to the new medical paradigms of central-nervous disease and psychogenesis. Pain and fatigue came to the forefront of the consultation as examples of symptoms that \u201cexhausted cerebral centers\u201d would be likely to produce. For what better corresponded to the notion of intrinsic cerebral deficits than the highly subjective sensations of pain and tiredness?<\/p>\n

* In the social history of medicine there is no more striking phenomenon than the disappearance of classic hysteria. Enthroned in the middle of the nineteenth century as the quintessential illness of the \u201clabile\u201d woman, the fits and paralyses that had been summoned from the symptom pool since the Middle Ages\u2014spreading almost epidemically during the nineteenth century\u2014virtually came to an end by the 1930s. Although doubtless caused by many circumstances, this change was in part a consequence of changing medical paradigms. <\/p>\n

* At the psychiatric hospital in Florence, for example, grave hysteria declined from 4 percent of all admissions in 1898-1908 to 0.1 percent in 1938-48.2 Whereas the total number of patients diagnosed as hysterical at Cery Hospital, the university psychiatric clinic of Lausanne, did not change between 1910-29 and 1970-80, the kinds of symptoms that \u201chysterical\u201d patients presented did alter significantly: Eighty-one percent of all hysteria patients in the former period displayed muscular tetany and agitation; only 27 percent did so in the latter. Fainting declined from 47 to 31 percent of all patients, and globus hystericus (lump in throat) from 13 to 5 percent. The dissociative conditions so popular at the turn of the century also dropped off sharply: \u201cTwilight states\u201d (\u00e9tats cr\u00e9pusculaires), which is to say second states, declined from 57 to 24 percent of all hysteria patients; amnesia dropped from 32 to 18 percent. By contrast, general fatigue rose from being present in 4 percent of all hysteria patients to 13 percent, and visceral problems from 8 to 22 percent. Whereas no patients had complained of sexual frigidity in 1910-29, 22 percent (all of them women) did so in 1970-80.<\/p>\n

* In 1916 almost all German neurologists came to agree upon the purely psychological origin of shell shock. Since then we have trained an entire generation of physicians in this tradition. Shell shock is now nipped in the bud, meaning that we would let the front soldiers rest for a couple of days instead of sending them home as in 1914-18, where their symptoms would become fixated and contagious to others. By 1945 the military district had over 30,000 beds and over 3000 neurological cases; and the neurotic division almost never contained more than 30 or 35 soldiers.<\/p>\n

* From the viewpoint of the patient, pain and fatigue had the benefits (1) of corresponding to what doctors under the influence of the central-nervous paradigm expected to see, and (2) of being almost impossible to \u201cdisprove.\u201d Highly subjective sensations, neither pain nor tiredness can be said not \u201creally\u201d to exist, in the way that the Babinski test can \u201cdisprove\u201d a hysterical paralysis or an ophthalmic diploscope can \u201cdisprove\u201d the presence of achromatopsia (claimed inability to see colors). One could disprove medically many motor symptoms by demonstrating their lack of an anatomical basis. The potential anatomic basis of fatigue and pain was, by contrast, so much more complex and difficult to investigate that patients could retain the symptoms far longer before physicians would start murmuring the word \u201chysteria.\u201d Advancing medical knowledge had the ironical result of driving somatization deep into the nervous system, where a \u201cmillion-dollar workup\u201d would be required to clarify matters.<\/p>\n

Writing the history of chronic fatigue as part of the symptom pool involves disentangling it from the diagnosis of neurasthenia. This is a chicken-egg problem: Did a rise in the frequency of fatigue prompt adoption of the diagnosis neurasthenia? Or did Beard\u2019s creation of neurasthenia elicit a rise in the complaint of tiredness among patients who wanted to be taken seriously? Both are likely.<\/p>\n

* The psychosomatic symptoms of the 1990s are not very different from those of the 1920s. Now as then, pain and fatigue continue to be the commonest physical complaints. But there are two significant differences between the psychosomatic patients of the 1990s and those of the 1920s. Sufferers today are more sensitive generally to the signals their bodies give off, and they are more ready to assign these symptoms to a given \u201cattribution\u201d\u2014a fixed diagnosis of organic disease. Many patients today have acquired the unshakable belief that their symptoms represent a particular disease, a belief that remains unjarred by further medical consultation.<\/p>\n

This increase in illness attribution stems, at the level of the doctorpatient relationship, from the loss of medical authority and from the corresponding increase in the power of the media to suggest individuals into various fixed beliefs. At the cultural level, these new patterns come from a distinctively \u201cpostmodern\u201d disaffiliation from family life. If the psychosomatic problems of the nineteenth century resulted from an excess of intimacy in the familial psychodrama, those of the late twentieth century have been the result of the opposite phenomenon: a splintering of close personal ties and the lack of intimacy. These changes of the late twentieth century have had the effect of making people more sensitive to bodily signals than ever before and more willing to shift the attribution of their plight from internal demons to external toxins.<\/p>\n

A New Sensitivity to Pain<\/p>\n

Our culture witnesses a kind of collective hypervigilance about the body, a sensitivity to variations in weight, for example, that has sufficed to make many fortunes in the industry devoted to dieting and slimming, or a bowel consciousness that keeps pharmacy shelves stocked high with medically unnecessary laxatives. This kind of extreme alertness to the body\u2019s normal functions is itself without historical precedent. But even more striking is a willingness to amplify bodily signals so that they become evidence of disease and justify seeking help or taking medication.<\/p>\n

People today believe themselves to be highly symptomatic. After reviewing various studies, one scholar writes: \u201cOnly 5 to 14 percent of the general population do not experience symptoms in a given two-week period. The average adult has four symptoms of illness on one out of every four days.\u201d She concludes: \u201cThere are probably many people with vague symptoms in search of a diagnosis.\u201d1<\/p>\n

Some of these symptoms are psychogenic; some come from organic disease. People today are more sensitive to both.<\/p>\n

* In addition to psychogenic pain, fatigue is the other great somatoform symptom of the end of the twentieth century. For many reasons one might expect people leading frenetic, compartmentalized lives in crowded cities to feel tired. But we are talking about fatigue as an illness rather than simply feeling tired at the end of the day. Many individuals who are chronically fatigued believe something is physically wrong with them and end up having more than just a symptom. From their physician or from some other source, they acquire the diagnosis of chronic fatigue syndrome. Accordingly, fatigue is both a symptom and a syndrome, or pattern of illness.<\/p>\n

* In the 1990s it is above all chronic fatigue syndrome\u2014consisting of a combination of severe fatigue, weakness, malaise and such mental changes as decreased memory\u2014that has won out over its competitors, just as reflex hysteria triumphed over spinal irritation in the nineteenth century.<\/p>\n

The saga of chronic fatigue syndrome represents a kind of cautionary tale for those doctors who lose sight of the scientific underpinning of medicine, and for those patients who lose their good sense in the media-spawned clamor that poisons the doctor-patient relationship. As a precondition, we have a pool of nonspecific symptoms in search of a diagnosis. These symptoms include, in the experience of Donna Stewart, a psychiatrist who has dealt extensively with fixeddiagnosis somatizers, \u201ctransient fatigue, headaches, muscle or joint aches, backaches, digestive upsets, respiratory complaints, vague pains, irritability, dizziness, poor concentration, and malaise.\u201d It is chronic somatizers, Stewart continues, who are \u201cespecially prone to elaborate on non-specific symptoms, and tend to embrace each newly described disease of fashion as the answer to long-standing, multiple, undiagnosed complaints.\u201d28<\/p>\n

How does a given symptom become a disease of fashion? An epidemic of illness attribution, or epidemic hysteria, seems to involve two phases: (1) appropriating a genuine organic disease\u2014whose cause is difficult to detect and substantiate\u2014as a template; (2) broadcasting this template to individuals with often quite different symptoms, who then embrace this template as the explanation of their problems. This broadcasting is effected by sympathetic physicians, patient support groups, and the media.<\/p>\n

* Chronic fatigue syndrome is without a doubt the illness attribution that has dominated the last two decades of the twentieth century. One researcher estimated in 1990 that \u201cat least one million Americans [are] currently carrying a diagnosis of CFIDS [chronic fatigue immune dysfunction syndrome], and possibly another five million are ill and yet to be diagnosed.\u201d32 By 1990, some four hundred local support groups for the illness had arisen in the United States, and the Centers for Disease Control of the U.S. Government, in Atlanta, were receiving a thousand to two thousand calls a month about chronic fatigue syndrome.33 Many similar stories of wildfirelike spread elsewhere could be told.<\/p>\n

A whole subculture of chronic fatigue has arisen in which those patients too tired to walk give each other hints about how to handle a wheelchair and exchange notes about how to secure disability payments from the government or from insurance companies.34 The whirl of activities within this subculture sounds so diverting that one can understand why the members would be reluctant to part with their symptoms. Among various local associations for chronic fatigue in England, for example, we encounter the following notices: \u201cBerks and Bucks. On 21st May [1988] there will be a stall for M.E. [myalgic encephalomyelitis, the English version of chronic fatigue] at the Young Farmer\u2019s RALLY at the ChildBeale Wildlife Trust near Pangbourne. Please do look out for anything yellow that you can spare,\u201d wrote the local organizer, \u201cand either post it to me or let me know so that I can arrange for its collection (Stall themes are colours).\u201d<\/p>\n

\u201cGloucestershire. Seventeen members, together with partners and friends, attended a coffee morning at Lapley Farm, Coaley on March 5th. This was an excellent turnout for such a large and scattered county\u2026. Next: Family Ploughmans Lunch, also at Lapley Farm, on Saturday, June 4th. We are hoping to arrange a meeting for the autumn in Cheltenham.\u201d35 Chronic fatigue thus can become a way of life.<\/p>\n

* Yet infectious mononucleosis never really achieved phase two\u2014diffusion to large numbers of somatizers in an epidemic of symptom attribution\u2014because doctors looked for the characteristic misshaping of cells before granting mono as a diagnosis. It was really after the discovery in 1968 of Epstein-Barr virus as the cause of mononucleosis that EBV became a disease of fashion, because the vast majority of the population bears EBV antibodies in the blood. Disproof was impossible. Finally \u201cevidence\u201d was at hand that sufferers were \u201creally ill\u201d: Their blood tests (and everybody else\u2019s) showed the antibodies. This particular proof seemed to be dramatically delivered in 1984, when an epidemic of stillinscrutable character occurred at Lake Tahoe. EBV antibodies were detected in blood samples of some of the victims, and the case for organicity seemed to be clinched.42 In the mid-1980s EBV was warmly embraced as the explanation of one\u2019s difficulties, a series of learned medical articles strengthening the supposition of organicity. 43EBV was christened in the press \u201cthe Yuppie flu,\u201d an infection to which fast-tracking professionals were thought especially vulnerable.<\/p>\n

Unfortunately, the very ubiquity of Epstein-Barr virus caused its downfall as an illness attribution. In 1988 Gary Holmes at the Centers for Disease Control, along with coworkers, realized that the correlation was poor between those patients who had hematological evidence of chronic EBV infection and those who had the symptoms of chronic fatigue. Holmes therefore rebaptized chronic Epstein-Barr virus infection as chronic fatigue syndrome, or CFS.44 This renaming did not sit well with patient groups, who promptly renamed their condition CFIDS, chronic fatigue immune dysfunction syndrome, to better insist on its organicity.45<\/p>\n

These two templates therefore, neuromyasthenia and mononucleosis EBV, provided the presumption of organicity for self-labeled sufferers of chronic fatigue in the United States and Canada. Donna Greenberg, professor of psychiatry at Harvard, wrote of these diagnoses: \u201cChronic mononucleosis and chronic fatigue syndrome represent neurasthenia in the 1980s\u2026. It is in the nature of chronic fatigue that [the diagnosis] will inevitably recruit subjects with depressive disorders, anxiety, personality disorders, and other common medical syndromes such as allergic rhinitis or upper respiratory infections.\u201d46 Exactly as appendicitis had given way to colitis, and reflex neurosis to neurasthenia, so in the United States chronic EBV gave way to CFIDS as somatization attempted to keep one jump ahead of science.<\/p>\n

* In a curious inversion of the normal diffusion of scientific findings, the media advocates of CFS seize immunological data as they become available in the lab and apply them willy-nilly to their pet illnesses. \u201cNot just the blues,\u201d trumpeted Newsweek, as a cover story of November 12,1990, on chronic fatigue syndrome alerted readers to new findings about \u201ca newly discovered herpes virus called HHV-6.\u201d Research on patients\u2019 \u201cinterleukin-2\u201d levels had also proved promising, the story said.63 Although individual sufferers may display disparate immunological abnormalities, no pattern of findings has emerged common to CFS patients as a whole. Nor is it clear how widespread these abnormalities are in the general public, nor to what extent they are shared by individuals with other psychiatric illnesses. Driving forward the pseudoscience underlying CFS has not been the medical profession itself\u2014it has been the media.<\/p>\n

In the United States, a widely read story in Rolling Stone magazine in 1987 gave the signal for converting chronic fatigue into a media frenzy. Entitled \u201cJourney into Fear: The Growing Nightmare of Epstein-Barr Virus,\u201d the journalist-sufferer, once \u201cin control of my career and my life,\u201d explained how an \u201cenigmatic disease\u201d had rendered her \u201cunable to lift my toothbrush or remember my phone number.\u201d Of course her physicians had been unhelpful. \u201cAfter rendering their diagnoses, my doctors made it clear they had served me to the limit of their ability. One of them, the internist, tried to comfort me: \u2018At least it isn\u2019t terminal.\u2019\u201d The writer cried a good deal and felt \u201ca sadness akin to the raw grief of mourning.\u201d Then one day she read about the Lake Tahoe \u201cepidemic\u201d and realized what she had.<\/p>\n

The writer located a physician-enthusiast. Because she carried with her copies of all her blood reports \u201crolled up and stuffed in my bag,\u201d she pulled them out for him to look at. Sure enough, she had the Lake Tahoe disease. He explained to her that her reports displayed the \u201creactivation phenomenon,\u201d a phenomenon unknown to his medical colleagues generally.<\/p>\n

\u201cI understand there are doctors who leave the room after speaking to one of these patients and can\u2019t stop laughing,\u201d he told her.<\/p>\n

The message to Rolling Stone readers was that a terrible epidemic was ravaging the country and that a mainline physician was the last person one would want to put one\u2019s trust in.<\/p>\n

* Television has spread this plague of illness attribution even more rapidly than the print media. A \u201cchronic fatigue\u201d story on \u201cTV Ontario,\u201d for example, prompted more than fifty-one thousand viewers to try to phone the station during the forty-minute segment.68 A short spot on chronic fatigue on Channel 3 in Philadelphia produced seven hundred calls to the station\u2014a record for that particular program\u2014and a further two thousand inquiries to the CFIDS Association.69<\/p>\n

On September 23 and 30, 1989, NBC aired a two-part show in the \u201cGolden Girls\u201d series, featuring Dorothy\u2019s struggle with chronic fatigue. Her first doctors, mainline physicians, had been beastly. As Dorothy is about to leave for an appointment with \u201cher virologist,\u201d her friend Rose tells her: \u201cGood luck, I hope he finds something wrong with you\u2026. Oh, I don\u2019t mean something wrong wrong, I just mean something wrong so you\u2019ll know you\u2019re right when you know there\u2019s something wrong and you haven\u2019t been wrong all along.\u201d (This is the exact functional equivalent of nineteenth-century young women hoping to be admitted to hospital for ovariotomies.)<\/p>\n

In the program Doctor Chang, the virologist, reassures Dorothy that \u201cshe really is sick and not merely depressed\u2026. There are new diseases arising all the time,\u201d he says.<\/p>\n

\u201cSo,\u201d Dorothy says with relief, \u201cI really have something real.\u201d70<\/p>\n

Dorothy\u2019s encounter with chronic fatigue demonstrates the oppositional stance to mainline medicine of this subculture of invalidism, a refusal to accept medical reassurance. The chronic fatigue sufferers of today are far more skeptical of medical authority than were victims of ovarian hysteria in the 1860s or brucellosis patients of the 1930s. In 1990 Woman\u2019s Day bannered \u201cThe Illness You Can\u2019t Sleep Off.\u201d \u201cCan you imagine,\u201d asked the author, \u201chow it feels to know there is something terribly wrong with you and have one doctor after another tell you there can\u2019t be?\u201d71 This theme of medical incompetence and indifference runs throughout the movement, which elevates the patients\u2019 subjective knowledge of their bodies to the same status as the doctors\u2019 objective knowledge. This presumption of privileged self-knowledge of one\u2019s body dovetails perfectly with media marketing strategies.<\/p>\n

The rejection of psychiatric diagnoses by chronic fatigue patients is much more violent than are the normal reactions of medical patients to psychiatric consultation, and is itself a characteristic of the illness. Anything smacking of psychiatry or psychology is completely taboo. The chronic fatigue subculture evaluates internists, for example, not on the basis of the quality of their clinical judgment but their friendliness to the diagnosis. The work of Stephen Straus, a distinguished internist at the National Institutes of Health in Bethesda, was initially greeted by hosannas because in 1985 he seemed to take the EBV explanation at face value. Three years later, however, Straus became an object of vilification when he said that psychopathology might help to explain the symptoms as well.72 \u201cExpecting Stephen Straus to talk about CFS for very long without inevitably mentioning psychiatric disorders is like expecting Blaze Starr to walk without jiggling,\u201d wrote one disappointed sufferer.73<\/p>\n

The chronic fatigue subculture brims with folklore about choosing physicians thought to be sympathetic. How does one pick a doctor? A patients\u2019 organization advised selecting one who would share test results and let the patient keep a copy\u2014a bizarre request in the context of normal medical practice.74 Chronic fatigue patients, reluctant to disclose emotional symptoms, are often quite resistant to psychological probing of any kind from the doctor.75 Needless to say, psychiatrists are unwelcome in the subculture of chronic fatigue. The several psychiatrists who appeared at a chronic fatigue symposium in 1988 in London were called, by one physician-enthusiast, \u201ccolourful and frankly strange remnants of prehistoric medicine\u201d and \u201cas mad as hatters.\u201d76 Behind this fear of psychiatry is the horror that one\u2019s symptoms will be seen as \u201cimaginary,\u201d which characterizes most patients with fixed illness attributions. Thus patients welcome the occasional blood abnormalities that turn up in their testing.77<\/p>\n

Another characteristic of the subculture of invalidism is its \u201cpathoplasticity,\u201d the willingness to change symptoms and attributions as new fads appear. Chronic fatigue sufferers are quite willing to believe that they also have other illnesses that are stylish at the moment. Monilia infections, sometimes called candida or total body yeast infections, enjoyed a certain currency during the 1980s. \u201cCould Yeast Be Your Problem?\u201d headlined one American chronic fatigue newsletter.78 An English sufferer suggested an \u201canti-candida diet,\u201d including \u201chalf an avocado pear sprinkled with lemon juice.\u201d79 A number of English patients expressed their concerns about yeast in letters to Doctor Dawes: \u201cI put myself on an anti-candida diet, and persuaded my doctor to give me Nystatin [a fungicide],\u201d wrote one patient. \u201cHe is gradually reducing the amount of Nystatin I am taking but he was reluctant to allow me to have Nystatin in the first place. I am not sure that he is the best judge of how much I should be taking.\u201d (Doctor Dawes responded: \u201cA number of people need to take it for a year or two.\u201d)80<\/p>\n

Other patients believe they have chronic fatigue and multiple food allergies (\u201ccausing immediate sensations in my stomach and legs\u201d).81 Pyramiding the syndromes one atop the other, one person wrote to a physicianenthusiast, \u201cI have CFS and was recently told I have Candida and given a special diet that excluded food items to which Candida sufferers are allergic. I was about to start when I saw you on TV and now wonder, what happens if I am also allergic to foods on the Candida diet.\u201d82<\/p>\n

Still other patients believe that they have chronic fatigue and hypoglycemia (\u201cIt took me two years to find a doctor who understood.\u201d)83 Or that they have TMJ syndrome, polio, and Lyme disease. One sufferer believed she was being poisoned by the mercury fillings in her teeth. She failed, however, to get better after having all the fillings removed.84 Indeed, the only current disease chronic fatigue patients are sure they do not have is highly stigmatized AIDS. The occasional suggestion that whatever organism ails them is similar to the one producing AIDS is greeted with dismay.85<\/p>\n

One study has demonstrated how closely the diseases of fashion are interwoven with one another. Fifty patients with \u201cenvironmental hypersensitivity,\u201d a disease attribution closely related to chronic fatigue, were asked what else they thought they had. Ninety percent were found to be \u201csuffering from at least one other media-popularized condition,\u201d including EBV, food allergy, candidiasis hypersensitivity, and fibrositis. More than 10 percent of the patients reported eight or more diseases of fashion. In 1985, when the study began, all patients attributed their problems to environmental sensitivity, but by 1986 many had shifted to Candida albicans as the main cause, and by 1987 EBV had become particularly popular. Most of the patients were on disability; none expected to return to his or her former job (88 percent were women). The author concluded: \u201cThese patients are suggestible and at high risk for acquiring diagnoses that are popularized by the media.\u201d86<\/p>\n

Such hypersuggestibility is conceivable only in a population that has quite lost its moorings in the folk culture of body knowledge. In the United States there was once a common set of assumptions, or folk culture, about health and illness that was handed down from generation to generation. These assumptions gave people a commonsensical understanding of their own sensations. Instead, individuals today are buffeted by every new \u201cfinding\u201d on television or in the morning paper. Accompanying this loss of contact with a folkloric inheritance and its tranquil interpretation of bodily symptoms, has been a loss of willingness to believe in \u201cwhat the doctor says.\u201d For example, the percentage of patients in the United States willing to use the family doctor as a source of \u201clocal health care information\u201d declined from 46 percent in 1984 to 21 percent in 1989.87 As for selecting which hospital to attend, more than 50 percent of patients polled in 1989 said that \u201cthey or their family have the most influence in selection of a hospital\u201d\u2014as opposed to listening to the doctor\u2014up from 40 percent in previous years.88 (Non-American readers will recall that private American hospitals compete for patients.) According to a Gallup poll in 1989,26 percent of patients said they respected doctors less now than ten years ago (14 percent said more). And of those who respected doctors less, 26 percent said, \u201cthey [the doctors] are in it for the money.\u201d Seventeen percent claimed that doctors \u201clack rapport and concern.\u201d89<\/p>\n

The late twentieth century is writing a new chapter in the history of psychosomatic illness: fixed belief in a given diagnosis. The diagnosis itself may be changeable, based on fashion, but the fixity of belief remains the same, a questing after certainty resulting from the rising influence of the media upon public opinion and the corresponding decline of medical authority.<\/p>\n

* Although the term postmodern has been bandied about in a nonspecific way, it does have a specific meaning in the area of family life: the triumph of the desire for individual self-actualization over commitment to the family as an institution.90 This kind of larger commitment, not a commitment to specific individuals but to the ideal of \u201cfamily,\u201d characterized the modern family of the nineteenth-and early-twentieth century. In the postmodern family, the notion of \u201crelationship\u201d has taken priority over the concept of the family as a building block of society. Indeed since the 1960s the relationship has often supplanted the concept of marriage itself. Sexual relationships involving periods of living together are becoming the antechamber to marriage.91 Adulterous relationships often exist on the side for both partners, and after divorce the partners are spun once again into the world of relationships. So the notion of \u201crelationship\u201d has deeply pervaded the institution of marriage.<\/p>\n

The intrinsic logic of the relationship lies in achieving self-actualization, or personal growth, instead of pursuing communitarian objectives. It is this search for individual psychological fulfillment for the individual partners that gives the postmodern family its remarkable fragility, for once personal growth ceases within marriage, the marriage itself terminates. Thomas Glick, a senior demographer at Arizona State University, wrote in 1987: \u201cThe relatively fragile state of American family life at present is undeniable in view of the prospect that close to one-half of the first and second marriages of young adults will end in divorce.\u201d92 Accordingly, instability is becoming the rule rather than the exception.<\/p>\n

The keynote of postmodern life is the solitude and sense of precariousness arising from ruptures in intimate relationships. As the average age at marriage rises, the number of young people living alone increases. Divorce further accelerates singlehood. And the social isolation of the elderly has greatly increased.<\/p>\n

* What are the consequences of postmodernity for psychosomatic illness? People who are socially isolated tend to have higher rates of somatization in general than those who are not. One scholar concluded, after a review of the literature on health and loneliness, that \u201cloneliness is linked with reported feelings of ill health, somatic distress, and visits to physicians as well as physical disease.\u201d<\/p>\n

* By removing \u201cfeedback loops,\u201d social isolation intensifies the tendency of individuals to give themselves fixed selfdiagnoses. The advantage of living closely with others is that one can test one\u2019s ideas. I\u2019m feeling poorly today. Do I have chronic fatigue syndrome? No, it\u2019s because you slept poorly last night. This is the kind of feedback that occurs routinely in living together with others. We profit from the collective wisdom about health and illness of our co-residents. These feedback loops cease to function when one lives alone, and function imperfectly in living solely with one other individual, for one is either cut off from the collective wisdom entirely or has substantially reduced access to it.<\/p>\n

The unmarried, divorced, and widowed tend to be easy prey for chic media-spawned diseases because they have few \u201csignificant others\u201d with whom they may discuss interpretations of their own internal states. Of fifty patients with chronic fatigue syndrome seen at Toronto Hospital, \u201cmost were unmarried women and at least 4 had been divorced.\u201d Their average age was thirty-three, and fully 50 percent had had a major depression before the onset of the fatigue.99 Of eight patients in one study who were \u201callergic to everything,\u201d four were married, two divorced and two single.100 As for \u201ctwentieth-century disease,\u201d psychiatrist Donna Stewart describes a population of young, middle-class female sufferers whose personal lives were in chaos. Of her original eighteen patients reported in 1985, seven were married, eight single, and three divorced.101 Lacking feedback loops, such individuals have only the media against which to test readings of their internal sensations, and the media purvey the most alarmist view possible.<\/p>\n

In the nineteenth century the \u201crestricted\u201d Victorian woman gave us an image of the motor hysteria common among women. In the late twentieth century somatization has become the lot of both sexes. Both men and women have been victims of the shattering of the family, and both experience the kinds of pain and fatigue distinctive to our century. It is the lonely and disaffiliated who give us the image of our own times, who are the latter-day equivalent of the hysterical nineteenth-century woman in her hoop skirts and fainting fits. The difference is that, whereas the nineteenth-century woman was virtually smothered by the stifling intimacy of family life, the disaffiliated of the late twentieth century expire in its absence.<\/p>\n

The development of psychosomatic symptoms can be a response to too much intimacy or too little. And if our forebears of the \u201cmodern\u201d family suffered the former problem, it is we of the postmodern era who endure the latter. The disaffiliated, having lost their faith in scientific medicine and unable to interpret body symptoms in social isolation, seek out alternative forms of cure. The therapies are largely placebos, if not directly harmful to the body as in the case of colonic irrigation\u2014a revival of the outdated practice of curing reflex neurosis by \u201cgetting those poisons out of there.\u201d This alternative subculture represents a population that has lost its faith in medical reassurance, that in the absence of folkloric family wisdom seeks its knowledge of the body from the media, and that has taken the full blow of the \u201crelationship\u201d stresses of postmodern life. It is a generation that did not invent psychosomatic illness, but finds itself singularly vulnerable to pain and fatigue that have no physical cause.<\/p>\n","protected":false},"excerpt":{"rendered":"

Edward Shorter writes in this 1993 book: This cultural pressure is the crux of the book. The unconscious mind desires to be taken seriously and not be ridiculed. It will therefore strive to present symptoms that always seem, to the … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[9250],"tags":[],"class_list":["post-135630","post","type-post","status-publish","format-standard","hentry","category-cfs"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t