In medicine today there is a new spirit, a new openness to ideas and perceptions that come from the outside: from lay observers, from “the patient.” But there are problematic aspects to this new spirit, and certainly the profession is not open to all ideas or criticisms from the outside. What is it open to? When are laymen’s ideas well received? A recent instance—of a layman’s account of his illness, and the profession’s extraordinarily positive response1—permits us to look more closely at such questions.
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I
In 1964—at the age of forty-nine—Norman Cousins, then the editor of Saturday Review and a well-known author, became ill after returning home from a trip abroad. The illness involved a “general feeling of achiness” and gradually increasing stiffness or loss of motion in his neck, arms, hands, and legs. There was fever, and a sedimentation rate of over 80; this later rose to 115. (The sedimentation rate—“sed rate”—is a non-specific blood test that indicates the presence of infection, inflammation, or malignancy.) Nodules appeared on his neck and the backs of his hands. He was hospitalized and after further (unspecified) tests, was told that there was “no agreement on a precise diagnosis,” but a “consensus” that he was “suffering from a serious collagen illness—a disease of the connective tissue. All arthritic and rheumatic diseases are in this category. . . . In a sense . . . I was becoming unstuck” (“Collagen . . . binds the cells together”). One or more consultants offered a more specific diagnosis: “ankylosing spondylitis”—arthritis of the spine—“which would mean that the connective tissue in the spine was disintegrating.”
His doctor—a close friend of more than twenty years’ standing—told him that his chances of full recovery (it is not clear whether from an unspecified “collagen disease” or ankylosing spondylitis, but the discussion seems to lean toward the latter) were 1 in 500. A specialist said he had never seen anyone recover from this condition (which condition?): it was incurable and progressive.
Cousins says he simply refused to accept this verdict. And when he found that his doctor expected him to die, he decided to take the management of the case into his own hands.2 But Cousins had taken some matters into his own hands even earlier. From the start, he assumed charge, or tried to assume charge, of hospital routines insofar as they affected him. For example: one day four blood samples were taken by technicians from as many departments. Cousins had no intention of putting up with this kind of thing. “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 one vial for their individual needs.”
In the book this is followed by a fairly comprehensive condemnation of common hospital practices:
I had a fast-growing conviction that a hospital is no place for a person who is seriously ill. The surprising lack of respect for basic sanitation . . .; the extensive and sometimes promiscuous use of X-ray equipment; the seemingly indiscriminate administration of tranquilizers and powerful painkillers . . . ; and the regularity with which hospital routine takes precedence over the rest requirements of the patient . . .—all these and other practices seemed to me to be critical shortcomings of the modern hospital.
Cousins has since abandoned all of these criticisms. In his writing and his public appearances he has clung only to a criticism of the hospital’s food—“Perhaps the hospital’s most serious failure was in the area of nutrition”—citing, among other nutritional failures, unbalanced meals and processed foods.
But now Cousins is thinking about his illness and its apparently grim prognosis. He wants an interpretation of it, or of its origin. And he rapidly comes up with one. He thinks back over the days when he was in Russia as a member of a cultural delegation. He was busy and went to bed late. One day a driver took him eighty miles out of his way and he arrived at a reception hours late. During the nights, under the open windows of his hotel room, “a procession of diesel trucks plied back and forth,” sending fumes into the air. And on the last day, at the airport, “I caught the exhaust spew of a large jet at point-blank range as it swung around the tarmac.”
These facts provide him with causal explanation for his illness. Several days of strain (harderthan-usual work, inadequate sleep, an annoying experience) must have produced “adrenal exhaustion”; and this, coupled with exposure to “hydrocarbons” in the truck and airplane exhausts, must have produced his disease (ankylosing spondylitis?).
Having determined—to his own satisfaction—the cause of his illness, Cousins sets about finding its cure. He concentrates on “adrenal exhaustion” rather than toxic hydrocarbons. “Assuming this hypothesis was true [i.e., that he was suffering from “adrenal exhaustion”], I had to get my adrenal glands functioning again and to restore what Walter B. Cannon . . . called homeostasis.”
How would he overcome “adrenal exhaustion” and get his “adrenal glands functioning again”? What would restore “homeostasis”? Again, a solution came quickly. “I remembered having read, ten 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.” The solution, then, is obvious. If negative emotions have negative chemical effects, and cause illness, shouldn’t positive emotions have positive effects, and cure illness? Shouldn’t “love, hope, faith, laughter, confidence, and the will to live have therapeutic value?”
Having asked the question, Cousins has already answered it. “Positive emotions” will be the cure—or at least part of it.
But there will also be another, pharmacological, part. Cousins was being given large doses of aspirin, phenylbutazone (butazolidine), codeine, colchicine, and sleeping pills. “It developed that I was hypersensitive to virtually all the medication I was receiving. . . .” (though it is not clear how this was determined). He sent one of his assistants at Saturday Review “to look up pertinent references”; the assistant found that these drugs can depress adrenal functioning or have other deleterious effects. Cousins decides to do without them, but not to forgo medication completely.3 The drugs act to reduce pain and relieve inflammation. He has already found, a substitute treatment for pain: positive emotions. But what will combat inflammation? As always, memory comes quickly to his aid. “I recalled having read in the medical journals about the usefulness of ascorbic acid [vitamin C] in combatting a wide number of illnesses. . . . Could it also combat inflammation? . . . Did it serve as a starter for . . . the adrenal glands?”
Why not? And so his plan is complete. He will restore homeostasis, get his adrenal glands working, and cure himself of his disease, with great quantities of salutary emotions and massive doses of vitamin C.
It is a significant part of the story that Cousins’s doctor supported him at every point, consenting to every step he chose to take. “He said that what was most important was that I continue to believe in everything I had said.” This is a double-edged statement, although Cousins doesn’t realize its irony—and quite possibly his doctor didn’t either.
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Although Cousins decided early to find a more cheerful setting for himself than the hospital, he embarked on the “salutary emotions” part of his cure while still there.
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. . . . We pulled down the blinds and turned on the machine.
The Candid Camera classics were eventually supplemented with other comic films, books of humor, etc. And—the treatment works! “I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect that would give me at least two hours of pain-free sleep. . . .”
After some time, Cousins moves to a happier environment: a hotel. (He doesn’t tell us how long he was hospitalized, or what his condition was when he left the hospital.) Here he sets up in effect a hospital room, with nurses or other attendants, IV equipment, and so on. His doctor continues to acquiesce in every decision, and the choice—indeed the invention—of “treatments,” dosages, modes of administration, etc., continues to rest entirely with Cousins. And now Cousins institutes the vitamin-C part of his cure. His doctor has warned that huge doses may damage the kidneys, but Cousins has a solution. If given intravenously, and slowly, he decrees, the risk to his kidneys is minimal or nonexistent—as is any risk to his veins. He decides on 25 grams over a four-hour period—more, his doctor says, than any dose on record. (On what basis he chose 25 grams—rather than 15 or 40—is not indicated. Nor are we told for how long this regimen was followed.)4
This, too, works! Cousins is getting better. Motion is returning to his thumbs and other joints. The nodules seem to be shrinking. Sleep is increasingly prolonged. And by the eighth day, there “was no doubt in my mind that I was going to make it back all the way. I could function, and the feeling was indescribably beautiful.”
Over the next months, Cousins recovered sufficiently to return to work full time. Over the next eleven years “mobility has improved. I have become pain-free, except for one shoulder and my knees.” For an unspecified period, metal braces were needed, but he no longer uses them, and “I no longer feel a sharp twinge in my wrists when I hit a tennis ball or golf ball. . . .”
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What conclusions does Cousins draw from what he obviously considers a near-miraculous recovery, a remarkable triumph of will and insight over incurable disease? While the story—on its own terms—would seem to imply a number of conclusions, Cousins himself stresses only two. First, “the will to live is not a theoretical abstraction, but a physiologic reality with therapeutic characteristics.” And second, “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.”
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II
Most of this is contained in the first chapter of the book, which reproduces an article Cousins published in the New England Journal of Medicine in 1976. The book adds little. It is mainly an extension of the basic theme: the will to live is therapeutic; positive emotion cures. In the final chapter, however, Cousins tells us that after the journal article appeared, he was asked whether there had been anything in his medical history to prepare him for the “partnership” with his doctor in the “diagnosis and treatment of [his] illness. . . .” There had been two previous experiences, he relates. First, as a child of ten he was mistakenly diagnosed as having tuberculosis—he was not ill at all—and sent to a sanatorium. But he had a positive outlook, and he got well! The second incident was ten years before the events of the book (i.e., at age thirty-nine), when he was found to have a heart condition. He was advised to stay in bed, avoid exertion, etc., but he chose to ignore this advice, to remain active and exercise. Years later, the famous cardiologist Paul Dudley White told him he had done the right thing.5
And so, on three occasions, Cousins deliberately bypassed his doctors, ignored their advice, set aside the standard treatment—and got well. He could have said that on one and possibly two of the three occasions medicine grossly misdiagnosed his case; and that on all three occasions it advised the wrong treatment—or at least not the treatment he believes made him well. But this would have led to serious questions about the reliability of medical diagnosis and the soundness of standard treatment—and this is not what Cousins cares to pursue. Of course he was right, in rejecting standard medicine, substituting his own theories and cures, and so on, but medicine is fine, too. “Has my respect for the medical profession diminished as a result of the three episodes? Just the opposite.” Why? The letters he has since received have convinced him that “Most doctors recognize that medicine is just as much an art as it is a science and that the most important knowledge in medicine . . . is the way the human mind and body can summon innermost resources to meet extraordinary challenges.”
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The publication of Cousins’s article in the New England Journal of Medicine was itself an event, since that prestigious forum rarely carries laymen’s discussions of medical subjects, or their own accounts of their illnesses. In commenting on the article in the issue, the editor, the late F.J. Ingelfinger, was somewhat tongue-in-cheek, but not at all critical. He made no attempt to evaluate the substance of Cousins’s story, or to indicate why—without this evaluation—it was deserving of such attention. But publication in the NEJM gave Cousins’s account a certain medical cachet—and was the first cheer in what eventually became a resounding chorus of medical acclaim. And it is this acclaim that gives Cousins’s story its broader significance. There were, apparently, no questioning or critical letters received by the journal after publication of the article: those published in a later issue (March 31, 1977) speak of the article’s “tremendous impact” and “the deep implications behind [Cousins’s] words of wisdom. . . .” They describe the writing as “beautiful” and hail Cousins as “a true scientist.”
Even more remarkable were the letters to Cousins himself—“some 3,000 letters from doctors in about a dozen countries”—in support and appreciation. I believe this is unprecedented: I wonder whether any scientist, any doctor, who made a major contribution to medicine, could boast of a similar outpouring from the profession. Since then—according to the book’s dust jacket—the article has been reprinted in medical journals in fourteen countries, and “some two dozen medical schools use it for instructional purposes.” Five medical schools invited Cousins to join their faculties; he is now senior lecturer in medical humanities at the School of Medicine of the University of California at Los Angeles. Cousins is asked to lecture at medical schools, to address AMA conferences; and he serves as consultant to some 200 doctors and their patients. (This last piece of information comes from one of his recent television appearances.) He has been named consulting editor of Man and Medicine, The Journal of Values and Ethics in Health Care, published at the College of Physicians and Surgeons of Columbia University. His book—a Book-of-the-Month Club Alternate selection—has become a national best seller. There can be no doubt that the prior medical acclaim, set off by the NEJM publication, is the base on which the book’s popular success rests.
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III
Was Cousins’s gradual and good, but not total, recovery the remarkable triumph of will and insight that he believes it was? And what is it that made such a large—and influential—part of the medical profession hail the article and lionize its author?
Let us look at the story more closely, and ask some of the questions that neither Cousins nor his admiring medical readers found it necessary to ask.
First, what was Cousins’s illness? Was it arthritis? Ankylosing spondylitis? Remarkably, Cousins never answers this question directly and unequivocally. Was it a disease that is generally fatal, or at least invariably progressive and irreversible? Clearly the entire story hinges on Cousins’s overcoming overwhelming odds. (In his commentary, Ingelfinger noted this, but—in effect setting the tone for the subsequent medical response—saw no need to pursue the point: in the groundswell of enthusiasm thereafter, every logical, every substantive, question became irrelevant.)
Cousins mentions that there was no agreement on a diagnosis, beyond that of a “serious collagen illness.” This is a very broad, even vague classification: on this basis no definite prognosis could be made. Collagen diseases are highly diverse and poorly understood; they may run variable, unpredictable courses. There are all levels of severity. And they are not, as a category, inevitably progressive and unremitting. Cousins himself notes that a major subdivision is rheumatoid arthritis—which has many forms.
It seems entirely possible that what Cousins had was an acute attack of an arthritic condition which then subsided, slowly, but quite naturally. All of the symptoms he describes are compatible with a severe bout of arthritis: fever, pain, stiffness, nodules, a high sed rate. If any other symptoms—or other diagnostic measures—pointed to some other, rapidly progressing, irreversible condition, he doesn’t mention them. There were other laboratory tests: Cousins doesn’t identify them or tell us what they showed. There must have been X-rays: he never refers to them. Did X-rays—over some period of time—show a rapidly or even consistently progressing “disintegration” of his spine? Why was there no agreement on the diagnosis? There must have been some area of uncertainty, some ambiguity. Cousins never goes into this. Above all, how could it have been determined, in an apparently brief hospitalization, with the sed rate the only disclosed test—and this was dropping steadily before he left the hospital—that his condition would be progressive and irreversible? Ankylosing spondylitis—if this is what Cousins had—is not a fatal disease; and remissions—after ten or more years (as in Cousins’s case)—occur, with stabilization and a normal life course.6
It is interesting that while Cousins creates his own etiology for the disease and adopts his own cures in preference to the medically accepted treatment, he never questions the diagnosis or the prognosis he was given. Could these have been in error—or overstated? Could his recovery have been a routine event? He is willing to question all other aspects of his case; why not these, too? The answer, of course, is patent: to admit these questions deprives him of a story—and wipes out all of his glory.
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Now let us look at Cousins’s cures. First, the vitamin-C cure. Cousins shuttles back and forth between attempts to prove that vitamin C is a specific treatment for arthritis and related diseases, and a perfect willingness to believe that it “worked” in his case as a placebo: it worked because he believed it would work. (“Two or three . . . doctors . . . have commented that I was probably the beneficiary of a mammoth venture in self-administered placebos. Such a hypothesis bothers me not at all. . . .”) But vitamin C was not an accepted treatment for arthritic conditions at that time—and it isn’t now. It is fascinating that doctors, in hailing the article—and Cousins himself—failed to realize that their enthusiastic and uncritical response would seem to lend credence to claims that vitamin C is therapeutic in arthritic—or collagen—diseases.
There is, of course, Cousins’s fall-back argument: it worked as a placebo. But on this ground a claim may be made for anything a patient may hit on, any cure or panacea he may have heard of or read about: brewer’s yeast, laetrile, etc. (Incidentally, one of the toxic drugs Cousins boasts of having rejected is aspirin: if his illness were happening today, he might well decide to cure himself with aspirin, which is rapidly becoming the new panacea, the vitamin C of the 80’s.)
There is another question in Cousins’s drug treatment that he brushes up against, but characteristically is neither willing nor able to pursue systematically. It is possible that vitamin C “worked” in Cousins’s case neither pharmacologically nor psychologically, but simply by substituting for other, possibly more dangerous drugs. That is, we may doubt that Cousins was helped by what he took—the massive doses of vitamin C—but clearly he made a good recovery without the drugs that are standard in such cases.7 And this may, very often, be the value of the “placebo”: it frees the patient from other (standard or experimental) drugs, which may overwhelm the body’s defenses, or create diseases of their own—whose harmful effects may be greater than their benefits.
Interestingly, the history of medical treatment of ankylosing spondylitis provides striking illustrations of exactly this: that the treatment may sometimes be at least as dangerous as the disease. Thus it is now recognized that patients do not die of ankylosing spondylitis, but in the past many did die of leukemia that resulted from—useless—radiation for it. Similarly, surgery was formerly resorted to—but is now recognized as being of no value in the disease, except in certain limited situations. Cousins’s theories and treatments are humbug—but they may have spared him prolonged treatment with a multiplicity of powerful—and dangerous—drugs. Tragically, humbug is sometimes less dangerous than accepted treatment; and resistance—based on humbug, instinct, whatever—is sometimes better than compliance with highly fallible expertise.
Should doctors have given no thought to Cousins’s “cures”? Should factual questions not have been raised before the author was hailed as a “true scientist”?
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What about the other part of Cousins’s cure—the “salutary emotions” part?
Did Cousins bring about an extraordinary mobilization of his body’s recuperative powers with Candid Camera and the rest of it? I have a strong feeling that those who can find solace for the ills of the world, and for their own supposedly crippling and possibly fatal illnesses, in Candid Camera and similar “classics,” are nearly indestructible in any case. I have the same feeling in regard to those who think that the operation of their body’s natural processes is somehow due to their own brilliance or originality. This is the mentality of the cock who perceives clearly that his crowing made the sun rise. But again, taking the account on Cousins’s own terms, and using only the facts which he himself provides, did the remarkable level of “salutary emotion” Cousins claims for himself derive from the movies, the joke-books, and so on? Is the will to live so easily manipulated, so dependent on trivial, superficial agencies, in anyone, even in Norman Cousins?
Let me say at once that I believe “positive emotions” play a role in health. But the “positive emotions” that are a force in maintaining life, well-being, resistance to disease, recuperative or regenerative capacity, are those that stem from deep, relatively constant levels of one’s psychological nature, one’s inner being. They are affected by long-term circumstances of life and by major life events. (On the deepest level, these forces are purely biological and to a great extent autonomous.) And here, just as I think that if Cousins’s drug cure had any value it was not through what he took but through what he escaped from, so I believe that if “positive emotions” operated in Cousins’s case at all, they did so not through the acts or thoughts for which he takes credit, but through his extraordinary freedom from all inner and outer stress: from any possible negative reality. There is nothing in what Cousins tells us (or what we know or can infer of the man himself) to suggest any serious emotional or intellectual strain, any stressful life circumstances. The pressures and constraints—the anxieties, frustrations, turmoil—of other lives, are not even dreamed of here.
It is, indeed, this same restriction to trivia that makes Cousins’s etiological explanations as unconvincing as his explanations of his cures. If a few days of moderate exertion, an annoying but basically unimportant experience with a taxi, and brief exposure to truck and airplane exhausts, cause, instantly, in a presumably healthy man of forty-nine or fifty, “adrenal exhaustion” (whatever that is) and ankylosing spondylitis, it may not be surprising that Candid Camera and joke-books cure these conditions. Cousins’s causes of disease, and his cures, are indeed well matched.
But there is another aspect of Cousins’s “positive emotions” which is crucial here—and which Cousins ignores. One of the most tragic effects of major illness is the sense—the realistic sense—of loss of control over one’s life, and over one’s environment. Hospitals—to some extent medical care itself—foster this sense of helplessness, of impotence. The seriously ill patient is deliberately rendered helpless, denied control over anything that has to do with his illness or his care; even information about his condition, or his treatment, is often withheld; there may be deliberate mystification; the patient is treated as irrational, incompetent, and allowed only to be passive and “compliant.” This deprivation of intelligence, self-determination, dignity, is a further burden in what may already be an overwhelmingly negative reality.
Cousins’s experience was totally different. The treatment he got—from his doctor, and from the hospital—was almost completely unlike what almost anyone would get, from almost any doctor, in almost any hospital. Cousins is in charge at every point. He can choose to be hospitalized—or to set up his own hospital room in a hotel; to take the standard drugs—or to direct his doctor to institute unconventional, unapproved (and even dangerous) treatments of his own devising. He knows that he will be listened to, deferred to; whatever he chooses—whatever he “remembers having read”—will be done, by his doctor and other personnel—even when his doctor does not believe in these notions himself. He issues decrees regarding laboratory procedures (recall his “turning away” the technicians who came for blood samples, and the posted notice: even the tone is remarkably highhanded). When he decides he needs slapstick movies, they are sent in, a nurse is turned into a projectionist, the blinds are pulled down—and other patients, and hospital requirements, be damned.
Incidentally, in boasting of his hotel option—as of everything else—Cousins assures us that a hotel room costs only one-third what a hospital room costs. Of course he never considers that in a hotel one must make private and surely quite complicated arrangements for nurses, technicians, hospital equipment, as well as for food and other services; apparently all of this was taken care of for Cousins—he never even mentions it. Then, too, most doctors will not go along with such arrangements—and insurance plans are unlikely to cover self-prescribed hospitalization, and patient-invented procedures, in a hotel room. Actually, such an arrangement would, for most people, be very much more expensive than a hospital room: in fact, completely infeasible and unrealistic. But realities of this sort are utterly foreign to Cousins. Also, one would have supposed that non-hospital care could be more easily arranged at home. Cousins never tells us why he chose hospitalization-in-a-hotel.
The trivial elements in Cousins’s story—telling patients to cure themselves with movies, with belly laughs—cannot be separated out from the more serious elements which Cousins took for granted, but blurs in the presentation: his freedom to choose his own drugs and treatments—to reject whatever he believes is harmful to him; his confidence that his doctor will do whatever he (Cousins) wants him to do; his social and economic freedom to create alternatives—to move to hotels, to set up his own hospital; and so on. The kernel of truth here is not that Cousins was either wise or original in cultivating “positive emotions,” but that to an extraordinary extent, he hardly needed to: there are hardly any “negative” realities in Cousins’s life, thoughts, or feelings—or in the features of his medical care, as he describes them. This state did not come about from an appreciation of Candid Camera, or from a unique mobilization of inner resources—but from being what he is, and from his life, and medical, circumstances. In fact, nothing in Cousins’s presentation, self-serving as it is, suggests any particularly strong “inner resources”—rather, everything points to an impressive mobilization of outer resources: social, economic, and medical. (And at that, it may all have had little to do with his recovery.)
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There are many questions involved here, which have been completely ignored by Cousins and his medical admirers. For example, should all patients have the same rights and freedom that Cousins had? If not, why is it inspiring that such rights and deference were accorded to Cousins? Under what circumstances should doctors allow patients to choose their own drugs, invent their own routines and regimens—in effect, direct their doctors? When the patient has a foggy notion of “adrenal exhaustion” or a contentless echo of “homeostasis”? When he remembers having read, somewhere, that X may be useful in a “wide number of illnesses”? When he is a celebrity? When he has a need to believe whatever he happens to have said?
How was it possible for so many doctors to greet Cousins’s account with enthusiasm, and ignore every substantive and ethical issue in it?
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IV
To sum up, then: every scientific, medical, social, and ethical issue involved in his case—as Cousins himself describes it—is skirted, muddled, or totally evaded. Instead of pursuing any critical point, Cousins provides an uplifting sermonette, an inspirational (and scientifically worthless) ramble. For doctors, he ends with praise and “increased confidence”; for the rest of us, with the message that we can cure ourselves, by salutary emotions, by the will to live, by belly laughs. Of course this appeals to some part of the general public, as does every self-help, triumph-over-tragedy promise, no matter how flimsy. But—despite obvious disingenuousness and the absence of scientific or even logical thought—it clearly appeals as well to some part, indeed an influential part, of the medical profession, which also wants to believe that patients can cure themselves, if only they want to. (“Good patients get well.”) Consciously or unconsciously, many doctors react to the incurably ill, the chronically or terminally ill patient, with hostility. Doctors, too, want miracles. Doctors, too, want a guru. They, too, want an escape from the complexities and frustrations of medical diagnosis and treatment; they, too, want the cheerful certainties of a pseudo-philosophy in place of the unending search of science. They, too, want simple, positive answers—especially those which seem to absolve the profession from failures and blunders; they, too, want cures which are painless to themselves and carry no onus of responsibility.
Should medicine not admit lay examinations of medical care; should it reject out of hand the patient’s views, insights, knowledge? Of course not, There should in fact be much more openness—much more receptivity—than there is now. But true openness, true receptivity, involves a willingness to examine, honestly and seriously, what a non-doctor says about medicine, his disease, or his treatment. This is not what happened with Cousins’s Anatomy of an Illness. Rather, the unrestrained enthusiasm in this case, coupled with the total absence of serious evaluation of the account—or any substantive or moral issue involved in it—has the unhappy effect of suggesting that, ultimately, what is sought, what is welcomed in “laymen’s contributions,” is what consciously or unconsciously corroborates or panders to medical prejudices or stereotypes: in this instance, the comforting assurance that patients can cure themselves, if only they will “think positively.” Cousins created an illusion of criticism—and the medical enthusiasm for him creates an illusion of openness.
Medicine must bear a responsibility for creating “heroes,” “experts,” and “therapies” with such morally and intellectually dubious foundations.
1 Anatomy of An Illness, As Perceived by the Patient, by Norman Cousins, Norton, 173 pp., $9.95.
2 On television he has explained that he learned of this expectation from a letter which his doctor left “on a shelf.” In the book, there is nothing to indicate that a fatal outcome was expected.
3 He does not actually state that once he decided on his own medication, he took none of the prescribed drugs. He simply implies it, or leaves the reader free to draw this inference.
4 Cousins tells us he “tested” his cures by comparing his sed rate before the “laughter episodes” and some hours after them—i.e., later in the day. “The drop by itself was not substantial [about 5 points] but it held and was cumulative.” He did this again—apparently once—with the ascorbic acid treatment; again the sed rate showed a drop over the course of the day. Of course he never considers the possibility that the rate was dropping because he was recovering—i.e., the attack was subsiding. But it is surprising that in all of the years since, no one has told him that since he did not make the same comparison in the absence of his “treatments,” or with control substances substituted “blind,” he cannot claim that the steady drop in the sed rate was produced by his “treatments.”
5 The cardiac disease, too, is only vaguely described, and Cousins does not indicate whether it remains. And, he says, “there were other factors in my case that might not apply to others”—but doesn't tell us what they were.
6 Indeed, the entire presentation makes one wonder whether Cousins wasn't simply told that total recovery from ankylosing spondylitis is Tare. And this, after all, is true: by his own admission—again not in so many words—he hasn't “totally” recovered.
7 It is important to remember that Cousins never actually states that he totally stopped taking the standard drugs: this is simply implied. Neither does he tells us whether, after the brief acute stage described in the article, he continued to take massive doses of ascorbic acid over the long—eleven-year—period of his recovery. Everywhere, crucial facts are omitted or blurred.
