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There’s a good bit of history for the date, May 6th.

For instance, Olga Korbut, Sigmund Freud, and Maximilien Robespierre, among others, were born on this day.   In 1527, Spanish and German troops sacked Rome, signalling the end of the Renaissance.  In 1863, Confederate forces defeated the Army of the Potomac at Chancellorsville.  In 1889, the Eiffel Tower officially welcomed the public.  In 1954, Roger Bannister broke the four minute mile.  In 1994, the Chunnel opened underneath the English Channel, better linking Britain and France.  In 1998, Chicago Cubs pitcher Kerry Wood struck out 20 Houston Astros to tie Roger Clemens’ major league record.  May 6th is also police day in Georgia (U.S.), and International Diet Day.

But for whatever capricious reason, the historical factoid that resonates the most with me today is the admission on May 6th, 1757 of English poet Christopher Smart to St Luke’s Hospital for Lunatics in London.  He had developed a religious mania which compelled him to pray continuously, and apparently wandered the city doing so in public.

Samuel Johnson remarked, “My poor friend Smart shewed the disturbance of his mind, by falling upon his knees, and saying his prayers in the street, or in any other unusual place.” And also, “I did not think he ought to be shut up. His infirmities were not noxious to society. He insisted on people praying with him; and I’d as lief pray with Kit Smart as any one else. Another charge was, that he did not love clean linen; and I have no passion for it.”

Smart himself wrote in his work, Jubilate Agno, composed during the years of his confinement (though not published until 1939):

“For I blessed God in St James’s Park till I routed all the company. For the officers of the peace are at variance with me, and the watchman smites me with his staff.”

In all likelihood, Christopher Smart suffered from bipolar disorder.

He was, if excessively ardent in his devotion, harmless.  Certainly, far worse has been done in the zealous demonstration of faith.

Here is a poem for which he is well known.  One can imagine what effect the loss of freedom and bleak ambiance of the asylum must have had on its author.

For I will consider my Cat Jeoffry (from Jubilate Agno)

For I will consider my Cat Jeoffry.
For he is the servant of the Living God, duly and daily serving him.
For at the first glance of the glory of God in the East he worships in his way.
For is this done by wreathing his body seven times round with elegant quickness.
For then he leaps up to catch the musk, which is the blessing of God upon his prayer.
For he rolls upon prank to work it in.
For having done duty and received blessing he begins to consider himself.
For this he performs in ten degrees.
For first he looks upon his forepaws to see if they are clean.
For secondly he kicks up behind to clear away there.
For thirdly he works it upon stretch with the forepaws extended.
For fourthly he sharpens his paws by wood.
For fifthly he washes himself.
For sixthly he rolls upon wash.
For seventhly he fleas himself, that he may not be interrupted upon the beat.
For eighthly he rubs himself against a post.
For ninthly he looks up for his instructions.
For tenthly he goes in quest of food.
For having considered God and himself he will consider his neighbor.
For if he meets another cat he will kiss her in kindness.
For when he takes his prey he plays with it to give it a chance.
For one mouse in seven escapes by his dallying.
For when his day’s work is done his business more properly begins.
For he keeps the Lord’s watch in the night against the adversary.
For he counteracts the powers of darkness by his electrical skin and glaring eyes.
For he counteracts the Devil, who is death, by brisking about the life.
For in his morning orisons he loves the sun and the sun loves him.
For he is of the tribe of Tiger.
For the Cherub Cat is a term of the Angel Tiger.
For he has the subtlety and hissing of a serpent, which in goodness he suppresses.
For he will not do destruction if he is well-fed, neither will he spit without provocation.
For he purrs in thankfulness when God tells him he’s a good Cat.
For he is an instrument for the children to learn benevolence upon.
For every house is incomplete without him, and a blessing is lacking in the spirit.
For the Lord commanded Moses concerning the cats at the departure of the Children of Israel from Egypt.
For every family had one cat at least in the bag.
For the English Cats are the best in Europe.
For he is the cleanest in the use of his forepaws of any quadruped.
For the dexterity of his defense is an instance of the love of God to him exceedingly.
For he is the quickest to his mark of any creature.
For he is tenacious of his point.
For he is a mixture of gravity and waggery.
For he knows that God is his Saviour.
For there is nothing sweeter than his peace when at rest.
For there is nothing brisker than his life when in motion.
For he is of the Lord’s poor, and so indeed is he called by benevolence perpetually—Poor Jeoffry! poor Jeoffry! the rat has bit thy throat.
For I bless the name of the Lord Jesus that Jeoffry is better.
For the divine spirit comes about his body to sustain it in complete cat.
For his tongue is exceeding pure so that it has in purity what it wants in music.
For he is docile and can learn certain things.
For he can sit up with gravity, which is patience upon approbation.
For he can fetch and carry, which is patience in employment.
For he can jump over a stick, which is patience upon proof positive.
For he can spraggle upon waggle at the word of command.
For he can jump from an eminence into his master’s bosom.
For he can catch the cork and toss it again.
For he is hated by the hypocrite and miser.
For the former is afraid of detection.
For the latter refuses the charge.
For he camels his back to bear the first notion of business.
For he is good to think on, if a man would express himself neatly.
For he made a great figure in Egypt for his signal services.
For he killed the Icneumon rat, very pernicious by land.
For his ears are so acute that they sting again.
For from this proceeds the passing quickness of his attention.
For by stroking of him I have found out electricity.
For I perceived God’s light about him both wax and fire.
For the electrical fire is the spiritual substance which God sends from heaven to sustain the bodies both of man and beast.
For God has blessed him in the variety of his movements.
For, though he cannot fly, he is an excellent clamberer.
For his motions upon the face of the earth are more than any other quadruped.
For he can tread to all the measures upon the music.
For he can swim for life.
For he can creep.

War, Mental Disorder and Suicide

(Loncar et al. Coll. Antropol. 28 (2004) 1: 377–384, Zagreb)

“War as a human disaster of major significance has led to an increase in the number of suicides committed by people suffering from mental disorders. Considering the results of similar research, we were particularly interested in the effect that war has on the incidence of suicide among of people with mental disorders. The research included 16,362 patients with mental disorders, treated at the Clinic for Psychiatry at the Clinical Hospital Split during the nine-year timeframe which were divided into pre-war (April 6th 1988 – April 7th 1991), wartime (April 6th 1991 – April 7th 1994) and post-war (April 6th 1997 –  2000) periods… In our research, we found a statistically significant difference in suicide incidence between three observed periods …with the incidence being the highest during the wartime period …With this research we intended to offer a better understanding of the complexity of the suicide problem…”

During WWII the cherry blossom was a symbol of the beauty and transience of life used to motivate kamikaze pilots.   Fliers painted them on the sides of their planes or carried branches with them in their cockpits.

Here in Philadelphia for the past week, we have enjoyed tranquil, temperate weather and the blossoms have emerged in force.

These were taken at Morris Arboretum.

Alexander and his Doctor, about 1648-9, Eustache Le Sueur

According to classical anecdote, Alexander the Great suffered from mysterious maladies and from his own mystique. No one dared to treat him for fear that a bad outcome would doom the would-be healer to certain persecution by Alexander’s wildly solicitous minions. Finally, Phillip, Alexander’s physician, frustrated by the young king’s decline, offered care in the form of a salubrious potion. But a general had already impugned Philip in a letter to Alexander, which claimed Philip to be acting seditiously on behalf of Alexander’s Persian enemies, and not to be trusted. Despite this warning, Alexander boldly drank the medicine, as he did so, handing the letter to Philip to read.

In the painting, Philip stands above a recumbent Alexander, as the doctor-patient relationship would demand. But Alexander’s broad chest and raised eyes reveal his power, while Philip’s stooped posture and frown expose the frailty of his position. The painting reveals, perhaps unwittingly, the vital duality of the relationship, each risking himself, proffering his full commitment to the other. Here the physician assumes the role of servant rather than patriarch, though his experience and wisdom are evident.

The intern who cared for Vincent van Gogh after he severed his ear. The painting was a tributary gift. While Dr. Rey was quite fond of Van Gogh, who mentioned the physician favorably and intimately in his letters, Rey did not appreciate the painting, at least not at first. His parents used it to cover a hole in a chicken coop. Nevertheless, Dr. Rey clearly appreciated the essential role art played in his patient’s life, and recommended Van Gogh continue to pursue it. At this time, of course, Van Gogh’s painting was for the most part unknown and/or dismissed.

Haus LebensWert is a philanthropically developed and supported facility in Cologne, Germany where patients may receive oncology services free of charge.  An integral part of Haus LebensWert’s vision and mission is to vigorously help cancer patients cope with life both during treatment and afterwards.  Another key component is the use of alternative and complimentary therapies.  These therapies are made available to patients in addition to traditional measures as part of a seamless whole.   Examples include psycho-oncology, art & music therapy, gymnastics and other exercise, voice instruction, Feldenkrais training, Nordic walking, dance therapy, massage and aroma massage, Tai-Qi, Qi-gong and acupuncture.   The Haus LebensWert, which complements a more traditional hospice, has been well received by both patients and practitioners, including those who refer their patients from outside (Hematology Am Soc Hematol Educ Program. 2009:320-5).

Critics of “complimentary and alternative medicine” (CAM) frequently complain of a double standard, and a lack of rigor in its evaluation.  Some feel this looseness encourages bloat and charlatanism, and risks distracting patients and practitioners from the path to “good outcome.”

“Academic medicine integrates three of the most honorable human activities: treating the ill, teaching, and research. The quality that all three share is persistent quest for truth. However, there is reluctance of academic medicine today to openly defend scientific truth by challenging the arguments and the very existence of “complementary and alternative medicine” (CAM). There is no sound proof of CAM effectiveness, no hypotheses on the mechanisms of their action, nor scientific reports testing them. The fact that patients are charged for these “healing” activities makes CAM a plain fraud. With these facts in mind, the name “complementary and alternative medicine” is undeserved and misleading. CAM advocates maintain that CAM should be recognized precisely because it is widely practiced and very promising, that it has a special holistic/human approach, and works at least as a placebo in situations where medicine can do nothing more. As it seems that the public interest in paramedicine will only grow stronger before it grows weaker, scientists must raise their voice and question the truthfulness of CAM more openly.”
Croat Med J. 2004 Dec;45(6):684-8.

While a truth-centered paradigm is difficult to dispute, there is more than scientific truth at stake in the quest for human understanding.  There is also existential truth.  While physician-scientists optimize therapeutic regimens by evaluating their effects on controlled trial populations, each individual patient attempts to grapple with his or her radically changed reality both in terms of life, and death.  Quantity—be it months of survival, tumor size, or fraction cured—can be measured with increasing accuracy and predictive value.  Quality can’t be so easily parameterized.  Moreover, even attempts made to evaluate “quality of life” tend to fall short because experience transcends subjective criteria when they are too rigidly circumscribed.  Patients exist within the larger communities of other patients, clinicians, family, and the omnibus of culture.  If society views the sick as mechanisms in need of repair, and devalues anything regarded as “touchy feely,” then those in charge will cut the funds that allow physicians to spend time talking with patients or considering the larger life outside the body, while adding to the already glutted ranks of surgi-centers and MRI scanners.  Certainly the possible advantages of reinvigorating the art of medicine, or even expanding it to include real art, such as expressive writing, or speaking, as therapy,will be viewed as unworthy of “serious” exploration.  This is what has happened so far.  The impersonal and alienating experience of illness is nearly a truism, at least in the U.S.

Hospitals, especially large referral centers, can be daunting and soulless places.  As we move necessarily towards more “cost-effective” healthcare it will be important not to lose sight of the fact that quality and quantity exist to a large degree as orthogonal axes.  Designing healthcare to have a more empirical and inclusive approach to alternative healing strategies assures a better chance at quality of life, and should be encouraged as long as these don’t induce patients to forego proven treatment.   A life of fear and despair may be nearly as much a lost life as for the patient who dies of his or her disease.

Haus LebensWert, by the way, means House for a Life Worth Living.

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