Preventable Diseases

by Woods Hutchinson

The stories seem to be little more than pure creatures of the same force whose power they are supposed to illustrate, amusing and dramatic fairy-tales, handed down from generation to generation from Heaven knows what antiquity. Death under such circumstances as these may have occurred, but the proofs are totally lacking. One of our leading neurologists, who had extensively experimented in hypnotism and suggestion, declared a short time ago: "I don't believe that death was ever caused solely by the imagination."

Now as to the scope of this remedy, the extent of the field in which it can reasonably be expected to prove useful. This discussion is, of course, from a purely physical point of view. But it is, I think, now generally admitted, even by most believers in mental healing, that it is only, at best, in rarest instances that mental influence can be relied upon to cure organic disease, namely, disease attended by actual destruction of tissue or loss of organs, limbs, or other portions of the body. This limits its field of probable usefulness to the so-called "functional diseases," in which—to put it crudely—the body-machine is in apparently perfect or nearly perfect condition, but will not work; and particularly that group of functional diseases which is believed to be due largely to the influence of the imagination.

Nowhere can the curious exaggeration and over-estimation of the real state of affairs in this field be better illustrated than in the popular impression as to the frequency in actual practice of "imaginary" diseases. Take the incidental testimony of literature, for instance, which is supposed to hold the mirror up to nature, to be a transcript of life. The pages of the novel are full, the scenes of the drama are crowded with imaginary invalids. Not merely are they one of the most valuable stock properties for the humorist, but whole stories and comedies have been devoted to their exploitation, like Molière's classic "Le Malade Imaginaire," and "Le Médecin Malgré Lui." Generation after generation has shaken its sides until they ached over these pompous old hypochondriacs and fussy old dowagers, whose one amusement in life is to enjoy ill health and discuss their symptoms. They are as indispensable members of the dramatis personæ of the stock company of fiction as the wealthy uncle, the crusty old bachelor, and the unprotected orphan. Even where they are only referred to incidentally in the course of the story, you are given to understand that they and their kind furnish the principal source of income for the doctor; that if he hasn't the tact to humor or the skilled duplicity to plunder and humbug these self-made sufferers, he might as well retire from practice. In short, the entire atmosphere of the drama gives the strong impression that if people—particularly the wealthy classes—would shake themselves and go about their business, two-thirds of the illness in the world would disappear at once.

Much of this may, of course, be accounted for by the delicious and irresistible attractiveness, for literary purposes, of this type of invalid. Genuine, serious illness, inseparable from suffering and ending in death, is neither a cheerful, an interesting, nor a dramatic episode, except in very small doses, like a well-staged death-bed or a stroke of apoplexy, and does not furnish much valuable material for the novelist or the play-writer. Battle, murder, and sudden death, while horrible and repulsive, can be contemplated with vivid, gruesome interest, and hence are perfectly available as interest producers. But much as we delight to talk about our symptoms, we are never particularly interested in listening to those of others, still less in seeing them portrayed upon the stage. On account of their slow course, utter absence of picturesqueness, and depressing character, the vast majority of diseases are quite unsuitable for artistic material. In fact, the literary worker is almost limited to a mere handful, at one extreme, which will produce sudden and dramatic effects, like heart failure, apoplexy, or the ghastly introduction of a "slow decline" for a particularly pathetic effect; and at the other extreme, those imaginary diseases, migraines and vapors, which furnish amusement by their sheer absurdity.

Be that as it may, such dramatic and literary tendencies have produced their effect, and the popular impression of the doctor is that of a man who spends his time between rushing at breakneck speed to save the lives of those who suddenly find themselves in articulo mortis and will perish unless he gets there within fifteen minutes, and dancing attendance upon a swarm of old hypochondriacs, neurotics, and nervous dyspeptics, of both sexes. As a matter of fact, these two supposed principal occupations of the doctor are the smallest and rarest elements in his experience.

A few years ago a writer of world-wide fame deliberately stated, in the course of a carefully considered and critical discussion of various forms of mental healing, that it was no wonder that these methods excited huge interest and wide attention in the community, because, if valid, they would have such an enormous field of usefulness, seeing that at least seven-tenths of all the suffering which presented itself for relief to the doctor was imaginary.

This, perhaps, is an extreme case, but is not far from representing the general impression. If a poll were to be taken of five hundred intelligent men and women selected at random, as to how much of the sufferings of all invalids, or sick people who are not actually obviously "sick unto death" or ill of a fever, was real and how much imaginary, the estimate would come pretty close to an equal division. But when one comes to try to get at the actual facts, an astonishingly different state of affairs is revealed. I frankly confess that my own awakening was a matter of comparatively recent date.

A friend of mine was offered a position as consulting physician to a large and fashionable sanatorium. He hesitated because he was afraid that much of his time would be wasted in listening to the imaginary pains, and soothing the baseless terrors, of wealthy and fashionable invalids, who had nothing the matter with them except—in the language of the resort—"nervous prosperity." His experience was a surprise. At the end of two years he told me that he had had under his care between six and seven hundred invalids, a large percentage of whom were drawn from the wealthier classes; and out of this number there were only five whose sufferings were chiefly attributable to their imagination. Many of them, of course, had comparatively trivial ailments, and others exaggerated the degree or mistook the cause of their sufferings; but the vast majority of them were, as he naïvely expressed it, "really sick enough to be interesting."

This set me to thinking, and I began by making a list of all the "imaginary invalids" I had personally known, and to my astonishment raked up, from over twenty years' medical experience, barely a baker's dozen. Inquiries among my colleagues resulted in a surprisingly similar state of affairs. While most of them were under the general impression that at least ten to twenty per cent of the illnesses presenting themselves were without substantial physical basis and largely imaginary in character, when they came actually to cudgel their memories for well-marked cases and to consult their records, they discovered that their memories had been playing the same sort of tricks with them that the dramatists and novelists had with popular impressions.

Within the past few months one of the leading neurologists of New York, a man whose practice is confined exclusively to mental and nervous diseases, stated in a public address that purely or even chiefly imaginary diseases were among the rarer conditions that the physician was called upon to treat. Shortly after, two of the leading neurologists of Philadelphia, one of them a man of international reputation, practically repeated this statement; and they put themselves on record to the effect that the vast majority of those who imagined themselves to be ill were ill, though often not to the degree or in precisely the manner that they imagined themselves to be.