Health:Is social isolation just as hazardous to health as smoking or obesity? And is modern medicine mistaken to ignore personal details of a patient's life?
After a patronising comment about her show by Kevin Costner on television, Madonna mimed vomiting. Everyone knew what she meant: she was vomiting up Costner and his remark. Some emotional experiences can quite simply make us sick, physically ill.
The authors of this book, Leader, a psychoanalyst, and Corfield, a philosopher, pose some initial questions. Why is it that although every case of TB is the result of exposure to the bacillus, only a minority will go on to develop the disease? If two men of the same age have heart attacks, why is the single, depressed man more likely to die of heart disease than the married man who is not depressed? Forgotten anniversaries can act as a trigger for illness: men often die on the anniversary of their father's death.
These observations are now less surprising since we know that the immune system is in constant dialogue with the brain. According to the authors of this book, social isolation is just as hazardous to health as smoking, obesity and lack of exercise.
It is in the detail of the patient's individual biography that the authors believe some of the answers can be found. As a psychoanalyst, Darien Leader is an expert in detailed biography, and, unusual for a follower of Jacques Lacan, wears his theory lightly. The book reworks Stephan Zweig's argument (from Freud's day) that disease no longer means what happens to the person as an individual but what happens to their individual organs. The modern focus on organs has eroded interest in the personal details of a patient's life, reduced to a single box on medical forms: "Occupation". Overworked doctors, increasingly computer-assisted, simply do not have the time for detailed listening, and this includes psychiatrists. It is not surprising, according to the authors, that so many go to alternative practitioners to get individual attention and interest in their plight.
This is not a self-help book but in the light of considerable anecdotal evidence the reader might wonder what physicians can actually do to identify and treat physical illness caused by emotional distress. One case concerns a patient who consulted 15 specialists about heart palpitations. The 16th found out the symptoms had begun three days after his father had died from coronary thrombosis. The palpitations were in this case due to a severed relationship. The question "how long have you had the illness?" is often asked of patients. But the authors argue that the more precise (psychoanalytic) question, "when did the illness start?", is far more useful since it encourages biographical responses such as "it was after my mother died" or "when the firm took on the big American contract".
ANOTHER INTERESTING AREA is the psychology of the cure. A doctor's authentification of suffering may be more effective than his medication. Also in psychotherapy the undivided interest from the therapist may be more effective than his insights. The authors cite an interesting example of a man rushed to hospital with palpitations. After a number of attempted cures he finally succeeded with acupuncture. However, while undergoing the treatment he complained bitterly about the pain. It later emerged in psychoanalysis that the man felt guilty and anxious about cheating on his wife and the painful treatment satisfied his desire for punishment. We could say acupuncture, in his case, was truly the treatment of (unconscious) choice. What this shows is that treatment from both medical and alternative practitioners has a psychological dimension.
Fascinating though it is, the book is too long and most of the substance is found in the first half. The overall impression is of being drowned in anecdotes for there is little attempt at a general theory that might have simplified the book. What theory there is here is due to Lacan. According to him, people locked into what he calls the Imaginary perspective are like isolated atoms in conflict but those individuals who have achieved what he calls the Symbolic Order are socialised, cooperative and healthier than those stuck in the Imaginary.
Interestingly, Lacan is cited as saying that our modern preoccupation with stress is due to the decline of the family and lack of emphasis on the social dimension of our lives. Consequently we as individuals (independent atoms) are expected to "deal with" our stress and maintain internal balance by ourselves. This is borne out by the current massive sales in self-help books. It is interesting to note that those immigrant populations who maintain family ties and cultural rituals are apparently healthier than those who do not.
Influenced as it is by the Lacanian theory of culture, the book is also a social critique: the individual person's narrative is being lost in a society where the family is in decline and medicine is increasingly dominated by technology.
Ross Skelton is senior lecturer in philosophy and psychoanalysis at Trinity College. He has recently edited The Edinburgh International Encyclopaedia of Psychoanalysis, published by Edinburgh University Press last year
Why Do People Get Ill? By Darien Leader and David Corfield Hamish Hamilton, 376pp. £19.99