Among physicians with a humanistic soul, perhaps no quotation is more fondly remembered than one from Dr Francis Peabody. He was born in 1881 to a prominent New England family, trained at Harvard and Massachusetts General Hospital and was the first director of the Thorndike Laboratory at Boston City Hospital. Tragically, he died of sarcoma at age 46.
Archive for the ‘History of Stress’ Category
In October 2010, while lecturing in Europe, my wife and I spent a few days hiking in the beautiful Lauterbrunnen valley south of Interlaken in Switzerland. Sometimes walking in a beautiful place can get you thinking about the larger picture.
I first met Howard Spiro, MD in 1980 when I applied for a position in the Department of Gastroenterology he established at Yale in 1954. He brilliantly blended encyclopedic knowledge (he wrote one of the major textbooks in the field singlehanded), superb clinical skills and droll wit. I really wanted to learn from him and thought I might have a chance when I was the only person on rounds that day (apart from him) to know the cause of an abnormality on a patient’s x-ray. Alas, it was not to be and I completed my training at UCLA instead.
Thirty five years ago, Robert Ader, PhD serendipitously discovered a key part of our physiology that was not thought to exist. The story begins with rats drinking water sweetened with saccharine. Half the rats were simultaneously given low doses of Cytoxan to cause stomach pain. (Cytoxan is a chemotherapy drug for cancer.) It was no surprise that soon the rats associated the sweetened water with the pain and refused to drink it.
David Seidler was pre-school age and living in London when the Nazis bombed his apartment and later killed his grandparents in the Holocaust. Understandably, the family decided to relocate to New York. David developed a stammer during the move that he believed was connected to the war-time traumas. He struggled with his voice for over a decade.
In 1876, Josiah Macy, Jr, scion of a wealthy Nantucket mercantile family, died of yellow fever at age 38, when his daughter Kate was only 13. In 1930, at age 67, she established a charitable foundation in his name. During the next 15 years until her death, she donated the equivalent of $20 million annually (in today’s dollars), much of it during the Depression.
To continue discussion of the Kroenke & Mangelsdorff research*, let’s begin by looking at what became of all 567 symptoms (in 380 patients). For 2/3 of the symptoms, doctors did diagnostic testing or referred to a specialist. In the other 1/3, no evaluation was done beyond the initial visit. Treatment was recommended for only 55% of symptoms, and this took the form of a prescription in over ¾ of cases. There was nothing to suggest that anyone searched for hidden stresses linked to the symptoms (posts tagged with “Stress History” explain how this is done).
Last year marked the 20th anniversary of one of the most frequently quoted studies in the stress illness literature. The paper reports a discovery that would have shocked me if I had read it during my training years. Their finding has profound implications for primary care practice.
Stress-related illness is not a new disease. Greek physicians of the school of Hippocrates (460 – 377 BCE) recognized a disorder characterized by symptoms commonly seen in stress illness today: palpitations, migrating pain, difficulty breathing, a lump in the throat and others. This was diagnosed exclusively in women and attributed to the uterus wandering around inside the body. The Greek word for uterus (hystera) gave the disorder its name, hysteria, and this was a common diagnosis through the early 20th century. The term was finally dropped by the American Psychiatric Association in 1980, replaced with conversion disorder.
Two weeks before Sigmund Freud’s fortieth birthday in 1896, he presented a lecture to his Viennese colleagues on the cause of the neuroses, to “show them the solution of a thousands-years-old problem.” The evening ended in humiliation when one of the most distinguished listeners dismissed his work as a “scientific fairly tale.” The talk even harmed his professional practice because he later wrote to a friend that a “password has been given out to abandon me.” Though many scientific pioneers have been misjudged by their contemporaries, in this case the assessment by the audience was correct.