“One believes things because one has been conditioned to believe them.” Alduous Huxley
Since the dawn of time and across all cultures, the established social agreement and common knowledge was that the mind profoundly impacts the body. The interplay between society and individuals, however, adds another layer to the picture. The way we perceive our illnesses and the way physicians diagnose them is directly influenced by the surrounding culture, wherein templates of symptoms are deemed legitimate or illegitimate. The “legitimate” ones are ascribed to underlying pathologies for which a patient can’t be blamed, whereas “illegitimate” ones are viewed as malingering, simulation, and secondary gain,… all of which carry a negative stigma. As a result, when it comes to stress conversion/somatization of inner pain, there is a cultural pressure on the unconscious mind to produce sensations from the available schema termed the “symptom pool”. It’s not that society invents symptoms, it simply retrieves them from the prevailing pool.
We pass on dis-ease, disorders, and symptoms to one another in a collective unconscious game of telephone tag. The socially acceptable symptom pool in any given timeline, becomes “de rigeur”. We can “catch illnesses” from a mere suggestion, an anecdote, or observation. Yawning is a common example. Our minds are the most powerful force on earth, but when the medical model or the media, sanctions and broadcasts various symptoms from the pool, they morphe into a chronic (and often ever worsening) form of tms, in which the sufferer falls and risks drowning. What begins as a safe haven from emotions and a way to “belong to the tribe”, becomes a prison of our own making, and is compounded by the marketing barrage of popularized diagnoses and treatments. Chronic pain and other unexplained chronic symptoms, therefore carry an enormous social weight, as compared to structural injuries or disease pathologies. The more we conform to the medical paradigm which seeks to scientifically engineer the body from the outside, the more we play into the diversionary tactic of tms. The pain is a coping mechanism, and until we ask ourselves why we need this defense and address the deeper emotional pain, on the hamster wheel, we shall remain.
Culture, family, and society, don’t change anatomy. What changes is our belief systems. When it comes to human anatomy, Italians are particularly fixated on it, which has made them prone to a wide range of maladies, such as “meteorological” ones and the dreaded “colpo d’aria”. As a hearty American, this hit of air poses no threat to me, but it can be dangerous to Italians. Having enjoyed a trip to Italy this September, in which we were blessed with warm temperatures, I found myself perspiring in sleeveless summer dresses, while its countrymen were clad in winter puffer jackets. Flashbacks from my time of college study abroad, observing babies and tots bundled like mini Michelin men, lest they receive a “hit of air”, and venturing out with wet hair to the horror of bystanders, came flooding back. This hit of air could land anywhere…the eye, the nose, the stomach…the slightest seasonal change is considered a health hazard, signaling the need for scarves, without which could lead to the “cervicale”…the pain in the neck resulting from an impromptu gust of wind. My Italian husband described this scenario upon returning from a sweaty jog in the summer heat. Pausing for shade under a tree, He glumly recounted the moment in which he paused under a tree for shade and was assailed by a “colpo da’aria”. With a fatalistic sigh, he proceeded to change into more suitably absorbent attire. Fortunately his condition was not contagious since I’m an American. Whew!
So striking is the enculturation of mindbody disorders that we can learn much from the past about our own seemingly idiosyncratic symptoms. Wherever and whenever there are symptoms, there are sure to be marketed diagnoses and cures of varying efficacy and quackery. Even since medieval times, the much maligned uterus had been widely implicated as the seat of all problems, including insanity. During the Victorian era, bizarre treatments ensued, including ovary compression belts and the surgical removal of ovaries called oopherectamies….Oof indeed! Gender politics in medicine raged on, spanning the witch trials, when women experienced “anesthesias” (the term for skin sensory deficits), up until the age of hysteria, heralded by Parisian neurologist Charcot in 1879. Initially his theory rested on heredity, but ultimately he concluded that it was an organic nervous disease. This “Napoleon of the nervous system”, as he fancied himself, enthralled high society and sparked a belle époque of suggestibility, and an “age of nerves”. Social mores and behaviors rose to match the medical doctrines with “fainting rooms” and clubs for trendsetting ladies who referred to themselves as “les hysteriques”. There was even competition and jealousy between cliques of the hysterics and epileptics, the former differentiating themselves with red and blue hair ribbons and delirious hallucinations, and the latter with flowers in the hair, wandering barefoot in the rain and collapsing into convulsive fits.
The swift rise and fall of Charcot’s hysteria was discarded, when other physicians turned away from his theories and shifted to the diagnosis of “neurasthenia” or tired nerves. Hysteria was out, and the concept of nervous disease and weakness was in. By placing symptoms squarely in the nervous system paradigm, it reassured patients that their ailments were not “all in their head”. The idea captivated the public so much so, that even heroines in novels like the 1883 “A Fashionable Sufferer” exhibited neurasthenia. The core symptomology of this label has been precisely replicated in our modern iteration of “chronic fatigue syndrome”.
After WWI, the psychological paradigm and insights on psychogenesis began to take shape. Charcot’s notions of hysteria were transformed into a disease of the “imagination”. In yet another historical twist, the unfortunately titled, “On the Physiological Weak Mindedness of Women”, posited that hysteria belonged to the category of “psychosis”. This new psychological paradigm, heralded by the wave of psychoanalysts in Europe, supplanted the Victorian views of nervous system dysfunction. It was violently rejected by patients however, who took umbrage to the imputation of mental illness. One physician in 1908, wrote, “I have had patients rebelliously declare that they were not going to leave my office until they got a prescription for some medicine.” The sense of triumph that the fields of psychology and psychiatry enjoyed in the discovery of the role of the unconscious mind in pain and symptoms, was thus a fleeting one. An informal consensus emerged in medicine, that somatizing patients should be offered some king of treatment, even if they knew it was a placebo. The inverse of neuroplasticity is “pathoplasticity”, the tendency of illness attribution and presentation to change with the fashion of the day. When patients were bestowed an in vogue label like appendicitis, but balked at the prospect of appendectomies, doctors had to invent new labels like “colitis” to meet the general demand. As medical historian Edward Shorter notes, “It was a neat complaint, safe from the surgeon’s knife, suitable to everyones taste.” Nobody knew when it came, nobody knew when it went away. Pathoplasticity raged on …from the ulcers in the 1970’s, to chronic back pain and chronic Epstein Barr (yuppie flu) in the 80’s, to fibromyalgia in the 90’s, to chronic lyme, to chronic fatigue, to crps, to mast cell activation syndrome, to mold illness, sibo, long haul covid, and stiff man syndrome…”On it on it goes, where it ends nobody knows…” Through the lens of history we can appreciate how fragile and unscientific our current labels are. It will be up to each of us to decide for ourselves, and to replace the social contagion of fear, with one of hope and truth!
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