Patients are often still unusually touchy when you broach the topic of stress during discussion of their physical problems, and on may occasions I have had them remind me that they have come to find an “organic” reason.
This deeply entrenched concept of “mind body duality” is a legacy of the 17th century French philosopher Rene Descartes according to whom the mind and body were really distinct, unconnected and independent.
Modern medicine is however finding it difficult to shrug off evidence that the mind could be impacting our health. Episodes of stress making the blood pressure to shoot up in a hypertensive, blood sugar to go awry in a diabetic, or precipitate an attack of migraine is now being recognised.
During my training days in the early eighties when we were being brought up on the belief that physical problems were unrelated to the state of mind, a 50-year old lady was admitted to hospital with an acute episode of dysentery. She was passing 15 to 20 bloody stools every day for 20 days, got diagnosed at AIIMS as a case of Acute Ulcerative Colitis, an auto-immune disease, and had to be administered corticosteroids and blood transfusions as therapy.
Interestingly, her symptoms had started the day she had heard the dreadful news of the brutal murder of her two grand children that had pushed her into a state of shock. As young doctors we had debated whether the two were indeed related or had occurred just by chance, and as expected, our opinions had remained divided.
Over the next 30 years, my personal observations suggest that shocking or stressful life events often act as a trigger for major physical health problems.
Last month, a 54-year old lady came down suddenly with severe pain and swelling of both her legs. Her white blood counts went up to 17,000 (normal less than 10,000). A reputed orthopaedic diagnosed her to have bilateral cellulitis and prescribed intravenous antibiotics, but her pain and swelling refused to settle.
She was then found to have the rare Lofgren’s syndrome, an acute form of sarcoidosis, also an auto-immune disease, and prescribed steroids. What was intriguing is that this rare immune disorder appeared abruptly in this otherwise healthy woman just 2 weeks after the devastating accidental death of her sister, with whom she had been very close.
There could of-course be several ways to react to these case scenarios. The Descartesian approach would put the 2 events (tragedy and health problem) as unrelated and purely temporarily coincidental.
Some, especially in India with astrological inclinations, may invoke “stars” and “bad times” to offer an explanation of why they occurred so close to one another.
But it is getting increasingly difficult to ignore the possible causal role of deep stress and shock on the body’s organs and functions, especially of the immune system.
“Old is Gold” may apply to many things, but Descartes’ thesis may need a close scrutiny and review in modern times.
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