The Health Blog

Thus you see that drugs are inseparable from medicine. With only a few of them does the profession expect a cure. In the case of many diseases which have increased in importance, while the infections have taken a back seat, the most we claim to do is to help. We do not cure heart disease with digitalis, but by slowing and strengthening the beat we give the heart rest and help it to work more efficiently. There are many good drugs which are not used to influence disease directly. Such are the anesthetics, the pain killers, and those which quiet the nerves.

It is difficult for the individual physician to form correct judgments as to the value of drugs. Impressions are not reliable. Any “herb woman,” such as Mrs. Todd in Sarah Orne Jewett’s Country of the Pointed Firs, has great certainty as to the value of her simples and may be perfectly genuine in her beliefs. The greater number of human diseases is self-limited and a few happy coincidences after taking medicines are unduly convincing. Long series of cases, careful observations, and good recording are necessary before conclusions can be reached.

The conscientious physician may get great help from the Council on Pharmacy and Chemistry of the American Medical Association. Practically all members of this group are professors in leading medical schools. Conscienceless quacks and also well-meaning, over-enthusiastic physicians are forever reporting the virtues of new medicines. The Council investigates most of these.  The quacks usually have mixtures of no virtue but also of little harmful quality. It would be dangerous to poison their “clients.” Honest men may be wrong, however, so the Council checks on them. There is a weekly report in the Journal of the American Medical Association and also a book of New and Unofficial Remedies.

The great mistake of the therapeutic nihilist who decries the use of nearly all drugs is that he ignores what has long been spoken of as the influence of mind over matter. What nearly every human being, whatever is wrong with him, believes is that the proper medicine, if it can be found, will help him out of his difficulties. So, when he goes to a doctor, he expects that doctor to make a try for the correct drug. There is no folderol in his mind about self-limited diseases and the healing power of nature. The doctor knows that, and he, himself, being human, has the same feeling. So he writes a prescription or two, which in these days involves no picayune financial transaction. The doctor is not so foolish as I may have made him seem. There is a school of thought that feels that all protective devices of the body are largely dominated by the mind. Long ago Dr. Walter B. Cannon, in his Bodily Changes in Pain, Hunger, Fear, and Rage, laid the foundation for this. The theory has been much elaborated since. Although the whole system takes part, the brain, pituitary, and adrenals seem to play the leading parts. The doctor, with his confident ordering of medicines, appeals to the patient’s mind and sends him optimistically into battle.

An interesting commentary on all this has just come to me in a recent number of the Journal of the American Medical Association. Dr. Emil Novak, the eminent Johns Hopkins gynecologist, wrote an article suggesting that few women need a sex hormone for the symptoms of the menopause, and those who do should take them by mouth rather than by injection. A physician wrote in to the editor taking exception to Dr. Novak’s ideas and outlining his own handling of such cases. This was most definitely psychotherapy with numerous visits for education and reassurance. He concluded: “Why not do all this without the injection? First of all, in the beginning, the patient would not return. The ‘shot’ gives a ‘respectable’ hook on which to hang the visit to the doctor and it is up to the physician to give the proper weight to the injection.”  The letter, only a small part of which I have given you, suggested a conscientious, earnest physician, and I am sure that his patient was in good hands. But one cannot help feeling that psychotherapy could be used without such adjuncts.

This discussion has had to do with the using of drugs by physicians. What about the many millions of dollars worth purchased by the public on their own (and the cost added to the statistics on the high cost of medical care)? Naturally physicians do not approve. When their automobile engines act badly, they turn them over to mechanics, skilled in such matters. They argue that the human body is fully as valuable as an auto engine and its complicated mechanism more difficult to adjust. But I am afraid that they are not credited with pure disinterestedness. The president of a large university remarked to me a few years ago: “I see that now that the public can get without a prescription an antihistaminic to use against colds, the profession finds objections to its use.” Anti-histaminics have not fulfilled their promise, but I still feel that the president knows a lot about education. My own feeling is that as we approach the millennium and you stop dosing yourselves, you will then require mighty little doctoring.

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GENERAL HEALTH

To the outsider, the setting resembles an ordinary nursery school, except that there are far more “teachers” than usual, and some of the children are so young that they are still crawling.

Also on her hands and knees, one of the adults “plays” with Johnny, 2.5 years old. Dr. Eleanor Galenson, a psychiatrist, has just handed him a huge yellow-and-gray hammer made of sponge. He takes it and begins whacking away with all his might on a large red sponge block.

With each blow, Dr. Galenson says to Johnny, “Gee, you must be really angry. You really want to hit that block.” Up to now, Johnny had pounded away with his fists – on other children, including his brothers. Johnny is one of a set of triplets. The psychiatrist is teaching him two things: First, it’s OK to hit nonliving things. Second, he’s putting a name on his feelings – anger.

“A healthy angry adult might work out his anger by talking or painting an angry picture or going for a run,” says Dr. Galenson. “Sometimes, an unhealthy angry adult shoots somebody. Generally, that’s a person who never learned to put a name on his feelings.”

Dr. Galenson wants to intervene with Johnny before he grows up with twisted feelings. She wants him to experience the sort of babyhood that his mother, overwhelmed by having to care simultaneously for three infants, simply couldn’t give him.

We are visiting a therapeutic nursery for disturbed children at Mount Sinai Medical Center in New York. Dr. Galenson and her partner, Dr. Herman Roiphe, with a squad of psychiatrists, psychologists, and volunteers, teach healthy babyhood to children between the ages of a few weeks and 3 years. These babies feel bad but cannot say how they feel.

Statistics are hard to come by, but one study suggests that three out of 100 children under the age of 3 have grave emotional problems and need help. With 9 million American children in that age group, that could mean that 270,000 babies are troubled. And such troubles could trigger personality problems that follow them into adulthood.

“These children are the ones who are most at risk for committing crimes and taking drugs, especially the boys,” warns Dr. Galenson.

Dr. Jerry Wiener, of the American Academy of Child and Adolescent Psychiatry, says that the field of infant psychiatry has blossomed in the last 10 years.

“The most exciting change,” says Dr. Wiener, “is this: We used to view the infant as a blank slate, molded and shaped by the home environment. But now we know that babies are much more active participants than we used to think.”

For example, scientists now know for sure what parents had only suspected: each baby is born with a temperament unlike that of any other. Johnny is one of triplets, yet only he gives his mother difficulty; only he bites and hits. His two brothers are quiet and friendly.

Some children, from birth onward, do not like to be touched. Others may find high noise levels to be irritating. In fact, a baby comes into the world with a distinct personality, ready to respond in his or her individual way to parents and the environment. Each child is different.

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GENERAL HEALTH