Plight of People in Twilight Zone

As a people we have become obsessed with health. There is something fundamentally, radically unhealthy about all this. We do not seem to be seeking more exuberance in living as much as staving off failure putting off dying. We have lost all confidence in the human body.

LEWIS THOMAS

Man has never been successful in his war against disease as in the previous century. Almost all infections that used to wipe out vast sections of population were checked and a few eliminated. Only cancer and heart attack still elude conquest—thanks to our faulty life-style and some genetic factors. AIDS also has emerged, threatening the future of the race itself No cure is yet in sight.

The stubbornness of a disturbing mental condition known as obses­sive compulsive disorder (OCD), a form of neurosis, defying treatment, is rather ironical. Among the manifestations of OCD, ‘hypochondria­sis’ is the most painful. OCD is the general term for two distinct inter-related disorders, obsessions and compulsive behaviour.

Obsessions are morbid thoughts a person cannot get rid of however hard he tries, like the fear that he has a particular disease or a terror of heights or closed spaces. Compulsive behaviour manifests itself in repeatedly touching objects, uttering words or checking taps. Of all these, hypochondriasis, the persistent preoccupation with the possibil­ity of having one or more serious diseases, to the point of being incapable of concentrating on anything else, is the most agonizing. It may just appear as an eccentricity or a nuisance but in the sufferer’s mind there is a hell. Two aspects make it intolerable: the patient’s obsessive fear of having become afflicted with a terminal illness and a simultaneous lack of courage to go in for an investigation, for fear his suspicion may be confirmed. If the person suffers from any of the familiar ailments, such as a disorder of the stomach, or throat or urinary tract or exhaustion while climbing, there is a tendency on the part of the doctor to merely treat the physical ailment and prescribe a tranquillizer for the mentalcomponent which does nothing to solve the real problem.

In the post-Freudian era, hypochondriasis as well as other anxiety neuroses were explained away as ‘punishments’, subconsciously being inflicted by a person on himself for some guilt. Neuro-science has now disproved this and shown that the neurotransmitter called serotonin is the villain. Neurotransmitters carry messages from one neuron (nerve cell) to another by settling in the ‘synapses’, the gaps, between the cells. This makes ‘adaptive’ behaviour possible. If the nerve cells do not allow serotonin to remain there, but reabsorb them through receptors called ‘reuptake pumps’, the person concerned would lose his ability to see options. He would get stuck on thoughts like a broken record—the result, an ‘obsession’.

Hypochondriasis, like other obsessions, remains one of the biggest challenges to medicine, mainly due to a lack of awareness of the functioning of the human brain and also partly because of the callous attitude of doctors (barring a few) who are reluctant to devote their time and energy to an ailment, the treatment of which may not be remuner­ative. However, some new drugs like Prozac which block the reuptake pumps and prevent reabsorption of serotonin, combined with behav­iour therapy seem to offer hope.

But hypochondriasis is a chronic illness and so prolonged treatment may be necessary. Hypochondriacs remain in the twilight zone between terminal diseases and other illnesses which respond to treatment. What is worse, they are the butt of ridicule and jokes. Even doctors who should be the first to sympathize with them not only do not take them seriously but also chide them for their fears. Besides being inhuman, such an attitude also shows lack of respect for the dignity of human life.

In a hard-hitting article written in Newsweek three years ago, Chris Marrou, TV newscaster of Texas, drew attention to precisely this aspect and called for dropping the words like ‘anxiety’ and ‘panic’ while referring to society’s attitude* towards mental disorders, arguing that even death would be a sweet release compared to the agony of these patients, which according to him only another victim of mental illness can understand.

Condemning the stigma attached to mental sickness, he expressed a fond hope that a future presidential candidate’s battle against depres­sion or anxiety would be considered a mark of courage, instead of something to be hidden, and that Prozac could be swallowed openly without embarrassment by people who need it just as a patient with blood pressure takes a beta blocker today.