Anatomy of an Illness as Perceived by the Patient by Norman Cousins Page A

vulnerable in varying degrees. The disease is not hereditary; again, however, as with other diseases, increased susceptibility can be passed along from parent to child.
    Basically, leprosy is the product of filth, poverty, and malnutrition. It is not, as is generally supposed, a disease of the tropics and subtropics. It can exist wherever unsanitary conditions, hunger, or poorly balanced diet exist. It has existed in countries as far north as Iceland. Scarcely a country in the world has been untouched by it. But the important thing is that it is eradicable, and its victims can be cured or appreciably helped and rehabilitated. And it can once and for all be rescued from the general ignorance and associated superstitions assigned to it over the ages.
    Medical researchers have given high recognition to Dr. Brand and his colleagues for their new insights into the nature of leprosy, but even greater accolades within the profession have come his way because of his work in rehabilitative surgery. He has been able to transform hands, long clawed and rigid because of nerve atrophy brought on by leprosy or other causes, into functioning mechanisms. Almost legendary in India is the case of a lawyer on whom he operated. For many years, the lawyer had been at a disadvantage in court. His gestures, so essential a part of the dramatic courtroom manner, were actually a liability; judge and jury were distracted by the hideously deformed and frozen hand. Then one day the lawyer raised his hand to emphasize a point. The hand was supple; the fingers moved, the gesture was appropriate. Paul Brand had operated on the hand, hooking up muscle and nerve connections to the forearm, then educating the patient to retrain his command impulses.
    Paul Brand and his staff have performed thousands of similar operations on patients at Vellore. But they have also gone far beyond surgery into what they consider an even more vital phase of the total treatment. This is psychological rehabilitation. A man who, as a leper, has been a beggar for twenty years is not considered to be fully treated at Vellore until he is mentally and physically prepared to be a useful and proud citizen in his society. At Vellore, handicapped patients are given the kind of training that will enable them to be as self-supporting as possible. They gain a respect for the limitless potentialities and adaptabilities of the human organism. They learn that even as little as a 10 percent mobility can be made to yield a high return in terms of effective productivity. And, in the Emersonian sense, self-reliance creates self-respect.
    It is not necessary, of course, to provide any precise assessment of the relative importance of the three main phases of Paul Brand’s work—taking the black curse and superstition out of leprosy, reconstructive surgery, and personal and psychological rehabilitation. All are important; all are interrelated. But one aspect of his work may perhaps be more evocative and compelling than any of the others. He is a doctor who, if he could, would move heaven and earth just to return the gift of pain to people who do not have it. For pain is both the warning system and the protective mechanism that enables an individual to defend the integrity of his body. Its signals may not always be readily intelligible but at least they are there. And the individual can mobilize his response.

FIVE
    H OLISTIC H EALTH AND H EALING
    One of the results of the article in the New England Journal of Medicine was that I had opportunities to observe the holistic health movement at first hand. Leaders of the movement were good enough to say that I had had a holistic experience and that they hoped I might come to their meetings to talk about that experience as a way of reinforcing the beliefs of its members.
    My problem, however, was that I had said as much as I thought I ought to say about the illness itself. Besides, I was aware of the tendency of a few advocates in the movement to