'“Rasehn ... libehn … hodehn,” literally, “My head … my heart … and my stomach,” with the patient's hand touching each part as she pronounced the words.'
The hospital's internal medicine specialist Dr. Ghosh calls it the RLH syndrome, and it describes a general malaise with various physical symptoms brought on my the stresses and dissatisfactions of life. Verghese writes:
'It had taken Matron her first year in Addis to understand that this was how stress, anxiety, marital strife, and depression were expressed in Ethiopia – somatization was what Ghosh said the experts called this phenomenon. Patients might see no connection between the abusive husband, or meddlesome mother-in-law, or the recent death of their infant, and their dizziness or palpitations. And they knew just the cure for what ailed them: an injection.'
My mother was introduced to a similar disorder when working as a senior physiotherapist in a large city hospital in the UK. She was attending a lecture given by an eminent orthopaedic surgeon, who asked his audience how they would clinically manage the Undeer syndrome (so named after a “famous Hungarian physician”, he told them). All the physios looked at each other blankly and then contemplated their feet. “Oh, you know,” the eminent man said, “it's the one who comes in with a vague pain “here” ... , “und 'ere ... und 'ere … und 'ere”. Then they all looked at each other again with smiles of recognition. My mother often received patients with this complaint who had been sent down from orthopaedics, organic causes being considered insufficient to explain their suffering, with a note to “do something with this”. Only in this case the cure was not an injection, but a bottle of tender loving care and the placement of healing hands on each and every one of the offending parts. For, as Francis W. Peabody noted, “...the secret of the care of the patient is in caring for the patient”, which the physios in general were better at than the orthopods. Unsurprisingly, there is no Hungarian surname "Undeer" - I have checked.
Of course I would not wish to suggest that all presentations of multiple or diffuse, vague bodily pain are psychosomatic in nature – this is plainly not the case - and any clinician should guard against such a potentially dangerous prejudice. Neither would I wish to diminish the importance of the suffering involved when a condition is psychosomatic: I should know, I have suffered from troubling psychosomatic symptoms myself.
I have used the word “psychosomatic” here, a thing I have been pulled up for on occasion by a colleague or two. Some of my colleagues, more holistic than thou (or at any rate me), consider that the word either implies some kind of mental disorder (like somatoform disorder), or that it has overly Cartesian connotations, in the assumption that mind and body are somehow detached. However, I stand by my use of the word as being entirely appropriate when there are clear indications that the presence or extent of a person's physical ailments, with or without objectively observable physical manifestations, is heavily influenced by psychological processes. As to the Cartesian argument, on the one hand I think that while mind and body are clearly not detached entities, the counter-posed philosophical idea that “mind and body are one” runs up against some serious difficulties if taken to an equal extreme. On the other hand the very union of the Greek word roots “psych-” (mind) and “soma-” (body) into one whole word denotes a holistic perspective, does it not?
My own view is that the influence of the mind over bodily health is an extremely commonly observable phenomenon, existing in ailments common and rare, minor and life-threatening. Patients will readily recognise this (“I think it's the stress I've been under”) but will not always so readily wish to address the problem properly, the majority preferring to hope for a quick fix in the form of a pill (whether pharmacological, homoeopathic or a food supplement) or a nice massage. Conventional medicine has often over-diagnosed “psychological” causation, whenever, in fact, conventional tests and physical examination do not explain a person's symptoms. For their part, alternative practitioners have frequently disconsidered or denied the possibility that mental processes could be at the root of their patients' complaints, because they believe that the means and attitudes of conventional medicine are too limited to see what can be seen, have unfaltering belief in their own special system to discover and treat the “real” underlying cause, and because it is in their interest that the patient believe in a single, simple, clearly identifiable, physical cause. After all, this is what the patient has been looking for and their doctor didn't take them seriously. The reader might divine that I have a rather cynical attitude about much of this shaboodle, whether the colour is conventional or alternative.
It occurs to me that the RLH syndrome – rasehn, libehn, hodehn – is the ultimate description of a condition unifying mind and body: the head, seat of that miraculous organ the brain, whose workings provide us with awareness, awareness of ourselves, emotions, thoughts, behaviours, urges, dreams and nightmares, in a word “mind”; the heart, seen by many cultures as the seat of the spirit; and the stomach, gut, viscera, representative of everything bodily. That is rather a beautiful thing.
With apologies if needed - far be it from me to celebrate outdated prejudices (especially ones I do not share) - but I would like to end on a humorously pertinent note. Ever-loving Adelaide, in the wonderful musical Guys and Dolls, laments the bodily effects of her own major preoccupation in life as she reads from one of those popular medical encyclopaedias:
It says here:
The average unmarried female
Due to some long frustration may react
With psychosomatic symptoms
Difficult to endure
Affecting the upper respiratory tract.
In other words, just from waiting around for that plain little band of gold
A person can develop a cold.