University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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v C 1 is . 425343- .,' ' 5 If if x Q 1' I 1' 'Y I fi Y 'Ric S When it is found, however, that after the identification and removal of the responsible allergen, a regular Dr. Jekyll-Mr. Hyde trans- formation has taken place fassuming other factors have been properly controlledl and the patient becomes calm, relaxed, con- fident a.nd energetic, then we must look elsewhere for an explanation. The fact that many of these patients improve with psychotherapy cannot be taken as proof of a primary etiologic role, one might as well postulate that all diseases which respond to steroid ad- ministration are caused by a primary lack of intrinsic corticoids. In our scientific enthusiasm over the discovery of the cortico- hypothalamic-pituitary-adrenal axis, we often tend to slight the benerable milieu interne. The miraculous personality transformations of ulcerative colitis patients after colectomy are too well known to require elaboration. The experiments in human starvation conducted at the University of Minnesota have demonstrated profound personality changes as a result of enzymatic and vitamin deficiencies. The psychotomimetics, tranquilizers and psychic energizers point to the importance of the biochemical and pharmacological environment. There can be no question that psychophysiologic disorders con- stitute an important problem in medicine, we must, however, resist the impulse of affixing this diagnosis after only a cursory investigation-with often admittedly gross tools-has failed to show organic disease. Harold R. Styler '63 29

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PSYCHOSOMATIC OR SOMATOPSYCHIC Prior to the ascendance of Freudian psychology, little attention was paid in medicine to the effect of the psyche or the somag presently, opinions are being published in the medical journals to the effect that up to 909 of patients seen by the practitioners are suffering from a psychophysiologica1 disorder. The time may now be ripe for a re-examination of our concepts and for a nudge to the pendulum toward a more balanced position. As an example, let me raise the question of allergy. A multitude of objective biochemical and physiological abnormalities, such as elevated blood histamine level, altered serotonin metabolism, depressed serum potassium, depressed tissue and serum calcium, as well as EEG and triple response abnormalities have been demonstrated in the allergic state, Many workers have stressed the mental symptoms of lack of concentration, forgetfulness, and the mental symptoms of lack of concentration, forgetfulness, con- fusion and decreased learning capacity and their psychological sequelae of frustration, irritability, hostility, aggressiveness, para- noid ideas and compulsiveness. Competent investigators have pointed out the frequency of complaints like tension, fatigue, headache, tremulousness, urinary frequency, facial tics and paresthesias. Some of these manifestations may be related to disturbances in histamine and serotonin metabolism, which have only recently been elucidated. Yet the bewildering array of diffuse complaints often make the patient appear neurotic. 28

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A PROBLEM! HOW TO TRADE A HEADACHE FOR AN UPSET ATOMACH Today's modern world of communication, with its radios, television, movies and satellites, has produced a dilemma which the modern medical school must face-or fall behind in the race for education. A physician is suppose to be a pillar of the community, a well-liked, well- educated, well- rounded fusually physically as well as scholasticallyl, symbol of health and a leader of society. As society advances, there is a trend for the doctor to lose a tinge of social status. Why? In the early years of the growth of our country, before anesthesia, antibiotics and aspirin, the average doctor was basically a brace-although relatively ignorant-purger and bleeder who had just recently traded barber shears for sawblades. Nevertheless, he was a staunch leader of the town and highly respected. The main reason behind his success was the acrid odor of his office, his secret language, foreign handwriting and basically uneducated patients. His medicines, regardless of their contents, had several grains of built-in placebo working before the prescription was even filled. This was the day of eye of an eagle, heart of a lion and the healing hand. He was as close to healing on faith alone as our profession has ever come. Modern communication has changed all this. Today, we are no longer looked upon with awe, respectful fear or love. Today we are coping with the mass media television-and advertising, Patients no longer are satisfied with aspirin. Instead they want buffering, or worse yet, they want a 'fcombination of ingredients which won't upset their stom- achs, in easy to take tablet form. It does no good to explain to the patient that it is not important whether the alittle A's beat the little B's into their bloodstreams, because they have seen it in scientifically proven tests on TVO In fact, they immediately brand you as one of the uninformed because you don't belong to that group of 7 out of 10 doctors. What ca.n be done? The public is being taught faster than the medical schools can teach public health or statistics. 30