Saga Magazine review of Sick and Tired- by Dorothy Rowe


When I worked in the NHS in the 1970s one or other of the local GPs would occasionally send me a referral in the form of a terse note, ‘Could you see Mr A who for many years has been troubled by a severe pain in his stomach and other symptoms. He’s had every possible test and nothing has been found. As a last resort could one of you psychologists see him?’

Mr A would arrive polite but resentful. He had done everything his doctor told him to do but he was offended at the suggestion that his illness was all in his mind. I’d ask him about himself but soon find that, while he could talk easily and at length about his physical symptoms, he couldn’t talk about anything to do with his feelings. Indeed, it would seem that he hadn’t even learnt the words for emotions. Everything he felt he felt through his body.

Many of these clients came with a diagnosis of Irritable Bowel Disorder (IBS) but none of them had the same pattern of symptoms. They resented any suggestion that their symptoms might be associated with stress. They didn’t talk about their emotions, yet the metaphors they used linked their feeling with parts of the body. One woman said of her father, ‘I hate his guts,’ and of her mother-in-law who looked down on her, ‘In her house nobody farts.’ When I heard that an IBS Network was being set up I was pleased because I knew that belonging to a self-help group for depression was more beneficial than taking anti-depressants. I gave the Network what support I could and through that met the consultant physician Nick Read. The Network started a magazine Gut Reaction which initially was chiefly about diets and drugs, but when Nick became their medical adviser and answered readers’ questions in the magazine I felt he was going where psychologists feared to tread. While dealing with the readers’ questions about symptoms, diets and medication he began to talk about the effects of stress on the body. Because Nick writes very simply and gently, and doesn’t talk down to people the readers accepted that they needed to consider what was going on in their life and how they reacted to difficulties. Nick trained as a psychotherapist and as a physician he specialised in helping people cope with illnesses which have no clear pathology. He has now published a book about his work, Sick and Tired: Healing the Illnesses That Doctors Cannot Cure. If you have such an illness, or know someone who has, you should read this book.

Doctors distinguish between organic illnesses which have a clearly demonstrable physical basis as revealed by scientific tests, and functional illnesses where no physical basis can be found. Over the last century when there has been an immense increase in medical knowledge along with improvements in housing, nutrition and sanitation, rates for organic illness have greatly decreased, but rates for functional illnesses have not. Nick wrote, ‘Surveys from different countries throughout the Western world have shown that on average between 30 and 40 per cent of people who seek health care have illnesses that have no clear cause and no obvious basis in pathology. Literally millions of people are racked by back pains, tormented by abdominal gripes, alarmed by ringing in the ears, tortured by headaches, exhausted by sleep deprivation, debilitated by nausea or faintness or anorexia, overwhelmed by the burden of obesity, terrified by shortness of breath or palpitations or just too sick and tired to cope. These are the illnesses the doctor cannot cure.’

Research has shown that people with such illnesses differ from healthy people and people with organic illness in three striking ways. First, they have experienced more life events which threaten their sense of identity, second, they score more highly on tests for anxiety and depression, and, three, they score significantly less on tests of self-worth. That is, they feel helpless, insecure, frightened, despairing, isolated, lonely, and they dislike themselves. They try to deal with the unhappy situation they are in by denying their feelings, but denied feelings don’t disappear. They fester and display themselves in what Nick calls ‘the theatre of the body’. Nick wrote, ‘In the whole of my medical career, I have yet to meet anybody I thought was imagining their symptoms or making them up, but I have met thousands upon thousands of ill people who are struggling desperately to protect themselves from potentially mind-shattering effects of unbearable life situations. These people don’t deserve to be dismissed with a diagnosis that cannot be treated. Their illness needs to be understood as a state of disharmony involving the whole person – mind, body, spirit – within their particular social environment. They need to be helped to uncover their illness’s meaning and to find an appropriate resolution for what caused it.’

The meaning of the illness lies in the person’s life story, and in his book Nick tells the life stories of many of his patients and shows how their symptoms arose out of each person’s experiences. For instance, there was Malcolm whose severe attacks of stomach pain had meant many emergency admissions to hospital. Nick asked him when he had first experienced the pain. It was just after his sister died. He’d promised her he’d pick her up from a dance but he was with his mates in a pub and didn’t bother. She got a lift on the back of a friend’s motor bike. There was an accident and she was killed. As he at long last talked about his feelings Malcolm realised that he saw his pain as his punishment, that is, his way of dealing with his guilt. He had to face up to his feeling of guilt because, until he did so, he had to go on and on punishing himself with this terrible pain.

Unfortunately, there are not many doctors who seek to understand their patients as people living in a particular environment, and we have a health system based on the assumption that doctors must be trained to diagnose disease in a body and cure it. Despite all the talk about ‘emotional intelligence’ there is still in our society a belief that a person who suffers mental distress should be despised, not understood. When bombs went off in the London underground government propaganda insisted that Londoners took it all in their stride, when in fact we all felt anxious. Sometimes we have to lie to others in order to protect ourselves but we should never lie to ourselves. It only makes us ill.

Dorothy Rowe

published in SAGA Magazine, 2006