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Chilling Tales From the Medical Fringe : FROM PARALYSIS TO FATIGUE: A History of Psychosomatic Illness in the Modern Era, <i> by Edward Shorter,</i> The Free Press, $24.95; 400 pages

SPECIAL TO THE TIMES

The last thing an ill person wants to hear is that his or her malady is all in the mind.

This was as true in 1800, when hysterical people ordered surgeons to amputate their psychologically paralyzed legs, as it is today, when people drag around oxygen tanks to protect themselves against “total allergy disease,” says author Edward Shorter in this meticulously researched and revelatory look at the last 300 years of psychosomatic illness.

These people aren’t faking, Shorter emphasizes. “There is nothing imaginary or simulated about the patient’s perception of his or her illness,” he writes.

Shorter’s thesis is that since the dawn of modern medicine, sufferers of psychosomatic illness unconsciously produce symptoms of whatever disease happens to be fashionable among the more delicate members of the upper-middle class. Their behavior is reinforced, Shorter says, by pricey “society doctors” who indulge them by accepting their patients’ self-diagnoses.

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The symptoms of psychosomatic illness have changed dramatically over the last three centuries, Shorter says, from hysterical fits and paralysis to exhaustion and hypochondria. He draws his illustrations from eye-popping case studiestaken from the medical literature of Europe, the United Kingdom and the United States.

In one case, a young German woman hysteric--near death from the effects of fits, paralysis and self-starvation--compelled her surgeon to remove her ovaries, a standard treatment in the mid-19th Century for hysteria. After the operation she quickly regained her health and suffered no further symptoms. Yet her surgeon later revealed to his colleagues that he had faked the operation. He merely made shallow incisions on her abdomen, leaving her ovaries intact.

Ironically, Shorter claims, doctors themselves unwittingly brought about the bewildering evolution of psychosomatic symptoms. By developing new theories to explain real illness, the doctors compelled their psychosomatic patients subconsciously to develop new symptoms to match the new thinking.

The most dramatic development in the history of psychosomatic illness, Shorter says, was the disappearance of classic hysteria. A staple of the medical literature since the Middle Ages, it spread through Europe almost like an epidemic during the 19th Century. Yet hysteria “virtually came to an end in the 1930s,” he writes.

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Not coincidentally, Shorter says, hysteria began to die when psychoanalysis was born, in the 1890s. Well aware of the beneficial effect of sugar pills, faked operations and other placebos, and recognizing the stubborn fact that faith healers and hypnotists could cure hysterics as effectively as physicians had been able to do, medical scientists finally began to investigate the role of the subconscious in illness, especially in nervous disorders.

It was with the introduction of psychotherapy, Shorter says, that the partnership of psychosomatic patient and sympathetic physician began to break up. Told to see a psychiatrist, and denied access to straightforward surgical or medical treatment, the patients felt hopeless. Then, as now, they refused to accept the diagnosis and shopped around among doctors until they found one (or more) willing to attribute their illness to an organic cause, not a psychological one.

Today’s psychosomatic patient has made the mass media a new ally in the ceaseless search for an organic cause and cure, Shorter says. Rejecting doctors’ advice to seek psychiatric help and isolating herself or himself, in the quest for “self-actualization,” from such traditional sources of medical knowledge as parents and grandparents, church members, friends and neighbors, the sufferer looks to television, newspapers and magazines for relevant medical information.

The result of this trend, which Shorter calls “a new chapter in the history of psychosomatic illness,” is a rigid belief in a given self-diagnosis.

Despite its encyclopedic treatment of psychosomatic illness, “From Paralysis to Fatigue” leaves important questions unanswered. If the syndrome can be recognized historically despite its wildly varying symptoms, a clear pattern should be visible. Can the malady be expected invariably to strike a certain percentage of the population? What characterizes the people most at risk? Might these people be genetically susceptible, as the influential 19th-Century French research physician Charcot believed? What is the cure rate? Has it changed over time?

It would seem that Shorter has access to enough data to try to answer such questions. This absorbing story from the fringes of medical history cries out for a sequel.

Next: Jonathan Kirsch reviews “A People’s Charter: The Pursuit of Rights in America” by James MacGregor Burns and Stewart Burns (Knopf).


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