Anatomy of an Illness

Introduction

Dealing with disabilities and terminal illnesses is a complicated matter for doctors and for patients as well. People are different and therefore, their reaction to successful diagnosis with terminal illnesses and prescribed treatment plans also differs. Some retrieve into their own world while others open up and try to do as many things as possible before their time is up. Even though their reactions vary, scholars such as Norman Cousin, Kubler-Ross, and Dr. Maslow suggest that the process of accepting and learning to deal with the challenge is similar to all human beings. They take different approaches in explaining the stage of illness in a bid to create an understanding of what patients go through. In this paper, we shall focus on the ‘Anatomy of an Illness’ by Norman cousin. This is a personal story of how he lived with Ankylosing Spondylitis, a disease of the connective tissues after doctors had told him that he would not live for long. This essay hopes to compare and contrast the stage he went through with those cited by Dr. D, Maslow and by Kubler-Ross.

To begin with, we must understand what Cousin went through during his time of illness. He was diagnosed in 1964, consequent to which he was asked to get his affairs in order because he would not live for a long time. Instead, he carried out his own research in a bid to find a solution for his illness. He realized that the medication he was given fueled the illness by depriving him of vitamin C. Moreover, he was well aware that the attitude of self-defeat was likely to cause faster deterioration of his health. Armed with this knowledge, he made crucial changes. First, he fired his doctor and found another who was willing to collaborate with him in his preferred path to healing. Then, he checked into a hotel room and purposed to watch movies that would make him laugh until his stomach hurt as a form of therapy (Cousins, 1976). These actions paired with massive vitamin C injections earned him another 26years after his diagnosis, even though qualified medics had preempted this eventuality. 

Comparison and Contrast to Kulber- Ross

Kubler-Ross highlights certain stages in the process of illness that are clearly evidenced in Norman Cousin’s progression. Kubler-Ross identifies the first stage as denial. This is when the patient is yet to come to terms with their diagnosis. It is exhibited in many ways such as patients refusing to take their medication or even seeking a second, third or fourth opinion in the hope of getting a more favorable diagnosis. In Cousin’s case, during his denial phase, he threw himself into research on his diagnosis and the possibility of treatment. He questioned what his doctor had told him and sought to find a better treatment. The second stage is anger. Kubler-Ross emphasizes that at this stage the patient may choose to take the anger out on themselves or on those closest to them as a deflection of the fear that engulfs them. For Cousin, he managed to withdraw himself from all the negativity that was around him at this stage. He withdrew himself by choosing to stay alone. Further, he chose a doctor who worked with him as a team player and did not demand complete control of the process leading up to his healing.

The next stage in the illness process is bargaining. Many patients at this stage start to accept that they are sick and bargain with a higher being, themselves or a loved one. At this stage, there is an emotional attachment to accepting the disease. For Cousin, he had an interesting change in this phase and solidified his doctor-patient relationship. He established a relationship where he was in-charge of stimulating his body to conditions that promoted healing while his doctor advised him and coached him through the treatment process. Setting this terms and conditions for his day to day operations did benefit him because he felt comfortable and trusted in his eventual healing. This was followed by the depression phase. He fought this with laughter. Cousin knew that if he allowed himself to feel sad, he would get weaker and therefore, he chose to accept that he was sick but refused to be sad about it. Instead, he took action and fought in the best way he could.

Comparison and Contrast to Maslow’s Hierarchy of Needs

As Maslow would also describe any illness, it must go in certain stages. Physiological needs are stated as the first priority. This refers to ensuring that basic needs in terms of food, clothing, and shelter are fulfilled. Cousin ensured this was possible as he was keen to take a healthy diet and ensure he had a place to stay where he was well taken care of. At this point, he also ensured that he took his own doses of vitamin C because his illness and the medication he was given deprived him of this. In terms of security needs, there are many aspects to be considered. There is a need to secure ones’ life, morality, health, and property. Cousin mainly focused on his health when he charted his course to a customized treatment. He found security in laughter because he felt better after he watched those movies and they kept him from being depressed. Due to his profession and his education, Cousin already had a fulfilled self-esteem. He was well known in his career field and had published a number of books. Some would dare say he was actualized enough to challenge doctors opinions and do what he felt was best for him.

Contrary to Maslow’s analysis, Cousin did not feel the need to establish a relationship with family and friends. For his own reasons, he chose a more reserved life after his diagnosis. Even the relationship formed with his doctor was on his own terms, and he did not try to appease others who wanted to take the lead in his treatment. Cousin had an already self-actualized mindset when he received his diagnosis. He was so confident in his abilities that he determined what was best for him at a time when many would have lost hope and trusted in their doctors completely. He knew what he wanted for himself to the extent of picking out a specific doctor that would allow him to experience the illness and overcome it in his own way. Many would argue that Cousin was perhaps a unique case, but he is also proof that not everything is black and white.

Comparison and Contrast to Dr. D

Another scholar that defines the process of illness is Dr. D. His process is similar to that of Kubler-Ross but has some additional elements. In stage one, he points out signs of trauma. It means that when the patient receives the diagnosis, they receive it with great concern, shock, and sadness. This is true as in Cousin’s case whereby he disavowed the minimal chances of survival that qualified medics’ said a person with Ankylosing Spondylitis had. The second stage is characterized by understanding denial and desire for emotional support. The denial in understanding led Cousin to seek knowledge in research. He went through sources that gave him information on the disease and analyzed each medication that was given to him. This is seen as an approach that allows an in-depth understanding of the nature of the disease, how bad it really was and the presence of any hopeful chances for survival. This initial stages and how an individual accepts them determines how they continue into their illness. The outcomes are different and therefore, cannot be completely defined by particular stages.

For example, Dr. D suggests that the third stage is identified by depression, mourning, loss and anger outbursts. However, a cousin was aware that indulging in these emotions would only make his condition worse. He consciously refused to dwell on this and to avoid it he used laughter therapy as it is commonly referred to as at present. He made sure that he stimulated all the relevant healing hormones through laughter. Many would define his approach as an unhealthy form of denial, but he was well informed before taking the route that he did. This helped him move past the next stage of distress and discouragement because he understood what he was dealing with in terms of what to expect from his illness and the medication he was taking. In essence, he took a very short time to get to stage five which is reassessment, reaffirmation of life and emerging self-identity. He re-established himself by providing a new treatment process for patients with terminal illness.

Conclusion

In conclusion, Norman Cousin made a valid contribution towards the readjustment of medical approaches to Ankylosing Spondylitis. He enforced that, a patient’s attitude determines the direction that their disability takes. He took a positive attitude that gave him the courage to fight against his disease for many years. Also, he cut out all the negativity that would have had a detrimental effect on his mindset including doctors who sought to apply old, harmful medication to his case. Cousin also redefined the relationship that doctors and patients should have. He recognizes that both parties have a role to play. Patients are responsible for ensuring they stimulate their body towards healing while doctors are to work with patients side by side in order to customize treatment. He also motivated laughter as a form of treatment. Many terminally ill patients today use this method and confirm that it helps with the pain and they are able to cope better. He also gives hope to those who are told the odds are not in their favor.

Reference

Cousins, N. (1976). Anatomy of an illness (as perceived by the patient). New England Journal of Medicine , 295 (26), 1458-1463.