Human beings may belong to the same species, but they experience sickness differently. Each nation has its favoured illnesses and its favoured explanations, which alter over time. A doctor in one country may label an illness as depression, while the identical symptoms may be labelled as low blood pressure in another, or as the effects of dental amalgam in yet another.
These cultural variations throw light on illnesses that are poorly defined but that impose a huge burden of suffering on individuals, and on the workload of doctors and hospitals, who can often do little to help.
It reminds us that while medicine in the modern world has achieved an extraordinary level of sophistication, there is still much it cannot do. We can create babies in a test tube, transplant organs and bring people back from the dead. We are beginning to grow new body parts from stem cells, to defeat diseases by genetic engineering and to help the blind see.
Yet 40 per cent of those attending GPs and hospital out patients departments never receive a conventional medical explanation for their symptoms. These are people who typically complain of headaches, fatigue, inability to concentrate, aches and pains, and feeling unwell. They are suffering from malaise, of unexplained origin, whose expression apparently depends on which country they live and how the culture responds to their condition. Are these different conditions? Or the same condition, just given different names?
Simon Wessely, professor of psychiatry at Kings College, London, who has studied cultural trends in illness, says: "People will always seek explanations when they feel under the weather or not quite right. Much of it depends on what is currently hot in medicine. Each age and each culture has its own answers. Doctors use many different labels to describe patients with unexplained symptoms - somatisation, burn-out, chronic fatigue syndrome, multiple chemical sensitivity, subclinical depression, post traumatic stress disorder, low blood pressure, spasmophilia - despite no evidence that any of these are distinct or separate entities. Our belief is that most of these labels refer to similar clinical problems."
The choice of label has profound implications for how patients deal with their symptoms and the treatment they expect from doctors. "Clearly someone who believes their symptoms are due to spasmophilia or low blood pressure will seek different treatments from someone who believes they have a food allergy or chemical sensitivity. Public health measures will also differ and the resulting controversy and political indecision can cause ill feeling, distrust and suspicion," Professor Wessely says
In Britain, our obsession with our bowels extends back to the 19th century when a condition called intestinal auto-intoxication - self poisoning from one's own retained wastes - was widely diagnosed, especially in young women.
It was thought that the colon leaked toxic material into the bloodstream, which caused sufferers to feel tired, weak, depressed and wracked by unexplained aches and pains. Constipation was seen as "the disease of diseases" and the public became prey to marketers of anti-constipation remedies and, in extreme cases, surgery to remove a section of the colon was carried out.
Professor Wessely said: "The condition was always diagnosed in young women, surgeons took out their colons and quite a percentage died. You can see the legacy of it today in the fashion for colonic lavage and the interest in detox treatments. Surgeons no longer take out people's bowels and so they go for the detox option instead."
Germany: low blood pressure
Regarded as a sign of excellent health elsewhere, in Germany low blood pressure is seen as a disease responsible for weakness and fatigue and is treated with drugs to boost it. Chronic low blood pressure is said to cause tiredness, giddiness, black-outs, anxiety and sweating. …