Attitudes, Behaviors and Illness
While a third year medical student I decided to write a Medical Thesis and asked Dr. Holmes to be my supervisor. He accepted and said by my doing so I would become a "Third generation Cornell medical researcher." He explained that the "first generation" belonged to Harold G. Wolff, M.D., Professor and Chairman of the Department of Neurology at Cornell's New York Hospital. Dr. Wolff carried out pioneering medical and psychological studies of patients with headache, particularly migraine headache. In his scientific papers he identified typical thoughts, feelings, and behaviors reported by migraine patients that significantly influenced the onset and severity of their headaches.
Dr. Wolff later recruited a "second generation” of trainees from doctors training in Internal Medicine at Cornell and challenged them to conduct similar studies on patients coming to the New York Hospital outpatient clinic with commonly experienced illnesses. Stewart Wolf, M.D. chose disorders of the stomach. William Grace, M.D. and David Graham, M.D. explored endocrine and gastrointestinal illnesses. Lawrence Hinkle, M.D. selected cardiovascular disease. Dr. Holmes chose to study the nose! When Dr. Holmes asked me what illness I might study I chose a surgical disease - inguinal hernia. I wanted to see if any attitudes and behaviors existed for these patients. That summer I interviewed 37 men coming to surgery for an incarcerated inguinal hernia, this Medical Thesis led to my first scientific publication.
Patients in my study came from two regional medical centers: the Seattle Veterans Hospital and the U.S. Public Health Service Hospital. May of my volunteering patients were employed in the Merchant Marine. These men were generally enlisted sailors, of low to moderated rank, who had frequent prolonged shipboard tours of duty. Their hernia emergency often happened when they were at sea. When I asked about possible life stresses that had existed prior to, and during, the cruise they often mentioned striving for promotion by working hard but not having their efforts recognized. Instead, they said they were criticized by supervisors. I then asked about how they felt while being "unduly criticized" and many said: I was so angry I thought I would explode!”
I then asked: "If you were able to do anything you wanted about this situation, what would you have done?" He answered: "I would have knocked his stupid block off." As actually punching a supervisor would have resulted in a reduction in pay, or even a demotion, they actively held their anger inside. Active restraint taking strong physical action is accompanied by contractions of abdominal musculature and breath holding. This action is called a Valsalva maneuver. Resultant strain from repeated Valsalva maneuvers could well promote inguinal canal weakening and later herniation.
One behavior that was reported by several of my hernia patients was carrying out an extremely strong physical action, but one not directed toward a supervisor. The behavior related by the patient above was the following: “After he (the supervisor) left, I picked up my heavy four layer toolbox and threw it overboard." Such heavy physical exertions were often the final step leading to an incarcerated hernia and surgery.
Below are 26 attitudes and behaviors discovered by these three generations of Cornell medical researchers. It is important to remember in reading this list that their research studies were carried out decades before more recent discoveries identifying neuronal, hormonal, biochemical, and electrical communications between the brain and body! None-the-less, behavioral interventions have been done for persons with these attitudes and behaviors with rewarding results and gratifying improvements in health!
Attitudes and Behaviors that Facilitate the Expression of an Illness:
Acne - A person that feels they are being picked on and wishes to be left alone. They believe that they are being nagged at and are angry, even hostile, over the situation.
Asthma - A person who is a non-participant and feels "shut out" by their life difficulties. They feel isolated and unprotected.
Backache - This person wants, but can't allow himself or herself to literally walk away from an unpleasant life situation.
Cancer - A person with cancer is frequently very considerate of others, to the point of over-giving and self-sacrificing behaviors, with strong inhibitions towards their own displays of strong emotions - especially anger.
Constipation - When a person feels they are in a life situation from which nothing good can result, but they are grimly hanging on. They believe that the best they can hope for is that things won't get any worse!
Coronary Heart Disease - The person who develops this illness devotes enormous amounts of time energies their work. However, work is often seen as "joyless striving." They are frequently intense, emphatic, competitive, rushed, and easily aroused to hostility - particularly when they are out of control of a situation.
Diabetes - An individual that is "starving in the midst of plenty." That is, they are literally surrounded by many desirable things in life, but believe that none of these things are available to them.
Diarrhea - A person that when faced with a meaningful task, wants to perform it extremely well. However, they wish that the task was already completed, finished, done with, and behind them.
Duodenal Ulcer - An individual with marked competitive strivings, who craves support and recognition from others. However, they feel that they have recently been deprived of what was rightfully theirs!
Eczema - Frustrated! Attacks occur in life situations that are seen as frustrating and embarrassing.
Hives - An individual with this affliction often feels abused and is angry about it. They feel they are "taking a beating" but are helpless to do anything about it.
Hypertension - The person feels threatened and is constantly "on guard." Anything could happen, at any time, from any direction. They feel they have to be always prepared to meet all types of possible threats.
Hyperthyroidism - This person believes they are about to lose something, or somebody, they dearly love. They unsuccessfully try to prevent this loss by “holding on mightily.”
Inguinal Hernia - This person feels he must "bottle up" his anger over current life frustrations. He feels he is "ready to explode." However, his attention is focused on rigidly restraining his anger.
Metabolic Edema - A person that feels they are carrying a heavy load and wishes somebody else would come and help them with their burden. They feel they have too many responsibilities on their shoulders.
Migraine headaches - A person who attempts to control feelings of anxiety and resentment through extremely organized and intense activity. Insecurity and tension lead to behaviors and feelings of inflexibility, perfectionism, and resentment.
Multiple Sclerosis - This person feels forced to undertake activities that they don't want to do. They feel they must carry on independently and without any help.
Nausea and Vomiting - These symptoms tend to occur when a person feels something undesirable has just happened, for which they were, at least partially, responsible. They wish it hadn’t happened and things could go back to how they used to be.
Paroxysmal Auricular Tachycardia - This cardiac racing may occur when a person feels that life is not proceeding according to schedule and should be speeded up!
Psoriasis - A person with an exacerbation of this illness often feels that a life situation is "gnawing" at them and that they must put up with it. A steady, boring, nagging life irritation has to be endured.
Raynaud's Disease - This affliction of dramatic cooling of a person's hands and fingers occurs when they wish they could take hostile, physical action. They wish that they could hit or even strangle someone.
Regional Enteritis - This person feels he has been the recipient of something harmful to their body and wants to get rid of it. They feel that they have received something that was damaged or inferior. It is as if they have been poisoned.
Rheumatoid Arthritis - This individual often feels tied down and unable to get free. They see themselves in a life situation where they are restrained, restricted, and confined.
Tuberculosis (Pneumonia) - Despite valiant efforts, this person feels helpless and unable to deal with their recent stressful life events.
Ulcerative Colitis - This individual feels they are being injured and degraded. They wish that they could get rid of the responsible agent, as it is humiliating. They wish the unpleasant situation would be finished, over with, and done.
Vasomotor Rhinitis - An afflicted person frequently wishes they could "shut out" and "wash away" recent life difficulties. They feel helpless to solve these problems on their own.
