Browse extracts from the book

Immune System: Disorders of Immunological Competence and Autoimmunity

In both humans and animals immunological disturbance has been shown to follow loss in its broadest sense, notably depression of immunological competence, typified by the infant bereft of a parent and predisposed to infections. Secondly, in humans pathologically prolonged mourning may precipitate distortion of the normal system for defence of self to an attack on self by antibodies and lymphocytes in the AI diseases.

Please follow this link for a full contents list.

Rheumatoid Arthritis and Autoimmune Disease

"...Halliday was one of the first to recognise that patients with RA were typically stiff upper-lipped, enduring and inclined to martyrdom. Himself a Scot from Glasgow he used the local word thole (= to suffer and endure) to describe it. Subconsciously, patients with RA and AI disease often see their illness as the cross they must bear in reparation for guilty feelings of anger and bitterness over "lost" key figures..."

Infectious Mononucleosis

"...We have reported that a combination of physical and emotional exhaustion usually precedes the onset of the disease, for example, in students before their final examinations with much burning of the midnight oil, associated at the same time with family or social disharmony, or in a nurse on night duty who is running three love affairs simultaneously.

Children with infectious mononucleosis usually recover spontaneously and without the prolonged morbidity which is the curse of the disease in adolescents and young adults. The cause of the intense exhaustion affecting so many adults for months or years, and which may jeopardise their careers, is not known, is rarely discussed and deserves more attention than it receives.

The symptoms mimic states of anxiety which may follow head injuries or accompany virus or toxoplasmic encephalitis, and are characteristically intensified by attempts at mental concentration or physical effort. Even a telephone call or someone coming to the door is likely to cause palpitation, sweating, shaking and exhaustion. Hyperventilation may develop secondarily, but there is no reason to see it as primary..."

Sarcoidosis

"...Histology points to an abnormal immunological response to an allergen or allergens, which may have some similarity to the outer coat of mycobacteria or to beryllium. Again physical exhaustion combined with emotional exhaustion precedes the disease. Crohn's disease, another disorder in which lymphoid hyperplasia [39] has been felt to reflect an aberrant or excessive immunological response [40], but has a different psychopathology...."

Cancer and Malignancy: Psychosomatic Aspects

"...There is an extensive literature covering half a century suggesting that certain emotional stresses, including loss, may determine the onset of malignancy. More recently work has been done on predisposing personality traits, especially the lack of emotional expression in such patients. In the past 10 years the main focus of such work has been to demonstrate the predisposing effect of the "giving-up response" in such patients and that psychological counselling designed to modify this attitude can delay or prevent relapses after treatment for breast cancer, a disorder in which psychoneuroendocrinology may also be influential. We do not have personal experience of the effect of psychological management but can testify that malignancy often follows closely on loss and pathological mourning as well as being an apparent hazard of immunosuppression...."

Guillain-Barré Syndrome

"...A woman aged 26 was engaged to be married, but her mentally defective brother resented it so much that he tried to murder her by throwing a small piano down the stairs on top of her. Until the wedding a few weeks later, she went to live with her fiancé's parents. She was still in their house when a year later she went into a long labour with an abnormal presentation. Forceps delivery was attempted but failed, a further forceps delivery was attempted under anaesthetic on arrival in hospital where her pulse was uncountable. She required Caesarean section to deliver a dead baby, and then remained for hours in shock requiring large amounts of hydrocortisone to restore her blood pressure. Although aware of the baby's death her family felt it better not to tell her that her father-in-law, of whom she was very fond, also died unexpectedly shortly after her admission to hospital. She was told 3 days later when her own condition was improving. Polyneuritic symptoms then developed, and GBS was confirmed. The patient had been withdrawn since admission, and this behaviour now increased. She would lie with her face to the wall and would not speak unless addressed. A black wooden cross appeared on her bedside table, and it was learned that she was about to be converted to an obscure religious sect by a man who was constantly sitting outside the ward. She presented every indication of giving up this life and following her baby and father-in-law.

Psychological management involved helping her to talk and weep, and by discouraging visits from the man trying to convert her. She became less withdrawn, the cross disappeared, and she began to fight to get better. Recovery was slow, but she was fit enough to go home to her husband in a specially equipped bungalow after a year.

This illustrates the combination of severe emotional stress and physical exhaustion preceding onset of polyneuropathy...."