Читать книгу The Sickening Mind: Brain, Behaviour, Immunity and Disease - Paul Martin - Страница 19

Sex and drugs and rock and roll

Is all my brain and body need

Ian Dury, ‘Sex and Drugs and Rock and Roll’ (1977)

A cousin of mine who was a casualty surgeon in Manhattan tells me that he and his colleagues had a one-word nickname for bikers: Donors. Rather chilling.

Stephen Fry, Paperweight (1992)

Our minds can have a profound impact on the physical health of our bodies by altering the way we behave. Psychological and emotional factors can dispose us to do all manner of unhealthy and self-destructive things. The self-destruction may be absolute and abrupt, as in suicide or fatal accidents, or gradual and cumulative, as in smoking.

Stress and anxiety, for example, can prevent us from sleeping properly and make us more inclined to smoke, drink excessive amounts of alcohol, eat too much of the wrong sorts of food, omit to take our medicine, neglect physical exercise, consume harmful recreational drugs, indulge in risky sexual behaviour, drive too fast without wearing a seat belt, have a violent accident, or even commit suicide (though not usually all at once).

Anna Karenin offers an impressive catalogue of self-destructive behaviour engendered by psychological and emotional trauma. Anna abandons her husband, the colourless bureaucrat Karenin, for the dynamic Count Vronsky. But their love is doomed and the emotional pressures on Anna build up to a fatal climax.

As a preamble to her eventual self-destruction, Anna nearly dies giving birth to Vronsky’s illegitimate daughter. In what she thinks are her final hours Anna appears to reconcile herself with her husband. Mad with emotional torment at this turn of events, Vronsky goes off and shoots himself – but not fatally. Although Vronsky is an army officer, and therefore presumably capable of hitting his own heart at point blank range, the bullet misses. He is seriously wounded – enough to make it a meaningful parasuicidal gesture – but does not die. Anna and the baby go to live with Vronsky, but her husband refuses to divorce her and she becomes a social outcast. The strain of her position renders Anna increasingly unstable and she develops paranoid delusions about Vronsky’s supposed unfaithfulness. Consumed by the madness of her passion, Anna suddenly decides that she must end her torment and punish Vronsky for his imagined misdeeds by killing herself. Anna famously ends her own life under the wheels of a train:

‘There,’ she said to herself, looking in the shadow of the trucks at the mixture of sand and coal dust which covered the sleepers. ‘There, in the very middle, and I shall punish him and escape from them all and from myself.’

And she does. And there is more. Almost insane with grief at Anna’s death, the bereaved Vronsky volunteers to fight, and very probably die, in a war between the Serbians and the Turks. Vronsky no longer places any value on his life and relishes the prospect of death: ‘I am glad there is something for which I can lay down the life which is not simply useless but loathsome to me. Anyone’s welcome to it …’

The melodrama of Anna Karenin’s suicide and Vronsky’s death wish are positively restrained in comparison with the high-camp posturings of Werther, the suicidal hero of Goethe’s The Sorrows of Young Werther. This eighteenth-century piece of unfettered Teutonic sentimentality tells the tragic tale of an unbalanced youth who tops himself after a bad dose of unrequited love.

The story is a simple but eternal one. Werther loves Lotte. Oh, how he loves her! But, alas, he cannot have her. Lotte is already promised to the worthy Albert and soon marries him, leaving Werther to wallow in emotional excess. He sheds a thousand tears one moment and ‘overflows with rapture’ the next, and each step on the way is recounted in copious letters to his long-suffering chum Wilhelm. So it comes as no surprise that, denied his one true love, Werther decides to end it all. Characteristically, his suicidal decision is reached only after much beating of chest, gnashing of teeth, shedding of tears and general languishing in melancholy, during which time an unkind reader might be forgiven for urging the lad to get on with it. Even when Werther finally does get round to pulling the trigger he takes several hours to die.

Incidentally, the tragic tale of young Werther had a fairly profound effect on the health of a number of readers. So resonant was Goethe’s writing with the romantic spirit of the times that the book triggered an epidemic of copy-cat suicides and was consequently banned in many places.²

All the leading causes of death in industrialized nations – including heart disease, cancer, accidental injury and AIDS – depend to some extent on how we behave. Smoking, eating habits, alcohol consumption, physical exercise, sleep patterns, sexual behaviour and choosing to wear a seatbelt, to name but a few, have ramifications for our health and wellbeing.

In industrialized societies, for example, accidental injuries and violence now account for at least half of all deaths among young men: a fact that is not wholly unrelated to the behavioural characteristics of young men. In extreme cases people who are very depressed or upset commit suicide or deliberately behave in a way which invites serious injury or death. Severe depression can lead to self-destructive behaviour. Besides making us act in positively unhealthy ways, psychological factors like anxiety, stress or depression can also inhibit us from engaging in activities that are beneficial to health, such as physical activity or social relationships with others.

In certain cases, such as crashing your car or committing suicide, the causal connection between behaviour and the subsequent damage to health is pretty obvious and requires no intimate knowledge of medical science to understand. Thanks to education and constant repetition in the media, less obvious connections between behaviour and health are also now widely recognized. The public accept that there are links between smoking and all manner of fatal diseases; between slothfulness and heart disease; between alcohol abuse and cirrhosis; and between unprotected sex and AIDS.

A stark illustration of how behaviour affects health is provided by AIDS. There are enormous geographical variations in the incidence of HIV infection and AIDS. For example, the incidence of AIDS in Honduras is fourteen times higher than in neighbouring Guatemala. Even within a single country or a single city there are massive variations in rates of infection between different social groups.

Since the HIV retrovirus was discovered to be the causal agent for AIDS in 1983 it has become clear that these large variations result primarily from differences in people’s behaviour – especially their sexual behaviour, which remains the route by which the virus is transmitted in the vast majority of HIV infections. It is generally accepted that a practical vaccine or cure for HIV/AIDS is at least a decade away.³ In the meantime, the only effective means available for limiting its spread is to change the way we behave.

There are plenty of commonplace behaviour patterns that kill people gradually but in huge numbers. Smoking is the prime example. As long ago as 1604 King James I, in his treatise A Counterblast to Tobacco, did not exactly pull his punches when he described the new-fangled habit of smoking as:

A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless.

Smoking is the riskiest thing that most people will ever do in their lives. At present, smoking-related diseases account for 15–20 per cent of all deaths and result in over 100,000 premature deaths every year in Britain alone. Smoking greatly increases the risk of lung cancer, now the commonest fatal cancer in Britain. Smokers are ten times more likely to die from lung cancer than non-smokers and around 90 per cent of lung cancers are attributable to smoking.

Smoking also increases the risks of various other fatal or debilitating diseases including coronary heart disease (the biggest cause of death in most industrialized countries), chronic bronchitis, emphysema, and cancers of the oesophagus, bladder and pancreas. A quarter of all deaths from coronary heart disease are smoking-related. As if that were not enough, smoking causes birth complications and doubles the risk of a pregnant woman miscarrying.

Think about these statistics from the British Medical Association. The average risk that you will die from leukaemia within the next year is about 1 in 12,500. The average risk that you will die in a vehicle accident is 1 in 8,000. If you are, say, forty years old, your risk of dying from natural causes of any sort during the next twelve months is 1 in 850. However, if you smoke ten cigarettes a day your odds of dying within the year are 1 in 200. Or look at it another way: take a random sample of a thousand young men who smoke; on the basis of actuarial data it can confidently be predicted that one of these young men will eventually be murdered, six will be killed on the roads and two hundred and fifty will die prematurely from the effects of smoking.

Smoking is clearly bound up with what goes on in people’s minds. The reasons why individuals start smoking and why they then find it impossible to quit are neither simple nor well understood. Psychological studies of smokers have, however, confirmed the truth of several common assumptions.

It is indeed true that people who are depressed or stressed are more likely to smoke (and, consequently, more likely to die from lung cancer). Smokers really do experience a stronger desire to smoke at times of heightened anxiety. To add to their problems, psychological stress is associated with a higher failure rate among smokers trying to kick the habit. One long-term study of smokers found that individuals who had been depressed as much as nine years earlier were 40 per cent less likely to be successful in their attempts to give up smoking.

It gets worse. The psychological and emotional factors that make people inclined to smoke induce them to do other unhealthy things as well. Research has shown that moderate-to-heavy smokers are, on average, significantly less conscious of health-related issues, hold less favourable attitudes towards healthy behaviour and have a generally less healthy lifestyle in comparison with non-smokers or light smokers. (Conversely, wholesome behaviour patterns also come in clusters; researchers at Harvard University Medical School found that individuals who drank only decaffeinated coffee also tended to eat lots of vegetables, take regular exercise and wear their seatbelts.)

As well as prompting people to smoke, stress is also linked to increased alcohol consumption – at least, in certain types of individual. The health implications of excessive drinking can be profound. Approximately 20 per cent of all male in-patients in British hospitals have alcohol-related problems. Alcohol can rot people’s livers and kill them in drunken accidents (though alcohol is not the only recreational drug capable of damaging health: there is reasonably good evidence, for example, that marijuana impairs the immune system, with potentially adverse consequences for the health of long-term users.)

The perils of the grape are amusingly described in Othello. The scheming Iago lures the unwitting Cassio into getting steamingly drunk, as a result of which Cassio lands himself in serious trouble and loses his job. On sobering up, Cassio bemoans the loss of his reputation and curses the demon drink:

‘Drunk! And speak parrot! And squabble! Swagger! Swear! And discourse fustian with one’s own shadow! O thou invisible spirit of wine, if thou hast no name to be known by, let us call thee devil! … O God, that men should put an enemy in their mouths to steal away their brains! That we should with joy, pleasance, revel and applause, transform ourselves into beasts!’

Literature is amply stocked with characters who drink themselves into an early grave in reaction to emotional crisis or unhappiness. There are roistering drunks who drink to escape boredom or poverty, like J. P. Donleavy’s Ginger Man, Sebastian Dangerfield. There are determined drunks who drink to escape from grief. In Wuthering Heights, the unfortunate Hindley Earnshaw becomes a hopeless alcoholic after the death of his wife (from consumption, naturally) and drinks himself into the grave by the age of twenty-seven. And there are aimless drunks who drink to forget their own pointlessness. In F. Scott Fitzgerald’s The Beautiful and Damned, for example, we have Anthony Patch, an independently wealthy and well-educated young man blighted by indolence, boredom and melancholy. A turbulent marriage and self-imposed idleness push him into self-destructive alcoholism and he degenerates into ‘Anthony the poor in spirit, the weak and broken man with bloodshot eyes’.

Incidentally, when it comes to self-destruction by alcohol the track record of doctors is almost unrivalled. As a profession, they rank second only to pub-owners and bar staff in the league table of deaths from alcohol-related liver disease. Doctors are 3.4 times more likely than the average worker to die from cirrhosis of the liver. According to one 1995 estimate, as many as one in twelve British doctors is addicted to alcohol, drugs or both, thanks mainly to the enormous stress the majority of them are constantly under. (But I should not be too smug about this statistic because ‘literary and artistic workers’ also fare badly, with twice the average death rate from cirrhosis.)

On the other hand, moderate alcohol consumption can be an effective buffer against stress – and here again science has only of late managed to verify thousands of years’ worth of everyday experience. Psychological studies have confirmed what countless millions of people have discovered for themselves, namely that when we are under stress we often feel less anxious if we drink alcohol. (A moderate intake of alcohol also appears to reduce the risk of coronary heart disease, but that is another story.) Sir Winston Churchill’s opinion was clear: ‘I have taken more out of alcohol than alcohol has taken out of me.’

There is nothing surprising about the fact that alcohol has its good side. It has, after all, been an intimate part of human life since the dawn of civilization. Alcohol was in use for medicinal purposes (in the literal rather than euphemistic sense) over four thousand years ago and was probably quaffed for recreational purposes long before that.

Opinions differ as to when exactly humans first discovered the joys of booze, but there is evidence that wine was being drunk in Transcaucasia eight thousand years ago – long before the wheel was invented. Some authorities have argued that Stone Age man was cultivating vines as early as ten thousand years ago. Wine growing was well established in the Middle East by 4000 BC and was an integral part of daily life in ancient Egypt and Mesopotamia. It says something that wine is mentioned 150 times in the Old Testament.

Then there are the social benefits of communal drinking to add to the purely pharmacological pleasures of alcohol. Samuel Johnson spoke for many when he declared that: ‘There is nothing which has yet been contrived by man, by which so much happiness is produced as by a good tavern or inn.’

Yet the things that give us pleasure carry risks, and we are very poor at assessing those risks. While we consistently overestimate the dangers posed by rare or exotic threats like plane crashes, murders, nuclear accidents or shark attacks, we tend to disregard the risks of common killers like heart disease and vehicle accidents. We are especially prone to underestimating the risks arising from our own behaviour, such as smoking, travelling in cars, abusing alcohol or having unprotected sex.

Smokers now acknowledge the unappetizing fact that their behaviour significantly increases their risk of dying prematurely from heart disease or cancer. Nevertheless, psychological research has established that they seriously underestimate the magnitude of that risk. There is a consistent ‘optimistic distortion’ of perceived health risks among smokers; they know smoking is bad for them but they do not recognize just how bad. No matter how often the statistics are quoted they do not seem to sink in. One reason why the health consequences of smoking have such a muted impact on people’s perceptions is the large delay, often measured in decades, between starting to smoke and falling ill.

If you should happen to be an overweight, tobacco-addicted, boozing, couch potato who loves fried food, you can take a few crumbs of comfort from the fact that others’ attempts at healthy living can backfire. Dieting, for example, almost invariably fails to bring about the desired result of sustained weight loss. The sense of personal failure that comes as the scales lurch upwards again can produce a damaging drop in self-esteem and a sense of losing control; the frustrated dieter’s response may be to abandon the diet and thus swing back to even greater porkiness. Mother Nature also conspires against the earnest dieter. People whose body weight oscillates because of dieting have a greater risk of premature death from coronary heart disease or other causes. Unsuccessful dieting can be bad for your health – and most dieting is ultimately unsuccessful.

What of behavioural self-destruction in literature? Fiction is littered with protagonists who recklessly expose themselves to danger, neglect their health or run themselves into an early grave because of great unhappiness or emotional turmoil.

An early case history of self-destruction appears in Le Morte d’Arthur, Sir Thomas Malory’s fifteenth-century version of the legends of King Arthur and the knights of the Round Table. It is the sad tale of the Fair Maiden of Astolat and her doomed love for Sir Launcelot.

The brave, noble, irresistibly attractive Sir Launcelot rides to Astolat en route to a joust, and stays the night there at the home of the elderly baron, Sir Bernard of Astolat. Sir Bernard has a beautiful and virginal young daughter, the Fair Maiden of Astolat, who is at once smitten by Sir Launcelot. She is, as Malory so engagingly puts it, ‘hot’ in her love for the noble knight: ‘for he is the man in the world that I first loved, and truly he shall be last that ever I shall love.’ (Astolat, by the way, is Guildford and the maiden’s name is Elaine. Fortunately, ‘The Fair Maiden of Astolat’ has more Arthurian resonance than ‘Elaine of Guildford’.)

Sir Launcelot is grievously wounded and the Fair Maiden goes to look after him. Night and day she tends him, until his wounds are healed and Sir Launcelot is ready to take his leave. The Fair Maiden of Astolat beseeches Sir Launcelot to marry her or, failing that, at least go to bed with her. But the upstanding knight will not countenance marriage and refuses to dishonour the Fair Maiden by indulging in extramarital frolicking. She begs him again to be her husband or her lover, but to no avail. ‘“Alas,” said she, “then must I die for your love.”’ The noble knight leaves Astolat to get back to some real man’s work (fighting), leaving the emotionally wrecked Fair Maiden of Astolat behind him. Her mental state and self-destructive behaviour soon wreak havoc upon her physical health:

Now speak we of the Fair Maiden of Astolat that made such sorrow day and night that she never slept, ate, nor drank … So when she had thus endured a ten days, that she feebled so that she must needs pass out of this world, then she shrived her clean, and received her Creator … ‘it is the sufferance of God that I shall die for the love of so noble a knight … I loved this noble knight, Sir Launcelot, out of measure, and of myself, good Lord, I might not withstand the fervent love wherefore I have my death.’

True words from the Fair Maiden of Astolat, because very soon she dies. Clutched in her hand is a letter proclaiming her love for Sir Launcelot. That love has sent the Fair Maiden to her death, a death achieved through her behaviour.

Reckless behaviour allied with emotional distress can destroy an individual’s physical health, as illustrated in Jude the Obscure, Thomas Hardy’s novel about ‘a deadly war waged between flesh and spirit’.

Jude Fawley, a self-educated young man of lowly origins, aspires to leave his unlovely country village and enter the hallowed portals of Christminster (Oxford) University. But the restrictions imposed upon Jude by class and poverty mean that he must instead make his way as a humble stonemason. Jude’s romantic life is as frustrating and unsuccessful as his academic life. After being trapped into an ill-fated marriage to a pig-breeder’s daughter he falls in love with his cousin Sue. The two are drawn together by an almost mystical affinity, but Sue leaves him to marry an older man. The two lovers are eventually united and live together, unmarried and condemned by society, in poverty and unhappiness. In the end Jude loses Sue, who returns to her husband.

Having failed to fulfil both his intellectual and romantic desires, Jude goes into physical and mental decline. Like many a nineteenth-century tragic hero, he succumbs to a consumptive illness which proves to be terminal. Jude’s behaviour exacerbates his medical condition. With careless disregard for his health he makes a long journey on foot in the pouring rain to see Sue for the last time. She rejects his pleas and he returns to Christminster, physically and emotionally broken. But, as Jude explains to his former wife, he was fully aware of the risk to his health when he undertook the journey:

I made up my mind that a man confined to his room by inflammation of the lungs, a fellow who had only two wishes left in the world, to see a particular woman, and then to die, could neatly accomplish those two wishes at one stroke by taking this journey in the rain. That I’ve done. I have seen her for the last time, and I’ve finished myself – put an end to a feverish life which ought never to have begun!

Eventually he dies, alone and neglected, not yet thirty years old. Hardy implicitly takes a multi-causal view of Jude’s final illness, since environmental and constitutional factors play a role in it, together with psychological stress.⁴ His emotional distress at losing Sue and at the death of their children acted as a trigger, but the illness also has antecedents in Jude’s weak constitution and the harsh conditions he endured during his time as a stonemason:

I was never really stout enough for the stone trade, particularly the fixing. Moving the blocks always used to strain me, and standing the trying draughts in buildings before the windows are in, always gave me colds, and I think that began the mischief inside.

Most of us die sooner than we have to because of the way we behave and the choices we make. Personally, though, I have some sympathy with Publilius Syrus, who two thousand years ago expressed the opinion that: ‘They live ill who expect to live always.’