The history of medicine consists of two major themes: development of new techniques to study the body and attempts to understand why illness occurs. Often these two themes lead to a synergism that creates a great advance, such as the development of the microscope so that we could actually see bacteria that cause disease. Before such technological breakthroughs occur, we are stuck trying to explain disease in the absence of being able to actually see the problem and therefore we develop theories on what is causing the problem. Sometimes these theories are correct, sometimes they are horribly wrong.
Ignaz Semmelweis was a Hungarian physician who noted that women who gave birth in the hospital setting had very high rates of post-partum infections (often fatal), while women who gave birth at home had much lower rates. The doctors at the time were doing autopsies and going from one procedure to another. Semmelweis thought that the doctors might be transmitting something to their patients thus causing the infections. He did an experiment to show that hand washing (using lime salts) actually did reduce the rates of death to below 1% (they were as high as 35%). However, he could not show why this worked and doctors didn’t believe him (despite being shown the research evidence). Sadly, Semmelweis ended up dying in an asylum in 1865 after becoming mentally ill. When one doesn’t understand the problem, the solution can be right in front of your face and yet you can’t see it.
I saw a woman this week whose story is shocking. She had a great childhood with loving parents who taught her that people could be trusted, the world was good, and that she should act with kindness and caring towards all others. She learned to sweep emotions under the rug and work harder when problems arise. She did not learn to speak up for herself. Her life was great until high school when she started a 3-year relationship with a boyfriend who came from an abusive household. Over time, he became jealous and possessive. She continued to make excuses for him and tried to be a good girlfriend, thus acceding to his increasingly controlling ways. He pushed her away from her family and her friends. He didn’t let her go out unless he was there. He even hit her on two occasions. And she continued to make excuses for him and cover up her pain and distress. She tried to be an even better girlfriend and hoped he would change. He didn’t; and finally (with the help of her sister) she broke up with him. She went off to college and did well. Her life was back on track. She was an active athlete and even ran in marathons. In her first job, she desperately wanted to prove herself and become the best employee in the company. However, her boss was someone who took advantage of that attitude and her inability to speak up for herself. The boss piled more and more work onto her, causing her to work evenings and weekends. The boss did less and less. Yet my patient never spoke up to ask for some changes to be made. She felt trapped and her feelings were similar to how she felt when in a relationship with her abusive high school boyfriend. It was during this period in her life that her pain started.