Where Do Diseases Go?: The Great Delusion
by Steven Goldsmith, MD
In the summer of 1485 a new and exceptionally lethal disease of unknown cause struck the English populace. Many thousands succumbed after suffering from a unique succession of symptoms: a general sense of apprehension, headaches and muscle aches, giddiness, profound exhaustion, chills that preceded profuse sweating and then heat, shortness of breath, chest pains and palpitations, and finally delirium and coma. Deaths usually occurred within twenty-four hours of the symptoms’ onset, sometimes after only two or three hours, leading to the contemporary phrase, “merry at dinner and dead at supper.” Then the disease disappeared without a trace.
English sweating sickness resurfaced four more times during the following century, the last being in 1551. But so far as we know, it never struck again. Medical historians characterized these outbreaks as variations of hantavirus pulmonary syndrome, anthrax, influenza, and other maladies, but the evidence for each of these candidates contains flaws. Truth is, we don’t know what sweating sickness was, why it erupted, or why it disappeared. (I will explain the italics.)
Where did sweating sickness go? Why did we never encounter it again during the past four and half centuries? With apologies to Langston Hughes, did it (a) disappear like the last moment of darkness before sunrise? Or did it (b) morph into an alien incarnation, the way a maggot reinvents itself as a fly? Did it instead (c) hide in our air or water or in our very cells like a tiger camouflaged by jungle foliage, awaiting a congenial shift in our collective vulnerabilities before pouncing? Or perhaps (d) it went nowhere at all, for it never existed. If you chose (d), congratulations. Because the concept of “English sweating sickness” is a delusion, a product of our wrongheaded notions about illness. Asking why the sweating sickness disappeared is the wrong question.
Historians did not fabricate the accounts of those thousands of English deaths. Nor did hysterics or fabulists merely imagine the sweating sickness. Rather, no such thing as a disease exists in physical reality. Disease is not an it, an entity with a mass of certain dimensions that occupies space like a banana. You can neither see it nor hear it as you can a cell phone. Like pneumonia and acne, sweating sickness is an abstract noun. All we can know of such abstractions are their manifestations, their signs and symptoms. For instance, “pneumonia” does not exist in physical reality while abnormal thermometer readings, gunky sputum, and rapid breaths do. We call that assortment of abnormalities pneumonia, but we could just as sensibly label it Marlon Brando’s Underwear. By the same token, the term "sweating sickness" reflected contemporaries' attempts to abstract meaning from the simultaneous physical abnormalities—the profusion of sweat, muscle pains, shortness of breath, palpitations—producing that picture of disease.
Yet what are the manifestations of disease but products of dysfunctional patterns. Diabetes mellitus, for example, is not a thing but a general pattern of metabolic dysfunction. Depression is not a thing but a dysfunctional pattern of thoughts, emotions, and behaviors. Tumors are patterns of cellular dysfunction that ultimately form abnormal structures. Disease happens when we, our bodies and minds, don’t work right, malfunction ; conversely, health obtains when all aspects of us function in harmony. Each of us is not a thing but a pattern of interacting processes, just as the noun Beethoven’s Fifth is in physical reality not a thing but a harmonious interplay of instrumental sounds over time, a process.
Because “sweating sickness” was not really a thing, nothing (as in no thing) ever disappeared. What did change was the way in which over the centuries the bodies of dysfunctional, i.e. sick, individuals behaved.
In Victorian times, women with “hysteria,” aka “the vapors,” fainted under stress. Nowadays they do so far less often (unless they are on TikTok). That does not mean some thing called hysteria, an abstract noun that denoted certain behaviors, disappeared. Instead, the way unwell people—in this case mostly women—behaved changed. Now they have eating disorders and panic attacks, two symptomatic patterns that were rare not only in Victorian times but as recently as several decades ago. (During my four years of medical school in the late sixties, I saw only two patients with eating disorders and none with panic attacks, nor did I personally encounter anyone with either .)
This distinction between disease as thing and as dysfunction helps explain why my profession can’t prevent and cure most disease. That is, we can heal ourselves only through mobilization of our own self-healing resources. The best physicians can do is strengthen those resources. They can do that not by considering disease as things that must be excised with scalpels or suppressed with drugs but by helping the orchestras inside us function more harmoniously.
How can we understand why we become ill? Why in the sense of inquiring about ultimate cause is an unproductive and unanswerable question. Let’s face it, we don’t know the ultimate causes of anything. To ask why you suffer for example from depression is to solicit explanations that trigger an infinite cascade of your further whys of the sort that drive parents up the wall. “Mommy, why is the sky blue?” is never the end of the matter. Discovering the alleged why, the ultimate cause of your depression, rarely helps; the world teems with people who are unhappy despite knowing why. No good evidence exists that psychotherapists cure clients by enlightening them about ultimate causes—at least that is not the main factor in successful therapy and only a minor one at best (my book The Healing Paradox examines the crucial factors), as illustrated by the striking success of non-insight-oriented psychotherapies such as cognitive behavioral therapy and the strategic psychotherapies. “Okay, so my stepmother, Cruella Deville, never loved me. Now what?”
In short, to understand nature or yourself, do not ask why. Why promotes mental masturbation that strikes you blind and dumb. Life is not a because.
But do not ask what is the matter with you either. If you consider your depression a pathological thing, a bad what like a pile of roadkill rather than a dynamic dysfunctional process, you are less likely to fully and lastingly recover. If your depression is a bad what, especially one codified as an official psychiatric disorder, that is something only professionals can treat. Viewing your problem as a what, a thing, can leave you as the unempowered and passive recipient of drugs; then you can’t be expected to play a primary role in your recovery any more than if you suffered from arthritis or asthma or other bad things affixed with daunting diagnostic labels.
When you understand your problem as a what , you view it through a reductionistic lens, revealing only dead splinters of truth. Life is not a box of things. Instead it is a network of interactions, forces, and processes. So in attempting to understand disease, do not ask why or what. Ask how. Regarding depression, how you unwittingly depress yourself by interpreting life events in certain ways rather than others; how your interpersonal behaviors influence others’ reactions to you, which in turn trigger negative thoughts about yourself, etc.
To return to sweating sickness. What better way to discover what helps us become well than understanding how some of us resist illness better than others (i.e. the how of inner self-healing resources), a matter about which contemporary medical science remains clueless. For instance, Ann Boleyn, the second wife of Henry VIII, survived a bout of sweating sickness, whereas her brother-in-law, William Carey, died. Why? Why did not everyone who contracted this malady succumb? What was the telling difference between the survivors and victims, not only of sweating sickness but of the bubonic plague, smallpox, Ebola, AIDS, cancer, or any other disease? If medical science resolves to answer these questions, then the sacrifices of all those sweaty Brits were not in vain.
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Be well.
My first thought was also that sweating sickness was a poison. Quite an interesting and historical read, thank you. The only additional thought I have is that the fainting is now known as dusautono/POTS, for Postural Orthostatic Tachycardia Syndrome. I had it for 12 years, being disabled and bedridden the whole time. Hiw did I heal?
I went to God. I prayed. I fasted and prayed. And when I had a near-death experience, I asked God to take everything I ever did in my life, and make it good enough to come back so I could raise my then 2-year old. And God was gracious, so here I am.
We have lost the art of praying with our patients.
I was thinking about a story of an entire family who ate bad meat at a holiday supper and died. The son who was away and did not eat with them, found them all deceased. Of course in those days they didn't have refrigeration so spoiled food is a likely cause. I suspect poisoning as cause of sweating sickness. Many populations have been poisoned intentionally.