Real or imagined?

Lisa Kron, the author and star of Well, a very provocative and entertaining play now on Broadway, says healthy people tend to believe that 8220;people who are sick are just not trying hard enough8221;. Those afflicted by serious depression are often told by others to 8220;pull yourself together,8221; 8220;snap out of it8221; as if they deliberately choose to suffer.

Kron8217;s play is autobiographical: about her mother, Ann, who has been plagued since childhood with unexplained bouts of extreme fatigue and lethargy that she attributes to allergies and about herself, similarly afflicted as a child but who then recovered once she left home. Was Kron8217;s illness real or were her symptoms, so like her mother8217;s, a morbid form of identification with a mother she loved?

8220;I come from a family where everyone is ill. To some extent, my illness could have been learned behavior8221;. Kron said she recognized that she needed a new identity. 8220;When your identity is wrapped around being a sick person, you see a need to keep saying, 8216;I8217;m really sick.8217; Who will I be if I8217;m not sick anymore? But that8217;s not to say you caused yourself to be sick or that you don8217;t want to get well.8221;

As far as she can tell, her mother is really sick, even though no doctor could ever put a label on it. One doctor told her on six occasions that she had mononucleosis. Another labeled it 8220;tired housewife syndrome,8221; and still another thought she suffered from boredom and challenged her to get out of the house and find something she8217;s interested in. All these labels were laughable to her daughter, who described her mother as 8220;an incredibly curious, engaged person trapped in an utterly exhausted body8221; who is unstoppable on the days she has energy.

Finally, 8220;you blame yourself. Wasn8217;t it Susan Sontag who pointed out that whenever the cause of an illness is mysterious, it8217;s assumed to come from psychological problems or a moral weakness? And once science finally figures out the medical root of the illness, that assumption disappears,8221; says Kron.

Will we one day have a better8212;that is, more scientific8212;understanding of ailments like chronic fatigue syndrome, fibromyalgia, Gulf War syndrome, multiple chemical sensitivities or any of the other current 8220;wastebasket8221; diagnoses that many medical and lay people consider psychosomatic? I certainly hope so. After all, we now have scientific explanations for past 8220;mysteries8221; like depression, post-traumatic stress disorder, fainting spells and attention deficit disorder. And we now know that autism, migraine headaches and transsexuality are not caused by bad mothering.

Psychology8217;s Role

This is not to say, of course, that psychological makeup plays no role in people8217;s propensity to develop certain diseases, or their ability to overcome illness when recovery is at least a possibility. People who are pessimistic or fatalistic, for example, may choose behaviors8212;like smoking, overeating or drinking heavily8212;that reflect their belief that they are doomed no matter what, so they may as well do what they like.

Likewise, optimism doesn8217;t hurt even when the decks seem clearly stacked against people.

Dr Dan Shapiro, a clinical psychologist and associate professor at the University of Arizona medical school, a determined survivor, weathered two bone marrow transplants. He subsequently married, become a father and made a career of teaching doctors that patients are people. However, optimism is clearly not a cure-all. The most optimistic person I know is being treated for her seventh recurrence of chronic lymphoma. Christopher Reeve, paralysed from neck down in a horseback riding accident in 1995, lived nine years fostering research on spinal cord injuries, convinced he would walk again. What8217;s the bottomline? We should not be too quick to dismiss symptoms that seem to lack a physiological basis. A little empathy can go a long way while scientists continue to uncover explanations for what may now seem to be psychosomatic symptoms. 8212; JANE E BRODY