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THE LIST OF FALSE REMEDIES FOR ARTHRITISAcupunctureThe ancient Chinese—to fight arthritis—pricked the skin with needles made from different kinds of metals. When the surface puncture did not bring relief, they turned to acupuncture—piercing the deeper-lying organic structures.The purpose of this “medical stunt” is still debatable, although it was believed that piercing altered nerve currents and blood-vessel reflexes. Another drastic form of “cure” was burning with fire-soaked fibres. Small cones of fibres—taken from a flax-like plant called artemisia—were drenched with saltpetre, placed in the inflamed region of the body, and lighted! Think of the excruciating pain . . . and be glad you live in modern times.These terrible customs were not limited to the Chinese. The Japanese, Tibetans, and Malayans also employed the same tactics.TattooingThe highly decorated bodies of the African Negros are considered beautiful among their fellows. But did you know that a tattoo was also supposed to ease their arthritic pains? Certain types of tattooing have long been used to chase evil spirits. It hasn’t worked yet. In fact, I have actually met a tattooed man in a circus side-show who has arthritis!Hindu Habits HurtAbout 1ooo B.C. the Hindus of India became convinced that superficial arthritis was a skin and muscle disturbance, and they thought that nerve and joint conditions were deeper organic malfunctions. To cure it was a question of alteration or elimination.So, the Hindus turned to vegetable drugs to cleanse their bodies. Their methods of counter-irritation included liniments, applying bloodsucking leeches to the body, bleeding of veins and cauterisation by burning. They even tried cutting . . . making small superficial incisions which they termed scarification. The result: soon they had scars and arthritis!HippocratesHippocrates, the immortal Greek, contributed a great deal to medicine. But he was just as wrong as everyone else about arthritis. He believed, way back there around the year 450 B.C., that arthritics should be “drained.” He insisted that inflammatory fluids should be drained through the skin. Today, it is known that all too many cases of this illness do not show any sign of fluid.Hippocrates also thought of arthritis in terms of retained body poisons—especially in the female sex, when scanty menstruation or menopause was present. The Greek scholar criticised the men, and blamed their arthritis on excessive wine and sexual relations. (Hippocrates was wrong! Sex habits are not related in any way with arthritis.)WineOn the matter of excessive wine drinking, however, he was on the right track. The fact that the value of oils can be largely destroyed by wines is a correct observation. Consuming wine—in great quantity, like the Greeks of old—would take a drastic toll of ingested fats.The heavy wine-drinking in those days had an injurious effect on metabolism. Kept the liver in a constant state of repairing itself. No wonder thousands of people in those days became victims of gouty arthritis.Purging the BodyAccording to Hippocrates, pain above the diaphragm could be eliminated by forced vomiting. And, he said, all other pain below the waist could be removed by downward purging—by the use of strong laxatives or enemas.Can you possibly imagine an enema relieving the pain in a finger of the left hand? According to physicians of old, why not? The finger is below the diaphragm—and a warm saline solution can cleanse the blood. From the standpoint of logic, Hippocrates went too far with his ideas about purging. In all probability he urged sweating and bleeding, too.The Greeks blamed Uric Acid and Horseback RidingIn early Greece, too much Spartan horseback riding was considered a cause of arthritis. If they had painful hips, it was supposedly due to riding —or deposits of uric acid in the hip joints.The Greeks thought that the sciatic nerve was accumulating sticky deposits of black bile. Horseback riding might—through constant friction— injure a susceptible joint inclined to accumulate uric acid.Now, more than 2000 years later, the term uric acid has replaced the title of black bile. Acids and friction do complicate arthritis, so there was a germ of truth in those early Greek ideas.Turning the Heat on ArthritisThere must be millions of arthritics today who have arthritis of the spine. Fortunately for them, the practices of Hippocrates are outmoded. His theory of cure for this malady consisted of cauterisation … by burning!The back, on both sides of the spinal column, were given four burns. Then fifteen more burns were inflicted on each side of the spine. And, to top it off, two burns were added to each side of the neck. There are not many persons, arthritic or otherwise, who could endure this form of torture. (Personally, we would probably rather have arthritis!)*55\146\2*

SUICIDAL THINKING: COMMUNICATION OF SUICIDAL INTENTIf physicians find it awkward to ask about suicide, it is because they rarely do so. Patients are unlikely to be embarrassed or offended when questions are raised at an appropriate time and when the physician’s manner is both straightforward and sensitive. Discussing the topic will not increase the risk of suicide but reduce it. Most suicidal patients readily acknowledge their thoughts and many speak openly about them.     Psychological autopsy studies demonstrate that 55-83% of individuals who commit suicide have made their intentions known — usually to more than one person and on more than one occasion. These communications are often unambiguous (e.g., “I’m going to kill myself”), though sometimes they are less direct (e.g., “You’ll be better off when I’m gone”) or take the form of actions rather than words (e.g., putting one’s financial affairs in order). Given that the great majority of people who kill themselves have a psychiatric illness, remarks about suicide made by patients with depressive disorders, substance abuse, or schizophrenia should be a special cause for concern.     Although many suicidal patients spontaneously reveal their plans, it is more often to family members than to physicians. Even when a suicidal patient sees a physician in the days before his death, discussions of suicide are uncommon. Because spontaneous disclosure of suicidal thoughts cannot be expected, physicians must ask patients about them.*54\172\2*

HOW TO DIFFERENTIATE BDD FROM NORMAL APPEARANCE CONCERNS: QUALITATIVE DIFFERENCE BETWEEN BDD AND NORMAL CONCERNSAnother qualitative difference between BDD and normal concerns is that BDD symptoms often diminish with medication. We wouldn’t expect normal appearance concerns to improve with medication, because the medication normalizes a “chemical imbalance”; if a chemical imbalance doesn’t exist in the first place, medications wouldn’t be expected to have this effect.Perhaps the best evidence for qualitative differences between BDD and normal appearance concerns are the MRI study and the two neuropsychological studies that I discussed in chapter 10. Although the results need to be replicated by other researchers, as a group people with BDD differed from healthy control subjects. In addition, a study I’ll discuss below found that people with BDD differed from healthy control subjects in their ability to visually discriminate between similar-appearing objects.These differences between BDD and normal concern (or between people with BDD and healthy control subjects) suggest that BDD may be qualitatively different from normal concern, with different psychological and biological processes coming into play. This seems especially likely in those with delusional BDD or delusional referential thinking. Additional biological studies (e.g., brain imaging) and other studies are likely to help us solve this puzzle.The qualitative and quantitative hypotheses are not incompatible. It’s possible—even likely—that BDD is both qualitatively and quantitatively different from normal appearance concerns. BDD may be on a continuum with normal appearance concerns—differing quantitatively, as a more severe version of normal concern. But it’s likely that at some point on this continuum, qualitatively different psychological and/or biological mechanisms (e.g., involving the brain chemicals serotonin and/or dopamine) begin to come into play. This model is similar to that for high blood pressure: higher blood pressure is on a continuum with lower blood pressure, differing quantitatively, or by degree. But at the higher end of this continuum, qualitatively different physiologic mechanisms may come into play that pose dangers to one’s health.*208\204\8*