The Myth of Normal 68

faults; though they may cause us difficulty now, they began as modes of survival. As far as back as 1892 the great Canadian-born Johns Hopkins physician William Osler—later knighted by Queen Victoria for his contributions to British medicine—had already noted “the association of the disease with shock, worry, and grief.” Many years later, a 1965 survey reported the prevalence in rheumatoid arthritis–prone individuals of an array of selfabnegating traits: a “compulsive and self-sacrificing doing for others, suppression of anger, and excessive concern about social acceptability.”[16] An unusually perceptive Canadian specialist in autoimmune disease, Dr. C. E. G. Robinson, wrote in 1957 that his patients with RA “usually tried very hard to please both in professional and personal contacts, and either concealed hostility or expressed it indirectly. Many of them were perfectionistic.” The onset of disease was often preceded by stress. He added, sagely, “Frequently as much time is needed for dealing with the emotional problems of the patient with chronic rheumatoid arthritis as with the joint or systemic disorders . . . I think the emotional and psychological aspect of many rheumatoid patients is of first importance.”[17] Four decades after Dr. Robinson published his comments, American researchers likewise found that the degree of interpersonal stress was correlated with disease severity among a group of women with rheumatoid arthritis.[18] A case in point is forty-two-year-old Julia, from one of Canada’s prairie provinces, diagnosed with rheumatoid arthritis at age twenty-nine. She had been rear-ended in a motor vehicle accident and the next day felt some pain in her left shoulder, which quickly resolved—only to flare up again and again in various joints throughout her body, migrating with bewildering unpredictability. “It would show up in a joint and then leave,” she told me. “Then all at once I ended up with twenty-six joints that were all inflamed simultaneously.” Blood tests found one of the indicators of rheumatoid arthritis highly elevated, clinching the diagnosis. Her emotional profile aligned with the hyper-responsible, anger-suppressing personae described in the literature, traits she developed in a family of origin with an alcoholic father and an emotionally dependent mother to whom she could not divulge