THE OPEN MIND
Host: Richard D. Heffner
Guest: Norman Cousins
VTR: 11/19/83 Part II
I’m Richard Heffner, your host on THE OPEN MIND. I began last week’s program the same way that I’ll begin this week’s: by saying that whenever today’s guest joins me on the air – and the first time he did was three decades ago – my temptation is to introduce him at simply too great length. But only because I want so much to quote so much of what he’s recently written, for he is to me, and always shall be, not only one of the warmest, most decent human beings I’ve ever known, but the wisest as well. And after so many years of addressing the problems of war and peace, of international conflict, particularly in his long-time role as editor of The Saturday Review; now as faculty member of the University of California at Los Angeles School of Medicine, he directs his attention much more to each individual’s struggle for personal health and well-being. Norman Cousins’ “Anatomy of an Illness” made an incredible impression upon our country four years ago. Now his new volume, “The Healing Heart,” also published by W.W. Norton, promises to bring antidotes to panic and helplessness to even more of us.
Norman, in our last program – which wasn’t a week ago, but sitting here at this table just a few moments ago – you were ending the program on a very pointed not, and I wanted to ask you to pick up where you were there.
Cousins: Yes, you see, you challenged me – and I think you’re right in challenging me – on what you consider to be my confrontation with the cardiologist in the case. And I suppose that other people will refer to the same thing. But the fact of the matter is, Dick, that I wasn’t really going against the cardiologist. He believed that surgery was essential, and he had good reasons to support his recommendation. I respected that, because, given the basic facts, this is what one has to do. My position was that they hadn’t quite been able to rule out the possibility of the spasm instead of atherosclerosis. I was a little reluctant to open up the chest wall and touch off another spasm. But essentially, my question to Dr. Shein was of a different nature: I said to him, “Well, Doctor, you believe that that surgery is absolutely essential. What I’d like to be able to do – and I want your support in so doing – is to see whether significant progress is possible without the surgery. I won’t rule out the surgery, but I want to see whether it is possible to make progress without it. If we can make that progress without it, let’s see how long we can continue along that road. And if we don’t make that progress, we always have the option.” And he said something very reasonable. He said, “All right. I really think you ought to get a second opinion.” This is one case where the doctor, rather than the patient, recommends or looks for a second opinion. And I did find that second opinion. And the…Dr. David Canon, who had taught at Yale and had now come out to UCLA, believed that that was a reasonable course, and he would monitor my progress on a week-to-week basis. And we did make that progress. And he believed the progress was highly significant. So much so that at the end of only six weeks he himself said that he didn’t think that surgery would be a good idea. At the end of six months, Dr. Shein, who made the original recommendation, said he believed that there had been very substantial reconditioning of the heart. But he still believed that surgery was indicated, because he said that while the heart is reconditioned, the arteries are still blocked. And that’s a condition that’s irreversible. And the moment he used the word “irreversible,” I smiled. And he asked if he had said something funny. And I said, “No, it’s not that you said anything funny, it’s just that I said to myself, ‘Here we go again.’” The moment anyone says “irreversible” to me…
Heffner: That’s a challenge.
Cousins: …I get a rush of blood to the head. Well, after – it’s now been three years – and not having been able to make the first year, we’re now coming to the end of the third year. And the recommendation for surgery has been removed. Now this doesn’t mean that I would urge it on everyone. All I’m trying to suggest is that there are approaches – and I want to emphasize, too, that the heart can make its own bypass – it’s not that I refused a bypass, but I was able to make my own.
Heffner: Norman, look, this is a story of a man who had a heart attack. A man who was taken to the hospital amid all the stress and the strum und drag of that kind of situation. And you didn’t’ do what the first physician wanted you to do. You can’t, certainly, say now – I hope that you wouldn’t say now – that you recommend this procedure for everyone.
Cousins: No, I did not.
Heffner: All right. You’re a very literate, learned person. You know a great deal about the subject. And where would the practice of medicine be if others…
Cousins: But let me point this out, Dick, that I think that – not with respect to my case, but in general – there are a great many cardiologists who believe that bypass operations have become much too promiscuous. There are a great many cardiologists who believe that 15 years from now we will look back on this period the same way we now look back on the rash of appendectomies and tonsillectomies and lobotomies, and wonder that so many of them should have taken place. Now, this is not to say that the operation should never be performed. It’s a magnificent operation, and one of the high points of modern surgery. And it is true that some people’s lives can only be saved through bypasses. What I am saying is that the attempt to turn to a bypass operation as a standard approach ought to be reconsidered.
Heffner: Okay, but the attempt to turn to the unknowledgeable patient; isn’t that something that ought to be considered a little more seriously by Norman Cousins?
Cousins: Well, I didn’t attempt to run my own case, Dick. As I told you, I consulted a great many doctors in the case. Four of them write their own opinions at the end of this book. Three of them supported what I did. And even Dr. Shein at the end supported it.
Heffner: Norman, if you hadn’t found the medical support and the second opinion, would you have gone on to a third opinion or a fourth or a fifth until you got someone to agree with Norman Cousins, not-M.D.?
Cousins: It would have been very painful to do it. But I have to admit that I probably would.
Heffner: Therefore, what have we got for me or for anyone else in terms of understanding when you get beyond your basic point – and we began the last program by talking about antidotes to panic and helplessness.
Cousins: Well Dick, I don’t want…I should hate to think that people would regard me as a freak and that this is just an episode that is quaint, has interest, but has nothing of value for anyone else. The essential point to be made here is that there are things that can be done in heart attack cases. I wrote this book not because I thought my case was unique; I wrote this book because there were aspects of my experience which I believe are transferable. I believe that the need for patients to accept a certain measure of responsibility does apply to all. Second, I believe it is a serious mistake for anyone to think that all the answers lie in the doctor’s hands. I believe it’s important for everyone to recognize that the human body has this beautiful drive to right itself and to recover, and that there are things that we ourselves can do, as apart from all the wonderful things that medical science can do, to help that process of restoration to come about. We have a tendency to hold the human body lightly. I think we know very little about the way the human body works. As a matter of fact, we tend to feel that anytime that we have an illness or a pain that it’s a serious disease and can be corrected only through intervention. Not true. The human body has been beautifully honed, by three million years of evolution, in meeting its needs. There comes a time when you do need help, but even when you get that help you can optimize that health in terms of what you, yourself do. The human brain helps…is not just the seat of consciousness, but the human brain is a gland. The human brain produces secretions. These secretions can be triggered by attitudes. Attitudes of fear, for example, can produce alterations in the body’s chemistry. Similarly, attitudes of confidence, of purpose, of serenity, great will to live, all these things have…are of great medical value, and are as important in treating a patient as anything that comes in a bottle with a label on it. And we tend to hold that lightly. We tend not to understand how the human body works. We tend not to have confidence in ourselves. My only point – and this is why I wrote the book – is that we need not be helpless when we have serious illness. We need not be overcome by panic. There are things that can be done. But those things are best done in partnership, where the physician brings the best that medical science has to offer, and we bring the best that the human body has to offer. And believe me, the human body has a great deal to offer.
Heffner: You know, you used the phrase before, you said, “I’m not a freak. This isn’t a story about just one person.” But in your book you do write about the dichotomy of purposefulness between the scientist and the literary person. You do write about the literary person who is…he needs to be anecdotal. And the scientist needs not to be anecdotal. And as I read Dr. Shein’s comments at the end, I couldn’t help but think here was that – I won’t use the word “conflict” – but here was the meeting point of the two men; one necessarily anecdotal because he is a creative person, because he is a writer, and because he is the person about whom the anecdote is told; and the other, the one who needs to have things in order for all the rest of humankind.
Cousins: And yet, Dick, in medical science, we have had important changes, and all these changes have begun not as the result of statistics, but as a result of theory. As the result of what has happened to a few persons, or as the result of what some medical scientist thought might happen, whether or not it actually did. And this is how progress begins and how progress is sustained: an interaction between the two. I would hate to think that the approach that I have advocated would be raised to monopoly status. Just as I would hate to think that all cases would be treated statistically, because in the end it’s the individual that counts. And in the end, whether in literature or in medicine, everything begins with the importance of an individual soul. And perhaps, in the interaction between the two, we can find the essential balance.
Heffner: You know, Norman, I’m not moving away, but I wondered, as I read your book, I made a note to myself when I got to your epilogue, and you write, “The conclusion is inescapable, that the main threat today to the health of the human population on this planet is the foreign policies of the governments.” I think always of Norman Cousins as the man who pursued his goals, his ideals, of world government, who, for decades and decades and decades, brought our attention to bear upon the needs for mutual understanding of society at large. Now I know that, from An Anatomy of an Illness, and from the new book, The Healing Heart, that you’re focusing on the individual; you’re focusing on matters of personal and physical health. Have you run away from that larger field of ill health, that larger field of pathology? Has it been impossible to deal with it?
Cousins: Well, as the concluding chapter of my book may indicate to you, Dick, that single note on my bugle is difficult to resist. And even in the book dealing with heart attacks I have to find some way of taking up the trumpet. It is true that anyone who has come from the world that I have been in will be struck by the fact that billions of dollars are spent in medical research in attempting to improve the health of human beings. And yet the main threat to everyone’s health today is represented not by disease germs but by world anarchy; the breakdown of governments and the relationships with one another. The absence of standards to define and uphold the comic of nations. This is the main threat to your health and the health of all our children. And I just want to remind people that we cannot assume that if we find the answer to heart attacks or cancer, that we be meeting the main problem in the world today. The main problem in the world today has to be the need to create a world order, one that will tame the individual nation, and one that will set limits to what nations can do, even the pursuit of their own interests, and never at the expense of the interests of others.
Heffner: So interesting that the two men whom I admire most, you and Louis Thomas, he is a physician who moves insistently and persistently into areas where he is commenting upon world affairs; and you, whom I’ve always identified with – almost exclusively, you said, the one note – world affairs, who have moved into this matter of individual health. And I thought back to an editorial you wrote in The Saturday Review, oh, ages and ages and ages ago, in which you said, “We don’t know enough to be pessimists.” You raise the question of whether we know enough to be optimists. And I wondered whether you had concluded, particularly as I read your epilogue, that maybe we now do know enough to be pessimists about the world at large?
Cousins: Well, the ignorance about the danger is shrinking. I certainly agree with that. And I don’t think that we ought to assume that because of our ignorance we should be inactive. I would like to think that our ignorance would prod us to get answers where answers do not now exist, and answer the last questions in the attempt to get the right answers. I think, Dick, that we’re living in a very primitive condition of human society, and that existing institutions are no longer capable of serving human life on earth. Human beings have created institutions over the years to serve their needs. The state was created for the purpose of protecting the buyers, the values, the properties, the culture of its citizens. Bu I don’t think that any nation, any longer, has the ability to protect its citizens as it once did. And so now we throw all the way back to that primitive period in human history where we’re searching for rational means of advancing our lives and protecting our lives and the lives of our families. The moment the atomic bomb was developed and dropped, the whole fabric of national security was, I think, demolished. And it became necessary – and of course, is still necessary, all the more so – to devise new institutions for protecting our lives and our values and our freedoms. It’s so interesting that all the weapons that are now on the drawing board and have been urged on us – the MX missile, the B-2, the Pershing missile, the cruise missile – all these exotic new devices will not defend America to the slightest degree. These are not defensive weapons; these are weapons of surprise attack. And as such, they are added to other weapons of surprise attack that we already have, which are certainly not efficient in any degree. We have the capability, and the Russians have the capability, of unleashing instantaneous devastation of unimaginable proportions. And it’s that kind of weapon, you see, that we continue to embellish with all these others. Most people think that these weapons will somehow defend us. That they are defensive weapons. They’re not. But the reason that we are producing all these weapons is to persuade the Russians that we have overwhelming retaliatory capacity. We want to persuade them not to hit us first. So we are really engaged in psychological enterprise. But we’re engaged in psychological enterprise without a real psychological competence. We haven’t employed professional psychologists in the Pentagon to find out whether what we’re doing is not to have the desired effect. We’re spending hundreds of billions of dollars, threatening the national economy, on what’s really a hunch that we think that someone else could be persuaded by this. But the curious thing is that we, ourselves, are not being persuaded by the same thing the Russians are doing to us. And so, there’s that psychological failure, even though everything we’re doing has a psychological purpose.
Heffner: Okay. I come back to my question, nevertheless, because I was so impressed years ago by that editorial that indicated that we didn’t know enough to be pessimists, whether you may not have, by this time, in terms of our capacity to keep our society together, maintain civilization, avoid nuclear holocaust, whether you’ve become a pessimist. You haven’t answered that question.
Cousins: Yes, I’ll try to. It seems to me, Dick, there are two levels on which the question can be considered. First, I don’t’ think we ought ever to underestimate the size of the danger. And sometimes I think we do underestimate the size, the scope, and the nature of the danger. But at the same time, I don’t think we ought ever underestimate our ability to meet that danger, once we understand it, and once we have the will to apply ourselves. So I am basically optimistic about human capability. But so long as that capability exists, my hope is that you and many more like you who do have access to the public mind, and this case, what you like to call “the open mind,” will ventilate that mind with the ideas which not only can define the danger, but show people that there are answers. And there are answers to the dangers. Wherever you have anarchy – and we have anarchy in the world – the answer can only be order and government and law. I would hope that the United States would declare it as the underlying principle of its foreign policy that we seek to create a world organization, seek to strengthen the United Nations, develop it, and reform it, as may be required so that we can have an effective instrument for defense, for protecting our freedoms, for protecting our lives and security of nations. And that in too, we have an idea, it seems to me, it was addressed not just to our security, but to the security of all nations. Will it be security for ourselves? That is my hope. So, to answer your question: I am not yet despairing. I am deeply, profoundly apprehensive, but I haven’t given up.
Heffner: Do you think – and you’ve written here in the new book, “Antidotes to panic and helplessness” – do you think that panic has played a major or an important role in terms of our relationship to the world outside too? Prevented us, perhaps, from being as reasonable and as rational and as thoughtful as we might?
Cousins: I don’t think that we hold a monopoly on panic in that respect. I think that any aggregation of human beings tends to panic in the presence of things that threaten them or that they don’t understand. And one of the great dangers right now is that we live in a world of mirror images, where what we say about the Russians is exactly what they say about us. Our reaction to the Russians is the same as their reaction to us. And as they react to us they add to the danger, add to the threat, and so this thing goes back and forth. The same point that I tried to make earlier about the interaction between disease and panic. The disease produces the panic. The panic intensifies the disease. The disease becomes worse. The panic becomes worse. And we go rocking back and forth down this terrible hill. And see, you’ve got to interrupt that cycle. And the same thing, I think, is true in the world today. We have to interrupt this terrible cycle between the underlying problem of world anarchy and the panic produced by weapons of total destruction…are being piled higher and higher, with threats of accident, not just design. I play chess, Dick, against a computer. They’ve now developed a chess machine which is fiendish. And that chess machine is very smart indeed. And under ordinary circumstances that chess machine can beat almost any person alive. But, the interesting thing I’ve learned about that chess machine is that it tends to become flustered. There are times when that chess machine loses its cool and begins acting in very strange ways, and then you suddenly jump in and discover its fallibility. The same thing is true of these computers that are now governing the attack capabilities of the nations on one another. For example, we have computers designed to inform us when a surprise attack is occurring. But we’re placing not just our lives but the lives of generations to come in the hands of these fallible machines; machines that, themselves, can be flustered, become flustered. In the past five years, for example, there have been more than 100 computer errors which could have resulted in the last of the great wars. And so I think that we’ve got to start getting out of a reactive approach to our survival, and start taking grand initiatives; initiatives that…something to be about the making of a safe world; initiatives that have something to do about using these vast resources in a way that will enable life on earth; initiatives that have to do with creating the instruments of effective world law. We don’t know whether the Russians or anyone else will accept these proposals. We don’t know, indeed, if the Russians made those proposals, whether we, ourselves, would accept them. There’s alas, the possibility that just because the Russians made the proposal, we would turn them down; or because we made the proposals, the Russians will turn them down. No matter. It seems to me that there is a vital force in making a quick diagnosis. And in summoning up all those values and all those resources inside human beings, to create a situation of world health and not just individual health, a prescription now exists, it seems to me, for world peace. That prescription has to recognize, I think, that the security and freedom of the American people depend not only on a pursuit of force, but on the control of force in the world. The accumulation of weapons beyond any conceivable need tends to impel us in the direction of their use. That’s not only on our side, but on the Russian side. But I feel that there’s a force that lies outside the weapons, and that has to do with the things that you think, the things that everyone thinks, world public opinion, and the ability of the human race now to understand what is required for its own wellbeing and for its own survival. We will not survive in an atmosphere of panic and helplessness; an atmosphere in which we keep piling up the weapons beyond any conceivable value of use. We will survive, it seems to me, only as we have an idea by which the world can be governed, by which we can use our resources, our collective resources, for the collective good.
Heffner: I knew that if I could strike that note and get Norman Cousins to talk as Norman Cousins always did…
Cousins: That’s the one note on my bugle (laughter)
Heffner: Norman, thanks so much for joining me today again on The Open Mind. And thanks, too, to you in the audience. I hope that you will again join us her on The Open Mind. Meanwhile, as another old friend used to say, “Good night and good luck.”