Family Trouble

"It ain't the work," explained a clinic patient, "it's the aggravation."

Doctors now generally agree that mental irritation of some sort causes many a physical ailment. In Patients Have Families (The Commonwealth Fund; $3), published last fortnight, Manhattan's Dr. Henry B. Richardson suggests that the source of the irritation is usually to be found in the patient's family. Proposing that doctors consider "the family as the unit of illness," he supports his argument with the stories of patient after patient who could not get well until something was done to clear up his troubled family situation.

The Qs. The family on which Dr. Richardson reports in most detail included Martin Q, fortyish, "a little man with a pinched expression and a furtive look" who averaged under $20 a week from WPA or Home Relief, his plump, aggressive, somewhat stupid wife, their daughters Agnes, 19, and Catherine, 16.

When Dr. Richardson got to know them, Catherine had come to the New York Hospital clinic for a heart murmur. He later found that Mrs. Q was bothered by a gastric ulcer, that Mr. Q habitually vomited sometimes 20 times a night, that Agnes had a well-developed case of anorexia nervosa (nervous rejection of food). Both parents had very bad teeth.

Dr. Richardson and his associates mobilized their forces to fix up the Qs.

Mother Knows Worst. Investigation soon revealed that Mrs. Q was the dominant character and the root of the family troubles. She used her ulcer and her bad teeth to help maintain her rule. One of her favorite subjects was an older daughter, Laura, who had died at eight of a bad heart. Laura had been a paragon of beauty and intelligence and, in Mrs. Q's opinion, Catherine resembled her. Result: Catherine, whose intelligence was mediocre, overworked at school to get good marks, and developed imitative heart trouble. In contrast, Mrs. Q considered Agnes "dumb," the symbol of her own failure in life. Result: Agnes stayed timidly at home, rarely spoke up, refused to eat -- partly in imitation of her parents' stomach troubles, partly to get attention.

Meanwhile, little Mr. Q had few ways of maintaining his self-respect aside from his ailments. His chief satisfaction was in the paychecks he brought home, but some times there was nothing to bring. Marital relations were strained for fear of another child. (The doctors discovered that Mr. Q's vomiting began soon after his wife's last pregnancy.)

Instead of starting with Catherine's heart trouble, treatment began with Agnes' neurosis, went on from there to the parents' teeth and efforts to get Mr. Q to understand his vomiting and to get Mrs. Q to a birth-control clinic. (She never went.)

After a few sessions with a psychiatrist, Agnes talked back to her mother for the first time. Soon she gained weight, began to have beaux. Mrs. Q stopped criticizing her, happily occupied herself with supervising the suitors, succeeded in breaking a succession of engagements until at last a nice, submissive young sailor, reminiscent of Mr. Q, appeared. Agnes married him. But she kept on living at home and, when last seen, showed every sign of developing into a domineering woman like her mother.

When Mr. & Mrs. Q had their teeth out, Mr. Q reacted with fits of bad temper for several days -- he could no longer use his bad teeth as a means of keeping up with his aching, complaining family. But when he got a good job, his vomiting virtually stopped.

The doctors never did much about Catherine. Her complaints disappeared after she left high school and took a clerical job in which she was no longer pushed beyond her intellectual limits. But at story's end Mrs. Q, cherishing her martyr's role, had still done nothing about her ulcer.

Horse-and-Buggy Substitute. Dr. Richardson concedes that not all patients need treatment as a family, but insists that many do--the prosperous as well as the poor, people with infections as well as those with indigestion (he tells of one woman who got sleeping sickness when her mother had a stroke "and remained unconscious until after her mother's death").

Some such effort, he says, should be made to compensate for modern specialization and the doctor's resulting lack of knowledge of his patients' lives and hard times. The oldtime horse-&-buggy doctor knew all his patients most of their lives, and all about their aggravating families.

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