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Myths and medicine

In a piece for The Liberal (14 May, 2007), Marina Warner reminds us that the writer Jorge Luis Borges (1899-1986) “liked myth because he believed in the principle of ‘reasoned imagination’: knowing old stories, and retrieving them, reworking them, brought about illumination in a different way from rational inquiry”.

To the extent that the ‘art’ of medicine attempts to negotiate the fuzzy interface between science and human sensibility, myths help enrich our understanding of the human condition. Which is fine: Myths offer a bubble bath for the soul, where the stubborn grime of reality can be – temporarily – washed off. But when imagination masquerades as reason it is time for myths to be exploded because their perpetuation can destroy lives. Thus, in their analysis of the Ryan Report (2009) in to child abuse in Irish care institutions, Powell et al, in the British Journal of Social Work (2013, 43: 7−23) adduce evidence showing how “discursive tricks” allowed Irish civil society to blame victims, not perpetrators: “The ‘charity myth’ that led to the mass incarceration of deprived children was perhaps the ultimate discursive trick in terms of renaming the child victim as the culpable party.”

…although the medical myth train appears to be ‘ram-packed’, there are in fact spare seats available 

In the preface to his The Myth of the Mahatma: Gandhi, the British and the Raj (1986), Michael Edwardes warns that ignorance of the facts behind myths can become a menace. This applies not only to those who happily ignore the fact that Richard Attenborough’s film Gandhi (1982), for example, distorts the truth on a Wagnerian scale, but also to those who perpetuate medical myths. Given their propensity to strengthen on re-telling, it seems apt to borrow a recent Jeremy Corbyn phrase and suggest that although the medical myth train appears to be “ram-packed”, there are in fact spare seats available. 

For example, Schulz et al in the Journal of Emergency Medicine (2016, 51: 25−30) consider the ‘Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections,’ with myth number two, for example, stating that if bacteria are present in urine, “my patient has a UTI”. But the authors assert that bacteria in the urine, as detected by microscopy or following positive culture in the absence of UTI symptoms, do not indicate a UTI “due to the possibility of contamination and asymptomatic bacteriuria”.

Creed is busy ‘Exploding myths about medically unexplained symptoms’, dismissing, inter alia, in the Journal of Psychosomatic Research (2016, 85: 91−93) the myth that “medically unexplained symptoms indicate an underlying psychiatric disorder”. This arose partly because of the creation of the diagnosis of undifferentiated somatoform disorder and its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th Edition… now abandoned in DSM-5.

Staying with mental disorders, in his review of Ian White’s Beating Depression the Drug Free Way: Getting Better by Breaking the Myths (2011), Winking, writing in Ethical Human Psychology and Psychiatry (2012, 14: 78−79), agrees with White that declaring depression to be a disease does not make it one and that buying “into the myth of depression as a disease has some very negative and sometimes dangerous consequences … [making one] prone to taking pills to cure this mythical ‘disease’ perhaps forever and to physical and neurological detriment”.

And it was disquieting to learn that “police, prosecutors, clergy, medical providers, and therapists of both sexes have been known to endorse rape myths”. This is noted by Carr et al, whose ‘Debunking Three Rape Myths’ in the Journal of Forensic Nursing (2014, 10: 217−225) reports that, contrary to the myths endorsed by some of those in positions of power and trust, following sexual assaults women take variable amounts of time to present for emergency treatment; they only rarely experience moderate/severe physical or ano-genital injury; and do not typically display strong physical resistance against their attacker during at least part of the assault. 

Finally, I was surprised to discover in Nature (2013, 502: 32-33) that one of the most enduring stories in medical microbiology is false. In ‘Great Myths Die Hard’, Dufour and Carroll dismantle the myth surrounding Joseph Meister’s death. In 1885, nine-year-old Joseph was bitten by a rabid dog; he was taken to see Louis Pasteur at his eponymous Institute in Paris; and he became the first human to be treated and saved by a rabies vaccine. In June 1940 Meister was working as a gatekeeper at the Pasteur Institute, and it is popularly recounted that when German forces demanded access to Pasteur’s tomb, 64-year-old Joseph refused to comply and shot himself. 

However, the authors show that archive material in the Pasteur Institute, plus testimony from Meister’s granddaughter, reveal a different story. Meister had sent his wife and children from Paris ahead of the advancing Germans, but he believed that they had perished as a result of enemy bombing. Consumed with guilt at having sent them away, Meister used a gas stove to end his life. In a tragic irony, his family returned safely to Paris on the same day.

It seems that whether beard-twirling intellectuals or earnest, evidence-based zealots, none of us is immune to the lure of the myth. Our challenge is to recognise myths for what they are … and dispel them.

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