Literature Annotations

Cousins, Norman
Anatomy of an Illness (As Perceived by the Patient)

Genre Essay (6 pp.)
KeywordsArt of Medicine, Arthritis, Disability, Disease and Health, Doctor-Patient Relationship, Hospitalization, Humor and Illness/Disability, Illness Narrative/Pathography, Individuality, Medical Testing, Obsession, Patient Experience, Power Relations

After a stressful trip to cold-war Russia in 1964, Saturday Review editor Norman Cousins tells how he developed a debilitating illness which confines him to bed. He is admitted to hospital for tests and treatments, and is diagnosed with ankylosing spondylitis, but his condition deteriorates and he is given a gloomy prognosis. He notices that the depressing routine of hospital life tends to produce side effects that aggravate his condition.

With the blessing of one of his doctors, he checks out of hospital and into a comfortable (yet less expensive) hotel where the food is better and he can watch funny movies while he medicates himself with high doses of Vitamin C. He is convinced that the slow improvement in his condition is owing to his individualized methods of therapy and his having taken charge of his own situation.


An excellent essay for teaching, this famous autobiographical case history is often cited as the story of how a patient laughed himself out of an illness. That description is only partially correct. A Cold-War traveler, Cousins attributes his illness to the abuse he received at the hands of his incompetent Russian hosts; they made him hours late for an important engagement and then their environmental incompetence allowed him to inhale vast quantities of truck and airplane exhaust.

Cousins seems to flaunt medical advice when he signs himself out of hospital, but he is inconsistent in what he retains of modern science and what he rejects. For example, he views the sedimentation rate (ESR) as an absolute numerical translation of his condition--and obsessively clocks its variation with the interventions he chooses for himself. He displays a similar sort of eclecticism when it comes to hypotheses about metabolism and its history.

Keeping up his spirits with humour was indeed an important part of the treatment, but Cousins did not rely on laughter alone. He also relied on physiological rationalization for the efficacy of high-dose Vitamin C and on the restoration of control over his own condition. Treatment must be in line with the perceived cause.

Students should be aware of the tolerance of the treating physician and the privilege of this patient whose choices--both financial and personal--are available to only a few. After Cousins' death a memorial lecture on the connections between immunity psychology was established in his memory.

SourceNew England J. Med. 295 (23 December): 1458-1463 (1976)
Place PublishedBoston
Alternate SourceAnatomy of an Illness as Perceived by the Patient: Reflections on Healing and Re
Alternate PublisherBantam
Alternate Edition1981
Place PublishedToronto
Annotated by Duffin, Jacalyn
Date of Entry 07/06/00
Last Revised 08/15/00