Doctor's Review: Medicine on the Move

November 21, 2014
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Dying to go home

Can being far from family and friends make a person physically sick? In 17th-century Switzerland it was certainly possible

Can being far from family and friends make a person physically sick? In 17th-century Switzerland it was certainly possible

From Christmas-tree fires and alcohol poisoning to emergency C-sections and psychotic breaks, doctors know better than anyone the dark flipside of yuletide glee. But of all the conditions you may be treating this season, there’s one you won’t find in the ER — homesickness, known back in the day as nostalgia.

Swiss medical student Johannes Hofer (1669-1752) was the first to prove that yes, you can go home again... although home might soon be an insane asylum. The young doctor-to-be coined the term “nostalgia” in his 1688 thesis, combining the Greek terms nostos (for “returning home”) and algia (for “pain”) to describe an entirely new disease — a bold step by the lowly med student from Basel. Hofer described the disease as “the pain a sick person feels because he is not in his native land, or fears never to see it again.” Turns out it was that and then some.
 

Hofer and homesickness

Hofer’s assertions were based on two case studies he personally witnessed. The first concerned a student he attended to from Bern, who found himself lonely and sick while studying and living in Basel. He presented with anxiety, fatigue, palpitations and a fever, and he was growing worse by the day. He was sent home to die, but, amazingly, grew stronger the further he put Basel behind him. He made a complete recovery when he arrived home. The other case involved a local servant girl who was apparently fine, until an accident landed her in the hospital far away from friends and family. She too recovered as soon as her parents brought her home.

After Hofer noticed that no other medical diagnose could account for their mysterious symptoms — lack of appetite, pallor, muscle weakness, general sadness and hopelessness — he suggested that “nostalgia” was to blame. Once the initial symptoms set in, he explained, the stage was set for more serious pathological conditions. He believed that obsessing over memories of home caused vital spirits to flock to the brain, thereby depriving the remaining grey matter of essential ethers. And, of course, no vital spirits meant no vital functions, so the body’s systems slowed and, eventually, ceased to function.
 

Sad Swiss?

Nostalgia was particularly common in Swiss mercenaries — those brave soldiers who were hired to fight in other countries’ wars. During the late 17th and early 18th centuries, there were many of these Swiss soldiers scattered throughout Europe. For those who suffered from nostalgia, the prognosis was grim; even death itself was a possibility. So, for the next 150 years, soldiers (both Swiss and otherwise) who succumbed to nostalgia, were sent home. Although the diagnosis was regarded as medically valid at the time, it did carry with it the stigma and shame of mental instability, and most soldiers were not excited to receive the diagnosis, much as their homelands and sweethearts beckoned from beyond the battlefield.

At first, Hofer proposed that the disease was unique to the Swiss due to the isolating qualities of the extreme mountain landscape, and maybe the effects of moving from higher to lower latitudes were to blame. It was a moving notion at a time of great nationalism — that the love of home was powerful enough to exact a very real toll not only one’s mind, but one’s body as well — as if the very soil of one’s country, the sight of its mountains and the taste of the water in its streams might be a cure for the body and a tonic for the soul. This was an appealing concept that may hark back to Adam and Eve, who were never quite the same after their exile from Eden.
 

A lonely world

Word of Hofer’s disease, however, travelled through the Swiss medical community like wildfire. Before long, other doctors were looking to nostalgia as an explanation for a variety of diseases of unknown origin, as well as the reason behind all manner of spontaneous recoveries.

Nostalgia was soon an epidemic throughout Europe and North America. The illness became known by various other names, often paying tribute to its Swiss roots: the Swiss Disease, Mal du Suisse and Schweizerheimweh, or Swiss homesickness. Elsewhere, there were diagnoses of heimweh, or home pain, in Germany; mal du pays in France; el mal de corazón (heart sickness) in Spain; as well as straight-up homesickness in England and North America.

Around a century later, nostalgia was still a popular medical diagnosis, specifically a psychiatric disorder that was often listed as a cause of death. Robert Hamilton (1749-1830), an English army physician, recorded several cases, including one in 1787 in which he’d treated a pale, weak and anorexic soldier several years earlier. After three months in the hospital, the young man’s condition had grown steadily worse, even though there were no signs of fever or consumption. Upon noticing that the soldier’s vigour returned during discussions of his home and friends back in Wales, Hamilton offered the simple prescription of news that he would soon be discharged — provided he was well enough to travel. A miraculous return to health ensued within a week, as his appetite and demeanour returned to normal. Other military medical men in Europe and North America noted that cases of nostalgia appeared to be more prevalent — even reaching epidemic numbers — when battles were being won rather than lost.

A romantic thought

With the dawn of the 19th century, a new medical consciousness emerged in the West. Germ theory gradually replaced the musty vapours, ethereal humours and dark spirits that had been believed for so long to be the cause of disease. Understanding in anatomy, biology and pathology exploded, leaving flimsy notions like nostalgia out in the cold. Although there were still cases of nostalgia being reported during the American Civil War, by the middle of the century it was no longer a medical diagnosis, but rather an emotional one, much as it is today.

Understandably, as the belief in homesickness as an organic disease fell by the wayside, the enlightened thinkers of the Romantic Movement picked it up again. Poets and philosophers like Byron and Rousseau pined for the fields, forests and faces of their youth.

Today, we are left with much the same idea of homesickness, or nostalgia, that the Romantics had — much like heartbreak, no physical harm can actually result from nostalgia, though it might feel that way sometimes. Ailing for a kinder, gentler place or time, alas, is no justification for hospitalization. In utter disregard for the healing properties of mom’s candied yams or bubby’s chicken soup, nostalgia remains, quite simply, the amalgamation of fond memories and the yearning for home.

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