What do you know about Mark Twain? That he was a famous humorist? That he wrote Tom Sawyer and Huckleberry Finn? Maybe you know he questioned many conventions like organized religion. What you may not know is that he was an enthusiastic proponent of “alternative medicine” long before the term was coined.
Mark Twain, the pen name of Samuel Clemens, was born in 1835, long before germ theory, antibiotics, randomized clinical trials, or modern vaccines. The medicine of his day was pre-scientific and unregulated, splintered into sects with allopaths, homeopaths, hydrotherapists, osteopaths, and others battling each other for primacy. Anyone could practice medicine without a license. Twain had no rational basis for choosing one sect over another.
Twain always feared death, with good reason. In his day, life was very uncertain, with 25 percent of children dying before their first birthday, and 50 percent by age 21. Twain was a premature, sickly child. As an adult, he asked his mother if she had been afraid he wouldn’t live; he claims she said no, she was afraid he would! He saw four of his siblings die. Frequent epidemics of smallpox, cholera, and scarlet fever tore through the population; mortality was high due to poor nutrition and poor public sanitation.
As a child, Twain was so afraid of measles that he decided to put an end to the fear by catching measles; he deliberately exposed himself to a patient. He found that having measles was nowhere near as bad as the fear had been. He learned there was something worse than death: worrying about it.
Twain was raised with alternative medicine. His mother, Jane Clemens, dabbled in everything from homeopathy to spiritualism to patent medicines. As a boy, Twain saw a faith healer cure his mother’s toothache with suggestion. His mother frequently dosed him with Perry Davis’ “Pain Killer” — a mixture of alcohol, camphor, and cayenne pepper. All treatments apparently worked: he survived.
As an adult, Twain experimented with everything, sampling every system of medical treatment. He thought there was no reliable way to find out why people got sick or the best way to make them well. Back then, there wasn’t; but today we do have a reliable way: science. Twain thought that if enough treatments were sampled, there might be a remote chance of finding one that actually worked.
Twain always distrusted conventional medicine, and not without reason. The medicine of his day was pre-scientific: ideas about disease were fuzzy, and conventional medical treatments were harsh, ineffective, and often toxic, leaving a fertile field for other options. Twain called doctors “killers,” saying they were deadlier than the most efficient army. He may have been the first to use the “death by medicine” meme that is so popular in alternative medicine today. It no longer reflects reality, but it did then. Before 1900, doctors were just as likely to harm as to help their patients. Always a contrarian and a skeptic, Twain questioned the consensus of experts because “experts” squelched new ideas and refused to recognize lone geniuses like Semmelweiss, who struggled to get his fellow physicians to wash their hands.
Neurasthenia and Twain’s Wife Olivia
Neurasthenia was the disease du jour, “the American disease.” America was thriving, but many individuals were not. They complained of vague symptoms of weakness, fatigue, malaise, dyspepsia, depression, insomnia, and “nervous exhaustion.” Neurasthenia was thought to affect the best and brightest, and everyone believed it was a physical disorder, not an emotional problem. Excessive stimulation was said to “dephosphoralize” the nervous system. It could be caused by accidents or environmental stresses, or the body itself could produce toxic agents.
Twain’s wife Olivia (Livy) was diagnosed with neurasthenia and was bedridden for two years in her late teens. Today she might be diagnosed with chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, somatization, hormone imbalance, impaired immunity, hypoglycemia, chronic systemic candida, Lyme disease, or one of many other questionable diagnoses. Neurasthenia was a wonderful diagnosis with many symptoms and no organic pathology, and it was an excuse for failure or for not living up to expected roles. A quack told Livy she would get up and walk, and she did. For what was essentially faith healing he charged the family $15,000.
Electrotherapy was recommended for neurasthenia to replenish nerve force and as a way of providing exercise at rest. When Livy developed heart failure, at first electrotherapy seemed to restore her lost vitality, but the effect didn’t last.
In a misguided attempt to protect Livy from stress, Twain lied and concealed things from her. Autonomy is basic to medical ethics, but it requires truth. One can’t be autonomous if misinformed or deprived of all hope.
He Wanted to Try Everything
Mark Twain married into his wife’s family’s belief in hydrotherapy, and he taught his daughters to believe in this discredited treatment, as well as that they could improve their vision by “mind over matter.” He and they fooled themselves into believing they had succeeded, but they soon resumed wearing their discarded eyeglasses.
Later in life Twain suffered from gout and was often bedridden with disabling attacks. When he tried electrotherapy, he was enthusiastic because it relieved his symptoms in a day. But it failed to prevent recurrent lifelong attacks. He wanted to try everything because “they can’t all fail.” He needed to sustain hope.
“They can’t all fail.” And yet they did. They promised much but were only fool’s gold. They were better at creating feasible explanations for why they should work than at showing that they did work. Twain tried everything: water cures, rest cures, electrotherapy, osteopathy, homeopathy, faith healing, and many more. His gout appeared to improve with electrotherapy, his daughter’s epilepsy with osteopathy, Livy’s health with the water cure; but enthusiasm turned to disappointment and frustration when the improvements didn’t last.
Twain’s experiments fell into a consistent pattern. At first, he believed each new treatment he adopted was highly effective and he spoke out loudly and forcefully in support of it. Later he was reluctant to let it go, clinging to it beyond all reason even as he realized that the improvements had been illusory or only temporary. He didn’t understand factors like the natural course of disease, variations in disease pattern, regression to the mean, the imperfections of memory, and the misperceptions due to human psychology. Many diseases were self-limited; and when the body healed itself, any medical system the patient was currently using might falsely get the credit. Most of the things he tried were only elaborate ways of doing nothing. But doing nothing was not an acceptable option.
Mark Twain heard good things about cocaine and planned to go to the Amazon and establish a business. He only made it as far as New Orleans and became a river pilot instead. His experiences as a river pilot would later color his writing. At one point he believed in Plasmon, a dietary supplement, and invested in it. He even invented his own patent medicine to treat chilblains: it was just kerosene. Was this fraud or intelligent capitalism? He had faith in it and gave his own testimonial.
Twain did recognize that some treatments were scams. When he sent a servant to the Oppenheimer Institute for alcoholism, it cost $150 and the servant came back drunk. Oppenheimer blamed failures on patients for not following his advice, which was to stop drinking alcohol!
Twain always rejected Christian Science. He hated it intensely but acknowledged that faith did appear to heal some patients. His sister tried to treat his arthritis at long distance with Christian Science; it didn’t work.
Twain’s Children and Their Discontents
Twain’s son Langdon was born prematurely and was chronically ill. He was delivered by a homeopath and treated by one in his final illness until Twain lost confidence in the homeopath and replaced him with a hydrotherapist. Langdon died of diphtheria at the age of 18 months. Twain felt responsible for his death, not for having let quacks treat him, but for having brought on the illness by letting him get chilled.
Twain’s daughter Clara underwent a rest cure for significant emotional problems after her mother’s death. She was bedridden and distraught for seven months. She spent most of a year in a sanatorium and eventually became a Christian Scientist.
Twain’s daughter Jean had epilepsy. When the family took her to Sweden for treatment at an osteopathic sanatorium, the whole family seemed to benefit. Twain enthusiastically praised osteopathy and sought equivalent treatment in the U.S. Jean seemed to improve at first but then her seizures got worse. She was institutionalized in sanatoriums off and on for five years. The seizures came and went, interspersed with violent behavior (she tried to kill the housekeeper twice). She eventually died in her bathtub, apparently from a seizure.
Finally, Twain’s oldest daughter Susy died of meningitis; he was convinced osteopathy could have saved her.
Disease and Illness are Not the Same Thing
Diseases have biological origins. Unlike a disease, an illness is not a specific biomedical entity, but the way a patient experiences a sickness. The suffering is a personal experience but also a social experience influenced by cultural factors, education, belief systems, expectations, and the norms of society. Diseases can kill, but illnesses cause most of human suffering, often as a result of imaginings. Alternative medicine excels at illness, not disease. Giving hope is its forte; it is better than doctors at providing hope.
A doctor’s words have great impact, and sometimes conventional doctors’ words can seem impersonal, detached, mechanical, uncaring, and devoid of humanity. Perhaps the greatest sin of today’s science-based medicine is when it destroys hope. Doing nothing is rarely acceptable to patients even when it’s the safest course; and alternative medicines, while ineffective, serve as placebos so patients can believe they are doing something.
Twain failed to find a miracle cure, but he succeeded in demonstrating the role of placebo. He found that treatments that can’t possibly benefit do seem to help some people’s ailments. When placebo controls are used in clinical research, they produce no objective improvements; but 35 percent of subjects report improvement in their subjective symptoms. The cancer doesn’t go away, but the pain is lessened. Placebo effects are an essential part of all medicine, including mainstream medicine: any positive interaction between healer and patient has a placebo effect. The simple act of following a treatment plan can create something of value. Placebo response relies on: (1) positive expectations of patients, (2) positive expectations of providers, and (3) a good patient-provider relationship. A good provider can modify patients’ perception of their illness in a way that makes them feel better. Placebos alone can’t heal. What heals is one person helping another.
Homeopathy is the quintessential placebo: any active ingredient has been diluted out of the remedies. When Mark Twain employed homeopaths in the 1870s, 10 percent of all U.S. practitioners were homeopaths. Homeopathy was safer than the harsh treatments of mainstream medicine, since it is basically water with no harmful ingredients. It allowed for natural recovery and was at least as effective as any other medical system of the time. When warts go away with homeopathy, patients will say “I saw it with my own eyes” and will become believers, not realizing that the homeopathic remedy had nothing to do with it.
“Plus ça Change, Plus C’est La Même Chose”
The old adage is true: the more things change, the more they remain the same. Much remains the same in alternative medicine as in Mark Twain’s time. Conventional medicine is still vigorously attacked. Allopathic purging has morphed into “detox.” Patent medicines have morphed into dietary supplements, with the same exaggerated claims. Testimonials from celebrities are still common. Neurasthenia is gone, but it has been replaced by chronic fatigue syndrome and numerous questionable diagnoses.
Hydrotherapy has fallen out of fashion, but many of its ideas have been incorporated into mainstream medicine, making it more holistic and humanistic and more appreciative of hygiene, good diet, stress reduction, and the general well-being of the individual. Homeopathy is available in every drug store. Folk remedies and placebos rely on ritual. If they fail, the patient can be accused of not following the ritual properly. The treatment is never blamed.
The Future of Alternative Medicine
Alternative medicine will never go away. The treatment of disease has always been emotionally based as well as intellectually driven. Up to 80 percent of doctor visits are because of worry and anxiety not related to any disease.
Alternative medicine is really not alternative, but parallel. Orthodox medicine can’t win because it is not fighting the same battle. Alternative Medicine is not interested in why its treatments are illogical and shouldn’t work; it just wants to convince patients that they do work. People will continue to use them for the same reasons people turn to religions, cults, psychics, and faith healers: they want control over uncontrollable events.
In A Connecticut Yankee in King Arthur’s Court, Mark Twain wrote that any mummery will do if the patient’s faith is strong in it. Cures are rarely achieved, but healing is always possible. The role of doctors is “To cure sometimes, to relieve often, to comfort always,” an adage that originated in the 1800s with Dr. Edward Trudeau, the founder of a tuberculosis sanatorium. Mark Twain came to understand the mysterious force that underlies every successful interaction between a patient and a healer: the positive and caring interaction of one human being with another.
Twain Was Not to Blame for His Errors
Mark Twain believed in starving a cold and fasting for health. He smoked and never exercised. He believed bad habits were good because they can be discarded to promote recovery from illness. He tried all kinds of ineffective treatments. But he shouldn’t be blamed: he had no way of knowing any better. Sciencebased medicine was only one among many competing medical systems.
Finally, in 1910, the Flexner Report recommended that medical education be regulated, standardized, and given a scientific basis. That was also the year Mark Twain died. He wasn’t gullible or misinformed; he was simply uninformed. He didn’t understand the need for controlled scientific studies, and he didn’t have the advantage of knowing what we have learned about human foibles and critical thinking in the last 11 decades.
For further reading: I highly recommend K. Patrick Ober’s book Mark Twain and Medicine: “Any Mummery Will Cure.” It is based on Twain’s life, his published writings, and his private letters; and it offers insights into why the things Twain experimented with seemed to help.