Wednesday, January 14, 2009

More Medical Mysteries

I've mentioned my fascination with medical mysteries before on this blog (see: my post on Apotemnophilia). I suppose that part of that fascination is simply grounded in the strangeness of some of the conditions, but I am also particularly interested in the way that medical knowledge is stymied. A couple of years ago, I read Dr. Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science, which documents the myriad ways in which the myth of medical infallibility is wrong, wrong, WRONG. As a Type 1 (insulin-dependent) Diabetic, I spend way more time with doctors and their minions than most people, and though I generally trust them--because I have to!-- I still wonder at the unquestioning ease with which we all hand over that implicit trust. The human body is, as we all know, a complex and often idiosyncratic organism, so it shouldn't be a surprise that we know so little about why it does the things that it does. And still, the myth that medical doctors always know what they're doing prevails...

There's an interesting story about mysterious sleep disorders on MSN right now, some of which are familiar and several of which are not. We all probably know about SIDS (Sudden Infant Death Syndrome), but how many of us know about SUNDS (Sudden Unexpected Nocturnal Death Syndrome), which apparently only affects Laotian Hmong refugees? We all know about sleepwalking (somnambulism), but how many of us knew that you can also have sex (sexsomnia), assault people (parasomnia), and even murder (homicidal somnambulism) in your sleep? We all know that insomniacs have trouble sleeping, but who knew that so did people with Chiari Malformation or Fatal Familial Insomnia? We've all heard of narcolepsy, but how many know about hypersomnia? What do all of these conditions share in common? Medical science has ABSOLUTELY NO IDEA how or why they occur, save a collection of what can best be described as "educated guesses."

Anyone who has suffered a severe lack (or excess) of sleep knows how miserable this can be. Even if your experience hasn't reached the edges of hallucinations or death, everyone knows that sleep disturbances are truly crippling, affecting their sufferers emotionally, physically, and mentally. Even mundane changes in one's sleep cycles can be disorienting. An example: about 5 years ago, in what seemed like an overnight adjustment, I began waking up very early in the morning, without an alarm or anything. I am generally a kind of night-owl, and have been for most of my adult life, but no matter what time I go to bed these days, I still wake up sometime around 7am. Around the same time of this adjustment, I completely lost the capacity to stay up all night and "work." (Since I was a grad student a the time, I mean "work" here in the way that students think of work... that is, I could no longer stay up all night and write a paper or finish a book.) This is still my condition now: I can't work productively past a certain hour in the evening (usually around 7 or 8pm) and I always wake up early. I don't have any explanation for this rather dramatic change, and neither do any medical experts that I know.

Like food, we philosophers don't talk enough about sleep. But both food and sleep are necessities for human life and, without them, we are weak, vulnerable, helpless, and at risk. The article on mysterious sleep disorders has prompted me to think about adding this to my "weak humanism" thesis... something I should have thought of before, since one of the ways that human rights are being violated these days include torture via sleep deprivation. I wonder what it might mean to say that we all have a human right to sleep?

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