Richard Smith: Homesickness—my most serious “disease”

Richard SmithLast week I walked from Poole to Chapman’s Pool along the South West Coastal Path, and as I passed through Swanage memories flooded back, some of them very painful. This is where as a 10 year old I suffered the most pain I’ve suffered in my 60 years—from homesickness.

Some of the pain comes back to me. I was full of longing for my family and home. I fought back tears, not always successfully. Breathing was difficult. The pain virtually never went away. If for a moment I forgot my homesickness it came back with a thud at the end of that moment. There was extra pain in that I thought that I’d never be able to grow up and leave home. I’d be tied to my parents until either they or I died. Even in my present pain I thought of this future pain, of a failed life.

I was suffering homesickness while on a school holiday. The holiday was supposed to be two weeks, but when my mother and I turned up at my school in Bermondsey to catch the coach to Swanage I wasn’t allowed to go—because I had German measles. I can’t remember whether I felt ill or how my condition was diagnosed. But I was taken home and spent the week with my family.

Perhaps it was the week at home that made me so vulnerable, but I did have a history of something close to homesickness. When I first went to school  aged 4 I hated it when we were obliged to lay down for an hour on camp beds after lunch.  I didn’t like to be kept still and didn’t like to be away from my mother. In the bath at night I would cry and beg not to have to go back to school.

After my week at home with German measles I was driven to Swanage by the headmaster, Mr Hughes, and my class teacher, Mr Grant, whom I once called “Mummy” to my horror and probably his amusement. We stopped in Winchester for scones and clotted cream, a first for me–and perhaps the cosseting I received from them set me up for my homesickness.

My homesickness frightened me and had consequences. Terrified of never being able to leave home I forced myself to travel—went camping when 12 with another 12 year old, walked the Pennine Way when 15, cycled to Vienna when 19, picked tobacco in Canada when 21,  did the Hippy Trail to India when 22, and went to Africa at 23. Fear of my homesickness returning also meant that I didn’t apply for any medical schools in London, my home city.

Is homesickness a disease? I’m relieved to find that its not included in DSM-IV (so I’m not nuts), but I find that the American Academy of Paediatrics has a policy statement that is about 3000 words long and includes 52 references. There are sections on epidemiology, diagnosis, and risk factors, and some very strong advice: “Under no circumstances of planned, recreational separations from home should parents ever make a “pick-up deal” with their son or daughter.” Wikipedia also has a long section on homesickness, and I discover that Odysseus suffered from it (good company there) and that it was first described in 1688 by a Swiss physician called Johannes Hofer who linked it with nostalgia (another painful disease) and called it mal du pays.

My medical history is not entirely empty. I broke my leg when I was 18 months old, had the usual childhood illness of those days of measles, mumps, and chicken pox, and had a hernia operation in my 30s. While travelling I’ve been infected with hookworm, ascaris (I kept it in a bottle beside my bed), and giardia. Recently I had a fleeting dose of shingles. But none of these came close to the pain of homesickness. The only thing that has come close has been a bout of jealousy, some 40 years ago.

It’s been put to me that the prime concern of doctors should be suffering—not disease and death. In that case homesickness and jealousy should be major concerns of doctors, more so than cardiovascular disease and influenza.

 Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.