Tilman’s Foot – a new disease?

Bill Tilman is a personal hero of mine and lends his name to the disorder he described in his books. It is a debilitating disorder suffered by all mountaineers at some stage in their career and is characterised by the main feature of being utterly unable to put one foot before the other.

Tilman first described it in the 1930s and I would add my own observations as an occasional sufferer that extreme lassitude and feelings of hopelessness may also be present. The prognosis is good as it is usually cured with a good sit-down and a chocolate bar.

It is a brilliant example of the potential medicalization of the human condition and it is the kind of disorder that needs guarding from the pharmaceutical industry. All we would need is an eminent sports physician to research the condition, re-name it as Akinetic Foot Syndrome and the die would be cast. If the drug companies could find the ideal lifestyle drug we would be cursed with it forever. It is all too easy to imagine the mountaineering staple Mars Bar being re-branded as chocostatin or chocoprilol.

Tilman had his tongue firmly embedded in cheek (Lingual Buccal Adhesion Syndrome??) and the irony is that he was one of the great stoics of the twentieth century. Medicalization would have been a bad joke to a man that survived the trenches of the Western Front as a teenage subaltern. He was as tough as old boots; in fact, in a fair fight he would almost certainly give old boots a good kicking. After the trenches he turned to pioneering in Kenya in the 1920s and he subsequently had a career of climbing, sailing and exploration in the remotest and coldest corners of the globe. I commend his books as peerless examples of laconic understatement. He once fell while climbing in the Lake District and crawled on his hands and knees with a broken vertebra four miles to the village to raise the alarm. Typically, some killjoy doctors told him he would never stand up straight again and he rather insolently went on climbing for the next forty years.

If medicine has convinced me of nothing else it is that two of the surest facts in the clinical world are that people will over-estimate both their intelligence and more importantly for us, their pain threshold. Interestingly, doctors are probably guilty of the converse and we are prone to under-estimating our patient’s intelligence and over-estimating their pain threshold. There is a consultation theory in there somewhere.

Never mind living longer; what we need is for people to live a bit tougher and medicalization is clearly one of the greatest barriers to this philosophy of stoicism. Tilman is certainly not the type of gentleman that would have winced as a blood pressure cuff tightened on his arm. (A key clinical sign for the observant GP.)

One of the tenets of the philosophy of Stoicism was to be free of pain through apathy. At first glance this may seem a particularly pertinent policy for modern society but apathy had a slightly different meaning in the good old days. It had more to do with being a clear thinker than a couch potato that doesn’t bother to vote. It is well documented that all life has suffering and there are few who work in the NHS who will disagree. Tilman was a remarkable character but quiet fortitude is out of kilter with modern emotional incontinence.

It’s a shame really because as Seneca the Younger, one of the original Stoic philosophers said: “The point is, not how long you live, but how nobly you live.”