The French Have A Word For It — Malaise

She was a professional woman, at the top of business management, and in her mid-fifties. She was what the French call “astiquee.” That means “polished,” the way an antique copper vessel would be polished to a high patina. Meticulously made up, perfect hair. Also successful, respected. “I don’t feel right,” she said. Things had been getting worse. She was a little bit obsessional, but not enough for a diagnosis of either obsessive compulsive disorder or obsessive compulsive personality disorder. She was a little bit paranoid, but certainly not enough to be called a paranoid personality or a delusional disorder. She “held it together.” Nobody who knew her at work would ever guess that she was a “worrier.” She had that moniker for a long time, years even, but it had never occurred to her that it would not only stay with her this long, but sometimes get worse. Especially when external stressors were present. The only word she herself could find to describe it was a French word, too — “Malaise” (Ill-at-ease). She seemed to be worrying about everything. It has been said that 95% of the things that people worry about never happen. Telling her this was no help whatsoever. She did not fit the symptom lists for fibromyalgia or any of the sorts of diseases that often present to a psychiatrist. She did have some headaches, which seemed transient and benign by her description. Some were associated with eating very cold foods. Like all patients with whom I have any kind of control, I insist upon general blood work to rule out at least the major and most frequent medical illnesses. In her case, all of this had already been done by the expensive private doctor who examined her regularly. He thought she was just fine. She hit the ceiling when he offered her an antidepressant. She was right to refuse. She simply did not fit the criteria for depression. Her laboratory work, even more than I would usually order, was sitting in her chart and looked most excellent. Her blood sugar, thyroid gland, kidneys, and liver were textbook lovely. I was wondering if there was some kind of an infection. Her blood count, which would reflect what the body was doing to fight depression, was normal. I sat there looking at her. I was trying to figure out what I had been missing. As I looked at her face and she kept talking, I saw a lower front tooth was broken. She said it had happened recently, eating some kind of nut. She was so busy with her work that she had not gone to the dentist as regularly as she thought she should. I immediately realized that a dental infection could have caused “malaise.” I told her to go to the dentist.

The next time I heard from her, it was a phone call telling me that she felt fantastic and no longer needed my services. She had some infections beneath her teeth that had been there for so long that cysts had been formed. She had been given some kind of penicillin by the dentist, as well as some narcotics which she had decided not to take. The pain did not matter. The “malaise” was totally gone. Life was good. She would take very good care of her teeth and announced proudly she would never take them for granted ever again. Nor would I. In French medical school, the people who score in the concours or contest examination right below the future physicians, after the first year of studies, become dentists. I remember a young woman friend who told me at the time that she believed the spirits of people resided in their teeth, the gateway to the digestive system, and that what she would do for the general health of those whom she served was sacred and irreplaceable, maybe sometimes even more important than what doctors do. I wondered if this young woman would ever bring herself to pull a tooth, even if it were heavily diseased. Since I did medicine and she did dentistry, we saw each other little. As far as I know she is probably still practicing north of Paris. At the time I thought she was delusional. Now, this much later, I am beginning to wonder. I have never thought of a more cogent and compelling reason to get regular dental care. Unless you laugh with your mouth wide open or need cosmetic work to be on television, most people simply do not prioritize preventive dental care. Moreover, lots of people have had traumatic problems, either physical pain or emotional pain, from the way dentists USED to be. The profession has evolved plenty. There are caring dentists who really try to make the experience agreeable. For those who have problems, I suggest Emotional Freedom Technique or EMDR or some related kind of therapy that works well on phobias. Your emotional status gets better when your body gets cleaned out of infection, which just might be hiding in your teeth.