Diagnosis is “the art or act of identifying a disease from its signs and symptoms.”
It is our desire for understanding that causes us to want some explanation for our condition or pain that we are suffering from. As a society having the luxury of medical advancement and technological access, we have come to believe that if we can name our condition, then surely we can treat it successfully.
The simple idea that if we can name it, we can resolve it, however, is far from the truth.
To Diagnose or Not to Diagnose, This Is the Question
The largest preponderance of conditions that physicians treat in the U.S are chronic conditions that persist despite their being named. On the contrary, we believe that if a condition goes unnamed, it will only persist and then “it” will win and we will lose.
There will be those of you that will read this and think “Thank God my doctor figured out why I was dizzy all the time, it was a brain tumor and she saved my life by ordering that MRI.”
Let us begin with the acknowledgment that finding out information that empowers us to take a right course of action can save our lives and is without a doubt essential.
However, there are many detrimental aspects of what transpires when our condition is revealed to us.
The naming of a condition can frighten us and shake our belief in our sense of self as a healthy resilient individual. We also know that as in any field, just because one professional says this is what the problem is, does not necessarily make it true.
Other times, someone has suffered for years from a condition that no doctor has been able to figure out, which may have resulted in the subtle accusation that their symptoms must be “all in their head.” What a relief it must be to a patient when a physician finds a positive lab test or x-ray or CT scan and says “Aha, Mrs.. Smith, I believe we may have found the source of your problem.”
The sense of relief however is often short-lived as it only begins a process that may evolve from relief, to despair, to anxiety, fear and a sense of hopelessness and loss of control.
Research has shown these negative emotions can significantly reduce the likelihood of a beneficial outcome.
The Problem of “Association”
Once named, a condition exists in a patient’s mind forever — impossible to discard.
The brain creates neural nets of this condition entwined with associated statistics, prognosis, doubts, worries, fears, stories of friends who had the same condition, etc.
A marquis headline of cervical degenerative disc disease with spondylosis is not only quite a mouthful, it sometimes is repeated to me by a patient with a sense of pride when correctly pronounced. Often, earnestly in their desire to be the best patient, they will Google search their disease, only to be overwhelmed by the array of medical sites and ads for a wide array of treatments, varying from surgeries to herbal supplements.
The more time the person invests in this quest for knowledge, the more its definition and assorted outcomes, variations and possible allied symptoms become part of their consciousness.
Another problem is that once a condition is named, there is an automatic algorithm of treatment options that follow a diagnosis, based upon the current and accepted body of medical knowledge and the degree of influence that the corporations behind those treatment options (think the pharmaceutical/medical/surgical/technology industry or even just erroneous advice like weeks of bed rest for back pain) are having that particular time.
No longer are you an individual with a unique and complex internal laboratory of chemicals, history, beliefs, hormones and immunological resilience, you are a diabetic or walking cardiovascular accident waiting to happen.
You have this diagnosis; you therefore are prescribed this array of further tests, medications, treatments and prognosis.
Congratulations and welcome to the club.
Finally, our desire as both patients and physicians to associate a condition with a causal entity, in other words, to find something that we think is causing the pain is so strong that it often leads to assumptions that often prove incorrect.
For example, if arthritis alone was the cause of neck and back pain, every patient of mine over the age of 40 would be in pain all the time.
Studies by Magora and Schwartz reveal that as many people without back pain have osteoarthritis in the lower back as those with back pain. What’s more, over 30% of the adult U.S population have lumbar disc bulges that are without symptoms.
The Results of Scientific Research
John Sarno, MD, former director of outpatient services at New York University Medical Center Institute of Rehabilitation, has written extensively (in future issues I will explore his work in greater detail) that patients who are convinced that they “injured” their back will continue to have pain, especially when they have been given a diagnosis that they feel they cannot do anything to fix.
He goes on to state “It is difficult to escape the conclusion that conventional diagnoses unwittingly contribute to the severity and persistence of back pain because they frighten and intimidate.”
He has studied extensively the relationship between stress and tension that is stored in the musculature of the body which results in muscle contraction, leading to reduced blood supply resulting in decrease oxygenation which leads to pain.
His seminal early work was prophetic, shedding light on the role of emotions and stress that trigger non-symptomatic conditions into painful states, recognizing the need for a holistic psychophysical approach to pain. He reports how an extremely high percentage of his patients with back pain for example also suffered from other stress related conditions from headaches, hypertension, digestive issues and seemed to indicate a possible correlation.
In conclusion, while it is our nature to want to know, to identify and name our condition, we must learn as both patients and clinicians, to be judicious with how a giving and receiving of a diagnosis is performed. Its potential impact can have a life altering impact, both positively and negatively and should never be performed by rote or without understanding its potential consequences.
Understanding and knowledge, especially regarding the cause of unhealthy conditions is critical in allowing us the opportunity to correct behaviors that may be leading us away from health, but how we think of and hold the idea of what the diagnosis means to us is one that requires a deeper exploration.