I know, this is going to sound odd, but did you know that just because you have a symptom doesn’t mean that you have anything wrong? It’s odd because most of us only go to see a doctor because we have symptoms – pain, or dizziness, or lack of energy, or whatever. Kurt Kroenke and others have done a lot of interesting work on this phenomenon, showing that if you take the top 10 symptoms patients complain of to their doctors, over 80% of them never turn out to be related to any pathology or disease.
Charlie Vivian, an Occupational Health Consultant in Gloucester, wrote an excellent letter to the BMJ about this. Here’s a quote –
Western medicine is based on the biomedical model. This model is reductionist—all symptoms can be explained by underlying pathology—and dualist—if there is no pathology, it’s all in your head. This model was drilled into us at medical school and is the principal model for the National Health Service. Society largely accepts the model too.
But it’s wrong. For up to 90% of people presenting to their general practitioner with genuine physical symptoms, the symptoms are not explained by pathology. It is also not appropriate to label most of these patients as anxious or depressed. I now explain this to patients, and tell them that the problem lies with the model, not with them. It is normal to have genuine physical symptoms that cannot be explained through radiographs or blood tests.
You know, a lot of doctors don’t know this! There’s a general assumption two ways – that if someone has symptoms they have a disease, and that if a disease is treated then the symptoms will get less. Neither is actually true. For many people their symptoms are only indirectly related to their diseases. He also nicely summarises some of the psychological impediments to recovery from disease –
catastrophising (fearing the worst), low mood, avoidance behaviour, and having an external locus of control (for example, make me better doctor)
I like that latter summary. It gives us things to work with.
Heroes Not Zombies 
Very interesting and very true!
What do you make of children of alcoholics who have never had alcohol showing alcoholic behaviors? For me, it took going to AA and working the 12 steps alongside my Mother in order to break the bad behavioral habits I’d learned. Al-Anon/Ala-Teen didn’t help me much.
Sugar mouse, this is a key understanding that I try to get across to other doctors – because, really, most don’t think this way – and that really does surprise me because it isn’t hard to discover how true this observation is.
Katk, I’m not sure I’d find the term “alcoholic behaviours” useful. But I guess if any of us have behavioural patterns that we feel we need to change then it’s important for us to find the ways to do so. If I understand you correctly you’ve managed that yourself through accompanying your mother to her AA program. I expect that helped you understand her a lot better too. Oh, and I think that children are bound to be affected by the behaviours of their parents – modelling them – either to mirror them or to do their best to be the opposite!
It isn’t easy to explain, but things like not wanting to take responsibility for my ill manners/bad habits, blame shifting, procrastinating, and a cycle of perfectionism/pity parties. I had to learn to (putting it bluntly) “shit or get off the pot”, own up to my mistakes at least to myself, (also to stop beating myself up over mistakes, and not throw myself a pity party over them) and step up to the plate and make amends if I’ve wronged someone instead of just pretending it didn’t happen. If I hadn’t learned how to instill the self discipline that I did, when I did, I wouldn’t have grown to be a very likeable person at all, and I don’t think I’d be able to contribute to society since I’d be a black hole of need only able to see my “wants” and not consider others. The hardest part for me was getting it through my head that I could forgive myself for mistakes, and that people probably didn’t see the mistake in the same harsh light I did.