Thursday, 29 January 2015

World Of Hurt

There are some people who interpret most of their experience in pathological terms. That is, they look at each experience they have for its negative and sinister sides, as a sign that they are ill. They sometimes then go on to conclude that their illness is a particular disease entity based on sensitive rather than specific signs.  The issue of sensitivity versus specificity is vital here, so I will go into it in some more detail.

When a sign is sensitive, it means that most people with particular illness will have that sign, so it's unlikely that you will miss someone who has got it if you look for it. At first glance that sounds like a good thing, and of course it can be.  However, there is also a downside because there are also likely to be lots of people who don't have that problem with it. A notorious example of this is the underactive thyroid, which has all sorts of easily recognised signs and symptoms such as low appetite, weight gain and fatigue, most of which are also associated with many other conditions, meaning that it can be easily missed.  In terms of thought processes, sensitivity is akin to paranoia, and here I want to look at paranoia not in pathological terms so much as a state of mind we can all enter which can merely follow from an unusual set of experiences or a habit of jumping to conclusions. In any case, the idea of paranoia as a label for a psychiatric condition is now deprecated in favour of the rather unsatisfactory term "delusional disorder" (don't get me started!).

Then there are specific signs. These are the opposite of sensitive signs.  A person with a specific sign of a condition is unlikely not to have it, but there may be many people without that sign who do have that condition. An example, and I've cheated a bit here by making it broader than necessary, is that if someone experiences pain in their lymph nodes soon after drinking alcohol but not at other times, they will almost certainly have a lymphoma.  This is helpful for diagnosing them as an individual of course. Unfortunately it is still problematic for other people. Whereas few people with that symptom won't have lymphoma, lots of people without it will have lymphoma, so there's a risk of it not being diagnosed if you focus too much on that symptom rather than others. An example of a mental health issue similar to this is minimising the positive in depressive thinking, although of course depressive thinking also involves sensitive-style thought processes.  Reliance on specific signs is also akin to scepticism in the philosophical sense in that you don't start to believe in something until you've eliminated other things it might be. It is in fact an approach I've taken myself in recent years.

There is a tendency for some people, when they take what they hope is a medical stance towards their experience , to plump for sensitive signs rather than specific ones, particularly after a long period of frustration waiting for a diagnosis, because they really want an answer badly. They are frustrated and want not only an answer but also an explanation for their mystery illness.  Their motivation becomes emotive in a particular way, where they experience a depressive train of thought leading to a negative conclusion.

In some people, this is actually a substantial part of the explanation, not because it's "all in their heads" but because the depression is an integral part of the illness with a physical cause. This would apply to someone with an underactive thyroid, hypotension, anaemia or an autoimmune condition, or at least it might.  Alternatively, the depression could be endogenous in the sense that it is a manifestation of their brain function. Their problem might be directly connected to their serotonin or serotonin pathways. In this case, they may have an intuition that there is something amiss with their brain, since depression can manifest itself as a belief that there is something physically wrong, but the details of what exactly is gone agley can be incorrect. For instance, they might suppose that they have Parkinsonism, which is in a sense a problem with dopaminergic rather than serotonergic neurones, and if that's so it becomes very close to the "truth":  they have an organic brain dysfunction - that much is correct - and the problem is simply with  a different brain chemical than they think.  This is particularly so for people whose lives don't generally seem to have gone " wrong" in their own estimation yet they are still depressed.  They would be absolutely correct in their assessment that they had a brain dysfunction. Then again, a neurological examination might not elicit any consistent positive signs of Parkinsonism, which is where this entry starts to eat itself because that is itself a sign.

Looking at such a patient's world, if they are no accustomed to medical discourse it may be that their first excursion into such a narrative is suffused with fear. A starving person might see food everywhere and a frightened person might see threats everywhere. Someone who is in this predicament may see pathology everywhere.  They might look at a brain scan and interpret it in terms of dementia where I would just see normal ageing. The reason for this is that I am in the happy position of being able to see the default position of the body as healthy, mainly because my only health problem is that I was born outwardly male.

Such a person is susceptible to reaching out and exploring the ideas of health as the presence of disease and the entities within that world become threats or benefits rather than just part of the furniture.  Something like Coenzyme Q10 or tryptophan then becomes a highly specific means to an end and a kind of magic bullet rather than an integral part of a healthy body which doesn't really even need a name.

All of this is true, but now I'm going to throw a spanner in the works in the form of the observation that many practitioners become so because their health becomes an issue for them. One thing which set me off on the journey towards herbalism was going vegan. I decided my diet was an issue, and being a socially stigmatised diet it became problematised and mwdicalised.  It should also be noted that on occasion, an ill medical researcher is a good one because she is motivated to address her own problem.  This has happened with bipolar disorder and eczema, to give two examples. 

So what are we to make of this? On the one hand there is the problematised body of the informed patient where every new piece of information is a potential threat. On the other there is the response to a problematised condition which spurs someone on to a greater and healthier understanding of health itself.  Right now, it seems to me that there are in a sense two "healths". One is the apparently raw but extremely plastic information about the body, the experience of being healthy or ill as an apparently blank sheet on to which has yet to be written the words "I am well" or "I am ill". The other is the actual wielding of the pen and ink and the intent involved in writing that sentence. And there is a third sentence too: " this is interesting ".  Are there others and what might they be?