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Labels, medical and otherwise

Last week a patient of mine told me that her GP had diagnosed her with mild depression. (Evidently mindful of the advice of Sir William Osler, the so-called father of modern medicine, who said that one of the first duties of a physician is to educate the masses not to take medicine, this GP told her he was not going to prescribe anti-depressants because he thought she could sort it out herself without their help.) Now you might think that being told you are depressed would in itself be a bit depressing, but not a bit of it. The lady in question sounded really rather pleased. Pleased that she now knew what was the matter. Mild depression.

This is a common experience. We don’t like uncertainty. We don’t like to be in the no-man’s land of an undiagnosed condition. After all, if doctors can’t find a handy label for us, we might start to wonder if there is really anything wrong with us at all; or we might start to wonder if other people are thinking that we are malingering. Furthermore, we might start to fear that perhaps we have got some really dreadful illness, that we are really only months away from death. So I can see why this lady was pleased and relieved. Bumping into an acquaintance in Tesco’s, she can tell them unequivocally “I’ve got mild depression”. And whatever you think about mild depression, it beats the hell out of cancer, multiple sclerosis or heart disease.

I’m reminded of another patient who came for treatment for an occasional achy numbness in her limbs. She’d had various investigations which had ruled out things like multiple sclerosis. Acupuncture, as one might expect, proved pretty effective at relieving this mysterious pain, but she still had the occasional relapse. However, she remained worried that she did not have a clear diagnosis.

Or rather, she was worried that she didn’t have a western medical diagnosis. It wasn’t too difficult for me to give her a Traditional Chinese Medical diagnosis, but, somehow, that didn’t reassure her. I guess if she bumped into someone in Tesco, telling them she had ‘Damp Painful Obstruction Syndrome’ wasn’t going to cut much ice. Like many people, her assumption was that conventional medicine is the real medicine, and any other form of diagnosis does not really count.

I’m slightly suspicious of this craving for certainty, for a label to attach to ourselves. Labels, after all, are our creations; they are not part of the fabric of the world. And as the second example mentioned may make clear, they are relative. If you live in a different culture, with a different medical tradition, you get a different label. And labels also change with time. Bear in mind that, apparently, the label ‘heart attack’ (or, rather, ‘crise cardiaque’) was not used in French medicine before 1968. Presumably if you collapsed in Paris in the early 60’s, complaining of pain in your chest, you would have been given a different label. And of course there are plenty of people for whom there just is not a suitable label. People are it seems far more complex, and pathology is far more complex, than any system, any language even, can quite cope with.

In Traditional Chinese Medicine we have a saying: “Same disease, different treatment” which means that just because ten people have the same label, it does not follow that they will need the same treatment. One person’s migraine (or, in Chinese medical context, one person’s Pian Tou Feng, which might translate as ‘unilateral head wind’) is not the same as another’s. One person’s mild depression is certainly not the same as anothers’. Medical practice needs not to be too foxed by convenient labels. If we think, this treatment worked for that person who had migraine, so we will use it on this one, we might be making a mistake. We need to look beyond the labels (although what we will find, perhaps, is more labels!).

Anyway, I would suggest that we should maybe loosen our desire for a nice convenient label. In the Zen Buddhist tradition, there is a saying (they are full of wise sayings, these orientals!), “Small doubt, small awakening; big doubt, big awakening; great doubt, great awakening!”) Which perhaps means, in effect, that a refusal to categorise and label everything in a nice tidy way allows for openness to a broader, more satisfying experience; an awakened experience. In pressing for a label to fix on ourselves, whether a medical label or any other, we may deprive ourselves of the full richness of what being human is. Humans can’t be tied down and packaged up in a label. They are too complex for that. Sure, labels are useful, but only up to a point. If there isn’t a suitable label for us, maybe that is no bad thing. If your medical practitioner, after doing all their diagnostic stuff, can’t tell you what you have got, and assuming they are not just incompetent, it might not be such a disaster. Welcome the uncertainty. Welcome your uniqueness. Maybe it is telling you something important about life.

Written by Vimalaprabha

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