A fellow country doctor and blogger wrote a piece the other day about drug companies pushing medications for near-diseases like prediabetes and heartburn. I agreed with his sentiments and went on to think a lot about this. There is a tendency among drug companies and even some doctors (perhaps looking for business?) to medicalize the human experience. We all have heartburn sometimes, but is it a disease or pre-disease, or did we simply eat too much of the wrong kind of food?
I have said before in these pages that Thomas Moore, the scholar and philosopher about matters of the soul, has said that book titles on your shelf can be inspiring even if you haven’t read the book.
A couple of years ago, at a Harvard psychiatry or psychopharmacology course, the booksellers in the lobby had a book that caught my imagination and has been an inspiration to me from that moment, even though I didn’t start to read it until today. It is by John Ratley, MD (co-author of “Driven to Distraction”) and Catherine Johnson, PhD (author of “When to Say Goodbye To Your Therapist”). The title says it all: “Shadow Syndromes” (The Mild Forms of Major Mental Disorders That Sabotage Us).
People with near-diseases can benefit from comparisons with the full-blown thing only if the analogy provides them with a deeper understanding of their situation and a course of action to change their trajectory away from the disease they are heading towards. This applies to labels in general. Labels are good if they help you understand what’s going on, and bad if they lock you into some sort of fixed category where you either don’t believe you can get out or, perhaps worse, start to feel comfortable and liberated from your own responsibility for your life and health.
Somehow in the last generation of doctors, we seem to have lost our ability, or perhaps our perceived right, to give patients advice about their health; only if we diagnose them with a disease, or pre-disease, do we have something to tell them. We need to re-claim our position as health coaches, and fight for our right to tell people who are not yet diagnosable with an illness how to stay away from disease, instead of trying to make almost or completely healthy people carry a disease label, just so we can talk to them about how to stay out of trouble in the future.