Some time ago I was accompanying a friend to see a doctor. As I was waiting for them, I engaged in a brief conversation with a patient who had just left the surgery. The conversation was inconsequential, yet one thing struck me. The patient said:
‘It does take time to describe all the symptoms I have.’
I had to stop myself from saying: you don’t have symptoms. After all, symptoms are constructs that doctors make up on the basis of what we tell them. As Mishler would have it, as we speak in the language of the lifeworld, the doctors change it into the language of medicine (things are more complicated, but Mishler’s basic idea will do here at the time). When I teach psychologists, I tell them a joke:
A patient comes in to see the doctor and says:
‘Doctor, I have migraine.’
To which the doctor responds
‘No, you can only have a bloody headache.’
You can, of course, change ‘bloody’ into something else, if you wish your students to laugh some more. But, basically, the message is – no, the diagnosis is mine, you only have some (unpleasant) experiences, which I will take into account when giving you the diagnosis. If you need some more on symptoms, please read a recent paper by Kirsti Malterud and her colleagues.
But then, the patient I spoke to, wanted to describe her symptoms and I want to consider why. In other words, I am not so much interested in the theory of symptoms, but, rather, in why people would prefer to talk about symptoms, diagnoses and not about ‘a bloody headache’.
The first explanation would, of course, be medicalisation. There is a large body of research on representing experience in medical terms, with depression such a clear example of medicalising regular sadness. Indeed, there is also quite a lot of critical research that shows patients taking on medical or semi-medical language when speaking to doctors. It goes even further – as Konrad Opalinski and I showed, insight into schizophrenia was understood by psychiatrists as medical knowledge. They wanted their patients to read up on psychiatry!!
I don’t think this is the only explanation, though. The other, I think, is to do with accessibility of medical knowledge and, even more importantly, medical language, well, sort of medical language.
I was recently told in a conversation that when my interlocutor was a boy in the 1950s British GPs would simply give his mother or father a prescription for ‘medication’. No explanation. You just take your medication because you are told to do. No other information was needed. In fact, I remember similar practices in Poland when I was a child or a youngster.
But the internet (and probably a number of other things) has changed this completely. You can now read up on every illness, every medication, every treatment, including patients’ comments on all of them. “Dr Google” has introduced us to the sea of medical information, which for the most part, we have no way to process. As doctors often say – you cannot substitute years of education and training by an internet search. Yet, we all do it, including me – sometimes with distressing consequences. In fact, I actually suspect doctors do it, too! And in such a way we acquire this googled view of medicine and medical practice.
And so, I did a quick search for depression and colitis and wondered what I would get. Needless to say, I found them described in terms of symptoms! I started wondering whether the symptoms my interlocutor had, were at least to an extent supported by this symptom-led medicine you can find on the internet. She basically responded to a picture of medicine that is readily available.
To be fair, it is also supported by doctors’ questions. Both in the UK and in Poland I have for some time been asked about my symptoms. When, on a number of occasions, I said symptoms were the doctor’s job, I was looked at with disbelief! I still remember a young doctor looking at me very suspiciously when I mentioned the diagnostic criteria of hypertension. It’s like I was stealing something from them. I’m not entirely certain, but I think this is something that has changed. I think doctors didn’t use to ask about symptoms (at least I don’t remember it, but I would like to learn more about it). I do remember years ago being asked what ‘bothered me’. This is how I translate the stereotypical Polish doctor’s question ‘Co panu dolega?’. Google translate prefers ‘What ails you?’, which is not bad at all.
Now, I think there is another aspect of symptom-talking and it is self-presentation. As we ‘all’ talk about symptoms, how can I not? If reputable organisations tell me about symptoms, doctors ask me about them, perhaps, as a fairly intelligent person, I should follow their lead.
There are, of course, consequences, at least potentially. The moment I think about symptoms, I forget about my life. And illness, as has been said a zillion times, is social, while the doctor should treat me, Dariusz Galasinski, a professor, a dad, a runner and ice-cream lover and certainly not my symptoms! The moment I start speaking about symptoms I lose all that. I lose it myself, in fact. And that’s the somewhat pernicious side of it. I myself deprive myself of my personhood and become a token patient with symptoms.
And so, here is to experiences, to a bloody (yeah, right) headache!