This Book May Cause Side Effects

Implicit in our modern healthcare system is the assumption that, if someone has symptoms, there will be a diagnosis to fit if only they look hard enough. The result is that we go chasing labels, and, if we don’t find one from a doctor, there’s always social media and the Internet. Labels can offer meaning and reassurance, but they can also be daunting and scary. They can change the way we think and act, and turn transient problems into something more significant. When we self-diagnose and get it wrong, often we end up crowbarring our symptoms into our self-appointed label, creating a trajectory of ill health that becomes self-fulfilling.

They say that the practice of medicine is a science, but the delivery of medicine is an art. Both can help to make people better, but, when doctors achieve the right blend, they take their healing to new heights. People do better with doctors they get on with. There is the doctor and there is the patient, and there is the space that exists between them. In this space, through what they say and how they say it, doctors have the potential to diminish the nocebo effect and boost its well-meaning twin. Sometimes the way a doctor interacts with their patient can have more of an effect on the patient than what they prescribe.¹¹

Policymakers need educating too. Becca Levy’s work demonstrates unequivocally that negative expectations about ageing are a risk factor for diseases of old age and for reduced longevity. This is not well known, but it should be. Its an important public health message. The World Health Organization has pages devoted to the sorts of things we can change if we want to improve our health. While this includes tobacco use, physical activity and alcohol consumption, there is little mention of the health repercussions that flow from negative thoughts. People deserve to know.

Perhaps the biggest change that needs to happen, however, is cultural. For too long, symptoms that are functional in nature have been either denigrated or ignored. Collectively we have bought into the narrative that says if there is nothing physically wrong, there is nothing wrong. People who have functional symptoms are branded as hypochondriacs or hysterics. All too often, people are made to feel like they are imagining it, or that it’s ‘all in their head’. But as Emeritus Professor of Medicine Nortin M. Hadler from the University of North Carolina wrote around 30 years ago, ‘If you have to prove you are ill, you can’t get well.’²⁷ We need to start a conversation about the ubiquity and validity of functional symptoms, and the mind’s ability to conjure them seemingly from thin air. My hope is that this book will help to start that conversation.