Basically, Everyone's Crazy

It's like that song from Avenue Q, "Everyone's a Little Bit Racist."
Today we talked about 'functional somatic syndromes' in our doctorin' class. These are syndromes, ahem, "defined more by suffering and symptomology than by any consistently demonstrable pathophysiology." Which sounds a lot like saying "it's all in your head." Which, to me at least, sounds kind of paternalistic and dismissive--medicine as an entity and doctors in particular putting the burden of 'un-understandability' on the patient rather than admitting that Western medicine doesn't totally have its shit together with the whole mind-body connection. A little like hubris, I feel. In one of the articles we read for today, the authors listed 'side effects from silicone breast implants, irritable bowel syndrome, repetitive stress injury and vaginismus' as among these functional somatic syndromes. The paper was written ten years ago. In 2009, we have official diagnostic criteria for IBS and fibro; everyone and their sister knows that carpal tunnel DOES, in fact, exist; and I'm gonna go out on a limb here, but I doubt that even in 1999 a reasonably intelligent person would say, "Have 500 ccs of potentially allergenic, if not carcinogenic, material pumped into each of my breasts? Don't mind if I do!" As for vaginismus being an issue of mind over body--yeah, possibly, but that doesn't mean the suffering isn't real, and telling women to just relax about it doesn't address the problem. I guess what I'm saying is, we don't know everything there is to know about the world, and it's kind of pompous to say that if we don't, it's the world's fault. After all, just 50 years ago doctors were still telling women that dysmenorrhea was all in their collective heads (and had, apparently, been a form of mass female hysteria since time immemorial).

Our group leader described his thought processes well--when prescribing a tricyclic antidepressant for a woman with irritable bowel, it's common to be met with the dismayed cry, "Doctor, you think I'm crazy! I'm not crazy!" At which point he then points out, "Your gut is very special--it's the only organ system that has a complex 'brain' of its own...(explain about the enteric nervous system, neurotransmitters, la ti da ti da) and I think that these drugs, even though they were originally prescribed for depression, might have some usefulness here." Meanwhile, he says, 'I'm thinking, yeah, I do think you're a little bit crazy, but so's everyone.' So that's a nice message to keep in mind next time someone's acting like a whack job and being really frustrating--everyone has their own particular flavor of crazy. It's like the world is a huge Baskin-Robins, but with neurosis instead of ice cream.