What Makes a Disease Real?

From the FMS Global News Desk of Jeanne Hambleton

Contents provided by the Harvard Medicine School – Courtesy MSN.health&fitness

Some conditions cannot be diagnosed with any test
By Robert Shmerling, M.D., Harvard Health Publications

Doctors can be a skeptical bunch. I have colleagues who flat out deny that a condition can be “real” unless they can observe it or detect it with a test.

Yet, many physicians deal with conditions all the time whose symptoms can’t be measured. For example:

Depression—A depressed person will usually have normal physical examinations, blood tests and, if necessary, a normal brain MRI.
Headaches—Most people who have headaches have normal test results.
Joint pain—People can have joint pain (arthralgia) without any joint inflammation (arthritis). The pain could be due to tendonitis, bursitis, vitamin D deficiency or thyroid disease. But often we can’t find any cause of the pain.

Doctors rarely do extensive testing for these conditions because abnormal results are rare and the tests are almost never helpful.

Millions of people are affected by diseases that have “subjective” symptoms and cannot be confirmed by observation or tests. These include fibromyalgia, most headaches (including migraine), irritable bowel syndrome. So, does this mean that these conditions aren’t “real?” They’re certainly real to the people suffering with them.

“It is all in your head”.

When a symptom cannot be explained, it does not mean that it is imaginary or due to a mental illness, psychiatric disorder or psychological distress. That is what is implied when a doctor tells a patient, “It’s all in your head.” At the very least, we should assume that the pain or unpleasant experience is real regardless of test results.

In the end, all pain is perceived by the brain. So, in a way, all pain is “all in your head.” Yet there is a tendency to relegate unobservable symptoms to the realm of the psychiatrist. Never mind that a psychiatric disease is “real” even when imaging and blood test results are normal. If you have ever witnessed psychotic behavior or been with someone who is severely depressed, it is clearly real.

Unexplained symptoms could be due to a disease that has not been detected yet. Ideally, doctors and patients should identify the cause if possible, rule out a dangerous condition, and treat the bothersome symptoms. And that is true whether the symptom is measureable or not.

What is in a name?

We usually expect the doctor to make a diagnosis and recommend a treatment when we have a problem. It is reassuring to know that your particular problem has a name. It means that other people have experienced it and that studies have assessed the effectiveness of various treatments.

Yet for many conditions, the name is only a label. It is convenient to apply a name to a particular combination of symptoms, even though the cause is unknown and no clear-cut abnormalities can be found. Examples include fibromyalgia syndrome and irritable bowel syndrome. Assigning a name to symptoms can be reassuring but it does not make the condition more or less “real.”

Focus on improving symptoms

There are times when even the smartest health care provider cannot come up with a logical, compelling or even reasonable explanation for a person’s symptoms. In those cases, it is important not to get too focused on explaining or labeling them. Instead, the doctor should focus on:

Not missing some important clue

Treating the symptoms

In many fields of medicine, doctors spend all day improving symptoms rather than making a diagnosis. Headache specialists, for example, must be convinced there is no brain tumor, no meningitis, and no other serious and treatable cause of the pain. But once that happens, attention turns toward treatment rather than on sorting out a specific cause.

This can be frustrating for both patients and doctors. But until we understand the specific causes of common conditions like headaches, back pain, ringing in the ears (tinnitus) and chronic fatigue, controlling symptoms, not a name, is what will help the most.

The bottom line

Once again this shows that there is more uncertainty in medicine than most people think. But that does not mean a person is imagining their symptoms.

As I see it, debating the “realness” of symptoms is often a waste of time. Unless a person is deliberately “faking” symptoms (a rare event in most doctors’ practices), they are just as real as for those with an observable, measurable and testable condition.

Having names are nice, but they are not always helpful. All other things being equal, I would rather have a nameless condition that is well-treated than a definite, but untreatable diagnosis.

Copyright © 2009 by the Presidents and Fellows of Harvard College. Used with permission of StayWell. All rights reserved. Harvard Medical School does not approve or endorse any products on the page. Harvard is the sole creator of its editorial content, and advertisers are not allowed to influence the language or images Harvard uses.


About jeanne hambleton

Journalist-wordsmith, former reporter, columnist, film critic, editor, Town Clerk and then fibromite and eventer with 5 conferences done and dusted. Interested in all health and well being issues, passionate about research to find a cure and cause for fibromyalgia. Member LinkedIn. Worked for 4 years with FMA UK as Regional Coordinator for SW and SE,and Chair for FMS SAS the Sussex and Surrey FM umbrella charity and Chair Folly Pogs Fibromyalgia Research UK - finding funding for our "cause for a cure" and President and co ordinator of National FM Conferences. Just finished last national annual Fibromyalgia Conference Weekend. This was another success with speakers from the States . Next year's conference in Chichester Park Hotel, West Sussex, will be April 24/27 2015 and bookings are coming in from those who raved about the event every year. I am very busy but happy to produce articles for publication. News Editor of FMS Global News on line but a bit behind due to conference. A workaholic beyond redemption! The future - who knows? Open to offers with payment. Versatile and looking for a regular paid column - you call the tune and I will play the pipes.
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