To be well is not the same as to feel well.
Being well requires some sense of invincibility. No one is spared symptoms for long.
It's abnormal to go one year without upper respiratory symptoms or pain.
Lurking in our future are heartache and heartburn, shoulder and knee pain, headache, rashes and skipped heartbeats -- not to mention bothersome fatigue, sore muscles, bowel irregularity, insomnia and so much else to challenge our sense of well-being.
Nearly all of these predicaments can go away as mysteriously as they come about. To be well requires the wherewithal to cope with these ailments for as long as that takes -- and it can take weeks.
If you experience crushing chest pain or excruciating headache, if you have a fever and are coughing up green sputum, if you start vomiting blood, common sense and your caring community demand that you seek the attention of a member of my guild, the guild of physicians and surgeons. No other course is reasonable.
These are not ordinary predicaments of life -- they are extraordinary. Only my guild can respond in the affirmative if you ask whether you are clearly more likely to be aided by our ministrations than not.
Most symptoms are not so extraordinary. We have options to consider. In the last decade, epidemiologists have ventured into the community to study how we cope with these predicaments of life. Most of us, most of the time, cope on our own.
"On our own" does not denote a vacuum; we are bombarded by advice and advised ceaselessly to avail ourselves of all kinds of unctions and potions and widgets. Rare is the person who does not succumb; American medicine cabinets bear witness.
All this "help" is a cultural phenomenon fostered by legions of purveyors, a cultural phenomenon with roots in antiquity and with inventiveness across time and cultures that boggles the mind.
It's a waste of money to participate -- unless you like the taste (chicken soup, fish and garlic are examples) or the feel (massage, meditation, and girding your loins are examples) -- and a waste of breath to decry it.
For most of us, most of the time, our symptoms improve no matter what we do. When the particular symptom recurs, we are likely to cope as we did the last time, convinced that what we did or what we took or what we avoided was the reason we got better. So be it.
For some of us, some of the time, coping on our own seems inadequate. In all likelihood, we are not overwhelmed by the intensity of the symptoms. Rather, something else in our lives is compromising our ability to cope, something adverse in our lives at home or at work, something financial or interpersonal that renders the symptom the "last straw."
Are many of us destined to seek out someone who offers to fix, heal or cure the "last straw" and ignore all else that is making it so hard for us to cope?
The Language of Modern Medicine
We all need to get beyond the traditional complaint of "what's wrong with me, Doc, that I have this symptom?" and move on to more rational discourse, such as "is there any important disease that is causing my symptom? If so, can it be treated? If not, can we discern why I can't cope with this episode?"
For nearly all the predicaments of life we're discussing, a medical doctor can determine quickly if a terrible disease is lurking, often just by taking a history and doing a physical examination, and occasionally some simple testing.
If this leads to a "maybe you have …," beware. Diagnostic uncertainty in the absence of demonstrable disease should be reassuring enough.
Don't let doubts trip you up; if the doctor's approach was thoughtful and still came up empty-handed, get on with life and coping.
And don't leap to swallow "symptomatic treatment." The prescription of such treatment carries with it the notion that pills will help you cope.
Since nearly all the drugs you hear about are marginally effective for these predicaments of life, you are setting yourself up for disappointment and desperation. All have adverse effects which may further compromise coping.
None of this should surprise you since treating the symptoms is missing the point. There are other warnings regarding the approach taken by my guild.
No patient escapes a physician's office unchanged. You will learn a new language, the language of biomedicine. You will never forget these new words and the awful specters they suggest.
So much for my "dirty linen."
The Lure of Alternative Treatment
Many of you will shop among the alternative therapies. All offer the promise of a special insight into the cause of your predicament.
Most want to do something to you, apply a "modality" for which application the therapist has acquired some special skill. These modalities are treatments offered with the promise that they will fix whatever the therapist has determined to be the root cause of your predicament.
These are theories and beliefs, none of which have survived scientific scrutiny. Nonetheless, you will learn to speak their language: parts that want yanking and those that want soothing, spots that merit probing or sticking and spots that should be spared, chemicals that are unbalanced, missing or threatening, and the like. You will learn to think of your body in their terminology.
And if all they offer and all they say is appealing, comfortable and sensible, you will enter a long-term relationship based on trust, which invests power in the therapist.
Realize that nearly all "modalities" have been subjected to scientific scrutiny and fare even more poorly than the symptomatic pharmaceutical treatments discussed above. You are choosing an alternative conception of well-being.
You will think in terms of nutrition, or malalignments, or vital forces. You will be changed forever.
However, your ability to identify why the predicament became the last straw will be lost in the new "alternative" language, just as it was in the biomedical jargon you learned from your medical doctor.
I can't blame you if you participate in any or all of these alternative experiences. I am saddened to realize how few of us have access to more effective support when we find our next predicament of life to be more than we can manage on our own.
All I can say is don't lose control of the process regardless of the alternative chosen. Don't lose your ability to say, "I am well without you."
And don't ask me to share the cost of any alternative that is not devoted to returning you to your prior state of well-being.
Dr. Nortin M. Hadler is a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and attending rheumatologist at the University of North Carolina Hospitals in Chapel Hill, N.C.