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."
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.