At the end of a diagnostic impasse

Mr. V. does he have polyarthritis?

Patient seen this week, Mr. V. He has just moved to New Caledonia. Diagnosis of rheumatoid arthritis made in France by a distinguished colleague. Hasty? Treatments do not work, are quickly stopped for marked side effects. And above all: no clinical symptoms of polyarthritis, only multiple pains and no visible abnormalities.

The diagnosis has been made on these exuberant pains for several years and a positive rheumatoid factor . Moderately positive, without inflammatory syndrome. Autoimmune abnormalities of which this factor is a part (presence of antibodies directed against our own cells) are common at low levels. It is not easy for our leukocytes, brave policemen who watch for undesirables inside, to spot the tens of thousands of antigens allowed in the middle of the hundreds of thousands that can arrive from outside.

The brake is brutal

Traces of autoimmunity are therefore banal, harmless as long as they do not trigger an extensive mobilization of killer lymphocytes. The positivity of this patient’s test is, in isolation, only a risk of developing true progressive polyarthritis, of which he currently has no signs.

But Mr. V. does not mean it that way. I have just denied him the existence of a chronic and potentially severe disease, perfect label for his unbearable pains. Wouldn’t it be anything serious? Inconceivable.

Polyarthritis is not difficult to treat

Patient, I explain to him that polyarthritis are diseases today easy to treat for the rheumatologist. Successive levels of treatment make it possible to control almost all of these conditions. The majority of polyarthritics lead a normal life. Absent or discreet pain, and when it persists, tests immediately show the reason. Inflated joins confirm.

Nothing to do with the highly unbearable painful state of Mr. V, associated with normal joints. His body, better informed than his consciousness of biological normality, refused all the useless poisons that they wanted to inject into him. The systematic side effects show above all the nothingness of benefit, and the at least unconscious conviction of Mr. V. that these treatments are useless.

A rebellious consciousness

Only consciousness is not aware. How can it be so wrong? It committed itself to an observation: “This very uncomfortable body necessarily has a severe disease”. A pre-supposed diagnosis of which it seeks confirmation from docile doctors and of course from the immense ocean of information available on the net.

Mr. V. confirms by sending me by email, a few days later, a long dissertation and no less than 15 attached files on rheumatoid arthritis, intended to support his self-diagnosis. “You see! Everywhere it is confirmed that I have every chance of having this disease!”

But he doesn’t have it. And maybe this is not a chance, since polyarthritis is easy to treat. He suffers, you may have guessed, from fibromyalgia, a pathology much coriaceous but devoid of any vital threat. It is the subject of a separate article on this blog.

What mistakes led Mr. V. at an impasse?

It is not, for him, to simply change one diagnosis for another. The impasse is much deeper. How to turn around, tightly surrounded by the walls of polyarthritis, whose summit is lost in the infinite spaces of the networks? Backing up without seeing, without understanding the reason? Impossible for Mr. V, convinced that there is only one reality, that his is the universal. This is his first mistake.

The walls are dummy. They exist only for him. He put on a straitjacket on a body that is fed up with this unnecessary restraint. Which wants to live fully. Which demands from its consciousness less appetite for examinations and medications, and more discernment.

Difficulty trusting your body

The problem of communication between the body and the consciousness of Mr. V. has a simple cause: the second has formed a wickedly distorted image of the former. Image of delicate mechanism, fragile, exposed to all malfunctions, requiring careful care because unable to repair itself.

This image is as false as its opposite, a body that would take without flinching all the voluntary intoxications, drugs, tobacco, sugar etc. The truth is right in the middle: the organism is a self-organization that always seeks to return to a range of balance. It informs its central nervous system of favorable behaviors by a great wealth of signals.

Let reflexes work

The best way to stay healthy is simply to experience this information and let it act, without further interpretation. Hunger tells us when to eat, taste how to select food. Information processed at unconscious levels, for the most part. No need to pay attention to it. Imagine that it is necessary to consciously coordinate the hundreds of thousands of tiny impulses that provide information on joint positions, tendon tone and the consecutive orders to be sent to the countless muscle fibrils, before moving!

A healthy body allows you to dream all day, if someone fills your plate. But our daytime dreams, today, have given way to surfing on information networks. Bulimia of abstractions about the body from which consciousness is trapped. They eject the natural reflexes patiently installed since birth. Too bad. These reflexes are less sophisticated, but incomparably more personalized. Intimate knowledge is replaced by general knowledge. Second mistake, more serious.

If Mr. V. experienced his sensations without interpreting them, he would know intimately that he has no disorder of the polyarthritis type. Interpretation is an opaque screen for one’s perceptions. It is formed in a purely abstract and not physical way. Pain is stripped of all its richness of content by its intensity in consciousness, which reduces it to “I am (unbearably) in pain”.

Civilizational drift

At the end of his impasse, Mr. V. firmly believes that he is in the right direction. Because it is always possible, today, to find a sign that confirms it. So multiplied on the networks that it is easy to choose the one we need. The net is an information market where we shop according to our taste. Favorite merchants, influencers, they orient from an idea with us of the necessary. Fridge and cupboards are not filled randomly. The vision of the world to which we have rallied guides our choices.

This way of shopping, in terms of information, leads directly to conspiracy theory. The search result is already in the lead. Only interpretations that confirm this are accepted. Raw data? Impossible to process. Less accessible, too scattered, lack of expertise that becomes glaring (who knows how to spot a statistical bias in the data collected?).

Conspiracy theory, let us remember, is not to uncover a real conspiracy (whistleblower). It is to cling to a single interpretation and see all the others as conspiracies against “his” truth. It wins in fiction movies, which flatter our fantasies. Rarely in real life. When it comes to illness, the person seeks to make the diagnosis coincide with self-image and idealized health. He knows the result before paying attention to the data, recalibrates them in this sense.

The vulnerability of the painful on the networks

This bias is facilitated when pain is the master symptom. Severe pain is a raw, blinding fact. It is a screen for the finesse of perception. Consciousness becomes unable to access the details of sensations. This opaque screen causes Mr. V.’s blindness. and makes it vulnerable to multiple influences of the net. Disconnected interpretations of body data. Those used are statistical or belong to foreigners with the same symptoms. In consciousness settles any fantasy, rather the one that satisfies the self-image. It ends up erasing the contradictory perceptions, helpless specters behind the dazzling pain.

It is a commonplace to say that pain prevents us from thinking. But in its chronic form it is worse: reflection is no longer connected to its essential data. Specialized psychologists promote reconnection by verbalizing pain: Describe it. What are its nuances? What would you compare it to? If you made a fable out of it, what would be the beginning and the end? The patient’s pain becomes “his own” again and not the reproduction of those read or heard elsewhere.

Experience by the person and diagnosis by the collective

Knowledge of a disease has two facets: personal and collective. The personal is paramount. A good doctor can make a diagnosis that the patient experiences as false. The latter is often right because this direct experience is irreplaceable. The diagnosis should confirm rather than contradict it. Not shareable with the doctor, it also deserves to be verbalized. Unfortunately, the patient’s inexperience and difficulty in confronting the doctor’s technical discourse are an obstacle.

A situation that is becoming rarer, replaced by the opposite excess. The patient competes with the doctor rather than expressing his sensitive data. Real competition for diagnosis! Which is unlikely to confirm the patient’s hopes.

The collective facet of knowledge, in fact, is not measured in hours of surfing or reading. Medicine is neither an accumulation of health data, nor the first conclusion that comes to mind. It is, among the possibilities, to find the most suitable for each case. The more the aspiring doctor chains the diagnoses and verifies them, the more he improves his personal algorithm. Becomes experienced. A story without end credits.

The practitioner, an artist?

I try a daring analogy with Botto, the AI artist who ends up making millions of dollars. Not with its early works. It took a long training and supervision of a human audience for its digital production to fascinate. The emeritus doctor has a similar history: first uncertain diagnoses, subject to the verdict of additional assessments and therapeutic tests. Up to the sure eye, the sharp brain, the expert that everyone wants to consult.

Medical knowledge is not a collection of data but a tree of thought that even the most gifted apprentice will take years to appropriate. Each sign has a specific weight in each context and makes a branch take.

Specify the individual case by the complex look

Complexity that does not appear in any way in the general and statistical studies available on the net. Making a coherent synthesis is already a difficult job, outside the skills of a youtuber without specific training. But applying it to a personal story is impossible. The researchers themselves, at the origin of these studies and less available to consult, appreciate discussions with caregivers, to verify that their conclusions are not contradictory with real life.

This is the last mistake of Mr. V, corollary of the previous ones: to confuse the personal and collective knowledge of his disease. Mistake from which doctors are not immune! They routinely make fanciful diagnoses about themselves that they wouldn’t have done on others! It is better to divide the roles of patient and judge. Here Mr. V. is not a good patient because cut off from his fine sensations, and bad judge because disputing the role to more expert than him.

We turn around when we are alone, but can we still be alone today?

So he has very little chance of getting out of it. Should I make him read this post? Poor initiative when he is still to force the way into his impasse. The cost of the U-turn is too high. All those relatives to whom it would be necessary to announce the absence of a universally recognized disease, after having made it one of the centers of his life. Mr. V. will relentlessly, look elsewhere for confirmation of his polyarthritis.

In his situation it sometimes takes years for the radical mobilization of consciousness to fall, for the observation of being really at an impasse to emerge. Mr. V. will turn around when no one orders him to do so. It is still necessary to have pointed out to him that he is in the wrong direction. My role ends there.


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