Have You Been Saddled With a Garbage Can Diagnosis? Part I
As a chiropractor I was often the last resort for someone whose experience with previous health care practitioners was less than satisfying. Kinda goes with the territory when working in a fringe profession. So, neither one of us had anything to lose. I would either be the latest source of that person’s dashed hopes or I’d be able to bring a fresh set of eyes and find something the doctors missed.
One of the shortcomings of the medical model is its reliance on diagnosis. A doctor often lives or dies with it, and so will the patient. This jump to identify and label can actually impede a healing process because it can severely restrict the condition’s freedom to reveal itself. Instead of witnessing what’s going on in front of us, we impose a diagnosis that is generated by the intellect and its relentless obsession to categorize, explain, and rationalize.
The establishment of a diagnosis is treated as a victory of sorts, as if to say, “now we know what we’re dealing with.” When our intellect feels like it has reached a resolution of sorts, then it will often abort all further investigation and fall into the default protocol associated with that particular diagnosis. All it does is relieve our poor assaulted psyches of the anxiety of uncertainty. Well, certainty is often our worst enemy.
Also, the next step after diagnosis is to suppress whatever has just been named. So, say goodbye to finding root causes if the goal is simply to push everything back below the surface and turn off the body’s distress signals. In the rush to identify and suppress, the clues to the condition’s source are trampled.
This is especially true of a so-called “garbage can diagnosis.” It’s a label that is slapped onto a symptom or group of symptoms because the practitioner doesn’t feel that the principle of do no harm extends to a willingness to say “I don’t know.” As health care practitioners, we sometimes trick ourselves into thinking that we have someone’s best interests in mind when all we’re doing is covering our ass as a professional.
GCD’s are superficial umbrella terms used to classify symptoms that can have a wide variety of possible origins. A GCD is a prime example of using language to obscure rather than clarify, something American culture has elevated to an art form in more arenas than we can count. For example, the diagnosis of sciatica might be applied to a condition whose root cause might be any of the following: muscle spasm, lumbar disk bulge or herniation, infection, fibula misalignment, or repressed grief.
GCD’s also worm their way into everyday language, which accentuates their superficial nature. The words “TMJ,” “impingement syndrome,” “chronic fatigue syndrome,” “fibromyalgia,” “tendonitis,” and “bursitis,” glibly trip off our tongue like we’re talking about the latest hijinks of some Hollywood beefcake.
A good indication that you’ve been slipped a GCD is that you don’t significantly improve with the treatment protocol that accompanies the diagnosis. The condition ends up being managed rather than resolved because the diagnosis is a cop-out in the first place, and thus can leave a person in health care purgatory for years. It can cause even more pain and stress for the patient just because someone thought they needed to give a name to something.
I’m only going to cover some of the most common ones I’ve encountered, and I’ll be making generalizations that are based on my own experience.
Fibromyalgia: This is the mother of all GCD’s. There was surely dancing in the streets in the medical community when this diagnosis finally hit the streets. No longer did GP’s have to wince at seeing these folks in the waiting room, and have the joy of telling them after a 30-minute phantom evaluation that “it’s all in your head.”
Conditions like these of global pain or chronic fatigue often remain mysteries because their origin is precisely in that area that most practitioners and patients don’t want to go–repressed emotions. This doesn’t mean that the physical pain is not real; it most certainly is as real as the pain from an acute ankle sprain. The difference, though, is that the pain is being generated by the body to inform the person that unless these emotions get some expression, the pain will persist.
One of the dangers of this diagnosis is that if the person is resolved to remain in the dark about their repressed emotions, now they’re free to use the diagnosis as official confirmation that there’s something wrong with them. So, the diagnosis becomes ammunition for behaviors and beliefs that further alienate the person from her/his true feelings. This is a GCD that can perpetuate a particularly brutal cycle of suppression, particularly if extended use of antidepressants is also part of the treatment protocol.
Pneumonitis, costochondritis, angina, thoracic outlet syndrome, dyspnea: I’ve lumped these together because I’ve seen them all applied to what turned out to be rib misalignments, which are quite common. This is sad, because rib misalignments are one of the simplest corrections to make, and generally provide a quick resolution to the problem. When ribs aren’t properly aligned, it can cause intense, knife-like pain, particularly with deep breaths and particular movements, such as twisting of the upper body. Other possible symptoms are numbness and tingling in the arm and hand, or poor circulation to the arm.
Ribs can be misaligned both in the front where they join the sternum, producing a pain which can mimic heart-related symptoms, or in the back where they join the spine. The cause is generally an acute injury, such as a fall or car accident, repetitive stress, or a period of intense coughing and/or sneezing.
Stay tuned! Part II of this blog post will include old favorites like TMJ, carpal tunnel syndrome, leg length inequality, plantar fasciitis, scoliosis, tension headaches, and chronic low back pain.