Biography as Biology

I’d first come across this phrase during a lecture by psychologist and medical intuitive Carolyn Myss, PhD, at a meeting of the American Holistic Medical Association and later reading some of her books, especially Why People Don’t Heal. In it she explores the common problem of people with chronic symptoms and negative test results, delving into how these symptoms develop and what might be done to help them.

The heart of the matter, I soon came to realize, was, and continues to be, an essential flaw in the education of virtually all doctors–namely, an almost willful ignorance of the patient’s full life story. This failure to recognize how a person’s biography might influence her biology can place a real barrier between an ill patient and her doctor’s efforts to help.

It starts with what goes wrong in medical school

Medical students and physicians of all ages know the following initials by heart: CC, HPI, PMH, FH, SH, ROS. These are abbreviations for the questions asked in order to obtain the medical history of any new patient whose symptoms need to be diagnosed and treated appropriately.

• CC Chief Complaint is one sentence in the patient’s own words. For example, “I’m tired all the time.”

• HPI History of Present Illness are the patient’s answers to the doctor’s questions about when the symptoms first appeared, how they’ve progressed, and what other symptoms have been noticed along the way.

• PMH Past Medical History represents any other significant illnesses, surgical procedures, allergies, and the like.

• FH Family History stands for any significant family illnesses that might carry genetic risks.

• SH Social History is a series of lifestyle questions: occupation, tobacco, alcohol, other drugs, sexual partners, diet, etc.

• ROS Review of Systems is a lengthy questionnaire (often filled out by the patient before seeing the doctor) covering all other areas of the body.

This universal format has been written in stone for decades. It’s one reason why your medical records can be transferred around the country and be completely comprehensible to any physician you visit. I might add that it would be easier to parallel park the QE2 than to get medical schools, medical associations, and several hundred thousand physicians to agree on changing it.

But, to the peril of the patient, this format completely ignores what happened in the patient’s life during the months, or even years, before the appearance of her first symptom.

And this, Dr. Myss felt, was a key reason people didn’t heal. Not only did doctors fail to tease out this potentially valuable information, but patients themselves, seeking some medical explanation for their symptoms, would overlook what was staring them in the face. As a result, they’d be subjected to endless tests, often all negative, and would leave their doctor’s office having heard (yet again), “We can’t find anything wrong with you.”

Here’s an example of what Dr. Myss is talking about

Some years ago I had a patient in her fifties—let’s call her Pam–who told me she’d been utterly exhausted for five straight years. She’d seen numerous physicians around the country, both conventional and alternative, been given a wide variety of medical advice (including a shopping bag filled with supplements), and also brought in for my review a ream of generally unhelpful test results. In the end, nothing had helped. Pam remained exhausted.

But her biography? It could have been the subject of a drama on survival skills.

She’d been raised with her siblings by a mentally ill mother and a mostly absent, emotionally distant father. Her mother, long dead, had physically, emotionally, and sexually abused all of them from early childhood. All her adult siblings were now drug addicts or alcoholics. Pam herself had started out as an alcoholic runaway and had lived with a series of abusive men. However, blessed with an iron will, by her thirties (despite struggling with depression and self-esteem issues) Pam had created her own business and over the years became financially independent.

She’d also believed she’d entered a good marriage during her thirties, but her husband had transformed into yet another abusive man and they divorced a few years later. After the divorce, Pam became deeply depressed, and to deal with her plummeting self esteem underwent cosmetic surgery, which failed. (By the way, having cosmetic surgery after a difficult divorce is very common.) Shortly afterward, she’d lost her business, and shortly after that she’d become so fatigued she was unable to function.

Ultimately, her psychiatrist, rather than her internists, would make the correct diagnosis, likely because the psychiatrist had delved into Pam’s biography and understood its connection to her biological response. Her diagnosis was post traumatic stress disorder, her exhaustion a result of the repeated flogging of her stress-responding glands, the adrenals and thyroid.

Sadly, psychiatrists and internists virtually never communicate. Although her psychiatrist had been extremely helpful in getting her life back on track, Pam’s other physicians, by ignoring her biography, completely missed the connection between the life she’d lived and her exhaustion.

All they could tell her was that all her tests were normal.