Why take a syndromic approach?

July 26, 2022
By Vishal N. Patel, MD PhD

In our search for meaning, we often focus on the trappings of fulfillment and purpose, and we overlook how the afflictions of our body and mind affect our view of our self. When our physical body is disturbed –disordered, dysregulated, and even diseased – it affects us at a profound level: we question the body we have, how it came to be, and what is yet to come. A physical affliction introduces a new discordance into our view of ourself, and we often begin to grapple with this discordance by, first, labeling our afflictions. These are our signs, symptoms, disorders, and diagnoses. I call these “biomedical labels.”*

These labels mark the beginning of a long and uncertain journey, fraught with medical tests, trial-and-error remedies, and second and third opinions. When it is first bequeathed upon you, the label itself is meaningless: apart from indicating a course of treatment, a biomedical label does not inherently reveal more about you, and it does not allude to the significance of your ailment.

Eventually, some of us will find meaning in a biomedical label: we will find others who are suffering in kind, and, through the recognition of a shared experience, we will find solace in knowing that we belong to an ICD-10 code. We may even begin to identify with the label, for it signifies hardship and loss, a lifestyle and a mindset.

The rendering of a biomedical label could be a momentous occasion in one’s life, for, more often than not, it marks a turning point, but I lament how long it takes most of us to reach this point. What if we could use the biomedical label – the sign, the symptom, the disorder, or the diagnosis –as an opportunity to reframe your existence, to establish your bearings as you embark on the next, most arduous leg of this journey? What if the diagnosis was not merely a label to route you through the healthcare switchboard, but, rather, a sign in itself? Like a celestial body, both illuminating the ocean around and facilitating our navigation ahead, the label itself could continue to guide us when the journey becomes uncertain.

I believe this is possible through a syndromic interpretation of signs, symptoms, disorders, and diagnoses. Syndromes are a collection of co-occurring symptoms and, if we cast a broad enough net, the range of symptoms can include disparate elements of body, mind, and soul. With a syndromic context, a diagnosis, like IBS, would be rendered along with a story: what can we infer about your past, present, and future from this syndrome? In this instance, we can confidently infer that you have suffered from GI issues since childhood (ref and ref), that your feelings – particularly your stress – tends to be most noticeable in your stomach (ref), and that you may also suffer from anxiety or depression (ref). For your future, we can reassure you that, as life-threatening as it may feel today, this syndrome will not shorten your life (ref and ref). In the present, we can use this diagnostic label to help you notice other parts of your body: individuals with IBS tend to suffer from greater autonomic dysfunction, meaning that your recent urinary incontinence, erectile dysfunction, heart palpitations, and heart burn are all connected to what is happening in your gut (ref).We can even draw from the great syndromic traditions – Ayurveda and Traditional Chinese Medicine (TCM) – for added context: in Eastern traditions, IBS is conceptualized as a loss of digestive fire, called agni in Ayurveda or spleen Qi deficiency in TCM. According to the Eastern traditions, your IBS arose due to an imbalance in your behaviors – often an overindulgence in food, pleasure, or work, and a disregard for the innate rhythms of your body. If identified early enough, the Eastern traditions hold that it can be remedied by rekindling the digestive fire and by creating more balance and rhythm in one’s life.

As meaningful as all this could be, most medical labels, alas, are rendered as mere descriptions of your presenting signs and symptoms. At worst, a label confirms your most insidious fears, and, at best, it reassures you that you don’t have cancer – a grim value proposition, either way.

My sincere hope is for your wellness journey to be meaningful: a medical label can teach you much about yourself, beyond your physical body. I aim to bring both biomedical research and Eastern traditions to bear in imparting meaning to your labels, so that the next leg of your wellness journey begins on a lighted path with an identifiable constellation to guide you.

If you are interested in elucidating the patterns in your body, you may book a syndromic consultation with me here.