Opinion: How bad is healthy supposed to feel? — SkimNews
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- Kirsten Balin sees a 43-year-old patient who lost 50 pounds and has a normal exam, vital signs and labs, yet misses the stamina she ran 5 miles a day with at 23 — while working two full-time jobs and raising three children alone.
- Balin says the recurring question in her exam room has shifted from "Is something wrong with me?" to "Am I normal?" — medicine, she writes, is so good at finding answers it is being asked questions it was never designed to address, including how tired ordinary wear and tear should feel.
- Balin insists fatigue still gets investigated for sleep apnea, anemia, thyroid disorders and cancer, noting lives have been saved because vague symptoms were worked up rather than dismissed.
- George Beard named neurasthenia — nervous exhaustion — in 1869, blaming railroads, telegraphs, newspapers and industrialization for fatigue, headaches, poor sleep and poor concentration; the label disappeared while the complaints persisted under chronic fatigue syndrome, autonomic dysfunction and somatic disorder.
- Balin acknowledges medicine's history of dismissing women's symptoms as anxiety or menstruation, and argues that taking patients seriously does not mean every symptom must be labeled as disease.
- Instagram wellness influencers become the comparison standard in Balin's account, with up-at-dawn red light masks, vibration plates, green smoothies and 5-mile runs, so the yardstick is no longer peers but an algorithm curating optimization.
- Balin answers her patient that this is what 43 feels like with two jobs and three kids — "This isn't an abnormality in search of a diagnosis. It's life."
Why it matters: For the clinicians Balin describes, the consequence is a split workload: fatigue still gets investigated for sleep apnea, anemia, thyroid disorders and cancer, while the wear of two jobs and three kids gets a conversation instead of a diagnosis. For women, whose symptoms have historically been waved off as anxiety, that conversation is a safeguard that cannot be lost.
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