The question before the cure

“The unexamined life is not worth living.”

Socrates, in Plato’s Apology

Socrates was condemned for asking questions. He spent his life questioning important people until the easy explanation fell apart and what was really happening remained. He had no ready answers. He had a method.

Good medicine is the same exercise.

What do you feel?

Imagine someone who says they have been tired. Not ill: tired. They sleep, but wake without drive. They read a report and have to go back to the start of the paragraph. They have lost patience with people they love. At another point in life they would have called it a phase. Now they suspect it is something else.

It could be many things, and that is where the difficulty lies.

It could be low iron, which leaves the blood carrying less oxygen to the brain than it asks for. It could be low vitamin B12, which tends to show up in memory and mood before it shows up in a blood count. It could be low B1, quietly consumed by the glass of wine every evening. It could be a thyroid running slightly below where it should. It could be sleep that seems sufficient and is not. It could be an enzyme that, because of a small genetic variation, processes certain vitamins more slowly than in most people.

And it could be the mind. A grief that was never lived, a weight carried alone, a decision postponed for months. Or simply a head that will not switch off. Dostoevsky gave one of his characters a line many people recognise in silence:

“To be too conscious is an illness, a real, thorough-going illness.”

Some minds tire not from doing too little, but from thinking without rest.

What changed?

It is almost never one thing. More often there are two or three, each making the other worse. Low iron disturbs sleep; poor sleep darkens mood; a low mood changes how one eats and drinks, and the circle closes. Each of these causes has a simple treatment. The hard part is knowing which are present, to what degree, and which one is pulling the others.

That is why the questions matter more than they seem. It is not enough to know when the fatigue began. It matters what began with it: a new medication, a move, a partnership that ended, a child who left home, a whole year of night flights. And what the person stopped doing without noticing: the training put off until later, the books no longer opened, the friends no longer seen.

What was not said?

People tend to bring to a doctor the complaint they consider acceptable. The other one, the one that truly weighs, sometimes appears only in the second conversation, or the third. Listening is also examining.

There is an understandable temptation to skip all this. A symptom asks for relief, and relief exists: something for fatigue, something for anxiety, something for sleep. It works for a while. But relief without understanding is switching off an alarm without looking for the smoke.

What is its exact name?

What separates a good diagnosis from an excellent one is giving an exact name to what was found. “Stress” is not a name. “B12 deficiency from long-term use of a stomach medication, together with sleep broken by pauses in breathing” is a name. With the right name, treatment stops being an attempt and becomes a decision.

It is also necessary to know when to stop searching. Investigating everything is not rigour; it is anxiety by another name. A good question has limits: it looks for what could change a decision and leaves alone what changes nothing.

In the example at the beginning, the fatigue had three causes. None serious, all treatable. With the right treatment, clarity usually returns within a few weeks. What takes time is finding them.

If the unexamined life is not worth living, the unexamined symptom should not be treated.