Proactive vs. Responsive Medicine
By Jen Kost, MSW, LCSW, PMH-C
As a perinatal mental health therapist, I often sit with people who are not only navigating physical symptoms, but also the emotional toll of not being believed. Long before pregnancy or postpartum enters the picture, many have spent years trying to understand their bodies—chronic fatigue, irregular cycles, pain, inflammation, mood shifts, unexplained weight changes, recurrent loss, infertility. Conditions like autoimmune diseases, PCOS, endometriosis, thyroid disorders, and hormone-related challenges frequently live in the gray space of medicine: complex, nonlinear, and difficult to diagnose.
Much of modern healthcare is built on responsive medicine—treating what is immediately visible, measurable, or acute. A lab value is out of range, so a medication is prescribed. A symptom flares, so it is suppressed. This approach can be lifesaving and absolutely necessary. But for many chronic or hormonally mediated conditions, it can feel like putting out fires without ever asking why the building keeps igniting.
When Symptoms Are Treated but Causes Remain Unnamed
Many of my clients describe a familiar pattern:
“Your labs are normal.”
“This is common.”
“Stress can do that.”
“Come back if it gets worse.”
Over time, this can quietly erode trust—in the system, in providers, and often in one’s own body. When symptoms persist without explanation, people may internalize the message that they are exaggerating, anxious, or difficult. In the perinatal world, this is especially painful. Fertility struggles, pregnancy loss, postpartum mood disorders, and chronic illness intersect with identity, grief, and hope in profound ways.
Proactive Medicine As a Mindset, Not a Replacement
Proactive medicine doesn’t reject conventional care—it expands it. It asks different questions:
What patterns have been present over time?
How do hormones, inflammation, stress, sleep, nutrition, trauma, and environment interact?
What happened before the diagnosis—or before the symptoms began?
This is where some people find value in integrative or functional approaches, which tend to look more closely at systems rather than isolated symptoms. For many, this feels less like “alternative medicine” and more like finally being seen as a whole person. Importantly, proactive care is not about perfection or control—it’s about curiosity, collaboration, and prevention where possible.
The Psychological Cost of Not Being Believed
From a mental health perspective, repeated dismissal can be traumatic. Medical gaslighting—intentional or not—can lead to anxiety, hypervigilance, shame, and depression. People may delay seeking care, doubt their intuition, or feel responsible for not “trying hard enough” to get better.
In reproductive and perinatal contexts, this compounds quickly. When bodies don’t respond as expected, many people experience grief not just for outcomes, but for the relationship they once had with their body.
Advocating in a Symptom-Focused System
Advocacy should not be required—but often it is. Some gentle, practical strategies clients have found helpful include:
Documenting patterns over time (cycles, symptoms, triggers, treatments tried)
Asking direct questions, such as: “What could we be missing?” or “What would you test if this were happening to you?”
Requesting second opinions without apology
Bringing support, such as a partner, friend, or written notes—especially when conversations feel overwhelming
Naming impact, not just symptoms (“This is affecting my ability to work, conceive, sleep, function”)
Advocacy is not confrontation. It is self-respect in action.
Holding Both/And
As a therapist, I often encourage a both/and approach:
Evidence-based medicine and deeper inquiry
Symptom relief and root-cause exploration
Trust in providers and trust in oneself
Your body is not a problem to be managed—it is a system communicating something important. Sometimes the work is medical. Sometimes it is emotional. Often, it is both.
A Final Word
If you are on a long diagnostic journey, struggling with fertility, managing a chronic condition, or simply sensing that something isn’t right—you are not imagining it. Needing more time, more questions, or more support does not make you difficult. It makes you human.
And while the healthcare system may still lean heavily toward response rather than prevention, you are allowed to ask for care that treats not just symptoms—but you.
