Can I just take a minute to clear something up?
This is an issue that comes up for me with patients probably every week if not most days. It’s about pain. Many patients present to the doctor with a main problem which is about pain. The way doctors are trained is to focus on making a diagnosis. Now, that’s a good idea. I always tell people we can’t figure out what might help until we understand what’s wrong. But the problem arises with the dominant medical paradigm, which is known as the “biomedical model”. This model has been around for three or four hundred years now and it focuses on the concept of disease as a lesion. By lesion I mean something objective which can be observed, or measured.
Two problems arise from this rather mechanical model. First is that if a lesion can’t be found the patient’s symptoms tend to be dismissed as psychological (or worse – pretended!) Anyone who understands health and illness will know that this is nonsense. You don’t need to find a lesion to accept, understand and attempt to alleviate a human being’s suffering. Second is that symptoms and lesions do not exist within a linear relationship.
Pardon?
Well, let me take the example of pain. Let’s imagine someone has a disease where we can see and measure the lesion – cancer would be a good example. There is no simple relationship between the cancer and the amount of pain a person experiences. Two people with the same cancer of the same size in the same part of the body can have utterly different experiences of pain. And any one person can have a cancer that changes size (getting bigger or smaller) without any significant change in their experience of pain.
There is no direct, linear relationship between a pain and a lesion.
Strangely, a lot of people don’t understand that (and I include a lot of doctors there) but it should never be forgotten. Pain needs to be addressed, understood, and managed as pain. It cannot be understood, and managed effectively as a manifestation of a lesion.
This is the value of a holistic, patient-centred approach to illness. The focus is on the person and their experience, not exclusively on their lesions. Pain is real. It doesn’t become unreal in the absence of a lesion.
Heroes Not Zombies 
Isn’t it interesting that pain manifests itself in so many different ways – and many of them in ways no consistent with whatever “condition” a patient has?
I have a terrible time trying to describe the pain I get from my periodic outbreaks of shingles, and I’m someone who spends a great deal of her time with language; I consider myself to be pretty skillful with words, and yet I can never adequately describe that particular sensation. I often wonder, too, if the images that patients are able to create with their words are the same images that doctors form in their minds as a result of those words. The intersection of realities is always fascinating to me, though I tend to look at it more in terms of literature and interpretation than I do in terms of medicine and diagnoses.
I think a lot of it has to do – yet again – with our ability, or not, to empathize. We just keep coming back to that, don’t we?
mrschili, yet again you’re right on the money. Your example of what’s called “post-herpetic neuralgia” is a really good one. It’s quite a common and often debilitating complication of shingles yet there’s nothing to see and nothing to measure. It’s just pain!
You’re right about the images we create with our words allow our subjective realities to connect and be understood. It is, as you say, about empathy.
I was glad to read of this here. Over ten years ago I almost died from “it’s all in your head.” Thankfully something else broke and they found the problem just in time.
Suzi, sadly, you won’t be the last to have an experience like that. Have a read of the review I posted about Dr Groopman’s book “How Doctors Think” – it’s pretty insightful, and I really hope becomes a recommended text in medical schools – then, maybe, LESS people will suffer what you did