I do find the splitting of human beings in two apparently separate parts, body and mind, very odd. As I’ve said to patients, I’ve never met a mind without a body, and I’ve only met a body without a mind in the mortuary. Sure, it’s common for people think using a two-value system – right or wrong; good or bad; black or white – but it’s always a highly inaccurate way of describing reality. I’ve heard people wrangle over whether someone’s pain is in their body or their mind, and that seems a particularly peculiar question to me. In fact, I once I heard a health service worker describe a patient as “one of those people whose pain is all in their mind”. What did that mean? They were pretending to have pain? They were making it up? How do you experience pain without using your mind? Can we put the mind aside when considering pain?
I guess what people mean when they talk this way is where is the source of the person’s pain? Is it a physical lesion? Or is it a mental one?
I still don’t find that helpful. Surely we need to consider a person as a person, and a person with pain as a person with pain. Subdividing them isn’t helpful.
But, here it is again, in today’s Independent newspaper, that extremely odd tendency to consider human beings in two separate parts. In an article by Jeremy Laurence about research showing Cognitive Behavioural Therapy can be effective in people with back pain…..
Cognitive behaviour therapy is established as the most effective of the talking treatments and has revolutionised the way doctors approach psychological conditions such as depression and anxiety. But it is not usually associated with physical ailments such as back pain. The technique involves helping patients to break habitual ways of seeing things and to think positively instead of negatively. Zara Hansen, a member the research team from the University of Warwick said: “We are not saying back pain is all in the mind. It is very much a physical problem but the way you understand it affects the way you manage it.”
Physical ailments such as back pain? What does that mean? Does everyone with back pain have a physical lesion in their back? No, they don’t. Can cognitive behavioural therapy only help “problems of the mind”? How odd to consider patients in such divided ways. The researcher, Zara Hansen, promulgates the same peculiar thinking with her “We are not saying back pain is all in the mind. It is very much a physical problem but the way you understand it affects the way you manage it.”
Seriously, finding lesions which can be modified, repaired, or removed is one thing, but to consider a subjective phenomenon like pain as being divisible into physical or “in the mind”…….let’s move on. Far too many people with pain have had surgical operations to remove the claimed physical cause of their pain, only to find themselves with just as much pain as before.
People with pain deserve to be understood as whole people, and to have care which is suitably holistic. Otherwise, the pain remains…..
Wonderful Bob…. thanks
Great thoughts and comments Bob. I sent you some information which hopefully should add to this discussion.
This kind of dualistic thinking is ubiquitous and is probably embedded in culture , particularly biomedical culture. You have probably read this book by David Morris but looking at things with cultural and literary appreciation is probably helpful.
‘CBT’ seems to be a panacea for everything! Ron Melzack (of pain gate/neuromatrix fame) suggested that models are important as they influence how we act and behave. ‘Splitting’ models where people are fragmented is obviously important (in influencing disease states and obvious tissue trauma) but often makes many chronic pain states much worse as people bounce around specialist services.
However, practically it is clinically very difficult to ‘put people back together’ if they are unwilling or unable to look at themselves other than as a set of ‘isolated bones’ (as is the case with a lot of back pain interventions). People do try to offer ‘holistic’ treatments and approaches –pain association Scotland is a good example but the attrition rate from self management and therapy is very high. I feel a big problem myself is the lack of interest and understanding in pain science and perhaps in the philosophy of human suffering by many in the caring professions.
Thomas Egnew has a great paper on this- ‘Suffering,Meaning and Healing:Challenges of Contemporary Medicine’ which is available on line.
Meditation , climbing or anything which engages the whole of oneself certainly challenges the whole notion of dualism!
ian
I sent your post to my husband, he has pain. It’s called nerve damage and is so hard to get in front of. he is always treated so unkind by doc’s. I understand nerve pain I had shiggles and I have been 1 2 3rd degree burns it is so hard for people to beleave what pain can do. If you have never walked in thier shoes. My sister has pain to (it’s in her mind a gift from our father) and it is killing her it is real to her and I Know her pain to.
I think what is apparent as a healthcare industry and as a society is that we are shockingly inept at dealing with the complicated ills of a diverse and increasingly isolated social groups. ( generalisation of course there will always be exceptions to the rule )
Why ? Here are my observations from 15 years in healthcare.
Healthcare has become increasingly politicised with competing ideologies vying for votes and favour , numbers and figures carry more weight and value than quality of care.
Many of the problems we see have their origins in social deprivation , percieved deprivation and/or an increasingly disenchanted and materialistic values.
Healthcare funders have little interest in any of the above , stuctural diagnosis and drugs rule.
There is a vast chasm between pain science/research and the realities of living in pain ( as alluded to from the lady above )
Healthcare providers have little knowledge of or interest in modern pain science . Structure and Function still rule and are the predominant tenets of education
Listening as an active process is difficult and requires training .
Empathetic communication to help deal with all strands of society and groups is vital and requires training , funding and education. This should be a core element of training policies.
For me sitting quietly and listening , empathising and honestly challenging have brought the best results, unfortunately i have had to go outwith the healthcare service to acquire the knowledge and skills
Jim
wonderful set of observations Jim – thank you for taking the time to write them down here. I really appreciate that. Let me just add, of course, that I completely agree with all of those points.