Tuesday, December 2, 2008

Lugubrious Lucubrations

If you're down he'll pick you up, Doctor Robert

Take a drink from his special cup, Doctor Robert

Doctor Robert, he's a man you must believe,

Helping everyone in need

No one can succeed like Doctor Robert.


Psychiatry is mostly unlike the rest of medicine, for better and worse, but it seems to me it has some things in common with my (admittedly distant) understanding of what a pain specialist does. If any of the latter happen to read this, set me straight.

1. Mental disorders, like pain syndromes, are often correlated with objective factors, but they are nonetheless fundamentally subjective and therefore frequently misunderstood and vulnerable to stigma. Diagnosis is therefore ambiguous and liable to being contested.

2. Both mental disorders and pain syndromes may get better with the mere passage of time. Watchful waiting is always an option.

3. Conservative treatment methods (psychotherapy/physical therapy) should be considered first.

4. Both mental and pain disorders are at risk of settling into chronic pernicious syndromes (often in a mutually reinforcing way).

5. Medication treatments in both carry the risk of addiction, sometimes iatrogenic. This can create tension in the clinical relationship.

6. In both psychiatry and pain medicine, simple cases are rare because primary care physicians have already taken care of most of those.

7. Both mental and physical distress are sensitive to suggestion and placebo (or nocebo) effect, both cultural and medical.

8. The treatments are broad in their effects and not specifically pegged to diagnosis; therapy is therefore more empirical and pragmatic than theoretical.

9. The aim is not cure, but rather symptomatic management either indefinitely or until the episode gets better on its own.

10. Both physical pain and emotional distress, beyond a certain point, threaten to become all-encompassing and to monopolize consciousness.

11. Both physical and emotional pain are necessary and at times even advantageous, but one can have too much of a good thing.

12. People may be growing less stoic, more sensitive to both physical and emotional distress in contemporary culture. There is a straight line between aspirin and Prozac.


Anonymous said...

I'm a specialist in pain -- of sorts...but maybe not in the way you might think.

Physical and mental pain show similar patterns of brain activation.

Watching someone suffer-- provided you're not a psychopath--can hurt almost as much.

Chronic physical pain inevitably feeds into mental torment. People who suffer incredible agony from cluster headaches are often driven to suicide. There's no doubt that intense physical pain is psychologically toxic.

And apparently, redheads have a lower pain threshold. On the other hand, most men have a higher pain threshold (testosterone related stoicism, possibly a little machismo..just guessing). Which begs the question, why don't they give birth? I know, pain is character building and men wouldn't suffer nearly enough from it to sufficiently profit from the experience...that's our God, gotta love him!

Do people still start with aspirin?

Anonymous said...

I've heard people compare the pain of passing kidney stones to that of giving birth. I'm not buyin' it. :)

Female Anonymous