Why does it hurt?

Does the mind influence the body, and can the body alter the mind?

To better understand the healing process, consideration of how illness is perceived by the patient and by the treating professional must be given. If illness is only seen as a physical phenomenon that a person’s mind has no control over, then a person’s inner experience will most likely be one of helplessness. If this is the case, does the treating professional have a moral obligation to understand a patient’s inner experience of pain and illness and utilize this framework in their treatment, and is it necessary that both parties view illness in the same way for a person to experience a cure? Is it the responsibility of the treating professional to be aware of this differing view and they should adjust their treatment accordingly?

For the views of a patient and a treating professional to align, an accurate conveyance of information and experience need to be projected toward a willing recipient. Illness and pain causes one to call into question their beliefs and values in order to make sense of their current suffering.

Illness is not just something happening to the body, it’s something happening to the mind. To the afflicted, the experience of being ill or suffering a great deal of pain, can radically change a person’s narrative and alter their identity. “What ancient and obdurate oaks are uprooted in us by the act of sickness (Woolf 2012).” In this phrase, Woolf illustrates how powerful illness can be to a person’s identity. So powerful that it can uproot ‘ancient and obdurate oaks,’ tearing away at the very core of who we are, forever altering our moral fiber.

In this Tedx talk, Dr. Rita Charon talks about her approach to practicing medicine which she defines as Narrative Medicine.  She defines Narrative Medicine as “clinical practice fortified by the knowledge of what to do with [a patient’s] story.” She invites her patients to tell her what they believe she should know about them as people and she found that people had a need to share their stories. She connects with her patients through their stories and helps them navigate and cohere their illness and healing narrative.

If a person is viewed only as a list of physical symptoms, they are reduced to a thing the mind cannot control, and they cannot access the potential their mind and thoughts may have to influence their body. “Patients give their bodies over to doctors and hospitals only to enchant inattention and indifference, not because they cannot express their suffering, but because their language is unvalued and unrecognized in medical culture (Jurecic, 2002).”  A patient’s language is “unvalued” by the medical profession which has reduced the body to a collection of symptoms and has separated this body from one’s inner experience or mind. However, as this quote points out it is not only unvalued, but “unrecognized.” This inability to recognize or understand the language of sickness and pain could be why it is devalued. “One reason for the persistent belief that pain exceeds the reach of language is that pain poses the philosophical problem of subjective reality– that we are unable to have certain knowledge about another person’s inner life… pain is unspeakable (Jurecic, 2012).”

The moral responsibility lies in the level of impact this interaction has on the healing process. Promulgating a preconceived theoretical framework on those who are ill or suffering that differs from their own does pose a moral dilemma. Is it the sick person’s responsibility to grant privileged access into their pain experience, or is it the doctor’s obligation to actively elicit this access and be willing to openly receive it? In order to treat a patient’s illness without causing some sort of damage to their identity, it is necessary to meet them where they are both in body and mind.

Perhaps the key to healing is treating the whole person as a whole person. Doctors need to see their patients as people having a unique experience and invite them to share their stories as part of their assessment to treat and to heal.  This is difficult to do in a medically modeled healthcare system that values quantity over quality.  Doctors often have to book 4- 5 patients an hour and have very little time to personally connect with any of their patients if they want to generate enough income to keep practicing.  Patients feel rushed and neglected and in turn have learned to not trust their doctors and become guarded and defensive.

Illness creates a vulnerability in the patient and in the doctor. As Dr. Charon says in her Tedx talk, “Illness exposes.. causing very little separation between the doctor and the patients.” It is through this exposure that human connection is made and healing facilitated.

doctor-patient-relationship-1.gif

Narrative medicine addresses the relational and emotional aspects of illness through a patient’s sharing of their story, so a connection can be made.  It encourages doctors to look beyond their patient’s physical representation of symptoms–to not only ask where does it hurt, but why does it hurt?

 

 

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Printed References (not linked)

Jurecic, A. (2012). Responding to the Pain of Others. In Illness as narrative. Pittsburgh:
University of Pittsburgh Press.

Woolf, V., & Lee, H. (2012). On being ill. Ashfield, Mass.: Paris Press.

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