Faculty Bibliography

Because it focuses primarily on the sick body (disease), medicine ignores many of the concerns and needs of sick people. By listening to the stories of patients in the clinic, on the Internet, and in published book form, health care providers could gain a better understanding of the impact of disease on the person (illness), what it means to patients over and above their physical symptoms and what they might require over and above surgery or chemotherapy. Only by familiarizing themselves with the entire emotional landscape of illness, which includes fear, anger, shame, guilt, and above all loneliness, can the healthy--medicine as well as society in general--hope to heal in a comprehensive manner.

Medicine regards pain as a signal of physical injury to the body despite evidence contradicting the linkage and despite the exclusion of vast numbers of sufferers who experience psychological pain. By broadening our concept of pain and making it more inclusive, we would not only better accommodate the basic science of pain but also would recognize what is already appreciated by the layperson--that pain from diverse sources, physical and psychological, share an underlying felt structure.

The first question your doctor will ask is where does it hurt. That's an easy one. It's the next question that usually creates the difficulties and often leaves patients tongue-tied: now can you describe the pain? Describe what? Although we can usually figure out where it's coming from, pain is very much inside of us, even when there is a visible injury on the body's surface. We can't see pain, touch it, hear it. So how can we possibly paint a picture of what is inaccessible to our senses, for pain -- as Emily Dickinson, the American poet, once said -- "has an element of blank". Ephrem Fernandez, a psychologist, and his colleagues at the University of Texas who study the language of pain, are finding that metaphorical descriptors often provide invaluable clues that point to one cause of pain over another. Bone cancer pain such as [Peter]'s tends to feel "sharp" and "stabbing" in nature. Musculoskeletal back pain, on the other hand -- the kind that might be triggered by an injury at the gym--tends to be more "aching" and "gnawing". Similarly, a headache that is "throbbing" is more likely to be because of migraine while a "dull, constant pain" is more typical of a tension headache. Medicine has also not been very successful at dealing with chronic pain, defined as pain that lasts longer than six months. Nearly eight million people in the UK suffer chronic conditions such as lower back pain and fibromyalgia and the number keeps growing. Many of these patients trudge from doctor to doctor without ever finding relief. Some will lose their jobs and become clinically depressed. Clearly this is tragic for the sufferers, but it also affects the country as a whole, through increasing health care costs and the growth in the numbers of disabled people. Pain experts consistently point to three major reasons for medicine's failing: primary care doctors being poorly educated in pain management, disproportionately low funding for pain research (compared with cancer or Aids research), and a lack of access to pain medications and specialists