Why me? is so often the big question for many patients : Why me? Why did my pain turn chronic instead of going away? Maybe, if we can attempt to answer this question, we could work from here and in the process unravel the coping mechanisms that this person’s remarkable and beautiful brain has constructed, for the good, and wellbeing of its livelihood and transport vehicle – the body.
During our clinical examination how often do we actually treat from a truly biopsychosocial place? How often do we ask the question “how do you actually feel?” and “what is on your mind?” and want to hear the answer?
Are we prepared to enter into the realms of our patients’ thoughts, feelings and emotions? We are increasingly better educated in how the brain works with its “hardware” and “wetware” and its capacity to construct the most incredible coping mechanisms as it believes that it is for the good of the being. However, has anyone seen a thought under a microscope or anything more than a blur on an MRI scan? And yet, a thought can be so powerful in creating a patient’s reality, as each thought will trigger subsequent feelings! I have witnessed again and again that when one addresses the patient’s thoughts and feelings and is brave enough to handle the often dramatic outflow of powerful emotion (such as sadness, anger and despair) a shift occurs in their process of recovery. Then, working integratively and depending on the patient’s needs, one might consider engaging the help of a psychotherapist into the caring team.
My patient with her “pain in the neck” was in the middle of a very messy divorce at the time she fell off her horse and hurt her neck. Did her brain highjack this event and embody her process of grief -related to her difficult divorce – with its intense emotions and stages (denial, anger, despair, negotiation etc.) through her ‘pain in the neck’? Is the on-going pain and suffering ever going to resolve if, hypothetically, the primary wound, the divorce, is still wide open and unresolved? In our clinical examination are we actually prepared to go into the realm of thoughts, feelings and emotions by listening and asking how our patients are feeling, what they are thinking and how their psychosocial side of life impacts on them? Are we ready to really care about their answers, and even give the occasional hug where that might be appropriate? I am convinced that the big hug I give my ‘pain in the neck’ patient every time she comes in, is probably one of my most effective ways of treating her and expressing my genuine care – which in response opens her own amazing ‘drug cabinet within the brain’. When did you last give a patient a hug, a ‘squeeze of serotonin’? Apart from my hugs and other care via physiotherapy, she is now also seeing a psychotherapist to help her find ways to cope with her divorce. I am glad to report: her “pain in the neck” is now improving!
– David Bolton