My sister posted this article on Facebook recently. She suffers from chronic pain and has had trouble getting a diagnosis. This article by psychologist/ neuroendocrinologist Chandler Marrs discusses pain in terms of a philosophical principle. We don’t need to be in the forest to believe that trees fall when we are not there, and that they make noise even when no one is around to hear them. She says that we tend to think that “awareness predicates existence,” when that is clearly not true. If we close our eyes, the world doesn’t cease to exist.
The big idea in this article involves depending on our ability to “measure” pain objectively as prerequisite to its existence. Does pain only truly exist only when the clinician can objectively perceive it? Is it possible that there are some disease states for which we do not yet have adequate tools to be able to measure it? The fact that millions of people complain of pain where clinicians cannot identify the causes should make us consider the limits of our knowledge and tools.
Why is this important? In my experience as a healthcare provider, if someone higher in the chain of command ran all the available tests and couldn’t identify a known cause for the pain, then often the conclusion was not favorable. We thought that the patient was seeking drugs, or that they had some kind of mental imbalance. The polite term may have been “somatoform disorder.” They were often lumped into that big diagnostic basket of “fibromyalgia,” which basically meant “you have pain and we can’t find a reason for it.” This label could easily function as a flag to dismiss the reality of the patient’s claims.
Marrs also discusses how our perception is affected by our humility and our humanity. Our compassion is based on our ability to believe that another person is truly suffering. A lack of empathy can result in an inability to perceive someone else’s problems.
If we put these two factors together we may find that our insensitivity prevents us from believing someone’s complaint, and concluding that it is not real. And since there are real “malingerers” and drug seekers out there, we can easily put people into that category when they don’t fit. The result is tragic.
“In the case of modern medicine, if the suffering is invisible to current diagnostic tests and intractable to medical therapeutics, it is not real. Indeed, whether cognitively or reflexively, every time a physician dismisses a patient’s complaint or prescribes an anti-depressant for pain, he denies the existence and veracity of their suffering. He denies the tree in the forest, because he does not see or hear it himself in the context necessary to recognize it – e.g. by currently available diagnostic technologies and taxonomies. Here, medical technology, and the physicians who wield the technology, assume an infallibility that precludes the existence of realities beyond their sight lines, beyond their control.”