- Email: [email protected]
Response to Williamson et al.
Letters to the Editor / Pain 116 (2005) 166–171 b
Department of Liaison Psychiatry, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium E-mail address: [email protected] * Corresponding author. Tel.: C32 16 348701; fax: C32 16 348700. 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.04.009
Beyond epistemology and ontology, the value of empathy and a relational approach in pain management Dear Editor Williamson et al. have argued that when a bodily cause for the pain is not evident, there may be discordance between the clinician’s interpretations and those of the patient, along with a failure of language to cope with the situation. They also observe that, ‘we have tended to treat the pain of another person as if it existed as an independent reality a thing’. In responding to these concerns the combined wisdom of two great teachers provides guidance. Dr Ron Melzack, has stated that “pain is what the patient says it is” (Melzack and Wall, 1988). When one ascribes to this way of thinking there is no disconnect between the interpretation of patient and clinician. Issues relating to evidence of bodily causes, theoretical ways of thinking about subjective experience of the other, and different ways of knowing and communicating about knowing become secondary. Dr Jean Baker Miller (Baker Miller, 1986) and colleagues (Jordan et al., 1991) at the Stone Centre, Wellesley College, emphasize the importance of ‘the Selfin-Relation’ and the importance of connection in all relationships, including the doctor patient relationship. Through the process of empathy, mutual understanding is established, as opposed to a purely analytical approach. This is an excellent model for healthcare providers assisting patients with chronic pain (or indeed any presenting symptom complex). Through listening to the patient, believing that pain is what they say it is, and empathizing with their experience, connection occurs, ‘aporia’ or not. In this way one is able to move beyond traditional ‘analytical’ ways of knowing into the realm where healing is able to take place.
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References Baker Miller J. Toward a new psychology of women. Boston: Beacon Press; 1986. Jordan JV, Kaplan AG, Baker Miller J, Stiver IP, Surrey JL. Women’s growth in connection: writings from the stone center. New York: The Guilford Press; 1991. Melzack R, Wall PD. The challenge of pain. London: Penguin Books; 1988.
Mary E. Lyncha,b,* Alexander J. Clarkc,d a Pain Management Unit, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada b Department Psychiatry, Dalhousie University, Halifax, NS, Canada c Calgary Chronic Pain Centre, Calgary Health Region, Canada d University of Calgary, Calgary, Alta, Canada E-mail address: [email protected] * Corresponding author. Address: Department Psychiatry, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada B3H 1V7. Tel.: C1 902 473 6428; fax: C1 902 473 4126. 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.04.008
Response to Williamson et al. Dear Editor, I will emulate Gertrude Stein. A word is a word is a word. But extra words may not help us to assist patients much further, either in body or in mind. Harold Merskey* 71 Logan Avenue, London, Canada N5Y 2P9 E-mail address: [email protected] * Corresponding author. Tel. C1 519 672 2298; fax. C1 519 679 6849. 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.04.005
Department of Liaison Psychiatry, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium E-mail address: [email protected] * Corresponding author. Tel.: C32 16 348701; fax: C32 16 348700. 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.04.009
Beyond epistemology and ontology, the value of empathy and a relational approach in pain management Dear Editor Williamson et al. have argued that when a bodily cause for the pain is not evident, there may be discordance between the clinician’s interpretations and those of the patient, along with a failure of language to cope with the situation. They also observe that, ‘we have tended to treat the pain of another person as if it existed as an independent reality a thing’. In responding to these concerns the combined wisdom of two great teachers provides guidance. Dr Ron Melzack, has stated that “pain is what the patient says it is” (Melzack and Wall, 1988). When one ascribes to this way of thinking there is no disconnect between the interpretation of patient and clinician. Issues relating to evidence of bodily causes, theoretical ways of thinking about subjective experience of the other, and different ways of knowing and communicating about knowing become secondary. Dr Jean Baker Miller (Baker Miller, 1986) and colleagues (Jordan et al., 1991) at the Stone Centre, Wellesley College, emphasize the importance of ‘the Selfin-Relation’ and the importance of connection in all relationships, including the doctor patient relationship. Through the process of empathy, mutual understanding is established, as opposed to a purely analytical approach. This is an excellent model for healthcare providers assisting patients with chronic pain (or indeed any presenting symptom complex). Through listening to the patient, believing that pain is what they say it is, and empathizing with their experience, connection occurs, ‘aporia’ or not. In this way one is able to move beyond traditional ‘analytical’ ways of knowing into the realm where healing is able to take place.
171
References Baker Miller J. Toward a new psychology of women. Boston: Beacon Press; 1986. Jordan JV, Kaplan AG, Baker Miller J, Stiver IP, Surrey JL. Women’s growth in connection: writings from the stone center. New York: The Guilford Press; 1991. Melzack R, Wall PD. The challenge of pain. London: Penguin Books; 1988.
Mary E. Lyncha,b,* Alexander J. Clarkc,d a Pain Management Unit, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada b Department Psychiatry, Dalhousie University, Halifax, NS, Canada c Calgary Chronic Pain Centre, Calgary Health Region, Canada d University of Calgary, Calgary, Alta, Canada E-mail address: [email protected] * Corresponding author. Address: Department Psychiatry, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada B3H 1V7. Tel.: C1 902 473 6428; fax: C1 902 473 4126. 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.04.008
Response to Williamson et al. Dear Editor, I will emulate Gertrude Stein. A word is a word is a word. But extra words may not help us to assist patients much further, either in body or in mind. Harold Merskey* 71 Logan Avenue, London, Canada N5Y 2P9 E-mail address: [email protected] * Corresponding author. Tel. C1 519 672 2298; fax. C1 519 679 6849. 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.04.005