The Myth of Psychogenic Pain
- From: Sean C <redhawk@xxxxxxxxxxxxxxxxxxxxx>
- Date: Wed, 15 Aug 2007 15:08:20 -0400
Excellent article that refutes the idea that psychogenic pain, or pain
that has no physioligical cause but is generated solely by the mind,
even exists, and asserts that even if it does, it cannot in any way be
distinguished from "real" pain.
The Myth of Psychogenic Pain
http://www.english.ubc.ca/PROJECTS/PAIN/DHARDC.HTM
Psychogenic pains-pains for which there is no (known) organic cause-are
a billion dollar industry in the United States. Somewhere between 11%
and 34% of the adult population in the US and Europe suffer from some
form of debilitating and ongoing pain, and a majority of those patients
have pain for which there is no known cause, little or no medical
relief, and no good explanation. Chronic psychogenic pain is one of the
most disabling disease states around.
In particular, problem of psychogenic pain warrants a philosophical
analysis, for it raises complex questions over the relation of the mind
and body (Psychogenic pains are "mental" pains-pains that have a
"psychological" cause-if we be materialists, then what distinguishes
pathological pain from real pain?), the relation between neuroscience,
psychology, and folk explanations (Under what conditions, if any,
should neurophysiological data trump psychological theories? Under what
conditions, if any, should a (counterintuitive) scientific explanation
supersede an intuitive account?), the relation between alleged
psychological disorders and rationality (Could we explain pathological
pains as a rational strategy for coping with trauma? If so, then how
are we to understand the notion of rationality?), and the relation
between theory and therapy (If pain is "mental" rather than "physical,"
does that impact the treatment of pain? What are the epistemological
connections between how we conceive of pain and what we know to do
about it?).
The scientific community has already responded to these concerns. In
1986, the International Association for the Study of Pain (IASP)
Subcommittee on Classification concluded that, "Pain is always
subjective. ... Many people report pain in the absence of tissue damage
or any pathophysiological cause; usually this happens for psychological
reasons. There is usually no way to distinguish their experience from
that due to tissue damage if we take the subjective report. ... [Pain]
.... is always a psychological state." They reiterated and underscored
this position in their most recent 1994 report.
I view this move as most unfortunate, for it mischaracterizes pain
completely. Moreover, it does so in a way that has dangerous
implications for philosophy of mind in general and for the study of
mental disorders in particular. This is the first myth I debunk in my
recent book The Myth of Pain (MIT Press, 1999): that pathopsychological
pains actually exist. That pain is a subjective state of mind is the
second myth of pain I attack. I argue that all pains are physical and
localizable and that are all created equal.
Psychogenic pains are, by and large, a mystery. Some people have pains
that last for years, with no discernible cause, and completely
resistant to treatment. These are cases above and beyond things like
phantom pains (which also have no discernible cause and are resistant
to treatment), for one might argue that phantom pains are simply
abnormal instances of human suffering. (Who knows what is supposed to
happen if you lose something as large as a limb? Surely many areas of
the topographically arranged somatosensory system will be thrown off
track; maybe pains that appear to be in the limb that no longer exists
aren't so strange after all). But with psychogenic pains, otherwise
perfectly normal people-with no serious (or even superficial)
injury-live their lives feeling constant pain. Moreover, removing bits
of the spinal column, the dorsal horn, the thalamus, the reticular
formation, the somatosensory cortex, or the frontal lobe concerned with
pain have no effect on the patients being in pain.
There are few parallels of this sort of psychopathology with other
perceptual systems. Rarely do otherwise normal individuals have ongoing
visual, auditory, or olfactory experiences without some determinate
cause or explanation. Chronic hallucinations by themselves are quite
rare. The question is how to explain (or to approach explaining) such
phenomena within the materialist framework of the mind/brain sciences.
This task is made more difficult by the severe methodological problems
of many studies in this area. In particular, inadequate control groups,
selection biases, overinterpretation of positive correlations, and
inappropriate instruments hamper analyzing pain data. To take one
example, scientists perform much of their pain research using patients
enrolled in pain clinics who are receiving treatment for chronic
psychogenic pain as subjects. They then generalize results to the
population at large. However, to be most effective, a control group of
chronic pain sufferers who do not seek treatment in a clinic should be
included, for pain clinic patients differ on a number of psychological
variables-as well as in socioeconomic status-from non-clinic sufferers.
To be fair, because psychogenic pain is a clinical diagnosis, using
traditional scientific experimental protocols is probably not feasible.
At best we can expect a series of correlational studies. Of course, a
positive correlation alone does not indicate a causal relation, a fact
many researchers in this domain overlook. Moreover, some studies even
argue that poor correlations between different measures of pain for a
subject demonstrate the presence of psychogenic pain.
Most troubling, though, are studies that confuse or confound cause and
effect. Some researchers interpret the emotional state of a patient
after years of pain to reflect the emotional state of the patient
before the onset of pain. However, severe distress is a reasonable
reaction to unremitting pain, especially to pain for which doctors can
find no cause. Others link psychogenic pain to some psychological
disturbance caused by childhood abuse or deprivation. They fail to
consider that abuse and neglect could also cause physical injuries
which result in chronic pain, as well as in psychological
abnormalities. Still others cite a particular psychological
factor-e.g., hostility or depression-as being correlated with
psychogenic pains. Since several patients are not evidently hostile or
depressed, researchers conclude that those pain patients are repressing
their true feelings such that they could not be detected. And, here
again, hostility and depression and the other psychological variables
purported to be a causal factor in psychogenic pain are also natural
reactions the very existence of chronic pain. Indeed, several studies
indicate that most chronic pain patients have completely normal life
histories up until the onset of the pain.
That psychogenic pain is a clinical beast also creates trouble for the
clinicians and their traditional diagnostic tools. The MMPI has
questions concerning pain; consequently, chronic pain sufferers receive
scores indicative of neuroses even if their only aberrant responses are
regarding their pains. When we compare results from the NEO personality
inventory with the MMPI, we find that most psychogenic pain patients
have normal personalities. However, these patients might test
positively for schizophrenia, as schizophrenia diagnostics include
somatic complaints and complaints regarding difficulties in living. The
DMSIII criteria contain substantial overlap between pain and
depression. Getting clear on what is "merely" pain and what are (other)
mental disorders is no easy task with the slegehammer-like tools
clinicians use. Once we control for these sorts of confounds, it is
clear that there is no compelling evidence for a direct causal
relationship between any particular psychological factor and pain in
the general population of pain patients. Studies have tried to relate
psychogenic pain to family size, birth order, socioeconomic status,
abuse in childhood, and various personality disorders, all without
success. In each case, we find no difference between persons diagnosed
with chronic psychogenic pain and normal controls.
Furthermore, how we diagnose pain is a serious and embarrassing social
and scientific issue. One analysis of a single pain clinic concluded
that 70% of the tests done on chronic pain patients indicated
significant physical abnormalities, even though these patients were
ultimately diagnosed with pain with a psychological origin. This study
estimated that fully two-thirds of pain patients receive incomplete or
inaccurate diagnoses.
Speaking in general terms, if physicians can't find a physical cause
for a pain and it continues despite repeated medical interventions,
then it is attributed to something "psychological." However, this
diagnosis can be at best an unsupported hypothesis. At worst, it is a
euphemism for our own ignorance. If pains are driven by psychological
factors, then we should be able to isolate what those factors are. Thus
far, we have been unsuccessful in discovering any psychological trait
or ailment that is correlated with sensations of pain. Attempts to
distinguish psychological pain from physical pain have not been
successful. Both sorts of pain sufferers score the same on tests of
anxiety, phobia, obsessionality, and somatic preoccupation (and both
score higher than the general population, not surprisingly). Those who
claim that pain is subjective or psychological are being too facile.
And this mistake has grave consequences for those seeking relief from
their chronic pains.
.
- Follow-Ups:
- Re: The Myth of Psychogenic Pain
- From: trisha f
- Re: The Myth of Psychogenic Pain
- Prev by Date: Re: Group-Need Your Help
- Next by Date: Re: Enough Sleep Equals Productivity
- Previous by thread: Group-Need Your Help
- Next by thread: Re: The Myth of Psychogenic Pain
- Index(es):
Relevant Pages
|
Loading
