Staying Put

Elizabeth Berkshire, PhD

During a patient-centered collaborative on pain treatment, a clinician I’ll call “Lear,” blurted out that the patient is the problem. He later apologized, but the burden brought by the patient had been exposed. As part of his apology, Lear said that “they” (patients) needed to get out of their own way. I’m not customarily one for reliance on the notion of a Freudian slip, but this struck me as the kind of truth not easily introduced into speech. It is easy to suffer greatly in the company of a patient in refractory pain, and especially one who lacks the sort of organ-based evidence that can be relied upon to maintain interpersonal (or professional) boundaries. 

Contriving Social Boundaries

Why not welcome unbounded (or collective) suffering? In short, for blogs are meant to be brief, we must contrive social boundaries to stave off the dread that comes from realizing that we actually exist among bodies—not in them. So we’ve adapted ways of thinking about our being.  For example, we can exist in a faulty body. We can also exist in a faulty brain. Take your pick. As Judy Foreman reports in A Nation in Pain (2015), doctors are trained to refer patients on to a “shrink” when the medical model offers no progress (p. 5). Foreman also shares an anecdote from a University of Washington informal survey of graduating medical students who, when asked what would they do when faced with a real pain patient, netted the response: “Run!” (p.9) 

As for the patient, it is easy to suffer alienation in the company of anyone especially trained to keep important parts of you (and themselves) out of the way.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.