An item I share in my Bladder & Pelvic Floor Health for Practitioners class from Haslam & Laycock's "Therapeutic Management of Incontinence and Pelvic Pain", 2nd edition:

When pain persists, even after healing has taken place [from a trauma], the nerve cell membranes undergo a change in conformation, establishing new receptor sites and the formation of new neural pathways that become embedded into the central nervous system. Once established, the chronic pain pathways are difficult to eradicate. Chronic pain no longer serves a useful purpose, but leads to physical, behavioral, and psychological changes that combine to produce the pain experience.

There are a couple very practical implications here. Firstly, chronic pain causes very real physical changes, even when the physical cause can no longer be detected. Secondly, the longer someone waits to get treatment for pain, the more established will be those physical changes and the more treatments they will require to try to reverse the pathology.

I have had patients who have become frustrated with western medical practitioners who told them that the pain "is in your head". It's an unfortunate (and rather dismissive) way to language it, but sometimes this is to what they refer. The physical cause has resolved; the pain now lives in their neurology. Chronic pain requires both physical modalities and CBT (cognitive-behavioral therapy) in order to be addressed completely. It will not be resolved by medications or surgery.

This is a post I wrote for another blog on 22 Dec 2009:

I just read "Regular & Decaf: One Friend with Schizophrenia, One Friend with Bipolar, One Ongoing Conversation, One Cup at a Time" by Andrew D. Gadtke. It's a good review of some basic premises behind mental illness and lends a personal bent to the stories. Andrew, the author, has schizophrenia. His best, and only, friend, Benji, has bipolar (manic/depression). They recount their experiences with prodromal phases (early symptomology before getting diagnosed), the diagnoses, the hospitalization, changes in relationships and work.

Two things struck me as I read. First, it reminded me of that first-year psych student syndrome where one believes one has the disorder because symptoms are exaggerated from normal and because there is a range of symptomatic behavior. Andrew recounts that his mother didn't want to believe that he had schizophrenia--she could account for his behaviors within contexts. Those contexts, however, were too far-fetched and his behaviors too pervasive. I was reminded of the range of behavior and of that precarious line that separates normal from diagnosable. In particular, I found sympathy with the paranoia, obsessiveness, and narcissism of mental illness in general. Most mental illnesses have elements of these characteristics. It depends on the pervasiveness and how they are manifested, as to the diagnosis. Too, most "normal" people experience aspects of these elements. So, when psych students are learning about specific disorders, it is common for them to empathize with the disorder (or think they have it) because they have experienced the symptoms. However, they lack the persistence of symptoms, the pervasiveness of symptoms, or they lack the distress caused by the illness (to themselves or others) to qualify for a diagnosis. This experience, however, of feeling as though one could have a certain mental illness is instructive in one's approach to treating. If students could take hold of this uncertainty as part of their approach to healing, they would do well toward servicing their patients. Practitioners might offer a more balanced, realistic approach to care.

The other thing that impressed me in reading this book is the similarities between mental illness and trauma. The depression (as a symptom), the fatigue/weakness, the lack of motivation, the despair, the side effects from drugs are all commonalities between mental illness and trauma--and few people, including the doctors or practitioners treating these, really understand the basic experiences of their patients. I would have guffawed at it before I experienced it, but there is a level of exhaustion that one can only understand if one has experienced it first-hand. It has nothing to do with laziness and everything to do with changes in physiology. I really appreciate their (Andrew and Benji) belabouring the point.

One place I must disagree with Andrew and Benji is in instituting segregated church programs for the DD (developmentally-disabled) as a "step in the right direction" (p. 214). I find this problematic in many instances. I understand that some DD people create disturbances to the general public. I get it--I've worked with them. There are those people who are simply not able to be in crowds. But programs that segregate all DD people into special programs seems like a way to segregate people while feeling like you're doing them a service--a double standard one can feel all warm and fuzzy over. 'It's for their own good, after all.' Yesterday I accompanied a Downs-syndrome couple to a segregated program at a mega-church in a wealthy suburb of Minneapolis. I was appalled at the paternalistic setting designed mostly to serve the needs of the volunteers. Most, if not all, of these people could have easily sat in on the regular service (which was going on at the same time) without being too much of a disturbance (if any) to the people around them.

Andrew writes, "To me, the loneliness of mental illness is immeasurable. I ache in my body for relationships with others, but virtually to no avail." (p. 175). I know that historically mentally ill people, and really anyone deemed 'different' was ostracized. However, I can't help thinking that rather than getting 'better' or 'more advanced' in this regard, we've actually taken steps backward. This statement not only applies to mentally ill people, or the developmentally-disabled, but to anyone living alone or otherwise marginalized by mainstream society. We've created a deliberate social diabetes--loneliness within a sea of beings. (Diabetes is often described as a disease of starvation amidst plenty.) Loneliness--it's not just for geeks anymore.

Andrew Gadtke recommends "Proof", the movie, as a decent representation of the prodromal phase of psychosis. I'll be writing of that in the next weeks as I view it.