Societal Pain

Since I was so irritated by the recent NY Times piece on "medical gaslighting," it seems fair that I should call attention to Nicholas Kristoff's excellent Times essay on chronic pain. Yo, journalists, this is how to write about mysterious medical conditions: with an open mind, and with your eye on the whole world that surrounds the sufferers, not just their own gripes about doctors. As one doctor tells Kristoff,

I believe pain is the most complex experience a human body can have.

These days Kristoff mainly writes about the woes of the working class, among which chronic pain looms large. As he says, pain plays a big part in many stories of addiction and downward spiral. Some people will tell you that the opiate crisis took off when doctors began prescribing opiates for chronic pain rather than just specific injuries, and of course self-medicating with dangerous drugs is how many addictions begin. Every close examination of "deaths of despair" finds chronic pain among the major factors.

To Kristoff, chronic pain is largely a socio-economic problem:

chronic pain is not just a result of car accidents and workplace injuries but is also linked to troubled childhoods, loneliness, job insecurity and a hundred other pressures on working families.

Some of this is very much class based; 

One study found that poor Americans are more than three times as likely to report pain as wealthy Americans. Another found that just 2 percent of those with graduate degrees report severe pain, while almost 10 percent of high school dropouts do.

But another factor is clearly youthful trauma. People who were sexually abused as children suffer much more chronic pain than others, as do people who were ever in foster care. Certain doctors have argued that in fact all chronic pain derives from trauma, but that is too simple and neo-Freudian for me, and I think also for Kristoff. But the connections in the data are too strong for this not to be a factor.

In that awful "Medical Gaslighting" piece the villains are doctors who won't take conditions seriously or recommend radical measures, but Kristoff finds many people who have received multiple unhelpful surgeries, like this woman who suffers from lifelong abdominal pain:

For a while, doctors thought it was irritable bowel syndrome. Then they said it was endometriosis, leading to surgery at the age of 20 and a full hysterectomy a year later.

None of that helped, and doctors later diagnosed interstitial cystitis, part of a spectrum called painful bladder syndrome. All of these diagnoses — irritable bowel syndrome, endometriosis and painful bladder syndrome — are commonly applied to people with chronic pain that is difficult to explain.

So what should we do? The bad news is that nothing works for everybody. The good news is that we have identified a menu of approaches that can help a lot of people. One of the doctors Kristoff spoke to says he always starts out by recommending more sleep and more exercise. (Of course insomnia is another part of the pain, depression and addiction cycle, so that advice is cruel for some people, but, again, this is a menu.) Other things that help some people include physical therapy, psychological counseling, meditation, yoga, acupuncture, psychedelic drugs, and masssage.

To me the most serious side of this problem is its connection to the broader ills of our society. Loneliness is strongly connected to chronic pain. Probably in that case the causality goes both ways, with loneliness causing suffering and pain keeping people from going out with friends. But to live within a supportive community seems to be the best rememdy for many of our ills, and we don't know how to achieve that. Economic insecurity is another major factor, and what to do about ever increasing inequality and the difficulty less educated people have finding steady work seem to be problems that are very hard to solve.

My philosophy of life might boil down to believing that everything is complicated. Everything major in life is probably more complicated than we can even imagine. And that is absolutely how I feel about chronic pain, except that I think I know one thing, which is that your simple explanation that pins everything on sexism or racism or capitalism is useless and wrong.