I Feel Your Pain

We have been talking about the mind-body connection for years. Having such an awareness is a good thing, but using it to explain away someone’s pain isn’t.

There are many sophiscated models out there that attempt to explain the connection between depression and pain, for example. Research does suggest that certain cultural groups and older adults tend to have depressive episodes that are characterized by somatic symptoms. Indeed, we often remind healthcare providers to consider the presence of depression when an older person is complaining about pain. While the two do often go hand in hand, it is both maddening and frightening to naturally assume that someone is “complaining” of pain because she is depressed.

Treating the underlying depression is great, but denying the pain experience isn’t. I have worked with many individuals whose depression actually improved significantly, but they continued to experience pain. Instead of acknowledging that, I notice that many medical providers have a tendency to write in their note that the cause of pain is unclear but “probably due to depression.” Sometimes, they may even say with much certainty that the person must still be very depressed if they are still reporting pain.

This infuriates me. It’s as if saying these people are not supposed to tell anyone that they are in pain. If they do, they will be labeled as “depressed.”

There are many different ways to apply the mind-body concept and facilitate treatment. Blaming everything on “depression” or the presence of a mental illness isn’t.

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About C

If you consider volunteering at a luncheon for older adults as my first exposure to the field, I have been in geropsychology for at least twenty years. As family, friend, volunteer, trainee, and professional, I have found myself in adult day care centers, senior centers, senior living facilities, nursing homes, medical and psychiatric wards, hospice, and personal homes of older adults. Wherever I go, be it an orphanage, a museum, a prison, an airport, or a random corner in the neighborhood, issues related to aging and mental health often come to mind. I used to think that I could make a difference only if I became a top-notch researcher, educator, or clinician. As I continue to follow this meandering path, it dawns on me that as a nobody in the field, I can still add my light to the sum of light by sharing what I know. Over the years, I have "converted" a few very dedicated individuals to focus on aging-related work within their respective disciplines and encouraged a handful more to stay in this field despite its winding course. I believe by bringing aging and mental health issues to the foreground, we will amass a stronger force to promote advocacy, research, and quality care.
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2 Responses to I Feel Your Pain

  1. Cookinglass, pain in nursing home residents has been regularly underestimated and undertreated for years, despite numerous studies reporting this fact. Dismissing complaints of pain as being due to depression sounds like the medical healthcare version of what was said in the psychiatric hospital, “Patient is somaticizing his mental health concerns.” (Translation: reporting physical symptoms that were dismissed as being mental health problems.) I’m quite sure we must have said this about a patient I later encountered in the nursing home, who lived with both paranoid schizophrenia and multiple sclerosis.

  2. Cookinglass says:

    It is really unfortunate that attempts to train our healthcare professionals to be more aware of the presence and impact of depression have sometimes reinforced their black-and-white thinking that the “somatic symptoms” are “all in their head.”

    Labels are very powerful. Even if someone has been managing his medical conditions fairly well, 99% of the time people will blame any significant deterioration on medical non-compliance “due to” mental illness, if they can find a DSM diagnosis in the chart. It’s very troubling.

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