Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

unmedicated

Unmedicated: In the last half of the 20th century, the resistance to directly addressing psychological problems actually increased. We had a ready stream of medications that blamed and treated the brain for our various incapacities to deal with our lives. Some euphemistically referred to this as the Prozac Generation.

Individuals, as a first response to discord or burden, sought medications that would eradicate the “bad feelings.” Some became dependent upon medications such as Xanax for daily coping, and/or were very reluctant to relinquish their Paxil for their dysphoric mood. When you see patients that navigated that period, you find individuals who had very little understanding of how to cope with their lives, their losses, and their disappointments, but they may have had a medicine cabinet full of various agents prescribed for their inconsistently reported emotional problems.

It mattered comparatively little that the marriage was a shambles, they were failing on their job, the kids were out of control, debt was insurmountable, or there was conflict in most of their interactions. The unmedicated patients learned that this was a “problem in my brain”, and medication will fix that. Soon many thought of themselves as bipolar, ADD, etc., accurate or not, because it became both “fashionable” and medicated. The reasons for carefully examining a patient is to both discover the probable conflicts that are giving rise to their misery, and to enable the patients to realize that they do not have to assume a passive role in the solution of life’s ills.

They can effectively and permanently change many of life’s ills, and, importantly, they can feel pride and success that they have done so. Because we can find brain circuitry that impacts mood, anxiety, and pain, does not necessarily mean that putting chemicals in the body is the route to learning effective problem solving and conflict resolution. We chart pain behaviors. We make note of the patient’s vocal utterances of pain, facial grimacing, and the changes in motor behavior when walking, sitting and/or standing.

We are also told not to rely upon those physical manifestations of pain behavior as a true barometer of misery, since no two people demonstrate the same behaviors. We see patients with identical physical diagnostic findings that have quite different pain behaviors. Some remain stoic while others thrash about in pure agony. An article (Llyod, D.M.., Findlay, G. et al. (2014) Illness behavior in patients with chronic low back pain and activation of the affective circuitry of the brain. Psychosomatic Medicine, 76, 413-341) that addresses the connection between differences in pain behavior is an example. The authors note that areas of the brain known to be associated with emotional functioning are activated when a patient is in pain. This may ultimately tell us if the emotionality of one patient in pain is in great excess to another patient with the same back problem, but it does not tell us why the patient views and responds to the pain in such an excessive manner.

The problem with specifying pain as a brain activation problem runs the risk of having the patient dismiss responsibility for effectively coping with pain. As it is, many patients relinquish pain control to a series of narcotic medications. They do not seek a more adaptive response to the pain; they merely want it immediately eradicated, regardless of medication side effects. The response to many aspects of life that are difficult have become labeled as “disorders.”

The unmedicated individual becomes the victim of a disorder that is best treated without them exerting effort beyond being certain that s/he takes the prescribed medication. Perhaps it is past time for the patient to assume more individual responsibility, or then again, perhaps we shall soon find an area of the brain responsible for Road Rage Disorder or Marital Disappointment Disorder.

Academy of Integrative Pain Management

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