'Lost in Translation'




I don't think it's unfair to assume that most patients with chronic pain conditions are being treated
by operators who have never had the chronic pain experience. It's probably also not unfair to suggest
that most operators, not having had the subjective chronic experience, are only capable of imagining,
within the expanse of their own experiences, the entire complexity of a chronic pain experience. Taking
that notion a little further I might also suggest that, where the chronic event might have a 'hidden' nature,
as many do, with little apparent evidence of 'cause and effect', then the operator's imagining of the
condition becomes particularly vulnerable to misinterpretation, even to the point of a questioning of the
patients narrative.


We all, even those with chronic conditions, have a default mindset, which resists perceiving 'negative'
outcomes, especially where cause and effect are not so evident. This is a survival mechanism which restricts
us from assuming that any remedial actions might be pointless, and re-encourages us to always attempt to
correct whatever seems to be malfunctioning. It is a 'healing expectation' mindset, common to both operator
and patient. However, where a chronic condition has convinced a patient to expect less from this 'healing
expectation', they might easily find themselves at odds with an operator whose default mindset still insists
that 'healing expectations' should not be sacrificed on the road to managing the chronic condition. Put
another way.....with little evidence of cause and effect for the chronicity, the operator is prone to
assuming that the patient may be contributing to the chronicity, merely by seemingly abandoning their
'healing expectation' mindset. Much current pain theory seems to focus on this operator/patient disjoint,
and the theory then tends towards a questioning of the patient narrative as a contributory factor in the
continuance of chronic pain.


This is a mistaken perception on the part of the operators. Really, the only vulnerable variable in
that operator/patient equation, is the operator's lack of subjective experience, and their attempted
'imagining' of the patient's narrative, which doesn't seem to resonate with their own experience, and
actually conflicts with their own default 'healing expectation' mindset. What usually ends up happening
is an attempted disavowing of the patient's narrative, which includes a possible undermining of the
patient's intuitive understandings, in an attempt to steer the patient on to a course which the operator
feels more comfortable with.


The subsequent 'lost' patient narrative becomes, by default, the greatest loss for hopes to improvements
in treatments. Bearing in mind, for the purposes of this post, I'm only focussing on where some
approaches to treatment may be straying from a patient narrative empathy, into areas which seemingly
only satisfy the operator's own difficulties with imagining a 'no healing expectation' mindset. The
patient narrative, ethically, must always be the driving force behind any attempted treatments.