Resistance By Some Patients to Psychological Explanations of Their Pains

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Some patients welcome psychological explanations, especially if they are insightful and help them to understand with their problem. Some patients are thankful when their doctor helps them to see the connections between a stressor and their pain, such as their emotional tension with their boss which is connected to both their bad dreams and their fibromyalgia pains. They may realize that this information is useful to them because it opens up a new opportunity to reduce pain.

Others are quick to brand their doctor or therapist with undeserved accusations such as: “You are saying it is all in my head!” Few doctors say such things anymore. There is a rising appreciation of the role of psychological factors (precipitating, relieving, aggravating) in pain. For example, it is known that psychological factors can indirectly aggravate pain by aggravating insomnia and poor sleep.

Resistance to psychological explanations can come through in many forms including:

  • quick dismissal
  • advancing a half-baked non-psychological theory then tenaciously sticking to it
  • failure to volunteer psychologically relevant material sometimes even though one is fully aware that it could be helpful to the doctor
  • insisting that because the pain is so tangible and real that the doctor must be trying to imply it is not real if they bring up psychological factors
  • mental block against analyzing psychological aspects of their illness

In the experience of the author, some patients resist psychological explanations because they relate to an emotionally sensitive matter that they are reluctant to open up. The truth of the matter may only emerge if certain factors are in place:

  • The patient must trust the doctor.
  • The doctor must make the patient feel that they are not sitting in judgment; but rather they are just trying to find out the time sequence and factors relevant to developing the patient’s symptoms.
  • The doctor must not make the patient feel too rushed because of a busy schedule.
  • The doctor must not be anti-psychological and must not be aloof or uninterested. The more the patient sees that the doctor is asking penetrating questions, following up on clues to relevant life-conflicts offered by the patient and making a sincere attempt to connect the details of the patient’s life as it relates to the pains, the more cooperative the patient is likely to be. Some are very thankful.

Here are few examples of clues:

I had a patient who at first was mysterious to me because there were few good clues as to why their muscular pain started. They did, however, indicate there were a number of sleep issues. I, therefore, asked them to fill out a lengthy sleep questionnaire. From this it emerged that they were having bad dreams. When I asked them follow-up questions about the identity of their enemy in the dreams, it turned out that there was an obvious interpersonal conflict.

Another patient was a newcomer to Canada. They dropped their clue like a bomb. They were middle-aged when I saw them. In their native country, there were many superstitions. They too were initially a mystery case of fibromyalgia for which there were no good clues as to the cause. Then, at some point they mentioned the words “black magic” and indicated that they believed that they had been subjected to it. (They had mentioned this to their translator before their appointment with me, and their translator sensed it was probably important to their case and had been encouraging them to come forward with it and tell me.) When I asked them to tell me more, they were initially reluctant, but then it came out that there was a whole pot boiling, and this was the tip of an iceberg which involved a complex family feud, and intense beliefs of being persecuted and being the victim of black magic. This opened up an opportunity to assist the patient in overcoming this conflict which seemed to be either causing or at least aggravating their fibromyalgia pains. They made it clear that it was much more than a passing set of thoughts, but rather an ongoing source of turmoil. This case indicated to me that a focal conflict over good and evil could stir fibromyalgia.

(For further perspective on resistance of the kind discussed here, see the entry Anti-psychological Attitude.)