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Pain and the Mind

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jeanne's Pain and the Mind; inspiration taken from illustrative medical graphs in the NY Times article cited.

Pain and the Mind

California State University, Dominguez Hills
University of Wisconsin, Parkside
Created: August 28, 2005
Latest Update: August 29, 2005

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Index of Topics on Site Lecture on Pain
and conceptual linking across topics on
social issues of physical and mental pain

This first lecture for the semester contains a social issue discussion that will apply to specific questions in all my classes. I based it on a New York Times article of August 28: Spinal Cement Draws Patients and Questions by Gina Kolata. Backup. Shared lectures keep us on the same page for transform_dom discussions in our forum.

Introduction and Review of Concepts

Concepts introduced in my lectures are broad enough that sociologists, psychologists, philosophers, and behavioral scientists in general should at least recognize them as part of their background knowledge. Since we share a discussion forum, transform_dom, a rudimentary understanding of these concepts is integral to meaningful shared discussions.

  • regression to the mean - a statistical term that has crept into everyday language as exemplified in the article on spinal cement and pain. When someone experiences acute pain, there is a strong probability that when asked for a measure of that pain later it will be more or less, having moved nearer the average associated with that cause of pain. Measurement of pain is usually by self report. Consistency varies with many factors, so that the pain, as reported, will be distributed around an average for that person, those conditions, that cause of pain. If you take repeated measures you will discover that there is a tendency for all the measurements to group around the average. So that if the pain is very intense at one point, it will be less intense, nearer the average, at a subsequent point. If we are lucky enough to have done anything that the person can interpret as helpful, including sympathetic good faith listening, that will seem almost magically to have caused the lowering of the pain level. This is how placebos work.

    Regression to the mean by Steve Simon, Ph.D., Research Biostatician. This site offers a delightful plain English discussion for those of you who would like to read more. jeanne

  • How do the following concepts help explain "magical" cures for pain?

    • answerability: Answerability is a gift that each of us have to express our ideas, validity claims, and feelings about what happens to us in this world.

    • dominant discourse: What everyone just "knows" to be true. What most people accept at truth because others say it's so, and they've heard it so many times.

    • accountability: - Responsibility to which one is held for the results one causes to happen. Note that accountability is different from answerability.

    • spurious relatiionships - A relationship that appears, on the face of it, to make sense, like that people in departments that get more promotions will be more satisfied than those in departments that get fewer promotions, but that in fact, is not true. Actually, people in departments that get more promotions are less satisfied because more of their peers get promoted, so that they feel left out. When there are few promotions that is not so.

    • knowingness - The feeling that whatever I know is "right," usually accompanied by arrogance, and by certainty that the Other, who believes differently, is "wrong."

      Discussion Questions

        Questions on Conceptual Linking:

      1. Conceptually link the article on spinal cement to the AIDS issues in the U.S.

        Consider that those in fear of lethal pain are angered by the customary time-consuming procedures of drug approval.
        Consider that the states with the highest AIDS populations have the most privately-funded clinics.
        Consider that President Bush is suggesting that federal AIDS money be diverted to the states lacking privately-funded clinics.

      2. Conceptually link the article on spinal cement to the AIDS issue in Africa.

        Consider the difference in patient populations - gender. Consider the lack of federal organization and budget. Consider both local and extra-local organization. Herm Turks's thesis of need for local organization and link to national organization.

      3. Conceptually link the article on spinal cement to to truth in advertising.

        Consider the authority associated with the FDA.

        Questions on Moot Court:

      4. State this issue on the use of spinal cement as a moot court issue.

        Consider both sides of each argument.

      5. Argument: intensity of pain. Pro: Give me anything. Con: Do no further harm.

      6. Argument: placebo effect. Pro: If it works, I don't care. Con: May prevent finding of actual pain reliever.

      7. Argument: alternative methods for alternative people: Pro: I want what will be most effective for me. Con: Just stop the pain.

    Questions on Analytical Statistics:

  • What does it mean when the doctor says, "by chance it is likely to regress whether they are treated or not." ?

    Consider regression to the mean. By chance alone, sometimes the pain will be greater than the average, sometimes less.

    Questions on Love 1A:

  • Use Jonathan Lear's "archaic thinking" to explain why people are so ready to accept "magical" or "unexplained" cures for pain.

    Consider that pain is not a logical issue. It hurts. We want that to stop. So there is little conceptual thinking at a time like this. More likely response is archaic to beat on something, like a pillow, or smash your head against the wall, or claw at something.

    Questions on the sociology of the Helping Professions:

  • What role should experts and institutions play in choosing innovations?

    Consider that one of the advantages of the expert is supposed to be distance. Expert not feeling pain itself. More able to be rational. Consider also that psychoanalysis recognizes that the expert can't just tell the patient what the patient should do. The patient needs to interact with the context and then remove the emotional attachment to "Anything at all" to "Something shown to be good for me." (Lear)

  • What are the difficulties of leading in situations like this?

    Consider that the agency and/or the doctor and/or the psychoanalyst is helpless to tell the patient what is best, because the patient must grow on his/her own to accept available alternatives in a way that good emotions can attach to them. How many people in the helping professions do you figure are trained for guiding a client through transformation from emotional attachment to what is hurting them to emotional attachment to what can help them?

  • In what way does this suggest that teaching is one of the helping professions?

    Consider the approach of guide to learning, with hierarchy removed. Why remove the hierarchy? Because the only one that can transform these attachments is the self.

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