I didn’t sleep very well last night…
Anyway, in the depths of darkness feeling grumpy and restless I calm down a bit by thinking about my ‘heroes’. I started with recent ones and quietly worked my way back in time to the 16th century where I ended up thinking about Rene Descartes – who was a mathematical genius, ahead of his time, but has been much maligned by trendy pain researchers and lecturers of recent times. I’ll come back to him later.
As I really like good debate about the human state – like, why we are the way we are and why we think and behave the way we do…. over the years I’ve read a great deal of what’s called the ‘new-atheist’ literature – For me it’s more about the clarity of thought, the quality and incisive bite and the pure logic of the writing that I love – and it fits with the way I feel about things too. I guess that’s personal, but in reality it’s all about good reasoning based on sound facts, – something I spent a good deal of my teaching days trying to enthuse into those who listened to me. The trouble is that humans have the capacity to be logic and sound reasoners one minute, then the next they go completely potty. For the life of me I can’t understand why a highly trained research scientist, medical Doctor or anyone highly educated, can one minute apply exquisite rationality to a problem, yet peddle the creationist story of how we all came about come Sunday. Yes, going outside with wet hair you’ll catch a cold…drinking Guinness cures teenage spots… sitting in a draught gives you a stiff neck…..Everyone does crazy reasoning – and good schooling hasn’t changed any of this stuff one jot….
So my first hero at around 2.00am is one of the so called ‘four horsemen’ (from the Four Horsemen of the Apocalypse – the forces of man’s destruction as described in the Christian Bible in chapter six of the Book of Revelation) of neo-atheism, – who are: Richard Dawkins, Daniel Dennett, Sam Harris and the late Christopher Hitchens. My pick for clarity of thinking, beauty of writing and brilliant logic has to be Richard Dawkins. That he’s much hated and much maligned, even by some atheists, – is sad, and I believe most of those who criticise him probably haven’t read his books. You don’t have to read ‘The God Delusion’ – remember this man is an evolutionary biologist and his best writings are on this very subject – which just happens to be a great hobby of mine. While leaning on evolution, I’d recommend 2 books if you’re interested, – one by Dawkins himself: The Greatest Show on Earth: The evidence for evolution; the other by Jerry Coyne – Why Evolution is true…. mmmmmmmm!
Then came pain Hero Pat Wall who died August 8th 2001. Several of us wrote little pieces on him for the PPA News issue 12. Here’s mine:
On Patrick Wall
I first met Pat Wall on June 22nd 1994. It was the day, unbeknown to me, that the ‘Sun’ Newspaper featured on its front page a picture and story of a man who had willingly amputated his chronically painful leg by placing it on a railway line and having a train run over it. Pat began our meeting by asking if I had read the ‘Sun’ newspaper that day! Negative! I had to confess I hadn’t, and must have looked rather puzzled – I wasn’t expecting a Professor Emeritus to be discussing the front page of the Sun, or the fact that the story continued on at length on page 3! There was nothing stuffy here, I wasn’t a mere physiotherapist, I was someone who knew patients in pain, I was interesting to Pat Wall, I wasn’t a nuisance, I wasn’t wasting precious research time. Pat Wall made you feel comfortable, he watched normal human life, he had a most likeable twinkle in his eye that oozed rebellion. He relished findings and observations that did not fit expected patterns or standard dogmas, he was so refreshingly sceptical about the way Medical Students, and others like Physiotherapists, were taught and brainwashed by ‘unsubstantiated clinical twaddle’. Mischievous and witty on the one hand, yet such a brilliant scientist and observer on the other. It seemed to me that Pat Wall was the sole representative of real clinical pain, its mysteries and contradictions, in the world of research, the laboratory and academia. His recent book, ‘Pain: The Science of Suffering’ is testament to his thinking, his observations and his devotion to the understanding of human pain and suffering.
Since that first meeting Pat Wall has seemed like a friend. He has been very generous in his support for the activities and philosophy of the Physiotherapy Pain Association and at a personal level, with the content of the ‘Topical Issues in Pain’ books I have edited for the PPA. It was through discussions with Pat Wall that I came to realise that Physiotherapists’ historically ‘subservient’ position to medicine was untenable. ‘We’ had something special and had a unique knowledge that could contribute and was needed. For example, Physiotherapists have knowledge of pain states that no one has ever written up properly – ‘Text book’ medical descriptions of pain states are mostly inaccurate and at best vague reflections of clinical reality. I remember Pat Wall urging me to muster physiotherapists to record and publish unbiased accounts of the clinical pain states we see every day – and to present them to his laboratory based colleagues to unravel!
Most powerfully, he gave me the confidence to express my thoughts, relate my observations and freely discuss clinical interpretations of them in relation to the findings of pain science. I will miss him, and I hope that future generations of Physiotherapists take the time to read his work and respect the impact he has had and the support he has given to us all.
After our meeting I went and bought a copy of the paper…. here’s the pic from the front page…it’s certainly a page of pain – ‘Charles: Truth about me and Camilla…. and in the top right there…. ‘Steffi is stuffed in first round’ (that was Wimbledon!)…..
For those of you unfamiliar with ‘The Sun’ newspaper it’s a right wing ‘tits and bums’ newspaper, page 3 usually being a topless model.
(‘Unsubstantiated clinical twaddle’ would be a good title for a blog sometime perhaps!!)
The other day my Philippa was on the Physiotherapy website looking at the forums and noted someone asking where to start with ‘pain’ – My recommendation will always be Ronald Melzack and Pat Wall’s classic penguin – ‘The Challenge of Pain’. Everyone should read it and study it.
Well, (2.30am by now!) I then went back and back passing Hendrix, Bob Dylan, Robert Johnson, Oscar Wilde, Darwin and Wallace, Dickens… arriving with a doff of the hat at poor old Rene Descartes. ‘Cartesian Dualism’ – is the assumption that mental phenomena are non-physical and that the mind and body are separate or ‘non-identical’. For medicine it’s always been translated into this sort of reasoning: – If evidence for the symptoms a patient has cannot be found by reasonable investigation of the tissues of the body…. the symptoms must be coming from the mind – the patient is therefore blameworthy, is likely amplifying, exaggerating and manufacturing their problem….. best see a psychiatrist!
Then I started thinking about this desire for amputation – like the lad who used a train to cut his leg off – because I’ve recently be reading about ‘Body Integrity Identity Disorder’ or BIID – where seemingly perfectly normal people have a massive need to rid themselves of a limb. Check out this sort of website: http://www.biid.org/ if you want to know more! Then of course like the train kid there are occasional chronic pain patients in our own experience who ‘wish’ their limb were amputated – now called ‘Body Perception Disturbance’ or BPD. Apparently all these folk know exactly where they want the limb cut off….
So here I am about 3am thinking about where the cut off is between ‘me’ my ‘mind’ and my ‘body’ if I were able to amputate it…. You try it… simply ask yourself where ‘you’ are anatomically and when you’ve got a rough idea hone it down a bit more and a bit more…
For me I’m somewhere behind my eyes and forehead, I’m definitely not in my chin and lower jaw and I’m not inside my ears, the back of my head is ‘body,’ so is my nose……. I reckon that I’m a 4 inch slice of head just behind eyes and forehead – frontal lobe area …. What’ve you found?
I even woke Philippa up to ask her… she’s roughly the same as me ( without conferring).
So, what’s all this about?– Simple, mind and body are naturally separate even though it’s an old wives tale!
One last thing, this sometimes useful analogy that chronic pain is ‘like an annoying tune playing in your head’ – isn’t quite right really. Think about it and if you say this to a patient they could well come back to you and say…
‘No it’s not, when I’m aware of a tune in my head I know I’m imagining it, it’s not real…. My minds playing it to me…. But the pain I’ve got is in my body, its right here in my spine and my muscles, I’m not imagining it, it’s real.
Sort that one out!
I’ve added some more material:
From the Journal Manual Therapy: ‘A Medical report to a solicitor’
From PPA News: The Vulnerable Organism
From Peak Performance: 2 articles by Steve Robson and Louis Gifford