Brother Humans is a chapter of Souffrances (1994) a multi-authored book about pain and suffering. This book gathered specialist’s work in different fields to offer a large description of this subjects. We selected this chapter because it seems important to us, as future psychologists, to understand different points of views about patients who experience somatic pain, and suffering. Medical field has an old history, which is a key to understand some actual practice.
We choose to conduct a report on a (relatively) old account to illustrate the outlook of a some physicians on their patient’s pain. In 1994, the paternalistic model was still the main model for health practitioners. This chapter has been written during AIDS’s arrival , in France. At the time, patients (even young ones) were dying quickly and systematically. We think it can help to better understand some doctor’s behavior, and not to be judgmental about it. The 90’s are a determinant period regarding therapeutic relationship. At this time, HIV patients created associations in order to improve patient’s rights. They wanted, as patients, to be able to make informed decisions about their health. This social action led to reconsider the paternalistic model of therapeutic relationship and call it obsolete. We can see in this document an attempt from physicians to
to challenge the injunction they received not to consider patients’s subjectivity.
The distance that the physicians take with their patient’s suffering sometimes appears as disregard or indifference. According to Gazaix and Michel (1994), this distance is not disregard, quite the contrary. The reality of their everyday practice affects them personally, in their humanity. One of the main concern in medicine practice is to conciliate knowledge and subjectivity.
Let’s take the example of Adrien Brower’s painting “The Pain”. The tittle seems to be needed to give meaning to the painting. Actually pain cannot be represented. The image of someone suffering is not showing pain itself. According to the authors, if the painter wants to point out “everyday pain”, which physicians face daily, he will need a legend (as this tittle) to name it.
In medicine, pain is named according to the spot where it occurs (cephalgia,neuralgia …) in absence of anything better. Again, putting a word as much as putting an image, will always be insufficient to enlighten ourselves to someone else’s pain. Even if we love the person who experiences it, we don’t have any access to it. We can emphasize and sympathize but it remains a subjective and affective data.
When a patient asks a physician to relieve him from his pain, he actually asks him to objectify it but also to objectify his entire singularity: suffering, anger,fears, disease, the patient himself appears to be inseparable in a patient’s request. For the sufferer of a somatic disease, pain and diseases completely reorganize their lives and their loved one’s lives. Their libidinal energy is now directed to their symptoms, pain, suffering etc. The person “who has a sickness”, become a “sick person”. According to the authors, the patient’s unity as a human being must not be limited to the disease.
Physicians have to aknowledge his suffering. The demand is about pain, discomfort, symptoms, but also about the way physical issues are experienced according to the patient’s subjectivity. Can a physician answer this type of needs? The authors explain that, in a way, patients want them (at first) to be more “efficient” than caring. Some physicians put that expectation above everything else. The most important is to cure the person with as much objectivity as possible. With pain for example, medicine can only consider it as a symptom like any other to keep a pragmatic point of view. The aim of this pragmatism is to cure the patient.When we (as patients) entrust our health to a doctor we expect him to fix our body (or our mind) as if it was an object. Objects are fixable, but in this case patients became objects of their pain. Technical aspects of medicine may interfere with patient-physician relationship and be seen as violence or aggression. Even removing entirely the pain may be aggressive to some people who need some of their pain to feel they’re still alive. According to the authors, physicians have to understand this original misunderstanding with their patient to perceive their subjectivity, and stop using pragmatism as a defense mechanism to face someone’s suffering.
Words we have learned :
multi-authored book : un ouvrage collectif
entrust sth to sb : confier quelque chose à quelqu’un
sufferer : la personne souffrante (d’une maladie)
cephalgia: céphalée
neuralgia : névralgie
Flora Gonidou et Pauline Le Floc’h
Abiven, M., Amati-Sas, S., Bruxelle, J., Dejours, C., Gazaix P., Jacobi, B., Lambert, A., B., Lévinas, E., Marquez, C., Michel, F., B., Molinier, P., Murat, P., Rey, R., Ricoeur, P., Singleton, M. (1994). Souffrances : corps et âmes épreuves partagées. Paris: Autrement.