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CONTINUED...anybody, and advised me to enjoy my life, because it passes
very quickly. She died that night. At other times I identified as a
psychiatrist, reminded of the powerful relationship between our thinking
and our bodies. I thought about some of the people who consult me, for
example the woman whose mother lives in constant chronic pain from neuropathy.
She screams much of the day, which is very stressful for my patient.
Until reading this book, I had accepted her doctor's words "there
is nothing that can be done for her pain." While reading the first
few chapters of the book, I was acutely aware of my role as a concerned
and terrified friend. One of my closest friends, Shelley, was writhing
in pain on her bed in Southern California, her doctors reluctant to
prescribe narcotics. By the time I finished reading the book a couple
of weeks later, Shelley had died of disseminated cancer, in an intensive
care unit.
Michel Foucault, the French philosopher and historian, said that knowledge
and power are inextricable. This inseparability of knowledge and power
is most apparent in the health professions where particular expertise
rests exclusively in the hands of the professionals. This renders so-called
nonexperts disempowered in relation to their own bodies. As Nancy Hassett
Dahm tells us, there are doctors who are specifically trained in the
art and science of pain management. In the case of my friend Shelley,
it was her doctor who ultimately had the knowledge/power to prescribe
or not prescribe. He chose not to. I do not know why he left a woman
with ovarian cancer suffering throughout Memorial Day weekend. I can
only imagine that his choice was guided by what he considered to be
in her best interest. I believe this decision was influenced by the
powerful discourse in our culture that drugs are addictive and should
be avoided if possible. I think as doctors we are afraid of authorities,
and do what we can to avoid prescribing strong analgesics. This idea
is further strengthened by our cultural narratives about illness, which
praise people for having a "high pain threshold," and see
them as brave heroes for being stoic and not complaining.
"Mind, Body, and Soul" is an important work. It furnishes
us with a vast body of knowledge regarding cancer: living with it, and
dying from it. As readers we are empowered to take charge of our own
process throughout the course of our illness, or the illness of a loved
one. As such, we the "patients" become experts of our own
bodies. For doctors this is an important book too. It reminds us to
listen to our patients. Nancy Hassett Dahm reminds us that the best
way to measure pain is to ask someone whether they have pain, and how
severe it is. In the 21st century there is no reason for anyone to suffer
in pain, or to die in pain. We have sophisticated technology, pharmaceuticals,
and methodologies available to us, to ensure that we can all die with
dignity, pain-free, in our homes, should we choose.
I encourage you to read this book with an open mind. While it may be
uncomfortable, it is ultimately a book that creates freedom for us;
freedom to face our lives and our deaths with information, wisdom, and
courage.
Paul Browde, M.D.
Psychiatrist
Faculty, Albert Einstein College of Medicine
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