Understanding Chronic Pain

Mind-Soul Disease

[From Chapter 4 of Understanding Chronic Pain]

All cultures have recognized a world of spirit removed from corporal existence. The Greeks were perhaps the first to codify spirit or soul as inherent to humanness and unique to each individual. The Judeo-Christian belief extended the concept of soul as man's link with God, thereby giving it the attributes of empowerment, responsibility, and accountability. The body decayed, but the soul lived forever. Soul and flesh were different entities. Our cultural heritage has accorded us a legacy, that of a mind-body dichotomy. The body has gradually yielded its secrets to scientific inquiry. Human dissection led to the understanding of organ systems, but the mind-soul did not yield its secrets so easily. Through the ages, deviant and unaccountable behaviors including madness, melancholy (depression), epilepsy, and we can be certain, chronic pain, were ascribed to an unempowered mind-soul. The advent of neuroscience and molecular biology, appearing only in the past few decades, has begun to disassemble the mind-body dichotomy. It remains with us, however, expressing itself in many, mostly nefarious ways. We continue to ascribe unaccountable diseases to the mind. This is not an entirely bad conceit—it is just that we view the mind in this context as an organ of character, will, and empowerment, somehow different and beyond the laws of biology which govern the rest of the body. For much too long, psychiatric disease was thought to be due to spiritual weakness.

Clinical medicine became a truly scientific discipline in the first half of the twentieth century. The discovery of the X-ray, the electrocardiogram, and the increasing refinement of biochemistry led to the understanding of the biologic (organic) diseases. These advances, however, afforded no insight into the nature of psychiatric illness, and for the first half of the twentieth century, mind-soul disease languished as a medical backwater, an object of theory but little in the way of scientific substance. Among the theories was one relating to the explanation of diseases, such as chronic pain, which appeared to occur at the interface of the mind and the body. Many patients with chronic pain lacked defining pathology to account for their complaints. Their illness was ascribed, conveniently, to the mind-soul. They suffered psychosomatic illness. (That particular word certainly pays homage to the mind-body dichotomy.) It was presumed that in those with psychosomatic illness, the organ systems were intact and operative but worked in a dysfunctional manner. The irritable bowel syndrome was due to dyssynergic movements of the stomach and bowels. Tension headache was due to sustained muscle contracture over the neck and scalp. Fibromyalgia was the same, dysfunctional contractions of the muscles adjacent to the spine. These and kindred diseases came to be recognized as functional disorders (the term psychosomatic, roughly equivalent to functional, has largely disappeared from the lexicon). Functional diseases were ascribed to emotion, and they were identified with neurologic descriptors—irritable bowel, spastic colon, nervous stomach, tension headache. These are not bad descriptors, but hardly good ones. There are worse. Conversion reaction (presumably a functional disease) used to be called hysteria, from the Greek, hystera, the uterus. Thus, functional disease represented the subjugation of the body to those systems endowed with the greatest psychologic and symbolic authority, the mind and the genital organs.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:09 AM

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