Narrative, Pain, and Suffering
http://www.100md.com
《新英格兰医药杂志》
Long ago, Sir William Osler stated that it matters more what kind of patient has the disease, than what kind of disease it is. Getting to know the patient requires understanding his or her story and the meaning behind it — thus, the importance of paying attention to the patient's narrative. In recent years, there has been much discussion of the use of narrative in medicine as a way of understanding patients' conditions. According to Julia Connelly (writing in the Winter 2005 issue of Perspectives in Biology and Medicine),
narrative is ever present in medicine and is an integral aspect of the doctor and patient relationship. . . . If the patient's narrative is not heard fully, the possibility of diagnostic and therapeutic error increases, the likelihood of personal connections resulting from a shared experience diminishes, empathic opportunities are missed, and patients may not feel understood or cared for.
This book succeeds in reminding the reader of the challenges involved in understanding the phenomenology of the experiences of others as they describe them and which cannot be shared directly.
The editors have created a work that addresses several topics stemming from the challenge of understanding what is happening in the patient's brain as he or she relates the experience of pain. They draw on a multidisciplinary group of authors from five continents. The book has 24 chapters organized into 6 sections. Most of the chapters are well written, and many of them are provocative.
The second section, "The Challenge of Narrative to Pain," examines the differences between pain and suffering and presents a heuristic model, which is contained in an image of four concentric circles all sharing one point, with the circles from innermost to outermost labeled nociception, pain, suffering, and pain behavior. Other sections in the book deal with the neurobiology of emotions and pain; what has been learned from brain-imaging research on the subjective experience of experimental and clinical pain; pain, sex, and culture; the challenges of representing pain to another person and of understanding what is being represented; and how we discern the meaning of suffering. The final chapter takes on evidence-based medicine and asks poignant questions about how to maintain a balance between what has been learned from statistical models and what the clinician learns from the patient; the author appeals to us to see not the disease category but the patient who has the disease. Narrative, Pain, and Suffering is thoughtful, stimulating, and an important voice in the care of patients with persistent pain.
Philip R. Appel, Ph.D.
National Rehabilitation Hospital
Washington, DC 20010
pra1@medstar.net((Progress in Pain Researc)
narrative is ever present in medicine and is an integral aspect of the doctor and patient relationship. . . . If the patient's narrative is not heard fully, the possibility of diagnostic and therapeutic error increases, the likelihood of personal connections resulting from a shared experience diminishes, empathic opportunities are missed, and patients may not feel understood or cared for.
This book succeeds in reminding the reader of the challenges involved in understanding the phenomenology of the experiences of others as they describe them and which cannot be shared directly.
The editors have created a work that addresses several topics stemming from the challenge of understanding what is happening in the patient's brain as he or she relates the experience of pain. They draw on a multidisciplinary group of authors from five continents. The book has 24 chapters organized into 6 sections. Most of the chapters are well written, and many of them are provocative.
The second section, "The Challenge of Narrative to Pain," examines the differences between pain and suffering and presents a heuristic model, which is contained in an image of four concentric circles all sharing one point, with the circles from innermost to outermost labeled nociception, pain, suffering, and pain behavior. Other sections in the book deal with the neurobiology of emotions and pain; what has been learned from brain-imaging research on the subjective experience of experimental and clinical pain; pain, sex, and culture; the challenges of representing pain to another person and of understanding what is being represented; and how we discern the meaning of suffering. The final chapter takes on evidence-based medicine and asks poignant questions about how to maintain a balance between what has been learned from statistical models and what the clinician learns from the patient; the author appeals to us to see not the disease category but the patient who has the disease. Narrative, Pain, and Suffering is thoughtful, stimulating, and an important voice in the care of patients with persistent pain.
Philip R. Appel, Ph.D.
National Rehabilitation Hospital
Washington, DC 20010
pra1@medstar.net((Progress in Pain Researc)