Kindling a Healing Light

The mind is a powerful thing. In arguing for a better understanding of the unconscious, Carl Jung said "Man’s task is ... to become conscious of the contents that push upward from the unconscious. ... The sole purpose of human existence is to kindle a light in the darkness of mere being."

I recently had a new-patient visit with a woman in her 40s who had been diagnosed initially with Lyme disease (serologically negative) in the 1990s, then chronic fatigue syndrome, then irritable bowel syndrome, and then fibromyalgia. "Oh, and I forgot to mention, I have migraines, too." She had been to multiple specialists over many years and, while I am sure many treatment options had been offered to her, her perception was that no one had been able to help her.

After taking an inventory of her complaints, I asked if she had been abused as a child.

In a defiant and defensive tone she said "Yes, but that has nothing to do with why I am here." She came across as very matter-of-fact; she recognized her history of abuse, had already been through years of therapy about it, and felt that it was no longer an issue. So why was I bringing it up?

In situations in which I think the main diagnosis is fibromyalgia or chronic fatigue syndrome, I make it a point to ask if there has been trauma or abuse in the patient’s history. More often than not, the answer is yes. Of course, patients do not think this has anything to do with what they’re seeing me for, but childhood or adolescent trauma can rear its ugly head in ways other than explicitly identified mental health pathologies. I suspect there is an overlap between psychiatric illness (depression, anxiety, posttraumatic stress disorder, bipolar disorder) and those vague somatic complaints of the NOS ("not otherwise specified") variety. The universe of "secondary gains" seems so nebulous, especially for us doctors who picked a profession rooted in as much empiricism as possible. But we’ve all seen the Cymbalta ads that say "depression hurts." Perhaps we’ve even experienced this ourselves.

My sister is a mental health therapist in Washington, D.C. She recently recounted her experience with a "client" (as mental health therapists call their patients) who came to her because the client’s primary care physician suggested it as part of a treatment regimen for fibromyalgia. The client was unsure why she was in my sister’s office, but she gave it a chance anyway. After a few months the client began to see how her somatic complaints might have been a response to years of trauma that she’d experienced, and indeed, she started to experience a lessening of her pain.

Meanwhile, by the end of her first visit, my new patient seemed more receptive to the possibility that her complaints might stem from her past; it started to make sense. "I’ve seen seven doctors for this problem, and you’re the only one that’s asked me about my childhood."

A biblical scholar once said that there is a difference between "to cure" and "to heal." "To cure," according to him, was what doctors, nurses, and medical technicians do: They take your x-ray, they examine your blood under the microscope. "To heal," on the other hand, refers to meaning, to well-being, to integration. To peace.

Maybe there should not be a distinction.

Dr. Chan is in practice in Pawtucket, R.I.

The mind is a powerful thing. In arguing for a better understanding of the unconscious, Carl Jung said "Man’s task is ... to become conscious of the contents that push upward from the unconscious. ... The sole purpose of human existence is to kindle a light in the darkness of mere being."

I recently had a new-patient visit with a woman in her 40s who had been diagnosed initially with Lyme disease (serologically negative) in the 1990s, then chronic fatigue syndrome, then irritable bowel syndrome, and then fibromyalgia. "Oh, and I forgot to mention, I have migraines, too." She had been to multiple specialists over many years and, while I am sure many treatment options had been offered to her, her perception was that no one had been able to help her.

After taking an inventory of her complaints, I asked if she had been abused as a child.

In a defiant and defensive tone she said "Yes, but that has nothing to do with why I am here." She came across as very matter-of-fact; she recognized her history of abuse, had already been through years of therapy about it, and felt that it was no longer an issue. So why was I bringing it up?

In situations in which I think the main diagnosis is fibromyalgia or chronic fatigue syndrome, I make it a point to ask if there has been trauma or abuse in the patient’s history. More often than not, the answer is yes. Of course, patients do not think this has anything to do with what they’re seeing me for, but childhood or adolescent trauma can rear its ugly head in ways other than explicitly identified mental health pathologies. I suspect there is an overlap between psychiatric illness (depression, anxiety, posttraumatic stress disorder, bipolar disorder) and those vague somatic complaints of the NOS ("not otherwise specified") variety. The universe of "secondary gains" seems so nebulous, especially for us doctors who picked a profession rooted in as much empiricism as possible. But we’ve all seen the Cymbalta ads that say "depression hurts." Perhaps we’ve even experienced this ourselves.

My sister is a mental health therapist in Washington, D.C. She recently recounted her experience with a "client" (as mental health therapists call their patients) who came to her because the client’s primary care physician suggested it as part of a treatment regimen for fibromyalgia. The client was unsure why she was in my sister’s office, but she gave it a chance anyway. After a few months the client began to see how her somatic complaints might have been a response to years of trauma that she’d experienced, and indeed, she started to experience a lessening of her pain.

Meanwhile, by the end of her first visit, my new patient seemed more receptive to the possibility that her complaints might stem from her past; it started to make sense. "I’ve seen seven doctors for this problem, and you’re the only one that’s asked me about my childhood."

A biblical scholar once said that there is a difference between "to cure" and "to heal." "To cure," according to him, was what doctors, nurses, and medical technicians do: They take your x-ray, they examine your blood under the microscope. "To heal," on the other hand, refers to meaning, to well-being, to integration. To peace.

Maybe there should not be a distinction.

Dr. Chan is in practice in Pawtucket, R.I.

The mind is a powerful thing. In arguing for a better understanding of the unconscious, Carl Jung said "Man’s task is ... to become conscious of the contents that push upward from the unconscious. ... The sole purpose of human existence is to kindle a light in the darkness of mere being."

I recently had a new-patient visit with a woman in her 40s who had been diagnosed initially with Lyme disease (serologically negative) in the 1990s, then chronic fatigue syndrome, then irritable bowel syndrome, and then fibromyalgia. "Oh, and I forgot to mention, I have migraines, too." She had been to multiple specialists over many years and, while I am sure many treatment options had been offered to her, her perception was that no one had been able to help her.

After taking an inventory of her complaints, I asked if she had been abused as a child.

In a defiant and defensive tone she said "Yes, but that has nothing to do with why I am here." She came across as very matter-of-fact; she recognized her history of abuse, had already been through years of therapy about it, and felt that it was no longer an issue. So why was I bringing it up?

In situations in which I think the main diagnosis is fibromyalgia or chronic fatigue syndrome, I make it a point to ask if there has been trauma or abuse in the patient’s history. More often than not, the answer is yes. Of course, patients do not think this has anything to do with what they’re seeing me for, but childhood or adolescent trauma can rear its ugly head in ways other than explicitly identified mental health pathologies. I suspect there is an overlap between psychiatric illness (depression, anxiety, posttraumatic stress disorder, bipolar disorder) and those vague somatic complaints of the NOS ("not otherwise specified") variety. The universe of "secondary gains" seems so nebulous, especially for us doctors who picked a profession rooted in as much empiricism as possible. But we’ve all seen the Cymbalta ads that say "depression hurts." Perhaps we’ve even experienced this ourselves.

My sister is a mental health therapist in Washington, D.C. She recently recounted her experience with a "client" (as mental health therapists call their patients) who came to her because the client’s primary care physician suggested it as part of a treatment regimen for fibromyalgia. The client was unsure why she was in my sister’s office, but she gave it a chance anyway. After a few months the client began to see how her somatic complaints might have been a response to years of trauma that she’d experienced, and indeed, she started to experience a lessening of her pain.

Meanwhile, by the end of her first visit, my new patient seemed more receptive to the possibility that her complaints might stem from her past; it started to make sense. "I’ve seen seven doctors for this problem, and you’re the only one that’s asked me about my childhood."

A biblical scholar once said that there is a difference between "to cure" and "to heal." "To cure," according to him, was what doctors, nurses, and medical technicians do: They take your x-ray, they examine your blood under the microscope. "To heal," on the other hand, refers to meaning, to well-being, to integration. To peace.

Maybe there should not be a distinction.

Dr. Chan is in practice in Pawtucket, R.I.