Unequal Distribution of Pain
William Harjo Lone Fight
1/8/2009 7:42:13 PM
When does "cosmetic neurology" become reconstructive? If we use the metaphor of plastic surgery, it seems that many are graced with very few "wounds beneath the flesh" and others, particularly "subordinated groups," carry the pain of many.
Perhaps what Anjan Chatterjee was hinting at without directly addressing is pain without context or meaning. Pain is a part of many Native American ceremonies in which its meaning is explicit and supported by consensus. In a fragmented world, psychological pain is often without meaning. Psychological pain, we would presume, is intended to signify a need for change. "Pain means that something is wrong." But what if the cause is unaddressable or global?
Growing up as a child with the fear that every thunderstorm was the beginning of a thermonuclear war induced signficant pain. Perhaps that pain shaped me into a more moral human being. Perhaps it merely increased the suffering of a child. As has often been said, "if pain builds character, when do we have enough character for the day?"
There has never been equality in suffering. Some are forged in fire and some are melted. Not being a gambler by nature and having seen more melting than forging, I see the experience of psychological pain as a choice we adults may make. The complexity arises when it comes to children. How much pain do we allow? My answer would be that pain be prescribed, if you will, based on context and interpretation. We do need to learn what type and conditions of pain strengthen and what do not. There is research on the subject.
Leilani Doty, PhD, Director, University of Florida Cognitive & Memory Disorder Clinics
Leilani Doty, PhD
8/31/2007 1:23:58 PM
Anjan Chatterjee truly is a renaissance behavioral neurologist,a gifted eclectic thinker and wordsmith. As he discusses the contructs of cosmetic neurology and treatments for pain and other multi-level discomforts of the patient, where does he insert the benefits of the natural analgesics and natural mood modifiers?
Of course, I am speaking about the endorphin releases that occur during the unmedicated child birthings (that occur without medical complications and aggressive medical interventions). Of course, I am talking about physical exercise that releases endorphins and other ameliorative chemicals that alleviate physical, emotional and spiritual pain. Of course, I am talking about positive interactions in relationships, psychotherapy and other therapies such as positive reframing that transform psychological, spiritual and related physical pain. Of course, I am talking about the transformation of writer's stress, very emotionally painful, to the exhilaration of seeing the final manuscript in a refereed (or other)publication, such as this article.
Where do these natural "treatments" fit in cosmetic neurology?
Daily reasons for pause
Sean C. Orr
8/16/2007 10:41:37 AM
Dr. Chatterjee crystalizes a complex topic skillfully. As a neurologist, I encounter situations daily that, in this contextual framework, could give me pause. As a physician with the ability to judge and discern, I guide my patients on the basis of striving for the greatest good, or the best outcome, for that patient and for society. At times, that includes witholding certain medications that would temporarily alleviate pain, with the knowledge that a greater good is served in the long run. At times, that also includes administering medications in an "off-label" fashion, knowing that quality of life is enhanced without incurring a net negative effect for that patient or society at large. This is the essence of individualization of care.
To some extent, it seems a bit trivial to argue whether a relatively small number of people will abuse cognition enhancing medications when so many are already abusing more toxic substances that alter conscious perception. From a certain point of view, one might easily argue that alcohol is used to alleviate pain, to dampen anxiety, to augment self esteem and to stimulate creativity. Perhaps "healthier" alternatives will emerge that will replace alcohol, reducing its burden on our healthcare and justice systems.
I am curious, Dr. Chatterjee: Do you foresee a day in which Cosmetic Neurology would extend to genetic therapy and stem cell therapy, in an attempt to reengineer pain thresholds and cognitive capacities? If so, do you also foresee a day when wetware/neurocybernetic interfaces may also fall under the purvue of the Cosmetic Neurologist? Or would you advocate that other subspecialties of Neurology adopt these modalities instead? Does this smack of eugenics, or can our emerging neuroeconomy justify these therapies solely on the basis of improved health?