Summer 2010 - The British Pain Society

and “like having a blow torch on
my skin”. I imagine you will have
come across this sort of thing fairly
commonly. But just take a moment
to think about the words and what
the pictures that go with them
might be. Bear in mind that those
pictures are going to be faster,
unchecked and more powerful.
If every time I have a pain I have
one of these pictures that’s what
I’m going to react to first and the
anxiety kicks in and a whole lot of
other things with it.
Semiotic pain research revealed
that there were five basic areas
where the pain impacted on
people. Firstly there was a huge
impact on their self-image in
terms of their personal worth,
their strengths and their personal
agency in life. Ideas about where
the pain was coming from very
rarely seemed to have any basis in
fact. They constructed their images
based on other experiences in life,
with very little resemblance to any
anatomical details or pathology.
The issue of locus of control was
always interesting with patients and
as expected there was often the
idea that, the doctor was in charge.
Other people who had always felt
they were in control found it very
difficult to give up that control
to other people. Patients can
also express pain in kinaesthetic
terms like different temperature,
sensation, texture or weight – “my
leg has become a lot heavier” - and
visual ones such as being a
particular colour or a particular
shape.
Using imagery in therapy
At Bronllys we find it very useful
to use images as ways of helping
people to manage the experience
of pain. If you can change the
image you can change the
experience, and this can have a
very powerful impact. It is a very
useful source of healing if we
can give people a more adaptive
meaning to their experience.
People get some very strange ideas
of how their bodies work: “you’ve
got some notches in the middle of
each side and that just locks up”,
and misinterpret what doctors tell
them: “Dr T, at the pain control,
he said there’s so much where
they’ve cut into the spine the nerve
endings they’re just jumping”. Now
I’m sure Dr T wouldn’t have said
this but this was what was heard.
Physicians have to use metaphors
when explaining things to patients
but the danger is that the metaphor
becomes concrete for them.
Imagery can be used to create
a better understanding between
clinician and patient. I find pain
drawings very useful because
they tell me so much about the
patient’s experience and distress.
Pain is very multidimensional not
just in terms of words but also
the visual elements for different
individuals. Some images of pain
can even introduce a spiritual
element e.g. martyrdom and this
may be a powerful dynamic for
some. Historical perspectives on
pain are fascinating in this respect.
The concept of pain as in the hands
of the Gods is probably the highest
form of an external locus of control.
Should we then be making a point,
as part of clinical assessment, of
asking people to describe their
pain, not just in words but in
pictures? Asking something on the
lines of explain what I would see if
I took a photograph of your pain or
indeed one that represented your
life? That is very effective shortcut
to finding out a lot; people put their
priorities into their ‘photographs’.
Should we be making more out of
pain diagrams than simply getting
an idea of the distribution of pain?
Should art play a greater part in
pain clinics? Given that it has this
immediacy for people and can be
very therapeutic in itself.
To quote Epicetus, the famous
Greek Stoic philosopher: “Men are
disturbed, not by things, but by
the view which they take of them.”
So pain may be what the patient
says it is, what the patient sees it as
or how they move with it. It is up
to us to find out what that image
really is and, if we can to use it and
other images, for good.
Painting over the
cracks: creativity
when art and medicine
collide
Dr Diana Brighouse
Southampton General Hospital
Throughout my career as a pain
doctor and psychotherapist and
now in my final year of a fine art
degree I have been looking at
medicine as a healing art.
The Intertextual Space
I would like to discuss the wider
concepts of art and medicine and
firstly I would like to explain the
concept of the intertextual space.
The intertextual space is sometimes
called the interpersonal space but
that’s not strictly accurate. To put it
simplistically, the intertextual space
is the third space where something
is created in the interaction
between subject and object. That
subject and object might be two
people, but might be a person and
a piece of literature, music or visual
art, or a landscape. That is the place
where creativity occurs, where the
healing art of medicine occurs, and
where art and medicine collide.
Public space art
There is a difference between
public space art and art therapy
and these are quite different things.
In the UK art therapy only exists
as a tiny part of the mental health
sector and in palliative care but
is otherwise virtually unavailable.
Public space art on the other hand
is something we’re all exposed to
every day. It’s not just the visual
arts but includes architecture, the
performing arts and music e.g.
there is much literature about
narrative and writing therapy –
getting patients to write about bad
experiences can be a powerful of
way of getting into their world.
Drama therapy is used quite a lot in
adolescent mental health but not to
my knowledge in any pain clinics.
The most comprehensive body of
knowledge about art in medicine
can be found in the Arts Council of
England 2004 report “Arts in health:
a review of the medical literature”
edited by Dr Rosalia Staricoff and
reviews 400 papers. It is available
online at
http://www.artscouncil.org.uk/
publication_archive/arts-in-health-areview-of-the-medical-literature/
Some of the most compelling
evidence put forward for the
beneficial effect of “art” is in the
study of the environment on
rates of healing and recovery.
The implications of this for the
architecture, design, decoration and
setting of healthcare facilities cannot
be underestimated. There are some
visionary examples of new hospital
builds inspired by this principle
but nearly all are in the US. We do
have some purpose-built wards,
one of the most famous being the
Bart’s breast cancer unit. There
is evidence of a reduced length
of stay in medical wards just by
changing the environment, with
reduced analgesic requirements.
PAI N N E W S S U M M E R 2010 49