Tests and the narrative – one decomposes and the other builds; together they guide

Oliver Sacks describes how tests ‘decompose’ the individual into functions and deficits in his great book, ‘The man who mistook his wife for a hat’. I have learned a huge amount from reading his work, both in terms of the content but also his approach to complex cases. Sacks attends to such detail in describing the individual with a neurological issue yet never fails to recognise the human being and a person.

Punch says of Sacks writing the same book, he is ‘always learning from his patients, marvelling at them, widening his own understanding and ours’

What a word to use, ‘decompose’, yet on second, third and fourth reading, it is perfect. We use tests every day to break down what is essentially a complex being into components so that we may identify targets to treat. Increasingly there is reliance upon modern technology to diagnose and pin point a structure or an organ that is to blame for the presentation. Of course this has value, however, so does the narrative.

Allowing the person to tell their story and to validate it by listening is a fundamental start point. This both for developing a relationship and to learn about their experience. This first person description of their problem and how it manifests informs the clinician. For this we need time and space for the story to evolve using the language of that person, not our words. The metaphors, analogies and adjectives emerge from the very body that the symptoms emerge. The embodied experience is the one we need to hear.

Using the test results to add meaning to the narrative is important. Alongside there is a need to draw together what we see as clinicians to the story that is the patient and their first person reporting of what has happened, how it has happened and what is happening now. The ‘whats’ can often be answered (‘it hurts here’) but the ‘how’ and the ‘why’ must be elucidated to create a sense of meaning and purpose. From hereon in, closing the gap between the third person (what we see and find) and first person (what has been experienced) constructs the rounded picture that is necessary for tackling the more complex cases of pain.

Come and visit our main clinic page here for details on treatment programmes for complex pain including CRPS



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