Neuropsychiatry and the deauthorization of pain and suffering

Howard I. KUSHNER
Emory University, Atlanta, Georgia, USA

The biological revolution in psychiatry of the past quarter century has made remarkable strides in both the reclassification and treatment of a number of idiopathic illnesses. Even where effective interventions have yet to be developed, biological substrates have been theorized to the extent that expectation run high that both the organic etiology and pharmacological/genetic interventions will soon be uncovered to alleviate the pain and suffering of these disorders. But, the same revolution has served to deauthorize pain and suffering in a number of syndromes where no identifiable organic substrate has been identified. The DSM category of somatoform disorders is suggestive of the assumption that, without identifiable or putative physiological mechanisms, there can be no "real" pain or suffering. Today it appears that pain and suffering are only considered legitimate if informed by yet to be uncovered organic conditions. A psychogenic etiology of pain is viewed as synonymous with an accusation of malingering. As a result, those suffering from idiopathic pain syndromes including Gulf War illness, chronic fatigue, and fibromyalgia are adamant in insisting that their conditions are caused by yet unidentified organic mechanisms. When studies fail to uncover statistically significant organic substrate, claims of pain and suffering by the diagnosed are diminished in the eyes of often skeptical practitioners and the lay population at large. The idea that the social and psychological stress of work and family could, in itself, cause physical pain and suffering seems to have lost all validity. Yet, thirty years ago pain and suffering, as well as a variety of clinical signs were understood as common sequelae of emotional trauma and family tensions. Although psychosomatic frames have not entirely disappeared, they have become increasingly suspect especially in the face of triumphant psychopharmacology. Ironically, the rejection of psychological etiology has occurred at the very moment when findings in neuroscience have implicated the role of social stress and cultural conditions on a variety of "normal" or developmental neurobiological outcomes ranging from handedness to learning and language. Moreover, earlier assumptions that environmental influences last only during the plastic period have been revised. Even without these findings, enough has been learned over the past three decades to suggest that formative experience, especially those associated with learning and language have a major influence on the way individuals experience later stress. Although thebiological revolution in psychiatry has been very much influenced and shaped by the revolution in neuroscience, this has not necessarily been the case when it comes to pain and suffering. The reason for this comes in great measure from the fact that the psychiatric revolution has drawn mainly on psychopharmacological discoveries, which are only part of much larger neuroscientific contributions to issues of human consciousness. It would seem that these findings provide the interdisciplinary approach necessary for a reauthorization of a psychobiological theory of pain and suffering.


Session I -- 20th Century Brain Research and Emotions
Thursday, 14 June 2001, 10:00 am

Sixth Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and
Eighth Meeting of the European Club for the History of Neurology (ECHN)

Cologne, Germany