IN THIS ISSUE

Losing Hope In Treatment

This article is designed to give the reader a glimpse of what it is like to have given up hope from the point of view of the patient, I was the patient, a then thirty seven year old doctor of psychology, I suffer from recurrent acute upper back pain

By Eugene M. DeRobertis, PhD

In mid-2002, my then girlfriend and I moved in together. We had a terrible mattress and I was having manageable back aches. I did nothing about our sagging mattress. For two years I had recurrent thoracic discomfort. In May of 2004 I went bowling and made my condition far worse. I relaxed my muscles by drinking alcohol and used a ball that was too heavy. Two days later I was hunched over with back spasms and inflammation vertically, along the left side of my thoracic spine (a pain level of eight on a scale from one to ten).

I immediately went to a chiropractor. He took X-rays, but found no structural abnormalities. He nonetheless commenced treating me with heat and electro-stimulation, small adjustments in the area, massage, ultrasound, and finally cold laser therapy. None of this helped. Frustrated, I switched to a chiropractor who gave me more aggressive adjustments, put me in cervical traction, and assigned weight training exercises for my neck muscles. This made the problem worse.

I then went to a doctor of osteopathy for trigger point injections, seven in total. None of those worked for more than ten minutes. The osteopath ordered two EMG’s and MRI’s of my whole spine and brain. There was nothing in the EMG’s or MRI’s that could account for my pain.

At this point, I was feeling like I needed a simpler solution to my back pain, something more focused on musculature. I tried deep-tissue massage, which had more of an immediate effect than chiropractic, but ultimately had no enduring effect. I then went to physical therapy, where I was given a series of stretches to do, which provided negligible relief.

Feeling as if I had very little in terms of options for treatment I went to a neurologist, who showed more interest in discussing the work of her favorite psychologist, Carl Jung, than looking into my case. She boasted of high scores on her psychiatric board exams. When I was visibly unenthused at her desire to speak to me about Jung rather than my back, she misinterpreted my silence as evidence of nervousness. She then proceeded to immediately diagnose my pain as being the result of anxiety. Her answer was that I take up a spiritual practice and take medication. Although her advice did not sound offensive to me, I ignored her wholesale based on her complete inability to make feel as if she had given my predicament any serious consideration.

In a desire to speak to another medical doctor, I went to an orthopedist who diagnosed me as having a functional syndrome, wherein my muscle strain results from daily activities, such as sitting and bending. He ordered physical therapy to help strengthen my back. During my second round of physical therapy I was diagnosed as having atrophied mid and lower trapezius and rhomboid muscles. Nothing about my lifestyle was addressed. Rather, the therapist gave me strengthening exercises for those areas, which appeared to have some positive effect for about two weeks. As treatment proceeded, my pain slowly started coming back. The physical therapist was unable to manage this stumbling block, as it deviated from what typically occurs in her patients. I ended treatment without relief once again.

At this point, hope was almost gone. So I began looking into non-traditional treatments. I began acupuncture, which had a positive effect for about a month. Interestingly, it was the only form of treatment that yielded enduring results, even if only marginal. Eventually I sought out a chiropractor with a background in something called applied kinesiology whose “treatments” provided mild intermittent relief for about two weeks.

The summer of 2009 marked my fifth year living with back pain. I had seen three chiropractors, one osteopath, two physical therapists, a neurologist, an orthopedist, a massage therapist, three acupuncturists, and an applied kinesiologist. I purchased a more comfortable car, a new mattress, new chairs, countless back pads, muscle rubs, patches, and pills. All in all, I spent over thirty thousand dollars on my back, yet I lived in pain every day. I no longer sought help or treatment for my back. I no longer tried to find answers to my back pain.

Looking back at all the treatments I underwent, I recently thought about why I had given up hope and found that I can relate the reasons most directly to issues pertaining to developmental psychology, especially parenting. In particular, I relate my experience to a concept that is central to the works of three holistic, humanistic psychoanalysts: Karen Horney (1950), D.W. Winnicott (1965), and Heinz Kohut (1977). Though Karen Horney and Heinz Kohut are not usually seen as developmentalists in the field of psychology, they have nonetheless made significant contributions to that area (DeRobertis, 2008). For Horney, Winnicott, and Kohut alike, the key to good, health-conducive parenting is empathy. In my view, it was empathy that was most lacking over the course of my treatment experience. I never felt really understood.

Karen Horney (1950) noted that a child who receives empathy in the form of “genuine warmth and interest” will experience a deep and validating sense of belonging, or “we-ness” (pp. 18–19, & 87). Each time I went to a new professional, I remember hoping that I would be able to make a warm human connection that would keep my spirits up. I sought the we-ness that Horney spoke of, but never found it. I remember searching for a glimmer of hope in a person who would somehow give me the impression, not that they had all the answers, but that they really understood my pain and frustration and were willing to stay deeply involved in the search for relief. To be sure, this was the immediate appeal of the non-traditional practitioners that I visited. In the end, however, even they were unable to maintain empathic contact with me through my difficulties and frustrations.

Like Horney, D. W. Winnicott noted that the technical knowledge of how to parent, or merely “acting” in the role of a truly dedicated, loving parent, will not adequately assist a child in establishing a calm, confident, resilient orientation toward life (DeRobertis, 2008p, p. 40). Each time I went to a new professional, he or she would treat me with a standard repertoire of treatment modalities. I sometimes felt like I was “just another body” on a conveyer belt. Each treatment felt like the professional was going through a mechanical routine. Very little was done to custom tailor treatment in accordance with the feedback that I was giving. In fact, one of my physical therapists told me that I was “not allowed” to say that the treatments were not alleviating my pain. As each modality failed, no professional reexamined my case with an air of humility which would indicate to me that my case was being viewed as different from others.

Finally, Heinz Kohut noted that a child expects empathy from his or her primary caretaker in order to manage anxiety and build confidence. In the absence of empathic relations, the child becomes frightened, unconfident, and discouraged (DeRobertis, p. 48). In the end, I was unable to feel that any of the professionals that I saw truly understood my discomfort or had the ability to communicate to me that they were genuinely committed to understanding the unique details of my problem. As a result, I became progressively discouraged and finally lost all confidence in any form of treatment for my back pain.

Perhaps some day I will give treatment another try. However, when that day comes, whoever I seek out will know from the door that treating me is contingent upon treating me, the whole person, my entire lifestyle, not just my body. Based upon my past experiences in treatment, this will most certainly entail a genuinely empathic posture on the part of the practitioner that I as the patient can perceive in no uncertain terms. My experiences have convinced me that no collection of therapeutic tools can replace the human factor in treatment. Without empathic contact, treatment is at risk for becoming irresponsibly dependent upon the homogenized treatment regimen. As good as many treatment protocols may be, a lack of empathy will prevent them from being creatively or innovatively utilized to suit non-typical cases. Worse still, the non-empathic employment of treatment techniques can lead to a critical loss of faith in one’s healer, and a loss of hope in treatment altogether.

References

DeRobertis, E.M. (2008). Humanizing child developmental theory: A holistic approach. NY: iUniverse. Horney, K. (1950). Neurosis and human growth: the struggle toward self-realization. NY: W. W. Norton.

Kohut, H. (1977). The restoration of the self. Madison, CT: International Universities Press.

Winnicott, D. W. (1965). The maturational process and the facilitating environment: Studies in the theory of emotional development. NY: International Universities Press.