TRAUMATIC STRESS DISORDER AND PAIN
Hmmm. Something is wrong. A word is missing somewhere. Oh, there we go. The word POST is missing. POST traumatic stress disorder. According to the language, stress disorder is something the body and brain develop AFTER the stress. Apparently, during the stress, the mind has blanket immunity to such problems. But does it really? Do our everyday experiences confirm that during a robbery, tornado, assault, etc. that our emotions are held in check, our thoughts and feelings sturdy and true, while only later does the system collapse and become dysfunctional? Is that right?
On second thought, maybe there is a larger category of which POST TRAUMATIC STRESS is a subtype. Maybe DURING the catastrophic event, we can go all wobbly and confused and frantic. Maybe some kind of hysteria can overtake us when we are actually IN the throes of a crisis, DURING the dreadful event. How long does the PRESENT last. Is it a couple of minutes, an hour, a month or even longer. How about a lifetime. WHEN exactly does the system give out and a STRESS DISORDER set in? What do we call it if we never get out of the pain in order to develop PTSD.
Take for example, CENTRAL PAIN. Does the frantic nature of severe pain somehow have a protective feature, an adrenaline rush perhaps, which shields us from the impending shutdown? If so, how much adrenaline can we count on? Does it last years?
Dr. Ron Tasker, the famous neurosurgeon who discovered that pain in the body is carried in the spinothalamic tract, has indicated that fully elaborated central pain is the most severe pain state known to man. If he is even close to being correct, and no one has more experience with pain patients, then did anybody else notice this? Well, S. Weir Mitchell, the civil war surgeon, was amazed to find his most brave officer reduced to the “TEMPERAMENT OF THE MOST NERVOUS GIRL” as soon as Central Pain set in after a bullet to the neck injured the spinal cord.
The Civil War being notably brutal and gory, things had to have been pretty bad to attract the attention of someone who had seen it all. What exactly was going on? It must have been impressive, because after treating some more Central Pain patients, Dr. Mitchell convinced Johns Hopkins Hospital to set up an entire wing for nerve injury pain patients.
Was their treatment for POST traumatic stress or was it something different because their pain was ongoing. They were actually IN PAIN, still, so one could not very well term it POST traumatic since the pain trauma was still there. Imagine, an entire ward at a top hospital full of formerly brave soldiers, acting like the MOST NERVOUS GIRLS. This was not over their paralysis, but their pain. What is up with that?
Aside from the offensive to feminist aspect of Mitchell’s choice of words, we get the picture. They were not themselves. They were different from those charging into the cannon’s mouth. They had left part of themselves on the battlefield the day they were injured. They were in fact living a life of deaths. Their real personality was no more.
Was this worse than post traumatic stress, this intratraumatic stress? Was it less? Or did it have components of two different disorders? Is chronic PAIN really identical to post traumatic stress? Can we help one but not the other?
When Riddoch, who invented the term “Central Pain” gave his report in the Lancet, he called the condition, “A Pain Beyond Pain”. What could possibly have led him to characterize it this way? What was he talking about? There is nothing beyond pain, or is there?
These are the questions we ask. The psychiatrists and psychologists literally descend en masse on those with post traumatic stress, but they are conspicuously absent in the pain clinics. Is Central Pain too mysterious even for the psychiatrists? Does this mean the mind stays on even keel until AFTER pain has gone, at which time it flips out. Are psychiatrists only able to deal with incidents AFTER THE FACT, or can they be of assistance DURING a terrible trauma, even a long lasting one? Especially a long lasting one. Are the stresses and appalling shocks suffered by the patient’s family too remote and inaccessible even to study, much less treat? Does the condition even have a name? Is that out of reach? What are they waiting for?
Or are we assured that the human mind is durable and that the CP subject (who himself regards his pain condition as WORSE THAN THE PARALYSIS) will need no help beyond what opiates can provide during the months and years during which he is taken apart minute by minute, day by day, by an illness too terrible to describe.
If you relate to this quandary, and feel you could use some help now, you are obviously just“ a nervous girl” UNLESS, of course, the condition of pain present is really something sinister, and indescribably awful. Were the Civil War soldiers right that the pain is worse than the paralysis? Hmmm. That would make it pretty bad, now that you think about it..
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