The approaching episode of House on Tuesday (now past) should provide more reflection on whether the public can view pain accurately.
House is the only TV show or media of any kind to make nerve injury pain a central feature. Thus, it always seems remarkable when it comes out with genuine insights. Memorable quotes:
“If I’m in a buttload of pain, I need a buttload of pills”, also
“Okay, fine. I’ll father your child. But first you gotta write me a Vicodin prescription. Just so I can get through the foreplay”.
Shocked? Well, people in severe pain are shocking. Sorry.
In the late 1980’s, Ron Melzack, from McGill University in Montreal, (and at that time co-editor with Patrick Wall* of “The Textbook of Pain”) published an article in Scientific American arguing that opiates are NOT addictive to those genuinely in severe pain. One of the moving stories in the article was about a man in his early twenties with a severe pain state. He could not work, could not socialize, and could not go on. He was begun on regular, heavy doses of pain medication.
His life turned around. He began to be productive. He got a job. He even had a girlfriend. He did not turn into a crazed morphine junkie, robbing banks and causing mayhem. If opiates really caused outlandishly bizarre behavior, you wouldn’t need ads on TV listing subtle signs to detect if your kids are on drugs. By comparison, no parent would ever miss a child who is drunk, so we really should have known all along that opium for genuine pain is NOT a boogeyman. Alcohol, on the other hand, is. In other words, there is a difference between “politically correct”, and “correct”.
Things were going great for Melzack’s young man, and then, some federal regulator saw things differently. The whole business just had to be “illegal”. Quick steps were taken by the power authorities to stop the young man from receiving medication, lest he become “addicted” (ignoring the difference between dependency and addiction).
Melzack watched sadly as the young man lost his job, lost his girlfriend and lapsed back into a sorry pain state, his life ruined. Melzack gave examples of patients on heavy opiates who walked away with no problem if the pain could be solved. No detox comas, no delirium tremens, no life of crime.
We have seen national figures with addiction to pain meds function very well, but you won’t find media or government figures doing anything well if they are drunk. What is the substance abuse which should be of greatest concern to all of us? Hint: It is not pain meds for those with severe pain.
The world is still ignoring severe pain, and it has had enough time to come out of the dark ages and stop seeing demonic possesssion in those who are merely in severe pain. The Salem witch hunt for pain patients needs to be called off. The appalling self righteousness of prosecuting attornies is misplaced in many cases, especially regarding their jihad against doctors who treat pain patients compassionately and frequently.
Now we have a television show about a Melzack’s young man type as a master diagnostician in a New Jersey hospital, presumably Princeton-Plainfield. Dr. Gregory House is dependent on Vicodin for nerve injury pain in his leg. This week’s new episode of House has us wondering whether the network will flow into the public myth on pain–that a little rehab can fix the worst of pill takers and that the pain wasn’t really the problem, Somehow we don’t think so, but then, the producers will be fighting an uphill battle if they really let Hugh Laurie go back to his Vicodin. If they do, this is the is the only media site which would take such a stance.
The Wilson-House apology scene has already been called the most moving ever seen on television, although it is actually humorous. We also get to see how House, known to be a bit arrogant, deals with the arrogance and utter legal clout of a judge. The irresistable force meets the immovable object. The system versus humanity. We know who we are rooting for. It should be interesting. Given House’s prior demonstrations that it is never easy to represent the interests of mankind in this day of managed care, this episode may be the best yet. House trusts no one, especially his patients. Yet, he has a gut instinct of legendary proportions about when a patient is sick. The only incurable person on the series is House himself, who has nerve injury pain. See how realistic the show is!
Charm has been described as the ability to solicit a “yes” answer before the question is even asked. Sex appeal might be in the same category. And then there is just sheer brainpower when all else fails to get the job done. House’s associates have plenty of the former and House has enough smarts to outshine them all, not that we don’t love the charm and beauty of his colleagues. House’s bedside manner is pretty much “I’m in pain and much sicker than you will ever be, so just shut up and let me save your life so I can get back to my pain pills.” Not much of a life, but it works for House, who is the most loveable curmudgeon on TV. This is because we actually hate the phoniness in most doctors and also because House is like us, in some puzzling way. Interesting isn’t it, and just all too familiar. Funny how pain actually acts like pain and how House actually acts like someone in pain, and how the public is always shocked by his acting like he is in pain without acting like he is in pain. In other words, his behavior is that of the true pain subject, not the mythological overactor who holds onions near the eyes to let the tears flow. He acts pain rather than the pain stereotypes. He isn’t screaming, he isn’t bleeding, he isn’t grimacing, he is angry. He lives, jokes, and works just to spite the pain. He is also realistic enough to know that he is not eligible for any human relationships, no matter how charismatic he may appear from time to time. Hugh Laurie has won just about every acting award on television for playing pain straight. We hope this doesn’t change.
There is this odd thing about severe pain. It exposes human frailty and shows the human comedy in every pretension. Pain makes them all irrelevant. Like someone who needs to use the bathroom NOW, pain subjects don’t have time for the trappings of human dignity. Nor do they believe it exists, and that is why they are ready to laugh at themselves.
Several years ago, one of the outstanding pain nurses at the University of Washington wrote an article noting that when she walked down the hall where those in really severe pain were kept, about one third would giggle when they tried to talk to her. It is so silly to try to be human when pain is destroying you. It is no surprise that people laugh when they are embarassed that they are trying to be people but simply cannot. Laurie is likewise hilarious in his pain, in a sympathetic and deadly real sort of way.
Bryan Singer, one of the X Men producers who also helps produce House seems to have a sympathy for people who are different, and as TV medical heroes go, you couldn’t posssibly get any more different from the average TV doctor than House.
The strange thing is that House is not really fictional. Every doctor knows someone like House–so good at diagnosis they refuse to take even themselves seriously. Only pain and death are the real deal. Dr. David House types pay a terrible price for their medical Don Quixote fight against suffering. House is a hero, but tragedy has to be lurking somewhere. “Show me a hero and I’ll show you a tragedy”.
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*Dr. Patrick Wall, of St. Thomas’s Hospital Medical School in London initiated the Wall/McHenry database which continues to be part of painonline. His famous quote from “Pain” on why databases such as this are necessary, “It is crucial that we begin with precise and objective reports of what people and animals do when injured…”
This site belongs to those with central pain and could not exist without their input through the surveys. It is no coincidence that researchers at the NIH and elsewhere rely on data provided them from painonline. There is a reason why great scientists such as Nobel laureate Francis Crick have contributed to this site, and that reason is the pain subjects who have helped to build it, and the evil nature of unnecessary pain, which should concern every compassionate human being.
Hysteria over behavior of addicts can wait. There are alcoholics who do worse things than the worst an addict can imagine, every day. Check out the MADD website. We are not talking about criminals who kill to make money. That is not addiction over pain, it is addiction to money.
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Since the episode has aired, you know that House made it out of jail, because his hospital administrator lied for him. He is behaving like an addict, but he has not given up the fight. We can take that much from the program. The show is sympathetic to addicts. House continues to show the fundamental loss of real life which pain sufferers experience.
