Philosophy

"Do Unto Others ..."

“I’m ashamed of our profession,” Joe confessed to me (Charlie) not long ago. “I can’t believe how little they care about the person,” he continued, referring to his recent miserable experiences with chronic pain .And I'm a physician; I can’t imagine what it must be like for the typical patient. They must be continually exhausted and depressed.”

Most healthcare professionals share Joe’s insight after experiences of helplessness and defeat that can accompany the journey through chronic pain and illness. It is unfortunate, however, for us providers, that it literally often “takes one to know one,” before we can develop sufficient insight and empathy for patients suffering from chronic pain and chronic illness.

Our therapeutic philosophy is very simple. We strive to treat patients suffering from chronic pain and chronic illness in the same way in which we would like to be treated. Perhaps for the uninitiated, this statement appears obvious and even trite. However, in interviewing many patients about their experiences over the years we have found that this Golden Rule is rarely followed when a chronic condition is involved. The Golden Rule, by the way, preceded and extends far beyond traditional Judeo - Christian ethics. This core ethical guiding principle is found in virtually every scripture of the World’s religions.

Conversion from Cannibalism to Caring

As trainers and healthcare professionals we have found the fictional character of Friday in the book Robinson Crusoe to be a philosophical inspiration. Friday, incidentally, was neither the story’s hero nor even a particularly central character. Contrary to some modern interpretations of the book, he played a very small role, only entering the story after Robin had already learned most of the skills he needed to survive on the island. To be sure, Friday had specialized information about island-living from having spent many years surviving and prospering in similar conditions, but this was of less importance to Robin than might be expected. From Robin’s standpoint, the key to Friday’s usefulness was his ability to learn his language and listen to his thoughts. He was most useful to Robin once he had learned how Robin had survived and how he had organized his life on the island. This enabled him effectively collaborate combining his own knowledge of the island with Robin’s unique survival experience.

A key aspect of the story was Friday's own personal transformation, as he turned away from what was presented as his native culture's acceptance of cannibalism. Traditional psychotherapy and healthcare practice engages in a type of cannibalism when identifying patients with a variety of invidious labels; non-compliant, malingering, psychosomatic, weak, pathological, time wasting, irrational, “mental,” etc. These labels and the professional attitudes they represent literally consume patients’ energy, just as cannibals eat their enemies. The task for the current healthcare system, we believe, is to view each patient as an individual and seek solutions that are relevant, caring, and hopeful.

One Size Fits One: Integrating a therapeutic approach with a philosophy

Having good thoughts and the best wishes for patients are not sufficient to meet their needs, however. Paralleling our philosophy that is a solution focused treatment approach that invents a new theory for each patient. This is accomplished through disciplined therapeutic protocols that center on developing future possibilities rather than concentrating on past pathological labels. Thus, our focus is on expanding rather than reducing the patient’s life possibilities. Instead of relying on outdated beliefs we attempt to develop a new theory for each patient. This “one size fits one” approach honors the patient while marshalling his or her resources for effective change within a context of caring. Recrafting a Life presents the details of these protocols enabling both provider and patient to construct solutions to chronic pain and chronic illness.

It might appear that we have an interest in cannibalizing our own profession. The metaphors of Robinson Crusoe and of Friday are intended to elicit compassion for both characters--for our patients and for us. In some ways we are stranded together and our fates are, however temporarily, inextricably linked. We can become worthy companions, in part, by developing a caring philosophy, by listening without labeling, and by doing what patients define as helpful.