Reflections on “Addressing Patients’ Psychic Pain”

To the Editor: Joel Yager and the Journal should be congratulated for publishing the clinical article “Addressing Patients’ Psychic Pain” in the October 2015 issue (1). It was excellent. We who are trained in Boston, especially under Elvin Semrad, approach psychic pain slightly differently (2). We believe that most psychic pain is caused by loss or failure: loss of a loved one, object, job, educational opportunity, or the failure thereof. Such loss or failure usually precipitates signs and symptoms of psychic pain that are in both the mind and body.

Our job as physicians is to help the patient acknowledge pain in all its details. We want the patient to re-experience this pain in our office in all its forms. We ask questions such as when, where, and how the patient experienced and perceived the pain, and with whom. We want the patient to relive the experience in our presence—to feel it in his or her body and mind. We empathize (not sympathize) with the patient in this full acknowledgment of sorrow, guilt, shame, frustration, anger, and rejection as well as of love, hope, and desire. Then we want the patient to bear this pain and not to run from it but to sit with it. And finally, over time, we want the patient to put this in some kind of perspective. This process of acknowledging the pain, bearing it, and putting it in perspective can take a short time or can proceed over a longer period. Each patient will do this work in his or her own unique way. We want the patient to empathically understand and experience the pain in the presence of a skilled clinician. Often it is painful for us, as well.

We know the importance of family, friends, and social and community supports as well as the judicious use of medication. But we as clinicians have the special ability, skill, and opportunity to help patients, too.