musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

What is it like to be a…?


When I first read the philosopher Thomas Nagel’s ‘What is it like to be a bat?’ essay, I was intrigued by his idea that ‘an organism has conscious mental states if and only if there is something that it is like to be that organism—something it is like for the organism’. It makes sense, doesn’t it?

Empathy -the ability to understand and share the feelings of another- depends on it as well. It seems to me that if I couldn’t apply the ‘what’s-it-like-to-be’ test, I would be left with only something akin to sympathy -feelings of pity and sorrow for the misfortune of a being which I judged not to be conscious- but I would be unable to feel its plight, put myself in its place, as it were. Of course, the thing might not be able to communicate that it has any emotions, so I would still be at a loss to know if my feelings were even appropriate.

Thus arises the problem of pain, perhaps: although I obviously know the feeling of my own pain when it arises, I cannot actually feel another’s pain. I can neither feel its intensity, nor can I know, except indirectly, what the other really thinks about it at the time -how their mental state is affecting how they feel the pain. After all, pain is both physical and mental.

We all feel pain differently, and if I am stressed, I may experience pain completely unlike the way I usually do. And anyway, the pain would be my pain, not yours: I am the one feeling it, not you. Still, I may be overreacting to it; I may be a poor judge of my own idiosyncrasies. But you, as my friend, may be able to see through my well-worn cognitive dissonance.[i] So, although you cannot feel my pain, you may be able to guide me through it; calm me down and distract me so it no longer has the same intensity; no longer has the same fear and anxiety associated with it. You are not feeling my pain; you are sensing how I feel about it.

And there is a lot of information about me that a friend may be in a better position to know than me: whether I lose my temper too easily, or make snap judgements that I later regret; or even whether I can accurately assess if others believe me or not. Perhaps it is the same with pain; perhaps I am not always in a position to appreciate the effect my current mood is having on my pain perception; perhaps I do not even believe that I am in a mood… So, merely distracting me might change the intensity of the pain I feel. Friends can often do that; they can be the mirror that reflects how and what we see of ourselves.

Friends rarely contact me via video links; most of them, like me, are older and unused to many of the digital accoutrements hidden on their phones. In fact, it’s only recently that I’ve accustomed some of them to the ability of Emails to elicit responses from me; texting, however, is still beyond the pale for most of them. Voicing seems to be the default, and so I have to be careful to add those who prefer to talk to my list of contacts or my phone ignores them and sends them straight to voicemail.

One day however, quite unexpectedly, one of my friends was able to contact me on Skype; I suppose they knew I had been using it to connect to a relative overseas; maybe I’d even done the same with her; my phone accepted her at any rate…

“Just thought I’d like to see you when I talk, G,” she said, looking quite distressed. Jana had been a close friend for many years, but had recently moved to another city to care for her even more elderly mother. It was nice to hear her voice and see her face again, but her smile looked forced, and her swollen eyes suggested she’d been crying.

“I’ve been thinking about you since you left, Jan…” I replied, “But you look terrible.” I couldn’t have said that to anybody else.

She closed her eyes for a moment before she said anything. “It’s these headaches, G! They’re getting worse… I’m really concerned about them.”

She was using her laptop rather than her phone for the video call, so unlike the way most people hold their phones, the screen was stationary; I could see her whole face and even her shoulders. What I saw was concerning. Her eyes were bloodshot, her cheeks blotchy, and her hair was uncharacteristically dishevelled. I’d never seen her like this before.

“I’m beginning to think I have a brain tumour, G…” Her eyes pleaded with me to contradict her.

“You’ve had headaches off and on ever since I’ve known you, Jan,” I said to reassure her. “Didn’t you have some sort of head Xray a few months ago? You told me it was normal…”

“But the pain is different now,” she almost screamed at me. “It usually goes away after a few hours if I take pain killers… But not this time!” She started to cry and shake her head slowly, as if that might help. “Even my hair hurts, G!”

She often said that, and after doing various tests her doctor had suggested that it might be from muscular tension as she slept -clenching her jaw, or grinding her teeth; the muscles could pull on her scalp apparently. But out of an abundance of caution, she’d referred Jana to a neurologist in case it was migraine. The neurologist had done even more tests, including a CT scan of her head, but nothing alarming had been detected. ‘Probable atypical migraine’ was his tentative diagnosis but he’d suggested she try combining Advil and Tylenol before he tried her on the more expensive and side-effect laden prescription triptan medications.

“So have you gone back to the neurologist, Jan? What does he think?”

She shook her head. “I don’t think he really believes it’s migraine, G…”

I was going to ask her more about the neurologist and whether she was going to ask for a second opinion like she had when she’d switched GPs, but another thought occurred to me. “How’s your mother, by the way?” I asked, feeling a little guilty at changing the subject so unexpectedly.

Her eyes narrowed a little at the question. “She’s not doing very well, actually. I’m trying to find her a senior’s home, but right now there don’t seem to be any facilities without a long waiting list.” She blinked at the question, as she thought more about it. “I’m trying to arrange for some homecare in the meantime, but even there, I’m having trouble.”

I shook my head empathetically. “That must be incredibly stressful, Jan. I don’t know how you cope. I really don’t…” I knew she liked to believe she had control over things.

She shrugged and a tiny smile seemed to be hiding behind her lips. “You know me so well, G!” Her eyes softened and she wiped away the tears that had been forming.

“Most other people would catastrophize things -but you…? You just dig in until it’s solved,” I said. Jana always reacted to compliments with a shrug, but accepted them with a smile even if she couldn’t quite believe them. “I wish I could be more like you…” I added with a chuckle, hoping she’d realize my sarcasm was a way to lighten her mood.

Her smile blossomed like a flower and a bit of the old Jana began to write itself on her expression. “I suppose I do tend to react with my body to stress, don’t I?” She sighed and I could see her beginning to tidy her hair as she spoke

I nodded, unable to hide my own smile.

“Sometimes I think you know me better than I do, G,” she said, her face looking increasingly relaxed.

“It’s what friends are for, Jan…”

[i] https://psyche.co/ideas/sometimes-other-people-know-your-pain-better-than-you

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