‘‘Screw-ups’’ 95
The possible meanings of pain—uncertainties as to the problems it might
indicate—thus add to its distress. Yet the discrepancy between his pro-
fessional training and his disease experience shocked Albert; he had not
recognized the depth of this chasm before.
He was surprised, too, that his providers did not ask or care about the
details, the qualities of discomfort or pain.
Nobody asked me what kind of pain I was having. They asked me if
I felt better after the nitro. But not ‘‘Where is it, exactly?’’ Nobody
cared. As soon as your t-waves on your EKG are abnormal, the
doctors don’t care very much about the clinical quality.
Albert was disturbed that, to his doctor, his test results became far more
important than his feelings.
His experience was important to him, though only fellow sufferers
could fully appreciate it. Hence, Albert became eager to share it, as a ‘‘war
story.’’ Others, who had not endured it, could not relate.
If you’ve had it, you find someone else who has been through it:
you know that blowtorch feeling going up and down your
arm . . . having to walk around bent. . . .
As a result of their treatment, only now did some of these phy-
sicians question their definitions of ‘‘clinical significance.’’ Suzanne, the
psychiatrist who started lithium treatment for bipolar disorder, said,
for example, that clinicians are not sensitive enough to the impact of
weight gain as a side effect that can cause profound social and self-image
problems.
It really bothers me how definitive psychiatrists are: ‘‘Patients can
handle the weight gain on a medication. Let’s just throw them on
that. It doesn’t matter that she’s twenty-three. For the weight gain,
she can exercise.’’ That’s bullshit. Don’t put her on it: she’s not
going to take it because she’s going to gain fifty pounds. She’ll
never get a boyfriend, and in this society that’s more important
than anything.
Indeed, for Suzanne, weight gain was the hardest aspect of her treat-
ment. She continued, ‘‘That’s the main problem: I’m fifty pounds over-
weight. I’m a former athlete, a skier. I just can’t go on the ski slope now:
I’m exhausted.’’