Thursday, November 15, 2007

Words that hurt - Part 2

Thankyou for all the responses to the previous blog about painful words and phrases. There is no shortage of them and the context they are used in can enhance the nastiness of them.

“Degeneration” comes up a lot, probably due to its frequent use in radiological reports and so does “crumbling”, reminding one responder of an oxo cube. “Permanent” was another and a patient got “all seized up, be very careful” recently from a surgeon who should have known better. I can’t help smiling when a patient says “its bone on bone in there” or throws the thick package of imaging studies on the bed, saying “there it is”.

Different professional groups have different harmful words "your child's membranes are strained" and "there is a severe compression of the base of your skull" were sent by a therapist experienced with craniosacral techniques. Equally, any benefits from the current manual therapy focus on spinal instability could be negated depending on how a person views the word “instability”.

Most clinicians have heard these and other terms (even “slipped disc” is still around) and are realizing the impact of the language.

Reflect….. say a person is told they have “a degenerate L4 disc pressing on a nerve root and the thecal sac”. They will repeat that phrase many times and internalise it even many more times. Googling “thecal sac” will reveal that the problem is close to the spinal cord and notions of paraplegia may emerge.

When we can conceptualise that the “degenerate L 4……” phrase is a brain construction held in motor, perceptual, emotional, planning and other brain areas, we may realize that it is not much different to how a learned limp is held in the brain. Just as most therapists would try and reduce the limp, a search for new, variable and more positive language is therapeutic. Or even better, could the health community avoid the exaggeration, crazy metaphors and even lies at first encounter ?.

Please send your thoughts