Gravity's Rainbow

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Psychological explanations of migraine remain an extraordinarily popular trope in self-help books for migraine care. Take, for example, the most popular self-help book on this topic, Heal Your Headache: The 1.2.3 Program, by David Buchholz, a neurologist from Johns Hopkins School of Medicine. Buchholz recommends a strict treatment protocol for migraine prevention, which includes the immediate removal of all abortive drugs (i.e., the drugs that one takes to interrupt a migraine); a strict diet; and, if all else fails, preventive medications. The treatment plan is difficult to follow—he suggests that people quit taking their pain medications “cold turkey” without help from a physician, lest “you and your doctor … become entangled in a sticky web of victimization, dependence, blame and guilt …quick fixes … [that] undermine your determination to do what you can to prevent migraine.” If his methods do not work, Buchholz observes, “sometimes it’s hard to let go.” He confides that he is pessimistic about patients who are “entrenched in or seeking disability status, or pursuing a lawsuit, based on headaches.” Illness behavior, he explains, can help motivate migraine, as “when we’re sick, others give us their attention, concern, affection, sympathy, help, forgiveness, and permission to be excused from work and other responsibilities … our subconscious may have some other hidden agenda that interferes with response to treatment.”

Buchholz relies most heavily on psychological explanations of migraine when his recommendations fail to work for the patient. For him, the next obvious explanation is that the fault lies in the psyche of the person who refuses to get better. But it’s also important to remember that Buchholz isn’t talking about just any kind of person. He’s implicitly describing a feminized patient, one who could easily become involved in “victimization, dependence, blame and guilt.” Buchholz’s use of the psyche as a last-ditch explanatory model for the difficult patient underscores one remaining way that biomedicine manages the balance between mind and body in migraine: when patients— especially female patients—become “difficult,” the psyche remains a convenient explanation for treatment failure.

Joanna Kempner in Not Tonight

As Sara Ahmed says, “When you expose a problem you pose a problem.”

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