Gravity's Rainbow

botany, shoes, books, and justice

July 13, 2016
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[I]n 1973, Seymour Diamond and Donald Dalessio, then codirectors of the famous Diamond Headache Clinic in Chicago, wrote that the inability of people with migraine to adapt represents the repressed hostility of the migraine patient.

Joanna Kempner in Not Tonight

I am actually pretty angry about having a painful and debilitating disease that most people like to treat as an attitude problem so they can tell me to go to therapy and do yoga and meditate and otherwise remove myself from the world where I inconveniently highlight the failures of medicine, our bodies, and our economy.

July 12, 2016
by sarcozona
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The embrace of biochemical approaches meant the corresponding rejection of psychogenic theories. … That the efficacy of a medication should erode a psychosomatic theory is not surprising. This is a fairly common phenomenon. Several disorders understood to be psychosomatic (depression or stomach ulcers, for example) were reframed as somatic with the discovery of effective medication. Yet in the case of migraine, ergota­mine derivatives had been used successfully to treat the disorder for thirty-five years, yet had given a boost to theories of migraine as psychosomatic. Why did ergotamine promote psychosomatic theories, while methysergide eroded them? The answer is that methysergide worked as a preventative, eliminating migraines without changing the temperament of the patient. Raskin suggests this was an unexpected outcome when he says, “within a week they were headache free. No change in their internal milieu.”

– Joanna Kempner in Not Tonight

What does this say about a migraine patient today who cannot be cured, who doesn’t get better on preventative medications?

I think this idea of migraine patients causing their migraines does linger.

July 10, 2016
by sarcozona
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How did psychological theories come this far in migraine medicine? Judy Segal has argued that the explanatory power and popularity of the migraine personality could be attributed to its expansiveness — the migraine personality could describe almost anyone. The migraine personality became what Ian Hacking refers to as an “interactive kind.” Interactive kinds are categories that not only define but also constitute people. That is, some classifications organize individuals’ experiences in such a way that they adapt or respond to their classification. Such was the case with the migraine personality. People with migraine began to adapt to Wolff’s concept of the “migraine personality”: the category altered how they thought, behaved, and classified themselves.

Joanna Kempner in Not Tonight

How has migraine changed me? How has your idea of migraine changed me?

July 9, 2016
by sarcozona
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He worried that so many migrainous women sought diagnostic tests and spent so much money on doctors when doctors had so few effective migraine treatments. The more appropriate role for the physician, he argued, would be to spend time with the patient, “in talking over her life problems and in showing her how to live more calmly and happily, than in making useless examinations.” “It is an axiom with me, he added, “that whenever a woman is having three attacks of migraine a week, it means that she is either psychopathic or else she is overworking or worrying or fretting, or otherwise using her brain wrongly.

Joanna Kempner in Not Tonight

Yes, 8 year old me must have been reading too many Redwall novels. And programming is definitely too much for my poor lady brain.

Also everyone, their mother, and my GP want me to go to therapy regularly. Therapy that is $100-200/session when only $300/yr is covered.

July 8, 2016
by sarcozona
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…Wolff’s discussions of women and migraine were intriguingly limited, especially given that by then most physicians had agreed that women experienced migraines more often than men. Much like his Victorian predecessors, Wolff preferred to talk about headache disorders in the masculine. Likewise, his descriptions of migraine emphasized masculine anxieties about the rigors of work life.

Joanna Kempner in Not Tonight

The “father of headache medicine” basically ignored ¾ of patients.

July 7, 2016
by sarcozona
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If, as Foucault argued, modernity was the act of disciplining bodies, then Wolff’s migraine personality was discipline in its extreme—a pathological reaction to the corporeal demands of power. His subjects’ neatness and fastidiousness, he wrote, was exceeded only by their efficiency. People with migraine loved order and repetition, feared failure, and resented interruptions. They created elaborate “schemes, plans, and arrangements,” but “had great difficulty in complying with or adapting themselves to systems imposed on them by others.” The description of type A personalities varied depending on who had them. Women migraine patients who “worked” at home also wanted everything to be “just so,” but they had difficulty delegating even simple household tasks, like dishwashing, to housemaids.

Joanna Kempner in Not Tonight

This is how a 9 year old whose head won’t stop hurting gets sent to clinical progressive relaxation training

July 6, 2016
by sarcozona
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Wolff’s migraine personality was also informed by a burgeoning psychodynamic literature that viewed bodies as “systems of psychobiological adaptations.” Using this framework, migraine could be understood to be a protective device that provided a way for the body to withdraw from stressful situations. In fact, migraine was thought to be an especially useful adaptation for overruling an overdetermined, overly ambitious mind. Nevertheless, this psychosomatic framework emphasized the realness of migraine. Should any of his students forget that emotions could have as real of an impact as any somatic, measurable fluid, Wolff would remind them. Scrawled on the bottom of his lecture notes were the words “You are at the beginning of a new era when—Loves Hates Fears are as real as management of lump [sic] in the chest or pus in the pericardium.” Psychosomatic medicine did not, for Wolff, mean “imagined.”

Joanna Kempner in Not Tonight

Whereas psychosomatic now means the doctor is washing their hands of you.

Also HAH we distinguish between mental and physical states.