Gravity's Rainbow

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October 24, 2016
by sarcozona
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Migraine may affect my personality, but my personality didn’t give me migraine

Anna Eidt wrote recently about the “migraine personality,” an old and sexist idea that still influences how migraines are perceived and treated. It’s a succinct discussion and debunking of the idea. The “migraine personality” was coined in the early 20th century … Continue reading

July 20, 2016
by sarcozona
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For headache specialists, reducing the disorder to a specific mechanism in the brain doesn’t just relieve the symptoms of migraine [referring to development of Imitrex]; it also targets the stigma associated with it by shifting responsibility for the pain away from a weak or neurotic personality toward a body over which the patient has no control. In this, headache specialists are demonstrating a phenomenon known to cognitive psychologists, namely, that attributing low causal responsibility to stigmatized behaviors reduces blame and produces more positive feelings.

Joanna Kempner in Not Tonight

July 16, 2016
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Headache medicine’s problems with legitimacy persist despite the “discovery” of a neurobiological mechanism underlying migraine. For while the emphasis on the brain does somewhat mitigate migraine’s association with psychosomatic, feminized personalities, locating migraine in the brain also managed to inscribe gendered cultural assumptions about the personalities of headache patients into the physical structure of their bodies. The newly biomedicalized migraine has not eliminated characterizations of a migraine patient as a particular kind of person, but instead has transformed the moral character of the migraine patient into a new, still highly gendered biomedical configuration.

Joanna Kempner in Not Tonight

July 15, 2016
by sarcozona
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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.”

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?