For the past 200 years, the very considerable advances of academic medicine can be attributed to the insistence on identifying a clearly defined cause for each disease. Before the modern era, causes were often mystical and there was little attempt to verify them. The proposals that the patient was suffering from imbalanced humours had been accepted for two thousand years. Treatments which worked were justified by attributing their action to adjustment of the same mystical forces.
Our language retains the words from the old medicine invented by Galen, who was born in the second century ad in Pergamum in Asia Minor. He believed that all disease was caused by an imbalance of the four elements (earth, air, fire and water) with the four cardinal humours of the body (blood, phlegm, bile and black bile). This scheme dominated medicine for the next 1800 years, and we still speak of rheumatism (too much water), pyrexia or fever (too much fire), pneumonia (not enough air), cholera (too much bile) and melancholia (too much black bile). Galen was not unique in this way of thinking as the Chinese had a scheme based on the imbalance of yin and yang, and astrological doctors could explain all disease by the conflicting influence of the planets.
By the eighteenth century, mystical causes were largely dismissed in favour of causes defined in the new scientific terms. Pathology and physiology began to locate disordered tissue and to explain how the function of the body could enter disordered states. The discoveries of bacteria, viruses and chemical errors identified ultimate causes for the local abnormalities of tissue. The entire canon of modern medicine became pathology driven. A raft of diseases are now understandable as the consequence of exactly defined pathology and therefore rational therapy emerges.
Unfortunately, a large number of common painful conditions do not have an associated pathology and so represent a severe challenge to both doctors and patients. Many doctors are so impressed with the power of modern pathology that they refuse to accept the existence of disease without pathology. This attitude hugely exaggerates the problems of patients who suffer from pains that are not considered 'real'. Some doctors take the hopeful approach that, while the pathology has not yet been discovered, future work will reveal the basic cause. Even Sigmund Freud wrote that neurosis would eventually turn out to be a biochemical disorder but, in the meantime, he proposed that psychoanalysis was a productive approach. Other types of doctors, deeply frustrated by their inability to cope with diseases without pathology, turn on the patient and claim that the pains are self-inflicted by a faulty way of thinking.
*44\219\2*
Pain Relief
