The Problem with Medical Imaging

by Dr. Victoria Welch

“Based on the MRI, my surgeon said I need surgery.” This is a sentence I have heard countless times over many years in practice. I would love to share some opinions and observations I have regarding this sentence and diagnostic imaging in general.

Sometimes surgery is necessary. There’s no amount of neurological manual therapy, massage, nutrition, adjusting, or energetic awareness that can put a broken femur back together. However, situations like this are the exception, not the rule. The image below shows a number of common findings that often result in a patient “going under the knife.” The statistics listed here are “incidental” findings, meaning the person was experiencing NO symptoms of discomfort. (For example, 87% of people over 20 years old have a bulging disc but no pain.) And yet, when these findings are accompanied by discomfort, the abnormalities in the imagining are immediately assumed to be the cause. So if a bulge or tear is seen in the imaging, but many people with similar imaging are not in pain, then why assume your bulge or tear is causing the pain you’re experiencing?

Let’s think about pain for a minute. There are several series of neurologic inputs that can be interpreted by the brain as “pain.” Many things can feed in to this “pain” input: physical changes in the body, aberrant nerve signaling, emotions, nutrition, attitude, etc. Pain is not an exact equation, and therefore does not “have” to be present in all situations, even if there are changes evident on imaging. This is fantastic news! The following are a few examples of what I’ve seen over the years:

Example one: Two men entered within a week of each other with nearly identical low back injuries. Both acquired the injury during the warm up set of deadlifts, both with pain and numbness down the leg, both fit and in their mid 40s. The MRIs revealed moderate disc herniation at L5/S1. There was one stark contrast between these two men. One man was happy, the other pictured himself as a victim. The first improved substantially within 8 weeks. The second had no improvement with conservative care, surgery, still no improvement after surgery, and remained angry and victimized the whole time. These men were on two very different journeys and had two very different experiences, despite having similar imaging. I know they each had the experience they needed. However, it is interesting to ponder the influence of the mind on the body and the not-so-definitive findings of diagnostic imaging.

Example two: I have had three individuals enter my office within the last year with hip replacement surgery already scheduled. All three had findings of arthritis on their MRI and had pain for several years. Using neurological manual therapy, some nutritional shifts, and improving energetic awareness, all three have been virtually pain free for greater than 9 months. The arthritis is still present, but the brain is no longer interpreting pain within the body. All three cancelled their surgery. Again, imaging still showed the same abnormalities, but the individuals were no longer in pain.

The work we do at DPPS is geared toward not only reducing this electrical signaling of pain to the brain, but also addressing the body and mind as a whole. We are complex, unique beings, and trying to define our experience in our bodies just by looking at an x-ray or MRI can be misleading. Luckily, we don’t work with the MRI, we work with client, listening to what your body is asking for and helping create positive change you can feel.

Transference and Blame

 

In all relationships, we are prone to projecting our own feelings, beliefs, and experiences onto the other person. For example, if we feel disconnected from someone, feelings of abandonment, rejection, hurt, anger, or loss can arise and we can look at the actions or behaviors of the other person and want to blame them for these feelings. The fault of the emergence of these feelings lies with the other person, and this is victimization. “You make me feel this way” is the hallmark of this dynamic.

There is also transference, which in therapy parlance refers to the following:

“Transference is a psychological phenomenon in which an individual redirects emotions and feelings, often unconsciously, from one person to another. This process may occur in therapy, when a person receiving treatment applies feelings toward—or expectations of—another person onto the therapist and then begins to interact with the therapist as if the therapist were the other individual. Often, the patterns seen in transference will be representative of a relationship from childhood.”

In other words, when we develop the kind of intimacy with our clients that is required to facilitate the deeper work, we must be aware of the fact that people are coming to us with a long history of unhealthy relationships. It is because of these unhealthy relationships with others and with themselves that they seek us out, whether our intervention be at a physical or a soul level. And there will come a time when their unhealed feelings from these relationships may manifest in our therapeutic relationship.

Examples of this could be a client becoming angry at you for not making time in your schedule to see them, a client going out of their way to try and take care of you in some way (like asking many personal questions and giving you advice), blaming you for them not getting better, or even falling in love with you and/or making sexual advances.

It’s so important to be aware of this transference, and to also be very aware of our reaction to this (known as counter-transference) and to respond, not react, accordingly. We can also hold impeccable boundaries by gently but firmly talking about the therapeutic relationship and what is and is not appropriate in that relationship. Sometimes, that entails saying to the client, “I don’t think that I am the best person to help you with this,” if the client is not willing or able to see what is going on in the relationship.

I really love this passage from The Gift of Therapy, written by Irv Yalom on how powerful it can be when people begin to see their own patterns of blame, victimization, and transference:

“As long as patients persist in believing that their major problems are a result of something outside their .control—the actions of other people, bad nerves, social class injustices, genes—then we therapists are limited in what we can offer. We can commiserate, suggest more adaptive methods of responding to the assaults and unfairness of life; we can help patients attain equanimity, or teach them to be more effective in altering their environment.

But if we hope for more significant therapeutic change, we must encourage our patients to assume responsibility—that is, to apprehend how they themselves contribute to their distress.

Readiness to accept responsibility varies greatly from patient to patient. Some arrive quickly at an understanding of their role in their discomfiture; others find responsibility assumption so difficult that it constitutes the major part of therapy, and once that step is taken, therapeutic change may occur almost automatically and effortlessly.

Every therapist develops methods to facilitate responsibility assumption. Sometimes I emphasize to a much-exploited patient that for every exploiter there must be an exploitee—that is, if they find themselves in an exploited role time and again, then surely the role must contain some lure for them. What might it be? Some therapists make the same point by confronting patients with the question, “What’s the payoff for you in this situation?”

This passage is from a book on psychotherapy, but I think it’s quite important information for therapists of all kinds to be aware of, as we encounter the same dynamic constantly. Not to mention, when we can see these patterns within ourselves, we can make huge shifts in our lives and in all of our relationships. Taking self-responsibility is so empowering. Once you can really see yourself and others as things really are, you can begin to understand that things can change. And that change must start within ourselves.