April 29, 2008

Mini-Double Dose: Art, Pain and Illness; Genes and Race Disparity; Through Sickness, Health and Sex Change

There are a number of interesting stories in The New York Times, so let’s do a mini-double dose …

Pain as an Art Form: Well’s Tara Parker-Pope does a nice job describing how art is used to communicate physical pain, from some of Frida Kahlo’s self-portraits (now on exhibit at the Philadelphia Museum of Art) to a new online gallery called the Pain Exhibit.

The gallery is the brainchild of Mark Collen, 47, a former insurance salesman who struggled to explain his chronic back pain to a new doctor.

“It was only when I started doing art about pain, and physicians saw the art, that they understood what I was going through,” Collen said. “Words are limiting, but art elicits an emotional response.”

Taking it a step further, Collen started soliciting art from pain patients around the world. He teamed up with James Gregory, a 21-year-old college student who suffers from chronic pain following a car accident, and together they created the Pain Exhibit.

Parker-Pope writes:

Finding ways to communicate pain is essential to patients who are suffering, many of whom don’t receive adequate treatment from doctors. In January, Virtual Mentor, the American Medical Association Journal of Ethics, reported that certain groups are less likely to receive adequate pain care. Hispanics are half as likely as whites to receive pain medications in emergency rooms for the same injuries; older women of color have the highest likelihood of being undertreated for cancer pain; and being uneducated is a risk factor for poor pain care in AIDS patients, the journal reported.

Some of the images from the Pain Exhibit, like “Broken People” by Robert S. Beal of Tulsa, Okla., depict the physical side of pain. Others, such as “Against the Barrier to Life,” convey the emotional challenges of chronic pain. “I feel like I am constantly fighting against a tidal wave of pain in order to achieve some quality of life,” wrote the work’s creator, Judith Ann Seabrook of Happy Valley in South Australia. “I am in danger of losing the fight and giving up.”

The art is connecting with medical professionals. The journal of the International Association for the Study of Pain features an image from the exhibit on the cover of its November issue, which focuses on women and pain.

Quieting the Demons and Giving Art a Voice: Like sculpture and painting, writing is also a form of expression and release. This review looks at “Madness: A Bipolar Life,” a new memoir by Marya Hornbacher, whom writer Abigail Zuger, MD, describes as “a virtuoso writer: humorous, articulate and self-aware. She is also, as she has now documented in two books, incurably mentally ill.”

Zuger continues:

For scientists trying to parse the mystery of brain and mind, she is one more case of the possible link between mental illness and artistic creativity. With all our scans and neurotransmitters, we are not much closer to figuring out that relationship than was Lord Byron, who announced that poets are “all crazy” and left it at that. But effective drugs make the question more urgent now: would Virginia Woolf, medicated, have survived to write her final masterpiece, or would she have spent her extra years happily shopping?

Ms. Hornbacher brings to the discussion more than the usual pairing of disturbed brain and talented mind. Her talent has created a third self, an appealing, rueful narrator who can look back on three decades of manic-depressive illness, much of it untreated, and spin a story that is almost impossible to put down.

Zuger also considers “Poets on Prozac: Mental Illness, Treatment and the Creative Process,” edited by Richard M. Berlin, M.D. Essays were solicited from published poets with psychiatric illness.

“Most of the 16 contributors are decades older than Ms. Hornbacher, but while they may lack her vivid prose style, they do supply a long-term perspective on the terrain,” writes Zuger.

Genes Explain Race Disparity in Response to a Heart Drug: This is a fascinating story. Researchers at Washington University and the University of Maryland found that patients who are non-responsive to a beta-blockers used in the treatment of heart failure may be making what amounts to their version of the drug, all the time, due to a gene variant.

What’s also surprising is that as many as 40 percent of blacks have this altered gene, compared to 2 percent of whites. The website of the journal Nature Medicine published a paper explaining the study.

“Something that occurs with a 40 percent frequency is not something that was a blip on the radar screen,” said Dr. Gerald W. Dorn, a cardiologist at Washington University and principal investigator for the study. “It must have given a survival advantage.” — Though what that advantage is is still the big unknown.

Gina Kolata writes:

The discovery raises questions about whom to treat with beta blockers and how to decide, researchers say. But, they add, its implications go beyond heart failure.

For example, the gene variant may help explain why some healthy people cannot exercise vigorously — they may be making chemicals that act like beta blockers, making their hearts beat less forcefully. And variations in other genes might explain why some people with different conditions, like depression, do not respond to drugs used to treat it. It is possible that those people are already making their own versions of antidepressant drugs, and that adding more may not help.

But researchers say that people who make their own beta blockers are not protected from developing heart failure. That is because beta blockers are helpful only after the disease is established. And beta blockers can slow the disease’s progress but not cure it.

Through Sickness, Health and Sex Change: Finally, here’s a story from the Sunday paper about a married couple in New Jersey who are concerned about the legal status of their relationship, since the male partner underwent a sex change in 2005. The couple, who have three children, are still very much committed to each other. Tina Kelley writes:

Massachusetts is the only state to have legalized same-sex marriage, and the Brunners are two women married to each other in New Jersey. As this state (along with Connecticut, Vermont and New Hampshire) confronts challenges over whether its civil unions fulfill the mandate of providing same-sex couples equal rights and benefits, the Brunners offer themselves as Exhibit A on how the nation’s dizzying patchwork of marriage laws, which include the domestic partnerships of California and other states, may be out of step with people’s lives.

And here’s another mind-blowing breakdown of the complexities state by state:

The Brunners were already married when Donald became Denise. Transsexuals who marry after surgery pose a different set of questions, and there have been a number of custody, probate and other cases with decisions all over the legal map.

Urging the United States Supreme Court to tackle the issue in 2000, lawyers for Christie Lee Littleton, a Texas male-to-female transsexual suing her husband’s doctors for wrongful death, noted the confused landscape: “Taking this situation to its logical conclusion, Mrs. Littleton, while in San Antonio, Texas, is a male and has a void marriage; as she travels to Houston, Texas, and enters federal property, she is female and a widow; upon traveling to Kentucky she is female and a widow; but, upon entering Ohio, she is once again male and prohibited from marriage; entering Connecticut, she is again female and may marry; if her travel takes her north to Vermont, she is male and may marry a female; if instead she travels south to New Jersey, she may marry a male.”

The Supreme Court declined to take the case.


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