In fact, her physical pain may have become an important aspect of her identity.

Her physical pain may well have become part of her identity – much the same way that being fat has become part of my identity. I have lived being fat since I was 5. I don’t think my remaining fat (and choosing not to diet) has to do with not wanting to lose something on which my identity is based. It does have a lot to do with accepting the inevitability of my fatness (and learning to like it).

Similarly, I think it is possible to have chronic pain as part of one’s identity but still want an end to the pain. It sounds like nothing has worked for her in the past and so she may also have accepted the inevitability of pain. That doesn’t necessarily equate to martyrdom.

Having said that, however, I do understand what you are getting at here, and Kate has addressed the intent of the post as well.

But you know, the doctors themselves aren’t helping either. Too many of them really are giant flaming assbuckets and can’t see anything but fat or (and this goes for alt-pracs too) blame people of all sizes, Louise Hay-style, for having a “bad attitude” that caused them to be sick. That reputation certainly gets into the air. I don’t blame people for feeling like they don’t want to subject themselves to any kind of abuse, that they’ve suffered enough as it is.

Now, since I have the MIL story to work with, if I was in the LW’s position, I could tell my friend, “Look, this is what happened to my MIL, and it would absolutely kill me if something like that happened to you. Please, I will do whatever it takes to find you a good practitioner and go to the appointment and advocate for you, I’ll even pay the co-pay. But please, please don’t just let this go, please don’t give up. I really want you to have this. You have no idea what this means to me.” A little heavy-duty? Maybe. But sometimes a little shock therapy is necessary in a situation like that.

*steps off soapbox and quietly retreats*

Not that it is necessarily a valid description of anyone in a similar situation, but my mother (who has always been thin, and isn’t to my knowledge in chronic pain) REFUSES to go to the doctor at all. For anything. Ever. And will give the most ridiculous reasons ($10 co-pay too much, no time, et c., but hey are those new shoes? And how was that trip/seminar/event that you just did for 4 days?)
And the ‘martyr complex-choosing-to-suffer-as-identity’, is a thoroughly accurate assesment of her behavior in many aspects of her life; not just healthcare.
Did I mention she’s a psychologist?
~headdesk~

Also, I would like to add that having your crippling mental and physical disorders diagnosed as ‘pyschosomatic’, ie., all in your head, isn’t as bad as it sounds. You get to sit on a comfy chair and someone gets to tell you, ‘I think it’s all in your head’, and you smile at them and find someone else. It actually matters very little in the scheme of things. There are reasons for everything, and no one person has all the answers to everything ever; look for someone else.

Look into alternative medicines, look for someone else who knows their stuff. It’s possible that their friend is just too tired to vet doctors and treatment themselves, so they may require help to do it — I know I did. It’s also possible that their friend is depressed. There’s certainly also the possiblity, if her arms are falling asleep at night, it could be something as simple as the prospect of having to fill out or sign a form that could be tripping her up — I have rhuematoid arthritis in my hands, and it was bad enough that I couldn’t hold a pen, and that simple inability to hold a pen was enough to stop me from doing a damn thing about it because I might have to fill out a form when I couldn’t, and the thought of that broke my heart. It could be any number of things.

The point is, SIWF needs to talk to her friend. Not pressuring her to go to a doctor, or telling her that she’ll eventually end up crippled if she doesn’t go, or trying to bribe her, but sitting down and flat-out talking to her. Get an understanding of what is going on, and an idea of the friend’s mental state, WITHOUT judging her or immediately going on the offensive/putting her on the defensive, which is hard to do, yes, but worthwhile. Don’t talk about the pain directly, unless she brings it up — talk about how she feels.

I really can’t stress enough how important it is for SIWF to listen without jumping in to correct her friend. How her friend sees it is how her friend sees it, period, and telling her that it’s wrong or unfounded isn’t going to go anywhere — that’s like telling me that sounds at a hundred decibels hurt your ears; it’s useless and achieves nothing, because that makes it about you, not me. It makes it about SIWF, not her friend. Work with the assumption that your friend is right, right, right dead right about how everything she feels, and the emotional/mental impact that it will/does have on her. Even if you don’t think she is, think of it as she is anyway, and you will minimise her pain less, and solutions that will help both of you will come easier.

If she describes it as a crushing weight, don’t tell her that the rock is really just a crumb and she should damn well stand up straight; tell her that she can make a yoke to balance the load. Given her history of broken bones, a cure is not likely, and something along the lines of a yoke is probably all you’re going to get.

Further, treat her current condition, and her pain, as though it’s something that needs balancing between her ability to cope and her need to do this or that, rather than as something that needs to Magically Go Away. It really is a case of, ‘something somewhere is off-balance and is straining you beyond what you can cope with. We need to find a way to redistribute it until it balances again’. Part of that rebalancing may involve a Western-style doctor. It might not. However it’s dealt with, it’s important to put it in the proper context so as to avoid screaming with frustration when your current mode of thinking isn’t working. ;)

That’s all I’ve got, really — a bit of reframing, to put things in a context that I find most people in SIWF’s position handle better. SIWF’s burden is just an invisible as her friend’s, but it’s no less a burden for it. Being a friend in her position is very, very emotionally taxing, and I applaud her bravery in asking this. Hopefully Shapelings as a community can come up with something that works for this particular situation.

Also, I am a private person, probably in good part due to the fact that I was not given the luxury of medical privacy for any of my childhood. I would not be immediately open to a friend accompanying me to a doctor appointment for that reason – I would be terrified that some humiliating detail about myself would come out. However, if a friend were willing to open up that part of her life to me first…. this has never happened to me, but I think I would feel like we could be allies in this, rather than my thinking “here’s another person who thinks she can live my life better than I do.”

I also hope that SIWF considers that she probably does not know her friend’s full medical history, nor quite understands the complexities of whatever condition is being discussed. Some of my medical history is too personal to tell my own husband.

Oh, and Eucritta – absolutely, on being in pain (or in my case, being chronically ill) IS part of your identity. I am the person I am because I grew up ill in an unforgiving medical environment, just like someone else is the person she is because she grew up fat. I wish it weren’t so, but it is so, and one makes the best of it.

Aunt Fattie hit the mark with her final bit of advice. As difficult as it may be, SIWF will need to let her friend make the final decision about her own health. I just hope she can support her, even if she strenuously disagrees with her actions.

Throughout the whole process, everyone was really nice to me and never complained about my size. In fact, the surgical intern and I were flirting at one point!

Yeah, I have complaints about my doctors’ office (about which you can read on my blog), but over all, they don’t stress the weightloss issue. I suppose I’m lucky like that.

I think this post is bringing out how much personal experience — with both medical history and friendship history! — informs how one reads the tone of the original letter.

I’m not too happy with this rephrasing. I mean, I can’t speak for everyone. But me, I’m in some pain all of the time. I have been for roughly twenty years, and in all likelihood I will be for the rest of my life. So, yeah, I don’t think my understanding of pain is the same as that of the well and able-bodied, and yeah, pain has become an integral part of how I perceive myself. But this doesn’t mean that I suffer from some, what, ‘martyr complex’ or the like. It’s just an ordinary adjustment to my differing circumstances.