Dr. Stahl presents on women’s pain panel at Conference on Medicine & Religion

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl recently attended the 2019 Conference on Medicine & Religion, held in Durham, NC. Dr. Stahl was part of a panel titled “”Ask Me about My Uterus:” Theological Responses to Women’s Pain in Contemporary Western Medicine.”

The three panelists, all women living with chronic pain or chronic illness, discussed their experiences dealing with pain, and the theological resources that have helped with that endeavor. Dr. Stahl discussed how the Desert Mothers provide models for understanding and handling pain in illness. Overall, the panel considered “how a theological re- narration of chronic pain might offer insight into the significance of women’s pain as well as resources for meaning-making in the midst of pain.”

Read more about this panel on the conference website.

Dr. Stahl delivers keynote at Western Michigan University Medical Humanities conference

Devan Stahl photoThe Eighth Annual Western Michigan University Medical Humanities Conference was held September 13-14 in Kalamazoo, MI. Center Assistant Professor Dr. Devan Stahl and her sister Darian Goldin Stahl (dariangoldinstahl.com) delivered the keynote lecture on September 14, “Visualizing Chronic Illness in Medicine and the Arts.”

Based on their recently published book, Imaging and Imagining Illness, the presenters discussed the history of anatomical illustrations, the use of contemporary medical imaging technologies in the doctor-patient relationship, and how medical images affect persons living with chronic illness.

To hear more about this work from Darian and Dr. Stahl, listen to their episode of No Easy Answers in Bioethics, the Center’s podcast series: ‘Imaging and Imagining Illness’: Devan and Darian Stahl – Episode 7.

Episode 7: ‘Imaging and Imagining Illness’ with Devan and Darian Stahl

No Easy Answers in Bioethics logoEpisode 7 of No Easy Answers in Bioethics is now available! This episode features guests Devan Stahl, Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development, and Darian Goldin Stahl, artist and printmaker. This episode delves into the intersection of fine art, illness, disability, and self-identity. The recently released book Imaging and Imagining Illness: Becoming Whole in a Broken Body began as a collaboration between sisters Devan and Darian, one with personal origins. The edited volume examines the impact of medical imaging technologies on patients and our wider culture. In this episode, they discuss Darian’s artistic process, how audiences have reacted to the artwork, and how they came to invite other scholars to build on their work.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics—clinical ethics, evidence-based medicine, health policy, medical education, neuroethics, shared decision-making, and more. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

Dr. Stahl published in ‘Journal of Medical Humanities’ special issue

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl has an article in the March 2017 issue of the Journal of Medical Humanities, titled “Caretaking through Art: A Sibling Story.” The article is co-authored by artist Darian Goldin Stahl, Dr. Stahl’s sister.

Available online first on October 1, 2016, the article is now published in a special issue of the journal: “Caregiving, Kinship, and the Making of Stories” (edited by Carol Schilling and Mark Osteen). The article is available in full on the Springer website (MSU Library or other institutional access may be required to view this article).

Read more about Dr. Stahl and Darian Goldin Stahl’s work together: Seeing illness in art and medicine: a patient and printmaker collaboration.

Seeing illness in art and medicine: a patient and printmaker collaboration

Devan Stahl headshotAssistant Professor Devan Stahl, PhD, recently published an original article in Medical Humanities. Dr. Stahl’s article, “Seeing illness in art and medicine: a patient and printmaker collaboration,” is co-authored by her sister, artist Darian Goldin Stahl. The piece features personal and insightful commentary from both authors, delving into chronic illness, body image, and reclaiming or reframing one’s experiences through art.

Abstract: For many patients, viewing one’s illness through medical imaging technology can be an unsettling experience. Patients are likely not to see themselves represented in medical images and may find it difficult to reconcile this new image with their own body image. In this article, a patient with multiple sclerosis and a printmaker describe a collaborative project they have developed, wherein the patient’s medical images are incorporated into pieces of fine art. The aim of the project is to open up the interpretation of the ill-body to persons outside the medical field, so as to do justice to the multiple dimensions of the body chronically ill persons often inhabit.

Darian Goldin Stahl, Doorway, Silkscreen, 84″×42″, 2013. dariangoldinstahl.com

“Seeing illness in art and medicine: a patient and printmaker collaboration” was published online first on March 21, 2016. The article was selected as an editor’s pick on Multiple Sclerosis Discovery Forum. To learn more about Dr. Stahl’s work, visit her faculty profile.

Overdosing on Prescription Painkillers: Dying for Pain Relief?

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series. For more information, click here.

By Karen Kelly-Blake, Ph.D.

There has been much news coverage in the past few weeks regarding the increasing number of prescription painkiller deaths from opioid and narcotic pain medications such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone (CDC Vital Signs). This trend is especially striking among women (CDC Vital Signs notes a 400% increase since 1999). Non-Hispanic white and American Indian or Alaska Native women have the highest risk of unintentional, suicide, and other deaths from prescription painkiller overdose. The Centers for Disease Control reports that “about 18 women die every day of a prescription painkiller overdose in the US, more than 6,600 deaths in 2010, and for every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse” (CDC Vital Signs). While men are still more likely to die of prescription painkiller overdoses (more than 10,000 reported deaths in 2010), women are closing the gap.

Several theories are posited to explain that gap, for example, women are: more likely to suffer from chronic pain than men; more likely to be prescribed higher doses and take painkillers for longer periods of time; and more likely to seek out multiple prescribers, i.e. “doctor shop” to get their prescriptions. Moreover, women typically have smaller body masses than men, and so the gap between a therapeutic dose and a fatal dose is narrower. The overall increase in painkiller deaths does not appear to be linked to a measurable increase in the kind of severe pain that would require prescription painkillers. Rather, the medications may be increasingly used to treat moderate pain (NY Times OP-ED). News coverage has focused on how to curb and monitor the apparent increased prescribing of these medications and how to educate patients about the risks of narcotic painkillers. What’s missing in the news coverage is how to deepen the conversation to speak to the issue of providing effective pain management for chronic pain sufferers.

In light of the new data about the troubling increase in painkiller deaths, how can healthcare providers effectively manage pain and simultaneously avoid under-treatment, misuse, and abuse of prescription painkillers? The CDC offers strategic advice on how to counter this growing problem, including tracking prescription drug overdose trends to better understand the epidemic, using prescription drug monitoring programs to identify patients who may be improperly using prescription painkillers, prescribing only the quantity needed based on the pain diagnosis, and improving access to mental health and substance abuse services through implementation of the Affordable Care Act (CDC Vital Signs). The CDC has spotlighted an important public health issue, and many agree that these strategies are reasonable and will go a long way to curb the epidemic. But one could also argue that in order to curb this newly identified epidemic we have to address another pressing public health issue: under-treatment of chronic pain.

Healthcare providers have failed to provide adequate pain relief. Barriers to providing pain relief include clinician fear (fear of patient abuse and addiction, diversion, and regulatory scrutiny), clinician failure in identifying pain relief as a patient care priority, and a clinician knowledge deficit in the assessment and management of pain (Tomlinson; Rich 2000). Under-treated pain results in a host of physiological, psychological, social and economic consequences ranging from reduced mobility and strength, disrupted sleep, depression and anxiety to difficulty working and lost wages (Brennan et al. 2007). Scholten et al. (2007) assert that 80% of the world’s population fails to receive pain relief when needed. To address this deficit, instead of narrowly focusing on potential abuse, they suggest implementing more balanced policies on opioid use so as to enable access to pain relief that would address human suffering. The optimal way to treat chronic pain is through a multidisciplinary pain clinic, using a team approach offering physical therapy, psychological support, and appropriate pain medications. Such facilities are rare, and not surprisingly, a significant number of chronic pain sufferers are from low-income groups. As such they commonly lack insurance to cover costs for this ideal model for pain treatment.

If we believe that relief of pain is a core ethical duty for medical professionals then in light of the barriers listed we have to find a way to advance that moral imperative. First, clinicians have to trust their patients’ reports of their pain. There is an abundant literature on trust between patients and physicians, focusing largely on whether patients trust their healthcare providers, yet a dearth of literature on the trust physicians have, or don’t have in their patients. To advance this agenda, providers would have to stop viewing their patients as potential drug abusers and dealers, discounting their pain. Second, clinicians would need to appreciate, or be taught to appreciate, pain’s capacity to seriously impair a patient’s quality of life. As Tomlinson suggests about pain, “it is a malignant force in and of itself, a fact clearly evident to most humans who have not had medical training if not to those so trained.” Third, clinicians would need to understand that under-treatment is poor medical practice (Brennan 2007). ’Doing no harm’ does not mean ‘do not treat’ or ‘under-treat because you are scared.’ It requires one to balance the benefits and risks of pain treatment strategies. These strategies would not mean resorting to painkillers first, or to painkillers alone, but instead would involve trying a variety of treatment modalities. Fourth, having balanced the risks and benefits, clinicians should respect patients’ autonomy to choose and reject treatments. This is not to suggest that physicians have to go along with a patient’s choice that is counter to his/her professional rights. What it does mean is that if the clinician has a professional objection, then he/she should provide the patient with information about accessing treatment elsewhere. Lastly, clinicians should demonstrate equal concern for all patients. When a patient presents with a pain complaint and wants help, and the clinician’s response is to be suspicious, to disrespect the pain report, and to underestimate the impact the pain has on the patient’s quality of life, that provider has violated the principle of equal concern. Such violations are more likely when the pain patient is female, African-American, Hispanic, or low socioeconomic status.

So if we are to make any inroads in the epidemic of painkiller deaths, then we have to address the equally compelling public health issue of under-treatment of pain. This would require addressing the barriers outlined here and repackaging the alleviation of pain as a moral imperative in medical practice. Unfortunately, as it currently stands, “the good of relieving pain is far too invisible/too little recognized” (Tomlinson). The absence of pain management as a healthcare priority is seen at every level of health care delivery. This is most evident in the lack of available National Institutes of Health funding for, or focused on, pain relief. Avoiding patient addiction and abuse, diversion tactics, and clinician self-protection are important parts of this conversation to be sure, but these issues cannot dominate the discussion. Understandably, clinicians may feel that they are walking a tightrope when it comes to pain treatment. They may feel they are in a “damned if they do and damned if they don’t” situation when prescribing painkillers, but as Johnson (2007) observes “unrelieved pain blocks enjoyment of all other human goods and values.” Thus the challenge is how to achieve the social and medical change that will make pain management a fundamental component of health care– for that most fundamental physician duty—to care attentively and equally for all patients.


list-cropKaren Kelly-Blake, Ph.D., Dr. Karen Kelly-Blake is a Research Associate whose research interests include health services research, medical shared decision-making, physician training, health disparities, and medical school curriculum development. She is a medical anthropologist and MSU alum. Karen also teaches in the CHM Social Context of Clinical Decisions courses.

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