by Leonard R. Friedman, MD
In diagnosing areas of chronic pain for adult pain management, I have come across a helpful test which I have unable to peer review.
It is the Draw a Person test. Pain management physicians have not used this easily identifiable test to evaluate the subconscious of the patient. This is done by asking the patient to draw a male and a female, with clothes, on a sheet of regular copy paper. These pictures can be faxed to other parties for further verification and ideas.
During the last year, I have asked patients to write the pain problems they have on the back of a sheet of paper. The pain patient leaves gaps in the outline they are drawing. They are unable to fill in the area of their pain complaint. These can be headaches, neck pain, shoulder pain, elbow pain, wrist pain, low back pain and ankle pain as showing gaps from the outline of the body.
Knee pain is usually noted by the inequality of the size of the drawing of the knees. A same day headache will produce a gap, in a day there will be an x or a crossing of the headache line, and the second day will reveal a connected line. The pain patient may draw the pain on the opposite side of their figure or in the other figure drawing. The interpretation is that people may not want subconsciously to admit to pain, but find it subconsciously acceptable to place the sign of pain, the gap, in the other figure. Adult females will draw heavy lines 50% of the time, instead of a gap which is drawn by the other 50% of females.
I do very little psychiatric diagnosing according to the Diagnostic and Statistical Manuals. But to deal with and discuss significant relationships and social patterns required by the diagnosis of chronic pain syndrome, one should note the following: the relationship with the significant other is inversely proportional to the space between the two figures. The further apart, the stronger the relationship. The size of the hands is proportionate to the aggressiveness of the patient as noted by Karen Mackover in her book on projective testing in 1949. In treating the chronic pain patient, the findings can initiate discussions over areas of social life and employment, for instance.
Draw a Person tests were the second most popular psychological tests in the sixties. It is now the eighth most popular test and usually applied to children. I do not try to interpret psychopathology from the picture.
For those who care for the chronic pain patient, one typically has documentation of the visit with a signature and date added. The back of the page could have the patient’s own record of his pain patterns with a 0-10 scale listing on the back page. If enough people find this acceptable to diagnose just chronic pain, and not other psychiatric conditions, then we have an accepted documentation of pain. The patient will usually repeat the same picture for years. A change in the picture will usually be followed by new diagnostic tests.
I am asking for others to try and replicate my results, so that adult pain management will stand on firmer footing.
Leonard R. Friedman is a psychiatrist and pain management specialist.
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