Recently I read a "Chronic Pain Reconsidered: A New Role for Therapists" By Dr Howard Schubiner (a retiring physician) in the September/October 2018 release of Psychotherapy Networker.
https://www.psychotherapynetwo...ic-pain-reconsidered
While the entire magazine is dedicated to psychedelic therapy, this article was an exception.
There are many patients who suffer from chronic pain without any tissue degradation or anatomical changes. Since those patients continue going to the regular physicians, physical therapists and doctors that are accustomed to treating the body instead of the mind, they receive physical therapy, pain relief medications (sometimes opioids) and occasionally - surgery.
Meanwhile, the source of pain may be of psychological or psychosomatic nature. Conditions such as fibromyalgia, irritable bowel, phantom pain, shifting back pain or inability to move a limb may come as a result of psychological trauma, rather than physical injury or physical degradation.
Yet it would be very discouraging to tell the patient that “all the pain is in your mind”. A sense of pain is always created in our minds and sometimes the pain is lacking during physical injuries or tissue degeneration, while a sense of pain without a physical injury or tissue degradation is also possible.
Thus, the author of an article believes that there are many cases when a psychotherapist would be a lot more helpful to treat the underlying trauma that causes pain. By creating a sense of pain or paralysis, the patient may internalize anger or some other strong emotion, associated with the body part.
As someone who suffered from a psychosomatic illness for many years, as a result of adverse childhood experiences, I would like to develop the subject of this article a little bit further.
Once I met a wise old shaman in the woods. We had a lengthy conversation and he told me that sometimes the cause and effect are so intertwined that it is difficult to tell which one is the cause and where is the effect. A similar concept exists in Ancient Chinese philosophy. In my case, there is a physiological anomaly, there are painful spasms and chronically tense muscles and there is pain that may correlate with the tension and spasms or it may appear in different parts of my lower back.
In the course of my recovery, I was able to trace every layer of my mind-body illness to a specific trauma in my life, starting with an original prenatal trauma. I had colon spasms since early childhood. This created a sense of guilt, that in turn created more tension. During adolescence, I felt guilty for being stiff and clumsy. As I child, I was also emotionally abused in an isolated nuclei family and I felt a lot of guilt from being who I am.
My inability to work kept me in suffering because I could only rent a room in substandard housing with dangerous people around me. Constipation is humiliating itself and fear of dying a slow and painful death from intoxication by my own waste tormented me for years. It culminated when I was arrested, because vulnerable poor people do get arrested. My charges were dropped, yet the fear of incarceration made me panic, further immobilising me and increasing my pain.
There are conditions when I felt such intense fear that my legs would lose sensitivity and I would be overwhelmed by the spasm that would almost pinch my body in half. Such condition prevented me from avoiding the situation that lead me to my arrest.
During my later recovery, I had also done some barefoot hiking and balance exercises. My lower back muscles became very strong and my sense of balance improved. Recently I learned that there are medical conditions such as ileus that are treated surgically by removing sections of the colon. Such surgery may create long term side effects that would be comparably uncomforting to the maintenance routine that the illness requires.
Some people with psychosomatic conditions similar to mine would take the physiological-surgical route an lose a section of their innocent colon in the fight with the windmills of psychosomatic illness.
However, after such sacrifice, the body may find another way to project the pain of the underlying psychological wound, that would still remain unhealed. Placebo effect may also apply so if some scientist were to design a study, it has to consider this. How do we create a placebo for surgery? Put people under without actually operating them?
Post-operative, it may be the same patient carrying their burden of trauma, yet they will also have a colostomy bag for the rest of their lives.
A short research lead me to a conclusion that some psychosomatic illnesses may have several different names and be classified as several different medical conditions if they are described to the physician, physical therapist vs a psychiatrist vs a psychotherapist.
Unfortunately, we live in the society where surgical intervention is much better understood than psychological trauma. This kind of thinking prevented me from becoming an engineering student in the past. Being a survivor, I started thinking about how fine our technology is and yet how little do we understand about ourselves, our psyche and propagation of psychological trauma.
When the mind chooses a body part to take out anger on, the body part that may be chosen has likely distinguished itself from the rest of the body in the past. It may be pre-selected by some physical wound of the past or chosen for symbolic reasons. In case of a man whose hand become immobile,he cursed it as a child, in a way , when he saw his drunkard father beating his mother. According to some more spiritual sources, mortal wounds that ended our past lives may also bias parts of our body to become collectors of injury and pain in the present life.
A pre-biased organ or a body part that somehow distinguished itself from the rest, and became the scapegoat for accepting pain, may eventually develop physical symptoms. That may be due to that part being treated as ‘sick’, receiving less exercise, leading to less blood circulation and reduced oxygen levels. When some illness looks for a weak part of the body to occupy, it would likely land in such stagnant area. This condition may be more common in the post-industrial age society where people have a choice of not using a body part when it hurts.
My illness does have a physical presence and I tremendously lessen the symptoms by being aware of how my body responds to fear. I sleep on the floor and stretch my pelvic joints in my sleep. (I associate certain kinds of nightmares with my early morning-spasms.) Those exercises proved to be more effective then yoga or tai chi, while they are a product of my unconscious, as I stretch to avoid spasms in while I remain half asleep. I swim and spend time at the hot tub at the local YMCA and have several other methods of lessening the pain. I eat lots of apples and drink buttermilk (the one I buy is similar to kefir) for digestion.
There are different muscles that become overly tense in my body, lower back, pelvic and the colon. As a rule, tension leads to more tensions and I try to interrupt the fear-t-spasm cycle at different instances.At the beginning I tried to decrease the amounts of fear and guilt that I was exposed to. Good luck with that when you are living in the slum.
My illness has a psychosomatic origin, yet there is a lot of back and forth between the brain and the body, while fear response produces tension that leads to spasms and to pain, stiffness, constipation and a sense of intoxication of my body that in turn produce itching and burning sensations throughout my body and leads to panic attacks. Thus there are physiological abnormalities that result from fear and those abnormalities induce more fear and pain and make me more vulnerable. In the past I could spend weeks in my bed with the painful spasms, yet that was due to the active presence of guilt and fear triggers in my surrounding.
I always thought of my illness as a signal blockage that creates refraction in the conductor. Refraction is a parasitic effect that appears in fiber optic or high frequency cable communication. Refraction appears to be the closest analogy to ‘energy blocks’ that we hear about in holistic medicine.
For many years, I believed that the trapped energy resided between such two fixed refraction points, restrained the overall flow and acquired the mind of its own, as some energy bounced back and forth between two refraction points. I am sure that this model is applicable for some illnesses, yet mine was more complicated: muscle tension and spasms had different nature at different times.
When we think about diseases that are treated by regular physicians: tissue degenerations, tumors, enflamations, bulging vertebrae discs, we hardly think that the backstage for disease may be set by the mind. Yet it is very possible that some amount of such back and forth miscommunication is required for an illness to develop and that physical symptoms follow the emotional pain.
Whether it is the “mirror neurons” or our entire being that predisposes some part of our body to become ill, based on the previous history of trauma, every illness registers on the mind, body and spirit level. I believe that it would be wiser for physicians and psychotherapists to work together on dismantling the back-and-forth co-occurrence relationship that sustains chronic illness and chronic pain. It may take a similar kind of back-and forth communication between physicians, physical therapists and psychotherapists to treat such stubborn conditions.
The author of the article also tells us that since physicians, physical therapists and surgeons graduate with a lot of medical school debt, there is very little room for them to experiment and to question traditional medical approaches. Psychotherapists at the other hand, experience less debt slavery than medical doctors and are more inclined to try new ideas.
Very limited recovery is possible in an unjust society where popular indifference is supplemented by very inefficient welfare and where someone who lost their ability to work due to illness are driven out of town by high rent.
Although I am still not completely recovered and old symptoms revisit me occasionally, an anonymous support provided me with a safe and affordable place to live, gave me an opportunity to recover.
And how many illnesses could we cure by simply relieving economic pressure of people who are not able to work? How many lives could we save by creating a welfare system that is aimed at removing traumatized people from traumatizing environments.
Image borrowed from https://cdn.the-scientist.com
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