Chronic pain has been correctly described as the invisible crisis at the heart of contemporary life. Despite stunning advances in other areas of medical science, no similar breakthrough in the treatment of chronic pain has resulted from an exclusive focus on the body. Dr James Alexander's young life was redefined by a tragic car accident in his late teens, and the chronic physical and emotional trauma inspired him to become a psychologist. Now pain-free, Dr Alexander has dedicated the last three decades of his life to helping others overcome similar challenges, specializing in the treatment of chronic pain and psychological trauma. His success is proof that recovery from chronic pain is possible, and this guide offers a valuable resource for working toward that goal. The recovery from chronic pain requires that we revisit and challenge the outdated attitudes and practices that have been used with little result. With the proliferation of medical and psychological research, for the first time we are at a point in history where these notions of pain recovery can be validated by research-based evidence. For too long, Dr Alexander feels, we have been looking in all the wrong places. Specifically, the problem lies at the core of our culture, which still treats the physical and nonphysical aspects of the human as separate experiences. This innovative program involves a journey of self-discovery, a new way to approach medical and psychological care of chronic pain, and advice on the most effective types of help to pursue.
The HIDDEN PSYCHOLOGY of PAIN
The Use of Understanding to Heal Chronic PainBy JAMES ALEXANDERBalboa Press
Copyright © 2012 Dr. James Alexander
All right reserved.ISBN: 978-1-4525-0680-7Contents
ACKNOWLEDGMENTS................................................................................................xiiiINTRODUCTION...................................................................................................xvEpidemic of chronic pain.......................................................................................xviiiPain Questionnaires............................................................................................xxivChapter 1: PSYCHOLOGY & PAIN...................................................................................1Chapter 2: PHYSICAL PERSPECTIVES ON PAIN.......................................................................20Chapter 3: BIO-PSYCHO-SOCIAL MEDICINE..........................................................................34Chapter 4: CHRONIC PAIN MISUNDERSTOOD..........................................................................47Chapter 5: THE PHYSIOLOGY OF CHRONIC PAIN......................................................................76Chapter 6: CONSCIOUS & UNCONSCIOUS FACTORS.....................................................................96Chapter 7: THE DEPTHS OF THE UNCONSCIOUS.......................................................................113Chapter 8: GETTING BETTER......................................................................................140Chapter 9: SELF-HELP STRATEGIES................................................................................174Chapter 10: PSYCHOLOGICAL TRAUMA & DEPRESSION..................................................................195Chapter 11: THE HEALING POWER OF DREAMS........................................................................208Chapter 12: THE PROMISE OF ENERGY PSYCHOLOGY...................................................................236Chapter 13: IMPROVING YOUR SLEEP...............................................................................262Chapter 14: EFT, ANXIETY & STRESS..............................................................................283Chapter 15: PSYCHOTHERAPY FOR PAIN.............................................................................299Chapter 16: EYE MOVEMENT DESENSITIZATION & REPROCESSING........................................................317Chapter 17: MINDFUL AWARENESS OF THE PRESENT MOMENT............................................................333APPENDICES.....................................................................................................367Appendix 1: Pain Questionnaires (I)............................................................................367Appendix 2: A neurological understanding.......................................................................370Appendix 3: Anatomy of the spine...............................................................................384Appendix 4: Standard medical treatments for chronic back pain..................................................386Appendix 5: The value of physical therapies?...................................................................389Appendix 6: The evolution of psychology........................................................................397Appendix 7: Sample of research demonstrating structural pathology in pain-free populations.....................405Appendix 8: EFT on a Page......................................................................................409Appendix 9: Process for staying in the present moment..........................................................411Appendix 10: Testimonials from the Hidden Psychology of Pain clients...........................................412Appendix 11: Pain Questionnaire (II)...........................................................................418Appendix 12: Placebo treatment?................................................................................421BIBLIOGPRAPHY..................................................................................................425
Chapter One
Psychology & Pain
I was first alerted to the true nature of chronic pain from the experience of a friend whom I had known since my early teenage years. As a young man, he had suffered for months from such intense back pain that a surgeon had advised him to undergo a fusion of what were believed to be the offending vertebrae. Nothing else had helped up to that point. Desperate for relief, he made arrangements for the surgery. I rang him a few days later to see how he was after the operation. He told me he ended up not having the procedure at all. On the day of the surgery, he simply woke up with no back pain, and had concluded that it was not necessary. He experienced a spontaneous remission, and has remained largely pain-free ever since. Many years later, now a middle-aged man, this friend regularly trains for and runs half-marathons.
What had happened here? Was he a malingerer who, having achieved the sympathy he figured he deserved, simply decided to drop the issue? This explanation simply did not hold with my knowledge of his character. Something else had happened to remove his pain, but at the time I had no idea that psychology could be part of the answer.
Years later, a similar thing happened with a different friend who complained of chronic rhinitis, asthma and food allergies. I saw her after shehadjustcomebackfromaweekendof"spiritualdevelopment"ataquasireligious workshop. Over the weekend, she had simply realized that she no longer "needed" to have these respiratory complaints or the associated food allergies. From then on, she was symptom-free. As with my other friend, I had no way of understanding this experience at the time, but nor could I deny the reality of it. It was not until several years later that I was able to make any sense of these two puzzling reports.
Let's look now at another sufferer—this time, experiencing a chronic groin pain. At its worst, the pain in his left groin was excruciating, barely allowing him to walk normally. At other times, he was able to run and even play tennis, but the pain could return without any notice or warning. As an otherwise fit and healthy young man, being stuck with a limiting pain was inevitably depressing. Fortunately, his occupation did not require heavy lifting or vigorous movement, as that would have left him unemployable around 50% of the time. Regardless of its fluctuations, the pain was a constant in his life for eighteen years.
A physiotherapist tried manipulation and traction to treat him. She diagnosed that a lower back nerve was being pinched as a result of a car accident he'd had a few years earlier, producing a referred pain in his groin. She placed him in traction a couple of times a week, which according to the bio-mechanics, would stretch the offending vertebrae apart, allowing more room for the nerve and thereby reduce the pain.
The traction helped to alleviate the pain, but it usually returned immediately after the treatment—often, as soon as he got into his car in the physiotherapist's car park. Then he tried a highly regarded chiropractor who said the pain came from a twist in his hips, again sending a referred pain into his groin. Like the physiotherapist, the chiropractor viewed the physical trauma from the car accident as the likely cause of the problem.
In addition to vigorous manipulation, the chiropractor had him lay flat and placed blocks under one hip and the opposite buttock. As did the physiotherapist's traction, the blocks relieved the pain during the treatment, but it generally returned again soon afterwards. He became resigned to having this pain for the rest of his life, due to the impact of the car accident. All he could do was to attempt to manage the pain with using blocks he made for himself, and replicating the treatment each day at home. For years, he tried to come to grips with this pain being with him for life. In fact, he suspected it was likely to get worse with age as his body naturally deteriorated, and the best he could do was to accept the fact.
After eighteen years of pain, he came across the notion that psychological distress and traumatized emotions could play a role in the causation of chronic pain. In his case, accompanying the physical trauma from his car accident was a high level of emotional trauma. He had been hit in a head-on car accident, with the front of his van collapsing in on his legs. He was trapped in the car wreck for the next two and half hours, with broken bones protruding from his body, and bleeding profusely. For the most part, in the laudable medical attempts to heal his body, the distressed emotions were ignored by the treating health practitioners. He, in turn, suppressed and ignored the emotional trauma as well.
The Hidden Psychology of Pain details the role which suppressed psychological distress plays in the causation of chronic pain—usually, so suppressed that for all intents and purposes, it is hidden from the sufferer's awareness.
For this man with chronic groin pain, discovering these well-hidden emotions, and seeing the role which they played in his pain, resulted in the same type of symptoms elimination which the other two people detailed above experienced. This breakthrough gave him the physical freedom he believed would never again be possible, even allowing him to play amateur Australian Rules Football after a twenty-year absence.
How do I know about his experience? That sufferer of chronic pain was me. After struggling with it for nearly two decades, I have now been free of that pain for more than twelve years. What brought about this seemingly miraculous cure? Nothing other than the information you will find in this book.
It is possible to cure yourself of chronic pain; however, the ideas in this book are not "conventional." For the most part, the contemporary "pain industry"—the medical and associated professions, and even psychology—do not subscribe to these ideas. They are, however, ideas with a very long history and a very well-demonstrated track record. They have been on the edges of medicine and psychology for many decades, however, in previous eras they were regarded as conventional therapeutic wisdom. The time has come for these notions to again take center stage if we seriously want to relieve the chronic pain epidemic currently gripping our society.
Some readers of this book will respond with "Of course!"—you will find the approaches described as merely reinforcing views which you have long held, and always suspected were relevant to chronic pain. For many others, these ideas will be radical and challenging—so challenging for some people that they will dismiss the notions out of hand, despite the evidence presented. This is each person's prerogative. Perhaps such people may come back to these ideas at a later time in their lives.
For professionals reading this book, especially physicians and psychologists, my hope is that you are able to go beyond what have become standard concepts of chronic pain. This may also require that you go beyond the views with which your training equipped you. If you do so, many of your patients and clients will ultimately thank you for having the insight and the courage.
My early 1980s academic training in psychology treated "depth-psychology" and the highly related "Freudian psychology" more as an historical artifacts than viable approaches to the study of human psychology. Certainly, many of Freud's psychoanalytic notions can now be seen as reflecting 19th century European beliefs and thoughts, and as such, are now quite dated. However, one of the lasting contributions which Freud and his predecessors made is the notion that when it comes to human psychology, there is usually more going on than meets the eye. It is quite common for people to show a lack of awareness of psychological factors operating within them at a level below their conscious awareness.
Freud's approach—psychoanalysis—left psychology with an emphasis that we are aware of only a small portion of our psychological realities at any one time. Much of what is actually dictating our emotions, thoughts and behaviors are factors which are operating at an unconscious level. By definition, we are largely unaware of these.
Rather than learning from the depth-psychology tradition, contemporary psychology has overwhelmingly opted for the cognitive-behavioral model, which emphasizes the role of our conscious thoughts in producing our feelings and actions. For many people, such an approach may prove quite adequate, especially when they are suffering from problems other than chronic pain. This book will argue, however, that chronic pain often requires a different approach.
We like to think that our rational mind is in charge of the show; however, Freud suggested that this is merely a vain fantasy. As a European, he was profoundly affected by the mass-murder on his doorstep which was WWI. Industrial society was so convinced of its own rationality that it came as a bewildering shock to most people that racially and culturally similar people could slog it out for years on end, killing countless millions in the process, in order to temporarily gain small parcels of land. This did not strike Freud as an example of rationality dictating our actions, or as evidence that humans are an essentially logical and reasonable species. Rather, he suggested that our behavior is largely instinctively driven by factors outside of our conscious awareness, and our mind will go to almost any lengths to ensure that the real causes remain hidden from us.
However, to many contemporary psychologists, the importance of psychological factors operating at an unconscious level is seen as irrelevant at best, and as a ridiculous insult at worst. Originators of the currently very popular cognitive therapy, such as psychiatrist Aaron Beck and psychologist Albert Ellis, spent their careers arguing that a focus on what occurs in the conscious awareness is all one needs attend to in order to progress psychologically.
Ellis viewed suggestions of unconscious factors creating behavior and feelings as utterly incorrect. His goal was to have us fully utilize our capacity to think rationally by the very conscious endeavor of arguing sense to ourselves. Beck's goal is to teach us how to avoid typical thinking errors, and instead use scientific methods for arriving at rational conclusions through gathering evidence. As such, Beck and Ellis argue that our conscious thoughts are both the problem as well as the potential solution.
This is the mind set in which I was trained as a psychology student around thirty years ago. As such, I was scornful of the entire depth-psychology enterprise until, when in my early 30s, I attended a weeklong residential workshop in a therapy called "re-birthing." This was not an approach that I would ever have voluntarily chosen, however my wife had participated in the workshop a couple of months earlier and strongly urged me to do so as well. On the first night of the workshop I was brought face-to-face, against all of my expectations, with material that was clearly of an unconscious nature.
Many years earlier, I had been nearly killed in a head-on car accident as an eighteen-year-old whilst attempting to travel around Australia. My journey was brought to a sudden halt one night when the VW Kombi van I was driving was hit by a drunk driver. This experience, and the associated trauma, was so powerful that within a year it had led to my decision to become a psychologist, so that I could help other people who had been similarly damaged.
For around six months after the accident, I was clearly in a bad way psychologically. This lasted until I began to recover physically. Six months later, around the time I came off crutches, I discovered in my father's library his psychology books on meditation, self-hypnosis and other forms of personal development and self-help. This was the beginning of my recovery. A year and a half after my accident, I was studying psychology, and my indoctrination into the contemporary psychological worldview commenced.
By the time I had completed my post-graduate training and became a trainee psychologist, I was convinced that any form of depth-psychology was interesting as a theory, but essentially a load of bumpkin as far as its practical applications were concerned. Upon graduation, I proceeded to practice the cognitive-behavioral psychology that I had been trained in, and never gave another thought to notions of the unconscious, unless it was dismissive. Applying the rationality of Ellis, and Beck's CBT notions of thinking errors to myself, I proceeded to get on with life, and viewed my accident as something akin to a bad movie I had seen years earlier.
Opening to the unconscious
When, in my early 30s, my wife urged that I attend the week long rebirthing workshop, no approach could have sat worse with where I was as a psychologist (although as a husband, I had been married long enough to know that it was highly advisable I attend). More than feeling that it was a complete waste of time, I resented the money involved, as well as the "fruitcake" notions that I would have to endure over the week. I was wrong, however, and the whole experience opened my eyes to the reality of the unconscious mind.
The term "re-birthing" suggests that it involves re-experiencing one's birth. It may include this, but the process is more commonly used for working with any upsetting experience, especially traumatic ones.
On the first night, with little introduction to what was involved in the re-birthing process, we were paired up with other participants. In my pair, I was to be the "subject" first. I lay on the ground and began rapid, shallow breathing as instructed. The only thought repeatedly going through my mind was "What an outrageous waste of time and money it's costing me to lie here and breathe!"
Before too long, other participants in the workshop were "going off," with shouts, howls, and much screaming. "Great'," I thought, "and it's costing me money to lie here and breathe, and listen to this!"
A short time later, I became cold and started shivering. My thoughts quickly incorporated this complaint into the growing list. Then my body began gyrating, and I couldn't believe my stupidity, a cognitive-behavioral psychologist, getting caught up in this madness. Before I had time to complain internally any further, with a whoosh, I was transported into a virtual-reality scene of when the medical team were examining me in the emergency room after finally being freed from my car wreck. I was reliving the moment when I began to cry from the shock of what I had been through. As an eighteen-year-old, even in such a serious state, I noticed that many of the medical staff attending to me were attractive young nurses. On realizing this, I felt embarrassed and stifled my crying. People can die from shock from the type of injuries I had. Not giving in to my emotions may have been a survival instinct, or it may have just been the dumb shame of a teenage boy.
In the re-birthing session, without any programming or expectation—in fact, with only very negative expectations—I re-experienced the emergency room scene, and this time bellowed like a wounded bull. Part of me was listening to the noise that I was producing, and was shocked by the intensity of it, as well as the lack of control which "I" had over it.
"I," being my conscious mind, was clearly not choosing to do this. In fact, "I" did not even believe it was possible, as up until that moment I believed that the unconscious was an elaborate and outdated myth. But then where was this howling coming from, if not from my unconscious? While on a conscious level, I firmly believed that I had dealt with my trauma (reciting positive mantras, changing my thinking errors, learning to cope, etc.), there was something obviously a lot deeper within me that was howling. A part of my psyche was still carrying the trauma, and was now giving expression to it. All of this was happening without any conscious choice or control.
I howled like a broken record for perhaps twenty minutes, until the workshop leader came and talked me through the experience. I didn't stop being a cognitive-behavioral psychologist in that moment, but I certainly did become one who appreciated the reality of the unconscious mind, and the distress that could be deeply buried within. Despite my training, the reality of the unconscious had become suddenly and dramatically undeniable to me. With this experience, I became a cognitive-behavioral psychologist who is open to notions of depth-psychology.
(Continues...)
Excerpted from The HIDDEN PSYCHOLOGY of PAINby JAMES ALEXANDER Copyright © 2012 by Dr. James Alexander. Excerpted by permission of Balboa Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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