October 22, 2010

Language And Behavior, Embodiement, and Chronic Pain

fingerscrossed.jpg
apparently, effective


Fast food makes you... faster?


57 college brats watched images flash for 12ms on a screen.  That is too fast to consciously perceive.  One group saw colored squares, the other saw fast food logos.

Then they read a passage.  The control group read it in 84 seconds, the fast food group read it in 69.

Repeat: 12ms is too fast to consciously appreciate.



II. The embodiement of lying 

87 college kids were asked to either tell the truth, or lie, in one of two formats: a voice mail message or an email.  They actually performed the message.

Then they were asked to rate the desirability of some products, including mouthwash and hand sanitizer.



lying mouthwash.jpg
When they lied with their mouth, they preferred mouthwash.  When they lied with their fingers, they preferred hand sanitizer.  When they told the truth with their fingers, they didn't want hand sanitizer.  They were already clean.


III.  Tylenol reduces psychic pain

62 college kids took 500mg Tylenol BID, or placebo, for 3 weeks.  Every day they completed the "Hurt Feelings Scale" (e,g, "today being teased hurt my feelings.")



tylenol pain.jpg
Tylenol users felt less psychological pain.  However you want to explain this,




tylenol mri.jpg
it is evident that being on Tylenol made the brain work differently.




IV. Locking up negative thoughts


80 college students were asked to write about a recent decision they regretted.   Half were asked to seal their answer in an envelope and turn it in, the others just turned it in.

Those that sealed their answers reported feeling less upset, less negative than those that didn't.  The obvious but easily overlooked point is that the subjects didn't seal their answers in order to gain closure; the increased closure was the "accidental" consequence of a physical behavior.  This physical action produces a psychological analogue because Freud was right: the unconscious operates like a rebus.  The act is read by the unconscious in its own way, abstractly, semantically.



V.

The point of all of this is not to suggest that we are desparately out of touch with our bodies, purposely disconnected, unwilling to accept that its flaws and strengths are intimately tied to our personalities and behavior, though this isn't such a bad thing to suggest.  The mind/body problem hasn't been solved not because it is philosophically or scientifically insoluble, but because it is a psychological defense. You may be able to circumvent Darwin but you can't beat Freud.

Consider someone with somatoform disorder, who has physically manifested some psychological pain.  You can't logic this away, you can't show them normal MRIs and blood tests as evidence that it's psychological, because they're not operating on a logic level, they're not even operating on a verbal level.  The ability to manifest the pain physically instead of psychologically means this is a more basic, unconscious maneuver.   So it's not that they don't believe the MRI is normal, they are fully convinced of it; but they're not making a distinction between mind and body the way you are.

An analogy would be your computer crashes.  So?  You may be able to identify some of the internal parts and you know what Windows "is" but you have no idea how they work together, what affects what.  So you say, "my computer won't start" and the IT guy is frustrated, "you mean there's no power, or there's power but Windows doesn't load, or...?"

The fact that your brain made your lower back hurt is not qualitatively different than the fact that a tiger made your back hurt.  The fact that Prozac makes your back feel better doesn't mean it wasn't "really" your back.

Some of you will recoil from this thinking, and you're the same people who ask if there's no power or Windows itself won't boot up.    I sympathize, but you can't talk his way out of this.

Behavior got you into this mess, and behavior will get you out.  The more words you use to explain/encourage/dissect/intimate the more the behaviors or symptoms dig in.  Words are perceived as a trick, like a kid suspicious of mom talking up broccoli.  The pain is there for a reason, and you're trying to fool away the pain without taking away the reason.

VI.

The solution to managing this kind of mysterious chronic pain is to not manage the pain, but the behaviors.  The problem of physically manifested psychic pain is the problem of learned helplessness, which means the longer you suffer like this, the more likely you are to give up trying not to suffer like this.

Like a POW, you can't tough your way through the pain, it will outlast you.  You can't trade short term benefit for long term set back because again, it will outlast you.

This kind of pain I am talking about-- crippling, debilitating, and infuriating to everyone else is more about the consequences of the pain than the pain itself.  You may actually have been injured by a tiger, but what has paralyzed you now is your brain wondering:

  • what's going to happen to me?
  • This will never get better.
  • My husband will leave me because of this.
  • I will never be able to work because of this.

and a bunch of what ifs/if only:

  • if only I hadn't fed that tiger
  • if only I had iced it sooner
  • if only I could do it all over again I'd--
  • what if this is a sign of something worse?

That's the part of the pain that is crippling.  Anyone can tolerate any kind of pain as long as they know there's an end in sight or that it doesn't prevent you from being yourself.

So you have to find a way to make your body do the things that are you:

  • "I will never work again"---> what kind of job could I do?
  • "it hurts much worse today"--> acknowledge the days when it hurts less
  • "my husband will leave me"---> maybe this is a good opportunity to try a menage

and stop planning things which are impossible, in the future, or delay tactics

  • "I wish I hadn't fought that tiger"
  • "I'll rest it for 6 weeks, then..."
  • "I'll order aquatherapy, then..."

All that matters is what you are going to do today.  Do something.

---

http://twitter.com/thelastpsych










Comments

Are you familiar with the w... (Below threshold)

October 22, 2010 12:19 PM | Posted by Anon2312: | Reply

Are you familiar with the work of Dr. John Sarno?

http://www.medscape.com/viewarticle/478840

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I was also thinking Sarno. ... (Below threshold)

October 22, 2010 12:54 PM | Posted by Anony: | Reply

I was also thinking Sarno. I was wracked with chronic pain in multiple joints for nearly a year and recovered quite quickly after realizing the cause was psychosomatic. I went in very skeptical but it didn't matter, some part of my brain realized it was the truth. It was incredible and I would love for TLP to do a write up on it.

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"The mind/body problem hasn... (Below threshold)

October 22, 2010 1:25 PM | Posted by AnAnon: | Reply

"The mind/body problem hasn't been solved not because it is philosophically or scientifically insoluble, but because it is a psychological defense."

Nicely said. And I'd suggest that the concept/intuition that "mind" and "body" are two different things (and that we have an eternal "soul") is also a psychological defense.

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I must say I am absolutely ... (Below threshold)

October 22, 2010 2:21 PM | Posted by Anonymous: | Reply

I must say I am absolutely floored this "psychosomatic pain" deal is actually real. It sounds like some old, misogynistic diagnosis that should be replaced with a sufficient physiological explanation sooner or later (e.g. many but not allpeople with chronic atypical depression have subclinical or clinical hypothyroidism and improve with T3).

So are there really people out there who develop physical pain disorders from their thinking, and find relief via controlling their negative thoughts? Wow. I am skeptical but will read more.

Well, the obvious implication here is perhaps then many cases of depression are not unlike psychosomatic pain. Perhaps a subset of depressive will improve by being mindful of their negative thoughts and reframing them. CBT.

I just can't believe this actually is possible. Maybe it is because I am much more like the person who troubleshoots and understands how things work (and if I don't I figure it out) that I find all of this incredible. I'm actually extremely proficient with computers because of trouble shooting any problems myself that I encountered.

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Another factor is that the ... (Below threshold)

October 22, 2010 6:02 PM | Posted, in reply to AnAnon's comment, by AnAnon: | Reply

Another factor is that the intuition/feeling that mind/body are two different things, and we have a "soul", are also a byproduct of our neurobiology. A lot the experiences we attribute to being "spiritual" or "supernatural" - or explain as supernatural - are just biological glitches that are a result of the fact that our brain is a kluge rather than a highly designed machine. We've built whole belief systems that we feel are very meaningful around these experiences - even when we don't have them ourselves - so there are many reasons for the resistance to understanding that mind/body aren't part and parcel of the same thing.

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For all anybody knows, Dr. ... (Below threshold)

October 23, 2010 2:28 AM | Posted by Ben: | Reply

For all anybody knows, Dr. John Sarno (or Dr. David Hawkins) has just told you what he *really* thinks.

Publish this, if you haven't already. Use a pseudonym for all I care. Why shouldn't a psychiatric/behavioural psychology text be explicitly normative? Publish it.

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offtopic request. It would ... (Below threshold)

October 23, 2010 12:05 PM | Posted by MemVandal: | Reply

offtopic request. It would be quite a good read on your blog about "Unthinkable (2010)" movie. Thanks :)

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Excellent post. Also, it's ... (Below threshold)

October 23, 2010 9:18 PM | Posted by Anonymous: | Reply

Excellent post. Also, it's nice to see you posting some positive, helpful stuff along with the regular, analytical, cynical stuff.

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"The solution to managing t... (Below threshold)

October 24, 2010 12:14 PM | Posted by AnAnon: | Reply

"The solution to managing this kind of mysterious chronic pain is to not manage the pain, but the behaviors. The problem of physically manifested psychic pain is the problem of learned helplessness, which means the longer you suffer like this, the more likely you are to give up trying not to suffer like this."

The multidisciplinary approach, which takes a behavioral approach to managing chronic pain, is useful even for people who have an identifiable (and obviously physical) cause of their pain (keeping in mind that just because a cause can be identified it doesn't mean it can be treated/cured). This is because pain is a subjective experience and experiences can always be modified by how we think about and frame them (the narratives we build around them). It should also be noted that some of the behaviors that are "learned helplessness" can look like the opposite on the surface when it comes to chronic pain. A lot of people who end up with chronic injuries and chronic pain are workaholics and stoics. (They're not very good at self care really but because they're high achievers, appear "tough" or drive themselves through all kinds of pain - which is generally your body's way to stay "stop doing that" - they're more likely injure themselves and "need" an injury to be able to stop, get help, be looked after, etc.) Not all are of course, you get all kinds of people but in many cases a lot of it is about helping people shift self image and expectations through a variety of approaches.

How we perceive and deal with pain is cultural - we learn what is acceptable and what isn't in terms of expressing (and even experiencing) pain both from our family culture and larger tribal culture. And religion and punishment/reward play a large role since our parents either punished us or rewarded us for how we responded to pain. This training or indoctrination, which is usually very deeply embedded into our idea of who we are and what we're worth on both a conscious and subconscious level, also very deeply colours how we respond to other people who are in pain or suffering.

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It has been nice to do coun... (Below threshold)

October 25, 2010 10:07 AM | Posted by medsvstherapy: | Reply

It has been nice to do counseling with some patients with mysterious symptoms. I think it scares the docs, because with all of the booklarnin' and sheepskins and MRIs, the touchy-feely counselor, not the lab-coat MD, meets with "difficult" patients for a few sesions, and the path of care veers sharply away from the somatic issues. Not always, but it is cool when it happens.

With one chronic-apin suffering pt, with obvious swollen arthritic knuckles, I had plans to do some evidence-based CBT strategies for pain. But, I "went with" the client's agenda, discussing difficult relationships. The arthritis problem alleviated. It was still there, but no longer the bane of her existence. My supervisor and I of course had to play the game and require me to have an evidence-based agenda, but fortunately we are both enough in the philosophical school of client-centered, non-directive strategy that we kindof just sat tight and swallowed our over-achiever restlessness. Roges was right: the client was right.

One young man quit having pseudo-seizures altogether after one session! A seizure had apparently been captured on some waiting room surveillance tape, like at the unemployment office or something. I never saw it, but apparently at least one seizure was witnesses to some degree. After the one-session cure, he tapered himself off the anti-epileptics. I kept giving a call to check up, and reschedule, and at those communications, would ask how things were going. Plus, I was a counselor integrated into his health care setting, so I knew his health care utilization from those calls and checking his chart.

So, I let his doc know, and the doc, I believe, gave some guidelines on figuring out what to do if seizures returned. End of story.

I would like to brag, but these clinical happenings were as ersatz as the studies noted above. These things do happen, but it is a matter of working with the beliefs in someone's mind. It surprises me, in one way, that one session could resolve pseudo-seizures, but in another way, it is as reasonable as these remarkable study findings. At the same time, I have had scores of chronic pain patients dutifully follow various directions, and not improve notably.

In another setting , we set up a quit-smoking group for all of our clients with mental illness who were smokers - hey, if you can get reimbursed for this, you pretty much have a job for life.

One person quit smoking, and everyone else bought into the ongoing-nature of the group, and never quit. So, we gave it up. I believe we would have had more success with a three-session "cure" modality, rather than an ongoing "drop-in-and-take-what-you-need" group.

For findings like this, Ken Resnicow is throwing around the "quantum" hypothesis: change does not happen gradually, programmatically, across the timeline of our "treatment-plan" curricula, like we intellectuals want it to do; instead, people seem to approach some change, then jump a quantum level to non-smoking, or whatever.

And we are left to guess how/why by retrospective armchair analysis. Cuz we know we cannot easily replicate with the next client.

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You have solved the mind/bo... (Below threshold)

October 25, 2010 6:00 PM | Posted, in reply to AnAnon's comment, by skeptic: | Reply

You have solved the mind/body problem. That is, you are convinced that they are the same thing.
How did you reach that conclusion?

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Re: Tylenol reduces psychic... (Below threshold)

October 27, 2010 7:21 PM | Posted by Jack Coupal: | Reply

Re: Tylenol reduces psychic pain

Tylenol users felt less psychological pain. However you want to explain this,

Excellent summary, because there are probably 50 different opinions on why that happened.

It would have been great to add a double-blind cross-over, where the Tylenol and placebo arms were switched. Would the hurt-feelings trends reverse, or remain the same? That would be the real test.

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This post discusses psychos... (Below threshold)

October 28, 2010 4:00 PM | Posted by svr: | Reply

This post discusses psychosomatic pain, but it occurs to me that the same thing works for managing real pain that does have a physical cause. Well, behavior can't lessen the real pain, but I do think it can lessen perception of it (that's my experience, anyway). Well, ok, to be more accurate...controlling behavior may not lessen it, but it can prevent you from perceiving it as more than it actually is.

That took a bit to get out right.

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svr - Many of the same stra... (Below threshold)

October 28, 2010 4:44 PM | Posted, in reply to svr's comment, by AnAnon: | Reply

svr - Many of the same strategies are indeed used in pain clinics to help people manage chronic pain. They can actually reduce not only the perception of pain and "pain behavior" but also contribute to reducing actual pain (often people "protecting" an injury can lead to creating other strains or injuries, and pain is magnified if you're tense so being able to relax can actually reduce pain).

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November 2, 2010 2:04 AM | Posted by coach handbags: | Reply

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I could use some help. ... (Below threshold)

November 12, 2010 3:08 AM | Posted by Medifast Coupons: | Reply

I could use some help.

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thank you for reassuring me... (Below threshold)

November 19, 2010 4:31 AM | Posted by achtungbitte: | Reply

thank you for reassuring me I'm on the right path.

I have a depression, social phobia(and so forth) and I've realized that the best way to handle "them" is to fake not having "them".
I've read somewhere that 1hour excercise per day is a more efficient treatment of depression, than medicines.
I dont know how true it is, but I can easily belive it.
doing things you "dont" do when you're depressed, breaks the pattern of depression.
1hour every day you fake not being depressed.
I'm not free from depression, but faking not having social phobia has sure helped me. in 2 months of "faking" I had made more friends than in the last 5 years.
"what would I do if I didnt have this phobia?"
and then doing my best to do it, not aways succeding in making friends, but always succeding in not-having-social-phobia.

but, the point is, from a "patient" pov, I think you're right.
While you didnt have anything to do with me adopting the "fake it till you make it"motto, I hope someone in my (former)situation reads your blog.
keep up the good work and great writing.

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"The mind/body problem hasn... (Below threshold)

March 28, 2012 6:08 AM | Posted by chronic disdain: | Reply

"The mind/body problem hasn't been solved not because it is philosophically or scientifically insoluble, but because it is a psychological defense. You may be able to circumvent Darwin but you can't beat Freud."

What are you trying to say? That consciousness is a defense against...coma? You obviously don't know what the mind-body problem is (hint: it's not the same as the mind-body connection).

Bet you've never experienced chronic pain personally. It's much easier to be preachy from the side of the bed. And your manner leaves a lot to be desired.

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I wish you'd write more abo... (Below threshold)

March 28, 2012 11:06 AM | Posted by Anonymous: | Reply

I wish you'd write more about this. I have legitimate medical issues but I also have noticed that how I am treated has a strong effect on how well I cope with pain and illness. Infrequently I notice pain that seems without cause that affects my ability to function normally...unfortunately most healthcare professionals do get pretty mean about it, which makes it worse. I really hate living this way. I think I'm going to try what you suggested. Can you write something about exhaustion? I'm wondering if what you said can be applied to how tired I am. I've always been this way. I can fall asleep sitting up at work or at school. But I want to be normal.

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"infuriating to everyone el... (Below threshold)

June 18, 2014 12:22 AM | Posted by 777: | Reply

"infuriating to everyone else"

Hello? TLP is talking about narcissism. Not chronic pain. Although probably applies to both.

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