When we are in physical pain, we react to it, knowing there are ways to manage the pain for immediate relief. We clean wounds, bandage cuts, take painkillers.
We see our doctor when unexplainable physical ailments worry us, and we think nothing of booking that yearly check-up. The same cannot be said for the psychological pain we experience, despite it having the potential to have serious consequences on our lives.
We will heal from a broken arm in a certain time, but bullying may have a lasting effect, including depression and anxiety. The relationship between pain and emotion is inherently complex with both based on pathways that promote primitive protective behaviours. Regardless of whether our pain is physical or mental, it is equally valid and deserves to be recognised and treated.
"The medical model that governs our health system is based on the idea that something or someone is broken or sick and must be remedied and put right," says Caroline Martin, consultant chartered psychologist. "A psychological perspective may offer a humanistic lens, one which recognises that the emotion is valid, that the person is not broken, rather their emotion is seen in the context of an event, series of events, or experiences within their social system."
While our emotions can be painful and overwhelming, they are not inherently bad. Our capacity to manage these big emotions lies in our resilience. Our mental pain acts as a signal that something is occurring for us, but as with physical pain, we do not need to hold on to it.
“When people speak of resilience,” says Martin, “they are referring to our ability to tolerate, navigate, and not get stuck in these difficult emotions. Resilience is not about avoiding, ignoring or employing contrived positivity.
“Our ability to ride the inevitable waves of joy, fear, distress, sadness, etc, is informed by a number of things, including our previous success of managing other, perhaps more minor events that have brought sadness, stress, anger, etc. These moments of mastery can give us confidence in our ability to move out from difficult emotions when faced with another traumatic event. This is why it is important that we encourage a strengths-based approach to education and wellbeing rather than a deficit approach, which can contribute to a strong negative bias and to the over-pathologising of very normal responses to difficult life events. It is important that we pay attention to our successes, as they are a critical factor in future success.”
Martin refers to the work of Peter Levine, a clinical psychologist and expert on trauma who describes the "empathetic witness" as being an important factor in contributing to our ability to tolerate and move through difficulties.
“This is someone who can deeply understand how you experienced an event or series of events,” she says. “This person does not need to be a therapist, yet this act of being able to accept how you feel at that time can be therapeutic and critical for future life experiences. This is often a parent or guardian, a family member, a coach, a teacher, a mentor, or a friend and it can be different people at different times in our lives. This ‘empathetic witness’ allows us to accept ourselves and our responses to the event or situation without shame.”
Our experiences of events are not uniform, in fact, our experiences of the same event can be wildly different
Our minds and bodies are inherently connected, influencing each other greatly, meaning stress and pain are often locked together in a repetitive cycle. Trauma and unsolved emotional concerns can cause stress which contributes to this cycle.
“Unfortunately, some of us have traversed difficult events and have experienced them as traumatic,” says Martin. “The word ‘trauma’ comes from the Greek word which literally means ‘wound’. Our experiences of events are not uniform, in fact, our experiences of the same event can be wildly different. This may be because of our gender, race, ability, previous life experiences and access to supports, among other contributing factors. Indeed, the presence of supports and ease of access to those supports will influence the effect of that event on the individual.
“There are in essence three components to determining whether an event is traumatic or not: the event or series of events, the individual’s experience of the event, and finally the effect on the person. When the individual, who has experienced this wound, has neither the previous life experience nor the presence of an empathetic witness, the individual will possibly feel unsafe and activate their stress response system. Without support, they may find themselves ‘stuck’ in this space.”
Trauma triggers the nervous system into a state of overreaction as it aims to protect. It intuitively activates when our safety is compromised. However, like a faulty alarm, it can get stuck in a state of stress.
“Some will recognise this as the fight or flight response,” says Martin, “and we now know that there are two additional stress responses: freeze and fawn. Each of these responses is very useful. However, if we have to call on them too often, for prolonged periods of time, our systems can deploy them rather indiscriminately and we can leave them running in the background much like leaving tabs open on your computer or leaving apps open on your phone.
“We might do this because we feel [rightly or wrongly] that we may need to access them quickly but, much like those tabs and apps, they are draining our systems.”
Constant activation of our stress response system is compromising our immune system, our body's way of warding off other ailments
When our body judges sudden or severe stress it can activate our stress response. Our heart rate increases, our lungs dilate as we rapidly breathe, and our blood pressure and blood sugar increase as the liver releases glucose for energy. As a result of this intense activity, our immune system is suppressed.
“This is great when we are in danger,” says Martin, “but not great over a prolonged period. This constant activation of our stress response system is compromising our immune system, our body’s way of warding off other ailments. For this reason, we may experience recurring sickness and pain. It is understandable, therefore, that when people have experienced trauma, there will be both psychological and physiological responses.”
Someone with a history of trauma may encounter a wide range of symptoms that can be linked to chronic pain and can have a significant effect on pain levels. Martin says about 30 per cent of people who have experienced trauma are also diagnosed with chronic pain.
“When our stress response is activated, even in that low energy mode,” says Martin, “we are holding tension in our body. Some of us will hold it in our stomachs, others will hold it in our joints, others in their shoulders, neck or head. Pain in our muscles, bones, organs, wherever we hold tension over a long time or too frequently, will in and of itself become distressing.
“If our experiences of trauma are dismissed, ignored, rebranded and minimised, our bodies will remind us over and over again that there is unresolved work, work that will require an empathetic witness. Therapy by a trauma-informed practitioner is important and recommended. Working with a psychologically minded GP is a great asset in identifying a course of action that guards against re-traumatisation and works towards healing.”
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