Dr James Alexander, PhD- Psychologist

This may seem like a silly question, as the obvious contender of combat experience would seem like the logical answer- there is nothing pleasant about trying to kill other humans, or having them try and kill you. However, despite the most obvious possibility, researchers of Vietnam vets founds that the biggest predictor of post combat PTSD was trauma incurred during childhood and adolescence. Recent research with Danish vets of the war in Afganistan has again confirmed this finding. Soldiers who experienced family violence during their childhoods, parents stalking or threatening their former partner, and violent punishment which resulted in physical damage, were more likely to suffer from PTSD following their war experience, regardless of the nature of their combat experiences. Soldiers who did not experience childhood trauma were unlikely to suffer from PTSD, regardless of their war experience. And soldiers carrying childhood trauma were more likely to fare well while in the theatre of combat because of the high level of support from their fellows; and to subsequently suffer more when returning home as this higher level of support was no longer available.

This research (linked below) shows the importance of negative childhood experiences, and informs us as to the accumulative nature of trauma. The real answer is for us as a culture to take care of people, especially little people, more than we currently take care of things.

The current high level of suicide by veterans is likely to be resulting from a combination of factors such as PTSD, and pre-disposing childhood trauma, as well as the misguided attempts to treat such problems with a crude pharmacological approach. Many people suffer extreme adverse reactions from anti-depressant drugs, including increasing depression and suicidality, anxiety and panic; and sometimes psychosis. The study of pharmacogenetics can explain in scientific terms why one drug can appear to help one person and nearly kill another. Unfortunately, veterans are being treated primarily with psychiatric drugs, and secondarily (if at all) with psychotherapy. They deserve better.

http://www.sciencedaily.com/releases/2012/11/121119140625.htm#.UrC6728424o.email

The following quote, from my favourite spiritual philosopher, may only make sense in relation to his overall spiel (much of which can be heard these days on excellent You Tube clips of his many recorded discussions- well worth listening to them). These themes are explored in more detail in the final chapter of 'The Hidden Psychology of Pain".

"…how does the mind absorb suffering? It discovers that resistance and escape- the “I” process- is a false move. The pain is inescapable, and resistance as a defense only makes it worse; the whole system is jarred by the shock. Seeing the impossibility of this course, it must act according to its nature- remain stable and absorb.

To remain stable is to refrain from trying to separate yourself from a pain because you know that you cannot. Running away from fear is fear, fighting pain is pain, trying to be brave is being scared. If the mind is in pain, the mind is in pain. The thinker has no other form than this thought. There is no escape. But so long as you are not aware of the inescapability of thinker and thought, you will try to escape.

From this follows, quite naturally, absorption. It is no effort; the mind does it by itself. Seeing that there is no escape from the pain, the mind yields to it, absorbs it, and becomes conscious of just pain without any “I” feeling it or resisting it. It experiences pain in the same complete, unselfconscious way in which it experiences pleasure. Pain is the nature of this present moment, and I can only live in this moment.

Sometimes, when resistance ceases, the pain simply goes away or dwindles to an easily tolerable ache. At other times it remains, but the absence of any resistance brings about a way of feeling pain so unfamiliar as to be hard to describe. The pain is no longer problematic. I feel it, but there is no urge to get rid of it, for I have discovered that pain and the effort to be separate from it are the same thing. Wanting to get out of pain is the pain; it is not the “reaction” of an “I” distinct from the pain. When you discover this, the desire to escape “merges” into the pain itself and vanishes.

Discounting aspirin for the moment, you cannot remove your head from a headache as you can remove your hand from a flame. “You” equals “head” equals “ache”. When you actually see that you are the pain, pain ceases to be a motive, for there is no one to be moved. It becomes, in the true sense, of no consequence. It hurts- period.

This, however, is not an experiment to be held in reserve, as a trick, for moments of crisis. It is a way of life. It means to be aware, alert, and sensitive to the present moment always, in all actions and relations whatsoever, beginning in this instant.

Alan Watts. ‘The Wisdom of Insecurity’ (1951). P.97

The Coherence Therapy Network in Australia are very pleased to announce training in this innovative approach to psychotherapy. For more information on the approach, see the Coherence Therapy button on the home page.

This will be the first time that the annual Manhattan training will be offered outside of America. It will be conducted by Coherence Therapy Institute trainer, Dr Niall Geoghegan, PsyD, on 5th & 6th July 2014 in Sydney. Two additional days of training are on offer for those with existing knowledge and Coherence Therapy skills, while the latter two days (5th & 6th) will assume no prior experience. In total, 4 days of training are available.

If you are interested, it is advised that you get in quick for this unique opportunity. 

https://www.eventbrite.com.au/e/coherence-therapy-training-workshop-sydney-australia-12-hrs-ce-credits-registration-10788266997

As stated throughout The Hidden Psychology of Pain, we are never either just physical beings or psychological beings- but are always both. The biomechanical view of the human organism almost totally ignores the psychosocial aspect, requiring a reintroduction of psychological factors in order to redress this imbalance. It may seem, therefore, that books such as mine are also committing a one-sided error by focusing almost exclusively on psychology. There are repeated references throughout my book that we are never just psychological beings, nor that we can ever ignore psychological factors. We simply need to be equipped with valid information in regards to what physical factors are genuinely associated with pain, and which ones are demonstrated through research to be merely correlational to chronic pain, e.g long standing disc pathology.

The research article linked below demonstrates the role which depressed mood can play in making us more sensitive to chronic pain. The brain processes both emotional and physical pain in similar ways. When a person is experiencing a lot of emotional pain, they are more vulnerable to experiencing chronic physical pain. Addressing the reasons why a person is experiencing emotional pain is therefore a viable treatment approach to working with chronic pain. Simply treating depression with drugs, as though it is a disorder like a flu that can be resolved with an antibiotic, is simply not likely to help. There are too many people who suffer adverse side effects to all of the prescribed antidepressants for this to be a viable option for treating even depression, not to mention chronic pain. CBT is also not likely to get to the life experiences which have resulted in depressed mood; nor is it likely to successfully treat chronic pain. Fortunately, there are a range of transformational psychotherapies which are known to successfully treat depression (and the trauma which is often underlying it), such as EMDR, Coherence Therapy, Emotion Focused Therapy, NLP, Gestalt, etc.

http://www.sciencedaily.com/releases/2010/06/100607111318.htm

As discussed in 'The Hidden Psychology of Pain', despite the natural inclination to rest when experiencing back pain, the research consistently demonstrates the value of moving. However, a bit of common sense is also needed- if you are suffering from a recent injury (referred to as acute pain), then the opposite of what makes sense for chronic pain may be viable options. For example, resting an injured part of your body makes sense, allowing the healing process to occur. Also, research indicates that physical therapies (chriopractic, physiotherapy, massage, etc) can be effective in alleviating acute pain from a recent injury.

The problem with both rest and physical therapy is that what makes sense in the short term can easily become problematic in the long term. While rest may make sense, too much rest is definately not what health authorities suggest. With back pain, for example, publications like 'The Back Book' recommend that people keep moving as much as possible, in as gentle a manner as possible. There is nothing to be gained by overdoing movement when injured, but the opposite (no movement) is dangerous in that it can create bad psychological habits (eg. allowing one to become phobic about movement), and can slow down natural healing by decreasing blood and oxygen supply to the pained area via lack of movement. Movement, like massage and physical manipulation, brings blood and oxygen back to the pained area- and this is essential for healing to occur after an injury.

There is a great deal of research which shows that inactivity is common in people who's pain progresses from being acute (less than 3 months duration) to chronic (more than 3 months duration), and this is not because they are in more pain. Lack of movement and over-resting is a key factor in pain progressing from acute to chronic. Other psychological factors include the range of distressing emotions which can accompany physical pain, eg. anger, fear, anxiety, grief, shame, hopelessness, etc. It is also common for people to be vulnerable to chronic pain because of underlying psychological issues, e.g generalised fear, poor self concept, feeling trapped and helpless in life, feeling overwhelmed, and all of the distress that comes from having been traumatised by life experiences. A relatively minor and common back injury may escalate to chronic pain in a person suffering psychologically, rather than resolve in the normal time frame of less than 3 months.

In order to prevent acute pain from becoming chronic, people are well advised to keep moving (as demonstrated in the research cited below), and also to start thinking psychologically about their pain (as seen in 'The Hidden Psychology of Pain').

http://www.sciencedaily.com/releases/2011/09/110920095251.htm

With between 1/3 and 1/5 Australians and 1/3 Americans experiencing chronic pain, it can be rightly referred to as a problem in epidemic proportions. The following link is to a webpage in which Ken Pope cites 39 different studies reported in peer reviewed medical and psychology journal articles in 2013/2014 which demonstrate the effectiveness of psychology in treating pain issues. Reading the list and brief descriptions of the interventions, it is clear that the research is covering a range of psychological interventions which appear to be effective. The only way this is possible, for psychological interventions to successfully treat physical pain, is if physical pain has a large psychological component. This is NOT, however, to say that the pain is all in one's head! The pain is nearly always entirely real, and felt in the sore part of the body. But the mind/brain always has a role to play in the perception of pain, even if we do something as physical as stand on a nail. Our emotions, perceptions of the circumstance, perceptions of our self, and a range of psychological factors which we have no conscious awareness of all play a role in allowing our brain to wind up with the conclusion that pain is the appropriate thing for us to be feeling. Chronic pain is when the pain has become entrenched, over at least a 3 month period- the time which the body takes to repair most forms of damage. When it has become entrenched, there is an even greater role for psychological factors, such as fear, anxiety, grief, hopelessness, anger etc, to feed into the experience and thereby maintain and exacerbate the pain.

Unlike the treatment of acute pain (short term, usually resulting from an injury), most physical interventions for chronic pain have no proven track record of treating it, beyond the temporary relief which it can offer. Intervening on the psychological component provides a way forward for many people suffering chronic pain.

http://kspope.com/pain.php

An innovative pre-marriage program has demonstrated the benefits of watching 5 movies per month as a couple, and together answering a range of relationship issues questions posed by the movies. The early years of a committed relationship can be particularly stressful as people get used to sharing their lives, time and personal space with another person. Many relationships falter in the first few years. Using a sample 174 couples, the UCLA marriage enrichment project managed to cut the 3 year divorce rate in half by getting people to ponder the relationship issues presented in a list of specific movies. The movies included a mix of classics and lesser known ones, as well as old and newer movies. Click on the link below (at the bottom of the linked page) for a list of the movies and the questions which couples were required to discuss.

The results of the study point to the need for a heightened level of awareness in regards to how we approach relationships and our selected other. The world can easily intrude, with the business of life, jobs, kids, commitments, and the needs of the relationship can easily take a back seat. Movies plus targeted discussion appear to be an enjoyable way of keeping relationship needs in awareness. My guess is that established relationships could do with this type of intervention as well, as relationships in distress often result from a loss of awareness more than anything else. People dont, by and large, set out to hurt each other. But this often results when we simply lose awareness of the importance of the relationship in our lives.

http://www.sciencedaily.com/releases/2014/01/140131130514.htm

Since the late 1980's, pharmaceutical companies have been very effective in convincing us that emotional problems result from 'chemical imbalances in the brain'. While many of us were never convinced of this, research continues to show that problems in living result from problematic life experiences; and that there is at best only scant proof of the chemical imbalance theory. It has come to light that the serotonin deficiency theory for depression was dreamed up by the marketing branches of drug companies, not by the research branches, in order to sell Prozac. As a result of phenomenal marketing to sell this idea, we are all now viewed as being Prozac-deficient, and one in every 10 Australians is on an antidepressant (one in every 5 Americans).

And all along, people have been suffering depression and anxiety because of the impacts of negative experiences in their lives. Traumatised people suffer- not exactly rocket science, but the implications are huge. If we accept this reality (as opposed to the chemical imbalance theory), then it means that we need to look at how we as a society treat each other- and it is pretty unimpressive. The amount of child abuse in our culture is horrendous, and always has been. People who dont cope with traumatic events as adults are typically those who have been traumatised in their childhood. Rather than confront and deal with this reality, our culture (led by the drug companies) has opted to largely ignore it, and instead promote the idea of individual pathology explaining emotional problems in living. Psychiatry has been a leading light in this pathology seeking, ably assisted by the drug companies which have afforded it a credible status as a legitimate branch of medicine (as opposed to its traditional status as being largely an embarrassment to medicine), with scientific sounding theories. Psychology has also participated in this individual pathology focus with its embracing of Cognitive Behaviour Therapy (CBT), despite it being a product of psychiatry. Both drug treatments and CBT have for the most part ignored traumatic experiences in preference to individual pathology theories, either chemical imbalances or thinking errors.

The other option is to listen to the research evidence (and example is seen in the link below), and acknowledge the role which adverse life events play in creating subsequent problems in living. This means that we as a culture need to confront what we do to each other (as seen in the Royal Commissions happening in Australia at the moment regarding the sexual abuse of children by institutions such as the Catholic Church). It also means that we need to offer sufferers psychological therapies which address the trauma they are carrying. There are a range of highly effective trauma therapies which are not pathologising of the individual, but which aid in the transformation to resolution.

At the moment, the Australian government offers 10 subsidised psychology sessions per year for people referred by GPs, however it offers 50 psychiatry subsidised sessions per year. Most psychiatric intervention conducted these days is drug intervention. So, people can have more drug intervention than they could need (once a week every week of the year for as many years as they want), but they can access only 10 psychology sessions per year. One has to question the amount of pharmaceutical company finger prints all over Australia's mental health policy.

http://www.sciencedaily.com/releases/2013/10/131016213223.htm#.UmLoZnXF_eU.email

The bio-mechanical model cannot make any sense of why kids of parents with chronic pain are far more likely to experience chronic pain themselves, however a psycho-social understanding can. There is no suggestion that structural pathologies of the body (which usually result from lived experience, ie. injuries) are genetically passed on to off-spring. However, the bio-mechanical model blames these structural pathologies for chronic pain. The only way of making sense of off-spring of sufferers of chronic pain having the same affliction is in terms of either social learning (eg. learnt as a way of dealing with emotional pressure in the same way depression or anxiety may be learnt as responses to pressure), and/or as a result of growing up in a family where the predominant feeling is hopelessness and despair.

The current research (below) demonstrates that kids from single parent families where the mother is suffering from chronic pain are far more likely to suffer themselves than kids from either intact families (where one parent suffers chronic pain), or where a single dad suffers this affliction. The reality is that most kids in single parent families are growing up with their mums (not with their dads), so what ever challenges are happening for the mum are more likely to impact on them than challenges going on for the dad. Where they are growing up in two parent families where one parent suffers, at least the other parent is not suffering, so there is a role model for not suffering, and there is likely to be less suffering for the whole family (a gross generalisation, but true in many ways, eg. economic disadvantage of single parent families).

Do kids learn to 'do' chronic pain from a suffering parent? Why wouldn't they, at least in an unconscious manner? We learn from our parents all sorts of ways of being, from religious beliefs through to irrational passions for unsuccessful football teams. Despite personality having a large genetic component, much of it is still socially learnt- over a childhood, we see our parents responding to life in patterned ways, and we internalise many of these patterns. If chronic pain is an unconscious strategy for dealing with distressed emotion which is too threatening for conscious awareness, there is no reason why this tendency could not be learnt, along with everything else we learn from parents. This may create a vulnerability to manifesting emotional pain as chronic physical pain (as an unconscious 'coping strategy'), but I suspect it then takes challenging life events to create the need for diverting pained emotions in this way. Maybe being in a single parent family with mum suffering from chronic pain (as well as perhaps her ongoing conflict with the ex-partner, financial harship, loneliness, lack of social support, resulting depression, etc, etc) could be fuel for this vulnerability to be launched?

These possibilities are all entirely plausible from a psycho-social perspective. The structural pathology theory of chronic pain cannot even begin to explain why the observation of more chronic pain amongst kids of sufferers has been found. More evidence that if we want to make sense of chronic pain, we need to understand the person's body in context of their lived experience, which includes psychological and social factors.

http://www.sciencedaily.com/releases/2012/11/121119163349.htm

Researchers have recently demonstrated the value of talk-therapy for people suffering from osteorthiritis. This is significant as osteoarthritis is an example of a demonstrable physical pathology in the body- it can be seen on X-rays. However, research is demonstrating that we can have a bone-on-bone problem, and still not be in pain. As such, something else must be present for people to suffer pain associated with osteoarthritis. This something else is a psychological factor- and that is why psychotherapy can be effective, as it is addressing the specific individual psychological issue which is contributing to the experience of physical pain. Yet another example of the evidence which is slowly but surely accruing of the inseparability of mind/body. A bio-mechanical approach is simply unable to address the complexity of the human organism, and any hope of alleviating chronic pain must take into account the broad range of realities- be they physical, emotional/psychological, social, cultural and even political.

http://www.manchester.ac.uk/aboutus/news/display/?id=11695