LONG ARTICLE: 3798 words
1 MY PERSONAL EXPERIENCE OF MENTAL PAIN
For several years, unremittingly, I was in a constant state of intense psychological torment. I realize this sounds melodramatic or exaggerated. It isn’t. In fact, no words can fully convey the intensity of the mental anguish from which I suffered.
I would complain to others I had ‘terrible pain in my head’, neither physical nor solely mental, but some appalling, inarticulable, combination both. I constantly meditated on suicide as an escape, thinking about it, talking about it to anyone who would listen (other psychiatric inpatients when I was in the hospital, cab drivers, even, once, when I was in a desperate state, sobbing, to complete strangers in a coffee bar, much to their alarm), planning it, researching how to do it online, buying various items to make it practicable (including, once, a rope with which to hang myself, a surprisingly complex purchase involving considerations of thickness, strength, and length) and, more than once, attempting it. Indeed, the knowledge I could escape my pain by suicide was, ironically, the only reason I was able to endure it.
I told various psychiatrists about this, but, having experienced some psychiatrists to whom it was difficult to warm, I frequently felt paranoid in their presence and believed if I used terms like ‘psychological torment’ and ‘mental torture’ to describe my emotional state they’d regard me as a hysteric prone to exaggeration.
Instead, I used terms like ‘severe mental pain’ or ‘intense mental pain.’ Now, you’d think (would you not?) that that was putting it strongly enough to galvanize them into immediate and fervent therapeutic action. Stunningly, however, the usual response was a blank stare, a barely perceptible nod, and a quick Biro jotting in their notebook (although I would not be surprised, in some cases, if they carried out this latter action because they were working on their shopping list at the time).
Another name for the mental anguish I describe is ALGOPSYCHALIA. This condition is particularly prevalent amongst people who suffer from a borderline personality disorder (BPD) as we’ll shortly see.
2 WHAT IS MENTAL PAIN?
Mental pain is just as serious as physical pain and, at its worst, can drive individuals to suicide. However, within the medical community, it tends to receive far less attention than physical pain.
Mental pain has variously been described as:
- psychic pain
- psychological pain
- internal perturbation
- psychological torment
SOME OF THE MAIN CAUSES OF MENTAL PAIN INCLUDE:
- separated from a significant other
- a discrepancy between ideal and actual perception of self
- high self-awareness of inadequacy and acute sense of self-disappointment
- intense guilt
- intense fear
- intense panic
- an intense sense of helplessness.
- loss of hope
- frustrated psychological needs
- loss of sense of self
- loss of meaning in life
- a sense of disconnection from society
- repetitive, intensely distressing ruminations
Mental pain is like physical pain:
At the height of my own mental turmoil, which lasted many years, my emotional suffering and distress were so intense that the only way I could carry on was to remind myself constantly that I could escape it through suicide. The major part of each day I spent obsessively going over and over in my mind how I could accomplish it successfully.
I wanted a method with a one hundred percent guarantee of working; however, whenever I came up with a method I thought I’d be brave enough to undertake, I always also came up with an idea of how it, just conceivably, might fail.
However remote the chance of this failure was, it would prevent me from going ahead as I was terrified that I would end up not only suicidally depressed, but additionally crippled, quadriplegic, and/or brain-damaged. (A previous suicide attempt I’d made, which I thought to be fool-proof, left me in a coma for five days and easily could have caused me to incur brain damage)
Furthermore, (and I am embarrassed to admit this) although I am not a religious person, in my paranoid state I was afraid that if I succeeded in killing myself I might be cast into hell and tortured for all eternity (actually, this is a common fear many deeply, clinically depressed people have: to sleep, perchance to dream, as Hamlet metaphorically and euphemistically expressed it). I would then go over and over in my mind all the different kinds of torture I might have to endure.
On one’s own, unable to sleep at 3 am (cue thunder clap, lightning strike, and eerily howling wind), this is a truly terrifying state of mind to be in.
When I would try to describe to doctors, therapists, and psychiatrists how I felt (impossible – this is one of the worst aspects of mental illness, the sheer incommunicability of the depth and intensity of one’s suffering) I would explain, as best I could, that I felt a constant pain in my head which tortured me, and that this pain was neither wholly physical nor wholly mental; rather, it was some indefinable combination of the two.
Why is such emotional suffering so painful, even agonizing? In fact, a look at the neurology underlying emotional pain helps us to understand at least part of the answer.
The Underlying Neurology Of Emotional And Psychological Suffering:
Recent studies (e.g.DeWall et al.) have highlighted how the brain may respond to emotional pain (such as rejection) in a similar manner to how it responds to physical pain.
Indeed, brain scans have revealed that irrespective of whether it’s the case that a person is experiencing emotional pain or physical pain, the same brain regions become highly activated. These two brain regions are:
1) THE SECONDARY SOMATOSENSORY CORTEX
2) THE DORSAL POSTERIOR INSULA
Because the brain seems to interpret physical and emotional pain in similar ways, it is perhaps not surprising that some evidence has been found suggesting some pain killer medication (originally intended to treat only physical pain) may help to ameliorate emotional pain/mental distress, such as aspirin and Tylenol. However, this idea remains (currently) controversial due to the paucity of reliable data.
More research needs to be conducted – at the time of writing the jury remains out.
DEPRESSION AND MENTAL PAIN
Klein viewed depression as having its foundation in three biological anomalies in the brain:
- inhibited central pleasure (the brain’s ability to feel pleasure becomes highly restricted)
- disinhibited central pain (the brain’s sensitivity to mentally painful stimuli becomes greatly increased)
- an inhibited psychomotor facilitatory mechanism (physical and mental skills such as walking, thinking, and talking can be considerably slowed due to impairment of this mechanism; this is sometimes also called psychomotor retardation
BPD AND MENTAL PAIN:
Research shows that those with BPD are worse affected by algopsychalia than are people with any other personality disorder and/or mood disorder (including bipolar and unipolar depression).
This is, perhaps, why approximately 10% of those suffering from BPD end their lives by suicide and why many, many more BPD suffers unsuccessfully attempt suicide.
Patients with borderline personality disorder have a range of intense dysphoric effects, sometimes experienced as:
chronic feelings of emptiness and loneliness
DYSFUNCTIONAL WAYS OF COPING WITH MENTAL PAIN:
Use of recreational drugs like heroin
WHAT EXPERTS SAY ABOUT REDUCING MENTAL PAIN:
DON’T TRY TO FIGHT PAINFUL FEELINGS
Recent research suggests that the constant pressure society and culture impose on us to always be ‘positive’ can actually make people feel worse rather than better. Think, for example, of a time when you’ve been deeply unhappy and someone has said with poorly judged flippancy, ‘Cheer up it may never happen.’ If you’re anything like me, it probably made you want to hit them.
Instead of constant self-monitoring and judging our emotions in a negative way (e.g. ‘why am I still feeling like this; it’s ruining my life and I’ll never recover’ or ‘I shouldn’t be feeling like this’) in a negative way a recent study has shown that those who are able to accept their emotional experiences are more psychologically healthy. The authors of the study were unable to say with certainty why an accepting, non-judgmental attitude to our emotions reduces our suffering but suggested that it might be because adopting such an attitude prevents us from focusing all the time on how we are feeling.
The research also showed that those who are prepared to acknowledge their most painful feelings and let them run their course, rather than deny them, change them, escape them or hide from them, were more psychologically healthy and better able to cope with stress than those who did not adopt such an attitude.
- LABEL EMOTIONS AND DON’T ALLOW THEM TO DICTATE YOUR IDENTITY:
As we have seen, if, as children, we grew up in an environment in which we were subjected to severe stress over protracted periods of time the way in which our internal physiological systems would normally operate may be seriously compromised. Such long-lasting stress may be caused by various factors such as abuse or neglect. In her book, How Emotions Are Made: The Secret Life Of The Brain, the author, Lisa Feldman Barrett explains the theory that this kind of stress can adversely affect the area of the brain that she refers to as the interoceptive network.
What Is The Interoceptive Network?
This is a brain region that consists of:
- the prefrontal cortex
- the insula
- the striatum
- the cingulate
What Does The Interoceptive Network Do?
The interoceptive network functions to make us aware of our internal body state feelings, regulate bodily physiological purposes and keep the body in a state of homeostasis (homeostasis means a relatively stable internal physiology).
Chronic Stress, Homeostasis, The Mind-Body Effect, And Physical Health:
Chronic stress during childhood can disrupt homeostasis by damaging the interoceptive network and reducing the amount of tissue it contains (literally shrinking it in physical size by a process of cellular atrophy)via the mind-body effect (the mind-body effect refers to the phenomenon whereby our feelings, beliefs, thoughts, and attitudes may affect our internal biological functioning and, as a consequence, our actual physical health.
As described by Segerstrom (2006), prolonged stress leads to the body producing excessive amounts of the stress hormone known as cortisol and this, in turn, reduces cortisol’s ability to regulate the body’s inflammatory and immune responses Whilst a certain amount of inflammation is beneficial, when, due to chronic, severe stress, the inflammation process becomes dysregulated, it can result in the breakdown of healthy tissue and a diminution of the effectiveness of the immune system.
Chaotic families, Family Conflict, And Repeated Criticism:
Feldman Barrett points out that it is not just unambiguous abuse and neglect that can lead to the kind of chronic stress which results in dysregulated inflammatory processes, weakened immunity, and, subsequently, poor physical health but also the stressful effect of living in a chaotic environment can have on the child or the effect of living in a family in which there is a high level of conflict or in a family in which the child is frequently criticized over an extended period of time.
Also, Feldman Barrett states, that children who are bullied at school may also develop problems related to inflammation and these problems can extend into their adult lives, thus also increasing their risk of developing both physical and psychiatric illnesses.
The Good News: Whilst the above is, of course, concerning, Feldman Barrett also explains that individuals with high emotional intelligence who ‘categorize, label and understand their emotions, according to research, may increase their chances of recovering both from stressful experiences and from physical diseases related to stress. And, this being the case, Feldman Barrett infers that individuals who are able to ‘categorize their interoceptive sensations as emotions’ may reduce their risk of problematic inflammation, thus also reducing their chances of ill health.
Research Into Benefits Of Labelling Emotions:
A study conducted by Lieberman et al. involved participants being shown photographs of angry faces whilst measuring brain activity. It was found that when participants were exposed to these photographs there was an increase in activity in the region of the brain called the amygdala which is sometimes referred to as the brain’s alarm center it is activated when a threat is perceived.
Indeed, this increased activity occurred even when the photographs were presented to the participants subliminally; this is not surprising as the amygdala evolved to warn us of potential danger as quickly as possible and acts on an unconscious level. However, when the participants were exposed to the angry faces with the label ‘angry’ attached, the intensity of the amygdala’s reaction was reduced.
Furthermore, when the participants labeled the faces as angry activity in another part of the brain, the right ventrolateral prefrontal cortex, increased and it has been hypothesized that this area of the brain helps to inhibit emotional responses. Lieberman and his colleagues also found that practicing mindfulness increases the activity of the ventrolateral prefrontal cortex and reduces activity in the amygdala.
Summary Of Some Of The Benefits Of Labelling Our Emotions:
- It reduces the unpleasant physiological arousal strong emotions induce
- It helps us to control our emotions
- It decreases emotional reactivity
- Individuals who dismiss, fail to acknowledge, and suppress their emotions tend to have a poorer sense of well being
- Labeling emotions activates the part of the brain that controls negative feelings and stop them from spiraling out of control.
- Labeling emotions helps to convert visceral feelings into a more concrete concept that can be analyzed and more rationally considered
- PRACTICE SELF-COMPASSION:
Therapy that emphasizes self-compassion (as well as compassion for others), not inappropriately called COMPASSION FOCUSED THERAPY (CFT), has become increasingly utilized for the treatment of the effects of childhood trauma over the last decade or so. It is based on 3 main components :
- being mindful of one’s own suffering.
- being kind to oneself (with positive internal ‘self-talk’, for example). and non-self-critical
- being open about own suffering and communicating it without feelings of shame or weakness.
CFT is a particularly useful and effective therapy for those of us who tend to be ashamed of our internal emotional state, are prone to severe self-criticism, and come from an abusive and neglectful background (ie suffered in such an environment during our childhood). CFT motivates and helps individuals to develop a compassionate self-view as well as a compassionate view of others.
Research suggests that many of us who suffered disturbed childhoods are fearful of giving compassion to ourselves or receiving it from others. Neuroscience (the scientific study of the brain) has shown that giving oneself compassion or being self-critical (i.e. where compassion or criticism is INTERNALLY GENERATED) has very similar biochemical effects upon the brain as would be generated by EXTERNAL STIMULI (ie others showing us compassion or criticizing us).
For more about this very interesting area of research, it is well worth reading the study on EMPATHY AND MIRROR NEURONS by Decety and Jackson (2004). Because CFT is based on a similar theory to cognitive behavioral therapy (CBT) it focuses on reasoning, rumination, behaviors, emotions, and motives in a similar way to how CBT does.
EVIDENCE FOR THE EFFECTIVENESS OF COMPASSION-FOCUSED THERAPY: – A study carried out by Lutz et al (2008) demonstrated that showing compassion towards others led to beneficial changes in the PREFRONTAL CORTEX (a specific brain region) and a much-increased sense of personal well-being. -A study by Fredrickson et al (2008) demonstrated that 6, one-hour COMPASSION FOCUSED MEDITATION sessions per week increased POSITIVE EMOTIONS, MINDFULNESS, and FEELINGS OF PURPOSE.
A study by Gilbert and Proctor (2006) focused on individuals with long-term mental health problems and found that COMPASSION TRAINING significantly reduced their feelings of shame, depression, and anxiety; it also greatly reduced their previously pronounced tendency towards self-criticism.
MINDFULNESS is an exciting technique, its effectiveness supported by much research evidence, which is now becoming very popular as a tool for the treatment of conditions related to childhood trauma, including depression, anxiety, difficulties regulating emotions, and borderline personality disorder (BPD). It derives from Buddhist philosophy.
The technique teaches people to improve their coping ability and resilience by concentrating on :
– how they breathe
– adopting a non-judgmental attitude
Individuals are encouraged to just accept and observe their thoughts, their physical sensations (perhaps caused by anxiety) and their emotions as they come and go in the mind.
The technique emphasizes the importance of just observing these phenomena in a detached way, stepping back from them, avoiding engaging with them or getting caught up in them. A metaphor for this would be watching leaves on a stream float by.
Mindfulness is also all about being intensely involved in the MOMENT (rather than thinking about the past or future). It is about accepting the moment as it is and being fully involved in it – for example, becoming aware of our breath going in and out, the feel of the temperature on our skin, the feel of the seat we are sitting in, the feel of the clothes against our skin, the color of the walls – everything, in fact, which is currently impinging upon the senses. By existing at the moment, unconcerned by the past or present, we can just dispassionately, non-judgmentally ‘watch’ our concerns and worries as they pass through our minds.
In this way we can detach ourselves from stressors, and, with practice, we can prevent our previously unhelpful, ‘automatic responses to stress. The technique also encourages us, as we simply observe, in a detached manner, thoughts, and feelings passing through our minds, to label them. For example, ‘worry’, ‘fear’ etc; the reason for this is explained below:
NEUROLOGICAL EXPLANATIONS ABOUT WHY MINDFULNESS WORKS:
As I have already said, there is a lot of evidence showing MINDFULNESS to be a very effective coping technique. In terms of how the brain works, this has been explained in the following way: – labeling our emotions rather than engaging with them activates the PREFRONTAL CORTEX (an area of the brain) which reduces anxiety – a high level of MINDFULNESS correlates positively with the level of neural activity in the PREFRONTAL CORTEX; this has the effect of dampening down activity in the AMYGDALA (high activity in the brain area known as the AMYGDALA is associated with intense emotions); in this way, we become much calmer. – the effects of practicing MINDFULNESS, and the subsequent effects on the brain given above, result in us being able to achieve much greater emotional regulation (emotional control).
As well as reducing anxiety, and depression and helping us to master our emotions, MINDFULNESS, research has shown, also benefits the immune system, helps people control obsessive-compulsive disorder (OCD), and is also used to help control chronic pain. Furthermore, people who continue to practice mindfulness have been found to have stronger coping skills and greater resilience than others.
- REDUCE PAIN OF BEING LOCKED INTO THE ‘FIGHT/FLIGHT’ STATE.:
Severe and protracted childhood trauma can damage the development of the brain’s amygdala, leaving us, as adults, prone to chronic anxiety and a sense of being ‘stuck on red alert’ / trapped in a state of perpetual ‘fight or flight.’ Indeed, being locked into this state of hypervigilance is a hallmark of complex posttraumatic stress disorder (complex PTSD) which some victims of childhood trauma go on to develop.
Such a state, as I know from my own experience, can be intensely painful and affect one on four levels :
- a cognitive level
- a behavioral level
- an emotional level
- a physical level
Let’s look at each of these in turn. According to Pullins (2016), these four levels may be associated with the following types of pain :
THE COGNITIVE LEVEL :
- proneness to interpreting people and situations negatively even when objectively unwarranted
- proneness to view others as hostile even when not objectively warranted
- a preoccupation with pain
- dysfunctional alterations of personality
- distortion of perception of personal control (this can involve both underestimation and overestimation)
THE BEHAVIORAL LEVEL :
- irritability and hostility
- social withdrawal
THE EMOTIONAL LEVEL :
- fear, anxiety, panic, chronic worry
- proneness to explosive rage
THE PHYSICAL LEVEL :
- loss of libido
- muscle tension
- vision disorders
REDUCING PAIN ASSOCIATED WITH THE ABOVE FOUR LEVELS :
According to Pullins, in order to reduce the above types of pain generated by being ‘stuck’ in the ‘fight/flight survival mode’, and the distress that it causes, it is necessary for us to: REDUCE THE OVER-ACTIVITY OF OUR SYMPATHETIC NERVOUS SYSTEM.
In order to achieve this, it is necessary to INCREASE THE ACTIVITY OF THE PARASYMPATHETIC NERVOUS SYSTEM (so that the sympathetic and parasympathetic nervous systems return to an optimal level of balance) which is CONDUCIVE TO FEELINGS OF REST AND RELAXATION.
HOW DO WE ACHIEVE A COMFORTABLE BALANCE BETWEEN THE ACTIVITY OF THE SYMPATHETIC NERVOUS SYSTEM AND THE ACTIVITY OF THE PARASYMPATHETIC NERVOUS SYSTEM?
Pullins suggests we can help ourselves achieve this balance, and, thus, free ourselves from being permanently locked into the pain-inducing fight/flight state, through the following activities :
- mindfulness meditation
- relaxation techniques
- diaphragmatic breathing
- engaging with others socially
- undertaking meaningful activities persistently and with pacing
- undertaking pleasurable activities/hobbies
- writing about our thoughts and feelings in a journal
- distracting our attention from an unremittingly negative focus
- reframing pain
- positive self-talk
- verbal communication
- THE IMPORTANCE OF BOTTOM-UP PROCESSING
BECAUSE OF THE BIOLOGICAL EFFECT OF TRAUMA, IT IS VERY IMPORTANT TO KNOW THE DIFFERENCE BETWEEN ‘TOP DOWN’ AND ‘BOTTOM UP’ THERAPIES. I EXPLAIN THIS DIFFERENCE BELOW:
A ‘top-down’ therapy is one that aims to create a positive change in the individual’s behavioral, emotional, and somatic symptoms in a ‘top-down’ direction (i.e. by beneficially ALTERING THE INDIVIDUAL’S THOUGHT PROCESSES). Techniques for doing this include cognitive restructuring and increasing the traumatized individual’s insight into his or her condition, amongst many others.
Whilst ‘top-down’ therapies are necessary and can be very effective, there is now a growing realization when treating the traumatized individual, the addition of ‘bottom-up’ therapeutic techniques may be of paramount importance in relation to treating the bodily adverse effects of trauma such as sensorimotor symptoms and autonomic dysregulation.
WHAT ARE ‘BOTTOM-UP’ THERAPEUTIC TECHNIQUES FOR THE TREATMENT OF TRAUMA?
Unlike ‘top-down’ therapies, which concentrate on an individual’s thinking processes to treat the effects of trauma, ‘bottom-up’ therapies concentrate upon BODILY EXPERIENCES as an initial route through which to treat the effects of trauma by ameliorating dysfunctional trauma-related, chronic and automatic bodily responses.
This approach is taken because it is theorized that our nervous systems and muscles store distressing images and memories on an unconscious, nonverbal level and that this is manifested in various physical and bodily ways, such as :
- body posture
- how the person moves
- pain and bodily sensations
Bodily reactions to emotions, events, and situations In essence, then, ‘bottom-up’ approaches to the treatment of the adverse effects of trauma aim to correct the sensorimotor dysregulation that has occurred as a result of childhood trauma. Examples of ‘bottom-up’ therapies for treating the bodily effects of trauma include :
- sensorimotor psychotherapy
- somatic experiencing
- breathing exercises
- tapping / Emotional Freedom Technique