Dr. Stephen L. Salter

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Return of the Talking Cure:

finding the words for chronic pain

It's nearly impossible to understand chronic psychosomatic pain without having experienced it. The toll is anywhere from inconvenient to incapacitating. It can afflict any part of your body-your neck, your shoulders, your feet, stomach, fingers, face-anywhere. That is to say nothing of its effects on everyday living. You lose your ability to move around freely. Ordinary tasks like going to the grocery store can become complex events. You may lose friends who can't or won't accommodate to your life. You may lose your job. Potential romantic relationships can become quite limited. Perhaps worst of all, few people in your life, if any, will have the ability and willingness to "get it."

Though you may feel your body has betrayed you and taken over your life, it would be a mistake to see it as the enemy. Your body needs to communicate with you! But it only knows the language of pain. At times it may scream desperately and incessantly like a child who has been ignored.

In a manner of speaking, it is a neglected child. Chronic psychosomatic pain can be traced to childhood development. All children long to be loved and accepted, safe and contained. When those needs are met with rejection, frustration, or intolerance, the child becomes quite shy with regard to her needs. She loses the opportunity to put feelings into language...because that capability requires the nurturing of a caregiver in order to develop. The child understands her feelings as unacceptable. Since she still needs to maintain her relationship with her caregiver, she attempts to get rid of them, feeling her caregiver doesn't want them. She represses them.

She continues to repress them as she develops because she has never learned how to process them. Her efforts to "get rid" of her needs usually result in her treating herself poorly. For instance, responding to the demands of life, she may place severe pressure on herself, beat herself up, terrify herself-sometimes incessantly-all day long-and every day. Because she is unable to articulate her feelings, they will reside as bodily symptoms, at times as chronic pain. Chronic pain may manifest as headaches, neck pain, fibromyalgia, joint pain, and back pain. Freud and Breuer discovered the nature of psychosomatic symptoms over a hundred years ago. They found that their patient Anna O. was able to heal her bodily symptoms by finding words to express its emotional dimensions; the beginning of psychotherapy. By understanding the origin and giving words to her symptoms, they disappeared! Hence, she coined the term "talking cure." It was earth-shifting-talking itself cured an illness of the body.

Almost as striking, Freud's discovery was repressed by the world of psychotherapy not too long thereafter. We forgot the powerful connection between expressive language and the body. Freud and his colleagues were in the medical profession. They conducted their work with the rigor of science. Nevertheless, the medical community today is for the most part unaware or distrustful of mind-body medicine. Traditional medicine has an enormously powerful influence over what practices are considered legitimate. Whatever the reason is, people tend to trust doctors. They have the stamp of legitimacy and have used it to physicalize psychosomatic illness, disconnecting mind from body, rendering impotent the body's potential to speak meaningfully. With that said, there are plenty of instances in which chronic pain is not amenable to psychotherapy--when its causes are embedded in the body's physical structure.

Over 30 years ago medical innovator John Sarno resurrected the talking cure for many people, inviting patients to understand the meaning of their psychosomatic illness. He assembled a psychotherapeutic model wherein the first step is pinpointing the cause of the pain--psychosomatic or structural. Treatment moved forward when he and his patient could develop some certainty that the cause was psychological. A great deal of enthusiasm surrounded his work. A student of Sarno's states "Fifty million people in the country are in chronic pain and forty million of them don't have to be. Thirty nine million don't even know they don't have to be. The ultimate goal is to get the word out to these people so they have the opportunity to heal."

With regard to healing, those who suffer need a voice. The therapist must attune to their patient's unarticulated emotions and trauma. In doing so, they offer a bridge that welcomes the patient home from deadened isolation into relatedness awareness. Access to emotions becomes less frightening. Emotions that were impossible to tolerate become tolerable. The body's ceaseless lamentation finds words and ears. And it can finally rest. The symptoms lose their purpose.

Note: It would be a mistake to take away from this article the message that psychosomatic pain isn't "real." For all those who suffer from chronic pain, it is very much a physical phenomenon and it is very real, regardless of whether the cause is structural or psychogenic.