What’s in a name?

The final update from my trip to Canada and the US was an announcement from Dr David Clarke, who some of you will know as one of the team who edited the Psychophysiologic Disorders (PPD) textbook. He announced that the Psychophysiologic Disorders Association is changing its name, to the Association for Treatment of Neuroplastic Symptoms (ATNS), with a catchphrase of “symptomatic”. His aim is to reflect the neuroscientific research of the field.

PPD practitioners spend a lot of time thinking about names, as they can be very significant to patients, practitioners and their relatives. Describing pain as “chronic” can sometimes be difficult for people, as they feel they are somehow not entitled to this term, or their pain is not “bad enough” to meet a certain threshold. I use the term chronic pain to describe pain that has been present for more than three months, while acute pain does not last as long. Importantly, chronic pain is not the same as “permanent” pain, and if it is caused by stress illness then it is possible for it to be resolved. 

A word that used to be in common usage was “psychosomatic”, referring to a physical symptom with a non-physical cause such as stress. However, I find this term unhelpful, as it has become associated in popular usage with something that is “not real” or “made up”, undermining the very real symptoms referred to. As you all know, I find it important to recognise that the symptom of pain is both physical and very real.

The names that we use can sometimes influence the outcomes of our pain, as names influence how we mentally frame a situation. Emphasising the dramatic, chronic, and seemingly “permanent” nature of pain can make it feel as though that pain will never be resolved, decreasing the motivation to try. On the other hand, dismissing very real physical symptoms as minor or “made up” can in turn increase feelings of isolation, misery and frustration, increasing the stress response and further exacerbating pain.

Something that I am frequently told by patients who have successfully diminished their pain through their work with me is that they appreciate that the resolving chronic pain process is individual and patient-focused. While working with me they come to appreciate the importance of recognising that the words we use matter and that using particular words may have ramifications.

Boulder, Colorado

It’s been a while since I returned from the Psychophysiological Disorders Association (PPDA) conference in Boulder, Colorado. It opened with a summary of Dr John Sarno’s work and the current PPD research taking place locally. The highlight of the conference for me was a pre-recorded video from psychologist Arlene Feinblatt PhD, who talked about her work with Dr Sarno. I met Arlene six years ago in New York to discuss her relationship with Dr Sarno and the psychological contribution she made to PPD, or Tension Myositis Syndrome (TMS) as it was called then. She is a very special woman, and was an enormous asset to Dr Sarno in my opinion. We’ve kept in touch by email, and it was wonderful to see her again on video at the conference.

Me and Dr David Clarke MD at the conference

The following two days were packed with presentations during the day and good food with friends in the evenings. It was a pleasure to see colleagues who I’ve known for many years again after a hiatus due to Covid, as well as meeting some people I’ve corresponded with in person for the first time. Most attendees were based in the US, but there were some from Israel, Canada, the UK, and several other European countries. Since the conference I’ve been in touch with many of those new contacts and will bring their expertise to you in time.

With Jeffrey Axelbank PsyD at the conference

 One subject that came up repeatedly was the difficulty of communicating the concept of stress illness and the links to physical pain or anxiety and or low mood, which is difficult to convey to both patients and healthcare practitioners. A filmmaker was also resident at the conference interviewing us about our experience. In addition to those live interviews, some of the people I currently teach kindly contributed to the mini videos that the filmmaker will use to create snapshots of this process and the healing experience. It’s an ambitious project and will take time to materialise I suspect. I’ll keep you posted.

Movement session

As I touched on last week, the first task during my recent work trip was teaching a movement session at Lissa Rankin MD’s Transformations and Transitions retreat to around 25 healthcare professionals.

We all sat down in a circle at 8.30am on a Saturday a few weeks ago in Mill Valley, California. My intention was to make the session accessible, fun, and instructive, so immediately plunging into movement felt a bit extreme. Instead, I began with a story a patient told me about the role movement played in their recovery from chronic pain. We then had a discussion about posture and non-verbal communication. How does posture impact our confidence, and our understanding of self? What messages might we be sending non-verbally without realising it? What interpretations do we make from the non-verbal signals we receive from others?

Me and Lissa Rankin MD

 In the next part of the session I asked everyone to find a partner, which helped to form introductions and get people working together at the beginning of the retreat. We experimented with core stability work, before moving into the main movement session, during which one partner took the opportunity to move without constraint and the other acted as witness, watching out for them. I was really impressed by how caring each witness was towards their partner. There is never a right or wrong way to move in this context, and there was a huge range of movement from quite static small movements mainly in the arms, to large movements involving the whole body – sometimes rolling across the floor, requiring vigilance from their partner to keep them safe.

The final part of the session offered an opportunity for everyone to discuss their movement experience. The feedback from the session was positive, with some extracts below.

Jamie Hale: “It was an innovative and integrative mind and body experience – and it was interpersonally bonding, empowering and fun!” 

Mary VanLaarhoven: “I found myself moving organically, guided by the wisdom of my body rather than the constraints of my mind. The emotional releases witnessed in other participants were profound, revealing deep connections between movement and healing.” 

Tori Maricich: “I really enjoyed the core stability and awareness exercise that Mags taught. Getting to move with my eyes closed, and reciprocating being a witness, while somebody moved initiated from inside their body felt uplifting.”

Rachel Gilgoff: “It was so beautiful to connect to my body in a purposeful, energizing, supportive, and patient way. You have translated the art of movement into an inspirational, authentic healing strategy that allows the clinician and the patient to feel empowered, capable, and trusting of our own body and inner strength.”

San Francisco

As some of you know, my household was affected by one of the many viruses doing the rounds a few weeks ago, unfortunately just before my work trip away, which resulted in a few weeks’ gap in the blog. Luckily, I managed to recover before the trip, and had a very productive time traveling to the United States and meeting lots of wonderful and like-minded people.

My trip began in San Francisco, after an eleven-hour flight from Dublin which gave me a good opportunity to catch up on my research! I stayed with a friend, who picked me up from the airport. It was wonderful to receive such a welcome in an unfamiliar environment, and reminded me how precious it is to nurture friendships, even when you don’t get to see each other regularly.

The Transformations and Transitions Retreat with Lissa Rankin MD began the following afternoon. There were seven Whole Health Medicine graduates including myself, and 20 healthcare professionals. Lissa is intuitive at creating an intimate group where everyone has the chance to make real individual progress.

The next morning, I taught the first session at 8.30am (not quite completely recovered from jet lag!). Lissa had asked if I could teach a movement session that related to Resolving Chronic Pain - most of the healthcare professionals attending were eager for new experiences to help them navigate a change to their previous career trajectory. Lissa includes three pathways in her 'Whole Health Medicine' (WHMI) graduate programme. My teaching session related to the first, called ‘Heal the Healer’, directly addressing the healthcare professionals' relationship with their own body and range of movement.

I’ll write more about that first session in detail in the next blog, as well as further updates from the trip. I’ll try to include an extra blog to catch up on those missed, as there is a lot to tell!

Progress

An acquaintance of mine, I’ll call him Fred, changed jobs a few years ago. The new job felt instantly overwhelming, and at first he struggled to get though each day. He was so busy he felt as though he couldn’t possibly get anything done on time, and was repeatedly missing deadlines. He found his new colleagues difficult to work with – those more senior were incessantly demanding, those at his level were prickly and uninclined to offer him any help, and the juniors he was trying to manage were obstreperous bordering on rude. He struggled to sleep, felt constantly tired, and frequently fell ill.

 The months passed, and things improved as he became more practised at handling his workload, and got to know his colleagues better. Eventually, he was offered a new job, and came to train the person who would replace him. He tried to ease her into it, to make helpful introductions and give her guidance that hadn’t been available to him when he started. However, she still struggled to cope with the workload, even while she was in training and only taking on a quarter of what the job involved. She missed several deadlines, miscommunicated with other teams and made several mistakes. Fred’s colleagues muttered to him that they wished he wasn’t leaving, as he was such a competent member of the team.

But rather than roll his eyes at the new person, Fred thought of his own first few months in the job, and how difficult he had found it. Only then did it hit him how far he had come. His work had become easier and easier as the months went by, and he had received positive feedback from his bosses several times. But it wasn’t that the job had become easier – as the struggles of his replacement proved – it was that he had become better at it as time went on. While Fred only wished the best for his replacement and didn’t want her to suffer, the experience of training her showed him his own progress, in a very satisfying way.

We don’t always recognise our own progress, especially if it is something gradual, which is not easy to measure. Fred’s example is very extreme, and the extent to which he was overworked is not something to aspire to. But his story is a reminder that sometimes it’s worth taking a moment to take stock, and recognise just how far you have come. Thankfully, he has now moved to a much less stressful job - and the woman who replaced him in his own role has adapted to it over time, in the same way that Fred did.

Gold medals

Just before my son started secondary school, he discovered there would be a mandatory section of his day devoted to sports. His timetable clearly showed that every afternoon he would have to spend at least an hour out in the sunshine… or more likely in Ireland, in the wet, mud and lashing rain. As he prepared to begin the school year, he was dreading it. He was an excellent student and very talented in many areas, but sports were not one of them.

Imagine his delight, then, when he discovered that the mandatory sports hour could be swapped for another suitably productive activity. He was thrilled to begin spending his time inside, in the warm, doing art. He is very creative, and hugely enjoyed having the time to hone his skills, plan projects and complement the work he was already doing for his curriculum art classes. He did still have to do PE lessons, so was getting regular exercise, he was just given the choice as to whether he also wanted to do extracurricular sport.

Earlier this week, as Team Ireland returned home from their most successful Olympics ever, he joked that we should have pushed him harder towards sport as a child, and he could have been bringing us home a medal. But it made me think back to that time, and how happy he had been to spend those afternoons doing art. I will always be grateful for the opportunities my son was given to take part in sport at school, but I am also incredibly pleased that he was allowed to choose his own areas of interest. He was encouraged to work hard, set and achieve goals, and learn new skills.

I am always awed by the talent, determination and hard work of Olympians, and always find the games inspiring – not to chase a medal, but to aim high and work hard, and to enjoy whatever areas of interest take my fancy.

The upside

As many of you noticed, I made a small mistake in last week’s email. The link to click through to my blog about the Kinesiology conference in Athlone was the same as the previous week’s link, so it actually took you to that week’s blog about sleep. As you know, the blog is published on the website at the same time as being sent out by email, meaning I include the link in advance before it’s live so it’s not possible to test it – and in this case it didn’t work! My apologies. The link still took everyone through to the website, where the new blog was already published, so I happily moved on and was ready to forget about the issue. However, there was an unexpected upside, in the number of people who contacted me directly to point it out.

There were several reasons that I began sending these fortnightly emails some years ago. One of them was to build up a body of blogs that new clients could read through when they joined, and another was to document some of the wonderful stories of resolving chronic pain from clients who were willing to share them. It is also intended as a way to discuss my research, conferences and publications, and a way to highlight interesting and useful research, thoughts and advice from elsewhere.

What I was also really hoping for was a sense of community and connection. The blogs are a way to keep in contact even with those whose sessions are less regular than every fortnight, as well as those who have resolved their pain and no longer have sessions. I always really appreciate the comments and emails you send in response to the blogs, and the discussions we have about some of them. I have never seen such a flurry of messages as I did last week! Even though it was not ideal and I apologise for including the wrong link, it was wonderful to realise how many of you had been looking forward to reading the blog. I hope you managed to find it. If not, this is a direct link (tested this time!) just in case.

As always, I very much welcome any thoughts, comments or requests you have regarding the blogs – I would be delighted to hear from you.

A rainy trip to Athlone

I recently gave a lecture to the Irish Kinesiology Conference in Athlone. Well, a lecture is what I had planned, but the event turned out a little differently! I had driven over on a Friday afternoon around 5pm, hitting the usual M50 traffic, made even worse by heavy rain and flooding. When I finally arrived I was delighted to be enveloped by the warmth of the conference room, and the friendly conference attendees – many of whom came up to introduce themselves to me, explaining that they had attended one of the Resolving Chronic Pain courses online.

My speaking spot was the following day, just before lunch. I was going to have to work hard to compete with rumbling stomachs! I had planned a formal lecture with detailed slides, but inspired by the warm welcome and relaxed atmosphere, as well as the timing of my slot, I decided to deliver something a bit more dynamic. I left my notes on the desk and spoke to the room about the importance of understanding pain neuroscience, and the role of safety and connection in promoting healing. Patients whose anxiety is exacerbated by PPD can find it difficult to be present and to feel safe, creating a barrier to progress. But when defences ease, less conscious emotions and traumatic material can start to emerge, becoming more accessible to explore, reflect on and potentially resolve. Responding to the interest from the audience, I used several anonymous case studies to illustrate my points.

Far too soon, the allotted time was up. There was just enough time to briefly talk through my lecture slides, and many of the audience members took pictures so they could look through the scientific evidence to back up these points at their leisure. We finished off with some brief movement and body-based work, to complement the discussion of safety and connection. And then it was time for lunch, and a fascinating remainder of the conference.

Sound sleep

“Sleep that knits up the ravelled sleeve of care… sore labour’s bath, balm of hurt minds… chief nourisher in life’s feast”. I studied Macbeth at school, and it was one of my favourite topics. We had to learn pages and pages of quotes off by heart, and while the vast majority seemed to be instantly wiped from my memory, as soon as the exams were over, this is one that has stayed with me.

One of the few things that hasn’t changed since Shakespeare’s time is our inevitable need for sleep, and how much better it can make us feel. Despite all of our advancements in medical knowledge and technology, there is still no substitute. In fact, better scientific knowledge has only served to highlight just how important sleep is – a fact that is still not really recognised today.

Sleep is still seen by many as a “waste of time”, and going without it is often considered a positive thing – because you stayed up late working or studying, or got up early to go for a run or get a head start on some chores for example. But those who suffer a lack of sleep – including new parents, or those with insomnia – know all too well how precious it is. A few years ago a popular book about the subject, “Why We Sleep”, by Professor Matthew Walker, opened some conversations about its importance, but on the whole, attitudes have not changed.

Stress can often lead to difficulty sleeping, and I have discussed ways to try and improve sleep, and the concept of good “sleep hygiene”, with many of you. One important and more general thing that needs to change is our attitude to sleep – recognising it as essential for both day-to-day functioning and long-term health. Time spent sleeping, or trying to get to sleep, is incredibly valuable, and should never be seen as a waste.  

As Matthew Walker writes: “Sleep is the single most effective thing we can do to reset our brain and body health each day […] unfortunately, the real evidence that makes clear all of the dangers that befall individuals and societies when sleep becomes short have not been clearly telegraphed to the public. It is perhaps the most glaring omission in the contemporary health conversation.”

Mark's story

In November 2023, after I had given a stress illness presentation to the Irish Law Society in Kilkenny, a woman approached me to ask if I would give her son a consultation. Mark, who was ten years old at the time, had been experiencing ‘tummy aches’ for 18 months. They began when three new children joined his school and started bullying him, and the adults he had trusted were unable to put a stop to it. He had since moved school, but was still feeling pain, which was worst in the morning, or when thinking about going to school the night before. He was still under stress as he had moved to a Gaelscoil, or Irish-speaking school, with a limited knowledge of Irish. He was now taking grinds, or extra tutoring, to improve. The pain was intermittent, but Mark had been consistently withdrawn, no longer the carefree child he used to be. He was assessed by a gastroenterologist, who concluded that PPD was the likely diagnosis.

His mother asked if I could help, but my immediate thought was that meeting the boy myself would be counter-productive. If the diagnosis was PPD, then I believed that Mark didn’t need another expert involved, he needed to be reassured and to feel safe. It seemed to me that the best people to do that were his parents, so I proposed that I could teach them how to help their son. Working with Mark’s mother also allowed me to understand the impact his parents’ attitude to his pain, and the way they dealt with their own stress, had on him.

I taught his mother the principles of Resolving Chronic Pain, and identified what was appropriate to pass on to Mark, how to deliver the information and the importance of the care-giver’s nonverbal communication. Through our sessions, his mother concluded that her son was still feeling the hurt of the previous bullying situation, and needed time to get over it. She and her husband also needed to rebuild his trust after they had been unable to make the bullying stop. He needed reassurance that things would be ok, and help to relax at his new school and to focus on positive experiences there.  

After our second session, Mark’s mother wrote: “After Mark's experience with the bullying, we need to build up his trust and confidence in himself and expressing his opinion. It would have been shattering for him to see that neither his parents nor his teachers could fix the bullying problem. Thankfully, a lot of repair can happen quite quickly.” 

Mark’s mother also identified that she wanted to work on her own stress, as Mark may have been picking up on her concern over his tummy aches.  

After six weeks of sessions and exercises, Mark’s pain was resolved. He no longer complained of tummy aches, and attended school without needing encouragement. His confidence increased noticeably both at school and at home, and his parents recognised his old ‘joyous’ self.  

After the fourth session his mother wrote: “We discussed how Mark has not had any tummy cramps since before the Christmas holidays, and has been happy going in to school this week - a miracle! Mags explained there may be blips going forward as Mark learns to navigate new experiences but it’s okay to be euphoric now! Mark is doing so well, with absolutely no pain…”