Grief, Pain, Freud, and Melzack (Don't worry... this post is way more fun than it sounds)

I’m currently doing a masters thesis on the topic of pain. It’s interesting (to me). I’m examining the multiple determinants of pain in a sample of cardiac patients. So I’m studying the relationships among psychological and biological factors in predicting angina, a particular type of pain brought on by CAD. The reason I got interested in this area is that the heart has for so long been considered an organ tightly related to emotions (see this awesome website http://www.heartsymbol.com/) and because I have had chest pain since I was a child (Research is Me-search…)

The most interesting thing I have found about the topic of pain (read: emotional distress) is the combination of 2 theories: 1) the Neuromatrix Theory of pain (Melzack, 1993, 1999), and 2) Freud’s psychosexual theory of development.

Yes.

Here’s how.

Freud, as we know, was a neurologist (Galbis-Reig, 2004).  His theory, which many these days shorten to “aggression and sex”, was actually intended to indicate that the neural loops (he didn't use those words) laid down as children would dramatically influence personality later in life. He took his theory further in the discussion of “trauma”: the traumas of childhood were repeated in experiences in adulthood. (He was not the first to have this thought: http://en.wikipedia.org/wiki/Eternal_return#Friedrich_Nietzsche.)

But let's translate this into psychological distress speak: The emotional distress established in childhood would be repeated in adulthood.

Crazy talk? Maybe. (Of course not.) But then let’s fast-forward 100 years (give or take.) and get to Melzack’s new and improved theory of pain.  This theory is designed to explain physical pain, and grew out of observations of phantom limb pain, where in fact a limb that has been amputated seems to cause intense physical pain.

Melzack’s theory is a complicated piece of psychological thought, but boils down to this: 1) we have the capacity to feel pain, 2) this capacity is both innate (i.e., we are genetically predisposed to knowing what ‘burn’, ‘itch’, ‘peirce’ feels like) and learned (i.e., if we have been burned before, now we REALLY know what that feels like). According to this theory, there is no need for the peripheral body’s existence in order for humans to feel pain because the experience of pain only becomes translated in neural loops that ‘code for’ certain types of pain. That is to say that if you didn’t have a body, and were nothing but your brain, I could make you feel any type of bodily pain just by activating the right neurons. (I wouldn’t though.)

Doesn’t this sound to you a lot like the physiological version of Freud’s trauma theory? Especially when you think of chronic pains like back pain, joint pain, and oh recurrent chest pain. Some pattern for these pains gets laid down early on in life, and 20 years later, people are still complaining about it because it got worse. (And just in case you were wondering, there is a terribly poor relationship between how bad it hurts and how bad it's broken. That means, it doesn't always hurt more because it's more broken. Sometimes it is, sometimes it isn't.)

So what about a psychological neuromatrix? Old pains, laid down in childhood (rejection, abandonment, grief), would have formed their own neural loops, and the more those pains were felt, experienced, reminded, … the more practiced the neural loops became. The more practiced those loops become, the easier it is to activate them, until they would come to dominate. Until you couldn’t feel anything else. That's why childhood trauma is so bad. The neural loops for happy would be rusty, the neural loop for love may have atrophied…You need to practice those too, you know.

As an aside. Have you ever noticed how some people refuse to feel bad? (Those people annoy me.) You have a bad day and they say something along the lines of 'it'll be better tomorrow', as if anybody cares. But maybe those people are on to something. Maybe it's related to this fear of losing the ability to feel good if you spend too much time feeling bad that prompts some people to say “don’t be sad” when you’re sad. (Or just be sad for three days. THREE DAYS? See Paulo Coelho’s blog http://paulocoelhoblog.com/2011/02/18/past-and-present/ Some religions suggest to keep mourning down to a minimum too… I’m thinking Islam and Hinduism and I think there are others too http://en.wikipedia.org/wiki/Mourning). And maybe there's sound scientific logic behind this. Maybe we want to make sure we keep the neural loops for pain unpracticed. I think there’s something to that. You always need to remember that it is possible to feel good, and you should practice feeling good so that your mind (and brain) gets used to it.  

BUT – here’s the twist. Ignoring negative emotions doesn’t work. Psychology is all about not allowing people to repress negative emotion. Therapy is all about feeling those emotions, and realizing that that’s the only way through them. That was Freud's big discovery. (And yes I know that therapy has a bad track record when it comes to oh working and all... But more on that later. I'm still on this whole feeling-the-burn kick.)

As long as I'm bringing religion into this, “turn the other cheek” is a Biblical quote often used to encourage forgiveness over revenge. But I think it makes more sense to think of “turning the other cheek” as a response to something or someone causing you pain. For example, if someone hurts you, let’s say through rejection, and you get mad. Then the whole concept of an eye for an eye kind of breaks down doesn’t it? What are you going to take revenge on? And I think this happens a lot in romantic relationships: someone screws you over, and you go screw somebody else over to feel better about things (because often it’s impossible to take revenge off the original person). Does it work? Uhh. Don’t think so. (An other interesting site : http://www.healmybrokenheart.com/)

 

But turn the other cheek? That makes sense. It says “fine, go ahead and hurt me, hurt me again because I am going to deal with these emotions”. You know what that sounds like? Systematic desensitization (Wolpe, 1961)! The process of exposure through which people are taught to get over all sorts of things from snake phobias to motor vehicle accidents. Exposure seems to be the best form of therapy for dealing with trauma or post-traumatic stress disorder. In my opinion (and I’m sure I could find some references to back me up), the main ingredient operating in ANY form of therapy is exposure: therapists encourage patients to try new things, to form new relationships, to expose themselves to their fears – and then offer them the support they need to talk about those experiences, to experience them, to see how they are similar and different from the previous experiences that left a hurtful and sensitive neural trace.

The process of therapy is probably related to the process of creating new neural loops that are not painful, but that contain some elements from the painful neural loops. Some ingredients that seem to make therapy particularly useful (and likely to work...) are reflection and validation. These are fun ways that let the person know you connect with them, and your best friend is probably pretty good at this (though your parents may not have been...) 

But yes, reflection and validation... Possibly the way around the whole painful neural loops thing. how? I don't know, I'm just speculating here and this post is getting way too long. But it wouldn't surprise me if this activated mirror neurons that were instrumental in the process of building new neural loops... Hmmm. More to come.

Aggression, Social Psychology, Threat, and Communication

A couple of weeks ago, I was TAing a Social Psychology lecture on the topic of "Aggression".  A big topic, a great topic... Something you can really sink your teeth into... Metaphor that works on many levels.

At some point in the class, an interesting question came up (posed by me! yey TA!): "Why do people aggress towards others?"

Two answers really grabbed my attention: Threat (survival) and communication.

Threat, I had expected (it was in the readings). Communication, I had not.

But I loved these answers. Both answers really got me thinking (this is the point in the class where I lost everybody though.) Here's the thing about the "communication" answer though. I, too, have often found that there's nothing like a good fight to really connect with somebody. You bond on a deep level when you're willing to just go to the depths of your soul and pull out all that is most intense (ugly? maybe beautiful?) and show it to somebody else. That's really something. (Granted not all aggression gets this epic, but I think we can all agree that it can. "300" anybody?)

Here's the thing though. I wanted to get the students thinking about how these two motivations to aggress could come together and could grow apart.  Here's the reading in a nutshell: "People aggress towards others if they are under threat, because looking down on others makes us feel better about ourselves" (not verbatim, Wills, 1981). But, there's more: "Unless EVERYBODY is under threat. In that case, we just make friends." (also not verbatim, called "shared-fate" in Wills, 1981).

What does that tell you? (Well, who knows what it tells you, this is psychology, ok?) But I think you could make the argument that aggression is communication.  Does it stem from the need to communicate or does it EQUAL communication, that is another question. But I think you could pose the same one with threat, couldn't you? Is aggression a response to threat, or is it an expression of threat?

Hm. I don't know that that's known. Would probably depend on how we define aggression and threat and everything else. We could draw lines in the sand to make them distinct but they probably overlap.

I'm getting bogged down in the weeds. The point is, threat can lead to aggression, but it can also lead to affiliation (read: communication). That would put the two on par (aggression = communication).

But you could go deeper. You could say, we have a need to connect with other human beings. And you could say that aggression is one of the ways to do this. There are other ways: conversation, sex, writing, ... But how often have you gotten angry at somebody and lashed out because they just didn't get what you were saying or how you were feeling and you didn't know how else to tell them - but you really needed them to know you?