#and my brain will always take the easy route for stimulus so I have to put the art away until I have this more sorted

[seth-the-giggle-fish]

my workload for the etsy shop has suddenly increased by a huge factor so I have to focus on that, but I will keep working at the art-tober prompts when I can

#ramping up production and possibly being a supplier for a local bath/beauty store for a few items #so yeah #lotta work #and my brain will always take the easy route for stimulus so I have to put the art away until I have this more sorted #etsy stuff

[entirebodyexercise]

The Art of Mindful Movement

The variety of things we are 'meant' to do for our wellness can be overwhelming. Workout, consuming tidy, hanging out with our household, obtaining adequate rest, lowering screen time, spending time in nature ... For those people hardly finding the moment to manage exercise as well as diet, this can be discouraging. The idea of resting still for five minutes and breathing appears like a little a waste when there are just 45 mins sculpted out in the day for health-related things. Most of us do not feel like we have time to meditate when a week, not to mention on an everyday basis.

Can Movement Be Meditation?

It is obvious that reflection is helpful. A 2014 study review wrapped up reflection brings about activation in the components of the brain associated with processing, self-regulation, focused problem addressing, flexible behavior, and interoception. It's virtually as though reflection is the remedy to an over-stimulated, go-go-go state of mind. Of course, the constantly on-the-go, over-stimulated individuals would certainly a lot rather do an HIIT workout compared to remain still. A conundrum.

What if including a conscious activity technique elicited comparable feedbacks in the mind as meditation? And also just what if relocating mindfully boosted performance?

Jon Kabat-Zimm, designer of the Mindfulness Based Anxiety Decrease strategy (MBSR), specifies mindfulness as 'the understanding that arises via listening deliberately, in the existing moment, and also non-judgmentally to the unfolding of experience.' Focusing on the job at hand as well as checking your partnership to the task as opposed to considering the next set, the music, or just what your boss said to you at the workplace is mindfulness. This could be done anytime, anywhere, as well as does not need sitting on the floor.

Research also suggests basic reflection techniques could bring about enhanced electric motor control, an enhanced capacity to spot subtle ecological adjustments, as well as much better self-correction to successfully complete a motor task when these modifications occur. These all seem like advantages if our goal is boosted physical performance, do not they?

Increasingly, scientists are stating motion can cultivate mindfulness when attention is routed in a specific way. This readies information for those of us struggling with the idea of meditation. ' Yes! Let me relocate as opposed to sit still! As well as get the exact same advantages!'

It Doesn't Have to Be Tai Chi

Don' t blunder conscious activity for very easy movement. To keep concentrated interest or to practice open surveillance (a reflection method that just suggests to observe what you are experiencing, without judgement) implies lowering interruptions as well as exploring the top quality of the motion, rather utilizing pressure. It becomes much less about exercise and more about curiosity and open-mindedness.

Moving slowly and also mindfully does not exactly match the objective of a conventional exercise. How can mindful activity be integrated without giving up the total objective of fitness?

The good information is health and fitness does not have actually to be compromised, if anything, exploring these concepts will likely boost fitness. The idea of mindful movement could be used in any type of fitness setup using noticing, sensation, and also adjusting.

Sensing describes the concept of taking a moment before your workout to feeling you. What is your physical state? What is your emotional state? Just what are you experiencing? Can you sense your breath? Can you pick up the ground? Taking 2-3 mins before the start of your exercise to ask yourself these inquiries makes you present. It sets you approximately be mentally taken part in the job at hand.

A fantastic means to do this is during joint mobility work. If you actively relocate your joints with numerous ranges of activity before your session, use this as a chance to examine in and also see just how you are really feeling and moving. And also if you do not do joint prep job, including 5 minutes of it could be a rewarding endeavor.

Feeling is the monitoring of exactly how you are doing a motion. As you move with your warm-up, for circumstances, can you feel on your own using unnecessary pressure? Or possibly if you're hypermobile, you do not seem like you're utilizing sufficient control. What can you do to earn the movement smoother, extra fluid? Can the top quality of the task be boosted without giving up ease?

This could also be used throughout the workout itself. If you are fighting with a certain ability, significantly lowering tons as well as moving with the workout gradually is a method to connect with the motion. One concept behind how this works is through the effect this carries the main nerve system. The main nerve system is included 2 branches: the sensory (afferent) anxious system and also the electric motor (efferent) nervous system. Self-awareness originates from the info we obtain from these 2 system.

Adjusting implies utilizing the details you discover from picking up and also feeling making an ability extra reliable. If, for example, you are moving slowly via a light deadlift and also you see (feeling) throughout the concentric phase of the activity you change your weight a little to the right to end up the lift, you can remedy this by telling on your own to remain focused as you do the following few. Your mind sends details to your motor (efferent) system via responses you obtained from noticing your weight on the flooring using your afferent system.

Obviously, just how you do a specific skill or workout is mosting likely to look various when you speed the workout approximately actual time and also load it sufficient to supply the proper stimulus for strength conditioning, but stepping back periodically as well as slowly points down will not lower performance. It might even enhance it.

Don't Price Cut Movement for Recovery

Another means to implement mindful motion into an exercise is to do it on recovery days. There are numerous types of relocating that enhance recognition and urge open monitoring. This is not to be perplexed with vinyasa circulation or a level 2-3 power yoga course with HIIT included. Instead, points like tai chi, restorative yoga exercise, qigong, as well as Feldenkrais are all types of corrective motion that could assist you establish focused attention and also mindfulness without disrupting recovery. They have the added advantage of being 'novel,' or consisting of activities that are most likely outside your typical collection. Novelty calls for focus, which means discovering a martial art, parkour, MovNat, or various other 'edge' exercise techniques breeds concentrate, though they most definitely do not fall into the restorative exercise category.

Focused focus has in fact been revealed to boost discerning and executive focus, or the capacity to concentrate on the task available. You know exactly how often you space out throughout your exercises and also discover on your own considering the meeting you have with your manager later on? The much better your exec focus, the less your mind will certainly wander and also the a lot more existing you will certainly be, not just throughout your exercises, but in life.

' But wait,' you may be believing. 'I don't have time to devote a whole additional hr on my day of rest to slow, laborious techniques created for old and sick people.' The excellent news is, with the net, there are lots of options offered to these forms of conscious motion that do not need leaving the house. Numerous of the on the internet options have courses that differ in length, from 10-60 minutes. Additionally, study recommends these types of techniques boost complete body control. For those of us aiming to enhance athleticism in any pastime or sport, this is possibly beneficial.

Emphasis Inward While You Trendy Down

So far, our choices for integrating conscious activity into our existing exercise program include during the workout, as part of ability job, as well as on day of rest. The last means to incorporate conscious activity into your existing routine is throughout the cool-down. As opposed to taking yourself via a stretching routine, core job, or whatever your common cool-down contains, try making little, straightforward activities that collaborate with your breath. This could be an extremely simple yoga routine, a gentle circulation that takes area on the flooring, or (my personal fave), a handful of somatic motions. Before lifting to leave, invest 2-3 minutes focusing on your breath. Not attempting to change it, just concentrating on it. Feel where your inhale goes, feel just what occurs when you breathe out. If your mind wanders, notification that and also return to concentrating on your breath.

It might possibly be suggested that every workout needs to be mindful, however I do not always assume that's the case. There will certainly constantly be days we require an exterior stimulation to obtain going, whether it's songs, an intense exercise, or brainless cardio. However, if each exercise does not have an element of focus and interest, you are doing on your own a disservice. Attention is like a muscle, it has to be worked progressively gradually for it to ever before boost. And also, like exercise, by exercising just a little of mindfulness in the beginning, over time, you will be able to exercise it increasingly more till it penetrates various other areas of your life.

#exercise #fitness #health #health and fitness #weight #wellness #work out #workout

[mentalillnessmouse]

i've been clean for a year and 5 months, but every time something bad happens my immediate response mentally is to self harm. i don't want it to be this way, but it is. i try so hard to get it out of my head and i never can. every time it happens i can never remember how i got out of it the last time, and now i'm here again and i don't know what to do

Self-harm

Hi Anon,

Thanks for your question. Congrats on being clean for so long, it’s not easy and you should be proud of yourself.

Unfortunately, the thought to self-injure is often an automatic one. If we’ve used self-harm to deal with a particular emotion and its worked, it makes sense that when we’re faced with the same emotion, the instinctive response is to self-harm. Our brain likes familiarity and finds it difficult to change; it’s not your fault and it doesn’t mean that you want to hurt yourself.

A good analogy would be this: Imagine you're rolling a ball in a jar full of sand. With each roll, the ball’s going to dig itself deeper into the sand in the same way as our self-harm neural pathway becomes more and more imprinted in our brain each time we use it. Once the ball is at the bottom of the hole, it’s going to take a lot of effort for it to get out. Our brain follows the most used and strengthened neural route in response to a stimulus, and for us that  would be the urge to self-harm. Trying to relearn alternative coping methods requires getting out of the hole and drilling new routes, which is not easy. 

Below are some alternative coping methods,distractions and tools to deal with self-harm urges. I encourage you to not be too hard on yourself, Anon. I understand that you’re afraid and you don’t want to get back to where you were last time. But in truth, you’ve come so far and even if you do have slip ups, what you’ve achieved so far is valid and will always be. It’s not about how many months clean you’ve been; recovery is a rollercoaster and having these thoughts does not nullify your progress. 

Resources

Self-harm Masterpost

Feeling the need to self injure? Please take a look at these posts: 24 ways to avoid self injury & Alternatives to self harm. More alternatives to self harm.

Help Guide A site containing articles to help understand, help numbers,  “tool kits”, and self help.

Understanding self injury is a text post that explains that self injury is an addiction and the different forms of self injury.

Mental Support Community A forum to talk about self harm and how it affects your life.

WikiHow on coping with self-injury

Self-harm coping tips and distractions

Take care, Anon.

- Tea

#Anonymous #ask mim #tea answers #self-harm #self-injury #automatic thoughts #impulsive thoughts #recovery #clean #sh

[whitestonetherapy]

It’s not brain surgery..... is it? (6.6.17)

When driving in France recently our route took us by a huge engineering plant in the rust-belt that borders the beautiful city of Rouen. I have no idea what is produced there, but the structure is massive, a maze of piping, funnels and furnaces.  There are conveyor belts and walkways extending for what seems like acres in all directions.

I’m fascinated by the complex design and coordination that must have been required to construct a monster like this. Someone had to design it all and actually understand what each bit of the maze must do... then translate that understanding to paper in schematic plans. It’s easy to imagine there were lots of changes - disagreements on what pipe goes where and what walkway points this or that way.  All of this had to be settled and agreed, so presumably there was lots of paper.  Then the work would have begun, all built to a final set of specifications, all of them meeting industry regulations.  It must have involved thousands of people and maybe tens of thousands in the supply chain. The whole plant would have been built from the now-hidden foundations upwards, connecting all the different layers from bottom to top and side to side.  All the materials assembled at just the right points, all cut exactly to size and bound together by many teams working to the over-arching plan, all to the nearest millimetre.  Wow.

Now I’ve got no idea if this plant is, or ever has been, operational.  It looks old and defunct to me, but as I’ve never built a factory my opinion definitely doesn’t count for much. I find it enough to know that there are people out there who can make sense of things on such a scale, and that ultimately something will be produced that is useful - maybe electricity, medicines, or tyres, or…well…you get the point. 

For whatever reason, this plant always makes me think of a huge, rusty human brain whenever I see it.  It does look a bit like one in outline. I like to imagine someone may one day press the ‘on’ button and the whole thing will crank up and start thinking rusty thoughts. Ok, I admit a production plant is probably not the best analogy for a brain - it is far, far too ordered and simple - but there is something about the process of building such a plant, and connecting all bits of it to run properly, that is reasonably analogous to healthy neural and psychological development. 

As a practitioner I think it’s helpful to have at least a basic understanding of neural development throughout the lifespan. Work in this area increasingly allows therapists to ground their clinical work in ways that are measurably effective, and, I think vitally, if we work in an integrative way (as I do) it may help us choose the right therapeutic approaches to help our clients. This is pretty exciting stuff.

A few things have recently reminded me of the importance of this topic.  One was reading a good article in an industry mag Therapy Today by Sally Brown titled “The neuroscience of depression”. The other was someone telling me they had a relative that used to shout, it’s not brain surgery! as an admonishment when, as a child, this person could not make difficult decisions. Hmm. The third was someone else telling me how ineffective they happened to have found the short course of CBT favoured by the NHS (and this is something of a repeat theme).  

We know that experience shapes circuitry within the brain.  We know that what we call 'experience’ is, from a neural perspective, patterns of activating / firing brain cells. And we know that this pattern establishes synaptic connections within the brain that impact upon structure and functioning. 

A stimulus, let’s say a smile on the face of a mother, sets off neural activity in a baby’s brain.  Synaptic connections are created and the stimulus is associated with feelings of wellbeing in a neural network.  It is in this way that experience shapes the circuitry of the brain, especially so with repeated experience. This is the idea that ‘neurons that fire together wire together’ (Hebb).

So, the physical and psychological experience of our imaginary baby begins to manifest as newly established neural connections that in turn play a role in determining how this baby will react to future experiences.  Let’s say the mother in this story did not smile and turned away repeatedly (or worse), this would impede the development of those neural connections thus limiting the potential of the baby to feel emotions associated with wellbeing.  Over time, as the brain develops, these neural pathways form the basis of the young child making predictions about themselves and their environment.

Sticking with my slightly dodgy power plant analogy, let’s look at the brain itself.

Brainstem

Like the Rouen plant, the brain has a few levels that need to work together. Physiologically, the Brainstem is the ‘basement’ of the mind and the oldest part of the brain from an evolutionary perspective.  

A key structure within it is the Vagus nerve that regulates critical organs (heart and lungs etc) and the muscles in the face and head that allow social interactions. This nerve plays a key role in shaping our physiological responses to situations of all kinds, whether threatening or pleasurable.  It also plays a role in down-regulating the sympathetic nervous system too, without which we would spend much more time in fight/flight/freeze modes.  The regulating capacity can be knocked offline due to trauma or extreme stress, as sometimes seen in those with PTSD.

In short, the brainstem governs critical physiological functioning, and helps control over/under-arousal.  David J Wallin in his book Attachment in Psychotherapy suggests those suffering the effects of trauma may need help to ‘effectively modulate’ their levels of physiological arousal.  The work here would focus on body, nonverbal experience and the nuances found in the therapeutic relationship.  Note how this differs from the approach of short-term time-limited cognitive therapies offered, sometimes remotely, by the NHS (more on this below).

Limbic System

Next up we arrive at the limbic system - the ground floor of the power plant. This is the ‘emotional brain’ where we process feelings. There are two key structures:

Firstly, the Amygdala which acts as a sensory gateway and is well developed at birth.  Within fractions of a second the amygdala can appraise sensory input (a snarl, a gunshot, a shout etc) and signal to the brainstem to activate fight/flight physiological responses. The appraisal the amygdala makes depends on personal history, as the amygdala registers experience and holds ‘emotional memories’.

Secondly, the Hippocampus which provides the capacity to sequence and contextualise our experiences.  The amygdala cannot do this, and makes no distinction between, say, a Lion on the TV and Lion in your sitting room.  The Hippocampus therefore acts as an important brake that engages the parasympathetic nervous system ‘downstairs’ in the basement and allows physiological calming depending on whether the Lion is real.

Crucially, the hippocampus is not developed at birth. Full functioning only becomes available in the second or third year of life. It’s easy to see how early experience and learning processed by the amygdala can result in context-free equivalence between safe and threatening situations, and be powerful and overgeneralised.  Again, ‘what fires together wires together’. 

From a physiological standpoint, these key structures within the brain can and do change in size, depending on the psychological state a person is in (over some time).  Sally Brown cites studies that show in a sample of people with depression the Hippocampus was 19% smaller on average.  Whether this is the cause or effect of depression remains unclear, but Brown quotes Schmaal: “We think that the association between a smaller hippocampus, especially in people with recurrent depression, is a result of prolonged and / or recurrent stress.”

Further studies show that psychotherapy does help.  There is good evidence that different modes of therapy treat  ‘different areas of the brain’ (more on this below).    This can help practitioners ask important questions: What therapeutic approach is the right one for this person?  Will cognitive approaches, for example, be as effective as deeper relational therapeutic work exploring sensations, feelings and impulses that are a reflection in the body and mind of these early pre-verbal experiences? But then cognitive or behavioural approaches might help develop strategies which reduce over/under arousal of the amygdala etc.

So maybe both are necessary as both do different things.  Alan Schore (a leading light in this field) suggests as much.  Sally Brown quotes him and I paraphrase: “For me there are two forms of psychotherapy. There is symptom reducing, short-term psychotherapy, then there is a second form of longer terms psychotherapy, which is growth-promoting.”

Austerity notwithstanding, what a shame the NHS doesn’t take notice of this and offer a much greater range of longer term talking therapies where it is indicated this may be a more useful approach. 

Neocortex

Back to the brain.  Now we are on the top floor of the power plant. The cerebral cortex is the higher and upper floor of the brain and is also the last to emerge from an evolutionary standpoint and in the individual.  This part of the brain helps us make sense of experience and our interactions with others and the world and its function continues to mature throughout life. The areas towards the back of the brain govern our perception of the world through the senses.  The front areas are responsible for thought, raising mental representations to awareness, planning, memory, language, reasoning and much else.

The most advanced area is the prefrontal cortex which has two distinct regions.  The first (dorsolateral) has strong connections with the hippocampus and the reason-oriented ‘left brain’ hemisphere.  The second region (middle prefrontal cortex) houses the orbitofrontal cortex, which sits behind the eyes and plays a vital role in emotional regulation.  It is a convergence channel through which bodily, emotional and cognitive channels pass. 

Behind the orbitofrontal cortex is the anterior cingulate which may be the seat of maternal behaviours and for conscious experience of emotion.  Finally, there is the insula, a small area vital for ‘interoception’ - how we know how we feel.  It is also suggested that this is the area responsible for the ability to impute the mental state of others, and involved in the observed phenomenon of firing ‘mirror neurons’.  A key area for the quality of empathy then.

The neocortex is essentially where we find memory and our predictive power.  Through experience (body, emotions, thoughts) neural patterns are laid down that help us make associative predictions about situations unfolding and future, potential situations.

Joining it up

So, we can see how the brain is built from the ground up in layers.  But as with the Rouen plant, one side has also to work with the other side with all the funnels and walkways linked up.  

The right-hemisphere (right-brain) is specialised to respond emotionally and nonverbally and has dense neural connectivity to the limbic system. The left houses conscious thought and represents experience in a linear way through language (the voice in your head as you read this).

There are some powerful arguments (Damasio, Siegel) that the higher cortex/left-brain structures are often dominated by sub-cortex/right-brain processes.  This suggests that neural traffic tends to be directional, coming from the ‘basement upwards’ rather than the ‘rooftop downwards’, with the sub-cortex ‘amplifying’ and the neocortex ‘moderating’.  This seems to call for a ‘basement upwards’ approach to psychotherapy.  Again, Wallin suggests should be grounded in body-work and including focus on non-verbal aspects of the therapeutic relationship and Alan Schore points also in this direction.

Brain Physio?

I hope that the mental health services offered by the NHS keep pace with discoveries in the field of neuroscience.  This should involve a much greater investment in longer-term relational therapies (as well as continuing investment in time-limited cognitive therapy, for which waiting times are far too long).  In my mind this is in no way a choice between approaches, but an acknowledgement that there is a clear need for the former, a current lack, and, I hope, a serious commitment to redressing the imbalance.

As mentioned earlier, psychotherapy of all modes can be helpful and Sally Brown cited several studies; one showed that over-activity in the amygdala was reduced to ‘normal’ after 8 months of psychodynamic therapy, and another study showed over 14 weeks of CBT a reduced over-activity in the amygdala and increased activity in the prefrontal cortex.  She quotes Siegle: “Cognitive Therapy teaches you to step in and use your prefrontal cortex rather than letting your emotions run away with you.”  This work perhaps helps the higher cortex/left-brain to regulate the arousal of the sub-cortex/right-brain processes. Maybe this is partly what Schore had in mind when talking about ‘symptom reducing’.

In the future as technology advances further, perhaps the idea of working directly with the brain might become even more explicit.  Maybe there will be such a thing as ‘brain physio’ where certain therapeutic approaches are known to have greatest neurological effect in certain areas of the brain.  For example selecting certain approaches that best strengthen, say, the anterior cingulate or insula regions, and another approach to develop strategies which regulate the over-arousal of the amygdala.  I am actually not sure at all how I would feel about such a development like this for various reasons, but I do suspect that this is what already 'happens’ through the course of effective psychotherapy.  Would it be such a giant leap to introduce an element of intentionality to proceedings?

Here is Schore again: “The right hemisphere is really the core of the problem.  It’s selectively involved in processing negative emotions in depression, pessimistic thoughts and feelings and outlook on life, as well as sensitivity to pain. And if you have connectivity that is poor within the hierarchical apex (bottom up) of the limbic system into the amygdala there is a poor ability by the ‘higher’ aspects of the brain to regulate the lower aspects of the right brain.”

For me these factors come together to make a strong case for an integrative approach to therapy, ensuring psychological foundations are solid from the ‘bottom up’, and a ‘top-down’ approach to our work to help alleviate symptoms and develop more helpful patterns. These things are not in competition but seem to complement each other and likely work on different parts of the brain.  

The Personal Consultancy framework may help with this (Popovic & Jinks, 2014) allowing, as it does, the integration of both the reparative and generative modes of therapy & coaching into a clearly demarcated framework of practice.  This is a reasonable proxy for the type of division of labour that Schore and others are talking about. More on this on my website if interested.

#counselling #psychotherapy #whitestonetherapy #wellbeing #therapy #therapist

[eikotheblue]

Darkness and Silence (on Aphantasia)

(This is an effortpost about my experiences with my self-diagnosed Aphantasia. While I believe everything that I’m saying and the personal stories are all accurate, I’ve not been formally diagnosed, the condition is understudied, and introspection is hard. It’s also very long, especially past the readmore.)

For me, one of the most obvious and powerful ideas in LW-rationalism is the typical mind fallacy, or the (often mistaken) belief that other people’s internal experiences are similar to yours when presented with the same stimuli. Reading that sentence really doesn’t convey how big of a deal this is, but I don’t think more words from me can do really do it justice; consider instead reading this post and the comments for a small glimpse into how different brains and experiences can be. 

When I first read that post, the thing I thought of immediately was smell. I’ve never had a sense of smell that produces anything that looks like meaningful input, and until I was about 13 or so I just assumed that nobody could smell much of anything, or that I’d never been exposed to a strong scent. (Then I encountered Axe, and realized there was a stimuli that really was invisible to me). I could talk a lot about lack of smell, but not in this post, because while that was the first atypical mind characteristic I identified in myself, it is far less impactful than Aphantasia. 

Aphantasia is described as “a condition where one does not possess a functioning mind's eye and cannot visualize imagery”. This describes my life experiences very well: I cannot recall or construct mental imagery, even slightly. To demonstrate this, I usually ask people to close their eyes and imagine a square. (Feel free to do so now, and lock the image in your head if you wish). I then ask questions like “What color is the square?” “What color is the background?” “How big is it, relative to your field of view?”, and people generate answers based on the square they imagined. I am always fascinated by these responses; if you perform the experiment and reblog, I’d love to see (either in reblog text or tags) the details of your square.

There is no square in my head. If you ask me to imagine a square, I see no image, only the concept of a 4-sided regular polygon. If you then ask me “what color it is”, I can pick a color at random (or one of my favorites), but the true answer is “None”; there’s no square to have a color. My thoughts and memories exist only as text, with webs of association and observation attached. If I’m asked to remember what something looked like, all that I can retrieve is thoughts that describe the thing I’ve seen, or facts that I know about it, if any. 

Observant readers might notice that while the title of this post is “Darkness and Silence”, so far all that’s been discussed is the inability to visualize. Something that I hadn’t realized until very recently is that Aphantasia is more general than the name implies, at least for me (and others online by anecdote). I can’t directly recall any sensory input from memory, or create sensory input-like experiences ex nihilo. I can’t imagine or recall any sound, taste, touch, or even pain, all of which I have heard other people tell me they can do. From my point of view, it feels unbelievable and incredible that people can do this, and it is hard not to be jealous of that ability. Inside my head, it is dark, silent, still.

Aphantasia is not an inability to receive sensory input: i can still see/hear/etc, and describe what i’m experiencing. It is also not the inability to store sensory input at all, because I can recognize things that I’ve heard and seen before, and after recognizing them I can access details that I wouldn’t have been able to before (this comes up most often in music and other time-component experiences). Additionally, I can dream, and my dreams include images that I saw while awake, which means that the information is stored, just not directly retrievable. My dreams are all very visual, and have other sensory components as well. However, memory of the contents of dreams evaporate almost immediately: since I’m not awake to fully process what I’m seeing, all that gets ‘stored’ is fleeting bits of information, and the emotional state it ended in.

According to the data I’ve seen (which was of limited quality, since Aphantasia is very understudied), visualization and image recall ability vary a great deal from person to person: eidetic or “photographic” memory at the high end, and Aphantasia at the very other. The only place I’ve seen offering stats suggests that the incidence rate is around 2-5%, but the actual numbers could be very different: if I had read slightly different blogs or made slightly different friends, I never would have known!

Going through life without noticing that you have Aphantasia is incredibly easy: people have been doing it for probably longer than recorded history. There just isn’t a lot of evidence that would cause the casual observer to notice the problem: it’s really easy to excuse descriptions of a “mind’s eye” or discussions of visualization as flowery descriptions of the Aphantasia-equivalent skills that fill the gaps, and to just assume that the other variances are just weird quirks, because they don’t feel connected; without the central problem pointed out, it’s just an unlinked set of “things I appear to suck at”.

For me, the biggest observable was memory, and particularly what I called “raw memorization” growing up. I am good at remembering things I understand conceptually, but there are times when information (a chart, dates, a list of names in order, a paragraph of text) just needs to be stored for recall. I am terrible at this! I can manage, if the information is in the form of bindable text (Examples of bindable text are hard to give: a catchy phrase or good song lyrics are bindable, but a list of names and dates are not). If I need to memorize a chart or set of data I don’t get conceptual links from, I don’t really have a long-term solution. In school, I would design a compression system to convert the information into a sentence, reread the sentence over and over right before the test, and write it down as the test started. Then I’d (hopefully) remember my decompression, and manually draw out the info I need. 

I was always quick to take pride in my mental abilities, so when I realized that I was extremely bad at memorization, I tried to learn to train it. And what I found was... advice on memory palaces, a technique for mapping specific memories to specific parts of an imaginary landscape. There were a lot of variations on this, but everything I read basically boiled down to “Step 1. Unfold your wings. Step 2. Practice flapping until you’ve built up enough muscle to fly”; the basic ability required to use the technique was something that it is literally impossible for my brain to do.

And, weirdly enough, this still wasn’t enough evidence to make me figure it out. I got angry and frustrated with advice like this, and eventually quit bitterly, concluding that it was snake oil stuff, or memorization couldn’t really be taught meaningfully, but there were people who were very good at it and thought they could teach it. I gave up on improving and (for the most part) avoided classes and situations where that kind of memorization would be a necessary skill. It took me reading about the original experiment to even consider that I might have it, and over two year’s worth of idle thoughts, research, and conversations with ordinary people about their sensory recall for me to really start to understand just how different (and... diminished) my experiences are.

Aphantasia impacts my life in several ways, almost all of them negatively. I can’t conjure up stimuli to stave off boredom, or crowd out intrusive thoughts. I can’t listen to music in my head (though i can hum or sing it subvocally). I can’t compare 2 images without seeing them side by side. It takes me a lot of exposure to learn enough about a face to describe it, or tell it apart from a similar one. I won’t remember licence plates, too many different passwords, or the birthdays and ages of the people I care about. I get lost very easily, and can’t remember directions well, or make adjustments that deviate meaningfully from the path. Without GPS, I will frequently take a route that is 5 or 10 minutes longer if the alternative is something less familiar or easier to miss turns on.

Gaming is an important part of my life, and Aphantasia does not spare me there, either. It’s easy for me to get hopelessly lost in any game without a good map or obvious landmarks/anchors; I get turned around and spend a lot of time backtracking. Being attacked by something I’m not looking at is terrifying; while I do have object permanence, I can’t visualize my surroundings or keep track of positions that I can’t see. This experience is awful enough that I will almost never play games that regularly cause it. (Overwatch and other pvp shooters, but also many types of single player horror games). Being unable to recall images also poses problems in myst style adventure or puzzle games, although screenshots are a good way to cheat at this. 

To be fair to Aphantasia, there are times that being unable to recall stimulus is useful. I am extremely visually squeamish on several axes (gore, blood, disfigured people, distorted / warped visuals of people), and this would be a much bigger problem if I could recall that kind of image. Similarly, I can’t get songs stuck in my head; until a few days ago, I hadn’t really understood what it meant to have a song stuck in your head. Idle thoughts often remind me of a note progression that i then hum out or think about, but this never really bothered me that much, and I had been lowkey confused about how much it appeared to bother other people, until I learned it was a completely different experience for them. And lastly, the details of my nightmares quickly fade, which limits how upsetting they can be.

But I won’t end on that note, because it would feel like lying. I hate Aphantasia. I hate that my brain is so broken. I hate that I can’t do these things that are so basic for so many people. I hate that I’ll never be able to develop these skills or experience these things. but more than anything, i hate being trapped in my head nothing but my thoughts; i hate that all that it is to be me is a fragile flow of words on a backdrop of terrifying emptiness, of darkness and silence.

#effortpost #aphantasia #original acid dream do not steal #neurodiversity #typical mind fallacy #longpost #sorry this isn't like great #but it was really hard to write and something that matters a lot to me #i hope it's interesting enough to be worth the read #and sorry about the negativity especially at the end #but this is not a part of me i will celebrate #not even ironically like ADHD #because there's no cure #it's just something i can't do that i wish i could

[kristablogs]

The right way to walk your dog

A nice, relaxing stroll. (Stephen Goldberg/Unsplash/)

Ever wish you could peer into your cat, dog, skink, or betta fish’s brain? It would give you a far better perspective of the world—or at least help you be a smarter pet parent. We’re here to demystify your animals (to some extent), while also shedding advice on how you can best thrive together. Welcome to Pet Psychic.

Walking your dog seems simple enough—it’s just you, your pup, and the great outdoors. But without the right equipment and approach, a much-anticipated W-A-L-K can be disappointing.

Get some good gear

Search for “walking a dog” online and you’ll find pages of photos with people holding leashes attached to a collar around a dog’s throat, which is exactly what the experts we spoke to advise against.

“I’m not a big fan of anything around the neck that’s pulling,” says Anna Mynchenberg, a manager at Bark, the company behind BarkBox. “I can’t imagine having any pressure on my neck, so I wouldn’t want to do that to my dog.”

There are simply too many reasons your furry best friend might pull on the leash, pressing the collar against their windpipe, says Kate Perry, a dog trainer based in New York City. That could choke them or, in a worst-case scenario where they leap off a bridge, leave them dangling by their neck.

A comfortable harness

You can avoid potentially strangling your dog by buying a harness. There are many to choose from, including models that can help keep an eager canine from pulling on the leash. Mynchenberg, who has a master’s degree in human-canine life sciences from Bergin University of Canine Studies, says she likes harnesses with handles because they offer an easy way to grab and hold your pet.

Going a little deeper, if your dog is stronger than you, or if you’re training a puppy, consider a front-clip or no-pull harness. Leashes that attach at the back of a dog’s shoulders only reinforce pulling, Perry says. But fasten one to the front, and it’ll block much of your pup’s power and keep them from yanking, she explains.

Before you strap on a harness, though, Perry recommends taking a few days to familiarize your dog with the equipment, as they may not be comfortable with it at first. That means creating positive associations by putting it on and taking it off multiple times in a row while giving them treats, and buckling them in during meals and playtime.

A leash that lets you maintain control

For most, if not all, of the time you’re walking your dog, your hand will be holding a leash—so get something comfortable. “You want something you can really grip,” Perry says. For a medium-size dog, she suggests a ½- to ¾-inch-wide nylon leash. Try rope-style leashes for another option.

Perry’s ideal leash is 6 feet long with three sets of knots along the length to use as grips if your dog pulls away from you (also the perfect length to help you keep proper social distance from anyone you walk by). If you don’t want to knot up your lead, you can buy a leash that has two or three loops sewn in.

A waist leash is another option. Mynchenberg says she likes these because they allow her to keep her hands free to work on training or simply enjoy time with her dog. Perry, however, isn’t a fan of these, as your dog could pull and injure you. Ultimately, it comes down to how well you know your dog and how well you’ve trained them, she says.

Another note: Don’t get a retractable leash unless you’re going to spend a lot of time roaming parks, beaches, or hiking trails, where you can let your dog run relatively free. On city streets, they can be more trouble than they’re worth. For one, you don’t really have control when you let the leash spool out, and while you’re supposed to be able to reel it back in, they sometimes malfunction. Perry has also seen unsuspecting pedestrians walk into leashes linking dogs and owners that are far apart.

Other useful options

A harness and leash are the bare minimum you need to walk a dog, but you should bring a bunch of bags along to pick up your pup’s poop, too. Don’t forget treats, either, especially if your dog is highly motivated by snacks, like Mynchenberg’s two boxers, Hercules and Denver. “If they want that squirrel, you have to have something better,” she says.

And if you like to accessorize, consider a fanny pack. They can hold treats, your phone, your keys, and whatever else you normally would’ve shoved into your pockets or carried in your hands, Mynchenberg says.

Plan when to walk your dog

A misty morning walk will keep your dog cool. (Tadeusz Lakota/Unsplash/)

Depending on your dog and the reason for walking, you should hit the street one to four times a day. That could include one long exercise trek, two shorter workouts, and/or bathroom time. Mynchenberg suggests heading out in the morning or evening to avoid midday heat and traveling less-crowded paths to avoid overstimulating your pup. These numbers may vary depending on your pet’s age and energy level, as well as whether you have a fenced-in yard.

Keep things consistent

As soon as the leash is on, decide which side you will keep the dog on for the duration of the walk. “If I’m walking with a child, I won’t let them zig-zag around, but will hold them in my left or right hand,” Perry explains. “You’re loving your dog by giving it some order.” Stop to reposition them if they wander astray while you’re moving. It’s also important that if multiple people are taking the dog out, they all maintain the same basic procedures, Perry says.

Think about the route

In short, don’t walk your dog on hot surfaces. If you can’t touch the ground with your bare hand or step on it with bare feet, it’ll hurt your pet, Perry and Mynchenberg both say.

Beyond that, though, the preferred path depends on the dog. Among Mynchenberg’s companions, Denver will walk on anything because he’s had a lot of experience getting to know different environments. Hercules, on the other hand, took a long time to walk over bridges. If something is new, dogs sometimes respond with fear or hesitation—so if they’re not a fan of what’s around them, you’ll know, she says.

Pick up your dog’s poop

That’s it. That’s the tip. Don’t let it decompose in nature or “fertilize” someone’s yard. Send it straight to the landfill.

Keep your dog’s pee away from people

Generally, try to find a grassy area or curb for your dog to urinate on and stick to it. Ideally, you’ll want to train your dog to pee in one or a few spots and keep them away from hosing down anything people might touch or pick up, including trash cans, Mynchenberg says.

Learn to handle distractions

If your dog has a high prey drive, anything that moves quickly will spark excitement, Mynchenberg says. Having the right equipment is one part of the solution, but training is the other. For example, Mychenberg’s dog Hercules will react to people and other canines, so they taught him to heel to her right side. He knows this means treats, pets, and praise, so he responds to the command well, she says.

You should also train your dog to look back at you every time they see a squirrel or something interesting, to essentially ask permission to investigate. Whenever your pooch does so, you’ll want to reward it, Mynchenberg says. She explains that every time Hercules sees a person, he checks in with her.

If your dog isn’t well-trained yet, it’s important that you understand their triggers and how much they can handle stimulus-wise. Know what to look for and keep an eye on your surroundings so you can manage any potential problems before the situation escalates, Perry says. Cities like the one she lives in are full of distractions, so she likes to stand between two parked cars and do command training to get the dog she’s with to focus on her and ignore whatever’s whizzing by.

Don’t always follow the same route

Once you’ve established a solid walking regimen, it’s good to keep things interesting. “Dogs will find something to sniff even if the path is familiar, but it adds that extra layer of excitement if you go somewhere new,” Mynchenberg says. If you’re still training your dog, however, stick to a route your pup is used to, which limits distractions.

Understand the risks of exercising with your dog

You may be a marathoner or an expert cyclist, but your dog may not be (we’ll bet they can’t even ride a bike). “Just like humans have to work up to running or exercising, dogs do, too,” Mynchenberg says. “You’re not going to be setting any personal records on your dog’s first run.”

If you do exercise with your dog, pay attention to them and make sure you meet their needs first. That means running when it’s cool out, bringing a bottle of water to keep them hydrated, and taking frequent breaks. After all, a dog’s normal body temperature is a few degrees higher than a human’s, and they’ve got a full suit of hair. “Imagine having a fever, with a coat on, and running,” Perry says.

Riding a bike with a dog is more complicated because wheels move faster than legs (even four of them). Any ride you take will have to be fairly leisurely. There’s also the risk that your dog pulls the bike off balance. But before you even get on a bike, you’ll want to make sure your dog is used to being near them. A good way to familiarize them with the machine, Mychenberg says, is to walk them next to it. To avoid having to hold anything while riding, you can get a bike seat attachment that connects to your dog’s leash.

Be careful when going off-leash

Before you set your dog free, make sure you know the leash laws in your area. Many places require dogs to remain linked to their humans at all times. You’ll also want to have rock-solid commands that will make them come to your side immediately, stop what they’re doing, and drop animals and objects they’ve picked up, Perry says.

Both Perry and Mynchenberg stress that enclosed areas, like a dog park or fenced-in yard, are most ideal for off-leash sessions. That goes for well-trained dogs, too, because once you take the leash off, a lot of factors will be beyond your control. Even wide open areas like beaches and parks are risky because your dog may encounter an unexpected trigger or unseen danger, says Perry, who has also authored the book Training For Both Ends of the Leash. In such situations, it’s crucial to have a deep understanding of your pet and a learned list of commands.

Cool down after the walk

Once you get back home, you can flop down and relax or try to squeeze a little more productivity out of your pooch. When a dog is calm and tired post-walk, Mynchenberg likes to take advantage of that time to work on essentials that are tough when a dog is amped up, like crate training.

Not every walk is going to be perfect, but if you have a plan and know what you and your dog want to get out of it before you go, each one will be better than the last.

[gaiatheorist]

‘A complex presentation.’

It’s me, it was never going to be straightforward, was it?

I have a copy of the letter from the Consultant Psychiatrist who verbally diagnosed the ASD in September. She asked me, on the corridor after the appointment whether I would like a copy, ‘Most people are OK with me just writing to their doctor, would you like me to copy you in?’ ‘Oh, yes PLEASE, for my file!’, then I pulled a face, and said ‘Oh, Gods, trait!’ 

She didn’t send the letter, and, when I phoned the clinic to advise that my GP had a copy, but I didn’t, the receptionist went all frosty on me, insisting I would have to make that request to ‘my worker’, that it wasn’t something she could do. I don’t have an allocated worker at that clinic, it was a one-off diagnostic appointment, the borough has a shortage of Consultant Psychiatrists, so she was mopping up over-spill from other clinics. It had taken ten months for my name to come to the top of her waiting list, and over a year before that for me to have the appointment that put me on the bottom of the referral list. It’s a good job I wasn’t in crisis. I was in crisis, one of my complexities is that I ‘save up’ my emotional and cognitive energy before ‘big’ appointments, and know perfectly well that I’ll fatigue-crash the next day. Trait- meticulous planning to make sure I have at least one escape-route, and ALWAYS turning up half an hour early for appointments.

She hadn’t sent a copy of the letter to me, so I asked the Psychiatrist I saw last week if there would be any reason for withholding the letter. ‘Probably not, but I only skimmed it myself, you can phone the other clinic again.’ Trait- I’d already phoned that clinic, and didn’t want to end up in an argument, if the receptionist was ‘wrong’ again. ‘I have an appointment with my GP on Friday, I can ask him for a copy.’

My GP is adorable, but his appointments are always running late, because he just WILL NOT stop talking. I imagine it’s to break up the monotony of being in a small room all day. I explained that, as per the instructions of the Neurology doctor, I’d been increasing my medication by 10mg every two weeks, but when I was taking 60mg, the side effects were outweighing the benefits of the medication, so I’d stepped-back to 50mg. All clearly communicated, because the GP probably sees dozens of people a day, and can’t be expected to remember all of us. ‘If it saves money, you can prescribe 50mg tablets, instead of 5x10mg boxes.’ Trait, I’m exceptionally linear-logical when I’m on  form. He had a bit of a waffle about the 50mg tablets possibly costing £2 for a month’s supply, whereas the 10mg pills might cost £1 per month, so it wouldn’t make a huge difference, and he wouldn’t prescribe JUST to save the NHS £3 a month. Yes, I know, I’m asking for the 50mg pills, it wasn’t you that suggested it. 

‘While I am here, the letter from the psychiatrist, is there anything in it I’m not allowed to see?’

‘I don’t think so, it’s just that sometimes medical people use terminology that’s not always easy for patients to understand, it can be a bit, erm, clinical, or technical.’

‘I can spell subarachnoid haemorrhage, if there’s a word I don’t understand, you can bet your bum I’ll look it up, and cross-check it.’

He pressed print. I’ve only read it a couple of times, so it isn’t entirely committed to memory, it will be soon enough though, trait- my skim-reading speed is phenomenal, and my retention borderline terrifying. ‘Complex PTSD, query Autistic Spectrum Traits- to be referred for full assessment.’ Further along in the letter she notes that some of my historical difficulties have been exacerbated by the brain injuries, but that I have shown ‘remarkable resilience’ in building a life for myself, despite all of these issues. Get me, not only am I ‘complex’, I’m also ‘remarkable.’

I’d already messaged my Mother to ask if she’d be my ‘person who knew me as a child’, last night, I messaged my Father and Brother. My brother is on speaking terms with both parents, and I didn’t want a Chinese Whispers scenario where Mum dropped it into conversation with my brother, who might then mention it to Dad. Trait- I think around corners. A fair few people have responded ‘I thought everyone knew.’ when I’ve mentioned the diagnosis.  I’ve always been a bit odd, something of an outsider, I’m smirking at a line in the letter ‘even now, as an adult, she only has two or three friends.’  I never could do the superficial-social stuff, I could mask my difficulties enough to pass for something approaching normal, but it was exceptionally draining. There was a thread on Twitter yesterday, about difficulties Autistic people have in employment. The ‘sociable’ thing came up over and over again ‘come out for a drink’ ‘come over for coffee’ ‘team night out’, and all of that malarkey. Trait- I was with my last employer for 14 years, I went ‘out with colleagues’ once, and it was an absolute disaster, the sensory overload was massive, so I drank too much, too quickly, to try to muffle the external stimulus. 

Sensory overload is a huge issue for some of us, ‘normal’ levels of sound, and light can be excruciating, The teaching assistant who always insisted on turning the lights on, or opening the blinds in my office, the screechy conversations about Slimming World, the stench of make-up, hair-product and perfumes. Don’t get me started on people eating noisily in the office. Before the brain injuries, I had mostly been able to ‘wing it’, although I was well known for flinging myself into other people’s offices, and saying ‘She is doing that THING with her tea’, or ‘She is eating an apple and it sounds like a HORSE.’ or ‘I think that one has BATHED in perfume this morning.’ The no-touching-rule was another dead give-away, and my dislike of ‘chokey’ jumpers touching my throat, my refusal to wear tights, the way I wouldn’t wear footwear that made a ‘clop’ sound that echoed down the corridors. 

I can usually communicate well enough to get by, but that’s a learned behaviour, and I have a million and one rules about how I speak to different people, my pitch, pace, tone and content are very deliberate, and because I know my ‘rules’ for communicating, I’m exceptionally conscious if other people are ‘off’. That goes on job applications as ‘able to listen to what is said, and what is not-said.’

High-functioning females with ASD slip through the diagnostic net because girls are conditioned differently to boys, or we were historically, small, quiet, polite, pretty. I do hope that’s dying out now. I’m smirking at the differences between my brother and I growing up, he was always getting into fights, coming home with broken spectacles, and skinned knees, I was relentlessly bullied, possibly because they knew I wouldn’t fight back. I was bright, and quiet, a watchful little creature, I mixed with the boys more than the girls because the boys seemed more  straightforward, they didn’t have secret rules, and hierarchical cliques. I still don’t ‘get’ most women, my closest friends are male. The parts of the media drawing attention to Greta Thunberg not wearing make-up, having her hair tied back simply, and wearing trousers, not dresses are playing into the ‘boys do this, and girls do that’ mentality. Greta being ‘out’-Autistic could turn out to be a double-edged sword, it’s good that more people are aware of Autism-not-Rainman, but there will still be the people who choose not to broaden their understanding. There’s a possibility that there will be a spike in females being diagnosed, it’s taken me three years, because of the prescriptive-restrictive way the NHS is structured. CAMHS has even longer waiting times, I worked with a student with AS traits, and it took two years to have him reliably allocated, he had four different workers over a period of four months. Trust is a big deal for some of us, the final worker met with me first, and then did a seamless hand-over. I trusted him, and my student saw that, so he trusted my judgement. There’s a possibility that high-functioning girls will be bounced out of the system because we pass too well, and will be accused of copy-cat mimicry of Greta. I’ve done the ‘not-disabled-enough’ battle with DWP and PIP, there’s a fair chance that I won’t have a full/formal diagnosis before my PIP is reviewed. ‘Not-autistic-enough’?  

[omg-chronoscontracter]

Pain: A Whistle-Stop Introduction

Some people have recently asked me why have I gone into pain management or have looked at me like they have gone on autopilot and have began dribbling down their face. It is a unique area of work, research and understanding, one that is far more complicated than imagined than those who speak of it in speech.

Personally, pain is fascinating. Pain opens up new research, treatments, philosophies and imaginations. I hope here to introduce people to the basics of pain, the basics of this mysterious void not fully understood. For me it is fascinating, but once understood it has an intersectionality with a multiple array of fields. Pain is not just physiological and pathological, but it also bonds ties within philosophy, linguistics, social theory, art, human rights, psychology and the law to name a few. I hope to cover this in some brief but overarching detail. Hopefully this piece will inspire some people to read up on the topic.

I should state that this will not be an academic debate, unlike some of my meatier blogs. It will provide an easy to understand insight with references to certain groups, people and disciplines. If interested then in more detail on the pain process, discourse and language; refer to the following:

1.       Pain and ‘The Beetle in the Box’ (October 2017)

2.       Bodies in Pain: Time to Destroy Discourse (January 2016)

3.       Who Was Dame Cicely Saunders? (September 2015)

4.       Is Being Pain Free a Human Right? (April, 2015)

 Pain: Pathophysiology and Pathology

All over the body lies pain receptors. These pain receptors are called ‘nociceptors’ and take part in the pain processing pathways which is called ‘nociception’. All over the body these nociceptors are free nerve endings that lie on the superficial layer of the skin. These free nerve endings are sensitive to different stimuluses. The primary stimulus’s involved are mechanical/force, heat/temperature and chemical stimuluses.

The pain process has 4 key stages (refer to my previous blog on pain shattering discourse) which begins with transduction, the change of a painful stimulus into an electrical impulse, which in turn travels via the central nervous system (spinal cord and brain), and ends up as a conscious experience which is called perception. Within medicine, and within other disciplines, there are two main types of pain, acute and chronic.

Acute pain is short lived. It holds a protective function to prevent further tissue damage. This definition has been developed by International Association of the Study of Pain. An example of this is the idea of putting the hand over an open fire. The hand goes over the fire and is removed as it is hot. Removing the hand is a mechanism to prevent the body from damage, that is burning. Chronic pain is a long-term pain, also referred to as ‘nociceptive’ pain. Unlike acute pain, chronic pain has no protective function. Chronic pain generally is defined as being experienced for three months or more, however, some surgical neuropathic pain is debated to be nociceptive under three months and some goes as far as to say six months before becoming chronic. Generally, in acute pain, sodium channels influence pain signals to the brain and are modulated around the spinal cord in a controlled response, such as inflammation after a cut. There is no coordination in chronic pain and pain signals are rather more trigger happy. Often, pain signals are modulated along the spinal cord, like a gate according to Melzack and Wall. Often, pain is seen to occur on nerves and fibres within the body often through disease on the nerve, lesions or nerve damage.

What is interesting about pain is that it is subjective. McCaffrey’s definition of pain is widely accepted within medicine, that is pain existing when a person says it does. Often in neuropathic pain, there is not always diagnostic testing to confirm injury or the cause of the pain. This can provide a problem for a clear diagnosis and upset amongst people going to non-specialist pain services who cannot treat or diagnose properly. General rule and thumb, chronic pain is diagnosed if it’s symptoms, the subjective experience, presents as though there is physical signs that usually come with a diagnosis. It becomes a long-term condition in its own right.

 Objective or Subjective

Consider McCaffrey’s definition of pain existing when it is said to exist. This puts a complex array of concerns and ideas forward to treat pain if the pain is believed. No matter how much training a person has, they may not successfully interpret pain, let alone treat it. It is important to note here that whilst pain can be treated, whilst there are measurement scales and attempts to measure pain, pain is always objective and subjective. Something described here and will be touched upon later on. We may know the nociceptive process of pain, from stimulus to conscious experience, it is not an objective or clear-cut definition of pain as this is subjective to the individual.

It is very true that one person’s pain is another person’s pleasure. Pain is objective under medical notes and treatments, but subjective when experienced by the experiencer. It is also a fact that one measurement tool for pain is not valid for all pain types. There are multiple assessment tools from numeric pain scales, non-verbal measures, behavioural measures, quality of life scales affected and psychological tools. These tools work differently depending on the situation. For example, a child may use the Wong Baker Scale, a faces scale going from happy to incredibly sad to explore their pain, but in an acute setting for adults a simple rate your pain from 0-10 scale may be appropriate. In areas such as palliative care, we assess pain based upon behaviours and the impact on quality of life.

Consider the terms, tolerance and threshold. A person’s threshold his how much a person can take before pain becomes a conscious experience whereas the tolerance is how much pain a person can tolerate before becoming an issue for the person and impacting on what they do. The same stimulus can be applied to two people and both people have various levels of tolerance and threshold. It should also be noted that a lot of things about pain is still being discovered. Many things we are bad at treating are slowly developing, but, whilst there are developments we are moving slowly in the wrong direction. Consider paracetamol, we still do not understand fully how it works but that it does when used correctly.

 Philosophy, Narrative and Linguistics

As touched on above, pain has its routes in both philosophy and linguistics. Descartes famous picture of the man and fire shows the first real attempt to explore pain in some scientific definition. Whilst there was a limited understanding of the body, veins, pain receptors etc, we have his attempt to link nociception as a process with a protective function, pointing out the points of the central nervous system.

Pain cannot be isolated from the dichotomy that is famous of Descartes, that is the mind and body dualism. In summary, the body is often seen as an irrational dead matter that has not consciousness of its own. The body is a vehicle for the mind which is rational, that perceives pain etc. Personally, this dichotomy is dangerous but is often taught as such in both the medical sciences and humanities. Pain as mind and body should be seen as a unified whole, proven by behavioural and physiological changes that can be observed. For example, shying away from social engagements is both a physical and psychological issue.

More so, pain should be seen as an event that is part of a person’s life but also something that shapes and changes the persons reality. Scarry argues that true pain can destroy discourse, shattering it totally. She refers to a person sent back to a ‘primordial’ state where language is not learnt, using the screams and shouts as an example. The person in pain cannot express their pain and it is up to somebody else to attempt to describe the persons pain. Here we have a double dichotomy, that is an experiencer that is living in a reality different from the observer. The experiencer cannot always express their pain, but the observer wants to give testimony to it. Even in chronic pain states, the experiencer may describe but has difficulty localising the pain or describing based on its nature. Acute pain, to refer again, is often localised and short lived described in terms such as sharp or burning. Chronic pain is often seen as dull, aching or tightness.

Even the professionals who are trained to treat pain, to help alleviate, has issues as they cannot always get on top of the pain that the person is experiencing. Within palliative care, pain is not just physical but is a holistic experience intensified but factors not dealt with by medical professionals. The idea of ‘total pain’, as defined by Cicely Saunders, encompasses social, Emotional, financial relationships to name a few, in my opinion an existential pain that cannot be treated solely by pharmacology and hence leads us to the rise of alternative therapies. For example, the young man living his children as he will die, not seeing them turn eighteen or getting marries, or the concerns of a person over the financial stability of their loved ones.

It should always be remembered that pain relies on testimony, that is the person experiencing or observing to say how they are feeling. Based on the subjective nature, pain exists as told by the person. Narrative is a wonderful tool to explore these issues. Two people with the same diagnosis will have different experiences, and this can be seen in the rise of groups who meet to tell their stories and to understand pain in their own ways. Through the telling and retelling of stories, people understand pain not as a medical phenomenon, but as something that allows them to reclaim their bodies and to take control. They no longer rely on the medical teams to tell them how to act or control their pain but find their own ways to understanding this (Mol and Law’s text on Hypoglycaemia is a good example of how this can happen referring to diabetes). In many respects, narrative allows people to reclaim their bodies from modern medical discourse that sees them as silent spectators in their own lives.

The Law and Human Rights

The Human Convention of Human Rights outlined a document that argues that everybody has rights for the very reason that they are human, this also includes the hub for debates on the rights of the fetus. After the rise of Nazism, Hitler and the Holocaust the World Medical Association made the Declaration of Helsinki in order to protect ‘human subjects’ from medical experimentation. Within medical experimentation, only those who can consent to experimentation can take part and this excludes dead bodies, comatose/unconscious patients, foetus, mentally ill and the tissues of people.

The Declaration of Montreal developed the human rights issue by arguing that freedom of pain should be a human right, where adequate resources should be available and accessible to those who need it. Unlike the human rights declaration, this is a touchy subject due to the fact it is not law and holds no real legal framework to support it. According the Declaration of Montreal, being in pain breaches Article 3 of the human rights declaration on ‘ill harm’ and ‘torture’. The Montreal Declaration sets out the following;

Article 1. The right of all people to have access to pain management without discrimination.

Article 2. The right of people in pain to acknowledgment of their pain and to be informed about how it can be assessed and managed.

Article 3. The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained health care professionals.

As stated, the law is a touchy subject. Much of the issues around legalities refers to professional conduct and ability to treat whilst in the care of a medical professional. At the moment, human rights and the law are not in synchronisation.

 Art as new openings for pain

More of a side note here, pain and art are linked and there are many show cases and small-scale projects looking at pain. Art is a form of expressive therapy and can take the form of dance, paintings, photography, diaries etc. Whilst art and pain is still a developing field, people are attempting to shed light on to the issues of pain and how it effects them. Like many people who view art, the observer has their own interpretation of the piece, even when the artists description is attached.

Pseudo Pain?

I would not argue that people who have pain are not experiencing pain. Phantom Limb Pain is a good example of this. Some people have a limb removed and the nerves and blood vessels have been quaterised and shut down. Yet, some people still experience pain within a phantom limb that does not exist. Imagine having a leg removed but you still feel pain where the leg was with no real explanation? Sadly, there are only hypothesis and theories on this tied to the brain and stimulation. Practitioners are having to use alternative treatments, both old and new, to explore this possibility as medication is not effective as there is nothing for the medication to be effective for. One example is the use of mirror therapy to reduce pain by showing the person where a limb was or more so to show people there is no limb present.

Another example could be withdrawal pain. When somebody is in much pain or they use analgesics dangerously, they may withdraw. This withdrawal effect can also be seen in acute settings with alcohol withdrawal also. When a person withdraws from a substance, their bodies retaliate. The only temporary relief for these patients is to have a small ‘fix’ of what they are withdrawing from. It is not uncommon for a patient to come in with alcohol excess and addiction to be told to have a small drink if they need it whilst on a withdrawal program. The body experiences pain and challenge’s the ‘normal’ emotions of an individual. Unlike pain from withdrawal, people can actively die from immediate cessation/stopping of a substance and so this must be monitored, and pain should also be measured accordingly to explore the level of withdrawal (although other factors in withdrawal are also measured including aggression, behaviour, hallucinations and sweating etc).

Other Considerations

Whilst pain is a huge problem, with GP’s seeing a large majority of their patients for chronic pain, back pain is a huge factor of health. Back pain is the most common condition within chronic pain and the most common complaint leading to disability, unemployment and reduced financial income. This has a knock-on effect on not just the individual but the family. For example, no work means reduced pay and this can impact dramatically their lives, home life and ability to self-sustain themselves.

Sex and age are crucial factors. Females are more prone to pain, ironically less inclined to experience heart attack until menopause and there has been reports of not experiencing pain and discomfort when experiencing a heart attack. Men tend to experience more damage from pain as due to the masculine expectations of our culture and society, they will not turn for help until something more serious occurs. This can have a detrimental effect, for example, if the pain is cancer related leading to late diagnosis. As age increases, so does pain intensity and experience.

People are also more at risk of pain if they have experienced pain in the past, been abused sexually or physically or viewed domestic violence. Memory is very important in pain perception, and past experiences and this is not just a psychological issue. Some people experience a high sensitive to pain via non-painful stimuluses, for example when you have a sunburn and then water is placed on the skin. Others may get a flare up of pain after a pain treatment and there are times when people do not experience pain when they should be, leading to effects on the body and comorbidities, such as diabetic retinopathy. Interestingly, pain developed through the observations of others in pain is a new area that is currently being researched.

Furthermore, pain management should be understood fully. Pain management is management and the ability to function as normally as possible before pain. People who expect treatment for pain should never be guaranteed pain will disappear. The aim of professionals in this area is not to fully alleviate, although this can happen, but to allow a person to enjoy a high quality of life.

 These are just some ideas and examples of other examples. Ultimately, I hope this whistle-stop tour has helped sparked your interest in the topic.