Our good friend EG likes to make us think, challenge ideas (old and new), look at things from different perspectives, and doesn’t mind ruffling some feathers (even ours) along the way – we love it! We’ve been having a bit of a chat recently about the ‘pain formula’ that appears in The Explain Pain Handbook: Protectomter and EG has written another great guest post with some thoughts:
Introducing the self
Can the following statement 1 stay true in face of the scenarios 2 and 3 that follow it?
1 “We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body. Equally we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger” Moseley and Butler, 2015, The Explain Pain Handbook: Protectometer.
2 A wounded soldier in a highly threatening situation often won’t feel the pain until much later when he is safe.
3 A bank teller held at gun point probably won’t feel pain despite the threat of death.
Scenarios 2 and 3 involve very significant threats to the body, yet no pain. In fact in scenario 2, we have something which seems to completely defy statement 1. Is statement 1 still correct?
I think it is correct in essence, but I’d like to offer a revision for comment here:
“We will experience pain when our credible evidence of danger related to our self is greater than our credible evidence of safety related to our self. Equally we won’t have pain when …”
By changing ‘body’ to ‘self’, it’s possible to allow scenarios 2 and 3 without contradiction.
Let’s consider the self
Let me back track a bit to explain…
The self (aka ‘sense of self’ or ‘ego’), can be considered as ‘consciousness identified with body’, where ‘consciousness’ is ‘the thing that switches on when we wake up in the morning’ (we don’t need a more complicated definition at this point).
Since consciousness is intermittent, so is ‘selfing’ intermittent. Consciousness stops completely during NREM sleep. And whilst the body continues to exist 24/7, the self does not exist in deep sleep. So, the self is an intermittent mental phenomenon. It depends upon consciousness and is made of thoughts. The thought-feeling of “me as a solid continuous entity” is in fact quite ephemeral and unreal. When the ‘me’ is operating, it can exist in degrees – ie. we can have moments of strong self-referencing and moments of reduced self-referencing. Occasionally, the self might be completely absent in the waking state, but by all reports, this is rare.
Back to the wounded soldier
Back to the wounded soldier scenario, so I can tie it together. When safety is threatened to a massive degree, the self tends to go into relative abeyance. ‘Less self’ means ‘less threat to self’ (in the same way that a shrinking target becomes less vulnerable). ‘Less threat to self’ according to the revised formula above means less pain – or no pain. The new statement incorporating self-image allows for the wounded soldier and bank teller scenarios.
The revised statement also allows for the injured sportsman who continues to play despite severe bodily damage constituting threat, feeling no pain. A high degree of distraction is yet another way of subduing the self. Have a read of this quote by retired NBA star Bill Russell. It’s obvious he is describing what Mihaly Csikszentmihalyi referred to as ‘flow’, a state of attenuated selfing. Tell me if you think he’d be aware of a sprained ankle in such a state.
“At that special level all sorts of odd things happened…. It was almost as if we were playing in slow motion. During those spells I could almost sense how the next play would develop and where the next shot would be taken. Even before the other team brought the ball in bounds, I could feel it so keenly that I’d want to shout to my teammates, “It’s coming there!” – except that I knew everything would change if I did*. My premonitions would be consistently correct, and I always felt then that I not only knew all the Celtics by heart but also all the opposing players, and that they all knew me**”.
Russell, and many others before him, have shown us that selfing can be subdued even in full waking consciousness, with predictable results. Reduction or complete amelioration of pain is one such result.
In the clinic
So the self is a critical process to understand and reference in pain sciences. After all, it is the self that feels pain, not the body. With the revised statement, we now have three approaches to the treatment of pain instead of two. We can:
1. Increase SIMs
2. Decrease DIMs and/or
3. Decrease selfing.
Whilst the sense of self tends to be shut down automatically under duress, it can also be reduced voluntarily through focussed attention (preferable). Less self -> less pain. No self -> less pain, no suffering. Hope that makes sense.
Regards
EG
* The reason verbalizing his insights would “change everything” should be obvious. Think about a moment of intense joy you have experienced. The last thing in the world you’d want to do is start describing it in words. Language (especially analytical language) immediately degrades and destroys the experience. ‘Zone’, ‘flow’, jhana, smadhi etc. require a relatively quiet mind. Flow actions are inspired actions – this is what sets them apart. They have an inspired quality. Most of the world’s top sports people, artists, musicians, poets, businessmen seem to speak this way.
** Russell is describing enhanced rapport. It’s a nice description – to know all the players ‘by heart’, even his opponents.
Thanks EG, I’m looking forward to the thoughts and comments of others, and the discussion that will follow
– Tim Cocks
It’s getting closer and closer to Sarno’s work, isn’t it?
Maybe one day a critical post on his theory?
Sort of. There’s common ground in the realization that negative emotions are a primary driver of pain. However, Sarno says these emotions cause vasoconstriction and ischaemia in peripheral tissues, which *then* causes the pain. In this sense, he appears to be saying he believes all pain is from nociceptor activation (even if it has the mind as the driver). I don’t agree with that.
He uses awareness as a tool, which I like. Any time we are truly aware of anything, we are moving towards presence (ie. a state of attentuated self).
Basically I like his work. There’s probably quite a few of us out there moving roughly in parallel towards a similar end-point.
In “The Body Keeps The Score”,the psychiatrist,Bessel Van Der Kolk states the 2 most promising therapies for PTSD are EMDR and having therapy whilst taking ecstacy.In both treatments you are creating a dissociative state that allows the client to observe their trauma in a more detached way.
The same might also be said of hypnotherapy for the treatment of chronic pain,which shows very promising data.
Perhaps we need as physical therapists to tap into this area somehow.Perhaps therapy whilst listening to the patients favourite comedy or music.
As regards Russell’s observation,I remember VS Ramachandrans work showing we only have skin as a protective barrier from literally feeling someone else’s pain.
Yeh, I read all these reports about MDMA being like some sort of wonder drug for empathy and connection – and of course empathy and connection are major SIMs. You’re probably well aware of the success of MDMA-assisted relationship counselling up unti the 80’s before it was made illegal. I think certain drugs like this will stage a come back in the next decade or two.
I posted a case report a few days back on noijam with this link. Might be of interst. http://www.maps.org/research-archive/mdma/healing/cp-antwerp.html
Love the way your blog has stimulated my thoughts on all this – thank you. Here are some of them –
If we look at your brain as your protector doing everything in its power to maintain your survival then it makes sense to me that the soldier and bank clerk feel no pain.
Pain is one of the ways your brain has of protecting you. In situations of extreme threat where you are possibly facing death, it would be detrimental to your survival to feel pain. Your brain is far more concerned with getting you out of that situation. When that soldier and bank clerk reach safety they will feel pain.
Am I over simplifying things?
In terms of decreasing selfing – should we adopt the buddhist perspective perhaps?
On another point, a lady I know is unfortunate enough to have CRPS of the whole of her right side. As a result she has a grossly distorted sense of body/spacial awareness. Her right leg and arm extend to infinity and she feels as if the right side lies 6 inches in front of her left. ‘I have two separate bodies’. She has little idea of where she (as a whole) lies in space and this seems very much linked with not knowing who or where she is in society or the world. She appears to have very little sense of ‘self’. ‘I don’t know where I am in space’ ‘I don’t know where or who I am in the world.’ ‘I don’t know who I am.’ It strikes me that if you don’t know where your body ends and the rest of the world begins then it must be difficult to know who ‘you’ are.
My point here is that alongside her infinitely large right side her pain is infinite so she has high levels of pain whilst at the same time appearing to have a low sense of her own ‘self’.
I’m not sure that I agree with that credible evidence of danger to the self is what causes pain. I think that when we take the example of soldier, that the threat of the situation around them, outweighs the threat the body. DIM’s and SIM’s may be too limited to describe this situation. Instead this is about resources. The body and brain have the resources to deal with the battle occurring around them, OR they have the resources to deal with the wound, NOT necessarily both. The brain opens the drug cabinet BECAUSE OF other DIM’s. This concept of self fails to describe those who are woken up by pain. This would be difficult if the self is truly shut down during sleep. What if we relied on a Painful Yarn and applied this concept of self to thirst? Does it still hold up? I think not. While there are certainly conscious elements of both thirst and pain, the largest, most difficult elements have little to do with self, and more to do with the brain trying to protect its container. This often occurs above our level of perception, and in some cases, may occur when we are unconscious.
Hi Patrick,
Before I wrote this post I went looking for evidence of using pain to wake someone from NREM sleep and couldn’t find anything. If there is some research along those lines , it could undo all my good work, so if let’s see if anyone can produce it. Pain can certainly wake us from REM sleep, but in REM sleep there is a vestigial sense of self operating. In our dreams, there is a “me” who does stuff. NREM is different.
Your point about brain resources I understand. I don’t think that negates what I said, however. Selfing requires a LOT of brain power. To detach from self is economical in a threatening situation.
In regards to thirst and other basic body functions, I do have something on that, but will have to dig it up and check it against what you’ve said. Will do tomorrow.
EG.
I guess my biggest problem here is it seems that the concept of self seems to imply that pain is a psychological phenomenon that arises from the conscious, cognitive mind. This would mean that we could simply think the pain away. While there are certainly cognitive and psychological components of pain, I think there has to be a non-psychological (or cognitive) element of pain. Again, I refer to the optical illusion. Is the optical illusion here, https://en.wikipedia.org/wiki/Optical_illusion, dependent on selfing? Is there any way we could possibly decrease selfing to the extent that this illusion is no longer effective? Short of rendering a person unconscious, how is it really possible to decrease selfing? If we are talking about decreasing the psychological threat then great. This will not solve a person’s pain problem, although it may help. I think we also need to consider organisms who may lack cognitive abilities, such as infants and animals.
If an infant puts their hand on a hot stove and is burned, do they have pain because they are afraid, or are they afraid because they have pain? Can an infant truly understand any future implications of pain or self beyond, “I have injured myself! I shouldn’t touch a hot stove!” Likely not. An infant probably won’t experience the psychological distress of, “I may never be able to use my hand again,” or, “I may never heal.” They may react to other contextual factors such their parents response to the injury, but this psychological phenomenon will likely occur after the onset of pain.
I think the most basic role of the self is that a person likely must be conscious to feel pain (NREM questions aside), but beyond that, other parts of self contribute no more than other DIM’s and SIM’s.
I’m glad you brought this up.
I’m really glad you brought this up because it’s something I neglected to explain in the original post.
People who have had terrible trauma or prolonged/severe pain will tend to move into some form of dissociation. The soldeir and bank teller would have a high tendency to experience dissociation in the moment of duress. It’s not so much that there’s *less* self in dissociation, but less *experience* of self, through detachment. A really important distinction. The end result in terms of pain is the same, but the mechanism is different. Dissociation has a role as an ego defense mechanism, but as a long term tactic it is clearly problematic. The thing about dissociation is that the description can mimic the state of true attenuated selfing. The sorts of words used to describe the experience will overlap a lot, but knowing the difference is crucial. ‘Less self’ or ‘less experience of self’ will both subdue the pain experience. ‘Less self’ is very adaptive and evolved. ‘Less experience of self through detachment’ can be severely pathological.
Jung was quite good on highlighting the importance of first developing a healthy sense of self before attempting to understand that self is only a concept and ultimately unreal. He described cases of mental illness caused by putting spiritual practices ahead of ego health.
So if I had a client like the one you describe, I would not be using trance techniques (for example), because she is obviously in dreamy state as it is. Such techniques could really backfire. Meditation could also backfire, but I think at some point, body-awareness is going to need some work. Re-inhabiting the body. Pulling the ‘infinitely large right side’ back in, using visualization maybe. But as a starting point- SIMs and meds. I always start there with the really hard cases.
The state described as ‘no-self’ has been discussed a lot in online forums, particularly as it contrasts with dissociation and de-personalization. I think it’s fair to assume the latter is happening when someone has been in trouble with pain. No-self is extremely rare. A subdued sense of self is common, but tends to happen in people who are reasonably happy and capable of focussed attention.
Whilst I use the term ‘no-self’, I’m not trying to encourage anyone to follow Buddhism (as I don’t myself). However there are some brilliant Buddhist texts which describe the ‘ins and outs’ of self, and we don’t need to wait for science to catch up.
EG
I am not sure that I follow. Essentially, this sounds like a reiteration of Rene Descartes and the separation between mind (or soul, or self) and body. While I think Descartes may have said pain is experienced in the body you seem to be saying, “it is the self that feels pain, not the body.” I don’t think we can make this separation. The “self” and body rely on one another, and while pain is an output of the brain, it is not wholly dependent on the consciousness of the being. I am not arguing that an unconscious individual could feel pain, but I do think that the conscious mind is only one component. I always think of the optical illusion that Moseley shows in his TED talk. The optical cortex makes the squares seem to be the same color because it is biologically advantageous. This is not the self making this conclusion. In the same way, parts of the brain not involved in consciousness are responsible for making biologically advantageous decisions regarding pain, nociception, danger and other inputs. Perhaps it would be more correct to say that we have multiple Protectometers for different kinds of threats. One for pain, one for alertness, one for thirst, another for hunger, fatigue, nausea, etc. etc. Each of these could be potentially thought of as a brain output, but each could potentially out-weight one of the others if threat levels rose enough, thus diminishing the biological resources available (of which consciousness is one) to deal with them. In this way DIM’s and SIM’s may be more effective at describing what is actually occurring with the soldier.
Body and consciousness.
The act of observing creates the subject-object split. The subject and object can’t be the same thing. Here, the object is the body, and consciousness is the subject. Selfing is the process of consciousness mis-identifying with the body, thinking they are one and the same. Full self-referencing isn’t necessary for normal functioning in the world. Actually the work of Csikszentmihalyi and others indicate that it’s advantageous. Fear drops away, creativity increases, pain disappears to some degree.
Without self-referencing, the body is still hardwired to survive, and thirst is part of that mechanism. A pertinent question is: “Is thirst truly painful without self-referencing”?
I don’t think it can be. Nociception without self is just a primitive signal to the body to ‘do something to survive’.
Shakespeare might well have said – “Pain is not good or bad, but selfing makes it so”. Pain is only an *issue* because we don’t like it (we judge it as bad). It’s high level of “badness” makes it an important topic for us. But if pain was neither good nor bad we wouldn’t be discussing it. It would be insignificant.
The video below illustrates what I mean. Half way through, Michael Mosley has his pain response measured when under the influence of a powerful anaesthetic. His response is that it hurts **but he doesn’t care**. It would have been interesting to re-test this at the higher dose.
Nociception occurs as the anaesthetist’s knuckle is ground
into his chest. Subsequently, a signal is given to the brain, but with a high level of dissociation, he is not fussed. And if things don’t fuss us, they usually become non-issues. Imagine pain being a non-issue. It is SO far from it. I think my original post explains why.
So long as we are alive, nociception will occur. But pain…?
https://www.youtube.com/watch?v=wH0ofXQshWo
EG
I’m intrigued by your comment on meditation backfiring – this was my instinct…
We were making slow but sure progress with this lady with a range of simple techniques based on her SIMS. I worked with an artist who drew the lady’s pain and spacial experiences which she found very helpful. We were able to get her knitting (modified and slow but none-the-less enjoyable) and encouraged her to paint her toe and fingernails as markers of where her limbs ended. An OT marked all her doorways with red dots which helped her to walk through them.
Unfortunately she was recruited onto an intensive inpatient programme at another centre. An important part of this programme was regular group mindfulness practice which had a near catastrophic effect on this lady. She became suicidal and unable to leave her home.
With a lot of cajoling from me, 18 months on she’s back with us and we’re way further back than our original starting point …..But were making slow progress. Working on her SIMS again, I’ve encouraged her to join a local choir which she enjoys. She not able to knit anymore but expressed a desire to re start some ‘folk’ drumming which she currently does with her unaffected side. We will progress to bilateral drumming when she is ready.
I feel the medical community and media have got onto the mindfulness/meditation bandwagon to such an extent that few realise it can be harmful to some people.
Hi EG. The concept of Self is quite central as a starting point in your post. According to some it is one of the most misunderstood concepts today. Can I ask which references or perspectives you have drawn upon here?
Hi Adam,
I’m interested why you have spelled self with a capital ‘S’. In a lot of the writings that I reference below, ‘self’ and ‘Self’ are very different. ‘self’ is used to describe the ego or self-image, whereas ‘Self’ is a description of our actual nature. I haven’t mentioned anything about Self because I have no personal experience with that side of things. AFAIK, it may not even exist.
Any tradition you read about will have one word for self and another for Self.
eg. Ramana talked about the ‘I’ and ‘I-I’. The first is the false self, the second, the true. Once you know this, it’s not hard to start understanding.
Best of the best, imo, is any work by Nisargadatta. ‘I Am That’ is classic. Aside from a few flowery quotes in the introduction, he is all business. As sharp as they come. Q & A format.
I also like Richard Rose, Jed McKenna, Eckhart Tolle, Carlos Castaneda (half fiction, but very sharp), Adyashanti, Jeff Foster, Rupert Spira… heaps of them. They all say it in their own way.
The whole thing is to do with this: do you know who or what you are? Logic can be used to prove that none of us has the first clue who or what we are. Quite unsettling, in a good way.
Purists or academics might like something along the lines of ‘The Discourse on the Not-self’, found anywhere online. But there’s lots of flowery talk, which has to be waded through. Not fun.
Thank you for the references and the perspective.
I didn’t spell self with a capital S for any particular reason other than to emphasize the concept. The concept is intriguing, extremely difficult to pin down in physical terms, but important to get a handle on if we are not going to eliminate it (and thereby us, i.e. us with our perspective, feelings and references) from our scientific theories as Harris, Crick, Rosenberg and others suggest.
I come at this question from a more naturalized metaphysics. That means a metaphysics that is “motivated by unifying hypotheses and theories that are taken seriously by contemporary science” (Ladyman & Ross, 2007) by trying to know “one’s way around with respect to the subject matters of all the special [scientific] disciplines” and “building bridges” between them (Sellars, 1962).
I don’t have much experience with the more mystical approach.
‘ “Pain is not good or bad, but selfing makes it so”. Pain is only an *issue* because we don’t like it (we judge it as bad). It’s high level of “badness” makes it an important topic for us. But if pain was neither good nor bad we wouldn’t be discussing it. It would be insignificant. ‘
Interesting observation….a revealing insight maybe. It would seem that our ‘self’ feels almost alienated or disjointed whilst in the throes of a pain experience. I don’t think the pain experience offers up the option of a sense of being a ‘good thing’, unless it is minor and well tolerated, and even then it requires some complex ‘self convincing’ to allow that. It might be said that pain disturbs a cohesive sense of ‘self’, and as such it arouses as much ‘self’ protective issues as it does ‘injury or threat’ protective issues. My approach to that would be to invert the argument, and rather than assume that pain is somehow an aid to the ‘self’ in its efforts to contain a threat, perhaps pain is something implanted into the ‘self’ in order to contain any inappropriate responses which the ‘self’ might be considering.
It might seem that pain is only a requirement when the ‘self’ is awake and conscious. Autonomic healing , or attempted autonomic healing, continues whether the ‘self’ is conscious or not, and any experience of pain is likely to have evolved from that process…..leaving aside any arguments which define pain as a purely psychological emergent event ( an inflammed appendix hurts without any psychological pre-conceptions or sensory evidencing, besides the pain being manifested ). The question which needs exploring is ….why does there seem to be a non-requirement for pain when asleep or non-conscious ?
The problem, as I see it, is our tendency to attempt to define pain within the limitations of ‘self’ consciousness. Yes, pain is manifested in consciousness, but it’s purpose might lie elsewhere. Its purpose might well be to restrain, hamper, or confuse consciousness, thus allowing the autonomic healing systems to go about their business unhindered by conscious interference….as they do when we sleep. Is it really too difficult to perceive an absence of consciousness as the ideal environment for non-painful autonomic healing ?
“why does there seem to be a non-requirement for pain when asleep or non-conscious “?
Dunno. Seems odd.
Actually, I still don’t know for sure whether pain can rouse us from NREM sleep. I pointed out that if this is possible, then it could undo everything I’m talking about here.
See what you can do with the following scenario…
I used to do some work for a football club (Aussie rules). Guys would get knocked out in play and I’d run out to help them off the ground. Whilst unconscious, they are completely unresponsive to pain, and yet the heart and lungs are going full pelt, recovering the oxygenation required after running hard. It’s an unusual sight. Obviously survival and pain are not completely integrated meachisms. Some overalp, sure, but they are not one and the same.
That would seem to imply that, again, there is no requirement for pain in the non-conscious state. I’d find it hard to believe that any biochemical factors would have time to kick in , and suppress any pain, or any other possible applied pain, in such an instant scenario. Once consciousness is restored, the pain sensations appear. The simple, and most obvious, answer would seem to be that pain is only relevant to the consciously awake state. The same rules might well apply to the sleep state as well.
Call me old fashioned but I believe in each to his own. I’m a Physiotherapist and, as such have a humble awareness of the realms of self and its place in when the patient weighs up the world in relation to Dims and Sims.
However I have enough of a battle helping them to understand that “It’s not a pulled muscle” but much more complex than that. To then add the complex subject of self into the mix would, in my opinion sabotage the union I’m trying to forge. Let’s stay physiotherapists, enjoy the “Crack” in the staff room concerning the subject of self and leave the patients journey into self for the psychotherapists………
I am what I am, nothing more and nothing less…..a Physiotherapist
DB on location
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Hi DB,
Yep, each to his own. I don’t have any expectation that this sort of posting will register with most clinicians.
For me, replacing ‘body’ with ‘self’ in that equation is vital for a deep and accurate understanding of pain. As a clinician, I want the maximum depth and accuracy possible. But there’s no way I would ever bring up the subject of self with a client. It would be highly counterproductive to mention it, let alone discuss it. It’s like pain education – always indirect, never direct. Most clients simply can’t handle anything outside Groupthink, and that needs to be respected as much as possible.
The original post is mostly theoretical, partly practical. Theory of self CAN be used in practice, and it need not be complicated. Whilst I’ve gone into a fair bit of detail, it can be reduced. And I do reduce it for my own use. I reduce it down to one or two things that I do when with a client. One thing I DON’T do when with a client is philosophize and analyze – that’s probably the worst possible approach to treatment.
EG
I remember reading Polyvagal Theory and Stephen Porges states that when we (mammals) are about to die a violent death we have the ability to dissociate from our bodies.The fight,flight mobilizes us,the freeze immobilizes us.This freeze state increases our pain thresholds and allows us to die without too much suffering.It is reflexive and in small mammals 20% will die purely from the freeze state.
In humans PTSD may be a way our body has been prepared for death but has survived. PTSD patients often feel an ongoing dissociative state and need to inject danger in their lives to feel a sense of self.
So perhaps this autonomic circuitry would be a great place to start our work.
I haven’t studied PTSD, but your description of ‘having been prepared for death and yet survived’ makes good sense in light of that first sentence.
When ‘bad’ stuff happens (like violence or near death), we all have this tendency to think we must also be bad (as if it’s deserved). You see it in children whose parents fight in front of them. The child immediately assumes it’s his fault, and his basic sense of ‘goodness’ fades.
Forcing SIMs will have the reverse effect – it makes us think we are ‘worth it’, allowing us to re-inhabit our bodies, creating self. Sometimes the worthiness needs to come first before someone will allow good things.
EG.
Same might be true for any ‘near-death’ experience. We call it a dissociative state because it lacks resonance with what we perceive as a normal survivalist dominated state. In reality, it may just be a state which ‘associates’ better with a lesser survivalist mindset which, through experience, has assumed a ‘fatalistic inevitability’ into its make-up. The negative implications of ‘dissociative’ have been imposed on something which may well be unavoidable as a result of experiences, just because it differs from the norm. I also think that some people seem to have a magnetised attraction towards a dissociated state….thus bunjee jumpers and Everest wannabees…..and perhaps those who seem to need the danger to feel a more real sense of self, as you mentioned. Sometimes seems like some people require a greater sense of fatalism so that they can have a greater sense of ‘self’…….realism at its extreme !
Got a few stdies here on applying a painful stimulus during sleep:
http://www.ncbi.nlm.nih.gov/pubmed/9351131
http://www.journalsleep.org/Articles/240105.pdf
Getting close.
In most posts here, I’ve been using ‘NREM’ and ‘deep sleep’ synonymously, which is incorrect. Deep sleep is slow wave sleep (SWS), which is a subset of NREM. Also, a vestigial self looks like it might be present is some lighter phases of NREM. EEGs will register nociception during SWS, but still not sure about it causing waking.
I think there’s enough here to say self is entirely absent in SWS (maybe NREM also, but not necessarily). Play on!
So, if ‘self’ is absent in SWS , and pain activity is absent in SWS, what might that say about pain only being relevant when the ‘self’ is consciously awake ? Unfortunately, we don’t have an instrument which can accurately measure pain activity, whether awake or asleep, so we must rely on patient narratives to confirm non-painful SWS. Here’s an anomaly…..a patient with a painful broken finger falls into painless sleep, which continues for most of the time they are fully asleep. Then they are suddenly woken with a pinprick to the foot. In other words, they are more likely to be woken by a new minor threat than by an existing more serious ongoing threat which would be much more painful in the awake state. Once awake, both threats assume their normal pain status. It doesn’t seem to make sense that the broken finger allows a pain free sleep, and the minor pinprick is felt and causes a return to full consciousness.
I’d like to see some research into monitoring autonomic response rates when asleep and awake, just to determine whether the healing rates differ in favour of the sleep state. Such a result might help establish what relevance pain has to healing rates in both states…i.e. if healing is quicker in pain-free SWS, then we would have to see the conscious pain event as an obstructive process with a purpose other than a mere threat warning.
“Unfortunately, we don’t have an instrument which can accurately measure pain activity, whether awake or asleep, so we must rely on patient narratives to confirm non-painful SWS”.
If there’s no one home, there’s no pain. Any experience requires an experiencer, ie. a self. We can assume no self means no pain. Nociception continues, as per those studies I posted, but even that looks to be reduced.
“a patient with a painful broken finger”…
Such a patient is unlikely to fall into SWS. If you’ve ever tried to sleep with pain, you’ll know that you dream most of the night. So that means you stay in REM and lighter NREM phases. See Danny Camfermann’s BiM posts also.
“I’d like to see some research into monitoring autonomic response rates when asleep and awake, just to determine whether the healing rates differ in favour of the sleep state”.
Yes that would be a good study, but probably unnecessary. We already have plenty of evidence to show that selfing is damanging to tissue healing. For example:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052954/
I’ve also got a hundred papers on how meditation (which reduces self) reduces excessive inflammation which is at the heart of almost every chronic disease state. Can post them if anyone is interested.
If I’m not mistaken, and leaving aside other issues arising on this page, I think you are suggesting that ‘replicating’ a sleep-like state, or a non-self conscious state, whilst conscious, might achieve the same pain-free results that are evidenced during any normal sleep state , and that might be achievable by reducing conscious self-awareness. Correct me if I’m wrong on that. Ideally, that might seem a possible method for negating pain sensations, but it is also likely to have to rely on questionable transient delusionery inputs to achieve its goal. I’m not sure there would be a general willingness to submit to such operator dominant techniques. Seems to belong more in the realms of ‘faith healing’, where locus of control is relinquished to favour some absolute trust in operator methods, and the patient must consent beforehand to the possibility of detrimental outcomes, should such outcomes occur. There’s an inherent imbalance in that operator/patient contract which I’m sure most patients would find unacceptable.
The embodyment of “Self” and why we chose to do so is a question that we might all need to ponder over on our journey towards the understanding of the maladaptive need for pain. To suggest that the majority of clinicians will fail to address this question, soner or later is probably insulting to them.
The journey to discovery of “Self” is more a spiritual one. Anyone can be well read on the subject and intellectualise the material thus risking “Spiritual flight”. True embodyment into the soul is a more perilous journey and takes great courage and self reflection……
I am confident that my profession, as it has done so down the years when faced with new knowledge, will equally embrace this challenge of ” Self” on its journey towards understanding the true meaning behind pain…..
DB on location
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“The journey to discovery of “Self” is more a spiritual one”
Well yeh, that’s what I’ve been saying. That’s why it will never be addressed by the majority of clinicians… or anyone for that matter.
“Anyone can be well read on the subject and intellectualise the material thus risking “Spiritual flight”.”
I don’t know what ‘spritual flight’ means. What does it mean? I do a lot more than wax lyrical about the intellectual side of this…. I practise regularly in a multitude of ways. You don’t practise, and that makes me wonder how you would know the following…
“True embodyment [sic] into the soul is a more perilous journey and takes great courage and self reflection…”….????
Then this…
“I am confident that my profession, as it has done so down the years when faced with new knowledge, will equally embrace this challenge of ” Self” on its journey towards understanding the true meaning behind pain…..”
Mate, 95% of Physios are stuck in the 1970s! They don’t understand basic pain science let alone this stuff. Once you’re past a certain point, all progress uncovers new fears. Most people are more concered with denying and repressing fear, not seeking it out.
‘All progress uncovers new fears’ – how true is that! The more I learn about pain the more I realise I don’t know. Completely open minded/out-of-the box discussions like this are so important for stimulating our thoughts and challenging us to ask why we believe the things we do. I’m a former physio (now a wellbeing coach) and I would hate to think that I was ever ‘just’ a physio. In terms of what type of discussion I’d have with a patient – it very much depends on the patient/client. If EG was a client of mine I’d love to be having this sort of conversation – we’re all patients at some stage and some are capable of a deep sharing of ideas 😉
I have personal experience of consciously separating my ‘self’ from my body. When I was nearly 8 months pregnant with my daughter I was bending over (in a way I shouldn’t have been!) making a bed, when I coughed and heard the lower rib on my right side go crack like a gunshot. The pain was extreme. I was unable to breathe, sit, stand, lie or do anything without extreme pain. I refused to take drugs and took myself to the pain clinic for an injection into the fracture site which took the edge off the sensation. Doctors explained that they could do this again during labour if my rib hadn’t healed sufficiently to withstand the contractions. BUT it meant not having any drugs or gas and air during labour because of the risk of pneumothorax.
So I prepared for a labour without pain relief and a broken rib. My mother-in-law came to the rescue. ‘Just practice, natural childbirth – WE all had to do it!’ She talked me through a process of ‘withdrawing my ‘self” from my body. It involved visualising withdrawing ‘self’ upwards and into my skull. Inside my skull right at the front I was taught to visualise a comforting warm dark cave with soft cushions. My self would sit there looking out onto the inside of my skull – it was dark with a pin point of light I focused on. It was a safe place.
I can’t really describe what I was feeling in that state. I was aware of pain happening to my body, but it wasn’t happening to ‘me’….I still felt pain but it was so far in the distance that it didn’t matter. I knew it was there but it was ‘just there’. It was real but happening to my body and not to me. My ‘self’ was safe.
Not sure if I’ve explained that adequately but 27 years on it’s an experience I still remember. It required effort and it’s not something I could have done over a prolonged period of time but I did go on to use the technique with my two younger children. I regard it as a valuable experience and lesson.
Thanks for the personal example bets. It’s skillful that you achieved relief by applying a technique rather than waiting for severe pain to tip you into shock or dissociation. I’ve heard quite a few stories of strong dissociation during labour. They describe experiences similar to the women in this study.
http://www.ncbi.nlm.nih.gov/pubmed/22022872
The descriptions are very close to what might be described with deep meditation or flow state. Unusual, in other words. ‘Dissociation from self’ versus ‘reduced selfing’ is still an area that needs careful exploration and definition, imo.
“I can’t really describe what I was feeling in that state. I was aware of pain happening to my body, but it wasn’t happening to ‘me’”.
Good stuff. Same as Mosley in the video I posted, but probably without the hangover of an anaesthetic.
Here’s a curly question: What would have happend if during labour you’d focussed on a DIM/SIM approach to pain relief? For example, you get lots of touch and comfort and massage and so on? I think it could have made the pain a lot worse. The DIM/SIM approach is about ego-boosting (trying to make the self feel safe and ‘good’), and yet the strong pain is urging you to let go of the ego. They actually work against each other. They aren’t at all complimentary.
“What would have happend if during labour you’d focussed on a DIM/SIM approach to pain relief?”
I think actually I was doing this. I think DIMs/SIMs are fluid and can change according to the context and your immediate needs. Yes you can build a safe foundation of SIMs that enable you to feel safe in day-to-day life but faced with a shorter-term more acute issue you can find safety in different SIMs. My SIMs at the time were Feeling in Control (of me), having somewhere quiet, dark and calm to retreat to, the light I focused on, the safety and comfort of my personal cave, the knowledge that the labour was progressing normally (had there been problems I probably wouldn’t have been able to keep my focus up) and also the knowledge that this would last for a limited time. I think I was creating my own short-term SIMs to deal with that moment.
“For example, you get lots of touch and comfort and massage and so on? I think it could have made the pain a lot worse.”
Agree but because these wouldn’t have been SIMs at the time. In fact touch and massage would have drawn me back into my body. None of my day-to-day SIMs would have worked – walking in nature, laughter with friends etc.
“The DIM/SIM approach is about ego-boosting (trying to make the self feel safe and ‘good’), and yet the strong pain is urging you to let go of the ego.”
I’m not sure about this because my strong pain had the effect of making my ‘self’ stronger. I felt I had control of my ‘self’ despite what was happening to my body. Will need to think on this one a bit more, but like you also need to work!
The DIM/SIM approach needs some caveats, and I think Lorimer, David and Tim have pointed this out – in particular, that they can *hide* in places we wouldn’t necessarily expect. This is absolutely key.
Some SIMs will create a feeling of safety and goodness, yet ultimately be harmful (eg. chocolate cakes, unchecked spending, cocaine, etc etc). All the SIMs can easily turn into addictions unless one is careful to seek out SIMs which are hidden beneath fears. These are the best SIMs. These are the SIMs which lead to an experiential understanding of self/Self.
DIM reduction techniques need strong caveats as well. Fear avoidance makes us feel safe, but just look at how it buggers the nervous system. Fear avoidance (or experiential avoidance in general) is something we all do, and it’s so damaging. And yet in theory it’s a DIM-reduction technique.
I better get off to work now! I’ve been talking on here non-stop for a few days. Time to put some of this into practice!
Anyone know what the best SIM is? You can base your whole practice around this one thing.
Gerry,
“…. ‘replicating’ a sleep-like state, or a non-self conscious state, whilst conscious, might achieve the same pain-free results that are evidenced during any normal sleep state , and that might be achievable by reducing conscious self-awareness. Correct me if I’m wrong on that.”
Yes, but this is all proven stuff (hypnosis research, meditation research, anaesthetics research). And just to be clear, none of it mine. Adding self into the pain equation was my only input. Doing so allows for a more inclusive model which is hard to dismantle or disprove.
“likely to have to rely on questionable transient delusionery inputs to achieve its goal”.
What’s that mean?
“I’m not sure there would be a general willingness to submit to such operator dominant techniques”.
Ahh… that old chestnut again. It comes through in all your posts that you won’t *submit* to therapy because you’re afraid of being “dominated and controlled”. You’d be stunned if you came into my rooms how little I do, and how unwilling I am to help you. I’d help, but without my will intruding (un-willing).
“Seems to belong more in the realms of ‘faith healing’, where locus of control is relinquished to favour some absolute trust in operator methods, and the patient must consent beforehand to the possibility of detrimental outcomes, should such outcomes occur”.
All treatment comes with risk. Are you like this when you visit your perosnal general doctor (GP)? Do you video the interaction for evidence? If so, you’d be doing yourself a disservice.
“There’s an inherent imbalance in that operator/patient contract which I’m sure most patients would find unacceptable”.
Most clients are fine with it. Personally, I don’t see myself as being “above” the client (part of the reason I use the word ‘client’ or ‘customer’ rather than ‘patient’).
My inner monologue goes something like this: I am just a person, (not a Physio) and the client is a person. We’re in a room somewhere (not a “clinic”) and we’re just meeting here because one of us thinks he can fix pain (me). Let’s see what happens…. if anything.
Just to be clear….I’d have no problem whatsoever where outcomes, even possible negative outcomes, are specified , and consent is sought, and given. That’s acceptable when the suggested processes are experimental in nature. I might have a problem with unspecified unknown outcomes arising….for instance, what limitations are imposed on operator control over someone who has volunteered compliancy, what legal redress would a volunteer have if outcomes didn’t match specified expectations, and what guidelines are in place to restrict any possible abuse of volunteered vulnerability. These issues are all competently covered for normal medical practices….should a licence to circumvent patient protections be offered just for these suggested methods ?
“Are you like this when you visit your perosnal general doctor (GP)?”….Yes.
“likely to have to rely on questionable transient delusionery inputs to achieve its goal”……..
What I mean by that is this….. The means to achieving, or encouraging, such a vulnerable ‘lack of self’ state are suggestive, transient (although that might depend on the operator’s power to decide how transient it should be), delusionery in the sense that a patient must evacuate their normal self-protective mode, and vulnerable to any contrived inputs which the operator deems fitting. The issue of compliancy is important, as with any therapy, because it includes the prospect of non-compliancy being rejected as unsuitable for treatment. Does the therapy exclude those who might choose to be non-compliant, or even those whose instincts don’t allow for compliancy to the unknown ? I can be totally compliant to an experimental therapy, but I also have reservations about just how much I understand any ‘hidden’ operator agenda…..that issue is well covered in normal medical practice, where an operator must abide by strict guidelines particularly where a patient has had their normal cognitive abilities interfered with.
“Are you like this when you visit your perosnal general doctor (GP)?”….Yes.
🙂 Alright, well I do appreciate your honesty here, but everything about your approach indicates an underlying anxiety about things *going wrong*. You wouldn’t have this anxiety unless you’d experienced a lot of failed treatments, so I’m not going to suggest that you just let it go and surrender to the process. However it might interest you to know that those who *do* surrender to the process have much better outcomes (so long as the clinician doesn’t inadvertently nocebo them). Other clinicians here can corroborate this. If you get a client who is asking a million questions and hesitating at every juncture, it’s going to take a lot of extra work and time before good things start happening.
I understand your concerns about compliance and vulnerability. Having had a few unusual reactions in clients, I take this much more seriously than I used to.
As a Physio, the moment you use any word that relates to the mind, most clients lock up to some degree. Not all, but most. Now imagine what happens when you use the word hypnosis! So here’s this tool which has great therapeutic power, and yet if you mention it, you actually make things difficult for the client. You make it harder for him to heal.
It’s important to point out that I don’t *do* anything to the client. I just change myself (my breathing and attention), and the client can follow along if it feels comfortable. That’s what I meant about leaving ‘will power’ out of the equation. I allow the client to do whatever he wants; in fact I encourage it. Some sessions I won’t use it at all because I’m not in the mood and can’t be bothered. And I have learnt not to induce a trance in those whose brainwaves are already dominated by theta (Mark Jensen taught me that pearl of wisdom).
I’m currently re-reading Richard Rose’s “Energy Transmutation, Between-Ness and Transmission” because the standard hypnosis stuff doesn’t seem to go deep enough. There are levels to this which goes way beyond education and reframing. Rose goes into the question of compliance and propriety to quite a high degree, which I think is good. Boundaries are critical in the maintenance of self and you can’t just go blasting away haphazardly.
Thanks for the detailed reply. I was obviously a bit concerned that parity in the therapeutic encounter might be overlooked in favour of operator over-enthusiasm to push possibilities to the extreme, because that’s something I would question anyway , even if the patient was a guinea-pig. It’s fine for operators to discuss the implications of therapeutic control imbalances, but I’m sure the chronic pain demographic would require a firmer structure of checks and balances, and possible redress, to reassure that proper processes would be adhered to. Is there even a set of established operating codes which would give the operator/patient contract a legal binding ?
On the matter of negating ‘self awareness’, and thus possibly creating a non-requirement for the experience of pain, I would tend towards agreeing that hypnosis might be one method for achieving such an outcome. How transient, or how ‘self’ detrimental, that might be, I’m not sure about. For me, this same effect already happens during the sleep, or non-conscious, process, and it would be much safer to explore that phenomenon for all it has to offer, without the need for any artificially controlled impositions. The problem with most, if not all, sleep research, is that it is usually assumed that the conscious awake state is the default best operating mode for comparative evaluations of the autonomic systems which continue operating whilst asleep. If the research was premised on the sleep state being the default best operating mode, which I consider it might well be, then I wouldn’t be at all surprised to find that research results might start looking very different to what we are currently accustomed to. It took 99% of human time on the planet before the realisation that the sun didn’t orbit the earth. Perhaps just a little longer to realise that our sleep state is our default, perfectly synchronised state, in terms of autonomic functioning.
“I would tend towards agreeing that hypnosis might be one method for achieving such an outcome. How transient, or how ‘self’ detrimental, that might be, I’m not sure about”.
1. Re: Transient – there’s enough literature and personal experience to suggest the changes in pain awareness can be permanent, meaning that the improvement remains once the client returns to the waking state.
2. Re: self-detrimental, not usually. Remember people have been doing this for ages, and that changes in consciousness are a normal part of life. If you’re at the beach, relaxed, sun shining and you become very relaxed and your attention gently holds on… just… one… thing ………. the sound of the waves lapping….to the point that your thoughts…. stop…. you’re in a hypnotic state.
Having said that, a very powerful hypnotist could do damage to the self structure. Anton Mesmer used to really push the envelope, but then again he did get some amazing cures (if one can believe historical reports). Richard Rose is reported to have been able to just direct his attention to someone and they’d collapse on the floor (although there’s a bit behind that story and it might not be quite as it sounds).
“For me, this same effect already happens during the sleep”
Not necessarily. I’d bet you wouldn’t get much SWS. If you did get decent amount, you wouldn’t have aches and pains. In that sense I agree with your assertion that deep sleep has a lot going for it in terms of healing and restoration.
“…and it would be much safer to explore that phenomenon for all it has to offer”
What are you going to do… listen to audio recordings in your sleep? Be careful!! Take the following excerpt as a warning (from wikipedia):
–In the subplot, Lisa worries that Homer’s obesity will lead to an early death. On Lisa’s suggestion, Marge orders a subliminal weight loss tape for Homer. However, the company is out of weight loss tapes and sends Homer a “Vocabulary Builder” tape instead, unbeknownst to Marge and the family. Homer puts on the headphones in bed and falls asleep. When he wakes up, he is suddenly articulate, but ends up eating more food than ever. Once he realizes the tape has not helped him lose weight, Homer gets rid of it and his vocabulary quickly returns to normal.
; )
“What are you going to do… listen to audio recordings in your sleep? ”
This is the thing about sleep therapy…..it’s natural and requires no interventions for the non-requirement for pain to activate (or, more precisely, for the requirement for pain to not activate because there is no conscious self-awareness to allow pain to express itself). As conscious beings we tend to always assume that some conscious intervention is needed to instigate change, when, in reality, it happens by autonomic default without even the need for suggestion.
I’m familiar with chronic neurological pain, impeded cervical spine nerve issues, and I have gradually, over many years, become aware that the sleep process is the only game changer that works with neurological pain issues. The relaxation of tensed defensive mode when in deep sleep seems to be the only environment which allows the nerves to address their own vulnerabilities, and encourage reactions, and symptom changes, which in turn allow certain movement functionalities to continue, or to change. It all seems to revolve around an imposition of referred symptoms, restricting some movements, and an allowance for some flexibility which ensures functionality…..in other words, a painful trade-off instead of immobilisation due to threatened status.
In my experience, no medications or applied therapies during waking hours have ever come close to the innate ability of the nervous system to attempt to self-correct during deep sleep. Whilst awake, and conscious, we resist external interventions because our nervous systems perceive any interventions as a potential threat…thus the tensions we experience, particularly if there is already a threatened nerve status present. Only when we sleep, and defensive mode is relaxed, can the threatened nerve address its own vulnerabilities, and encourage adjustments to suit whatever functionalities are deemed necessary for continuance of lesser threatened living status.
Probably drifted off the subject matter there, to give a little airing to my ‘pet interest’……food for thought, hopefully. One relevant point I’d like to make is this……any imposed treatments or therapies during wakefulness are likely to be resisted, particularly if they conflict with any autonomic responses already in play…and that’s something which isn’t always taken into account in the eagerness to try out different external interventions. In the relaxed deep sleep mode, the autonomic response system doesn’t have to compete with any confusing inputs, or perhaps even any innapropriate inputs, in order to go about its business to max effect. In fact, it doesn’t even have to compete with ‘self-consciousness’ interfering for good, or bad. It’s a free run ! Perhaps hypnosis could re-create the same conditions, artificially, but how deep the induced sleep state to accommodate beneficial non-requirement for pain is probably variable and unpredictable. For me, the clue to identifying the relationships between pain, consciousness, and sleep, is more obvious in the consistent everyday natural sleep event.
“In fact, it doesn’t even have to compete with ‘self-consciousness’ interfering for good, or bad”.
Yes, self is *the* problem. When it comes to pain, there is no bigger issue that needs investigating.
Be clear though, selfing is the problem, not the waking state. You’re starting to use ‘sleep’ synonymously with the ‘no-self’ state. Remember, if you’re in REM sleep, you will still register self-awareness, and because of that, the potential for feeling threatened….thence, pain.
“Whilst awake, and conscious, we resist external interventions because our nervous systems perceive any interventions as a potential threat”.
Stop talking on behalf of all pain sufferers!! *YOU* resist treatment. Most others with similar conditions come good quite readily because they take the opportunity as it presents, relax, let the therapist do his thing and whaddyaknow??…. the pain disappears. You are selfing at a high degree and that’s why your pain persists.
EG
“Yes, self is *the* problem. When it comes to pain, there is no bigger issue that needs investigating.”
Agreed. Without reservation.
” Be clear though, selfing is the problem, not the waking state ”
This is where I disagree. The waking state is absolutely the problem….it is where the requirement for pain becomes a default inevitability. By any definition, consciousness is a threatening state….i.e. it has the ability to interfere, or cause an intervention, for good or bad, in any enacted injury / infection / threat to the living organism. As such, any (autonomic) protective system worth its salt would be compelled to respond in a manner which would impact on that potential threat. The means of response have to be relevant to the functioning nature of that which is being responded to….in other words, in terms of consciousness, a ‘perception’ needs to be created in order to elicit a suitable responsive reaction.
That created perception is the pain event, and its purpose, or intention, is to hamper or restrain any potential conscious reactions which may be in the process of being consciously considered. In any endangered situation, the autonomic response systems can only respond to their full potential when there is no ongoing conflict with consciousness, and perhaps, because deep sleep, or non-consciousness, is not possible at any given time, there arises the need for some other form of conscious suppression to help recreate a suitable environment for autonomic responses to operate to as near as full potential as possible. This explains the need for the ‘unconscious’ state in some threatening instances, as with the sports injury you mentioned earlier. Think of pain as being a lesser restricted form of unconsciousness, which allows licence for autonomic responses to enact . less hampered by conscious interference.
“Stop talking on behalf of all pain sufferers!! *YOU* resist treatment. Most others with similar conditions come good quite readily because they take the opportunity as it presents, relax, let the therapist do his thing and whaddyaknow??…. the pain disappears. You are selfing at a high degree and that’s why your pain persists”
I think you are assuming more than what I said into my comments. I was referring to ‘autonomic’ resistence to applied treatments / therapies. Personally, I, ‘myself’, can quite easily acquiesce to any suggested treatment / therapy, even though my autonomic protective abilities remain on high alert, as they always are. It doesn’t really matter what my conscious ‘self’ decides, unless it impacts on autonomic responses already in play….in which case there may well be responsive conflicts arousing a need for conscious restraint in the form of pain. I may well be able to relinquish or reduce my sense of ‘self’, which I do when I sleep, or perhaps even under hypnosis (never tried) , but that doesn’t in any way interfere with the operations of the autonomic protective systems, except in the sense that it might clear a path for them to maximise their potential, given ideal circumstances. So, the question there for me, is not simply why a reduced sense of self might negate pain sensations, which I think is highly possible, but, more importantly, why consciousness and the autonomic systems can seemingly be in conflict in terms of threat responses, and where pain fits in that equation, sensibly.
“The waking state is absolutely the problem….it is where the requirement for pain becomes a default inevitability”.
No, it only appears that way. The waking state in itself is NOT problematic. You need to make the distinction between the waking state and selfing, otherwise you’re not going to get anywhere. A newborn baby screaming its lungs out because of the enormous change to its immediate environment is not in pain. Fully awake and yet not in pain. A newborn baby has no self-consciousness. It has no ability to distinguish “me” from “other”. The screaming is just *happening*; it has no owner. No one to whom it’s happening.
If you haven’t watched the Michael Mosley video I posted above, it demonstrates the same thing happening. Nociception without suffering. He’s awake.
“why consciousness and the autonomic systems can seemingly be in conflict”
They’re not. Consciousness identified with the body (self) is often at odds with automatic healing, but not consciousness itself.
People who bolster their self with SIMs will tend to feel relatively safe, but only so long as the SIMs provide the requisite validation. It’s all very, very precarious, but we pretend otherwise! Strip someone of his partner, assets, money, friends, job…. and suddenly fear dominates every cell in the body. Now here’s a really, really key point –
***That fear was always there underlying everything. It didn’t APPEAR in the midst of misfortune, it was UNCOVERED as being the VERY NATURE of the self***.
Better wrap this up Gerry. Tim likes to keep the threads relatively succinct.
email me if you want.