Early in my practice, a client said something that has stuck with me for the last 30 years. A trained dancer, she told me she avoided taking pain relievers because, in her view, pain was her body’s way of providing important information to her and she needed to “listen”. Although you’ll sometimes hear medical and body-work experts echo this view today, when you move from physical to psychological pain, it’s rarely mentioned. The idea that one needs to “listen” to one’s emotional pain gets short shrift, especially if that pain has been labeled depression, anxiety or an eating disorder. In the current mental health profession, dominated by cognitive-behavioral therapy and psychiatric medication, pain is something to be removed or eliminated. Take this drug. Try this CBT technique.
This perspective has been gaining in power since I started practice, long before the dawn of the Prozac era. In the “good old days,” most clients didn’t expect me to remove their pain. They wanted relief, but they seemed to accept that it would take time to understand their pain and then do something to make it better. I speak in generalities, of course; even then, I had the occasional new client who demanded instantaneous relief. But today, few new clients come into my practice with the idea that pain is something to be listened to — that is, that pain has a value and meaning to be understood. Helping people to accept that their pain contains relevant information and to try bearing with it is one of the earliest tasks of my work. Sometimes I fail.
In an earlier post about some bad reasons to take an antidepressant, I gave several examples of people using psychiatric drugs because they didn’t want to confront certain painful realities about themselves and their lives. I believe they are not unusual. The constant message from the medical establishment that mental illness is caused by a chemical imbalance insists that the pain of depression and anxiety have no meaning to be understood. We are told that eating disorders are maladaptive behaviors that need to be unlearned, rather than desperate efforts to cope with pain by people who have little mental ability to do so.
These are familiar observations to me, but I thought of them again in reading this article about I’ll Have Another, the racehorse that won both the Kentucky Derby and the Preakness Stakes before being retired by his owners. Apparently, his trainers had given him major painkillers prior to these Triple Crown races, and the practice is neither illegal nor unusual in thoroughbred horse racing. Many serious injuries are masked in this way and contribute to the catastrophic breakdown on the track of an alarming number of horses. This past Winter, 30 horses died at Aqueduct alone. In other words, instead of paying attention to their horses’ pain and viewing it as important information, the owners and trainers administer a drug to mask it. Millions of dollars in prize money are at stake, of course. In quest of those riches, they ignore the possible consequences of using painkillers — critical injuries on the track that often result in the horse being put down.
The widespread use of psychiatric medication today strikes me as analogous. By trying to mask or remove their patients’ pain with medication, psychiatrists and other medicating physicans ignore the long-term risks associated with using these drugs. Only now are we beginning to pay attention. Peter Breggin, Robert Whitaker, Joanna Moncrieff and Irving Kirsch are among those researchers who have not only exposed the false claims for cure but also revealed the disastrous consequences of long-term usage of these drugs: irreparable damage to the nervous system, permanent brain damage and reduced life expectancy. In pursuit of the short-term goal of relieving pain — understandable, if misguided — the medical profession does long-term damage to its patients.
I have one relatively new client, deeply depressed and anxiety-ridden, who has been hospitalized twice and tried innumerable psychiatric medications to alleviate his pain. He readily admits that all those drugs have done little to help and that the hospitalizations did nothing. Although he knows the short-term “answers” don’t work, he is suffering deeply and wants relief. When I talk about needing to bear with his pain long enough to understand it, he may grasp what I mean on an intellectual level, but on an emotional level, he just wants me to make it go away. One of the obstacles to our work is his belief and expectation that such a “cure” is possible, based in part on the cultural messages he has received for most of his life. My approach of bearing with and listening to pain is not at all what he expected.
It doesn’t help that modern psychiatry and the media have supposedly “discredited” long-term, intensive psychotherapy. If I suggest to someone that meaningful relief of a lasting nature might take years, he may view me as trying to foster dependency to my financial benefit. She may believe she’ll waste those years, a lot of money and have nothing to show for it at the end. Compared to the promise of a medical cure or 6-week behavioral course to unlearn those maladaptive behaviors, what I have to offer seems far too time-consuming and expensive. Unfortunately, I don’t know of anything else that can make a meaningful difference.
Long-term, intensive psychotherapy is expensive and it does take a long time, no doubt about it. I suppose that’s part of the reason I’m starting this new project with some of the visitors to my site. The goal is learning to hone our attention skills over time and to focus on our pain and the ways we try to escape from it. Taking part won’t provide immediate relief, but it might help participants to develop the habit of listening to and bearing with their pain … long enough to understand what it means and what they might be able to do about it.