Kindred Spirits
Kindred Spirits: The connection between emotional and physical pain.
During the summer break I reflected on the magical ways in which changes to my clinical awareness, practice, and research respond to my existing client’s needs, attract new clients, and sometimes overlap with my own journey of wellbeing. I feel immense gratitude for the many subtle ways in which your needs continue to expand my areas of interest, expertise, and knowledge, and hope that this newsletter will likewise inspire your understanding of our awesome human bodies.
Since training as a Freedom from Chronic Pain practitioner in 2019 I have been increasingly aware of, and fascinated by, the kindred relationships between trauma, neurodiversity, mental health, and chronic pain. Caring for the psychological aspects of these relationships is the realm of your individual psychological professionals and I am acutely aware of the boundary that defines my role as a remedial therapist and your psychologist’s role as a mental health specialist. However, there is a direct link between psychology and somatic wellbeing, so to respect the boundary between disciplines and strengthen my understandings of how to best serve you, my clients, I have been re-reading articles by Ronna Moore and Sarah Fogarty (Massage and Myotherapy Journal volume 20). They discuss principles of trauma informed care and recent mental health research to make a strong case for the beneficial role of massage in mental health care. In this article I summarise their key points, place them in a historical context and consider their clinical implications.
The impacts of trauma and post traumatic stress disorders were first thoroughly researched in the wake of World War II and led to the pioneering work of some of my favourite practitioners including Oliver Sacks, Candis Pert, Bessel Van Der Kolk, and John Sarno. Initially their work was conducted within institutions where the impacts of significant trauma and post-traumatic stress disorder (PTSD) were mostly hidden from public view. However, since the closure of mental asylums in the 1990s, concurrent advances in neuroimaging, and the move toward a care-in-the-community health model, awareness of, and discussions about trauma, PTSD, and neurodiversity have become increasingly common. This is the context within which our clinical relationship is situated, and since I and many of you were born before the 1990s, this history is particularly pertinent because it resides directly within our lived experience.
In recent years insights from clinical research, neuroscience, attachment theory, systems theory and somatic psychotherapy have converged. It is now recognised that everyone has trauma. Indeed, according to a National Survey of Mental Health and Wellbeing 12% of Australians experience PTSD during their life, with women being at almost twice the risk of men, and 2/3 children experiencing a potentially traumatic event by the age of 16. We now understand that “almost everyone who experiences trauma will be emotionally affected” (Phoenix, 2022), however, most people recover while some do not. So why is this? The difference between recovery or the development of PTSD is due to a spectrum and continuum of experiences. At the gentle end of this spectrum is benign or positive stress which is a natural part of human learning and adaptation. Positive stress stretches our bubble, increases our resilience, and often has beneficial mental, physical, and social outcomes. Residing in the middle of the spectrum is tolerable stress such as the impact of a sporting injury or difficult experience like losing your job. Tolerable stress can be traumatic, yet it remains within a person’s window of tolerance and recovery occurs in time, just like the healing of a strained ankle. At the pointy end of the spectrum we find profoundly disturbing experiences that occur outside of our capacity to cope. They are, or are experienced as life threatening, and they have potentially long term and disabling consequences.
It is important to recognise that each person’s experience of a shared or similar event is uniquely subjective. Your subjective response to any given stressor is influenced by three drivers.
1. Physiology – Our amygdala is located in our brain’s medial temporal lobe, and it is responsible for our stress response. It regulates the adaptive, protective mechanisms of fight, flight, and freeze, and it manages our return to baseline once the stress or threat has passed. However, “if the exposure to a stressor is either actually, or perceived as persistent or prolonged, the stress response may fail to complete the physiological cycle to return to baseline” (Moore, 2022), which leads to some or many maladaptive trauma effects.
2. Memory – There are two types of memory. Explicit memory enables us to recall experiences, knowledge, events, and facts intentionally and consciously. Implicit memory on the other hand is knowledge that we do not consciously acquire or access, and which is not easily verbalised. Implicit memory is often experienced in the body as a muscle or sense memory. It enables us to ride bicycles and play symphonies, but it also encodes our traumatic experiences where it can block explicit memory formation, diminish conscious recall, and activate unpredictable, disturbing responses such as flashbacks.
3. Context – The biopsychosocial factors that determine our genetic, psychological, social, cognitive, emotional, environmental, familial, historical, cultural, economic, educational, and occupational selves. Each of these highly individualised determinants influence how we are affected by stress and trauma.
The three drivers of trauma effects – physiology, memory, and context – are critical factors in our post-trauma trajectory. They directly influence our capacity for responding with either resilience and subsequent recovery or with chronic and continuous distress disorders such as PTSD.
Massage directly influences the physiology of trauma effects by promoting ‘bottom-up’ healing through nervous system regulation which in turn supports somatic, psychological, and even social wellbeing to reduce the distress response of PTSD. Occasionally, massage evokes spontaneous unconscious responses to past trauma such as shaking, sudden clamminess, or tears. Massage may also provoke conscious recall of a traumatic event. It is my role to provide a safe and non-judgemental place in which your body may regulate its response, and it is critical that I practice the following six principles of trauma informed care:
1. Trauma awareness – an informed awareness of the many and varied effects of trauma.
2. Safety and trustworthiness – creation of physical, emotional, and psychological safety. An active commitment to providing a healing environment based on trust, connection, confidence, and self-efficacy.
3. Client centred control – giving and promoting choice and voice. Transparent, explicit, and collaborative consent, including agreed touch zones, privacy, and confidentiality.
4. Collaboration and connection – recognising that healing takes place in and through relationships.
5. Focus on Strengths – affirming people’s strengths and resources to promote a belief in recovery, enhance existing recovery skills, and support flexibility and resilience.
6. Respect for cultural, historical and gender differences – an appreciation and respect of diversity and an awareness of one’s own biases.
Many of you engage my services for relaxation, management of day-to-day stress, recovery from injury, or maintenance of a long-term condition such as arthritis, so this article may or may not have been directly relevant to you. However, I do hope you have found it informative. During the coming months I will be studying a course of trauma informed care to refresh my knowledge, and better care for those of you who are actively engaging my remedial skills to support your trauma recovery. In the meantime, please do provide your feedback and let me know where I can do better.
