Jan 318 min read

Mental vs Physical Pain: What hurts most?

Writers note:

This article is based on my own experiences as a patient of multiple mental and physical health services and professionals, as well as my findings of these systems whilst actively being processed within them.

TW: Mental health, abuse, blood, eating disorders, self harm

When I look back on my life there is one word which comes to mind.

Pain.

And upon reflection, the distinction between physical and emotional pain becomes clearer to me. They are not mutually exclusive by any means, but they can be. It is in the blurred lines that I believe the potential for the most severe long-term damage lies. I write this having been diagnosed foremost with C-PTSD. I relive memories with such ferocity it makes some days seem unbearable. I relive every sight, scent, noise, taste and touch as if it’s happening as before. Because it is to me. Nothing makes me more furious that my past disrupts the wonderful present I find myself in. A caveat I have to disclose to everyone I find myself close to.

However, when I muse on these two elements of pain, it is far more the emotional instances which take a toll on me. Not all of it is caused by humanity, but for those individuals who chose to inflict both, it is the lingering memories of what they said to me, convinced me to believe and trust, that bullies me daily rather than the singular instances when they chose my body was worth less than theirs. The scars on my skin serve only as a tangible reminder of what is burned into my brain.

As I have begun researching the correlation between emotional and physical pain, I find that most experts agree with me. Physical pain can generally be distinguished as ‘acute’ or ‘chronic,’ with the latter becoming a subject of interest with mental health professionals than the former.

‘Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing,’ [Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011 Sep;67(9):942-68.]

A conclusion that my therapist has wholeheartedly agreed with. It was our last session, when I proposed to him these thoughts that he said, ‘you know, you have a psychologist's brain,’ Finally, a compliment I can carry with me through life. However, it was in the aftermath of this acknowledgment that he broached the dreaded 'D' word – 'Depression.' A concept I thought I was well versed in up until now. He told me that some experts consider depression to be an inward expression of pain. Pain that is unable to be expressed ‘normally,’ and therefore is turned to oneself. And as much as I find myself academically disagreeing with this theory, I become evidence of that. Neurological pain, which outlets itself into physical pain, but circles back to pain towards oneself.

One of the key parts of my meetings with the psychotherapist is realising how important emotional regulation and coping mechanisms are for pain recognition. For myself, I was never taught these, hence how much pain I feel when I encounter unpleasant experiences. For others though, this can occur at any moment through significantly painful events. The mind and body coexist, so if one were to have an experience which it cannot figure out how to respond to, often the other will react in a similarly disoriented way. When a child is dealing with pain and they are not taught to process the experience in a healthy manner, they will teach themselves coping mechanisms, usually based on their survival instincts. Whilst these methods may appear to be successful, they can have a long-term negative effect on the nervous system and create significant mental and physical health issues later in life. Of which I am told I am an example of.

‘Sticks and stones.’ What a lie. While physical pain can rarely come without emotional pain, the latter can often be a singular event. Though I have much evidence of this from my upbringing, my most distinct example is the miscarriage. Because it wasn’t the incomparable stomach ache or the tar that leaked from my body in the days after; it was the man who made me feel it was an incomprehensible experience. The man who used me for years for his own gain. And when I told him the feelings of disgust I felt for the way he treated me, he would storm out and later tell me, ‘I can’t pretend to be angry at you anymore.’

And I would fall for it. I would make it my fault. We discussed it briefly a few times, and only in a way that would make him feel sorry for himself. A way that would make me believe his sorrow was far superior to mine; despite the fact he left me alone for the duration of mine.

I am so furious I didn’t stand up for myself. Stand up for my pain. For my loss. For the fact I didn’t care that it was his, but that I cared I lost the only friend I had for those few months I carried it inside me. It was a period of desperation for me, a time when I felt profoundly isolated. A time where not only a choice was taken from me, but also a life.

The physical sensations are almost lost in my memory, but the heartache is still there. The realisation I was completely alone, uncared for and disregarded. I let him manipulate me for another three and a half years; bringing my pain up when it suited his needs before I took control. Not just control of my life, but control of my pain. It is mine and it is valid. It is my past and unfortunately my present, and I know now that I will never be able to move on unless I accept that pain.

There are so many things that are numb to me, and so many wildly overbearing things. When I was little I was insanely ticklish. Even people pretending to tickle me would make me laugh and convulse hysterically. But now it’s just nothing. After years of assault and even minor boundary breaking, I feel nothing. It comes to mind when boys would find it funny to poke and prod my tummy and sides when I was a teenager. I would make the most grotesque noise and they would laugh. They would sneak up behind me and I would make myself conscious of my squishy parts and curl into a ball. Now my girlfriend is the only one who can make me chuckle with her light touch. But I see the sadness in her eyes when it doesn’t work. Sometimes she tickles me and is met with me just laying there having my armpit hair stroked, feeling nothing. It’s not fair that I’ve lost so many bodily sensations. I was asked earlier today about my pain threshold. I told the analyst it was extremely high. I can withstand so much physical pain. It's only after I look at the bruises covering my body that I have to go over every detail of the day to remember how I stumbled heavily into a table. Heavy enough to make my colleagues ask if I was ok. But it does not occur to me then. I feel nothing in those moments. No pain nor injury. Not even when I launched myself down some stairs and it was only hours later on the train home I looked at my knee gushing with blood I thought, ‘shit.’ Or when I fractured my ankle. The nurses bandaged me up for a few days and waited for me to stop complaining, which I shortly did. Not because it didn’t hurt, but because I stopped caring that it did. Now it’s healed in a way that I can’t even jump half a metre high without stabbing sensations throughout my entire leg. There are so few physical sensations I can realise anymore. I think that’s from the amount of times I thought I was close to death. When you cross that barrier, there’s little that can phase you anymore. In those moments I felt so much physical pain inflicted by others that I think my mind died a little too. Emotional and physical pain are one and the same, but one is far better at eternal gaslighting than the other

As I have grown older, the evidence of physical injury that I carry on my body has come to remind me far less of the incidents, but more and more of the shame that I remember every time I look at myself in the mirror. One day when I was a child, sitting down for family dinner, my mother made me stand up, uncover myself, and show my brothers what I had done to my skin. I do not remember doing the actions, but those minutes of embarrassment will forever linger in my mind. This memory is far more painful than anything I could have ever done to myself. I’ll always recall having to defend my younger self as an adult telling her, ‘happy children don’t hurt themselves,’ words which echo in my daily life now almost twenty years on.

I think now about how every time I feel nervous or disgusted with myself, how acutely trained my response is to feel nauseous, often to the point of vomiting. And no matter how aware I am of this, it doesn’t seem to stop that sinking feeling in my gut, nor the tightness in my throat or numbness in my tongue. Sometimes there still remains a pain that I cannot escape, preying on my body to succumb to the gut instinct telling me to be rid of this humiliation. The humiliation of myself which I find my body trapped in.

There are a number of treatments available to be able to help patients be able to recognise and cope with pain, but also be able to distinguish the source. When a patient is unable to fully recall the incident is when recovery becomes a greater ordeal to heal. The mind is a wonderfully obscure thing, and has the ability to lock pain away in a box in order to continue with normal life. However, the hinges of these boxes often erode, still concluding that mental anguish should be treated as commonly as physical injury, as the symptoms may come to surface at any moment with the same, or sometimes more extreme pain responses. Doctors can prescribe medications to treat traumatic symptoms, but can often be extremely reluctant to administer them. Each person experiences pain in an individual way, resulting in no guarantee of improvement with medication. There tends to be a lean towards ‘Talking Therapies,’ i.e. seeing a therapist and discussing events, and in more severe cases, Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). However, the latter of these treatments relies on the patient being able to recall and remain within the traumatic event for the period of time required to reprocess the response, something which must usually be built up through initial CBT. The nervous system responses are developed through experiences and emotions, and if incorrectly wired, can become confused and create dysfunctional and counterproductive reactions. But this does not mean stability cannot be regained. It can be retrained and regulated into a state of comfort and safety, as long as the individual needs are able to be treated as such. Individual experiences and individual people. I hold on to this fact as the glimmer of sunlight shining through the stormy skies.

I have come to regret now, not seeking help as soon as I began experiencing physical responses to traumatic events. Whilst I was able to convince myself for a period of time that I was unaffected by physical and mental pain, it was not long before I experienced spasms at these recollections which began to severely impact my daily life. Waiting for these symptoms to simply fix themselves was my worst decision. Recovery now has been so much harder as painful layers are so much easier to build once the foundations have already been laid. I am learning so much everyday, including research showing that life expectancy can decrease by an average of twenty years with a high number of adverse traumatic experiences (a category which I unfortunately find myself in). With so many mental health services being inaccessible or requiring extensive waiting periods, there really is no time like the present to take any form of pain seriously. No pain should be disregarded. No one's pain is invalid.