Your body keeps the score of every bump, bruise, emotion, thought, situation and trauma together with your genes. It’s one continuous story.
It has take your whole life to get to where you are now. Everything that happens is brought forward, embodied and within our present expectations. The body keeps the score, is a phrase that I often use with people to help them understand their current experience of themselves within their world. I have borrowed it from a super book by Bessel van der Kolk, as it captures a reality.
When I meet people suffering persistent pain for the first time, I invite them to tell me their story. What is it like to be them at the moment? And how did they arrive at this point, in this particular way? Nothing happens in isolation and hence the ‘past medical history’ is far more than a list of other conditions and incidents. These life events make up the journey that brings the person to the room.
Resources and the person
Each person who arrives has been using their resources in the best way that they know. They have a range of coping strategies, some of which maybe helping. Overall though, the person seeks different and better results. This is why I am a proponent of the coaching approach, as it focuses on the person, their strengths and ways to get such results.
The body always participates. Whatever resources and strategies that the person is using, there it is, registering thoughts, feelings, emotions and emitting into conscious awareness an ever-changing range of bodily sensations.
The body always participates
How is this problem emerging in the person? And why it is happening this way, at this particular time? This is what we must consider, going upstream beyond a simple focus upon the location of pain. Most of the biology of pain is not where you feel it, is another phrase I use to help people understand the need for a whole person approach to persistent pain.
The biology of pain ~ arguably there is no biology of pain, instead mechanisms and behaviours of protection
For example, if I have on-going back pain, I will need a brain, a sensorimotor system, a peripheral nervous system, an immune system, an endocrine system, and an autonomic nervous system, most of which is not where I feel the pain. Pain also needs a context within which it arises in the person that is fundamentally part of the actual experience.
Why is pain persisting in this person, now, in this moment? This is a question in my mind as I gently enquire about their lived experience, seeing their strengths that they can use to move on.
What are their experiences that are being brought forward into the now?
Underpinning the narrative is always the body in which our experiences are grounded. How my body is will determine my ability to move and hence impact upon my perception of the world — literally how I see it in terms of opportunities or affordances. We know that our worldly perceptions change when we are tired or suffering chronic pain. Within this, so too does our thinking and decision-making adapt to the state of the body. There is not much that we can achieve without movement — watch here.
This is the primary reason why movement is such a necessary part of getting better. We can’t think ourselves better without moving and seeking to move in the best possible way: balanced. Most people carry tensions in their body from all the life events to date as we have established. We then move according to these tensions that are now habits. Some of these will be protective and be happening entirely subconsciously. We are not doing it on purpose or even choosing to move in a guarded way. However, when we identify the pattern, we can make gentle changes to develop better body sense and movement. This creates evidence that we can move more efficiently as we take this expectation forward.
We are one. Whole. The idea of a separate body and mind is merely a convenient way to try and understand our experiences. It is wrong. We have just one experience, utterly unified. To try and simplify this by using silos of physical health and mental health takes the person away from reality.
Approaches to pain must be seen through the lens of oneness, the person first and the whole. There is no simplification.
The person suffering persistent pain is experiencing this state frequently in their life for there are unmet needs, often running deeply through their existence. Listen deeply and you will hear them. They are in a state of protect over and over with a narrow window of tolerance as they shift into hyper- and hypoarousal.
We seek to understand the person and help them to use their existing strengths and resources. We expand their choice of resources and widen their window of tolerance as they meet their needs and build wellness towards the real results that they want to achieve: their ideal self.
The body keeps the score. We can note posturing, guarded movements, limited actions, fearful responses and more as we study the embodied nature of the person’s experience. The more you look, the more you see. The more you listen, the more you hear. With this rich narrative and observation, we can then go about motivating positive actions, choose treatments that are helpful to ease symptoms and encourage the person to reach their potential.