An inhabitant of the variegated landscape of experience is pain. Within this landscape, physical pain has location, distribution, coloration, brightness, sharpness, intensity, duration, and slope. Physical pain has texture and flavor. Pain signals injury, damage, threat, imbalance, dysfunction. Pain informs attention and correction of the cause of pain through feedback. The mitigation of pain guides removal of its causes through intervention, correction, and natural healing. In this sense, pain serves survival. Often, the cause of physical pain may be readily determined with acute injuries to the body, infections, internal blockages, dysplasia, and other local or systemic imbalances. When the cause is treated, pain abates.
Pain is as nuanced as pleasure, but unlike pleasure, pain is unwelcome. If pain has “served its purpose”, and its cause has been determined, then the reduction or elimination of pain is a worthy goal. Indeed, the argument can be made that the practice of physical medicine has progressed so far that the cause of physical pain can be identified and corrected, so that the suffering of pain is unnecessary. Physical pain is thereby treated with powerful analgesics and drugs but sometimes accompanied by new risks to wellbeing and survival. Sometimes the treatment is worse than the ailment.
Psychological pain is analogous to physical pain. Just as physical pain informs that something is amiss in the body, psychological pain signals that something is amiss in one’s inner world, relationship to others, or the broader world of work and the environment. Psychological pain that interferes with everyday tasks and ordinary activities is clinically labeled as “anxiety” or “depression”. Although these are recognizable emotions, these labels are highly imprecise and fail to describe the variation and subtilty of feeling and emotion experienced by clients.
“Depression” may encompass grief, sadness, disillusionment, purposelessness, narcissistic deflation, frustrated entitlement, and a host of other states of mind. “Anxiety” is even more fuzzy. The only method to know what psychological pain is about is to inquire with the patient, to follow Ariadne’s thread to the source. The source may be loss, isolation, trauma, early neglect or abuse, social stigma, physical illness, frailty, aging, regret, or their combination. The cause of depression or anxiety may or may not reside within the body but in life history, social circumstances, and prospects. Every person’s life is unique. Accordingly, the causes of malaise to be understood, reframed, or corrected is specific to each person. Psychological pain guides to the source of mental injury and therefore assists psychotherapy.
The medical treatment for depression and anxiety through administration of drugs addresses symptoms and not causes. Following an initial interview, psychiatric practice often devolves to medication management with occasional follow-up for monitoring side effects and drug efficacy.
The types of neurotransmitters number more than a hundred and include amino acids, peptides, monoamines, and purines. Heavily prescribed anti-anxiety medications promote or inhibit a subset of literally hundreds of biochemicals that modulate communication among the 1011 neurons with 1015 interconnections. The armamentarium of psychiatric drugs is non-specific to neurological complexity.
While psychiatric medication may mitigate overt anxiety and depression, physical “side effects” are frequent, including digestive, cardiovascular, and neural musculature complications, and, over time, tremors and wasting. Common psychological effects of psychiatric medication are dulling of senses, weakening motivation and resolve, and depersonalization. At best, common drugs are soporific. Perhaps, for this reason, elements within the psychiatric community have displayed renewed interest in psychedelics. Successful cases of LSD therapy, recorded during the 1960s, required an intense therapeutic relationship, attention to the inner world, and an intimate acquaintance with psychodynamics. Adoption of this therapeutic modality would call for a radical shift in current psychiatric training and education.
The complexity of environmental, social, and psychodynamic causality, the kindred complexity of neurology, and the thousands of substances that inhibit, promote, and transform neurotransmission argues for the role of lifestyle, diet, sleep, and traditional medicine in the healing of psychological pain, depression, and anxiety. The shift to a lifestyle consistent with the environment of “human evolutionary adaptedness” is life with a sleep cycle attuned to daylight and nighttime, a diet with a variety of fresh local foods, cardio and resistance exercise, belonging to family and group of colleagues and friends, and restriction of superfluous stimulation with primary attention to local survival and adaptation. These changes in lifestyle support neurological health and function.
Therapy complements lifestyle change. Therapy identifies the causes of psychological pain and how the causes have influenced the person’s emotions, choices, and life pattern. This process called “working through” identifies the consequences and ramifications of the causes of psychological distress. The newly generated “observer status” creates understanding and compassion for the self, a new framework for self-knowledge, choice, and relationship to others and the world.
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