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In his book Back in Control, orthopedic spinal specialist David Hanscom wades into some unexpected territory when he highlights the following:
“…children who had been bullied had significantly elevated levels of CRP compared to those who had not….[and] even more disturbing is that levels of CRP in bullies was lower than the norm.”
(CRP, or C-reactive protein, is a substance that is elevated in the presence of inflammation. Hanscom notes that it is often used to determine the presence of a hidden infection, and that chronically elevated levels indicate a stressed and overactive immune system.)
What, exactly, does this finding mean?—and more importantly, what is an observation about bullies and victims doing in a book on chronic pain?
The man making it is not a social scientist (like Elsbeth Probyn or Thomas Scheff) who is hypothesizing about how emotions like anger and shame are stored in the body—but rather, a renowned complex-deformity spine surgeon. As a practicing member of Swedish Neuroscience Specialists (SNS) at Swedish Neuroscience Institute, he has treated patients with complex spine problems (and chronic back pain) for over thirty years. Additionally, Hanscom himself suffered from chronic pain for over 15 years. I reached out to him for an interview, hoping to learn more about the radical ways he is configuring the relationship between pain and anger. Here is some of what he had to say:
Hanscom: In order to begin to understand the relationship between pain and anger it is important to first have an understanding of the nature of chronic pain as different from the acute pain we associate with tissue damage. Tissue damage, or 'nociceptive' pain is ‘felt’ in the sensory area of the pain-processing center of the brain. This is the area related to the physical senses, such as touch and temperature. Neural firing in this part of the brain creates a withdrawal avoidance response--which is how we respond to any acute unpleasant sensory input; to anything that physically ‘hurts’ us.
When pain persists for more than 6-12 months, the brain activity shifts from these sensory areas to the area (of the pain-processing center) that is associated with emotional response –and it does this 100% of the time. Same pain but a different driver. Which, in effect, means that chronic pain is a completely different entity than acute pain.
Neuroscientists have now defined chronic pain as a maladaptive neuropathological disease state that becomes embedded into the nervous system over time. It (the pain) becomes more and more connected to various life events, and the memories can’t be erased. (This understanding also explains why many amputees have phantom limb pain—the memory paths that connect the body to pain centers of the brain remain intact.)
You must couple this with the fact that chronic physical pain and ongoing mental pain are processed in a similar area of the brain with the same stress-chemical response.
Any threat to the body—whether physical or mental—will create a neurochemical reaction that tightens muscles and increases the levels of stress chemicals. These chemicals affect every organ and cell in the body, including nerves. When the body is full of stress chemicals the nerve conduction doubles and you will actually ‘feel’ more pain. As you calm down, the nerve conduction slows and the pain diminishes. So, chronic mental pain and physical pain both create an unpleasant sensation, that is centered around adrenaline. They are basically the same thing. The anxiety that arises around bullying and chronic lower back pain are similar problems.
Martocci: So if I understand correctly, you are saying a few things here.
First, you are concurring with social scientists like Naomi Eisenberger and C. Nathan DeWall, who have argued that the same centers of the brain that are activated when we hurt ourselves—do tissue damage—are also activated when we are cut off from acceptance and belonging.(1) That “social exclusion continues to represent such a basic and severe threat to human well-being that the body encodes these experiences in a manner all but identical to physical pain.”
Second, chronic pain is often more about well-grooved pathways to the pain areas of the brain than about tissue damage (nociceptive pain) itself.
Third, those pain circuits are enhanced by chemical responses that we link to emotion-states, such as anxiety, stress, fear, and anger. And again, those responses can be triggered by physical or social pain.
Hanscom: You’re correct on all of your points. Every living creature has an anxiety-like avoidance response to danger. Anxiety (from any source) elicits an immediate, unconscious flooding of the brain with adrenaline, cortisol, histamines and other stress chemicals. The result is an unpleasant sensation that causes us to take an avoidance action. It doesn’t matter whether the threat is perceived or real, to (re)solve the situation or escape the threat we need to escape the chemical response. We humans have a problem in that we can’t escape our thoughts, and thoughts can stimulate anxiety, so we are trapped with a progressively fired up nervous system.
When we are trapped for any reason, we increase our efforts to free ourselves—often by becoming angry, which creates even higher concentrations of these hormones. Anger is anxiety with a chemical kick that increases your chances of survival.
As is well known, the level of peer abuse at school is very capable of eliciting anger. In fact, it is so pervasive that many students do not even recognize the ways that ‘everyday situations’ are overwhelming their nervous system with stress hormones. Anxiety is the norm, and feeling trapped without resources creates anxiety and then anger.
This becomes a loop, the root cause of which is the solvable problem of effectively processing anxiety. One of the bonuses of less anxiety is that the speed of nerve conduction decreases and people will experience less physical pain. Before talking about the way out of this loop, I want to note that many victims who become angry (in order to master their anxiety and suffering) themselves become bullies. And unfortunately, there is a physiological reward for being a bully, which we see this in the form of lower inflammatory markers—the CPR levels mentioned above. Given this chemical ‘reward,’ it is unlikely that bullying can be stopped with any sort of punishment.
The way out of the loop—for anyone who is spiraling through stress-chemical reactions to bullying or to chronic pain—lies in addressing the anxiety. The key to solving the problem is first understanding that you can’t rid yourself of it. You would die. Instead, you must train your body to be comfortable with uncomfortable feelings and sensations. As you quit fighting anxiety, you are paying less neurological attention to it, and the chemical response dampens. As the adrenaline decreases, the anxiety decreases. It no longer becomes necessary to kick in with an anger response because there is less need for “power”.
Martocci: So this is why it is so helpful to take a deep breath. To stop and just breathe. I want to follow up with you about addressing anxiety—and anger—which, you argue is as central to working with chronic back pain as it is to negotiating painful experiences of bullying.
Hanscom: Although the initial back injury may be a strain of the soft tissues, ongoing movement keeps it irritated. The brain memorizes these pain impulses within six to twelve months, even though, as I explained earlier, the brain activity actually shifts from the sensory-pain centers to the emotion-pain centers of the brain. So, you will continue to experience the same pain, but it is now a neurological problem. And interventions aimed at a structural source can’t and don’t reliably solve chronic pain.
The principles of resolving chronic pain, regardless of which area of the body is involved, revolve around decreasing the body’s stress chemicals and stimulating the brain to re-route around the automatic survival response pathways. It’s not difficult to do once you understand the problem.
The sequence of freeing yourself from pain involves three steps;
- Awareness
- Of the nature of chronic pain
- Your diagnosis – make sure there isn’t a structural problem
- Treating all the relevant aspects of it simultaneously
- Taking control of your care
Since chronic pain is a complex problem and each individual is unique, the patient is the only one who, with guidance, can solve their problem.
Martocci: It seems you are advocating radical cognitive restructuring, a ‘solution’ you may have arrived at, in part, through your own experiences with chronic pain. You shared with me that your experience began with a spontaneous panic attack while driving over a bridge—that you had no clear injury to pin it on, and that you struggled with debilitating back pain for about 15 years. You also mention, in your book, that you had 16 symptoms, but we’ve only spoken here about anxiety. What else might readers learn from your experience, or what other symptoms should we be looking to identify?
Hanscom: When the body is under a relentless assault of stress chemicals, every cell and organ system will respond with its own unique way. That is why there are over 30 symptoms that can be problematic. They include tension and migraine headaches, irritable bowel, spastic bladder, burning sensations anywhere in the body, eating disorders, obsessive thought patterns, tinnitus and the list goes on. These symptoms can be found in people with chronic pain and in young people who are bullied. With all the stresses teens are under these days, it is hardly surprising that the incidence of these problems has risen dramatically. I lectured at a high school a few years ago where over 20% of the students were on medications for a multitude of problems. Although bullying itself is a horrible source of stress and anxiety, it is the need for power to control the anxiety it creates that drives it. It is necessary to break this loop to both stop bullying and improve our student’s health.
Martocci: So in sum, you would say that…
Hanscom: Gaining control over pain is a largely self-directed process. The reason that all aspects must be addressed simultaneously is that the various systems, organs, etc. of your body work in tandem to decrease different aspects of your particular pain, but none of them are effective in isolation. For example, a consistently restful night’s sleep is one of the cornerstones of treatment. If that isn’t resolved, other treatments won’t be very helpful. Conversely, adequate sleep by itself won’t solve chronic pain.
Lastly, but importantly, forgiveness has last been shown to be the dividing line. Letting go of (legitimate) anger by mastering the anxiety generated by being trapped by pain is challenging, but remarkably effective in allowing people to move on and leave the pain behind. From my personal experience, and my observation of many patients, it is clear that anger is one of the main drivers of depression. It doesn’t matter whether the anger is expressed or repressed. It is critical to address anger as its own issue.
The key is teaching all students how to process anxiety in a manner that obviates the need for power. The tools are simple and can be implemented in the school setting. It is a solvable public health problem. They are presented in a workable sequence on the website, www.backincontrol.com.
Philosophers have pointed out for centuries that the only person you can change is you. Mastering the tools to process anxiety/ anger/pain is a key step in learning to enjoy the life that has been given to you.
[1] Studies corroborate that taking acetaminophen—Tylenol—reduces the activations in the pain matrix of the brain following humiliation and social rejection. Tylenol actually makes victims of social aggression feel better.
