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Not all in the mind

It is unfortunately not uncommon for people in pain to be told by others (family, colleagues or healthcare professionals) that their pain must be ‘all in the mind’. Amanda C de C Williams gives some tips on how you can respond

There is a way of thinking that says that if something cannot be explained medically or identified by medical tests then it must be ‘psychological’. The idea is either that the person ‘believes’ that they have pain, but doesn’t really, or that whatever pain they have arises entirely from mental processes and is not ‘real’. It is different from acknowledging that pain and emotional distress or psychological disorders may be related.

The fact that current medical knowledge cannot explain something does not mean that a mechanism for the pain will not eventually be discovered leading to effective treatments.

If you have been told that your pain is all in the mind, here are four assertive responses you could use:

‘Pain is a mind-body problem. The two can’t be separated.’

‘I’m distressed because of my pain and the problems it causes. Pain causes distress, not the other way round.’

‘I realise it is good news that the investigations [X-ray, scan, blood tests] show nothing serious. But I feel pain because that’s what my nervous system tells my brain and no investigation can show that.’ After all, plenty of acute pains accepted as ‘real’ wouldn’t show up on investigations like that, from headache to muscle cramp to renal colic.

‘If you had pain like this, and it affected your life like it affects mine, don’t you think you would be worried/distressed/depressed/frustrated?’


Amanda C de C Williams is a Reader in Clinical Health Psychology at University College London, and Consultant Clinical Psychologist at the Pain Management Centre of the National Hospital for Neurology & Neurosurgery, London.

Not all in the mind © Amanda C de C Williams. All rights reserved. March 2014.

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