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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.