This involves the understanding and practice of the various ideas which we have discussed. Remember that this is not difficult, but it requires a little time and a little perseverance. Remember that many patients whom I have told these things verbally have succeeded. The only difference with you is that I am telling you by writing it down instead of saying it in words; and actually by writing it down I am able to explain it much more fully.

We have spoken of six general principles in the self-management of pain. If you were with me in my consulting room, I would repeat them to you in order to impress them on your mind. So I shall do the same now.

1. Reduce your general level of anxiety by understanding the nature of pain, by facing and resolving conflicts which cause anxiety, and by using the relaxing mental exercises to reduce anxiety.

2. Guard against the reactions that make pain worse. Do not allow distress, guilt, or fear to take over.

3. Use the reactions that reduce pain. Deny it and distract yourself from it when you can. Relax deeply and practice autosuggestion. When you can, use dissociation.

4. Practise the relaxing mental exercises.

5. Increase your pain threshold by conditioning yourself with the exercises in discomfort and pain.

6. Learn to experience and accept pain in pure form, which does not hurt.

We have discussed the means of fulfilling each of these principles, and we have seen that each step in itself is not difficult, as one follows the other in ordered gradation.

I always warn my patients of three things: Do not expect too much too quickly. Expect a few ups and downs, good days and bad days in the process of mastering the self-management. Do not get cross with yourself if at first you cannot do just what I ask.

I could relate many examples of patients I have had who have been successful in learning how to control their pain.

A man with cancer of the prostate suffered severe pain from secondary growths in the bones of his pelvis. He learned to relax and control the pain reasonably well, so that the last weeks of his life were actually spent in a clear mind and relative comfort.

A woman in her sixties complained of continuous severe pain in the legs, the vagina, and the area of the bladder. An operation on her back had shown a cystic degeneration of the nerve roots. So there was no doubt about the organic origin of her pain.

At first she found it hard to accept the idea that a psychological approach could help pain of this nature. She kept saying, “But the nerves have this degeneration.” I asked her to stick some pins into my forearm. She was reluctant, but she eventually did so, and was obviously surprised that it did not seem to hurt me. I then had her relax, and I did the same to her. When she opened her eyes she was astounded to find a couple of pins well embedded in her skin. From then on she was most enthusiastic about the exercises. She lost all the pain in her legs, and most of it, but not all, in her vagina and bladder. She later stated that she had developed a real peace of mind, and she volunteered that she was sleeping better than she had for eight or nine years.

I well remember one of my first experiments in helping people with organically determined pain. A woman in her sixties suffered chronic pain in her back from a degenerative condition of her backbone. She said that she had to fly from Melbourne to London and back, and she was terrified of the pain from having to remain in one position in her seat for so long. This was before the advent of the jets.

I taught her to relax and wished her luck. A few weeks later she came in to thank me, saying that she had made the trip without discomfort.

Just a year ago I saw a retired doctor, aged seventy-six years, who had had an extremely painful condition of his foot for nine years. He kept describing it as feeling as if someone were screwing up his foot in a vice. One surgeon had cut the main nerve, another surgeon had dissected the little nerves that lead to the toes, and later the artery had been freed of its nerves. But nothing had any effect on the pain. Another psychiatrist had tried hypnosis, but this was also unsuccessful.

In spite of his age he learned to do the relaxing mental exercises, and soon found he could control the pain.

A few days ago I received a note from his wife saying that he had died, and thanking me for the relief he had had in this last year of his life.

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There are quite different forms of meditation in which the brain functions in quite different ways. I have abundant evidence to show that the form of meditation which I am about to describe is much more effective than other forms in restoring the harmonious brain function that relieves stress.

In classical meditation as in yoga, in Zen Buddhist meditation, and in the meditation as practiced by the early Christian mystics, the thought processes of the mind are helped by will power concentrating on some object or spiritual concept. The mind is active, striving to attain and maintain this ideal. In the meditation that I would advise you to practice there is no striving, no activity of brain function, just quietness, a stillness of effortless tranquility.

This is not the tranquility of drowsy somnolence. The mind is clear but still. At first, until the meditator has learned the art of letting his mind run in this way, there will be moments of stillness, but these are soon interrupted by the intrusion of thoughts. Do not try to dispel the thoughts by actively driving them from the mind. Just let them be, and they will fizzle out, cease, and stillness will come again. Then thoughts will recur. And again, if they are let alone, stillness will supervene. And gradually the space between the thoughts, the stillness that we want, will become longer and longer.

At the start this process will come and go, very much like the natural rhythms that are all about us, night and day, the tides, our very heartbeat. There may be a tendency for the beginner to get cross with himself with the recurring thoughts. This, of course, brings the meditative process to a halt.

Another error, which may befall the beginner, is a tendency to examine the situation. ‘How am I going? Am I doing it properly?’ Of course, any enquiry of this nature involves activity of the mind, which is exactly what we are trying to avoid. At the start it is best just to let ourselves experience a sense of being. Just being. Not even being in the room. Not even being alive. Just being. This state of mental activity, or rather inactivity, is a step towards the real stillness of mind experienced in full meditation.

*86/98/5*

This basic neurological state of affairs is aggravated by the sense of frustration that stress brings. We don’t like being under stress. It means we have failed somewhere. We feel hostile about it. Hostile to ourselves and this is easily transferred to others in the form of aggression.

If we let fly our aggression, it means that the over-alert brain cells discharge, and there comes to us a period of relative tranquility. This is a common experience. We get angry. Blow off our aggression, and then quieting down. Some people get into this inferior way of coping with stress. They do not do it consciously. It is just something that happens. They feel tensed up with stress. Then with some trivial irritation they blow up, and their tension from their stress is relieved. With some people this becomes a habitual reaction and, of course destroys, not only the quality of their own life, but also that of those around them, particularly husband or wife, whichever the case may be.

In this respect it is worthwhile noting that different fashions appear in clinical psychology and psychiatry. For the last ten years or so there has been a foolish vogue of encouraging patients to learn to blow off their aggression rather than bottle it up. What should be done, of course, is to show the patient how to let his mind run smoothly so that his aggression does not build up.

*79/98/5*

Palpitations

“The tests were all normal. That does not mean anything.

They often miss things. If you feel your heart banging away, that’s evidence enough that something is wrong. Real evidence. I feel I am going to have a heart attack. I know I am. Father died of a coronary when he was forty. Life is too precious. Don’t want to do that. But they don’t do a thing for me. Gave me some tranquillizers! I’m sick of it. I tell you I am frightened. Who wouldn’t be? It’s going now. Thump. Thump. Thump. Put your hand on my chest and you can feel it. Worse if I get fussed or upset. Even coming here makes it worse. What can I do to stop a heart attack? I keep thinking that this might be the start of it coming on now.”

Palpitation, the abnormal awareness of the action of our heart, is one of the commonest bodily symptoms of stress.

When we are in good physical and mental health, we are not aware of the action of our heart except for brief periods following strenuous physical exercise. This in itself is rather remarkable, as the action of our heart involves quite considerable movement within our chest. But in normal circumstances, information about this movement is not transmitted by our nervous system to our brain with sufficient intensity to reach the threshold of consciousness.

When we are under stress, two factors may operate to produce palpitation. The over-activity of nerve cells produces anxiety. The basic physiological purpose of anxiety is to prepare us for danger. There is more adrenalin in our blood. It increases our heart action, and puts up our blood pressure so that we are better able to cope with physical danger either by fighting or running away. This, of course, is a very primitive reaction which was evolved in times past, in the early days of our race, to help cope with the physical dangers of primitive life. However, the danger that we perceive as a result of stress is not a physical danger, but a mental one for which this old, primitive, outworn reaction is quite inappropriate and no help to us at all.

The second factor in stress, which contributes to palpitation, is our increased awareness due to the over-alertness of our brain cells. As a result of this we become aware of movements of our heart in a way that would not normally come to our consciousness.

The important matter for those who suffer palpitation is to be reassured that the cause of the palpitation is nervous, and is not due to any disease of the heart itself. Those who suffer palpitation often accept this reassurance, but still feel that the frequent experience of palpitation must, in the long term, have some deleterious effect on the heart. This is not so, as the normal heart has a great capacity to increase its activity, as in strenuous exercise, without any harm coming of it.

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