In My Own Write: Beyond wear and tear

If you ever get a chance to see a 2010 film called Under the Hawthorn Tree, grab it. It’s superb. This poignant love story, directed by Zhang Yimou and set in the 1970s during the Cultural Revolution, will break any stereotype of the Chinese as incapable of deep emotion – so much so, indeed, that I spent much of the movie aware of the painful lump in my throat caused by choked-back tears. Many in the audience, I intuited, were feeling the same.

We often cry when we feel greatly moved. The occasion may be a happy one, such as a wedding; but what is that squeezing of the heart that brings on the tears, if not the physical expression of a kind of pain caused by thought and emotion? The same thing can happen when we listen to beautiful music that touches our senses profoundly: Even as our hearts soar, we experience a physical clenching, an exquisite anguish – you might choose to call it heartache – which may be what British composer Benjamin Britten meant when he spoke of music being “cruel” in its beauty, having “the beauty of loneliness, of pain; of strength and freedom. The beauty of disappointment and never-satisfied love....”

Now pains like these are clearly not caused by any physical hurt or injury to the body; rather they are triggered by thoughts and emotions which affect the nervous system all the way up to the brain, and back – resulting in the physical effects described above.

WHEN IT comes to chronic physical pain such as the persistent knee or back pain that plagues millions of people worldwide, medical experts are now looking more and more at thoughts and beliefs as contributing factors.

The traditional view has been that tissue damage – erosion of cartilage and wearing down of the disc – inevitably leads to pain.

But for many experts, such as neuroscientist Lorimer Moseley, this is no longer a foregone conclusion.

Advances in brain imaging over the past decade have enabled neuroscientists to see the areas of the brain that are working when someone is in pain.

Watch Moseley’s humorous but serious YouTube presentation called “Why things hurt,” in which he demonstrates that pain is one of the things the body does to warn and protect you when it is under threat.

The nervous system screams “Danger!,” all the way up to the brain, which responds with pain, sometimes excruciating pain – even in cases when there is no real danger.

It might seem counter-intuitive to some. But it is now held that a person’s thoughts, feelings and beliefs – shaped by an understanding of what is happening in the body and a gradual conquering of fear of using the painful part – can help wind down and “undramatize” the messages the nervous system transmits to the brain, thus reducing the pain.

“In recent times we know that wear and tear of the tissue occurs naturally, and that some people have a lot of wear and tear and yet have no pain; others the opposite,” Jerusalem physiotherapist David Fidler told me. “So X-rays don’t tell the whole story.”

“The new approach to chronic pain is to look at all the contributing factors – physical, mental and social – in returning a sufferer to normal functioning.”

I LIKE this view a lot – and can support it personally – since I suffered from osteoarthritis in the hip for many years and more than once came up against the discouraging medical response of “What can you expect? You have no cartilage left.”

“Move house to where there are no steps, and in general, do as little walking as possible. Travel? Join a senior citizens group,” counseled a distinguished Jerusalem orthopedic surgeon I consulted.

“Just live your life,” he advised cheerfully, as he saw me to the door.

Since I was far from senior citizenship status when this advice was given, I was dismayed at having been thus forcibly aged before my time, and didn’t see myself “living my life” amid these restrictions with any degree of enthusiasm.

Even back then, my feelings and beliefs played a part: I ignored the orthopedist’s diktat, and after several years of gradually ridding myself of fear of pain and regaining confidence in my ability to walk, I am now pain-free – although, as I have written previously in these pages, I credit the regular taking of Vitamin D as prescribed by Jerusalem nutritionist and dietician Edite Tsevi for much of my remarkable improvement.

“Working with people with knee pain,” comments Fidler, “you see that once they learn it’s safe to move the knee, they can return to functioning by bringing in all the components that contribute to chronic pain; and by decreasing fear and increasing understanding of what is going on inside the knee.”

HE GAVE an example of lack of awareness that resonated compellingly, since in my earlier days of writing a food column called Short Order, I had devoted an entire article to the phenomenon of driven Jewish women who cook massively and obsessively against the clock on Fridays preparing huge meals for Shabbat, often for large numbers of guests. I called the column “Keeping up with the Cohens,” and quoted one acquaintance saying plaintively: “I used to make thousands of dishes; now I make only hundreds.”

“Some of these women working in the kitchen on Friday preparing meals for Shabbat may have sore knees,” observed Fidler, “but they ‘have to get it done,’ and so they carry on anyway – and then on Shabbat they are in agony.”

If you push it, he said, your nervous system and brain will sensitize themselves to creating more pain as a way of protecting you more.

“Those Friday cooks who press on regardless, through the pain, need to take regular breaks and be more in tune with what is happening with their knees, rather than saying, ‘There are 10 people coming for dinner – I have to do this.’” It is now known, said Fidler, that the brain is capable of amplifying or reducing pain in a way that doesn’t necessarily reflect the state of tissues in the body.

None of this is to say that medications and other therapies do not have their place in setting a chronic pain sufferer on the road to less pain and better functioning. But clearly they are not the whole answer.

Getting in touch with your body and your feelings, overcoming your fear, gaining more understanding of what’s happening in your body and being an active participant in your recovery are all very much in tune with the modern approach to healthy living.

IS THERE such a thing as “good pain”? According to my Alexander teacher, Dalia Altmann, there is.

“Good pain is when there is a change, when you start to get your body into better balance. For example, if it has been tilting in any direction as a habitual pattern, you will experience pain as muscles that used to be tight, or were never used, begin to function.”

It’s something I keep in mind when I feel my muscles protesting during a session.

WHAT ABOUT emotional pain, such as the tremendous blow of a broken-off relationship, or other emotional hurt? One thing to observe straightaway is that while it can be gut-wrenching at first, such pain is almost never chronic, and so one can look ahead – mentally, if not yet emotionally – to better times.

“Broken hearts can mend,” a wise friend once observed.

One recipe for emotional pain is to tell yourself: “I’m feeling terrible now, it’s true, but I know that tomorrow I will feel a little less wretched; and slightly less bad the day after that, and so on. The extreme emotional distress I’m experiencing now will not last.”

Just knowing that intellectually can be a comfort.

TO END on a philosophical note, the Lebanese-American artist, poet and writer Khalil Gibran compared a person’s existence in the world to a full goblet, into which happiness can be poured only to the depth that sadness has been drunk out. It’s a way of saying that without darkness, there is no light; without grief, there is no joy; without pain, there is no ease – or, at least, no appreciation of it.

That’s life.