The Body in Pain: Interoception, Pain, Language

This week’s blog is all about pain, inspired by The Master Series: Pain Edition, coming soon in February. Use my code RC20 to get 20% off your tickets.

When we were growing up, if we did not feel well, our dad would say, “Get all ready for school and see how you feel after breakfast.” By the time I had done all that, I had pretty much no idea how I felt, and as a result, I ended up with a lifelong near-perfect attendance record. Unless I was actively vomiting, I assumed I was fine, and that too was rare. One of the handful of occasions I did was the unforgettable time in first grade when I threw up on the blacktop at recess, and someone circled it in chalk and scrawled in large caps, “RUTH DID THIS!” Oy vey, I guess that cured me of that particular affliction. 

In my first 30 years of private practice, I missed only two days of work for health reasons. Only in 2014, when I was struck by a systemic, near-septic infection that even I couldn’t ignore, I landed in the hospital for a week, and home watching baking YouTube videos for another week. There went that record. Until then, I was not only blessed with sterling health, but also cursed with florid hubris/denial and a completely failed sensibility of interoception. 

Interoception is the awareness and ability to perceive and read sensations within one’s body. The well-oiled organism emits constant signals to remain regulated, in balanced equilibrium and good working condition: food, hydration, rest, sex, temperature control, comfort, medical attention, etc. A good enough primary caregiver works to accurately read the cues and respond to them – not perfectly, of course, but well enough. That is how a child learns to perceive and interpret them, and ultimately, with luck, learns about self-care. With luck, that is. Many are not so lucky. Many of the little organisms, as we know, are met with pain and/or confusing overstimulation instead.

I developed an early interest in the ways trauma, eating disorders, and substance abuse met in a seamless braid because of my own sorry experience. I sought and found a largely unscientific little world of body approaches to psychological problems. My always ahead-of-her-time psychotherapist referred me to a colleague of hers who practiced what was called Self Acceptance Training probably well before 1980, which was the first body approach I ever tried. I don’t remember much of anything about it, but I stayed with it for quite a while and then became interested in bioenergetics and the writings of Wilhelm Reich, one of the early founders of more systematic body psychotherapy approaches. Although his work is in some ways quirky, I still find his book The Function of the Orgasm to be one of the great tomes of all time, and his unique way of bringing together social justice, psychology, and sexuality to be truly fascinating and not without merit. (His biography, Fury on Earth by Myron Sharaf, is also well worth the read!)

Now, as a field, we are blessed with truly evidence-based and effective body-oriented methodologies as well as a sophisticated literature that takes somatic psychotherapies out of the fringy or “woo-woo” category and into the highly respected trauma and even broader public mainstream. No need to mention Bessel van der Kolk’s record-defying blockbuster The Body Keeps the Score. We have all read it by now. 

It is now largely acknowledged that there are a host of (too many) confounding, somatic aberrations that may be the harbinger or the mouthpiece of a trauma story. Because neglect is often storyless, it communicates in painful code. It behooves us to learn its language, not only for the purposes of translating to a precise language narrative, but also because so many survivors are abandoned yet again by a medical system that tells them it is “all in their heads.” Unhelped or over/mis-medicated, they suffer, roaming from practitioner to practitioner or one bogus internet remedy to the next, depleting money they often do not have, and feeling more pathological, humiliated, often blamed, and alone. 

Thankfully, the ACE Study of 1995-1997 has finally come to the awareness of the larger world, broadcasting the “surprisingly” astronomical numbers of “Adverse Childhood Experiences” endured by the employed largely middle-income research pool of 17,000 North American subjects. Researchers have begun to link childhood trauma to health and disease (see neuroscientist Ruth Lanius’ 2010 book on the subject.) Many survivors like myself wandered in a desert of numbness or a tortured world of often alternating or otherwise confounding expressions of “disease.” Many are not so fortunate as I to have had a helper who could connect the dots.

It is now largely acknowledged that there are a host of (too many) confounding, somatic aberrations that may be the harbinger or the mouthpiece of a trauma story. 


On my otherwise idyllic recent holiday vacation, I had a little “mishap.” Admittedly, grace has never been one of my stronger suits, and as the years advance, my balance is not what it once was. In the middle of the night, in a very dark, unfamiliar bathroom, I slipped in my banana-peel-colored socks and crashed into the edge of the bathtub with my unsuspecting rib cage. Oy vey. My initial reaction was fear, knowing that at my age, many women have bones that crumble, and an injury could be serious. But well-schooled by Dad, I found I could pick myself up, finish my business and take myself back to bed. Sure it hurt, but… 

In the morning, I did tell my husband, and we worked around it, whatever it was, for the rest of the trip. I think I probably did crack a rib because when I yawned or coughed, I felt that sharp catch in my side. I remembered when our parents once had a little fender bender in the little Datsun, and Mom cracked a rib. There was no treatment for it, but she kept telling us, “DON’T MAKE ME LAUGH!” because that made it hurt. Fortunately for me, laughing was not a problem, but a sneeze could do it. I also happily discovered the analgesic properties of coffee, although the in-room coffee was not nearly as effective as the lattes made by our little friend at Starbucks.

When we got home, however, I had one really bad night. It was the night after I discovered that the heating pad was a real “game-changer” and quieted the pain so I could get my few hours of sleep easily and undisturbed. This next night, however, the pain was off the charts. I couldn’t get comfortable, and I could not sleep at all. My poor husband was frantic. I could not stop crying and could barely speak as I tried different every imaginable position, first in the bed, standing, and then sitting.

Finally, as I sat up, wept uncontrollably and shook, my body was wracked by involuntary movement that reminded me of the training I had done in the early 2000s with Pat Ogden and Peter Levine, where the body is completing unexpressed movement patterns locked in traumatized tissue. The movement kept going for quite a while, but it seemed to be moving the pain. Thankfully, well-trained by Peter and Pat, I was able to let it sequence through, albeit without the sort of mindfulness I learned back then. And the pain lessened.

I was able to go back to bed and sleep. In the morning, I awoke to what I think was an unremembered fragment of early trauma memory, most likely loosened and freed by a body sensation that resembled/evoked it just enough. And I woke up pain-free. My husband later woke up more rattled and less easily convinced than I. But that is my story, and I’m sticking to it.

When the body is in pain, it compels all attention.


I remember in graduate school, which for me was back in the stone age, I read a book called The Body in Pain by a woman named Scarry. I remember being amused by the author’s name of a book on that subject. Again, how odd that of the thousands of books I have read in the intervening years, I remember that one and its author. I only remember one little factoid from the book: when the body is in pain, it compels all attention. One truly can’t think of anything else. The body is hell-bent on communicating that something is wrong. 

Chronic pain is a short-circuiting of the communication system, where long after physical injury might compel attention and action, the alarm bell continues ringing, probably trying to summon emergency care for some other purpose. We must work to stay present and listen: to both the language, and the story itself. The good news is that once the story is received and can be told in words, with luck, the messenger is free to go!

Today’s song:

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

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