07 Apr Migrained
I was inspired to write this post because one of my photography teachers in college, Lorie Novak, posted an article from the NY Times about migraines that featured a stunning image of hers – taken as part of a series of self-portraits she made while suffering from migraines. Lorie was one of the better teachers I’ve had, as I will detail in a moment. First though, I want to discuss the article which is called, “Women’s Emotions Do Not Cause Their Migraines”. The article is written as part of a series of pieces addressing “misconceptions”. While I was in Lorie’s class, I had a couple of migraines and they were panic-inducing doozies. The pain was so intense I found it impossible to escape, which only increased my sense of panic. I understand how debilitating they can be and I feel great empathy for Lorie and others who suffer from chronic migraines.
However, I found the article frustrating for a couple of reasons that are both philosophical and personal. The “misconception” that the author chose to focus on was the idea that women’s migraines are caused by emotions. I have spent the past 12 years working on a film that focuses on the relationship between the mind and the body in relation to health, and this work has made it profoundly clear that our emotions play an integral role in both pain and illness. In fact, in the medical definition, pain is “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage”. This definition explains that emotions are always a causative factor in regards to pain.
One thing I’ve thought deeply about while making this film is how ideas move through the world – and how this process shapes our understanding of ourselves. In the last century, as technology allowed us to see deeper into the structures of the body and brain, the focus of science became increasingly tech- and biology-focused and the role of our emotions and consciousness were pushed to the edges of medicine. There was an increasing sense that if we simply unlocked the mysteries of our biology, we could solve all of the world’s ills. This process led to some fantastic advances in medicine, but it also created a limiting effect that blinded us to the import of our emotions. The paradigm is beginning to shift back the other way. Whenever there is a cultural shift, there is also a great deal of conflict.
The headline of the Times article made me curious about the percentage of men vs. women who get migraines. A perfunctory search led me to an article in Science magazine from 2012 that stated three times more women have migraines than men. While I understand why women – who are often seen as “more emotional” – would want to reject the idea that emotions play a causative role in migraines, a quick read of the article had information that seemed to indicate that emotions are involved. Brain scans of men and women who suffered from migraines found that the differences in the brains of men and women who suffer from migraines are related to the emotional centers of the brain.
The team then scanned the brains of the volunteers. The researchers gathered two kinds of data sets, one that captured brain shapes and features, and one that measured brain activity. Female migraine sufferers showed slightly thicker gray matter in two regions: one, the posterior insula, is well-known in pain processing; the other, the precuneus, has been recently linked to migraines but is more widely known as a fundamental brain hub that may house a person’s consciousness or sense of self. The other volunteers, including the male migraine sufferers, did not show this thickening. All of the scans were done when people did not have a migraine.
To figure out what those structural changes meant, lead author Nasim Maleki, a medical physicist at Boston Children’s Hospital and Harvard Medical School, returned to the MRI scans of only those men and women with episodic migraines. The team compared brain activity while the volunteers experienced pain—in this case, three 15-second bursts of heat to the hand, spaced 30 seconds apart, generated through a small metal cube, akin to touching a too-hot cup of coffee. In women with migraines, “these thicker areas talk to each other and work together to respond to pain” in a pattern not seen in the men, Maleki says. When Maleki checked for sex differences in well-defined pain networks, most of the structures that responded stronger in women were part of the emotional network. “In men, the pain comes in, and the brain says ‘ouch,’ ” Maleki says. “In women, the brain says ‘OUCHHHHH!’ ” Overall, the results suggest that “it’s not just one area that underlies the sex differences in migraines, but a network of areas, a system that leads to the problem or progression,” she says.
We are often taught that science is “above emotions”, and that it’s about seeing things clearly from a non-judgmental perspective. However, we are so deeply entrenched in our cultural frames that we often can’t see how they shape our narratives. The scientific method involves framing things around an expectation or hypothesis. Without a cultural understanding of the world that involves intricate layers of assumptions, we wouldn’t even have the words to begin this process. All of the questions in the article and the study look at physical structures and patterns as if these will illuminate the differences between women and men. Perhaps we need to step back a bit further and also consider the different demands that are placed on women and men from a cultural standpoint. In our patriarchal society, women are often expected to both repress and express their emotions in divergent manners. It is more culturally acceptable for women to cry than it is for me, but it isn’t acceptable for them to challenge the deeply entrenched mechanisms of male privilege. It is less acceptable for men to show emotion, but they are also given much more leeway to express power. Perhaps these conflicting pressures have an effect on how the structures of our brains form. Perhaps this process is both genetic and learned. Perhaps female brains are more primed to follow a pattern of greater pain responsiveness, especially in the emotional centers of the brain due to a pattern of passing on the cultural stresses that are imposed upon mothers. The neural pathways that govern this process are also established and defined through cultural programming. We know that if a child’s parents develop PTSD that they pass on these markers genetically. In this manner we can see that the cause is both physical and emotional- not one or the other. It’s important to remember that for most of the 20th century back pain was looked at as being caused by physical injury. Dr. John Sarno went against the grain when he argued in the 1980’s that repression of emotions was the more likely cause of back pain in the majority of cases. He was ridiculed by his colleagues, but increasingly science is coming to prove he was correct.
There is a lot of information that supports this complex approach; some of it scientific (like the above mentioned article) but also a great deal of N of 1, or cultural information. The Times article, while quoting Lorie Novak, hot links from the word “migraine” to a Times Blog about migraines that features an article about Wilco’s Jeff Tweedy detailing how his migraines were driven by emotional factors. It illuminates that treating his pain killer addiction concurrently with his anxiety and depression helped him to move past them.
I have a particular interest in this issue – and this article – because I have so much appreciation for Lorie and because I have been making a film in an effort to overcome my own struggles with pain. The problems began while I was in college at NYU. I knew that on some level I wanted to be a photographer, but I went to college without any real career goals. In fact, if I had a goal, it was probably to avoid having a career. My father, who taught psychology at the University of North Carolina, had me meet one of his favorite students before I left for college. This guy had spent a decade bumming around the East Village auditing almost every class that the university offered. I was inspired by both his thirst for knowledge and his ability to get educated for free. I think my father wanted me to see the end result of his work – this guy was now a big shot graduate student – but what I saw was the power of ignoring the “expected path” in a quest for knowledge unsullied by cultural demands.
My aversion to doing things the “right way” had something to do with having grown up in a small college town (Chapel Hill, NC). Frankly, there was something about the whole setup of a college town that felt corrupted to me in ways that I couldn’t articulate at the time. When I was a child, Chapel Hill was just beginning to emerge from segregation, but I don’t recall much discussion of that. The day after I graduated from high school, the Klan marched down the main street. They were met by 50 times more protesters than marchers. Still, the history of the South was encoded in the DNA of the town. There’s still a university building named after a prominent Klansman, and protests have recently erupted over the statue of a confederate soldier that sits on campus. My mother and father were Northerners who were active in civil rights, which only made me more unconsciously aware of the darker more complex truths that adults, and those in power, often try to shield younger people from.
In college, I was interested in photography, but I didn’t want to go to art school because I had a sense that this, too, would be corrupting (I don’t think that the word “corrupting” was bouncing around in my head- instead it was a more inchoate feeling- an emotional response to the world – a compulsion to challenge assumptions and take the long way around). Art school certainly would have made my path towards being an artist a lot easier. Still, I was able to take a few very good photography classes in college that helped me grow. In my second year, I took a photo class in the school of education because it wasn’t so easy to take a class in the art school if you weren’t already in it. It was in that class that I started my Malls project. By my third year of college, I was able to take a photography class in the “school of the arts”. Lorie Novak, who taught the class, was a tremendously nurturing soul who both supported and challenged her students. She taught to evaluate another artist’s work for what it was doing or saying rather than by what I liked or didn’t like. This is probably the most important thing I learned. The class was packed with talented and interesting people and I think we all pushed and inspired each other. I completed two major projects that spring. One was a self-portrait book and the other a document of the street market on Astor Place. I’d say I spent about 70% of my time on that class, and I began to have a faint idea that I might someday be talented enough to call myself an artist.
While my antipathy towards doing what I was supposed to do was one reason I hadn’t gone to art school, the truth is that I was also riddled with self-doubt. I didn’t believe that I was creative or interesting enough to be a “real” artist. It took me decades to shake off the larger weight of that doubt. I’m not overwhelmed with confidence now, but I am certainly more comfortable with myself. The teacher who put me on to the mall project gave me enough confidence to take a class in the art school (I cannot remember her name and NYU has given no help to figure it out), and Lorie Novak gave me a renewed sense that I might be able to make work that had meaning.
It was nearly 30 years ago that I had Lorie as a teacher, and since then I have spent almost all of my time striving to make art. After college I was in a band for a decade and I documented that world with images and also feature films. It wasn’t an easy road. I worked as a messenger, and a sperm donor, a production assistant and a waiter, a typist and busboy, in order to pay rent and get by. Being in a band cost more than we earned. Still, we toured a lot and made 5 albums. It was a good run.
When I quit playing in bands, I began to concentrate on making documentaries with my wife. Early on, I ran myself into the ground trying to start a new film while also trying to distribute our first documentary and ended up with incapacitating back pain. I knew that it was stress related because my family has a long history with Dr. John Sarno, author of “Healing Back Pain”. I had read his book when I first started playing in the band and had gotten rid of recurrent back pain for almost a decade. This episode was way beyond anything I had ever experienced and I was frustrated on so many levels. When it had first started up, I re-read the book- which details how the repression of emotions is a major causative factor in back pain. As the book points out, for many people simply understanding the connection can alleviate the pain. This had been my experience. It had also been my father’s. My brother had ignored my father’s insistence that he read the book, but eventually he went to see Dr. Sarno and had a rapid recovery. Still, when I hit the floor, I spent days trying to find a conventional cure. I even struggled through an MRI despite the fact that laying in the position demanded for it was almost impossible for me. When I finally realized that I could call Dr. Sarno and go to see him, I brought the MRI. He told me to throw it out. Early on he had found that “abnormalities” found on MRI’s rarely correlated directly with people’s pain. Dozens of studies have proven him to be correct. The AMA instructs doctors to forgo MRI’s for back pain, yet their use continues to rise.
It was a massive struggle for me to get to his office as I had trouble even sitting up, let alone walking. Somehow, though, my wife got me there. First we went through my medical history, and he made a connection between the migraines that I had suffered during college and the recurrent back pain I had shaken off. In fact, it was while reading about the connection between emotional repression and migraines that Dr. Sarno first made the connection between pain and emotions. While in medical school he often got them. However, after reading the article the next time he got his “warning lights”, or the aura that often precedes migraines, he focused on what might be bothering him. As he says, “I couldn’t think of anything… but now I know exactly what I was repressing, and I never got one again.” I went to his lecture, I journaled to refocus my attention on my emotions rather than the pain, and I began to improve.
Dr. Sarno argues that our unconscious brain creates the pain to distract us, or protect us, from “unthinkable” thoughts. He points out that many of his patients are what he calls “goodists”- people who feel compelled to take care of others before themselves. They put themselves under inordinate pressure to be “perfect and good”. Lack of awareness of the power of these unconscious urges can lead to a great deal of unconscious rage. In order to make sure that this rage doesn’t rise to the surface, the unconscious mind causes pain to distract the brain from these unthinkable thoughts. Allowing oneself to think these things is healing.
By 2011, we were pleasantly surprised to see that Dr. Sarno’s ideas had begun to find their way into other areas of medicine. Dr. Gabor Mate had written a book called “When the Body Says No”, which connected the repression of emotions (when we don’t say no our body says it for us) to a host of auto-immune issues. Dr. David Clarke, a gastroenterologist, had written, “They Can’t Find Anything Wrong”, about his experience of discovering the role that the repression of emotions play in gut issues. All of this work was strongly supported by a study that was published in 1999 called The Adverse Childhood Experiences Study. This study found that children who had suffered 4 or more adverse childhood events (divorce, incarcerated parent, alcohol abuse, sexual abuse, etc) were many times more likely to suffer a host of debilitating diseases, and died on average 20 years earlier. It took years before people started to recognize the import of this study- and in the last year it has started to break into the mainstream. NPR devoted an entire week of reports to discussing its import. These events that happen when we are children can have massive reverberations for years to come. While this is a scary thought, Dr. Sarno points out that understanding that these events can be causative factors in a host of illnesses gives us the ability to deal with them. He flatly states, “My only prescription is knowledge, I tell the patients what’s going on and lo and behold it goes away.”
While I improved after seeing him, I was not 100% better. Through Dr. Sarno’s practice, if a patient did not improve completely he would suggest that they see one of the therapists that he worked closely with. I avoided the therapists for a long time, but when the pain came back, I finally went to see one, and it helped a great deal. Still, one of the reasons it’s taken so long to make the film is that I had a lot of healing to do. I’m still on that path, and my experiences and explorations have made it clear to me just how powerful the mind body connection is. To say that stressful and painful experiences that I have had are causative factors in terms of my back pain is not to say that the pain is my fault. It’s not about blame or responsibility, its about understanding. For this reason, I find the article a bit troubling because the framing is all about blame.
“When people blame migraines on a person’s failure to control something in their life — be it anxiety, stress or environmental factors — they are succumbing to…scientifically flawed logic. This misconception is potentially dangerous for migraine sufferers and those advising them, Dr. Young and other neurologists emphasize.
“If they succumb to the myth that people get migraine because they can’t cope with stress,” adds Dr. MacGregor. “They are, one, completely wrong and, two, will not get optimal treatment.”
When the problem is framed as someone’s “inability” to cope, there is a suggestion of blame. This is an issue of framing. If instead we simply recognize that emotional factors are a powerful causative factor – that can change brain chemistry and spike the production of hormones as well as actually change the structure of the brain – only then can we start to figure out ways to address the issue. In talking about this issue of blame, Dr. Mate says that we should focus on being able to respond (he suggests that it much better to be “response able” – able to respond instead of simply react) rather than think of responsibility in terms of blame.
I believe Dr. Sarno is correct, that the repression of emotions is the major causative factor in relation to back pain. As I worked to finish the article, I searched for the percentage of men vs. women who have back pain. For some reason, I had assumed that men have more back pain than women. I was wrong. My google search quickly pointed out that the opposite is true. Once again if we look at the issue in relation to the cultural expectations about the suppression of rage then this makes sense. In a patriarchal society, those who have decreasing levels of privilege are going to have more profound pressure to suppress their rage. If we look at the rise in the wealth gap in America, it closely tracks the rise in health care costs. I don’t believe this is a coincidence. Further, there was a recent article in The Atlantic that discussed a study about increasing death rates for white middle aged males. The takeaway from the study was that because the trajectory of their lives falls well below their “expectations” this group of people has fallen into despair- which leads to drug and alcohol abuse- and a higher incidence of dying. It’s hard not make the connection here that the emotions don’t play a major role in our health outcomes. To be more clear- yes the circumstance of their lives are involved- but the depression also has to do with how they respond emotionally to that situation- and how that in turn impacts their health. None of these studies, in themselves, prove beyond a doubt that X causes Y to happen. However, they do clearly illustrate the power of the emotions to affect our health. Unfortunately for many decades these factors were largely ignored as medical scientists worked to unravel the “causes” of disease processes.
The good news is that the conversation is shifting away from the idea of blaming people for emotional patterns that were established in childhood towards figuring out how to both prevent these patterns from being put into place, and dealing with them when they exist. It is our great hope that our film will be a part of that shift. I am sending this article and a rough cut of the film to Lorie. This kind of interaction is always fraught with tension because when I tell people about Dr. Sarno, they often feel as if I am blaming them for their pain. Instead, I feel compelled to give information that might help them as it did me. I have great respect and appreciation for Lorie and all that she taught me. It is my sincere desire that I might be able to return the favor.