Saturday, August 28, 2010

You were anesthetized during surgery: Does that mean you forgot everything that happened?

By Alan Fogel
Aug 10 2010

In my book on body sense, I wrote about a middle-aged client I called Rebecca who, during a Rosen Method Bodywork session, "remembered" something that happened to her during an abdominal surgery under general anesthesia, a surgery that occurred a dozen years earlier. She remembered the body sense of having some kind of wedge put into her to hold her open during the procedure. She had no conscious memory of anything that occurred during the surgery to remove nonmalignant uterine fibroids. Since the surgery, for the entire 12-years period, she had continued to experience abdominal pain that should have, but did not, disappear in the months following the surgery.

Medicine is filled with cases of so-called non-diagnosable pain including chest pains with no evidence of heart problems, back pain without tissue damage, and in Rebecca's case, abdominal pain with no evidence of abnormalities consequent to the surgery or due to any other known medical condition.

These cases are indeed mysterious. First, why would pain continue for so long without apparent cause? And even more disconcerting is the possibility that the body could "remember" what the surgery may have felt like even though there was no ordinary, waking state of consciousness. Could these two mysteries be related? Could the fact that the body remembers even when the conscious mind does not account for the otherwise inexplicable persistence of pain? If so, it presents yet another unsolved puzzle: Why doesn't this happen to everyone who has surgery? Let's take a closer look at Rebecca's case.

I had been giving her Rosen Method treatments for over 3 months as her body sense deepened and she was better able to tolerate feeling the painful sensations in her belly as well as noticing more about her other sensations and feelings.

About mid-way through the session I reported in the book (Chapter 7), Rebecca said, "I feel like there's a division between the right and left side of my belly down there" (where my hand was gently touching her lower abdomen).

In a request to deepen her body sense, I asked, "Does one side of your belly feel different than the other side."

"I don't know," was the reply.

After a few minutes, she said, "You know that vertical split in my belly . . . (a long pause followed) . . . that's where they made the incision."

Her voice was a bit shaky with this so I could tell there was some emotion behind it. As I waited to see if there was a response in her body, I wondered about this statement. Surely, I thought, she knew the location of the scar. Then I began to feel her internal organs beginning to soften and her breathing slowing down, becoming less fretful. I said, "Your body remembers the surgery even if you were anesthetized, even if you thought you were asleep." As I talked, I was actually thinking of her complex history including the invasion of her reproductive anatomy and emotions by an alcoholic and abusive ex-husband and father of her only daughter, whose childbirth was no-doubt complicated by the marital troubles. I imagined that this new body sense of the surgery felt like yet another assault - another invasion of her uterus and vulnerably soft belly -- that was working through her in deep and unknown ways.

After a while she said, "I bet they put a wedge into me, to hold me open." Noting the relaxation response and the confidence in her voice when she said this, I replied, "Yes, that's probably what happened." As the session came to an end, Rebecca reported that she felt warmth and energy flowing through her whole body and a complete absence of the pain in her abdomen that had been there since the surgery.

This return of warmth and feeling in a previously tight part of the body is generally a consequence of bringing one's awareness fully into the present moment of felt, embodied experience. It is like the natural and effortless flow of tears and relief when one finally allows a previously suppressed emotion to surface. This is the "truth" of body sensing. More often than not, these spontaneous body releases (the activation of the parasympathetic nervous system) occur in the company of a listening and supportive loved one or therapist when one feels safe enough to allow the emotions to arise in the moment.

Why did Rebecca's abdominal pain continue for so long when other patients recover more quickly? It may be that when a physical injury or wound occurs in the same region of the body where some other trauma has previously lodged itself, the trauma from the surgical wound becomes linked to the earlier trauma in a way that amplifies the effect. The earlier trauma may predispose one to be more vulnerable to disease in that same region of the body, possibly explaining why some people may have persistent symptoms even though the tissues have completely healed.

The body sense of lasting effects of the surgery could also come from the trauma of the surgical procedure itself. Some of this can be prevented with appropriate pre- and post-operative relaxation and mindfulness meditation. One study found that women who listened to a recording of "positive therapeutic suggestions" while anesthetized for abdominal hysterectomy needed 24% less pain medication even though the patients claimed to not remember anything that was on the tape. Although people do not remember the specific suggestions, it is as if their body remembers the surgery as being less traumatic.

Rebecca did not have a visual image of the wedge, only a sensation in her belly which, when she was able to tune into it during the Rosen session, felt like having a wedge inserted. I call this participatory memory, not an armchair recollection of events but a déjà-vu style reliving of the feelings and sensations in the present moment. To have a therapeutic effect, this type of memory does not have to accurately reflect what the surgeon actually did. A clamp or other device may have been used. It doesn't really matter.

Rebecca's abdominal pain did not completely disappear following that session. As we worked together over the next few months, she discovered that her pain returned whenever she faced conflicts in her romantic encounters and in relation to her daughter's leaving for college. As a result, the link between the recurrent abdominal pain, her surgery, and her attachment difficulties and reproductive history could be felt, named and thus brought into the orbit of self-regulation and re-engagement with self and others. Eventually, she came to let go of her worries about the pain, accepting that it would come and go, realizing that it was informative of her emotional state, and that it didn't last long once she was able to just let herself feel it and its linkages to her interpersonal situations.

This is not a "cure" in the usual sense because the pain was not completely gone. Pain, as I've written in previous posts, has a large psychological component. The tissue damage from layers of prior trauma may never completely heal. What does change is the expansion of our body sense into a restoration of our sense of becoming, once again, a whole self, wounds and all. Even terminally ill people can be "healthy" in this broader sense of well-being.

I have worked with people who had undiagnosed chest pains consequent to open heart surgery or pacemaker implantation. In these cases, there was also a related attachment trauma, as if the disease and the surgical wound continued to fester in an unresolved emotional wound of a broken heart. I have seen the same patterns regardless of the sources of the compounding traumas: medical or non-medical, adult or childhood onset, automobile accidents or emotional abuse. It is not always the case that pain around the heart relates to protection against failed love, or that pelvic pain relates to sexual or reproductive trauma. Yet everyone's body has certain neuromuscular modes of expressing and protecting itself which become part of who we are, how we feel, and how we relate to ourselves and to others. Our body tissues carry a history that only the body sense, and not mental reflection, can reveal.

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