How we understand pain

I recently had a run in with pain as I have injured my back quite badly. Whilst I was in hospital recovering I began to think about all the aspects of communicating pain that were going on around me.

The first question I was asked was: on a scale of one to three, three being childbirth, how much pain are you in? The baseline on this is seriously flawed as I have had three entirely different experiences of childbirth, at three very different levels of pain. It also made me wonder how this question would be applied to men experiencing pain. Here my pain was owned by a scale of one to three for the benefit of statistical assessment with no definition of my own experience.

The second was being eyed by a suspicious nurse who told me that 'I couldn't be in much pain as I hadn't asked for painkillers at six o'clock'. This entirely subjective view on the part of the nurse was working on an assumption and not on my reality. I had not asked for painkillers at six o'clock because I had no buzzer to summon a nurse and could not walk up the ward to ask. Here my pain was owned by the nurse who was assuming based on his own perception.

The third was an account given by another nurse who told me, whilst holding the key to the pharmacy cupboard, that many patients admit themselves to the hospital with fake illness in order to obtain strong painkillers that give them a buzz. This societal problem of addiction is another way of communicating psychological and societal pain. However, it didn't help me as I was really in a lot of pain. My pain was owned here by an objective risk assessment of whether or not I was faking my injury.

In my five day visit to the hospital, no professionals asked me how I was feeling. Several nurses and doctors looked at me and made an assumption based on how I appeared outwardly or how I was holding my body. An MRI scan revealed my injury had caused a herniated disc (see diagram above). No one acknowledged that my pain was my own, and that I could find words to express it myself. By overlaying my pain with other measures that rely on someone else making and assessment, my pain was negated into a construction of something external to my body. This is not a satisfactory situation for someone who is in acute pain, or in any circumstance.

Because I am not someone who will make a fuss, I was discharged with a prescription for paracetamol and ibuprofen, whereas someone else with the same injury as me who cried and complained more was discharged with much stronger painkillers. It seriously worries me to think that in the NHS today it's the person who shouts loudest who gets the best treatment. What happened to an adult, non-hierarchical conversation about how we are feeling? What happened to someone listening to my expression of how I feel instead of form filling and rating my pain for me?

I took my pain home with me, whereas my pain 'outcome form' still lies in the bottom on my hospital file.

For my notes on a lower back herniated slipped disc please click here

Avoiding the hole in the road

Original Post

My lack of blogging over the past weeks has been due to some extreme focus on writing a paper that has taken my interest. I love being focused and interested; instead of getting caught up in family's and friends' drama I can retreat into my own world of thinking.

Whilst this may sound really boring to some people, it serves me a a kind of gestation time, an incubation of my thinking process where I can be quiet and alone and consider ideas that may, one day, be woven onto the fabric of my external life.

It's been a strange couple of months preceding this, with lots of difficulty and joy, being let down and realising people are not what they seem to be. Lot's of moving around outdated areas of my life to make room for the future, which looks very, very bright. So, instead of constantly going back over old things, reliving learned helplessness and old patterns, I am making my own new patterns. Making these new patterns depends a lot on whether you listen to other people's advice and to yourself.

Years ago someone gave me an anonymous poem (it was passed to me as anonymous, but I now realise it was based on Portia Nelson's 'Autobiography in Five Short Chapters') and it is still relevant today when culling the dead wood.

Edit notes 18th April 2011 Many thanks to the reader who left a comment below. It's interesting because when I wrote this blog I was working from my own memory of this poem, and from notes I took, at a time when I was working very hard to change my life. The comment relates to my not giving credit to the author, which of course I will do immediately. The poem was 'Autobiography in Five Short Chapters' by Portia Nelson. However, my own interpretation of this poem, through the lens of time and personal experience, and maybe even forgetfulness and sadness, has been mistaken for a misquote, and I will remove my own interpretation of this poem on this post, but not from my heart; this was how it filtered through my consciousness when applied to myself, an example of how memory can sometimes distort words to provide personal comfort - and perhaps exactly what the author intended.

The Plot Thickens... learning when to plan and structure

As I start another new story, I'll be blogging my progress. At the moment I am planning my novel, and I'm thinking about what will happen in general, an overarching plot.

I've written several novels to date, and it's been a learning curve. The first couple were a download of some stories I had in my head, with bits added along the way, in no particular order. They were stories about people and what they did, what scrapes they got into, and how they felt.

As time went on and I became more experienced, I discovered that although there is nothing wrong with writing for all you are worth, and worrying about the editing afterwards, as it helps to embed the 'write every day' habit (Nonowrimo is a perfect exercise of this) it makes the whole process a lot more interesting to plan first.

I did plan the other novels on a spreadsheet, chapter by chapter, in the full realisation that the end result would bear no resemblance to my neatly organised, colour coded, boxes. Instead, the novel would develop as it went along. In the first few novels there were likeable characters, perpetrators, crises and an ending, but there was always something missing, kind of meandering that didn't quite hold together.

During the rewrite of my last novel I discovered something really important, that had been lingering at the back of my creativity, squashed into the background because of my resistance to conformity. There is a universal, traditional plot structure. And, further, it helps rather than hinders and flattens. I researched plot structure and sure enough I came up with several variations of the three act, crisis-turning point-crisis-climax-resolution model. I'm particularly keen on Freytag's Pyramids (below) and the three act structure, which has been around since Aristotle's days.

 A version of Freytags Pyramid, combined with the three act structure, is even more helpful.

So why use these structure? Why not just go into free-fall and write a totally unique story with no real beginning, middle and end? Of course, that's up to you, but people resonate with traditional story, because that is what our lives are - a story with a beginning, a middle and an end. It's tempting, for me at least, to be very creative with story, and write something unusual, something different. It's taken me a long time to reel in the feeling that somehow plotting and structure take something away from my novels. This has been my learning curve, realising my own psychic connection with structure.

Writing to a three act structure, around a storied plot, does not necessarily means writing to genre or writing commercially, or, as someone put it to me, selling out your creativity .Rather, it is like a hidden message in the work, a shape that readers can recognise. The detail must be unique and engaging to hold attention, but she shape can still be solid and traditional. It makes sense, if you do want to sell your work, to present it in a recongnisable form: a story.

The Internet is brimming with information on plot and structure, but it is something that many writers shy away from, feeling that the sameness it brings will spoil the wonderful worlds they have created. Structure won't spoil your story, it will provide signposts and navigation for the reader, a matrix to build your world around.

Gestation of ideas in creativity

I'm gearing up for National Novel Writing month. During November I'll be writing about 2000 words per day to progress my latest novel. I'm currently in the gestation stage, where something small will trigger me into thinking along a particular tangent.

I'll develop this over time (sometimes a long time, sometimes in a couple of hours) by collecting clues for my plot. These can range from character formations to backdrop scenarios. Eventually I will have notebook full of - well, notes - that will form the basis of the story. These notes range from single words to scenarios and short stories about the story.

By the time I start to write I know the approximate journey. It's like looking on Google maps to plan where you are going, you can even see the location. However, going there is a whole different journey, and what happens along the way will seriously affect what gets onto the page and the arrival. After finishing previous novels I've looked at the gestation notes and they rarely bear a close resemblance to the story I have ended up with.

I consider the gestation period as my most creative time, where ideas are unformed and malleable. This is a time before I consider the audience for my writing or even the urpose of it. The story is unbound and living large in my inner voice, where it is unchallenged and uncensored. As it emerges onto the page, the story morphs into a container of rules and regulations, a language that allows someone else to understand it.

Words I would use to describe this stage of the process is exciting and uplifting, optimistic and free, because whatever happens in this novel is entirely loosely formed at the stage, just a glint in the mind's eye. I can wake up in the middle of the night with an idea for the story, or it may come to me in the middle of the day as I work at my desk. I carry a notebook and post it notes everywhere, and if I find myself without these, I've been known to phone my own answerphone and tell myself the idea!

I write in first person present and I have to get to know the main character really well before I start to write. I might try to imagine what books they would read, what they watch on TV, how they would dress, the rooms in their house; it always helps to know the mundane things in their day to day life before I try to describe how an extraordinary event affects their existence.

I'm looking forward to writing 50000 words in one month with focus and routine, but first I'm reclining in the garden of my mind with my ideas for a while.

Change is good...

It's been a funny couple of weeks with a couple of u-turns. The most significant was my return to fiction writing. I decided on a change of genre and wrote a psychological thriller - they say write what you know! I 'd had a big break from fiction writing because of disillusionment with the publishing world during the recession, but now I've decided that I can do it for fun, it's is fun again!

It was like riding a bike. The familiar rush of excitement at the plotting stage, the waking up in the night with a new idea. Of course, I was doing the novel for National Novel Writing Month, and reached 50000 words just in time. This time, though, it would be different. I'd been reading Scarlett Thomas books for a while, and really resonate with her writing because it has a scientific and philosophical edge to the content. So I decided that I would try to write something along the same lines. I actually felt like my brain was going to the gym, waking up the imagination neurons and the storytelling axons that had been resting for a little too long.

In previous novels I have written a love story, or a story about relationships, and inserted some quirky, sometimes, downright weird, scenes. So I decided to write something weird and just outside the field of normal vision, and insert a relationship! It's going really well and I'm glad I managed to change my mind about fiction writing. It's fun and a big part of my life. Watch this space for more about 23 Acacia Road.

I've also moved offices to a more modern place outside the city centre. One Central Park is a beautiful workspace and a perfect environment to work, a very different place to where I spent the past fifteen years. My office on Piccadilly, Manchester had a prestigious address, and looked good on paper, but was dirty and cold inside. It just didn't live up to expectations once you really got to know it. My new office hasn't such a good address, but just stepping inside gives a sense of serenity and well being. I was dreading leaving the city centre, but after just two weeks I'm very happy to be working in Newton Heath.

Change is good. Finally. Risky, but good. I've always been a safe routine kind of person - even holidays are a stressful break from the day to day, week to week, year to year. Yet now, I've managed to change two major aspects of my life and I'm feeling pretty chilled out about it. Maybe I'm finally emerging from the my caterpillar constraints and learning to fly? So all I need to do now is take a risk and write some fiction in my new office and who knows what might happen!

Groovy Tuesday! Fractals in nature

Although nature is wonderful to look at and experience on a superficial level, a deeper understanding of how it works can be gained through fractals. Fractals are repeating structures found in nature, from the huge to the quantum. Many people dismiss fractals as 'boring science and maths' because they don't really understand what science and maths is - rather than a belief system, science and maths are one way that human beings communicate meaning to each other in an ordered way to make sense of the world.

What could possibly convey the meaning of nature better than to examine the smallest parts of living organisms and find something so beautiful that we can organise words and symbols around to make sense of life?

Positive thinking - glass half full?

I couldn't let this week pass without writing about an uncomfortable experience with the photocopier repair man. In he came, with his hard black case and his porn moustache, a distinct throwback from the days of Jason King. He unpacked, immediately requested cup of coffee, and began to work on the machine.

Eventually I decided it would be polite to ask how he was getting on. He stood up and looked at me. "Congratulations!" he said gleefully. "What do you mean?" I queried, although I already had a hint of what was about to occur. His eyes drifted to my stomach. "Well, your either expecting or you've eaten all the pies!" I fixed him with my best PMS stare. "I ate all the pies then." He laughed. "Yes. When's it due?" I clarified. "I'm not pregnant." He became a little more serious. "Oh. Sorry." Me, making it worse. "I'm too old to have babies." Him: "No. You're definitely young enough."

Now, passing over all the feminist connotations of this interaction and ignoring the fact that he had practically accused me of lying twice on account of his personal opinion - and that he was clearly weighing up in front of me whether I was 'fit for purpose' - I was momentarily stunned. Then I was elated. The first thing that came into my mind and stayed there was: "Wow, I still look childbearing age!"

My colleague, who heard the conversation, asked me if I was OK. I told her that I was pleased with his assessment of my youth. She looked at me hard. "How do you do that? He's just really insulted you, called you fat, and you still get something good out of it?" I was only half listening to her because I was now starting to feel sorry for photocopier man who was hurriedly pushing his tools into his back case, the sweat dripping from his 'tasche.

It did make me think, though. I'm not the slimmest person in the world and I expect people notice that. After all I am hurtling towards 50 and don't 'diet', don't use any 'beauty products' and take moderate exercise. I think the key is that I don't really care. Obviously, I care what people think of me professionally and I really care that people see me as a nice person. Yet aesthetically, I'm not so concerned. Having grown up being bullied for my ginger hair and having had people point at me in the '70's when I had a child at sixteen (yawn, yawn; cue Alanis and 'I see right through you.'), I have had my fair share of other people's opinions thrust at me. Maybe I'm desensitised. I guess I'm a 'glass-half-full-person'.

I'm not sure if positive thinking is something that comes naturally to people or if it's something we have to work on. I am fairly sure, though, that worrying what other people think and trying to predict the future contribute to negative thinking. Sometimes the worst-case scenario, the most gut wrenching horrible situations do happen and then it's appropriate to feel bad. But on all the other occasions there is usually a the dregs of happiness at the bottom of a half empty glass. I've often heard people say, "I'm a natural worrier!" yet I hardly ever hear people say that they are natural optimists.

So I'm off to sit in the sunshine and feel pleased that I still look young enough to reproduce, happily ignoring my middle-age spread. Made me wonder which is real, though, what other people see or what I think? Or both?