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

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.

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!