Honors 222: Pain
HONORS 222: Pain presented a great opportunity to study in a field outside of what I'm used to - the field of medicine. I came into this class with an expectation (unsupported by the available materials about the class - wishful thinking) that this class would focus on pain from a psychological or humanities perspective. Instead, this class, led by John D. Loeser and Jonathan D. Mayer, two leaders in the field of pain medicine, provided a medical perspective on pain. The class began with an introduction on pain, and clarified that pain occurs in the brain, not in the body part that hurts - you may feel pain in your toe, but it is really occurring in your brain. This is critical to understand, since much of the class focused on the differences between acute and chronic pain, a difference which is often poorly misunderstood, leading to greater suffering for chronic pain patients.
They presented the model of the 'pain onion' (because it has layers), created by John D. Loeser. The first, innermost layer is nociception, the recognition of tissue damage in the body. The next layer is pain, followed by suffering (psychological hurt), and then pain behavior. The last of these is the only one which can be measured or observed by doctors. Therefore, it is pointless and harmful to mock or not believe patients' descriptions of their own pain.
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We then explored the differences between acute and chronic pain. Loeser and Mayer prefer to divide pain into peripherally-generated versus centrally-generated pain - this changes the focus from duration to cause. However, most acute pain is peripherally-generated while most chronic pain is centrally-generated. Peripherally-generated pain is due to tissue damage while centrally-generated pain is a nervous system issue. Many chronic pain conditions such as fibromyalgia and back pain often have no corresponding observable physical bodily damage. Regardless, the pain of chronic pain patients is very real and often disabling. We learned about many ways in which chronic pain patients are failed by the medical system (which is often tied to our private healthcare system) - their pain may be dismissed and they are often over-prescribed medicines such as opioids which have negligible effects on reducing pain. Instead, effective treatment involves programs which encourage chronic pain patients to slowly become more active rather than fall into cycles of bedridden states followed by over-eager activity that brings more elongated bouts of pain. Effective treatment also often includes psychological treatment.
This class involved a very reasonable portion of weekly reading assignments and 'thought pieces', short reflections on the reading assignments, and a twenty-page paper. Unsurprisingly, I neglected to work on the final paper sufficiently until the last week or two of the class, but I came up with a topic early on - the connection between emotional trauma and pain (I would say physical pain but Loeser and Mayer would chide me - all pain is pain and it is confusing to refer to suffering as pain). Centrally-generated pain patients have much higher rates of emotionally traumatic events throughout their lives. Some patients with centrally-generated pain and related emotional trauma experience pain that seems to stem wholly from their emotional trauma while others experience far worse pain than would be expected from relatively minor injuries. This topic is of interest to me due to my exposure with trauma-informed practice, mostly due to Jera Johnston and Margeux Feldman (the former due to my experience of her work at Lost Valley Educational Center, where she used embodied practice to express avoided emotions, the latter due to their Instagram page).
I did some preliminary research for my paper and decided to do my project on Emotional Awareness and Expression Therapy (EAET), an emerging psychotherapy for chronic pain which guides patients in becoming aware of their emotional trauma or difficult emotions and the link between those emotions and their pain and then helps those patients to express their emotions vividly. It has shown to be as effective or more effective than pain-CBT, the 'gold standard' psychological treatment for chronic pain. Pain-CBT critically differs from EAET since it focuses on controlling thoughts (cognitive processes) rather than emotions. EAET is an exciting instance of trauma-informed practice becoming more common in mainstream medicine.
I did some preliminary research for my paper and decided to do my project on Emotional Awareness and Expression Therapy (EAET), an emerging psychotherapy for chronic pain which guides patients in becoming aware of their emotional trauma or difficult emotions and the link between those emotions and their pain and then helps those patients to express their emotions vividly. It has shown to be as effective or more effective than pain-CBT, the 'gold standard' psychological treatment for chronic pain. Pain-CBT critically differs from EAET since it focuses on controlling thoughts (cognitive processes) rather than emotions. EAET is an exciting instance of trauma-informed practice becoming more common in mainstream medicine.
If you're interested, feel free to peruse my paper or check out some of the resources I cite. I will note that the paper mostly consists of reviews of the literature since I do not know enough about the subject to be confident reaching my own conclusions, although I try to reach conclusions through comparisons of different sources and the knowledge I gained from research. Due to the subject matter, the paper contains mentions of sexual assault and other highly traumatic experiences although it does not go into graphic detail.
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All in all, this class was a valuable dive into a topic I know as personally as most humans yet lack a medical understanding in. This knowledge will help me to advocate for best medical practices for my own and others' healing. Also, I enjoyed the opportunity to joke 'I'm in Pain' when asked what classes I was taking.
My first job
This quarter I only took 13 credits, and two of my classes were in fields I already had a good knowledge of - my workload was relatively light. I chose to pick up an on-campus job since I wanted the extra cash and the work experience, and it felt like the perfect time to do so, since in the fall I will be in the Landscape Architecture program and spending many hours working on landscape architecture projects. I was hired to work at Local Point, the West Campus dining hall, and worked 14.25 hours per week (although I was twice interrupted by sickness and missed some days for various events). I was paid $17.27/hour, but it ended up being about $15.75/hour after deductions.
The job was pretty straightforward (and I was given some of the more straightforward jobs available to students, for the most part). I worked in the dishroom scraping food off of dishes, running them through the industrial dishwasher, and putting them back and served food at Big Kitchen, one of the dining locations in the hall. Most students groaned when I mentioned that I worked in the dishroom, but I enjoyed it since I got to blast music or listen to podcasts while I did so. I especially enjoyed listening to the podcast Back Again, Back Again, a queer fantasy podcast that questions the tropes of royalty so common in fantasy, written and narrated by a fellow student in my dorm. I began the job very anxious and left more confident in my ability to work a job. Of course, there were frustrating aspects, such as realizing how poorly students sort their waste (including student workers, who put gloves in the compost all the time), but overall I enjoyed the experience and my coworkers, who were, for the most part, very sweet.
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Deepening My ecological knowledge
This quarter, I took the class L ARCH 363 – Ecological Design and Planning. I found most of the course material redundant since I’ve studied ecological design extensively inside and outside of the classroom, but the course still presented some fun opportunities to learn more about ecology, such as class field trips and class projects. For my final project in the class, I created a poster about water retention strategies in the shrub steppe, the dominant ecosystem of Eastern Washington where I grew up. I didn’t learn much of anything new from my research – unfortunately, ecological design resources for the shrub steppe are few and far between, which was a major motivation for choosing this topic in the first place.
Outside of class, I enjoyed two major opportunities to deepen my ecological knowledge. The first was the Washington Native Plant Society’s (WNPS) study weekend in Ellensburg, Washington at the end of April. I went on several hikes and witnessed plant-related talks with fellow WNPS members, most of whom were far older than me. However, some members were excited to see someone of the younger generations who was as passionate about native plants as they were. On my hikes, I got to return to Wild Horse Wind Farm and see Washington’s beautiful native ball cactus, the basalt cactus (Pediocactus nigrispinus), which I studied for an earlier project, and visit a wetland near Yakima. I met a few other WNPS members who were critical of the government-centered solutions encouraged by one of the speakers (who was in a state position) and, like me, supported grassroots ecological action to grow abundance with our native environments. I also viewed some interesting (sub)urban landscapes in Ellensburg, some inspiring and some frustrating, which kept my gears turning about public ecological design in the shrub steppe.
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The weekend after the WNPS study weekend, I enjoyed another exciting opportunity, this time to participate in a mass cultural planting project at Songaia, an ecovillage in Bothell, Washington. This ecovillage is an incredible plant paradise surrounded by drab suburban housing developments – the garden is lush and diverse, fruit trees abound on the property, and the back of the property is a wooded area full of native plants and wound through by meandering trails. This project was led by Patricia Newkirk, a family friend, and Anita Higgins, another Songaia resident. The project consisted of planting hundreds of native plants in an about 8,000 square feet area divided into 10’ by 10’ squares for planting ease. The planting area was divided into two halves – one was a control planting that would be planted to the recommendation of the Natural Resources Conservation Service’s (NRCS) – with one bush per 10’ square and several groundcover plants, some of which weren’t even native to Washington state (like California Poppy). This was contrasted with squares planted in the Miyawaki method of forest restoration, in which plants are densely planted – in this area, several bushes were planted in each 10’ square with several groundcovers, all native to Washington state. Time will tell which fares better, but I expect the Miyawaki method will do much better. The necessity for biodiversity and planting density is a growing understanding in the fields of ecological restoration and landscape architecture alike.
This planting was called a cultural planting since all plants planted are significant to Indigenous peoples of the region. The leaders of the project got in touch with Linzie Crofoot, a Tlingit expert in botany, who collaborated with the Songaians and visited during the planting to share wisdom about Indigenous connections to the plants native to the site. The acknowledgement and centering of Indigenous relationships to plants in this project set it apart from all other restoration projects I’ve been involved in so far – this project involved daily land acknowledgements and attempts to learn the Lushootseed (a language of the local Indigenous peoples) names of the plants we were working with. The project was also done with an understanding of the plants as relatives and collaborators, not simply objects to be planted for ecological benefit. This helped to make this project the most fulfilling restoration project I have been involved in so far.
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The cultural planting was the main event of Songaia’s Festival of the Earth, which involved yummy food made by residents and late nights on the rocket mass heater bench on Songaia’s patio. Several of my wonderful friends visited and helped out during the planting, and I met many other wonderful people who worked on the planting as well, making the busy weekend even more exciting. The Indigenous and relationship-centered perspective of the planting was powerful and something I hope to learn from and incorporate into restoration and design projects I’m involved with in the future.
I'm finishing up this reflection in my hometown in Eastern Washington, where I'll stay all summer growing my ecological knowledge. In the fall, I will start the University of Washington’s Bachelor of Landscape Architecture (BLA) program! I received this exciting news on my way to the WNPS Study Weekend, which was a fun coincidence! This is an incredible opportunity to deepen my ecological knowledge in a way that will incorporate an understanding of urban environments as unique ecologies. I’m excited to continue to learn more about ecology through this program, but more excited to get right to work in the shrub steppe over the summer.
Certainty of the Oar: A Year in ReviEW
I’m trying to come up with a metaphor to summarize my experience of this year and my current perspective on life, and the best I can do is the image of myself as a kayaker traversing unknown waters cloaked in fog. I’m frustrated by my tendency to conceptualize of myself as an isolated individual, and yet I find myself coming out of this year skeptical of the ability of humans to collaborate and create loving and creative societies with the ability to challenge the destructive capitalist society we live in that is grinding our planetary ecologies to dust, threatening Indigenous livelihoods, and oppressing many, many people in brutal work conditions for the profit of a few. Of course, the cultural planting project I write about above is a stark counter-example to this skepticism, yet it doesn't directly address larger-scale oppressive systems like the prison-industrial complex. Campus activism seems ineffectual and more concerned with looking radical and grabbing onto what has captured the collective consciousness than engaging in effective, long-term campaigns that analyze our condition as university students and target the issues which we have most power to effect. While I have my critiques, I’m not immune to criticism myself; I’m not as dedicated to activism as I could be and I don’t have all the answers. I’m incredibly grateful to my friends for providing sounding boards and affirmation as I vent my frustration with campus activism. The music of London-based Nigerian artist Obongjayar has also helped keep me afloat; his song “Wind Sailor” that closes his debut album Some Nights I Dream of Doors reflects my perspective perfectly.
Despite this perspective, I’ve found hope in my relationships with other students who inspire me and show me what it looks like to live with integrity. Paddling through these turbulent waters, I’m uncertain of anything, but I find solace in the knowledge that all I have control of is myself. I can do my best to live in accordance with my values and hope that I can move in a bountiful direction, building more connections with people that inspire me along the way.
Despite this perspective, I’ve found hope in my relationships with other students who inspire me and show me what it looks like to live with integrity. Paddling through these turbulent waters, I’m uncertain of anything, but I find solace in the knowledge that all I have control of is myself. I can do my best to live in accordance with my values and hope that I can move in a bountiful direction, building more connections with people that inspire me along the way.