Stories about bodies

Stories about bodies:
A narrative study on self-understanding and chronic pain


Objective. To explore experiences from a process of change for women with chronic pain.
Design, setting, and subjects. A group-based treatment program was intended to increase the awareness of how attitudes, habits and bodily practices are established, developed, and can be transformed, and thereby probably reduce pain. A single case story from this treatment program is presented. A semi-structured interview was conducted with all participants about their experiences after completion of the program. All eight women reported that they had benefited from participation. From these interviews a single case was chosen to represent the study's findings. A narrative analysis was conducted, focusing this patient's story from a phenomenological understanding of the body. Results. The patient's story illuminates how events and experiences can be connected, and how she interprets her contemporary situation in the light of previous experiences. In this way, she alters her understanding and develops a new approach to her situation. Her story demonstrated how symptoms can be understood as the result of stressful habits that the body has developed as a reaction to demands from the surroundings.
Conclusions. Reflection on how the body functions may lead to a new realization of how phenomena are interconnected, thus making changes possible.

Key Words: Case study, family practice, mind-body relations, myofascial pain syndromes, narrative medicine, self-concept
A group-based treatment with movement training and discussion for women with chronic muscle pain was developed in primary healthcare.
The goal was to increase participants' awareness of their bodies and the connection between personal experiences and bodily habits.
• A narrative approach can show how patients can link events and experiences together, and the significance attributed to the experiences.
By getting to know their own reactions, vulnerability and strengths in a treatment program, patients may get an opportunity to change.
Physiotherapists are often able to demonstrate bodily changes in patients with chronic pain, even when doctors make no objective findings. The patient holds her breath, her back and neck are stiff, and she has poor balance [1,2]. The physiotherapist's finding may help us to understand how the pain is triggered and maintained in the individual patient, but tells us nothing about why the patient has developed strainfilled bodily habits.
According to a phenomenological perspective, our natural acceptance of the human body develops by experiencing the world with and through our body, and by reflecting on our encounters with the world [3,4]. Experiences leave traces in the body as body habits and reaction patterns - posture, mimicry and movements. We acquire mental and bodily attitudes to ourselves, to the world and to other people. Security or insecurity experienced during childhood can result in different body habits and reaction patterns.
Kirkengen describes how abuse is inscribed into bodies, and may appear as various disorders, including chronic pain [5]. A continuous ‘‘being on guard'' attitude may be expressed as holding the breath, tense musculature, and a restricted movement pattern. Body habits are usually unconscious, and they have to be discovered before they can be changed.

Using this as a starting point, a physiotherapist and a doctor developed a group-based treatment programs for women with chronic muscle pain. Experiences in the group prepared the ground to alter bodily habits towards better balance, reduced muscle tension and more freedom when breathing [6]. Participants in previous treatment groups have reported experiences of change during the program [2,7,8]. The treatment program has been presented in more detail in previous publications [2].
We wanted to learn more about how the change processes were experienced by the participants.