Where Words Don't Follow ; Historical Trauma, Chronic Pain & Healing in Native American Communities.
'By the Death Bed', Edvard Munch, 1896.
CONTENT WARNING ; the following blog contains descriptions and references to pain, suffering, death, dying, sexual abuse, structural racial violence, historical trauma & substance abuse. If these topics are likely to trigger you, please don’t feel obliged to proceed for my sake.
The United States is in pain. Over 20% of Americans experience some degree of chronic pain, and approximately 8% experience high-impact chronic pain, which entails a degree of pain that frequently disrupts life and work activities (Dahlhamer et al,. 2018). The burden of severe chronic pain is immense, and words alone cannot even begin to describe the lived experience of inhabiting a body that will likely never stop hurting. Chronic pain is pernicious and elusive. It confers no physical mark, no signature scent. It has no voice, except when it dissipates through pursed lips, carried in the breath of a defeated sigh or an anguished cry.
And every experience of chronic pain is different. For some people, the pain they feel will always be relegated to a specific part of their body ; unwavering and consistent, yet devastating all the same. For others, their pain cannot be identified, located or mapped. It simultaneously envelops them, and radiates from within them, overwhelming their senses and suffocating all rational thought. It constrains and regulates bodies, turning them into carceral structures. And when we speak of bodies, we must also necessarily speak of the political, the social and the economic. Pain transcends the material. It produces and is productive of particular discourses about pain, bodies, gender & race.
This position necessarily provokes critical inquiry. Indeed, when we speak of pain, who’s pain do we speak of? In relation to pain, where do we draw the line between the material, the spiritual and the medical? What are the historical material processes that produce states of pain and suffering? And can alleviating psychological burdens help to resolve physical suffering? I hope the following essay will provide some insight into the nature of these questions. As a medium through which to investigate these questions, the following essay seeks to identify how intergenerational trauma and systemic racial violence are somatised and embodied by contemporary Native American people in America, expressed through the medium of profoundly felt physical and psychic pain.
In the course of this essay, I employ both the terms ‘Native American’ and ‘American Indian & Alaska Native’ somewhat interchangeably. Bearing this in mind, Native Americans are not a homogenous group, and I use collective terms for the sake of convenience. However, I try to make reference to the specific terms used by a given Native Group to refer to themselves collectively, such as ‘The Lakota’, when possible (Smithsonian, 2022)
Public Health Outcomes in American Indian & Alaska Native communities.
In the United States, the Indian Health Service provides healthcare to approximately 2.2 million American Indians and Alaska Natives (AI/AN). According to the IHS website, the Indian Health Service seeks to “ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people”. Unfortunately, this aspirational strategic goal is largely non-reflective of the lived experience of Native Americans in the United states, who generally experience dismal healthcare outcomes across almost every measure. Although I will caution against over reliance on impersonal medical data, here are a few statistics about healthcare outcomes amongst Native American men & women in the United States.
For instance, nearly half of Indian American men and women suffer from metabolic syndrome, a group of five risk factors which significantly contribute towards the development of cardiovascular disease (Schumacher et al,. 2008). Furthermore, the life expectancy at birth for the Native American population is between 2.4 & 4.4 years less than that of all U.S populations combined (Rice, 2021 ; IHS, 2017). Perhaps the most relevant statistic to the topic of this essay, is that Native American men & women are three times more likely to experience chronic pain than non-hispanic white people (Ross et al,. 2019).
There are indeed purely material reasons for why healthcare outcomes are so poor for American Indian populations. The Indian Health Service has been described as being “severely underfunded”, which critically undermines the delivery of effective & comprehensive healthcare services to American Indian patients (Roubideaux, 2004, P.v). The budget which is federally allocated to the Indian Health Service has largely failed to scale with growing healthcare burdens in AI/AN populations. Indeed, between 1993 & 2013, the gap between spending on the IHS & Medicare grew by a factor of 8. In 2009, per capita expenditure by the IHS was a meagre 2,130 dollars per capita; over a thousand dollars less than per capita healthcare expenditure on federal prisoners (Malerba, 2013).
Surely, the material inequities in the provision of healthcare services to these populations may be located within the context of America’s legacy of colonial oppression. Nevertheless, the lived experience of chronic pain & disability can not, and should not be viewed as incidental to historical processes of dispossession, colonialism & racial violence. Indeed, chronic pain is partially the physical & phenomenological embodiment of historical trauma itself, a concept which I will expand upon in the coming sections.
Bury My Heart at Wounded Knee ; The historical trauma of American Indian & Alaska Native peoples.
On a frigid winter's day in 1890, a crimson veil would descend upon the pristine, snowy banks of wounded knee creek. A band of Lakota Sioux people, 350 strong and led by Spotted Elk, would be stopped by a detachment of the U.S 7th Cavalry Regiment. The party consisted mostly of unarmed men, women and children, who had fled to join Spotted Elk after federal agents had executed another Lakota chief, Sitting Bull. Although nominally committed to peaceful deescalation, the regiment was preparing for conflict ; four mountain guns were positioned, encircling the camp of Lakota. After a rifle would misfire following an attempt to disarm a ‘non-compliant’ elderly Lakota man (who happened to be deaf), the US 7th Cavalry regiment would fire indiscriminately at the terrified Lakota. When the dust settled, anywhere between 150 and 300 of the Lakota lay dead, their lifeless forms soon cloaked in fresh snowfall (Grua, 2015).
Wounded knee is just one element of the historical trauma which continues to be borne, inherited and inflicted upon the descendants of the Lakota who were murdered at Wounded Knee. The Wounded Knee massacre would come to be viewed as the death rattle of a nation who had been left bereft of their lands, language, culture and very lives. In the years that would follow, the ‘civilising mission’ of the United States government would rend the fabric of the Lakota people asunder. In an effort to mandate assimilation with the encroaching white settler population, a system of boarding schools would emerge, which sought to “Kill the Indian in him, and save the man” (Bear, 2008).
Enrolment in Indian Boarding Schools was mandated ; children belonging to recently ‘hostile’ tribes and peoples were targeted with particular fervour. By forcibly assimilating the children of their (former) enemies, federal authorities sought to nip any potential resistance in the bud ; although violent ethnic cleansing had become distasteful, ‘assimilation’ remained relatively palatable. The boarding school system would nevertheless operate as the vessel by which the ‘savage’ native would be delivered to spiritual salvation and submission to imperialist domination. Cloaked in a veneer of piety and benevolence, the Indian Boarding School system would come to be a mnemonic for horror, alienation and dehumanisation amongst the children who survived.
The bodies of Native American children were systematically regulated, measured, observed and contorted. Hair, which possesses considerable spiritual and cultural significance in many Native American cultures, would be shaved. This action was ostensibly performed for purposes of hygiene. Nevertheless, its primary purpose was to initiate the incipient pupil into a systematised process of cultural effacement and biological regulation. Indigenous languages were forbidden, and the clothing provided to the children would be uniformly stark and homogenous. In doing so, the child could become a tabula rasa - homogenous, passive & malleable - to be forged anew, in the image of white, christian ‘civilised man’ (Davis, 2001).
Material conditions were abysmal. Infectious disease, exacerbated by malnutrition and physical abuse, would kill many children, who were frequently buried in mass, unadorned graves. Physical, emotional & sexual abuse was systematised. Inauguration into an orthodox discursive regime of christian sin, shame & guilt would further exacerbate the alienation of Native American children from their cultures, & provide a fertile ground for the development of psychosocial problems later in life. Upon graduation out of the boarding school system, the children who had survived would find themselves caught in a purgatorial space between their traditional communities and the ‘trappings’ of encroaching western civilization - bereft of their native culture, and yet nevertheless ostracised and subjected to violence by white settlers (Davis, 2001).
The Indian Boarding School system is not a distant memory. Indeed, Indian Boarding Schools operated, much as described in the previous section, until the early 1970s at the very least. And the memories of the horrors they beheld are not static either. As recently as June 2021, 751 unmarked graves would be discovered at a single residential school in Canada, which operated contemporaneously and analogously to the Indian Boarding School system in the United States (BBC, 2021). Historical traumas thereby intertwine and co-mingle with contemporary traumas, as old wounds are once more torn asunder, inspected and stitched up again, only to become infected and excised once more.
Somatising Intergenerational Trauma.
Mind & matter are not necessarily mutually exclusive. Psychological suffering can beget physical pain. The process whereby mental anguish, resulting from severe trauma, for instance, can produce physiological distress is called Somatisation. Sadness, terror, and anger can thereby be ‘converted’ into physiological symptoms, such as indeterminate pain, nausea or seizures. The somatisation of severe trauma is mediated by a number of physiological, epigenetic and cultural mechanisms. In this fashion, mental and physical trauma can be mutually constitutive ; the line between anguish and agony is necessarily blurred.
On a micro level, almost everyone will experience some degree of somatisation throughout their lives. When you’ve just asked your crush out on a date, and you’re held, breathless, in those purgatorial moments between confessing your affection and learning of their response, the butterflies in your stomach are the physical expression of your trepidation ; of your vulnerability. For those with experiences of severe trauma, the fashion in which memory, fear and alienation are embodied and converted may be more pernicious or dramatic. Somatisation in victims of childhood sexual abuse (CSA) will frequently manifest as chronic pelvic pain, irritable bowel syndrome, non-epileptic or dissociative seizures and back pain (Bae, 2018). Several studies have observed that holocaust survivors were more likely to be afflicted by a trifecta of higher experienced pain levels, more pain sites and significantly higher depressive symptoms than the general population (Yaari et al,. 1999).
Furthermore, extreme trauma and distress are capable of fundamentally distorting an individual’s ability to relate to others and to themselves. In particularly extreme trauma states, identity and sense of self may fragment, as we might observe in dissociative identity disorder, or dissociative amnesia in the context of PTSD (Dorahy et al,. 2014). As their bodies become haunted by the living memory of extreme suffering and stress, trauma survivors may experience emotional numbing, dissociation or extreme mood lability. Naturally, this distress is transmitted across generations, as the children of trauma survivors become reservoirs of hope for their troubled parents.
Having observed relationships between holocaust survivors and their children, the authors of one study identified the key mechanisms and processes that mediated the intergenerational transmission of holocaust trauma. On the one hand, the trauma of the holocaust had made their parents cold or severe, making it difficult for the children to develop secure attachment patterns with their parents. Furthermore, the caregiving style of holocaust survivor parents was characterised by frequent role-reversals, with the child having to take on an emotional caregiving role for their parent. Finally, the experience of having lost many of their family members to the holocaust would make holocaust survivor parents overprotective disciplinarians, which would distort the children’s ability to form relationships outside of the family (Dashorst et al,. 2019).
Furthermore, grief, rage and terror can become embedded and expressed in the very genetic makeup of a traumatised individual. Indeed, extreme stress can induce epigenetic changes ; heritable phenotype changes, that do not involve alterations in the DNA sequence. In a landmark study, Monica Uddin and Derek Wildman analysed the genomes of tutsi women who were pregnant at the time of the Rwandan genocide. They observed that the ‘terror of genocide’ was in fact associated with ‘stable, but reversible, chemical changes made to DNA that help to control a gene’s function’ (Meketta 2022 ; Uddin et al,. 2021).
In particular, the study revealed that the offspring of genocide survivors had higher rates of DNA methylation, which is an epigenetic process whereby methyl groups are added to DNA molecules. Studies conducted with the children of holocaust survivors have corroborated the influence of epigenetic changes on the intergenerational transmission of trauma. In particular, it was found that exposure to holocaust trauma prompted epigenetic changes in the expression of the Glucorticoid receptor gene, mediating alterations in the levels of the stress hormone Cortisol, in both mother and child. Furthermore, altered hormone expression and metabolism may itself be a risk factor for developing PTSD in the children of holocaust survivors (Kellerman, 2013).
Of course, the conclusion that trauma can be so fundamentally ‘encoded’ and transmitted across generations is not uncontroversial. The existing studies are of variable quality, and a more rigorous investigation would demand that we analyse third, fourth and fifth generation descendants of trauma survivors. Nevertheless, there’s something here. If trauma can, quite literally, change our genetic makeup, what are the implications for the children of trauma survivors? Is the distress and suffering of our ancestors irrevocably embedded in our bodies? Does Epigenetics represent another form of problematic biological determinism, or instead does it offer insight into healing Native American bodies and communities? The answer to these questions remains elusive, but I will attempt to explore these queries in the proceeding sections.
‘I feel your pain’ ; How the embodiment of historical trauma produces and mediates individual and collective chronic pain.
American Indian and Alaska Native children bear the highest child disability burden of any population in the United States (Srikanth, 2021). In general, AI/AN people are considerably more likely to experience chronic pain, severe disabilities and multiple medical comorbidities. Higher rates of disability and chronic pain correspond to a greater burden of care, which is almost always provided by family members, including young children. Carers provide not only financial aid and physical assistance, but also emotional support, helping to shoulder some of the burdens of immense suffering. As such, they are particularly susceptible to secondary traumatic stress. This distress becomes embodied by the carers themselves, potentially accentuating their own chronic pain and predisposing them to further psychological and physical illness. Furthermore, people who occupy caring roles, both physically and emotionally, are liable to experience ‘empathy burnout’, or compassion fatigue.
Compassion Fatigue is a term that is frequently used to describe the constellation of symptoms, spanning across psychological, physiological and social dimensions, that are generally perceived to be the result of secondary traumatic stress. In this capacity, trauma is ‘infectious’ ; witnessing or learning about the suffering of others can itself exact a considerable toll on our mind, body and spirit (Sabo, 2011). Physiologically, when we witness other people in suffering, we embody their physical pain and distress - we quite literally feel some part of that pain in our own bodies. Indeed, activation of specific brain areas when observing physical pain in others “overlaps with activation during directly experienced pain” (Lamm, Decety & Singer, 2011, P.2492). Our bodies can thereby become mirrors which reflect the anguish of our loved ones, and a canvas upon which the crimson hues of their torment are inflicted.
Furthermore, trauma itself can simultaneously connect and disconnect us from other’s experiences of pain. When we see someone in pain, physical or emotional, our capacity for empathy allows us to share in that experience. Certainly, compassion and empathy serve a positive and prosocial purpose. They allow us to distribute the burden of suffering, build bonds on the basis of shared experience & provide the compassion and love that are necessary to maintain our collective emotional health. However, there is only so much one person can take ; only so heavy a burden we can bear, before our body and mind begins to decay and fracture. Like a rock, relentlessly buffeted by the violence of the sea, our surface eventually becomes dulled and opaque.
Merely hearing stories about the traumatic experiences of others can have profoundly negative effects on our bodies and minds. Storytelling represents a critical component of the oral tradition of many Native American groups, whereby collective identity is partially constituted by stories of collective hardship and suffering. In this capacity, storytelling can serve to reinforce collective and historical empathy, thereby strengthening social bonds and insulating Native cultures from both forced and passive assimilative processes. Nevertheless, repeated exposure to stories of death, sexual abuse, structural racism, forced assimilation and physical illness can directly challenge deeply held social and moral values. Such experiences can contribute towards a progressive loss of faith in humanity, and a fundamental distortion of the self. In this fashion, historical trauma builds upon contemporary trauma. Lived experiences of suffering amongst AI/AN people are layered upon and co-constituted with ancestral, spiritual and phenomenological memory.
Suffering thereby begets suffering - pain is circulated and inflicted, and mental distress is somatised. These processes contribute towards a vicious cycle in Native American communities. As incredible trauma, pain and anger are distributed, the collective body begins to crack under the immense weight of traumagenic burdens.
Healing unresolved grief through trauma-focused psychosocial interventions.
Acknowledging the burden of historical trauma in AI/AN communities allows us to locate lived experiences of chronic pain and disability at the intersection of a complex interplay of historical, epigenetic & socioeconomic mechanisms. However, whilst it is undoubtedly important to contextualise the public health challenges faced by AI/AN communities, such a discourse is potentially problematic. In particular, epigenetic explanations, whilst interesting, may come dangerously close to articulating and reinforcing ideas of biological determinism, which have historically been used to justify racist discourses about Native Americans. For instance, does conceptualising chronic pain as the inherited & embodied memory of collective suffering take away agency from AI/AN chronic pain sufferers? Does it identify chronic pain sufferers as being the inevitable conclusion of monolithic socio-historical & biological processes, and thereby efface the ways in which AI/AN individuals have doggedly challenged the material medical inequities that affect their communities?
As I go forward, I would like to keep these questions at the forefront of my mind. However, whilst I would concede that such a discourse may be liable to bind and constrain individual agency, it may also provide the ground upon which healing can be achieved. For instance, whilst epigenetic mechanisms may mediate susceptibility to physical & mental illness, environmental factors may simultaneously contribute towards psychological resiliency & plasticity (Smeeth et al,. 2021). Furthermore, experiences of historical trauma likely play a critical role in consolidating collective cultural identity. Where there is suffering, there is also kinship, empathy, community & passion. To this end, I think a review of the concept of post-traumatic growth is relevant here.
Post-traumatic growth refers to positive psychological change that occurs in the aftermath of a traumatic event. Whilst trauma has the capacity to alienate and distort, it can also provide a foundation upon which we can critically evaluate our relationship with ourselves and our loved ones (Jayawickreme & Blackie, 2014). You yourself may have experienced some degree of traumatic growth. Indeed, most of us will, even if just in response to the many little losses, heartbreaks & challenges that are bound to speckle our lives. The bottom line is that whilst trauma has the capacity to tear us asunder, it can also provide the context and perspective we need to heal and transform our lives.
In this setting, maybe thinking about individual post-traumatic growth can give us some insight into how communities, cultures & even nations can emerge from the embers of collective suffering and grief. In relation to AI/AN communities, whilst historical trauma has produced great suffering, it has also produced incredible resiliency and passion. Furthermore, communities are not just constituted by kinship, but are indeed forged in the image of shared experiences of hardship and suffering. In this capacity, for good or for bad, historical trauma plays a critical role in constituting collective identity. Acknowledging and connecting to memories of collective suffering allow for individuals to build and reinforce bonds of empathy, solidarity & kinship with their families, communities & ancestors (Wiechelt, Gryczynski & Lessard, 2020). These are the ties that bind. And in binding us together, these ties also allow us to connect to and share in our love for one another.
With this foundation as our starting point, we can begin to consider how we might develop empirical interventions against chronic pain & illness that exist within a context of historical trauma. If we identify chronic pain as the phenomenological embodiment of collective trauma and suffering, we can also locate a path to resolution in the same place. On an individual level, the existence of a relationship between trauma and chronic pain is indisputable (Afari et al,. 2014 ; Åkerblom et al,. 2018). This relationship is complex and bidirectional. On the one hand, trauma itself disrupts physiological processes and imprints itself in our genetic makeup. Simultaneously, the behavioural response to unresolved trauma and grief amplifies the feelings of vulnerability, entrapment & hopelessness that accompany states of chronic pain. Consequently, by identifying & resolving profoundly embodied psychological wounds, trauma-focused interventions can in fact also contribute towards alleviating physical suffering.
In treating individual patients with comorbid PTSD and chronic pain, trauma focused interventions have been empirically proven to reduce measures of both psychological and physiological distress. In one study, a trauma focused modality called ‘Accelerated Resolution Therapy’ (ART) was implemented in the treatment of U.S military veterans who suffered from pain secondary to combat-induced PTSD. One element of the trial involved the study participants actively recalling the traumatic incident. They were then asked to identify and describe the psychological and somatic symptoms which accompanied re-experiencing the event. Following exposure to the distressing memory, a clinician would guide the participant through the “identification and diminishment (or eradication) of any uncomfortable emotional or somatic symptoms” (Kip et al,. 2014, p.3). This trial was a resounding success, producing marked reduction in not only PTSD symptoms but also in relation to the corresponding pain and somatic symptoms.
It’s therefore not exactly a stretch to postulate that trauma focused interventions may have applicability in resolving physiological distress in bodies and communities that stand at the intersection of historical and contemporary trauma (at least to some capacity). Departing from the assumption that unresolved historical grief and trauma produces psychosocial and physiological problems for members of the Lakota, Maria Yellow Horse Brave Heart describes the results of a four-day trauma-focused and community oriented intervention. To commence, Yellow Horse Brave Heart identifies a trinity of clinical manifestations that are produced by unresolved grief over historical trauma ; depression, substance abuse & somatisation. These three aspects are mutually constitutive, and mediate profound impairments to the quality of life of many Lakota people.
They note that “the perpetuation of suffering and victim identifications results from loyalty to the deceased as well as identification with parental suffering” (Yellow Horse Brave Heart, 1998). In this capacity, the contemporary body of the Lakota becomes a memorial site upon which the transposition of historical suffering is an act of ancestral & intergenerational solidarity. Departing from this intellectual foundation, the intervention sought to unearth latent historical traumas that are transmitted between generations of Lakota people. Faceless sufferings were identified & given names, initiating a process whereby the trial participants could begin to understand & validate the challenges they had inherited. The initiation of this dialogue produced a profound “cathartic sense of relief” among the trial participants, validating and facilitating the integration of their grief (Yellow Horse Brave Heart, 1998, p.293).
The resolution of historical collective grief through promoting emotional catharsis is a theme that is identified as one of four thematic components of healing discourse in trauma-focused interventions for AI/AN populations by Gone (2009). In the first theme, ‘emotional burdens’ are identified as the ‘etiological source of personal problems later in life’, such as substance abuse (Gone, 2009, p.775). In order to resolve these problems, ‘emotional burdens’ must then be ‘confessed’, a process denoted as cathartic disclosure (Gone, 2009, p.776). However, confessional expression is not the end of the line. Putting latent historical suffering into words initiates the service user into a protracted healing process, which is characterised by auto-reflexive contemplation and the integration of complicated grief.
Finally, the service users are provided with the tools to locate their own sufferings in relation to the legacy of colonisation, which had left their ancestors bereft of their lands, languages, families & communities. In totality, the production of this ‘healing discourse’ can thereby initiate the resolution of broadly disseminated and profoundly embodied historical suffering ; A preliminary move towards emancipating AI/AN people from the binds of unresolved grief, psychic distress and physical pain (Gone, 2009).
Whilst great suffering produces anguish and trauma, it can also provide the ground on which love, community & healing may blossom. The scorched earth can give birth to new life, and suffering can awaken what once lay dormant. In this context, trauma focused interventions may represent a particularly compelling avenue for public health professionals to take.
But a word of caution. Such interventions must be developed and implemented in harmony and consultation with the individuals and communities they serve. In the words of Paulo Freire, "It is absolutely essential that the oppressed participate in the revolutionary process with an increasingly critical awareness of their role as subjects of the transformation." (Freire 1971, p.127). A myopic and paternalistic emphasis on ‘liberating’ AI/AN people risks complicity in perpetuating the colonial discourses and structures of power that have produced these inequities in AI/AN communities in the first place. If such interventions are successful, it is only by virtue of the power invested in medical and public health institutions by Native American people, and the facilitation of their participation in those same institutions. Emotional emancipation will come from within these communities ; it will not, and should not be arbitrarily imposed from above.
Finally, alleviating the somatised burden of historical trauma also demands that we query the discourses that construct the form and provision of pain-relief in AI/AN communities. Whilst it may be unfashionable to say, opiates remain the only effective treatment we currently have for many forms of severe, intractable chronic pain. In the past decade, the backlash against perceived reckless prescribing practices has led to a thaw in the provision of effective pain relief to millions of chronic pain patients across the United States. In AI/AN communities which bear a disproportionate chronic pain burden, the abrogation of pain management services has delivered many chronic pain patients into the arms of heroin & fentanyl addiction. Racial stereotypes of Native Americans as being drunks & ‘junkies’ amongst medical professionals has further exacerbated this problem, leaving many Native American service users faced with an intractable dilemma ; endure unimaginable physical suffering, or pursue relief through other, illicit avenues.
Acknowledging the role that opiates play in the management of pain does not equate to approval of the pharmaceutical and regulatory institutions that once flooded the streets with strong opioid painkillers. Indeed, the predatory practices of pharmaceutical companies have undoubtedly wrought untold destruction ; violence which has frequently been inflicted across racial and ethnic lines in the United States. Nevertheless, critiquing capitalist greed & advocacy for ethical prescribing practices are not mutually exclusive. For AI/AN people who suffer from severe, intractable chronic pain, to deny them effective pain relief is itself a form of structural racial violence, as the historical provision of pain relief to indigenous communities has been indisputably mediated by colonial and racial discourses and structures of power. As such, if opiates are the primary currency exchanged in the political economy of pain, we need to consider some expansionary monetary policy. At least for the time being.
This has been a very long essay, and I’m going to end it here. If you’ve made it this far, I extend my gratitude, and I hope you’ve found it insightful. I would wish that you have felt that this material has been broached with the utmost respect, as that was my intention. I also hope that my predilection towards metaphor has not cheapened or devalued the emotional currency in which I trade ; I do have a flair for the dramatic, but I hope that any stylised language or description has validated and potentiated the depth, complexity and gravity of the topics on which I’ve written. For what it’s worth, I’ve also suffered from chronic pain. If you have as well, I hope my words have been soothing or intellectually stimulating.
Either way, thank you for sharing your time with me.