The Morning After

Barrett L. Dorko, P.T.

…In the morning she was asked how she had slept.

“Oh, very badly!” said she. “I have scarcely closed my eyes all night. Heaven only knows what was in the bed, but I was lying on something hard, so that I am black and blue all over my body. It's horrible!”

Now they knew that she was a real princess because she had felt the pea right through the twenty mattresses and the twenty eider-down beds.

Nobody but a real princess could be as sensitive as that.

From The Princess and the Pea by Hans Christian Andersen 

The Jungian concept of “synchronicity” includes the notion that our unconscious makes us aware of coincidental events that we would not ordinarily notice though they were present all along. By drawing our attention to them, the unconscious gets us to thoughtfully consider something important to us, and, if we take advantage of this opportunity, some insight or realization might be gained. 

While dealing with a gentleman recently who proved to be remarkably sensitive to some moist heat, I spontaneously commented that he was like “The Princess and the Pea,” a story I hadn’t thought of in years. The patient wasn’t exactly thrilled with the comparison, and I guess I couldn’t blame him. I thought about it for days. The following week I listened to a program on National Public Radio about the stories of Hans Christian Andersen and how the author felt that his work extended far beyond the world of children’s literature and into the realm of social commentary and universal psychological issues. The story The Angel was cited as an example. Last night I rented the recent Jack Nicholson film, The Pledge and heard someone read from The Angel to Nicholson’s character. I’d never heard of the story before, and I hadn’t realized until today that The Princess and the Pea was by Andersen as well, but this is what I call synchronicity, and I was bound to write something about it today. 

 I looked up The Princess and the Pea on the web and found it to be a very short story though I know many have expanded upon it. I remember the Broadway musical production Once Upon a Mattress from my youth. It was a big hit for Carol Burnett. Anyway, I noticed in every version of the story I read that certain details were unchanging. The princess was unattractive (though the fact she arrives having come through a storm might have contributed to that), the prince who sought her had been dissatisfied with all the other princesses he’d met, the princess seemed totally unaware of the depth and unusual nature of her own sensitivity, and, despite the removal of the offending pea, the princesses’ pain persists the next morning. 

So here you have an unattractive, phenomenally sensitive woman who lacks self-awareness to an enormous degree yet wins the prince’s affection for the same reasons I would personally back away, if not dismiss her from my castle entirely. Kind of makes you wonder, doesn’t it? 

The issue of “central sensitivity” in chronic pain states has recently been discussed on a few web sites I regularly frequent. Easily the best complete and most accessible resource on this subject is Butler’s text The Sensitive Nervous System (NOIGroup Publications 2000) and the short list presented here is adapted from that book. Basically we’re talking about people whose brain has undergone a morphologic alteration, perhaps secondary to chronic pain, which promotes the following findings: 

Ø      Symptoms are often not within neat anatomical or dermatomal boundaries. 

Ø      Any original pain may have spread and there may be sudden, unexpected stabs of pain. 

Ø      In the case of multiple area symptoms, pains may be linked in that they either occur together, or the patient has one pain or the other pain. 

Ø      Patients may say, “It has a mind of its own.” The pain is called “it” suggesting that it has lost the neat stimulus/response relationships of familiar, and to the patient, understandable tissue based pains. 

Ø      With the CNS dysregulation, changes in response and background homeostatic systems such as the autonomic, endocrine, motor and immune systems are likely.  Sometimes these responses may be overt in some systems, for example, focal dystonias of the hand in musicians, central contributions to complex regional pain syndromes (CRPS), or sickness responses in the case of the immune system. 

Ø      This state may be associated with anxiety and depression. 

Ø      “Miracle cures” are possible.  Miracles are great, but they are even better if you have some idea of why they happened.  It is more likely a central change involving some alteration in cognitions and emotions. 

Ø      Central sensitivity is likely to be involved in syndromes such as fibromyalgia, myofascial syndrome, reflex sympathetic dystrophy, chronic low back pain and post-whiplash pain syndromes, in fact anywhere pain persists or the word “syndrome” is attached to a piece of anatomy.

 Imagining marriage to the princess I can easily see how her central sensitivity might make both of our lives quite difficult. I wonder, did her sensitivity diminish once the prince kissed her? Was that the “miracle” needed in her case? Her complaint of pain the morning after sounds like a combination of fibromyalgia, chronic fatigue and complex regional pain syndromes. Would some restorative sleep (presumably without the pea) be enough to break  this cycle? Is this just a female issue? After all, there’s nothing about the prince’s sensitivity mentioned. 

Well, I’m no prince, and, as far as I can tell, my patients have no royal blood, though they may act like it at times. But often enough I see people who complain bitterly of pain that began with a small provocation or perhaps nothing they noticed. Like the princess in the story they continue to hurt well beyond the time the provocation has been removed, and they remain mystified at their own state, often taking no care to avoid those things that bother them. Is there a part of them seeking to appear special in some way? Does the “stormy” nature of their personal life render them permanently sensitized? Where does the story’s symbolism end and my patient’s findings begin? 

Stories that endure do so for a reason. The Princess and the Pea was written in 1835, and it might very well have existed as a folktale for hundreds of years prior to that. It compels me today, and for my patients who seek to deal effectively with ‘the morning after” a painful night, I’m looking for some answers.