Photo Credit: Michael Dawson

“An emotion is a strong instinctive or intuitive feeling distinguished from reasoning or knowledge of one’s circumstances, mood, or relationships with others.”

(This is a visual representation of the distribution of the 27 emotional categories by Alan Cowen. The colors between the pictures are the average placement of the 2000 videos in the study and how they fit on the continuum between each emotion.)

How many emotions do you experience every single day? From frustration to elation and everything in between, doctoral student Alan Cowen at UC Berkeley has recently conducted research suggesting humans have 27 categories of emotion. Alan also theorizes that an emotion is not a distinctive island of mental state, but more like a smooth graduation between the 27 emotional categories, therefore leaving us with a limitless possibility of emotional experience.

The conclusions drawn from Alan Cowen’s study corresponds to a study by Theadore D. Kemper in 1987, “How Many Emotions Are There? Wedding the Social and the Autonomic Components”. Kemper supports Cowen’s theory that we possess an infinite possibility of emotions. He explains that as society differentiates new social situations and behaviors, identifies them, and socialized individuals experience them, new emotions will continue to emerge.

Kemper theorizes that people have four psychologically grounded primary emotions: fear, anger, depression, and satisfaction. These emotions are evolutionarily important, culturally universal, ontogenically (the organization and timeline for the development and growth of an organism) early to emerge, and link closely to important outcomes of social relations. Secondary emotions such as guilt, shame, pride, gratitude, love, nostalgia, ennui etc, are acquired through socializing agents who define and label these emotions while the individual is experiencing the autonomic reaction of one of the ‘primary’ emotions. For example guilt is a socialized response to the experience of the physiological condition of fear; shame to anger; pride to satisfaction etc. (Theadore D. Kemper, 1987).

Where Do Emotions Come From?

The limbic system is our emotional cortex. It is a complex set of structures that lies on both sides of the thalamus, just under the cerebrum.  It includes the hypothalamus, the hippocampus, the amygdala, and several other nearby areas.

The theory of evolution suggests human beings have developed over hundreds of millions of years. Beginning from the most basic of cells through a stair case of ever increasingly complex and intelligent being, evolution has formed the people we are today. As human complexity has developed to the highly technical and multifaceted societies we now live in, the need for complex emotional capacity has developed and evolved alongside us.  American neurophysisist Paul D MacLean discussed his concept of the “Triune brain”. Consisting of reptilian complex, limbic system and neocortex, the triune brain concept constitutes an evolutionary jump in central nervous systems capabilities, ranging from primitive to the complex human brain respectively.

We can see the early development of the limbic system has evolutionary and ontogenical benefit to the survival of life. The Triune brain is our ancient warning system, a key instigator of the “fight and flight” mechanism (Hans Selye, 1936).

Emotion and Pain

Pain is the primary reason people visit a physiotherapist, podiatrist or massage therapist. Emotions, particularly negative emotions, play an important role in pain perception and responses. For example fear, anxiety and depression can lead to a reduced threshold, increased levels of pain and plays an important role in the development of chronic pain disorders. In contrast, positive emotions (happiness, optimism in the process and even laughter) have been seen to improve pain tolerance, enhance immune function, and reduce discomfort sensitivity.

Furthermore, negative emotions can lead to pain catastrophisation and fear avoidance behaviors, while positive emotions tend to elicit health promoting behaviors such as seeking out social and medical support.

“The irony of pain is that those who experience it persistently and respond to it with intense emotion are compelled to alleviate it at immense personal cost. Yet those who ignore pain or suppress the emotions associated with it may more readily perish.” (Carter et al)

From my experience as a physiotherapist, emotion plays an important role in both acute and chronic pain.

Acute: “During a rugby game the 2nd five on the opposition team went into a tackle. His thumb became wrapped in our player’s jersey and dislocated. When the two players hit the ground, the thumb was wrenched backwards, and the bone torn the hand open and almost ripped the thumb completely off. This was an important game, he jumped back into the back line, made another tackle, turned the ball over in a ruck securing his team possession. It wasn’t until he dropped a pass in a backline play about two minutes later that he looked at his hand, dropped to one knee and called the team physio for help.
The emotions involved in the heat of the game allowed the body to inhibit the player’s pain response from the injured hand, thereby allowing him to continue to perform his role. Emotions like; fear of letting the opposition score or letting the team down, satisfaction for making a tackle and turning over the ball are strong motivators to perform. This is the same mechanism that sees soldiers sustain severe injuries yet carry a fellow soldier to safety without being overcome by pain. The ability for pain inhibition in certain situations has evolutionary benefits as survival when attacked or injured may be at the mercy of a human’s ability to flee to safety and not be crippled by pain.

Chronic: “An elite athlete training for the world championships developed an injury. They were at the peak of their performance but nearing the end of their career. The pain caused the athlete to miss training sessions and reduced both the intensity and quality of practice. The athlete became increasingly upset that their performance began to slip, their routine had changed and they were no longer living their ‘ideal athlete lifestyle’. They became fearful and anxious they may not qualify for the event they had been training towards for so long and worried that they may have to withdraw, thereby losing the opportunity to compete at the pinnacle of their sport and would spell their early retirement. Fear of loss of identity, purpose, goals, routine, social network, and support structure spiraled the athlete into negative thoughts. This cascade of negative thoughts became an increasing influence in perceived pain of the injury. Ultimately the athlete’s fears came to fruition as the pain was unable to be managed, they could not complete the required training and retired from their sporting career.

As therapists we need to understand that everybody is different. We utilize a variety of skills and tools to help reduce pain and help to develop coping mechanisms for dealing with pain. One of the most important tools we can use is education. Building rapport, listening, explaining what has happened and the pathway of rehabilitation, ensuring full understanding, and helping to facilitate independence and healing.

As a patient it is important that you discuss your emotions with your healthcare provider. The highs and lows gives your therapist pointers to what is working and what may not. It is important for you to understand the plan of rehabilitation, to understand your injury and understand the mechanism and process that is pain.

If you don’t understand, ask questions. Be open if you still don’t understand. Ask for pictures, ask for metaphors and anecdotes. Ask for sources to read about your injury and further discuss with your practitioner. Ultimately, if you understand and are satisfied with the process there will be less confusion, fear and anxiety and a greater amount of buy in. Positive emotions will then replace the negative ones as you experience satisfaction as you work through the milestones of rehabilitation on the road to recovery.

Alex Lowen is a Sports Lab Physiotherapist. Alex believes in creating independence for his clients and has a firm belief in evidence based practice. Alex thrives on good banter and bad jokes.