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There is yet another psychological method of coping with pain, and I believe this is the best of all. It is not as complete as psychological dissociation, but it is completely free from the possible dangers which may result from the too facile use of dissociation. In this method we do not try to deny the pain, or make the part concerned numb, or stand apart from the pain. We accept it for what it is—a warning. But we accept it in its pure form without any overlay or embellishment at all. We allow ourselves to experience pure pain, simple and unadorned. When we do this we soon learn that pain—that is, pure pain—really does not hurt at all.

I have warned you several times that your success or failure with this method depends very much on your willingness to go along with me. The idea of pain in pure form not hurting is probably quite new to you. It seems strange. More than that, most likely it seems downright silly. But do not just reject the idea because of this. You have the evidence of my own personal experience and that of many patients. So let yourself go along with me.

The wise use of autosuggestion is very valuable, but the relief of pain by this method is often difficult. For it to be effective we may have to set out deliberately to increase our suggestibility. It is possible that this could have side-effects in the direction of increasing our suggestibility in other areas. These are the problems of the use of autosuggestion in the self-management of pain. Then if we consider dissociation, we see that it is essentially a disintegrating process of the mind, whereas our ultimate goal is complete integration and maturity, which of course is a manifestation of integration. A very significant point about the self-management of pain by feeling pain in its pure form is that it is essentially an integrative process. Therefore the

side-effects of learning the self-management of pain in this fashion are all to the good, and work for greater integration and maturity of the personality.

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Q. Whilst we are talking of liver disorders, who not mention the long-term effects of alcohol on the liver?

A. A good idea, especially as alcohol intake is increasing in Australia and serious liver diseases causing considerable health impairment are also on the upswing.

Q. How much alcohol is needed to produce serious liver damage?

A. It varies, and women are more susceptible to the adverse effects. Severe liver damage may result after ten years (sooner in females), where there has been a daily consumption in excess of 100 g. In practical terms this is roughly equivalent to ten 300 ml (10 oz) glasses of beer, 960 ml (32 oz) of wine or 10 to 13 oz of distilled spirits. About 10 per cent of alcoholics develop cirrhosis, severe liver destruction, but less severe damage is common. All degrees of liver damage occur, from a simple kind called fatty liver, to an acute alcoholic hepatitis, to cirrhosis.

Q. What symptoms take place?

A. In the early stages there may be few if any. A fatty liver tends to enlarge in size. Alcoholic hepatitis may show up as vomiting, diarrhoea, a fever with an enlarged, tender liver, probably felt in the upper left side of the abdomen as it juts down under the ribs. It is much like Hepatitis A. In cirrhosis, it depends on the extent and the capacity of the liver to cope. The liver is enlarged and the surface covered with hard, raised nodules of fibrous tissue indicating the liver cells are destroyed. General health deteriorates, there is fatigue and weight loss. Blood vessels on the skin of the face, arms and trunk appear, the palms become red, body hair decreases, the testes decrease in size and the breasts often develop lumps called gynaecomastia. Fluid may accumulate in the abdominal cavity. Drowsiness occurs.

As greater pressure is exerted on the blood vessels taking blood to the liver, this backs up, and swollen vessels called varices may occur in the oesophagus. These may haemorrhage causing life endangering bleeding. As the brain is gradually affected, mental confusion, slurred speech, shaky hands may occur which may lead on to coma.

Q. This all sounds a gloomy story. Is there treatment?

A. If the patient immediately stops taking alcohol, many cases show an amazing comeback in general health. This is often very difficult and convincing a patient of his health needs, whilst accepted, is often difficult to police. Psychiatric assessment is often necessary. This plus medical treatment under expert guidance can often provide a great deal of help.

Q. What are the current views on drugs and liver damage?

A. Quite apart from alcohol causing destruction of the liver cells, many known drugs if taken in large quantities may similarly produce adverse effects. Many doctor-prescribed drugs, if given in overdose, may cause serious liver disease. The more of the drug that is taken, the greater the degree of liver damage. The range is extensive, including the tetracyclines, corticosteroids, paracetamol (a drug commonly taken in overdose), salicylates, anabolic steroids (often taken by athletes to increase their muscularity), methotrexate (an anti-cancer drug). Many other drugs, in certain individuals, may also damage the liver in certain cases. Fortunately, in view of the enormous amounts of medicinal drugs taken, the adverse liver effects are relatively numerically small.

Q. Is liver cancer common?

A. Cancer which arises primarily in the liver is uncommon, except in some African and Asian countries where Hepatitis B is endemic, and this seems to predispose to it. In western lands, it may follow on from Hepatitis B infection but is much less common.

The liver is a very common site for metastases or secondary cancers which spread there “from another primary source.

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Doctors always know when spring has sprung. They start getting visits from gardeners – both young and old – who, getting back to work in the garden after the winter, have damaged their muscles.

The difficulties arise not just because of the sudden onset of activity in the cold and damp – but also because of the many opportunities that gardening offers for overstretching, bending too far for too long and lifting heavy loads.

Following these suggestions will help reduce the risk:

Before you start, stretch your muscles with a gentle warm-up.

Wear loose clothes and sturdy shoes or boots.

Choose your equipment carefully: lightweight, long-handled tools mean you don’t have to stretch arms and legs to the limit. Hover-mowers need particular care – don’t swing them around from your waist and keep as upright as possible, with the handle close to your body.

Overenthusiastic digging and weeding often cause damage .Don’t take huge spadefuls when you’re digging and keep your back as straight as you can. When weeding, kneel down as close as you

can to the bed. If you’re pulling out a deep-rooted plant, take the

strain on your arms and legs, not your back.

Some additional tips for gardeners from Dr Arthur Grayzel, senior vice-president for medical affairs of the Arthritis Foundation in America. He suggests:

Some people will feel more comfortable by not kneeling on the ground, but instead sitting on a small stool, so further reducing stress on the joints.

Use plant containers that are high off the ground – or small raised garden beds – to reduce stretching and bending.

Don’t work for long periods with a tool that you have to grasp firmly.

Divide your garden in several smaller areas and concentrate on one of these at a time to avoid overdoing things.

Don’t grip heavy loads with your fingers or arms, but carry them in your arms.

Look in your garden centre for tools specially made for people with arthritis – even if you’re not affected by this disease – as equipment designed for the arthritic will also often help prevent back strain.

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