Repression in chronic pain: An idea worth recovering

Repression, defined as a process by which threatening information is kept out of conscious awareness, has long been a topic in the chronic pain literature. Emerging in psychodynamic theories, chronic pain is thought to arise from repressed emotions that are converted into physical symptoms; this notion seems to account for much anecdotal evidence and has received empirical support from work with Minnesota Multiphasic Personality Inventory (Hathaway & McKinley, 1943) profiles-particularly the conversion-V. However, the construct validity of this profile among pain patients has been called into question. The emergence of the cognitive-behavioral model of chronic pain ignited a proliferation of research, but because it rejected psychodynamic pain theory, investigation of repression was largely suspended. This lapse leaves unexplained-almost unrecognized-findings that a plurality of chronic pain patients are characterized by constrained emotion, and that repressed, inhibited, and denied negative emotions or traumatic memories have a profound impact on chronic pain. To address these important phenomena and to reinvigorate research, three methods are proposed: (a) expand current empirical clustering procedures, which rely on the Multidimensional Pain Inventory (Kerns, Turk, Rudy, 1985), with measures of defensiveness to isolate patients who report high pain/disability and deny negative affect; (b) employ Weinberger and colleagues' (1979, 1990) "repressive style" to examine the responses of repressor pain patients; (c) pursue Pennebaker and colleagues' (1986, 1988) theory about disclosure of traumatic events to examine effects of inhibition and disinhibition on persistent pain. Although an integrated model may be premature, it is argued that repression should receive renewed appreciation; it was never really absent, just forgotten.