Opinion on emotional pain is divided. At one end we hear “just get over it” and “move on”, and if we can’t, we’re a snowflake. At the other end sit newer trends in self-care and spiritual healing. Wherever we stand, almost all of us know hurt, sometimes as a daily occurrence.

Start with the language. We use words like pain and hurt because they describe what we feel. Heartbreak, bereavement, rejection and ostracism all land in the body (the chest, the stomach, a “body blow”), even when nothing physical has happened. We’d love to “get over it”, but the pain isn’t under conscious control.

That’s less odd than it seems. Modern pain science treats pain as something the brain produces, not necessarily the result of direct tissue damage. The brain weighs incoming signals against context, memory and expectation. And if it judges the situation to be threatening, it generates pain or distress as a protective signal. Most of that appraisal happens below awareness. A dismissive look can trigger the same machinery as a physical threat: muscles brace, breathing goes shallow, the heart speeds up, the gut tenses. Brain imaging suggests social rejection and physical pain share neural territory, though the overlap is partial and the activation patterns differ. Either way, the pain is real and physiologically mediated, and it is not “all in the head”.

But why?

Why would we be built this way? Human infants are born far too early. A foal is running within hours, but a human baby depends on caregivers for years, so staying close to them is a survival matter. Neuroscience researchers such as Panksepp have argued that the distress of separation evolved through borrowing from the physical pain system. Hurt is the alarm that keeps us connected. Then, as the child grows, good-enough relationships teach “rift and repair”: hurt happens, but the relationship survives it.

So what goes wrong? The infant’s threat templates don’t disappear. The hurtful comment, the dismissive look and the unjust decision still set off an old appraisal, and the body mobilises before the mind has a conscious thought. Chronic stress and early adversity can sensitise the system further, so smaller triggers produce larger responses. Relational threats are also “sticky”: because they touch belonging and self-worth, the brain treats them as unresolved until there is repair or reappraisal, which is why, for some people, recovery can take hours or days.

People respond differently. Some do move on, some turn to anger, some to blame (“he made me feel like that”). In the therapy room the most common response is “I just blame myself”.

The Inner Critic

Self-blame has a logic. Fairbairn argued that a dependent child would rather believe I am the bad one than my caregiver is unsafe, because blaming itself preserves the hope of repair and some sense of control. That is our inner critic, formed before we had language, turning hurt into fault. It’s a stubborn passenger, and arguing with it usually means losing.

Understanding origins of hurt don’t switch the response off, either. Insight lives mostly in the language-based, top-down systems, while the threat response is driven from the bottom up. Naming the hurt helps us tolerate it, but it doesn’t always shorten the physiological and ruminative tail.

So we might manage the critic by avoidance: steering clear of relationships, social settings, even competition, because losing hurts. Or we can learn to live alongside it. In therapy we might question the messages (“who said you can’t be angry?”, “where did you learn to apologise so much?”) and discover that adult relationships are sturdier than the critic assumes, and that we can tolerate more hurt than we expected. Naming our feelings gives us some agency over them, and a therapist will not shy away from allowing these feelings expression in the room. And the therapeutic relationship gives us a place to practise rift and repair when the therapist inevitably says something that stings.

Final thought

But keep in mind that therapy has no monopoly here. Because recovery involves the body as well as the mind, a personal toolkit matters: good company, music, exercise, hands-on body therapies, intimacy, anything that calms the nervous system and brings us back into our “window of tolerance”. Meaning shapes how pain is felt, but easing it often means working with the body and the senses as much as the narrative in the mind.

Adrian Tupper is a practising psychotherapist, supervisor and counsellor based at Eyre Place Osteopathic Practice in the New Town and Space for Therapy in Newington. Sessions at Eyre Place are sometimes bookable online. Otherwise to find out more, visit adriantupper.co.uk.