A Life Larger than Pain

No one wanted Sue to die in the hospital, but she was heavily medicated and often incoherent. The children were telescoping a lifetime of emotions into this single event, cramming for finals without having taken the course. They had virtually no support system–their father was long gone, at least emotionally, and the boyfriend had disappeared. Their attractive mother, among the elite few with all the looks, power, and material things anyone could want, was dying, and all the medical knowledge money could buy could not help her. It was a dizzyingly steep fall from grace.

By the time I saw her after her hospital admission, some of the medication seemed to be clearing from her system, and she was noticeably brighter-eyed. I took her children into the hall and told them their counselor had called me. We discussed the importance of hospice, which they'd already begun to explore, and the option of bringing their mother home. But how do affluent young adults with a mother who is dying deal with that responsibility, having had no preparation for it? In our society, we are typically shielded from the graphic reality of death, even with family-friendly facilities. Nothing about the lives of these young people, who were so familiar with the things others envy, had helped them face such a moment as this. Fortunately they were very kindhearted and open; it was clear they were learning at a breakneck pace.

I spoke with Sue's children about non-denominational spirituality and how important it was for them to continue therapy for closure. To honor their mother and grow from this experience, they needed to see it as an opportunity to develop inner resources they didn't know they had, to explore spaces in their mind where they hadn't been before, to become more profound people with a deeper empathy for others. It was an opportunity for them to reach within, to find a philosophical or spiritual beginning. With tears in their eyes, they listened intently about these new concepts. My psychologist friend continued to work with them on the loss of a parent, on how to harvest this very difficult experience for their own growth.

Nobody would choose the pain of watching a parent die, but it is a sure catapult out of a pleasure-seeking orientation to a far more profound and enduring approach to life. In this respect, those who have not been

be down-regulated. Paradoxically, too much of a good thing can turn into a bad thing when the body conditions itself around the intervention.

For pain patients, recovery often starts with the recognition that they will have to let go of their expectations for what they thought would help them. At first this appears to be a very discouraging threshold to cross. But it is most often the entry point to discovering how to find genuine help. It represents an opportunity for pain sufferers to make a choice. Either they can go back to old ways of coping with the pain, which even if ineffective are at least comfortingly familiar, or they can brave the unfamiliar and move ahead into new ways of looking at their future. Virtually every day we lead people to this decision point. Some turn back in fear. Others summon the courage to move forward within hope. These individuals are learning to embrace the pain paradox.

Our culture is so fixated on eliminating discomfort and obtaining immediate gratification that the pain paradox is a new concept for many. We think that our technical expertise will continue to offer endless improvements to our quality of life. We presume that we can take control of our destiny, take charge of our health, and postpone our aging. We deserve a pain-free existence, and we follow whatever or whoever promises to bring us closer to achieving it. If we have an ache, we take a pill to make it go away. If the ache persists, we take more pills.

Productive, task-oriented people often measure their personal worth according to their accomplishments. When chronic pain strikes, they are at high risk for depression, because once they fall off the roller coaster of achievement, their self-esteem comes tumbling down. Ironically, those with power in our society are often the most fragile when they confront loss of control from pain. Receiving a disability check, for example, is both a blessing and a curse. It affords financial relief, but it can be psychologically limiting in reversing the concept of personal worth built around vocational productivity and accomplishment.

My Navajo friend Norman Yazzie observes that even education can be a liability, because it can lead to trusting the written word more than what is written in the heart. Education can pull a person's life off-center into spiritual imbalance when it confuses wisdom with acquiring information

was executed on a cross. Buddha, the Awakened One, died from food poisoning. Catholic mystic Terésa of Ávila was afflicted with crippling arthritis. Ultimately, the presence of pain is a mystery. In this life we see through a glass darkly, said the apostle Paul, but one day we will see clearly.[52]

For most of us, the great trials of life will simply leave us with a lot of unanswered questions. As we begin to let go of the demand for answers, the anxious thoughts of the mind may yield to the strengthening of the spirit.

understanding the pleasure-pain relationship

Another shift that most people in our culture are required to make in order to leverage the pain paradox is overcoming the artificial separation of pleasure and pain. We blithely assume that pleasure is good and pain is bad, so we pursue the one and flee from the other. But pain is not punishment, and pleasure is not reward, despite our persistent attempts to treat them as such. Where in Western society did we ever get the idea that we can have pleasure without pain? Birth is painful as well as delightful. The painful reality of death may bring with it a pleasurable release, an exhilarating closure. Pleasure and pain are inextricably linked.

Eugene d'Aquili and Andrew Newberg have identified what they call "cognitive operators" to describe specific functions performed by specific parts of the brain. These operators allow the mind to think, feel, experience, order, and interpret the world. One of them is the binary operator, which derives meaning by establishing "dyads," or pairs of opposites: good and evil, right and wrong, and justice and injustice. The description of these dyads provides an ideal depiction of the pleasure/pain relationship:

It is important to note that each opposite in the dyad, in some ways, derives its meaning from its contrast with the other opposite. In this sense, the opposites do not stand completely on their own, but require each other in order to define themselves individually.[53]

Today in the United States, when unprecedented numbers of people are living the so-called American dream, the good life does not always seem quite as good as promised. Why the deep irony that affluence in our Western society seems to make pleasure more difficult to reach? Certainly, no society has succeeded so well in trying to eliminate pain and to exploit pleasure. Yet happiness still seems elusive. Perhaps the more a society tries to eliminate pain, the less it is able to cope with the suffering that remains.

In our technologically advanced society we consider discomfort a problem to be solved, while cultures more attuned to natural rhythms tend to have a more balanced view of life's mix of pleasure and pain. This leaves us less prepared to face adversity when it strikes. Thanks to a gifted and determined teacher, Helen Keller broke through the imprisonment of her severe disabilities to provide wisdom and inspiration that no disability–free person could attain. "I am grateful for my handicap," she declared, "for through it I found my world, my self, and my God." She was insightful enough to recognize the dangers of complacency in a world lulled by comfort: "As the eagle was killed by the arrow winged with his own feather," she observed, "so the hand of the world is wounded by its own skill."

I have come to appreciate the Buddhist concept of tonglen as one of the best ways to avoid the swings between pain-phobia and pleasure-seeking extremes. Tonglen is a practice of taking in pain and sending out pleasure. For example, in the presence of a pain sufferer, it might mean quietly "breathing in" that person's pain and "breathing out" healing. Connecting in this way with the suffering around us helps to liberate us from self-centered patterns and awaken to compassion.

How little we realize what suffering we inflict upon ourselves by investing so heavily in protecting our own interests. When somebody criticizes us and we feel insulted, we mobilize our resources to defend against the attack. This doesn't do much except focus our attention all the more on the perceived insult, giving it greater power over us. When pain strikes, we focus all our energies on eliminating it, which paradoxically often intensifies it. If we enlarged our frame of reference to include the pain of others, allowing our pain to sensitize us to others' suffering, this

despair, but a quiet recognition that pain does not have power to define life–rather, life defines pain by placing it within a larger framework. It is possible to find serenity between the extremes of fear and hope. It is possible for suffering to be endured not as the end of hope, but as a path toward healing.

listening to inner knowing

Cultural conditioning is especially difficult to overcome in an outer-directed society that values conformity over integrity. In our consumer mindset, we have ceded enormous control of our values and decisions to the dictates of the marketplace. Market values inevitably reinforce a tendency toward the acquisition of material goods, the enhancement of personal status as defined by fluctuating social values, and the increase of power in wielding control over the instruments of commerce. Those who are socially disadvantaged by the encumbrances of pain are, therefore, consistently devalued. This chips away at their self-confidence, making it all the more difficult to trust in their own gut instincts for finding a way forward through the pain to a productive and meaningful life.

I emphasize the importance of inner knowing with my patients because I believe that, on one level or another, we all know the truth about ourselves. Accessing this knowledge can be a crucial component of the healing process. Apparently healthy people will sometimes have a premonition when they go to a doctor about a disease that will be diagnosed. Pregnant women sometimes have a sure sense of their unborn baby's gender. Elderly people have been known to predict the time and season of their death, even down to the day and location.

Our bodies are rich repositories of information about what is going on within. Sometimes the data is transmitted consciously to the mind through specific and identifiable symptoms, but other times the body buries information for years, especially in cases of extreme trauma, until mind and spirit are capable of recognizing and assimilating the information. Other times the body's wisdom is manifested in a persistent, nagging sense of something unidentifiable, like continually catching a glimpse of something in our peripheral vision that we know is there but can't quite identify.

this gave her a renewed sense of hope. "As my anger with God diminished … ," she wrote, "I began to feel anew that God would always have a place in my heart. I felt that I needed to pay more attention to the healing of my soul. I began reading the Bible and other religious books and to pray that God would have a bigger impact on my life."[56]

Developing this new orientation was a long, intense, and difficult process. Nyberg was forced to rely on her own inner knowing because all the conventional treatments had left her high and dry. "Reconstructing a life worth living is a slow, ongoing process of 'becoming'–of finding inside oneself a new person who can learn to live a meaningful life in spite of the pain,"58 she observed. She discovered that the two most vital but difficult steps were letting go of previous misconceptions, giving up attempts to change things that cannot be changed, and moving on–making a conscious choice to go forward with a new view.

Pain patients sometimes know better than their families and even their healthcare providers what kind of support they need–and what kind of help is not helpful. The self-help health movement has made tremendous strides in offsetting the imperialism of traditional medicine. We have become more aware than ever before of the need to be proactive in taking responsibility for our well-being rather than leaving it up to the professionals.

Nevertheless, those in chronic pain are by definition operating with a deficit of emotional and physical resources, which makes it harder to take initiative especially when it cuts against the grain of prevailing opinion. They are often viewed with suspicion or impatience, which can be very intimidating to the pain sufferer.

Standing firm on the basis of personal conviction when you are up against conventional "wisdom" is a difficult counter-move. But this is precisely when inner knowing may be the most valuable tool in your arsenal. Your body may be telling you that it doesn't need the operation everyone else thinks you should have. Or you may be realizing deep within yourself that instead of muscling your way through the pain or trying to get your mind off of it, you need to listen to it even more intently. The pain may be a signal of something happening within you at a

Pain unmakes a person's world. It disrupts the rhythms of daily life which pain-free people have the luxury of experiencing as routine, rituals that help define reality as safe and predictable. "The mind is its own place," declared the poet John Milton, "and in itself can make a heav'n of hell, a hell of heav'n."[60] Acute pain can be so disorienting that it is wise to prepare for it in advance by weaving a safety net of responses for modifying the pain and a support system to prevent isolation.

Belden Lane has written eloquently of the relationship between landscape and spirituality. He likens the intrusion of suffering to being thrust involuntarily into a desert experience:

The desert as metaphor is that uncharted terrain beyond the edges of the seemingly secure and structured world in which we take such confidence, a world of affluence and order we cannot imagine ever ending. Yet it does. And at the point where the world begins to crack, where brokenness and disorientation suddenly overtake us, there we step into the wide, silent plains of a desert we had never known existed.[61]

The unmaking of everyday reality is a painful stripping process. But it can also become a clarifying process, enabling us to see with sharpened vision what is essential to our existence.

If you have ever hiked in the desert, you know the sensation of being in an environment pared down to a few primal elements: blindingly intense light … heat so overpowering it seems to vacuum the moisture from your body … still air broken only by occasional sounds–a lizard scraping across the sand, the rustle of a bird in the brush, or the cry of a hawk circling far overhead. No longer distracted by the clutter of routine existence, your senses take on a heightened awareness of your surroundings. You realize there are only a few things you need for survival: enough water to keep from being desiccated by the heat; sufficient food to fuel your body to keep moving; and protective clothing to shield you from the burning presence of the sun during the day and the freezing absence of it at night. Mind and body telescope all concerns down to the acute awareness of how much your life depends upon these few essentials.

I think of the desert side of the human person as the arid, difficult, pensive dimension, in contrast to Carl Jung's dark side, which refers to the negative and destructive aspects of personality. Illness plunges us into the desert dimension, but it can open up spaces in the mind and heart that are new and stretching. Just as time away in the desert can have a purifying effect, so the forced retreat of pain can lead to a renewed perspective.

I like to ask my patients to visualize looking at something so intently they lose sight of everything else. Then I ask them to imagine taking a step back and looking at it from high above, like watching an anthill while standing up straight instead of crouching down to peer closely at it. This is what I ask them to do with the pain experience: instead of being absorbed by it, just notice it in a disengaged way. Observe without making value judgments or analyzing: simply become aware. When Pema Chödrön teaches basic sitting meditation, she advises giving up on trying to control runaway thoughts by simply labeling them as you say the word, "thinking."[63] If you let your mind run with anxiety about your pain experience, unable to separate yourself from the pain and identifying totally with it, you are likely to intensify your pain.

Standing back to look at your life is a hidden benefit of the enforced time-out, or desert sojourn, of the pain experience. It is an extended break from being immersed in, and distracted by, everyday demands. Pain is not the only circumstance that brings this about. Sometimes a major event will do this for you: a family or health circumstance will force a change in patterns of behavior that may allow you to see from a distance what you might otherwise never have recognized. To do this purposefully, as with a sabbatical, can be even more effective. A pain patient does not do this by choice, however; it arises from desperation. At the extreme end, the time-out may be permanent, in the ultimate escape of suicide. Becoming involved in service to others can help offset the desperation by putting personal experience in perspective.

Viewing pain as a time-out from life as usual can be a profound embrace of the pain paradox. Some people discover entirely new ways of orienting their lives in response to the trauma of illness and physical suffering. In Christian tradition, the term "calling" is often used to

Chicago. Carl has had thirteen major operations, most of them on his back and musculoskeletal system. He has been able to come back from every operation and reactivate by using small, meaningful goals each day–staying very physically productive and avoiding a limited range of motion.

Facing what Carl did, the average person might have settled for a limited range of motion, dependence on medications, or capitulation to a pain syndrome. Because of his need to treat the melancholy, Carl fought back each time and was able to regain strength and continue to refine his Olympic weightlifting technique. Although he has worked hard physically, Carl feels that the arena of true struggle comprises the psychological and spiritual challenges of overcoming adversity. Exercise has been a gift to him, and he shares it with others in his conditioning-center business. There is something mysterious about what makes a person reach beyond pain to conquer problems, he believes. If we try too hard to analyze it, we can destroy the mystery by dissecting it.

I have found that exclusive reliance on injections, surgery, or medications usually does not produce significant long-term improvement. Nevertheless, if we accept that the healing process is in many respects a mystery and therefore includes spiritual factors along with physical and psychological, we will often witness significant shifts toward wellness. Western healthcare providers are frequently burdened with the thought that the buck stops with them, so if they have neither cured the problem nor relieved the pain, they feel a sense of failure. Native American and Hispanic healers, however, are not as invested in being the most important part of the healing process. The curandera before Diós and the medicine man before the Great Spirit are human channels of healing, passive vehicles rather than the source itself. Curanderas often pray continuously while attending to their patients. Western physicians might take a cue from them by making the uncomfortable jump of offering prayer for healing their patients. They may find that dethroning themselves as the healer in favor of becoming a helpful vehicle would at times increase their effectiveness.

There are times when healers should leave analysis and procedures on the shelf, at least for a moment, and creatively, lovingly practice prayer

or goals as a way of participating in the process of recovery, it could ease the states of mind that are pain intensifiers.

Embracing the mystery of healing can also help us embrace the mystery of illness and suffering. Inevitably we search for cause-and-effect relationships as a way of understanding the painful and bewildering circumstances thrust upon us. Those in severe pain often aggravate their distress with the anxiety of second-guessing: if only I had changed my diet or exercised more regularly or taken the proper steps right away instead of procrastinating, I might have avoided this. Religious people especially are prone to becoming tormented by guilt, presuming sin or spiritual failure and feeling condemned by the ultimate authority in the universe: What did I do wrong? What is God trying to tell me? This self-flagellation is counter-productive when dealing with pain.

The Bible is sometimes invoked to justify rigid positions on who or what warrants divine favor or disfavor–yet some of its central stories illustrate the profound mystery of illness and suffering. The Old Testament figure Job was subjected to virtually every conceivable form of affliction. His protest to God was met not with explanation but with a thundering reproach of any effort to reduce the ways of the Divine to what could humanly be understood. Those who received the greatest censure in Job's story were the pious religious authorities who presumed to explain God's ways to Job with simplistic cause-and-effect propositions, such as punishment for Job's supposed sins.

In the New Testament, Jesus' disciples questioned him about why a blind man had been afflicted with his illness–whose sin caused it, they asked him, the man's or his parents'? Internalizing the moralistic legalism of the Pharisees, they believed that illness was a sign of God's displeasure. Jesus baffled them by answering that sin had nothing to do with it. It was something God could use to bring good from.

It is very difficult to accept the mystery of pain when it feels like a punishment we don't deserve for a transgression we weren't aware we had committed–or one that was not severe enough to merit such a consequence. Punishment works only when we know the reason behind it and can choose to change our behavior accordingly. Mystery is maddening