A Life Larger than Pain

Depression. Virtually all pain patients with chronic pain report depression and its effects on them. Cardinal signs are: loss of energy, deteriorating sleep patterns, and sadness over losses associated with the effects of pain.

Deactivation. Chronic pain patients lose motivation and energy for remaining active, whether in sports, at work, or at home with family. They're no longer doing what they want to do. It is an insidious deteriorating physical condition associated with weight loss or weight gain and muscle atrophy. Life has changed to a sedentary, slow rhythm.

Dependency. To compensate for the pain-induced limitations, patients are forced to rely on significant others, family members, and work colleagues to do simple or complex tasks that are really the responsibility of the pain sufferer. This dependency has a dampening effect on their self esteem.

Doctor-seeking. Patients frequently are seeking yet another doctor to help them with their chronic pain. They have a lurking feeling that if they can just find the right healthcare provider, a cure is in the offing.

Drug-seeking. Whether they want narcotics to blanket the pain or just a medication to help ease it, most pain patients are looking for more or different drugs. In desperation, pain sufferers find they are dominated and controlled by medications to relieve pain.

Deteriorating Relationships. Almost all people in chronic pain can point to close relationships that are now faltering or are less satisfying than they were prior to their entrenchment. The energy to nurture friendships is missing. Moodiness and irritability interfere with interactions with those close to them. Obsessive focus on health problems puts off family and friends.

Dormant Spirituality. Pain sufferers will often put their spiritual quest on hold while intensively seeking moments of pain relief. Few individuals who seek help for pain engage in a regular spiritual practice. Those who have developed faith convictions often experience severe testing of their beliefs under pressure of the health crisis. If patients can revive a

experience a deep inner peace as despair gives way to hope for the release of suffering, for the journey of the spirit out of the broken body to a home they sense is waiting for them.

avoiding woundology

Dr. Carolyn Myss, author of Why People Don't Heal and How They Can, coined the term "woundology" to describe a self-perpetuating and obsessive focus on one's personal problem. However real the problems may be, there is a seductive power to the wound. The downside of the recovery movement is that the sharing of wounds has become "the new language of intimacy."[8] Myss observes that people confuse "the therapeutic value of self expression with permission to manipulate others with their wounds."[9]

Woundology is a very important concept for pain patients. A significant percentage of them want to talk about their victimization. This is different than processing wound issues in a healthy way, in which the goal is to move from preoccupation with the injury to recovery and health. Victimization vocabulary is peppered with words designed to draw attention to wounds, suffering, and difficult circumstances. They are perhaps unaware that they have created relationships and dependence problems surrounding their wounds. American society is fascinated with the wounds of post-traumatic-stress syndrome, sexual abuse, and workers' compensation injuries. These are critically important issues, and I don't intend to devalue them in any way–but our focus on these violations can foster unhealthy preoccupation with them.

The media has been at the forefront of dramatizing personal trauma and encouraging woundology discussions. This is just one example of how our society tends to feed on the wounded. Some attorneys routinely advertise to encourage people to seek money for their personal injuries and to stay wounded at least until there is some monetary reward for their wounds. Caroline Myss calls woundology "a kind of welfare state of the soul, paying people dividends for blithely refusing to better their condition."[10]

listen to her, and she would go in search of other physicians who would. When I introduced words such as forgiveness or tried to help her change her vocabulary of victimization, Penelope grew angry and told me that I had lost interest in her as a patient. Her efforts shifted to attempts to control the medications I was giving her.

We reached a point at which I felt it necessary to have a conference with Penelope and her family in which I talked very specifically about the value of letting go of injuries and suffering from the past, and formulating new goals. Change is not cozy, I told them. It can increase pain intensifiers such as fear and anxiety. But it can also increase pain inhibitors, such as hopefulness, which would help Penelope move through the transitions on a path away from self-pity toward self-reliance.

The result of this approach was Penelope's disappearance from my practice for at least a year. Then Penelope surfaced again, with the same problem, most likely after having consulted another pain center and repeating the same processes. This time I discussed with her the importance of spiritual renewal in breaking free of the victimization trap and moving beyond the self to spiritual growth. Penelope is now on a spiritual quest that is beginning to open some chinks in the armor of her woundology.

Many of my pain patients are trapped in their need to talk about their pains and wounds. They create relationships around their woundology, whether in the form of support groups or intimate attachments. It is important for pain sufferers to talk about their woundedness, but it is equally important for them not to get stuck there. In a society in which the media glamorize wounds and some systems reward victimization, it is difficult for many people to make any headway in getting past their obsession with hurt. Therefore, physicians and therapists are especially crucial in helping patients recognize this preoccupation as a dependency they need to work through rapidly in order to move toward healing. One of the most effective ways to do this is by turning things over to a higher source and strengthening the spiritual life. For some, it proves to be the only way to get beyond their "comfort with discomfort."

self-compassion devolves into self-pity in a downward spiral. By contrast, an integrated life is free from excessive and unhealthy preoccupation with self. It is structured in a way that permits integration of the self horizontally and vertically–personally, socially, and spiritually. The difference in these two responses to pain is the difference between the self in isolation and the self in harmony with its surroundings.

Our cultural background can predispose us to one response over the other. Under the pressure of pain, this predisposition is magnified. Our consumer culture tilts us toward the self-centered life, away from a communally-based life. It bombards us with the message, "You have the right to go after anything you want. You deserve the best that life has to offer." Pain is an unwelcome interruption of the pursuit of success, like experiencing a car breakdown on the highway. You tow the car to the nearest garage, fix the problem, and get back on the road to the good life as quickly as possible. In conventional medicine, illness is perceived mechanistically–a biological problem with biological and chemical remedies. Medication is the most time-efficient way to eliminate such an intrusion.

By contrast, both in traditional Hispanic medicine and for most Native Americans of the Southwest, physical illness is perceived as a violation of spiritual law. Healing is therefore imbued with the divine. Most curanderas (Hispanic faith healers) of the Southwest emphasize the association of sin and illness, because their cultural traditions have been strongly influenced by a mystical Catholicism. For Native Americans, healing involves the recovery of harmony and balance in human community embedded in the mysterious flow of nature. To lose that balance and harmony is to be in a wasteland of emptiness.

In each of these cultures, there is a confidence level operating that empowers healing. Native Americans see the healing power in nature and have confidence that it will combat illness. The curandera helps reinforce confidence in prayer to saints, in confession, and in doing penance. By contrast, our consumer culture leaves us vulnerable to a failure of confidence in healing when we reach the limits of our resources of scientific theory, technology, and pharmacology.

Treatment at the reservation involved herbs and healing ceremonies. With assistance from peyote priests and medicine people, Norman reconnected with Mother Earth and experienced a healing of his illness. The doctors were amazed when he came back to work pain-free. During the ceremony, Norman had been given a specific vision of a childhood incident in which he had offended the creatures of the earth. He felt that the bladder infection was a consequence, and it had been necessary to heal this wound and exorcise the pain. "We are so connected to the earth that when one offends nature there will be consequences," he concluded.[12]

Navajo approaches to health and healing are all deeply rooted in the earth. Their medicinal remedies involve herbs, gifts from Mother Earth. Eating corn pollen is a healing act with spiritual significance, because corn is related to creation. Eating deer and elk meat confers the strength of these muscular animals upon the humans who ingest them, appealing to the slain animals' spirits for renewal. Traditionally, pain is always dealt with from a spiritual standpoint, reflecting the harmony and balanced unity of all of life.

The fragmented nature of Western culture works against pain patients. Chronic pain usually narrows the victim's world. It takes so much energy to fight the pain that there is little energy for other people and expanding personal horizons. Sincere attempts from others to extend care often fall short of what is needed. Instead of authentic presence and compassion, people will sometimes toss off shallow statements such as, "I know how you must feel." These expressions often have the effect of further isolating the sufferer. Yet it is imperative for people in chronic pain to avoid isolation. The burden of suffering can be eased in the context of healthy relationships that help to give the pain patient a sense of worth and identity that is defined by caring people, not by the limitations of the pain.

accepting opportunities for growth

Sometimes adversity can be viewed as a purification–a sifting process in which the winds of difficult change sweep away the chaff to reveal the wheat that is worth harvesting. In this process, whether inaugurated by

in a wheelchair. Pain and suffering can motivate people to go far beyond their comfort zones in the commitment to hope for a better life.

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Eric Varella, a big man who used to be a very good athlete, developed significant and chronic neck pain after his car was rear-ended. He was a conscientious employee and continued to work at his job as an auto mechanic. The pain was severe and constant, however, severely limiting the range of motion in his neck. He developed a pattern of depression, dragged-down relationships, and some deactivation. Since he had drifted away from his Catholic upbringing, he would need to find a way to rekindle his spiritual strength.

We emphasized Eric's need to begin the process of reactivation. He began swimming on a regular basis, but the neck pain persisted. Determined to decrease the pain, we performed x-ray-guided procedures–a cervical epidural followed by cervical facet (joints in the neck) injections. Now Eric was able to move his neck with less pain and his headaches decreased in intensity and frequency. Through two years of struggle, he learned that his adversity created an opening for him to rebuild his spiritual life. As he re-entered the Catholic Church, he began moving from depression to hope. His inward renewal, combined with physical reactivation, is helping him function more effectively and with less pain. His is not a welcome situation, but at times it is a joyful one.

Responding to pain with despair and withdrawal leads to entrenchment and woundology. Responding to pain with determination to discover a larger life leads to hope. Both involve suffering, but they lead in very different directions.