February 18, 2011

PAIN, Part 4: What Others Have Written on Pain and Suffering

Part 1, "An Introduction to the Subject of Pain"
Part 2, "My Personal Pain Story: The Pink Porcupine"
Part 3, "Creativity in the Midst of Pain"
Part 4, "What Others Have Written on Pain and Suffering"
Part 5, "Resources Related to Pain Management"

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Disclaimer: I am not a psychologist. physician, physiologist, or therapist. I have no medical or mental health training whatsoever. Therefore, no advice, medical or psychological, is intended or implied by any of the posts in this series on PAIN.

What Others Have Written on Pain and Suffering

We're nearing the end of this little series on pain, and I've said all that I know to say... Today I'd like to quote those with professional experience in pain, illness, and/or suffering, or with personal experience that has impacted their professional life.

It may seem as if the idea for this pain series began with my experiences and grew from there; but actually it began with my purchasing a book years ago, not long after 9/11, and pulling it off the shelf in early January of this year on a day when I was in considerable facial pain from cellulitis (a tooth abscess that had migrated into the tissues of my face). I didn't feel like reading women's fiction, or anything mysterious, or even one of the many beautiful illustrated art books in our home. It was the weekend, and while I had no other responsibilities, I didn't feel well enough to paint, bake, shop, or write.

The book is by Kathleen A. Brehony, PhD, and titled After the Darkest Hour: How Suffering Begins the Journey to Wisdom. There is more wisdom in this book than I can detail here, and I appreciate the way Brehony not only shares her impetus for writing such a book but delves into different religious and philosophical traditions on this subject. There are many wonderful passages, and I'll begin my list of "What Others Have Written on Pain and Suffering" with After the Darkest Hour.

"American writer Christian Bovee made the case for the idea that it is our relationship to the circumstances and the events of our lives rather than the events themselves that determines how we will see them." (p. 59)

"When we are immersed in periods of suffering, most of us feel it will never end. At those times, it helps to remember that the Latin root of the word suffering itself means 'to allow' or 'to experience.' In the midst of turmoil brought about by an unexpencted loss or change, very often we have no answers that ease our anguish; we simply must 'be' and experience the full pain of our loss. This is a particularly difficult notion in our culture, where we have learned to look for simple solutions, magic pills, or quick fixes to short-circuit the pain of suffering. It can be helpful to remember that even in the midst of our anguish, the wheel [of life] continues to turn. We can be certain that even in the blackest night our situation will change again. (p. 49)

"Pain is a common way through which we come to understand that our life has a transcendent aspect, a larger dimesion, and realize that 'my life is not just about me.' This transformed consciousness allows for the birth of true compassion (a word that literally means 'to suffer with'). This heartfelt tenderness removes all barriers between oneself and others so that we can experience oneness with each other and the universe. I find that it is easy to recognize those who have true compassion; it is apparent in their interest in other people, their empathy, and in their eyes, which seem to look on the world and everything in it tenderly. What we also usually learn about truly compassionate people, as we come to know them, is that most often they have suffered some great loss. (p. 35-36)

"[Carl Jung] believed that when we understand that we are all part of a world in which suffering is inevitable and universal, we can better understand how to grow through that pain. (p. 21)

"Mystics of all spiritual and wisdom traditions agree that suffering is the only key that opens the door to transformation of the soul and psyche. It is by way of pain, they say, that we come to terms with our true destinies, our true selves, and form an authentic relationship with God." (p. 13)

~Kathleen A. Brehony, PhD, After the Darkest Hour: How Suffering Begins the Journey to Wisdom (2000, Henry Holt and Company)

The following insight comes from my long-time friend (and former college roommate) Katharine Pumphrey Knapp. When she and I traded confidences in my parent's guest bedroom in August of 1978, the night before my first wedding, we had no idea what life was holding in store for us and how our youthful optimism would be tested. A wonderful teacher and gifted with children, Katharine went on to add additional degrees and qualifications to her name, and has a successful practice as a therapist for women and children in Charlottesville, Virginia. I asked for her input on the subject of pain:

"I believe that pain often gets confused with one's identity. We can become THE PAIN since it can command such attention. I've seen clients who allow the pain to sabotage their 'SELF', and hold it hostage. It can define us if we let it, and I've seen people give up on life, talking about it all the time and blaming others for not understanding how BAD it has made life. I've also seen folks live in denial, in anger about other things when the real issue is not addressed. The poles of west or east do not sustain health. A balance between sharing and caring for oneself, needs to be mixed with finding a passionate form of living with this aspect of life. Pain then becomes just one part of what we experience in life, NOT the defining aspect or SELF.

"Another thing that I discuss with depressed clients who have to manage chronic pain is this: The body holds memory in tissue, as well as in the frontal lobe of our brain. This means that the experiences that often get associated with pain, or the
experience that may have been part of what caused the pain (if an accident, or activity, or especially if our 'choices' were involved), get logged onto the computer not only at the site of the brain (executive functioning), but into the living tissue. Then we reinforce the highway of patterns—making associations of pain and feeling. Over time these can be linked and hard-wired into the body. Then we get a negative feedback loop and the pain and feeling (like perhaps victimization, guilt, anger, hopelessness, etc.) are linked. This can trigger a personality change. When offering help to others about this, I suggest that they consider first baby steps in building new highways in the brain and body connections. Before we can alter hard-wired conditioning, we must add in new highways (if you will grant me the metaphors here). By going down the same street, we end up at the same destination. Let's build new roads.

"So, I encourage loving the body (which is often hard when in pain and the body is the enemy). I start with asking folks to massage their hands or feet (unless these are the source of pain). It lets them discover the joy of meeting their body again, of loving it, accepting it, enjoying positive feedback as they are gentle and kind to their own body. After awhile, we look at new ways to nurture the self and the body. I'm over simplifying it to be sure. I work with folks a lot on this subject."

"I have lived with chronic pain for years as well. It has been worse lately. What I have learned is to build in distractions that seem to take my mind off of it and on to other things. Of course this does not always work, but often it does. Having broken my back, lived in a wheel chair, and currently deal with on-going issues, it's just worth focusing on other things. i love my work, my family and my friends. I enjoy creating beauty which takes my mind off of the pain. I remember when this was a harder choice, and worked less often. I think that our focus helps us regulate our reaction to the pain. It does not take it away, but helps us create dissociation or distance from it." Katharine Pumphrey Knapp, LPC Services for Women and Children

Katharine is also the mother to two grown sons. The youngest was recently accepted into medical school and, like his mom, will be helping to heal others.

A few years ago, I stumbled across an online post, "A Sudden Illness: How My Life Changed" by Laura Hillenbrand, the author of Seabiscuit and Unbroken. In the article she describes her personal health challenges. In reading it, I was struck by not only her honesty, but by how she persevered in her creative projects while battling an illness that sent her to her bed, robbed her of energy and the experiences many young adults enjoy and baffled her physicians. Here is a link to a recent (Nov. 28, 2010) Washington Post interview with Hillenbrand, that discusses her books and her illnesses. Here is a quote from the article:

" 'I have to detach myself completely from aspirations,' Hillenbrand says, discussing how she has learned to cope with her illness. 'I hardly ever listen to music anymore because it arouses all of this yearning in me.' She numbs herself to the things she cannot have."

This approach is also discussed in Brehony's After the Darkest Hour and I have found it a helpful attitude in the creative work that I do that is not "for hire." For me, keeping my focus on the process is key to not only doing my best work, but maintaining a healthy attitude toward rejection, disappointment, and unrealistic expectations. Even when doing creative work for a fee, rather than watching the clock and calculating a time-to-money ratio, it's best for me to focus on the process, the joyful creation of whatever, the privilege of being paid to do work I enjoy.

Another book that I purchased a few years after 9/11 was Coping with Public Tragedy, edited by Marcia Lattanzi-Light and Kenneth J. Doka, (2003, Hospice Foundation of America). Each chapter has a different author and I've pulled some interesting quotes out for you to read. Keep in mind that the subject of this book was disasters, events, and tragedies that are of a public nature; not pain or illness, per se, but public suffering. Yet I found the insights helpful as I re-read parts of the book while thinking recently about pain.

"Janoff-Bulman (1992) described an assumptive world as 'a conceptual system, developed over time, that provides us with expectations about the world and ourselvees' (1992, p.5). She argued that the most fundamental of these assumptions are 'the bedrock of our conceptual system" and are those that we are least likely to challenge' (1992, p. 5). In particular, Janoff-Bulman suggested that the most fundamental assumptions held by most people in the assumptive worlds are likely to be of the following types: 'The world is benevolent,' a conviction that is typically applied to people and to events... ; 'The world is meaningful," a conviction that there is a relationship between a particular person and what happens to that person... ; 'The self is worthy," a conviction that one is essentially good, decent, and moral in character, as well as wise and effective in one's actions.'

"Janoff-Bulman conceded that everyone may not hold these three beliefs, but she argued that they are at the foundation of many individual world outlooks even when the individuals in question do not think this is what they believe. She also contended that such assumptions are broad and adaptive, but not foolhardy, because they 'afford us the trust and confidence that are necessary to engage in new behaviors, to test our limits' (1992, p. 23). Tramatic events challenge the most fundamental counvictions in our assumptive worlds."

"Loss, Grief, and Trauma in Public Tragedy," Charles A. Corr (Chapter 6, p. 68), Coping with Public Tragedy, edited by Marcia Lattanzi-Light and Kenneth J. Doka, (2003, Hospice Foundation of America) Reference cited: Janoff-Bulman, R. (1992)
Shattered-assumptions: Towards a new psychology of trauma. New York: The Free Press.

"...the playwright Samuel Beckett expressed his own deep-seated need to write: 'one writes not in order to be published; one writes in order to breathe' (Ref. Mitchelmore, S. 2002, After the Disaster [online], Spike magazine).(p. 206)

"... in times of tragedy we desperately seek out those among us who can see beyond logic, analysis, reasons, idealogies, politics, and minister to our broken spirits. We need artists of all descriptions who can arouse our numbed or raw emotions and provide insight, catharis, sanity, connection, even consolation." (p. 206-207)

"In Zorba the Greek, Zorba asks the questions, 'Why do the young die? Why does anybody die? ... What's the use of all your damn books if they can't answer questions like that? What the hell can they do for you?' The young scholar answers him: 'Well, they tell me about the agony of the man who can't answer questions like yours.' "

(Kazantzakis, N., Zorba the Greek, 1952. Quoted in Bertman S., 1991. Facing Death: Images, Insights, and Interventions, Taylor and Francis) "Public Tragedy and the Art" Sandra Bertman (Chapter 17, p. 215) Coping with Public Tragedy

Twenty years ago, for a short time I saw a counselor who recommended several books to me. One was entitled Feel the Fear and Do It Anyway (which has been brought out in new editions and audiobooks since the time I read it.) My favorite quote at this time was Eleanor Roosevelt's "I must do that which I fear most." And while I know this post is on pain, not fear, it seems to me that fear is often a "frenemy" of pain; and it never hurts to seek to overcome our fears. So, I was also drawn to a book with a similar theme, and this quote from it:

"...we can let the circumstances of our lives harden us so that we become increasingly resentful and afraid, or we can let them soften us and make us kinder and more open to what scares us. We always have this choice." The Places that Scare You: A Guide to Fearlessness in Difficult Times by Pema Chodron, author of When Things Fall Apart

Judith Voirst is one of my favorite authors, and when searching for information on pain I wasn't disappointed in looking within her book Necessary Losses:

"It is easier to grow old if we are neither bored nor boring, if we have people and projects we care about, if we are open and flexible and mature enough to submit—when we need to submit—to immutable losses. The process, begun in infancy, of loving and letting go can help prepare us for these final losses. But stripped—as age does strip us—of some of what we love in ourselves, we may find that a good old age demands a capacity for what is called 'ego transcendence.': 'A capacity to feel pleasure in the pleasures of other people; 'A capacity for concern about events not directly related to our self-interest.; 'A capacity to invest ourselves (though we won't be around to see it) in tomorrow's world.

"Ego transcendence allows us, while perceiving ourselves as finite, to connect to the future through people or through ideas, surpassing our personal limits by means of some legacy we can leave to the next generation. As grandparents, teachers, mentors, social reformers, collectors of art—or creators of art—we can touch those who will be there when we are gone. This endeavor to leave a trace—intellectual, spiritual, material, even physical—is a constructive way of dealing with the grief we are feeling over the loss of ourselves."

~Judith Voirst, Necessary Losses: The Loves, Illusions, Dependencies and Impossible Expectations That All of Us Have to Give Up in Order to Grow (1986, Ballantine Books) p. 32-33

It seems common to being human to wonder why bad things happen to good people. I have not struggled with this as much as some do, because it seems to me that life is unfair and capricious and if something bad happens to my neighbor but not to me, it seems only a result of luck and circumstance. Tomorrow it might be my turn to be in the wrong place at the wrong time. Overall, I feel very fortunate and seem easily to realize that others are far "worse off" than am I.

What is of more interest to me is to think about why some people can take the awful experiences of life and grow from them; learn from them...while others crumble under the weight of sorrow and disappointment. This topic is what prompted Broheny to research the ideas within After the Darkest Hour and are noted as well by Frank Parkinson in his book Post-Trauma Stress:

"We tend to think that life is fairly safe and secure: 'Bad things happen to other people and not to me.' Our general experience of life is that most of us do survive without being involved in major accidents or disasters. Our very strong defense mechanisms are there to protect us from becoming overanxious. We live our lives as optimists, in the fase belief that we will live forever and that harm or danger will not touch us.

"When we are suddenly confronted by a traumatic and shattering experience, our safe little world can collapse or be turned upside down, resulting in confusion and fear.

"...these events make us aware that we are not invulnerable. We are mortal. We can die. Life is neither secure nor safe. ... These experiences can cause intense fear and anxiety, as well as the loss of security and confidence in yourself, others or life in general."

~Frank Parkinson, Post-Trauma Stress: Reduce long-term effects and hidden emotional damage caused by violence and disaster (2000, DeCapo Press) p. 15

His Holiness the Dali Lama continues on with this theme:

"Even for those who do not believe in future lifetimes, contemplation of reality is productive, helpful, scientific. Because persons, minds, and all other caused phenomena change moment by moment, this opens up the possibility for positive development. If situations did not change, they would forever retain the nature of suffering. Once you know things are always changing, even if you are passing through a very difficult period, you can find comfort in knowing that the situation will not remain that way forever. So there is no need for frustration.

"Good fortune also is not permanent; consequently, there is no use for too much attachment when things are going well. An outlook of permanence ruins us: Even if you accept tha there are future lives, the persent becomes your preoccupation, and the future takes on little import. This ruins a good opportunity when your life is endowed with the leisure and facilities to engage in productive practices. An outlook of impermanence helps."

~His Holiness the Dalai Lama, translated and edited by Jeffrey Hopkins, PhD, Advice on Dying and Living a Better Life (2002, Atria Books) p. 42-43

In Healing and the Mind Bill Moyers interviewed many interesting people. One such person was Jon Kabat-Zinn, PhD, author of Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, who spoke on the subject of pain and meditation:

Kabat-Zinn: "...if you look at it [pain] carefully, you'll see a sensory component to the pain which is just sensation. It can be very, very intense, and the mind will habitually interpret it as noxious. But if you understand it, you may be able to tolerate it better. ...But often...no precise physical cause for the pain may be found. Sometimes you have to learn to live with certain kinds of pain. Pain is the sourrce of enormous disability in our society."
Moyers: "But how does mediatation help deal with pain?"
Kabat-Zinn: "It allows you to learn from your own inner experience that pain is something you can work with, and that you can actually use pain to grow. Sometimes you have to learn how to work around the edges of your pain and to live with it. The pain itself will teach you how to do that if you listen to it and work with it mindfully."
Moyers: " 'Mindfully,' meaning—"
Kabat-Zinn: "Meaning that when pain comes up in the body, instead of focusing on the breath, you just start breathing with the pain. See if you can ride the waves of the sensation. As you watch the sensations come and go, very often they will change, and you begin to realize that the pain has a life of its own. You learn how to work with the pain, to befriend it, to listen to it, and in some way to honor it. In the process of doing that, you wind up seeing that it's possible to feel differently about your pain. "Sometimes, when you focus on this, the sensations actually go away. ... I don't say, 'Well, just fantasize about something that will be so interesting that you'll forget about your body.' I say, 'Go into the body, go into the shoulder, go into the lower back, breathe with it, and try to penetrate the pain with your awareness and with your breathing.' So it's the opposite of distraction." ...the more you are in distress from pain, the worse...the physiological consequences. If you can learn to be comfortable within the pain or anxiety, the experience will be completely changed. ...you're not trying to make the pain go away. ...we actually move into the stress or pain and begin to look at it, and to notice the mind's reactions, and to let go of that reactivity ... And then you find that there is inner stillness and peace within some of the most difficult life situations."

Jon Kabat-Zinn, PhD, author of Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. As quoted in Healing and the Mind by Bill Moyers (1993, Doubleday) p. 119-120

Moyers also interviewed Dr. John Zawacki: "...Some patients have pain they can't control. When we don't know what causes that pain, and pain medication hasn't worked, and the pain clinic hasn't worked, we have sent patients to the stress clinic to learn how to live with their pain and sometimes to overcome it." (John Zawacki, MD, as quoted by Bill Moyers in Healing and the Mind, p. 146).

I am always interested in the connections between various things that interest me. How does pain relate to art? How do words relate to images? And...how does reading relate to pain? Well, Ode Magazine addressed this issue in its October 2010 issue in the article: "Reading, writing and revelation: How the written word helps refresh body, mind and soul" by Ursula Sautter.

"Whenever the stabbing pain in her knee becomes unbearable, 17-year-old Mackenzie Bearup picks up a book and starts to read. Usually, it's a teen novel or a mystery. But Bearup will read 'anything that takes my mind away from the agony, that allows me to think of other things.'

"Reading and healing have an age-old association. In ancient Egypt, libraries were known as psyches iatreion, 'sanatoriums of the soul.' During the Renaissance, the poetry of the Psalms was thought to "banish vexations of both the soul and the body,' according to Italian humanist philosopher Marsilio Ficino. And, as far back as the beginning of the 19th century, the American psychiatric community was discussing reading as a therapeutic technique.

"Now, science is starting to prove what readers and writers have long known: Words cana help us repair and revitalize our bodies as well as our minds. As a result, bibliotherapy—reading specific tets in response to particular situations or conditions—is becoming more and more popular among psychologists, physicians, librarians and teachers."

Sautter goes on to explain bibliotherapy and its many forms and states that "Doctors or therapists write prescriptions in the context of a practice setting, or individuals explore what works for them at home." I found it interesting to learn what books therapists recommend and the personal stories she shares of people helped in times of illness, pain, or suffering by the simple act of reading particular stories. Sautter shares that in the U.K. physicians have the option of prescribing "self-help manuals to those seeking medical attention for mood disorders." Tens of thousands of people each year receive these presecriptions.

As a publisher and writer, I found this article to be one of the most interesting I've come across. I was interested to learn that Ms. Sautter is also the author of an article in Time magazine, back in 2002, titled "Dining in the Dark" about a restuarant where waiters are either completely blind or visually handicapped.

In Pain, Part 5, I will share with you the resources I have found that seek to help those with pain.

Pain—has an Element of Blank—
It cannot recollect
When it begun—
or if there were
A time when it was not—

It has no Future—
but itself—
Its Infinite contain
Its Past—enlightened to perceive
New Periods—of Pain.

Emily Dickinson

Postscript: On the day of my last post on this topic, Time Magazine arrived in our mailbox and the cover story? Pain. There is a lot of helpful information in the issue, especially related to research, medicine, and alternative treatments. Time: Health Special: Chronic Pain; The End of Ouch? (I suggest ordering a copy of the print or e-magazine, full version, because there is a lot of good information in the magazine that is not freely available on their website.)

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