Spiritual Issues in Pain Management

When tragedy befalls someone, it is common to ask “Why me?”  Some may feel that chronic pain must be punishment for past transgressions and mistakes.  Some may blame one’s self or others.  Some may feel that it is totally unfair and a great injustice.  Some take it in stride as part of life and roll with the punches.  It is natural to search for meaning when chronic pain establishes itself as a most unwelcome guest in your house.

A first response is to attempt to get rid of this visitor.  You visit doctors and other health practitioners for help.  Surgery, medications, physical therapy, exercise, diet changes, osteopathic manipulation or chiropractic adjustments, acupuncture, herbal supplements and so on are tried with varying success at evicting the pain. When these approaches have failed to eradicate all the pain, you may go on a search for the “magic cure”.  This usually results in disappointment.  You may feel overwhelmed with distress, despair, and frustration.

At some point, you are left to surrender to the reality that chronic pain is here to stay.  The question is how to live with it.  There are several strategies that people adopt at this point, depending on their personalities, past experiences, social expectations, and values.

One coping strategy is to adopt an attitude of stoicism.  This is a common attitude in our culture that prefers to deny chronic pain as a legitimate condition. Stoics hide their pain from others and, to some extent, from themselves, in order to avoid or reduce the judgment of one’s self and others.  Stoics usually feel guilty that they are not “whole” and functioning as they once did.  This attitude is often admired by people as being courageous and heroic. Christopher Reeve, who suffered with quadriplegia after a tragic riding accident, is an excellent example of someone who overcame huge obstacles to function beyond anyone’s expectations and maintained a stoic attitude to the end.  This adaptation is often functional and can be effective if not carried to the extreme of self-denial of available and effective treatment options to reduce pain and to increase function.  Some Stoics may opt to forego the use of opiates, for example, regarding it as only for the “weak and desperate”.  An underlying fear of dependence on a “crutch” can prevent the Stoic from gaining the benefits of relatively safe treatments and their benefits.

Another attitude is the identification with victimhood.  Some people feel abandoned by the people or by the God they assumed would protect them from bad things. They may feel betrayed and bitter.  A crisis of faith and trust may occur.  Some may unconsciously identify with the archetypal Victim…the person who always gets punished.  The seductive flip side of victimhood is identification with being an archetypal Savior…the one who sacrifices his/her life for the benefit of others.  This identity with martyrdom is a psychological trap since people with this unconscious identity often engineer more betrayals and victimhood experiences.  They may hate themselves, being filled with shame and guilt.  They may believe that they deserve their punishment of pain, and deserve even more. They may unwittingly sabotage their own efforts to cope by alienating their caretakers and friends, or by selflessly foregoing help that’s offered.  Victimhood, as a strategy, is poorly adaptive and usually regarded by society as a sign of weakness, thus inviting contempt.  The rejection of Victims by their friends and family is often a self-fulfilling prophecy with unfortunate consequences. One such consequence is regarding their rejections as “proof” of their martyrdom. This may create a stubborn pride in their “exalted” status as “saviors”. Most people soon see through this guise, leaving the Victim alone with his/her feelings of despair.

A very adaptive strategy is one I call humble mastery. The Humble Master is one who uses his/her own power to shape events and to make important choices, while also recognizing his/her own limitations.  Here humility is a key attitude to adopt. Being humble has been described as knowing your limitations and knowing when to ask for help.  Doing the best you can while obtaining the competent help of friends, family, professionals, and spiritual forces usually yields the best outcomes. The Humble Master takes responsibility for the chronic pain (not the blame) by reaching out to those who can teach new coping skills, provide comfort, support, and compassion.  He/she regards the condition of chronic pain as an opportunity for personal and spiritual growth.  With humility, you can forgive yourself for being human with your limitations, forgive others who you perceive may have failed you, and remain open to what others may offer you for help.

An essential adjustment in perspective is to regard chronic pain as a “natural” condition that is found throughout humanity and nature. Chronic pain is not exceptional, but common. The Buddha stated, “Life is suffering”.  Therefore, we are all suffering in some way or another. He then said “Suffering is caused by Desire”.  The most common desire of those with chronic pain is “I wish this pain would just go away”. He then said “One can eliminate suffering by letting go of Desire”.  In this context, the peaceful acceptance of chronic pain paradoxically reduces the anguish and suffering caused by a resistance to feeling pain. This resistance is usually generated by fear of the pain itself.  By letting go of fear and by humbly surrendering to pain’s presence, it is possible to reduce both pain and suffering.  Meditation is a very useful tool in this regard. Meditation promotes a peaceful acceptance of life on its own terms.  This allows one to be fully present in each moment of life, available to experience it in all of its richness and complexity. Meditaters may acquire the ability to shift their attention away from pain so that it is no longer “center stage”.  It is still there, but in “the wings”.  This creates a space for the rest of life to be experienced.  There are forms of meditation in all religions, and some forms of meditation, such as Transcendental and Mindfulness Meditations, which are free of any religious dogma.

In the Christian tradition, the image of the Crucifixion of Jesus is a powerful symbol of Divine Suffering. Redemption comes from humble prayers to have Jesus take away suffering. Experiencing the powerful spiritual presence of Jesus can remove personal suffering when the suffering is shared with this Divine Presence.  Those who have had this experience are transformed spiritually and see their pain as a prerequisite to participating in a Divine Mystery.

In ancient Greece before the arrival of Christianity, Asklepios was the god of healing.  He holds a staff with a snake curled around it.  His father was Apollo, the god of medicine.  In this old tradition, patients were prepared to meet Asklepios by first going through ritual cleansing, fasting, prayer, and meditation.  When deemed ready, each patient would sleep in an abaton or sleep chamber in the temple.  While asleep, Asklepios would visit them in a dream, which healed them. The physician/priest in attendance would interpret the dream the next morning or assist the patient in making the transition back to health. Here again, the patient subordinated himself to the Deity in humility and gratitude.  Healing was a divine gift to those who earnestly sought it.  Hippocrates, the father of modern medicine, was an Asklepian healer.  In the ancient Greek tradition, mind and body were seen as one. Ironically, it was Aristotle who later conceived of the two as being separate.  Unfortunately, this conceptual division of mind and body persists to this day.

Many people don’t have any particular religious beliefs, yet find solace and relief by maintaining the optimism that something good must somehow emerge from this misery. Positive expectations, faith, gratitude, the appreciation of Nature’s beauty, and compassion for others are attitudes that help lead you to find enjoyment and peace of mind in spite of pain.  I consider these attitudes to be spiritual even if a person has no specific religious beliefs.

The relationship of body, mind, and spirit is especially highlighted in chronic pain. Holistic healing works on all levels simultaneously to improve the quality of life and to reveal the great mystery that underlies all of Life.  The path of chronic pain is a spiritual path as long as the pain can be adequately managed and understood.

There is more I have to say on these Spiritual Issues relating to chronic pain.  For more, please read my first blog.