Staying Mentally and Spiritually Sane When You Have Chronic Pain
By Wendy Hendler
Reprinted with permission from Joint Ability, a quarterly magazine on arthritis and rheumatism.
All physiological illnesses affect us emotionally as well, and it is important to remember that we are complete entities comprising body, mind, and spirit.
When it is comes to dealing with chronic pain, it is not surprising that a person with a condition like rheumatoid arthritis or fibromyalgia may develop secondary psychological complaints, such as depression, fear, anger, and/or anxiety. Because our physical experiences are intertwined with our emotional experiences — and vice versa — it is beneficial to seek treatment for both our physical and emotional selves. The experience of living with a condition that involves ongoing chronic pain can cause you to become frustrated, and even depressed. For example, experiencing a prolonged prediagnosis period, poor or limited support from the medical community, lack of understanding by family members and friends, severe chronic pain and fatigue that can last for weeks and even months at a time, changes that disrupt your lifestyle, and the inability to do the things that you used to do, can all affect your emotional health.
Symptoms of Depression
The thoughts, physical changes and feelings that accompany depression, and interfere with daily life, include symptoms like:
- Loss of interest or pleasure in daily activities.
- Significant weight loss or gain.
- Sleeping too much, or not being able to sleep.
- Apathy (lack of feeling or emotion).
- Fatigue or loss of energy.
- Feelings of worthlessness or guilt.
- Recurrent thoughts about death or suicide.
Depression is not an emotional weakness or something that you can just will away, but rather a complicated medical condition that is caused by chemical imbalances in the brain.
If you have lost interest in activities that used to bring you enjoyment, or if you avoid participating in the normal activities of life because you feel empty, lonely, or fatigued, it is time to discuss your symptoms with a healthcare professional. It might be uncomfortable admitting that you are depressed, but by denying it, you are denying yourself treatment.
Everything can be taken from a man but — the last of the human freedoms — to choose one’s attitude in any given circumstances, to choose one’s own way. (Viktor Frankl, Man’s Search for Meaning)
Psychological and physiological symptoms can be treated with pharmacological agents or through behavioural interventions. Psychological counselling, particularly the use of techniques such as cognitive restructuring and biofeedback, may benefit some individuals who are having difficulties coping both physically and emotionally with their physical pain.
The Spiritual Dimension
The human being is made up of three dimensions: physical, psychological and spiritual.
So far, we have concentrated on the physical and psychological experiences of people facing a chronic illness. Let us now turn our attention to the spiritual dimension. This is the domain of Logotherapy — the therapy taught by psychiatrist and Holocaust survivor, Dr Viktor Frankl. Logotherapy is healing through meaning, and it focuses on the spirit of the person. This crucial aspect — in fact the central aspect of the human being — has largely been neglected by modern psychology. It is this spiritual core that defines us as human. This spiritual part of the human being, or as Frankl calls it — the noetic self — cannot get sick, cannot die, and exists beyond the limits of time and space. It contains the essence of life, but it can be blocked by physical or psychological sickness. Our task as logotherapists is to remove the block and to enable the human spirit to fulfil its tasks. We do this by helping people find meaning in their lives, and meaning in their suffering. This search for meaning is what characterises all human beings no matter what their circumstances.
Frankl spoke about suffering as a normal part of life experience. He asserted that when suffering cannot be avoided, a human being can still find meaning in it — by the way he faces it, and by turning human tragedy and suffering into a human achievement.
Self-detachment and Self-transcendence
There are two unique capacities that can elevate a human being: self-detachment and self-transcendence. Self-detachment refers to the human capacity to step away from oneself, and to observe oneself and any of one’s symptoms from the outside. As we do this, we become less self-focused, and less attached to our symptoms. This enables us to see ourselves as full human beings rather than as our diagnoses.
One of the dangers of illness is that we tend to hyper-reflect — that is to think about and be aware of our symptoms all the time. Self-detachment helps us to counter this tendency, which brings negativity and anxiety with it, and to see ourselves as people who are larger than our illness.
Self-transcendence is a specifically spiritual capacity. It means the ability to rise above and beyond outward conditions. It means transcending our limitations, and moving beyond ourselves, and our narrow circle of concern. It means loving others fully and finding ways to be of service to them.
Meaning can be found in many ways, but the one I would like to share with you is the attitude one takes towards one’s predicament, when required to cope with an unalterable fate, and unavoidable suffering.
Accepting One’s Destiny
According to Frankl, the measure of human fulfilment is the way in which a person accepts his destiny, the courage he manifests in suffering, and the dignity he displays notwithstanding his circumstances.
It is true that we cannot always control what happens to us, but we always have the freedom to choose how we respond to what life brings us. We can react with bitterness and despair, or with hope and optimism.
Mind body medicine, or psychoneuroimmunology (PNI), has now become an accepted scientific discipline. Our thoughts and feelings affect our immune system, causing chemical changes, which reflect themselves in our physical health.
Stress generated by chronic pain and illness can be managed when we see our lives as meaningful and purposeful. Stress generated by a negative mindset — one of hopelessness and helplessness — has a damaging effect on our health.
One of the strongest ways we positively affect our immune system is when we experience our lives as filled with meaning and purpose. Viktor Frankl personally experienced this while interred in the Auschwitz concentration camp. He noted that the people who had a meaning or purpose for surviving had a much stronger chance of survival than those who gave up on life. He found that his own goal of rewriting his manuscript on man’s search for meaning sustained him and kept him alive during his years in the camps.
So we see from this that our inner world of thoughts, feelings, hopes, dreams, goals and purposes has a life giving power, even in times of extreme physical challenge.
From which dimension of our being do we draw our inner power? It is from the noetic or spiritual dimension that we draw our strength. This is the storehouse of the human spirit, which contains all those precious resources that can be marshalled by the individual to counteract sicknesses and traumas. This is the dimension which contains our will to finding meaning in our lives, our goals in life, our creativity, love, conscience, sense of humour, imagination, self awareness, compassion and forgiveness. It is the toolbox from which we draw courage, hope, trust, faith and optimism.
Humour and Gratitude
Two powerful tools for triumphing over difficult circumstances — such as ongoing pain and suffering — are humour and gratitude. Humour has a life giving power, and helps us to distance ourselves from our situation.
Gratitude keeps us focused on what we do have, for all of our blessings, for those who love us and who serve us, and for our lives. Gratitude is a most powerful highway to meaning, and it is the meaning we ascribe to our lives and our journeys that sustains and enlivens us.
I will conclude with some of the basic principles of Logotherapy, which I hope will give you a message of strength and courage as you continue your journeys through life:
Principles of Logotherapy
- Human beings are three-dimensional entities — biological, psychological and spiritual. All of these dimensions must be considered in any treatment.
- The human spirit is the healthy nucleus in sick people.
- The defiant power of the human spirit is a potent force in the struggle for survival.
- Life has meaning in all circumstances as long as one is capable of choosing.
- Choices are present in all situations.
- People have the freedom to find meaning in life and the will to finding meaning is the main motivating factor in life.
- Each individual is unique and cannot be substituted with another.
- We can transcend ourselves for the sake of another human being in need — by the virtue of love.
- We can detach ourselves from constant preoccupation with ourselves by laughter and humour.
- Meaning is present in each and every situation. The individual decides whether to use, or to lose, the opportunity to find meaning in any circumstance.
May we use the defiant power of the human spirit to overcome suffering and to find our own unique meaning and purpose in our lives!