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THE HIGH PRICE OF INNER CONFLICTS ABOUT PAIN
I've been reflecting quite a bit about inner conflicts about pain as I've traveled through Europe teaching several workshops on this topic, culminating with "Working with the 'I' of Healing" taught with Dr. Fred Gallo this past weekend.
The inner conflicts related to physical/emotional pain can be complicated by the dynamics of dependency on, or addiction to, prescription medications. Many people living with chronic pain develop coexisting disorders, including depression, anxiety, or sleep disorders that they didn't manage very well, and so experienced life damaging consequences as a result. Others started have problems with their pain medication management and then developed a substance use disorder - prescription drug abuse or even addiction - and didn't see it coming.
Just as the human body has an immune system to protect it from dangerous physical organisms, the human mind has a kind of "mental" immune system to protect it from the painful reality of overwhelming pain and its related problems. The purpose of this psychological defense is to protect our mind and personality from what it cannot tolerate.
Denial is one part of this defensive system. It is activated whenever we are asked to think or talk about a painful or overwhelming problem. Denial is a normal and natural human response to severe pain and the problems of painful reality.
At times of high stress the brain can get emotionally overloaded. At these times the brain will activate specific automatic defenses, which we will call denial patterns. Each denial pattern is turned on by a specific trigger which threatens something that we value. As a severe problem causes intense stress, the brain turns on intense fear and/or anger. This activates a psychological program that starts mobilizing automatic defensive thoughts and the urge to use resistant behaviors.
A major obstacle to recognizing these self-sabotaging behaviors and achieving effective pain treatment is this denial system, the psychological defense mechanism that protects us from devastating pain and problems that is automatic and unconscious. It is important to remember that this system of defense was developed to protect us from being overwhelmed by our painful reality.
There are at least four levels of denial. The first is a lack of information -- in this case what ineffective pain management or medication abuse/addiction really is. Often this first level stems from the mistaken belief that, because a doctor prescribed the medication, there won't be an addiction problem. The solution here is education and up-to-date information about addiction. It is crucial for people living with chronic pain to learn as much as possible about effective pain management, pain disorders, and substance use disorders (i.e., prescription drug abuse or prescription drug addiction).
The second level of denial can be called conscious defensiveness. At this level we know that something is wrong, but we don't want to look at the problem and face the pain of knowing. The solution is to recognize that there is an inner conflict occurring where one part of us knows there's a problem, but another part doesn't want to admit it. To resolve this conflict we must be willing to listen to the part that knows the truth and take action. The old saying "the truth will set you free" is certainly relevant in this case.
Another level is the presence of unconscious defense mechanisms. We get to this level when we have stayed within the inner conflict, mentioned above, and the defensive voice keeps winning. Once this happens, denial becomes an automatic and more unconscious defense mechanism. The solution then is much more difficult. It usually takes an outside intervention, or what is called a motivational crisis, to break through this defense and allow us to know the truth, and then start addressing the problem. For some patients this motivational crisis gets generated when their treating physicians became concerned about their mismanaged chronic pain or use/abuse of pain medication. For others, family members intervene and urge them to seek help.
The fourth level is denial as a delusional system, which is the most difficult level to address. This delusion is a mistaken belief that is firmly held to be true despite convincing evidence that it is not true. If someone is experiencing denial at this level, they probably would not be open to reading this article. People at this level of denial usually need intensive psychotherapy to resolve their delusional system.
There are two primary antidotes to denial -- acceptance and problem solving. Acceptance is a peaceful acknowledgement of the truth. If you can calmly face the problem, acknowledge the truth about what is going on, and accept that it is happening to you, you can then develop a way of handling the situation. The person who accepts the truth of a serious problem also has the ability to affirm to themselves honestly: "I have a serious problem! I am responsible for dealing with it, and I'm willing to learn how!"
Problem solving is a system for finding solutions to various problems, which can then be employed. Effective problem solving systems involve identification and clarification of your problems, identifying the logical consequences of possible alternatives, deciding which alternative to use, taking action, and then evaluating the outcomes. By recognizing and accepting the problem and developing an effective problem solving plan, the need to use denial will go down because the ability to manage problems will go up by taking action.
Learning to identify and manage denial -- the inner saboteur -- is a necessary first step for people living with chronic pain who want to develop and implement an effective pain management plan. A second essential step is to focus on the troublesome emotions and thoughts that accompany and sustain pain over time.
The important interaction between emotions and body experience has long been recognized. Elmer Green, the famous Mayo Clinic physician who pioneered early work in biofeedback writes, "Every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state."
Neuroscientist and research professor, Dr. Candace Pert has contributed to much of the ground-breaking research on this subject. She states, "I believe all emotions are healthy, because emotions are what unite the mind and the body. Anger, fear, and sadness, the so-called negative emotions, are as healthy as peace, courage, and joy. To repress these emotions and not let them flow freely is to set up a dis-integrity in the system, causing it to act at cross-purposes rather than as a unified whole. The stress this creates, which takes the form of blockages and insufficient flow of peptide signals to maintain function at the cellular level, is what sets up the weakened conditions that can lead to disease."
Thus, it is not enough to accept that you have a problem, and then to identify possible solutions. It is also necessary to recognize and express emotions that may have been expressed in the body as an aspect of the physical pain problem.
A simple explanation of how inner emotional tension/stress creates physical pain is to remember that all thoughts and emotions are energy. An emotion or feeling is being denied or avoided and because of this repression it is now blocked, stored, or stuck energy in our bodies. This blocked emotional energy eventually creates pain and imbalance in our bodies because it wants to be experienced. There is one part of you, energy, trying to be expressed, and another part of you, also energy, that is holding this expression down and most of this is happening outside our awareness, in our subconscious.
This intense conflict erupts in our body/mind. The tension from this inner conflict will eventually erupt as a concentrated experience of pain. Blood flow can become chronically constricted, depriving our tissues of oxygen, and creating other problems.
If our intention is to heal, we can do this by keeping the information, our energy and emotions, flowing freely, and by communicating within and about our body & mind systems in a balanced, open, efficient way. When we do this we no longer have energy being stored, blocked and stuck. When our system is open and free, we have linked our psyche (thought, emotion and spirit) to our physical bodies (molecules, cells and tissue) in a free flowing exchange.
This requires a daily practice of present moment awareness of the totality of our experience, including body sensations and unaccepted emotions -- a waking, working mindfulness of who we are. As Eckhart Tolle, author and spiritual teacher, has commented, "The way out of pain is to create no more pain in the present moment." Tolle believes that every emotional pain that you experience leaves behind a residue of pain that lives on in you. It merges with the pain from the past, which was already there, and becomes lodged in your mind and body. This includes the pain suffered as a child, which Tolle believes is caused by the unconsciousness of the world into which each child is born.
One way to solve this conflict is to learn how to focus on the conflict-free self that can manifest in any current moment. To find the conflict-free self, think about a time in your everyday life where you feel the way you want to be able to feel all of the time. This can be a simple moment where you are drinking your morning tea or coffee, or working outside in your garden, watching the sun grace a favorite corner of your kitchen, or savoring the smell of fresh baked bread.
The content of the experience is unimportant. What does matter is that in this moment, all of you is engaged and sharing the same feeling of connection and wholeness. If you find a promising conflict-free moment where you experience no tension or symptoms and there is a feeling of flow rather than constriction, you can use breathing or imagery to make the connection stronger and more real. Not only is it important to generate as many of these moments as possible, it is also essential to reinforce their importance by recalling and reflecting on their essence, and using them as a bridge to a more pain-free life.
More information on the conflict-free self can be found in my books Finding the Energy to Heal(please visit www.amazon.com/Finding-Energy-Heal-Hypnosis-BodyFocused/dp/0393703266/) and Reversing Chronic Pain (go to www.amazon.com/Reversing-Chronic-Pain-10-Point-All-Natural/dp/1556436769/).
Other contributors to the material in this article include Dr. Stephen F. Grinstead, who is an author and internationally recognized expert in preventing relapse related to chronic pain disorders, and is the developer of the Addiction-Free Pain Management® System. Together with Terry Gorski and Dr. Jennifer Messier, he co-authored the Denial Management Counseling (DMC) for Effective Pain Management Workbook. See www.addiction-free.com.
Thanks as always for reading.
Yours in health,
Maggie
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