chronic pain – Page 2 – Mind Journeys

The Messenger reviews my book

I am proud of the review by Ruth McIntyre in February’s Anglican Messenger. Her comments are generous. Read them below.

SUFFERERS OF chronic pain, and those who care for them, will find great comfort in this short book. It does not recommend throwing away the prescribed medication, but offers carefully described ways to make the most of a life that must be lived as well as possible.

As Ted Witham writes: Pain disables us. Pain takes us out of circulation – it seems to erect barriers between us and our families, our friends and our work. Pain imprisons us. At its worst, pain claims our total attention, and we can do nothing else but react in anguish.

How then to cope? In twelve steps, each detailing ways of understanding, Ted Witham offers his own experiences of meditation with exercises that will challenge other sufferers.

Refreshingly honest in approach, Living Well discusses the accompanying depression of chronic pain and suggests ways that will help to overcome it. Spiritual responses are thoughtfully underpinned with practical methods of approach.

Practical and emotional support is highly desirable and the writer has produced a manual to accompany the text. Walking the 12 Spiritual Steps with those in Chronic Pain: The Manual for spouses, friends and pastoral carers (Spirit-Ed 2008 ) is carefully and thoughtfully presented to help people closely involved with the affected person to gain increased knowledge and understanding. How is it possible to be truly helpful and supportive without impinging on the dignity and privacy of the person with chronic pain? What inner struggles are likely to be standing in the way of accepting the burden of pain and probably affecting the relationship?

Ted Witham, though a priest himself, places no great restrictions on the views of God held by those who seek help. There is room to develop knowledge and grace on this journey of pain and he shares his experiences, both practical and spiritual. as guides to enrich the lives of others. Relevant readings from the Scriptures are suggested for each of the steps.

Pain Management Programmes have the capacity to improve the patient’s quality of life, reduce suffering and distress and provide a more satisfactory lifestyle. They are not designed to eliminate pain or provide the patient with a cure. (Australian Pain Society: http://www.apsoc.org)

Living Well: The Book's Cover
Ted Witham is equally realistic. His goal is abundant living – the best quality of life that is possible – and that will include taking part in some of the things patients want to do and activities that are important to them.

If chronic pain is a problem to you or someone you love, this book and its guide will prove invaluable.

Ruth McIntyre

It’s been an unpleasant surprise to me to find my movements so restricted by my pain. I was upset recently not to be able to travel 3 hours to the city for the interment of my goddaughter’s ashes. I even find it difficult to travel to Dunsborough 30 minutes away. Being ‘stuck at home’ means I have an excuse not to go to meetings. That’s generally good. The down side is that I can feel left out of the various organisations I belong to.

But the unpleasant surprise has been reduced by a gradual pleasant surprise. People are coming to see me about their Christian lives and ministries because I am at home and therefore have a largely empty calendar. They find it possible to fit me in their busy lives because I am here. I am here all the time.

This surprising availability to others has been a joy for me. Not only do my visitors bring me collegial company, but they also allow me to exercise my gifts of pastoral supervision and listening.

I have decided to name this surprise after one of the vows of the Benedictine monastic tradition. In addition to the three ‘Gospel’ vows of poverty, chastity and obedience, a Benedictine monk also makes a promise of ‘stability’ – to remain with this community for the rest of his life.

Benedictine stability: courtesy Benedictine community, Camperdown, Vic.

Stability is a protest against the busy running around most of us do in our work and in our family life. Monastic stability reminds the rest of us that being still, being less mobile, is a good thing. For monks, stability means that they can be found by God. But being a still point attracts others.

Unlike that of Benedictine monks, my immobility is not chosen. However, I can welcome it as stability, as a way that will bring me into different contact with people, as a way that links me more firmly to this little corner of my suburb, and as an opportunity where I might be found by God and so deepen my spirituality.

Reframing enforced immobility as chosen stability is a good thing to do with my brain.

Use your brain

Pain clinics usually have psychologists. That’s not because chronic pain is a mental illness, but because the mind has resources that can help us change the way we look at our pain. Pain psychologists are more like sports psychologists than ordinary psychologists. They are basically interested in getting us to perform better.

There are parallels between elite athletes and people with chronic pain. The most obvious is the necessity for exercise. To manage chronic pain we must be in training always. The type of exercise may vary depending on your level of disability, but I must have significant exercise every day to give the cardio-vascular system a work out.

At the moment, that means I start my walk with the ritual of calling the dog, getting her to sit and attaching her lead. Then we walk for 10-15 minutes. My next goal is to take a slightly different route that will add 5 minutes to my walk and conclude with a significant climb.

When summer comes, I take to the swimming pool and do ‘water-running’ and gradually build up my times and my effort. I’m currently on 4 x 50 metre laps, at just over 4 minutes a lap. My pulse and breathing rates get to near my safe limit, so I will continue doing 4 laps until my vital rates are lower. Then I will add a half-lap, and then another.

To do this properly requires a bit of obsession. I have to be disciplined like an athlete preparing for a big meet. To keep on track, I have to use my brain, and not only for exercise. Like an athlete, I use my brain to reframe and refine my attitudes. For example, the attitude that the world owes me is not a helpful attitude for an athlete or a person with long-term pain. My attitude needs to be not that I am owed anything, but that I have something to give, and I have the capacity to achieve.

Near the town where I live is a walking trail called The Bibbulmun Track. Named after the local aboriginal clan, the trail winds its way through most of the traditional Bibbulman lands. Walkers take up to 6 weeks to trek the length of the trail through jarrah and karri forests and coastland heath. From September to November, the wildflowers fill the bush with colour. The cool mornings of winter bring a crisp mist to the karri forests. I think it is the most beautiful country on earth.

For some time, I have not been able to walk on the Bibbulman track. It’s not that I want to walk from one end to the other. I would just like to be able to drive to a place where the trail intersects the highway and walk for three hours or so.

I am not physically able to manage that walk at present, but I use my brain to motivate my body to heal. I hold it up to myself as a goal. I set myself this goal as a participant in the Pain Understanding and Management Program at our local hospital. Now many months later, I am not much closer to my goal. But having the goal has kept me walking every day. Having the goal has increased my appreciation of our own native garden.

My brain can heal my body, and I like getting the most out of it.

God Pictures

The worst thing that the Western church has done is that we have turned God into a man. Ask any six-year-old to draw God, and she will emulate Michelangelo and draw an old man with a white beard. The orthodox Christians, the Jews and Muslims have taken much more notice of the second commandment: “Thou shall not make of the Lord thy God any graven image.” (Exodus 20:4).

We may not believe that God is literally a human being, but we picture a transcendent God in physical terms. Children may believe God is the “Friend for little children//Above the bright blue sky” in an absolute literal sense, and adults often believe transcendence describes God’s distance from the physical creation.

It’s true that the Bible often anthropomorphosises God: God walks out before the armies of Israel; God picks up and cuddles the human person, like a mother and baby (Hosea 11:3-4). In general, however, the Bible has a sophisticated notion that God is (a) holy, that is set apart from his creation, and (b) intimately involved in creation.
God is a wind (Genesis 1:3), an unseen and uncontrollable energy that stirs up of the raw materials of creation. God “sits above” the thunder and lightning (Psalm 39), more powerful than the raw energy of the storm. God stills the seas (Psalm 65:7), not with a giant hand, but with an irresistible will.

If you have chronic pain, your picture of God matters. If you think God is a sophisticated human upgrade, if you make God in the image of human beings, your God will not be strong enough to make a difference to your pain. Your picture of God will limit your ability to receive the powerful healing God wants for you.

In the last ten or so years, my picture of God has changed radically.

Sometimes this journey has been dangerous. I have wondered if I have lost my faith. The God I had believed in was not big enough, and certainly not powerful enough to positively affect my pain, and I had to let go of that picture of God.

In Peter Jackson’s 2001 film, The Lord of the rings: the Fellowship of the Ring, an underground sequence has the wizard Gandalf confronting a Balrog on a crumbling rock bridge. The hobbits run as fast as possible to get to safety. Gandalf falls with the monster to their death. Growing your faith in God is like that rush across the bridge of Khazad-dûm. When you let go of your picture of God, everything crumbles and precious ideas die.

But let me encourage you. The only way to have a picture of God adequate to your pain is to stop believing in the God you think you know. There is a well-trodden path to this believing atheism, and it is the path of mysticism.

1. Any picture of God you have is by definition too small. To continue to believe in it is to commit idolatry. You have no choice but to let go your picture of God.
2. When you let go of God in this way, you become an atheist in the sense that you have no God to hang on to. What you must then believe is that God is hanging on to you. You cannot know what manner of God this is, you need to trust only that you are being held.
“Blessed be the Lord day by day,
who bears us as his burden;
he is the God of our deliverance,” says the Psalmist (68:19)
3. As this trust develops, so you may begin to grope towards a new understanding of the God who is holding you. You may for example, begin to find new metaphors to describe God. God is energy; God is universal heartbeat, God lives as the tiniest cell in living things. These God-cells begin a process of healthy change in your body, and your pain is reduced.
4. But these are again pictures of God. The irony is that the process of letting go of your new pictures of God must continue.

In the audio for this session, I invite you to image a Spirit, a larger reality and to open yourself to encounter this Spirit. In this process, you may experience the reality of how deeply you are loved, how surely you are held, and how extraordinary is your future in this compassionate universe. This is what I call, and only for convenience’ sake, “contemplation”, the experience beyond muscle relaxation and centring.

I invite you to relax further into this journey into the Unknown God. I encourage along the only path through deeper atheism, which as it unfolds leads to a deeper experience of the power of God in healing your mind/body.

Meditating with the Aware Ego

Our minds are capable of standing back from ourselves. With the power of imagination, our minds can invite beneficial influences to reduce pain and to increase endurance.
Imagination is fun to use, and images begin their magic by engaging our emotions.
You can download this week’s Meditation (Level 2 – using the mind to reduce pain) from http://www.blognow.com.au/manager/add_entry.php?t=pod&up_id=83432

Relax: it reduces pain.

THe meditative state allows us to stop being aware of past pain, and to stop worrying about future pain; we have just cope with whatever there is in the 1-3 second gap that we experience as the ‘present moment’.

Progressive relaxation is a simple technique of relaxing muscle groups progressively through the body. It almost always reduces pain. More importantly, it can prepare the body and mind for meditative state, in which we focus on the present moment of awareness. This allows us to stop being aware of past pain, and to stop worrying about future pain; we have just cope with whatever there is in the 1-3 second gap that we experience as the ‘present moment’.

The audio should help. I find it best to listen in a comfortable chair with earphones of some sort, an mp3 player is ideal. Otherwise, use your computer speakers and be seated comfortably before you press ‘play’.

THe file is an mp3 file, and Windows Media (which should be built into your computer) will play it if you have no other means. If you listen on the computer, turn away from the screen so that the visual imagery doesn’t distract … especially on Windows Media!

You will find the audio at http://www.blognow.com.au/uploads/t/twitham/83309.mp3 (shhh! It’s on my other blog. I wasn’t allowed to upload the file to this one!)

Relax and enjoy.

Meditation, not medication

Meditation

The calm of Meelup Beach, near Dunsborough WA

I have been teaching meditation to groups on and off for 30 years. I am always astounded by the depth of response that people make. Meditation usually feels good, and people often love the sense of freedom that meditation opens up for them.

I divide meditation into three levels: progressive muscle relaxation, meditation (guided imagery) and contemplation (openness to encounter). These labels are very artificial. Other people use these labels differently. But I find my labels of the three levels helpful enough. In any case, as you go on in your practice of meditation, you will find the three levels melting together.

For those of us with chronic pain, however, it is helpful to see three ways in which meditation helps our pain.

Firstly, the muscle relaxation reduces pain. Whether our main area of pain is caused by muscle tension or not, we all increase our pain by the way we hold ourselves to compensate for the pain, or we put some muscles to extra work for which they are not ideally fitted. As we relax muscle groups in this form of meditation, other muscles around them also relax. On some days, we will find our whole body very deeply relaxed, on other days, not so much. But even limited relaxation reduces pain.

Secondly, the guided imagery assists our mind-body system in locating and managing our pain. Our brains have a map of the whole of our body, and significant interchange takes place between this map and where our pain is. The part of my brain where my thoracic spine is represented sends and receives messages from the spine. Using imagery about the specific area of pain opens up healing possibilities for the brain.

At the third level, in contemplation, the relaxed mind-body opens itself to the possibility of encounter with something other than itself. This ‘something other’ may be a spiritual reality, or it may be the ‘collective unconscious’ where we meet at a deep level with the whole human race, or it may be a construct of our minds. We will describe and understand this encounter according to our beliefs. But the ability to open ourselves to a spiritual power much greater than our own increases healing possibilities, including the relief of pain.

MINDFULNESS

The other powerful aspect of meditation is the way meditation cultivates ‘mindfulness’, or a sense of the presence of God. Meditation does not focus on the nature of God, so much as on the reality of presence. For the 17th century Carmelite friar, Brother Lawrence, cultivating the presence of God at all times, even in the dreariest drudgery of the monastery kitchen, was the secret of his happy life.

Being totally in the present moment removes from us the nostalgia for the past and anxiety for the future. In meditation, we are reminded that we are as we are at this moment. This moment is the only moment we have to live. We cannot live in the past. We cannot bring forward the future to live it now. We are alive in the present.

Much of the sting of our pain can be taken away if we limit it to the present. We are experts at remembering how painful our bodies were. We are superb at looking into the future with fear at how much pain we will have to bear. But if we practice mindfulness, we have to live only with the pain we have right now.

The best way to learn meditation is in a group. Churches, Buddhist and community centres often offer classes in meditation. Before you join, you need to find out enough about them that you feel comfortable with them. You will be entrusting yourself to the leader at a time when you are surprisingly vulnerable.

Also check out whether they will make allowances for your health difficulties. While there may well be a level of physical challenge in meditating, it should not be so rigid that you do not have the opportunity to learn.

In the next three posts I will teach you (1) how to relax your muscles and reduce pain, (2) how to meditate and use guided imagery and non-imagery to banish pain, and (3) an exercise in ‘contemplation’ in which you will be invited to allow a power greater than yourself to take away some of your pain.

The past is another country

The past, I find, can be extremely seductive. Someone somewhere in my extended family has a photo of my brother and I aged about 10 and 7 respectively sitting on a large Clydesdale horse. The photo reminds me, of course, of the hours Barry and I spent playing on that huge horse. The horse was too high to climb on, so we would lead him over to a strainer-post, and climb onto the large post. From there, we would try to mount the steed. Success came only after two or three attempts, because by the time we climbed up, the horse had plodded off, and would have to be rounded up again.

Being the elder, Barry would always ride up front and “steer’ the horse. This involved patting it on the side of the head, talking to it, and occasionally pulling the appropriate ear. The horse took it all patiently, just kept plodding on. I begged and begged to be allowed to sit up front. Eventually Barry had an idea. “I will steer the horse under the branch,” he said, “and I will grab the branch. Like he always does, the horse will keep plodding on and take you under me and I will drop on behind.”

My brother reached up and hung from the branch. I squashed down as the horse plodded on. But I couldn’t squash down small enough. In fact, the tree lifted Barry off the horse only a couple of inches. Barry was committed; the horse likewise was committed to keep walking. I tumbled off the back of the horse – quite a fall when you’re 7 years old and the horse is at least 17 hands tall! I looked up and Barry was still hanging from the tree. The horse was still ambling away. In the end, Barry too had to drop down, so we were both on the ground, and I had missed my chance to sit in the front! Despite my disappointment, it was so funny – especially as Barry got his come-uppance by being stranded 20 feet up in the air.

I’m glad we have that photo. It keeps the memory alive. I was lucky. I had a happy childhood – even as brother number four – and it’s pleasant to reminisce. But it’s also a distraction. Once I think of that photo, I start thinking of many associated happy times with Barry, with the horse, with the family. I’m in another world apart from the present.

At first glance, the past looks like a good place to escape when you are in great pain. And it can be. But the past is also a dangerous place. It can become, on one hand, an addictive escape that prevents us ever facing up to the real challenges of the present moment, until they escalate totally out of control.

On the other hand, the past has pleasant memories, but it is full of unexpected pot-holes. Just as we recall a pleasant event from our childhood, the memory sparks off another memory of being bullied, or being embarrassed, or of committing some act that even now catches us with an intensity of guilt.

While there are past experiences that do need attending to in order for healing to take place in the present, most of the incidents in our past are past, and should stay there. Bringing them back into the present just adds one more level of pain to those we already put up with. We can do without that.

Living in the present doesn’t mean forgetting the past; it means being mindful of the journeys we take there. Living in the present means we keep good hold of the coordinates of this present moment, so that when we visit the past we do it with awareness – both that nostalgia can be pleasant, but also that it is past, and has no direct connection with this present minute, this present day.

The same goes for the future. I can imagine wonderful things happening to me sometime soon. I can look forward to my daughter’s wedding. I can imagine the satisfaction I will have teaching a course next month. I can dream about being a famous author. But I must do so with awareness, mindful that the future, like the past, is full of dangers. We can worry about finances, especially when we are off work. We can project our disappointment if we cannot meet the travel plans we have made because of pain.

When we visit the land of future, the danger is that we will stir up unnecessary anxiety, just as when we visit the past, we trip over unnecessary feelings of guilt and shame.

Of course we must plan. But we plan with awareness that we are in the present. The future will never arrive. The present moment is the only moment which we can experience.

Jesus of Nazareth expressed it with realism, “So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.”

Indeed. The present may be full of trouble and pain, and we need to live it. But we do not need to make the present moment harder than it is by letting our imaginary journeys into past or future add to the sum of pain we experience now.

No Sex, Please: We Might be Sore

SEX AND PAIN
Definition of sexuality:
“Being so attentive to another that you tend to merge with that other.”
Those words, with capital ‘O’s, could equally be a definition of spirituality.
“Being so attentive to an Other that you tend to merge with that Other.”
For some mystics, sexuality and spirituality are aspects of the same reality: the purpose of human life is to “get out of oneself” and merge with the larger Reality. Saint John of the Cross, for example, lusciously described his prayer life as sexual pursuit and mutual seduction.

The Bible regards human beings as in-breathed bodies, that is, spiritual bodies: not spirits AND bodies, nor flesh AND soul, but just one united package. In classical Christian thought, no division can be made between body, mind and spirit. To emphasise one aspect (say, the spiritual) over another aspect (say, the physical) depreciates the essential wholeness of the human person. So for Christians, having sex is never purely physical, because the human beings engaged in sex are spiritual, emotional, thinking (etc!) bodies. Having sex should be making love. If it is not, the act is expressing hate, or showing indifference. The physical act is inextricably linked to the greater human reality.

For those in pain, sex may be painful. Doctors today even recognise this. In the 20 years following my major operation, sexuality didn’t appear to exist for pain sufferers. Doctors paid attention to the effects pain and pills had on every other function of your body/mind, but avoided mentioning the major impacts pain has on your sex life.

Nowadays, there are questions on pain questionnaires which ask you to rate the obstacle your pain causes for your enjoyment of sex, but I have not yet met a doctor willing to actually discuss the questionnaire results, which in my case document the additional pain of having sex and the decrease of enjoyment of sex. A doctor prepared to discuss sex and pain with me would be a bonus.

For those in pain, it can feel as though the physical pain is taking away the emotional and spiritual joy of making love. But that is not all. Not only is the pain a turn-off, but also body image,
disappointment and lack of control contribute to a diminished sex life.
The pain itself lessens the enjoyment of sex. The person in pain then sees their body as being less than it should be, and their body image becomes yet another barrier to full enjoyment of the other.

Faulty body image means not that something is wrong with the body, but with a person’s picture of their body. A faulty body image arises in chronic pain from not looking at the whole body. A person with chronic pain who looks carefully at their body, however, will find more that is right than is wrong. Looking attentively at what is really there is not only a spiritual act, but also a healing one.

Disappointed with their body’s betrayal, they withdraw from sexual activity, fearing more disappointment. Pills, the pain and one’s partner’s reaction to the medicalising of our lives all reduce one’s sexual response. Sometimes I’m aroused, but at other times, not. This loss of control adds to the spiralling decrease in sexual interest.
It’s easy to give up, or to give in to anger and resentment. But there are genuinely positive ways of responding.

1. Talk about these things to your partner.
Researchers have noted how difficult it is for even loving couples to talk about sex. It may be that your pain and the challenges it brings is a gift to your sex life. It can oblige you how to talk together about sex. The aim is to make love. The agenda of your conversation is how do we make love given the physical and emotional obstacles pain causes?

2. Fall in love all over again by realising how precious touch is; all touch, and not just sexual touch.
So hold hands. Gently brush your partner’s skin as you pass. Kiss when you wake up and kiss when you get ready for sleep. A sexual relationship is not restricted to 20 minutes in bed. Its joy is its anticipation of the constant presence of your lover.
Touch, too, is the precursor to massage. I am one of those who dislike massage. But a gentle touch relaxes my muscles and can reduce pain.
On the principle that ‘it is more blessed to give than to receive’, share the touching and be attentive more to your partner than to your pain.

3. Keep your bedroom a bower for intimacy (and sleeping!), and stop it looking like a hospital.
Take pills off the bedside table; put medical equipment in the cupboard; take pain diaries and exercise charts down from the walls and put them out of sight, preferably out of the bedroom. Cover hospital pillows with a quilt or colourful slips.

4. Be tolerant of your mind’s nocturnal fantasies.
Sexual dreams involving others are not necessarily temptations to infidelity. They may just be your mind working out ways of maximising your physical and emotional enjoyment of life under restricted circumstances. Learn to welcome your unconscious mind’s attempts to link physical sexuality with emotional and spiritual love. Your mind knows how important it is for you to love your body and with your body.

In all things, be attentive and open to the love of the Other. As other human beings do, make love as best you can within the limitations of what you are given.

In times of temporary or ongoing celibacy with chronic pain, the two-way definition of loving the other/Other still applies: “Be so attentive to an Other that you tend to merge with that Other.” In the 13th century Franciscan theologian Dun Scotus taught that every creature is a little Word of God: an instance of Incarnation. Every person or being to which one gives one’s loving and respectful attention draws us closer into union with God.

For those of us in continuing pain, this knowledge is a beacon of hope. We do have the ability to look beyond our preoccupation with ourselves and our pain, and look into the face of God. That’s sexy. That’s the ultimate in spirituality.

Tag: chronic pain