pain – Mind Journeys

This Painful Life

Every minute of every day, I experience pain. People say how hard it must be, and I don’t disagree. It just is. I have experienced pain since my late teens. I recently turned 63, and the pain has really been both continuous and severe for the past 20 years.

There are days when I complain about it. Not so much the pain as the extra limits it places on my life: less mobility, so a walk on the beach turns step by step into agony. Less ability to sit, so an evening at a restaurant becomes 20 minutes before the pain just makes me, well, go home. At least in recent years, I’ve learned that I have to either pre-order, or choose a restaurant that serves me quickly.

Doctors now recognize chronic pain as a disease of the nervous system or of the brain. That’s not to say that the pain is all in the mind. Rather it points to the mis-firing of the brain’s systems for experiencing pain. In chronic pain, the nerves that bring messages of pain to the brain and the systems that interpret sensations and the brain’s own map of the body are all out of whack, like an orchestra playing out of tune and out of time.

In my case, it’s as though the brain is replaying pain from previous injury to my spine. Ghost pain messages play havoc in my brain. For other people, the ongoing pain may not relate to tissue damage at all, but it arises, a mystery with no obvious cause.

On a scale of zero to 10, where zero is no pain and 10 the worst pain imaginable, my pain sits uncomfortably around 7 most of the time. Others with chronic pain have more fluctuation.

Pain is one thing. The experience of suffering is another. Both pain and suffering are mysterious experiences. But the extent to which a person suffers from their pain is partly a choice.

Rae Scott's cover "The Secret of Mount Toolbrunup"

As a young man, I climbed Mount Toolbrunup. In W.A.’s Stirling Ranges, Toolbrunup’s the toughest climb, because loose scree covers its steep sides. You scrabble up two or three steps, often on hands and knees, and then slide back one or two. It’s exhausting. Even though you seem to make no progress, the skinned knees and knuckles don’t make you suffer. You are climbing. An interesting activity engages you, and if you lift your head high enough, you see better and better views.

Climbing Mount Toolbrunup is a bit like living with chronic pain. You scrabble along. Your way is exhausting and the pain is real. But you are engaged in something other than the effort to move along: the fascinating activity of life. If you lift your attention away from the pain, you see how absolutely captivating life is. You see people to love, usually those who love you. You see an extraordinary world full of natural and man-made marvels; planets and meerkats and the Sydney Harbour Bridge. You choose interesting activities, reading, watching movies and setting crossword puzzles are some I choose. Life is there to be lived.

Or you can choose to suffer. Chronic pain is different from many illnesses. If you break a leg, it gets better. If you have diabetes, you can take insulin. There are pain pills, but they don’t always work. Meditation and exercise form the best base treatment for chronic pain, but note: you have to work at them. You have to choose.

The pain is unrelenting. I have many strategies to keep me sane, even cheerful. I don’t underestimate the climb. Researchers have found, for example, that chronic pain is experienced in the same region of the brain as depression. For many people ongoing pain and deep depression go hand in hand. It’s easy to slip into the chasm of depression, and I have once or twice.

But in the end, I choose. I choose to minimise the pain and limitations, and as well as I can, I choose not to suffer. The view’s great.

The Meaning of Pain

Melanie Thernstrom, The Pain Chronicles.
New York: Farrar, Straus and Giroux, 2010.
EAN:978-0865476813
$22 approx. on line

Reviewed by Ted Witham

One purpose of religious faith is to make meaning. Christians especially find it difficult to make sense of chronic pain. As Melanie Thernstrom explains in her entertaining Pain Chronicles (yes, entertaining!), acute pain is an excellent response to injury. Acute pain protects us. Chronic pain, like cancer cells that don’t know how to stop, serves no such purpose. It afflicts at least one person in ten and resists most treatments.

Christians need a strong theodicy to incorporate pain into their understanding of a loving God. In his 1993 memoir missionary doctor Paul Brand, famous for his work with leprosy, tried to sell the idea that pain is “the gift nobody wants.” Brand saw the lepers’ infected cuts and burns, injuries caused because they could not feel pain, and argued that we should praise God for the protective properties of pain. For Christians with chronic pain, this is not persuasive. Chronic pain serves no good purpose. As a chronic illness it challenges God’s ability to heal.

The Pain Chronicles tells two inter-twined stories: it is a memoir of Melanie Thernstrom’s own journey from her futile searching for cause and cure, to a more productive attempt to make sense of a life with ongoing pain. Formerly a staff writer with the New York Times, Thernstrom shares this journey with a robust honesty, especially her initial belief that her pain was a punishment for an ill-advised love affair.

This leads Thernstrom to meditate on the historical connections between the word “pain” and the Latin word for punishment “poena”. This excursion into history and language takes the reader through changing theologies and attitudes, and is typical of the second story of The Pain Chronicles: its pleasure in intellectual curiosity. Thernstrom follows her forensic curiosity down many byways in the history of pain and medicine, analgesia and anaesthesia. We learn both how the ancients understood pain and how contemporary researchers peer into the brain’s response to pain with real-time brain-imaging.

The Egyptian Ebers Papyrus from the 13th Century BC declares that “Magic is effective together with medicine. Medicine is effective together with magic.” “Although it would take millennia to understand why,” writes Thernstrom, “words in combination with physical treatment can alleviate pain in ways better than treatment alone.” (p. 35). She is clearly delighted to have affirmed that medications work better in a good healing relationship.

Some Christians believe that pain can lead one into the imitatio Christi. Elaine Scarry’s classic 1985 study The Body in Pain examines how the Bible understands pain, beginning with the pain of childbirth (“all those begats”) and following through the pain inflicted on God’s enemies in the Old Testament. Ultimately, claims Scarry, all this pain can only be understood through the lens of the Cross. Women’s pain, the pain of Israel’s enemies, and ultimately our pain should be viewed as a share in Christ’s Passion. After consideration, Thernstrom dismisses this idea as unhealthy: “I didn’t want to be in Pain. I didn’t want to want it. Pain is not a cross; it’s a Harrow.” (p. 76)

Ms Thernstrom cites studies that show “positive religious coping”. For some Christians, their faith does help them make sense of chronic pain by cognitive reframing the suffering or placing it in a wider context. For other Christians, however, pain leads to greater distress perhaps because they interpret their pain as punishment. (p. 206)

Hearing about the Hindu devotees who thread hooks through their flesh, Thernstrom heads to Kuala Lumpur to see whether they might have some insights into dealing with pain. Her journalist’s pen describes the festivals vividly, but they are of only marginal help on our journey. These pilgrims choose temporary pain to induce a spiritual high. This may lead to effective analgesia, but it is a practice worlds away from chronic pain: not choosing pain that never stops. No wonder the priest snorted when Thernstrom asked the god to take away the burden of her pain.

Thernstrom returns to science to make meaning of chronic pain. This malady is a disease of the brain, in fact, a disease of consciousness, that we cannot yet cure or treat effectively because brain science knows so little about consciousness.

She compares our current understanding of chronic pain to consumption in the 19th Century. Consumption was used as a metaphor for dying Romantic poets or operatic heroines. In 1882, a German physician identified mycobacterium tuberculosis. Although the cure, antibiotics, was half a century away, this scientific discovery reduced the illness from a metaphor to a disease. Chronic pain, Thernstrom concludes, currently evokes many metaphors, but until science unlocks its secrets, we will remain like pre-1882 sufferers of TB.

The Pain Chronicles cover much fascinating territory. Metaphors of pain and suffering are explored with elegance, intelligence and humanity. Melanie Thernstrom offers no theodicy of her own. She fears, I think, that to do so would belittle the experience of her fellow sufferers. What she does provide, though, is a fascinating sampling of others throughout history making meaning in chronic pain. While there may not yet be a cure for chronic pain, there is a lot of understanding here, and therefore comfort.

Spiritual help for people with chronic pain

I know what it is to live day in day with high levels of pain. My doctors tell me that, like 5 -10% of the population, my central nervous system is misfiring and produces chronic pain. For me, this pain seriously impacts my mobility. I appreciate the medical help that I receive. I also know that there are spiritual resources that I can use to live positively while still experiencing ongoing pain.

I describe many of these resources in my 56-page Living Well With Chronic Pain, a book structured around a 12-Step program. I have also written a Manual for the spouses and friends of people living with pain.

Chaplains, pain specialists and GPs approved of the ideas in the books. Over the last two years, many people living with chronic pain have found these books helpful. Read reviews here. and here.

Today the printer has dispatched the fifth reprint of Living Well With Chronic Pain. St John Books in Fremantle (WA) will sell these books, or they can be ordered directly from me for $22.95 +postage and handling.

I am also now making available a digital version of the book and the manual. These are in PDF format and cost $9.95 (the book) and $5.95 (the manual). Email me at twitham@cygnus.uwa.edu.au to order either or both, and I will email them to you. Payment can be made to my PayPal account.

(All prices quoted are in Australian dollars).

Suffering unto death?

The comment was only half in jest, and it caught me by surprise. “You sound disappointed that you weren’t diagnosed with bone cancer or blood cancer.” My answer was the sanctioned one: “I am disappointed that they haven’t found something that they can treat. I don’t really care what its name is.”

The truth is, there is a little part of me that felt disappointed when the scans and blood tests returned negative. Of course, that’s partly explained not as a death wish, but as frustration with my symptoms, which have been powerful enough on some days for me to think that death would be easier to bear than the pain.

But my friend made me wonder. During those days of waiting for results I did rehearse my reactions to the possible diagnosis of a fatal illness. The prospect that I would not have more years with Rae filled me with pain. The thought that, though I might live to see Clare’s wedding, I might not see the children she will have with James and watch them as babies, toddlers, children, adolescents and growing to adulthood, seared my heart. The idea that I would not be around long enough to see Brendan settled and happy troubled me deeply.

No, I am not disappointed. I want the chance of more life. But I hope I am also strong enough to face my mortality, and to wonder what that now means to me as a Christian. These last weeks have reaffirmed for me the stark fact that I will die, if not soon, then in the coming decade or two. And whatever I believe, I cannot escape the reality of nature: death is the end. We live, we die. Anything that might be beyond our life span would be a sheer miraculous gift of the Most High. Resurrection is by definition surprise.

It is many years since I believed (if ever I really did) in my continuing existence after death as an individual. I hope I have not given false comfort to people over the years that they will somehow be reunited beyond the ashes or the grave with their loved ones in some happy valley. This false but widespread belief is both arrogant and petty: Arrogant to believe that human beings are so important in the scheme of the Cosmos, and petty to think so poorly of God’s imagination.

By definition, “eternal” cannot be after anything. The word itself tells us that the grace of God operates not after our death, but beyond our life – out of time. As far as we can know now, eternal life is about the intensity with which we live in this too short space between birth and death. Eternal life is about our gratitude now. Eternal life is about intentionally taking time to be simply in the Presence of all that is.

Looking forward to some second-rate paradise after death will in fact take away from the joy and brilliance of living in the now.

Instead, we should be journeying within to discover the broad and marvel-filled country of our souls. Instead of yearning for a union with those whom we love in the past, we could be yearning for a greater quality of loving those we are given to love now.

I am not afraid of the darkness to come. The problem is that sometimes I am afraid of the brightness of the light here and now.

I can say Alleluia!

I wake on Easter morning with my wife’s kiss. “Christ is Risen!” she smiles. I hesitate before responding, “He is risen indeed.” it is a great day, but I feel just pain behind and in front. The Psalmist’s words were louder in my mind than Easter’s liturgical cry: ” Fat bulls of Bashan surround me on every side.” Back pain behind and gastritis before fill my consciousness. in the same breath, I pray, “You are behind me and before: such knowledge is too wonderful for me,”, and I feel the truth of Psalm 139 deep within.
But it is not enough to get me to celebrate the Great Feast in the company of fellow-Christians. I deal with disappointment by turning to the gospel account of the first Easter morning.
I have been reading Brendan Byrne’s “theological reading of Mark’s Gospel” – A Costly Freedom, and it being in the Year of Mark, I turn to Mark 16. It is exciting to re-read the Greek: so much new is there!
Three women leave for the tomb “very early in the morning” (verse 2), between 3 a.m. and 6 a.m. This, according to my hospice nurse wife, is the low time, the time when death often creeps through the house of the dying and claims those who are ready. It is a time of intense dark, and for most, the deepest sleep. Yet in Mark’s Easter story, they arrive “just as the sun was rising.” Easter is a dawn that arrives before expected, the good news that tears away the deepest darkness! The first Easter, and all those that follow, are extraordinary dawns.

The story moves on. I smile at the colloquial translation of verse 4(c) that springs to mind. The women are amazed that the stone is rolled away: it was a “bloody great boondie”! This whole business with the stone is amazing. The women discover that it has been moved by “lifting up their eyes and gazing” – the word theoriein calls to mind both wonder and the deep seeing of meditation.” its removal is literally “apocalyptic”, a heavenly revelation.

And then verse 5: “they enter into, into” – the preposition is repeated – the tomb, the realm of death. This detail sets Mark’s resurrection narrative apart from Matthew’s and Luke’s. The three women here enter deeply into the experience of death (“baptised into his death ” (Rom.3.6 perhaps?)) This is more than grief, although the grief is profound, like Jacob’s at the supposed death of Joseph.
This is a mythical experience of the profundity of death; Orpheus going into the place of the dead to retrieve Eurydice, and the lost possibility of new life with her. This is the place where many of Mark’s original readers may have been – in the hell of persecution or martyrdom. This is the place where true disciples must take shelter before they can shout the joy of Easter.
In my pain and disappointment this morning, I can identify some way with the women going into, right into, the place of death.
This also means I can identify with the hope put into the angel’s mouth: I too am looking for Jesus of Nazareth, the Crucified One, the Risen One. Any emptiness I experience is because “he is not here” (verse 6). I too can experience the thrill of being called again to discipleship and mission, “go and tell the disciples that they will see him again.”

Best of all Mark’s “shorter ending” with its abruptness restores to me the sense of being included in this ongoing mission of God. The other Gospels describe many Appearances of the Risen Jesus. Mark doesn’t crowd me out with the experiences of others. Mark trusts that my experience will be authentic on its own terms.
Even though I struggle with pain that takes my breath away, I can feel his breath filling me with new life. He is Risen Indeed! Alleluia!