DEALING WITH PHYSICAL PAIN

By reflecting on suffering during the quieter moments of our lives, when things are relatively stable and going well, we may often discover a deeper value and meaning in our suffering. Sometimes, however, we may be confronted with kinds of suffering that seem to have no purpose, with no redeeming qualities whatsoever. Physical pain and suffering often seem to belong to that category. But there is a difference between physical pain, which is a physiological process, and suffering, which is our mental and emotional response to the pain. So, the questions arises: Can finding an underlying purpose and meaning behind our pain modify our attitude about it? And can a change in attitude lessen the degree to which we suffer when we are physically injured?

In his book, Pain: The Gift Nobody Wants, Dr. Paul Brand explores the purpose and value of physical pain. Dr. Brand, a world-renowned hand surgeon and leprosy specialist, spent his early years in India where, as the son of missionaries, he was surrounded by people living under conditions of extreme hardship and suffering. Noticing that physical pain seemed to be expected and tolerated much more than in the West, Dr. Brand became interested in the pain system in the human body. Eventually, he began working with leprosy patients in India and made a remarkable discovery. He found that the ravages of leprosy and the horrible disfigurements were not due to the disease organism directly causing the rotting of the flesh, but rather it was because the disease caused loss of pain sensation in the limbs. Without the protection of pain, the leprosy patients lacked the system to warn them of tissue damage. Thus, Dr. Brand observed patients walking or running on limbs with broken skin or even exposed bones_; this caused continuous deterioration. Without pain, sometimes they would even stick their hands in a fire to retrieve something. He noticed an utter nonchalance toward self-destruction. In his book, Dr. Brand recounted story after story of the devastating effects of living without pain sensation—of the repetitive injuries, of cases of rats gnawing off fingers and toes while the patient slept peacefully.

After a lifetime of working with patients suffering from pain and those suffering from lack of pain, Dr. Brand gradually came to view pain not as the universal enemy as seen in the West but as a remarkable, elegant, and sophisticated biological system that warns us of damage to our body and thus protects us. But why must the experience of pain be so unpleasant? He concluded that the very unpleasantness of pain, the part that we hate, is what makes it so effective in protecting us and warning us of danger and injury. The unpleasant quality of pain forces the entire human organism to attend to the problem. Although the body has automatic reflexive movements that form an outer layer of protection and move us quickly away from the pain, it is the feeling of unpleasantness that galvanizes and compels the entire organism to attend and act. It also sears the experience into the memory and serves to protect us in the future.

In the same way that finding meaning in our suffering can help us cope with life’s problems, Dr. Brand feels that an understanding of the purpose of physical pain can lessen our suffering when pain arises. In view of this theory, he offers the concept of “pain insurance.” He feels that we can prepare for pain ahead of time, while healthy, by gaining insight into the reason we have it and taking the time to reflect on what life would be without pain. However, since acute pain can demolish objectivity, we must reflect on these things before pain strikes. But if we can begin to think of pain as a “speech your body is delivering about a subject that is of vital importance to you, in the most effective way of getting your attention,” then our attitude about pain will begin to change. And as our attitude about pain changes, our suffering will diminish. As Dr. Brand states, “I am convinced that the attitude we cultivate in advance may well determine how suffering will affect us when it does strike.” He believes that we can even develop gratitude in the face of pain. We may not be grateful for the experience of pain, but we can be grateful for the system of pain perception.

There is no doubt that our attitude and mental outlook can strongly affect the degree to which we suffer when we are in physical pain. Let’s say, for instance, that two individuals, a construction worker and a concert pianist, suffer the same finger injury. While the amount of physical pain might be the same for both individuals, the construction worker might suffer very little and in fact rejoice if the injury resulted in a month of paid vacation which he or she was in need of, whereas the same injury could result in intense suffering to the pianist who viewed playing as his or her primary source of joy in life.

The idea that our mental attitude influences our ability to perceive and endure pain isn’t limited to theoretical situations such as this; it has been demonstrated by many scientific studies and experiments. Researchers looking into this issue began by tracing the pathways of how pain is perceived and experienced. Pain begins with a sensory signal—an alarm that goes off when nerve endings are stimulated by something that is sensed as dangerous. Millions of signals are sent through the spinal cord to the base of the brain. These signals are then sorted out and a message is sent to higher areas of the brain telling of pain. The brain then sorts through the prescreened messages and decides on a response. It is at this stage that the mind can assign value and meaning to the pain and intensify or modify our perception of pain_; we convert pain into suffering in the mind. To lessen the suffering of pain, we need to make a crucial distinction between the pain of pain and the pain we create by our thoughts about the pain. Fear, anger, guilt, loneliness, and helplessness are all mental and emotional responses that can intensify pain. So, in developing an approach to dealing with pain, we can of course work at the lower levels of pain perception, using the tools of modern medicine such as medications and other procedures, but we can also work at the higher levels by modifying our outlook and attitude.

Many researchers have examined the role of the mind in the perception of pain. Pavlov even trained dogs to overcome the pain instinct by associating an electrical shock with a food reward. Researcher Ronald Melzak took Pavlov’s experiments a step further. He raised Scottish terrier pups in a padded environment in which they wouldn’t encounter the normal knocks and scrapes of growing up. These dogs failed to learn basic responses to pain_; they failed to react, for instance, when their paws were pricked with a pin, as opposed to their littermates who squealed with pain when pricked. On the basis of experiments such as these, he concluded that much of what we call pain, including the unpleasant emotional response, was learned rather than instinctive. Other experiments with human beings, involving hypnosis and placebos, have also demonstrated that in many cases the higher brain functions can overrule the pain signals from the lower stages on the pain pathway. This indicates how the mind can often determine how we perceive pain and helps explain the interesting findings of investigators such as Dr. Richard Sternback and Bernard Tursky at Harvard Medical School (and later reaffirmed in a study by Dr. Maryann Bates et al.) who noted that there were significant differences among different ethnic groups in their ability to perceive and withstand pain.

So it seems that the assertion that our attitude about pain can influence the degree to which we suffer is not simply based on philosophical speculation but is backed up by scientific evidence. And if our investigation into the meaning and value of pain results in a change of attitude about pain, our efforts will not be wasted. In seeking to discover an underlying purpose of our pain, Dr. Brand makes one additional fascinating and critical observation. He describes many reports of leprosy patients’ claiming, “Of course, I can see my hands and my feet, but somehow they don’t feel like part of me. It feels as if they are just tools.” Thus, pain not only warns us and protects us, but it unifies us. Without pain sensation in our hands or feet, those parts no longer seem to belong to our body.

In the same way that physical pain unifies our sense of having a body, we can conceive of the general experience of suffering acting as a unifying force that connects us with others. Perhaps that is the ultimate meaning behind our suffering. It is our suffering that is the most basic element that we share with others, the factor that unifies us with all living creatures.

We conclude our discussion of human suffering with the Dalai Lama’s instruction on the practice of Tong-Len, which he referred to in our earlier conversation. As he will explain, the purpose of this visualization meditation is to strengthen one’s compassion. But it can also be seen as a powerful tool in helping transmute one’s personal suffering. When undergoing any form of suffering or hardship, one can use this practice to enhance one’s compassion by visualizing relieving others who are going through similar suffering, by absorbing and dissolving their suffering into your own—a kind of suffering by proxy.

The Dalai Lama presented this instruction before a large audience on a particularly hot September afternoon in Tucson. The hall’s air conditioning units, struggling against the soaring desert temperatures outside, were ultimately overcome by the additional heat generated by sixteen hundred bodies. Temperatures in the room began to climb, creating a general level of discomfort that was particularly appropriate for the practice of a meditation on suffering.

The Practice of Tong-Len

“This afternoon, let us meditate on the practice of Tong-Len, ‘Giving and Receiving.’ This practice is meant to help train the mind, to strengthen the natural power and force of compassion. This is achieved because Tong-Len meditation helps counteract our selfishness. It increases the power and strength of our mind by enhancing our courage to open ourselves to others’ suffering.

“To begin this exercise, first visualize on one side of you a group of people who are in desperate need of help, those who are in an unfortunate state of suffering, those living under conditions of poverty, hardship, and pain. Visualize this group of people on one side of you clearly in your mind. Then, on the other side, visualize yourself as the embodiment of a self-centered person, with a customary selfish attitude, indifferent to the well-being and needs of others. And then in between this suffering group of people and this selfish representation of you see yourself in the middle, as a neutral observer.

“Next, notice which side you are naturally inclined towards. Are you more inclined towards that single individual, the embodiment of selfishness? Or do your natural feelings of empathy reach out to the group of weaker people who are in need? If you look objectively, you can see that the well-being of a group or large number of individuals is more important than that of one single individual.

“After that, focus your attention on the needy and desperate people. Direct all your positive energy to them. Mentally give them your successes, your resources, your collection of virtues. And after you have done that, visualize taking upon yourself their suffering, their problems, and all their negativities.

“For example, you can visualize an innocent starving child from Somalia and feel how you would respond naturally towards that sight. In this instance, when you experience a deep feeling of empathy towards the suffering of that individual, it isn’t based on considerations like‘He’s my relative’ or ’She’s my friend.‘ You don’t even know that person. But the fact that the other person is a human being and you, yourself, are a human being allows your natural capacity for empathy to emerge and enable you to reach out. So you can visualize something like that and think, ’This child has no capacity of his or her own to be able to relieve himself or herself from his or her present state of difficulty or hardship.‘ Then, mentally take upon yourself all the suffering of poverty, starvation, and the feeling of deprivation, and mentally give your facilities, wealth, and success to this child. So, through practicing this kind of ’giving-and-receiving’ visualization, you can train your mind.

“When engaging in this practice it is sometimes helpful to begin by first imagining your own future suffering and, with an attitude of compassion, take your own future suffering upon yourself right now, with the sincere wish of freeing yourself from all future suffering. After you gain some practice in generating a compassionate state of mind towards yourself, you can then expand the process to include taking on the suffering of others.

“When you do the visualization of‘taking upon yourself,’ it is useful to visualize these sufferings, problems, and difficulties in the form of poisonous substances, dangerous weapons, or terrifying animals—things the very sight of which normally makes you shudder. So, visualize the suffering in these forms, and then absorb them directly into your heart.

“The purpose of visualizing these negative and frightening forms being dissolved into our hearts is to destroy our habitual selfish attitudes that reside there. However, for those individuals who may have problems with self-image, self-hatred, anger towards themselves, or low self-esteem, then it is important to judge for themselves whether this particular practice is appropriate or not. It may not be.

“This Tong-Len practice can become quite powerful if you combine the‘giving andreceiving’ with the breath_; that is, imagine’ receiving’ when inhaling and’giving’ when exhaling. When you do this visualization effectively, it will make you feel some slight discomfort. That is an indication that it is hitting its target—the self-centered, egocentric attitude that we normally have. Now, let us meditate.”

At the conclusion of his instruction on Tong-Len, the Dalai Lama made an important point. No particular exercise will appeal to or be appropriate for everyone. In our spiritual journey it’s important for each of us to decide whether a particular practice is appropriate for us. Sometimes a practice will not appeal to us initially, and before it can be effective, we need to understand it better. This certainly was the case for me when I followed the Dalai Lama’s instruction on Tong-Len that afternoon. I found that I had some difficulty with it—a certain feeling of resistance—although I couldn’t put my finger on it at the moment. Later that evening, however, I thought about the Dalai Lama’s instruction and realized that my feeling of resistance developed early in his instruction at the point where he concluded that the group of individuals was more important than the single individual. It was a concept I had heard before, namely, the Vulcan axiom pro-pounded by Mr. Spock in Star Trek: The needs of the many outweigb the needs of the one. But there was one sticking point to that argument. Before bringing it up to the Dalai Lama, perhaps not wanting to come across as being just “out for number one,” I sounded out a friend who was a longtime student of Buddhism.

“One thing bothers me ...,” I said. “Saying that the needs of a large group of people outweigh those of just one single person makes sense in theory, but in everyday life we don’t interact with people en masse. We interact with one person at a time, with a series of individuals. Now, on that one-to-one level, why should that individual’s needs outweigh my own? I’m also a single individual ... We’re equal ...”

My friend thought for a moment. “Well, that’s true. But I think that if you could try to consider each individual as truly equal to yourself—no more important but no less either—I think that would be enough to start with.”

I never brought up the issue with the Dalai Lama.