Chapter Five
BEARING THE UNBEARABLE PAIN
“The mind is its own place, and in itself can make a Heav'n of Hell or a Hell of Heav'n.”
–John Milton
In the weeks following my conversation with Judy, the image of scales as a metaphor for suicide haunted and obsessed me. To put the scales (and my life) back in balance, I realized, I must increase my coping resources or find a way to reduce the pain.
“Reduce the pain?” I thought incredulously. “How can I find relief from agony this extreme?” I recalled what William Styron had told his daughter on the eve of his hospitalization—“I would rather have a limb amputated without anesthesia than to be suffering the kind of pain I am feeling at the moment.”
It was at this point that an old college friend of mine serendipitously reentered my life. Teresa Keane was a registered nurse who worked at the Oregon Health Sciences University Medical School, where she taught stress reduction to patients with chronic pain. Her classes were based on the groundbreaking work of Jon Kabat Zinn, a meditation teacher featured in Bill Moyers’ 1996 PBS documentary, “Healing and the Mind.” Kabat Zinn teaches the Buddhist practice of “mindfulness meditation” to patients suffering from intractable physical pain. Through employing his techniques, they learn to alleviate not only their physical discomfort, but their accompanying emotional distress as well.
I met with Teresa in her office at OHSU, where I described the nature of my torment.
“Facing pain is a learned skill,” Teresa responded. “When you are in a lot of pain, whether it is a migraine headache or suicidal torment, the pain dominates all of your awareness and becomes all-encompassing. It's hard to remember a time when the distress was absent, and it's hard to believe that it will ever go away. It's as if both past and present are blotted out, and you are left stranded in your present misery.”
“At least you understand,” I remarked.
“However,” Teresa continued, “if you can release your judgment of your pain and just observe it, you will notice a very important fact about the nature of pain—pain comes in waves!”
Upon hearing these words, I remembered the grief I felt after my divorce. There were times when I was so overwhelmed by sorrow and loss that I could barely function. After a period, however, the pain and the longing let up, perhaps for a day or two—until the heartache returned and began the cycle all over again—pain turning into relief, which turned into more pain, followed by more relief, etc.
“This is the body-mind's built-in protective mechanism,” Teresa explained. “If the pain were truly nonstop, you wouldn't survive. And so you are granted a few gaps in between the intense sensations to stop and catch your breath.”
“But it feels like the pain is unrelenting,” I protested. “If you were clinically depressed, you would understand.”
“The key to reducing your perception of pain,” Teresa continued dispassionately, “is to uncouple the sensations in your body from the thoughts about them.”
“What does that mean?”
There are two levels of pain that you are feeling,” she explained. “The first level is physiological—the raw pain in your body. The second layer (and this is where you have some control) consists of how you interpret your experience. Perhaps you may be thinking, ‘This torment is killing me,’ or ‘This will last forever,’ or ‘There is nothing I can do about it.’ Each of these despairing thoughts creates a neurochemical reaction in the brain that creates even more distress. If you can learn to detach yourself from these judgments, much of the pain that arises from them will diminish.”1
Detail from Michelangelo's “Last Judgement” in the Sistine Chapel
“How do I do this?”
“Think of your anxiety or depression as a large wave that is approaching you. As the wave makes contact, see if you can ride the wave by focusing on your breath. Breathe through the sensations, breathing in and out while attending to the sound of your breathing. Don't try to analyze what is happening, just breathe. It's not even about getting through the day; it's about getting through each breath.”
When I had worked as a salesperson in the corporate world, I learned the skill of breaking large goals into manageable parts. Now I discovered that one could divide pain into manageable parts. If I couldn't handle getting through the day, I would try to make it through the next hour; if an hour seemed too long, I set my sights on the next minute or second.
Teresa showed me another powerful technique to use with my self-talk when my pain became intense. Whenever I cried, “My pain is unbearable,” Teresa would reply, “Tell yourself the pain is barely bearable.”
“The pain is barely bearable,” I repeated aloud. There was a shift and I felt it.
In another session I screamed, “I can't take it anymore!”
“You can barely take it,” Teresa responded.
“I can barely take it,” I replied.
Mental Illness as a Spiritual Practice
“Emotions are like waves; Watch them come and go in the vast ocean of existence.”
Teresa was teaching me the practice of mindfulness, a spiritual practice of living in the present moment. In traditional meditation, when the mind wanders, one gently brings it back to a central focus (the breath, a candle, etc.). I was challenged to do the same, especially when, in response to intense emotional pain, I projected my present condition into the future using catastrophic self-talk that led to suicidal thinking—e.g., “If I have to put up with this suffering for the next 30 years, I might as well end my life now.”
“Just return to the here and now,” Teresa would say. “Over a period of time you can learn to relate differently to your pain. You can work with the pain and live around the corners of pain and develop your life around it. Eventually the turbulent emotional waters will become calm again. In the meantime, you can find inner stillness and peace right within the most difficult life situations.”
“You've got to be kidding,” I responded somewhat angrily. “How do you expect me to stay centered when the emotional equivalent of a migraine headache is pounding my skull?”
“Stop fighting the pain and see it as your life,” Teresa calmly replied. “It doesn't mean you should like your discomfort. But there is something transformative that happens when we simply allow ourselves to experience our pain without trying to judge, change or resist it in any way. Let me show you.”
At that moment, Teresa reached over and pressed a tender point between my right thumb and index finger (I later learned that it was a particularly sensitive acupuncture point).
Back to the Present
One of the most challenging aspects of practicing mindfulness was having to deal with my catastrophic thoughts and feelings about the future. These would inevitably arise when I suffered an unexpected anxiety attack or was engulfed by particularly bad depression. Self-statements such as “I can't go on like this” or “I won't live the rest of my life in this pain” further escalated my despair and hopelessness and drew me closer to the prospect of suicide.
As a way to keep me safe, Teresa and I devised a simple but powerful three-step technique for responding to catastrophic and despairing self-talk. I have rewritten these steps in a prescriptive fashion so that they can be used by others.
1. Notice what is happening. Become aware that your mind is dwelling on thoughts of catastrophe and doom. Identify the catastrophic thought—e.g., “I'll never get better.”
2. Realize that these thoughts are not about the present but about the future. Since the future has yet to occur, it cannot harm you.
3. Refocus onto the present moment through positive self-talk and constructive action. For example, you might replace the statement “I'll never get better” with “What self-care strategy (calling a friend, going for a swim, taking an antianxiety medication, etc.) can I choose right now to get me through this period?” Then put the strategy into action.
I cannot recall how many times this simple process allowed me to endure a day, an hour, or a minute of intense pain. In giving me a way to manage my catastrophic (and potentially dangerous) thinking, this technique literally saved my life.
“Ouch! That hurts,” I protested.
“Breathe into the place in your body where you feel the pain,” Teresa responded compassionately. “See if you can ride the waves of sensation as you would ride the ocean's waves. As you do this, notice how the experience of your pain begins to change.”
I breathed into the soreness and observed that the pain in my hand softened and decreased, until I could hardly feel it.
“Good work,” Teresa replied. “Now see if you can do the same with your emotional pain.”
On days when my depression and anxiety fell below a “5” on the mood scale, Teresa's technique worked well. As I breathed “into” the pain of depression and stopped resisting it, the pain diminished. But during those all-too-frequent instances when the agony registered close to “10,” I simply could not surrender. “Get the hell out of here!” I screamed at the hurt—and then felt guilty because I was not able to detach and “let go.”
“This is not about right and wrong,” Teresa responded. “It's about struggle and practice. It's about learning to cope—discovering which options work for you and which ones don't.”
Mindfulness meditation did not work all of the time, but it worked enough. The moments of peace it provided, when combined with intense exercise and small doses of the antianxiety drug Klonopin, interrupted the pain cycle sufficiently so as to make my suffering “barely bearable.”2
1 In a 1997 study, volunteers were given a painful stimulus once, and then a suggestion that the next stimulus would be either more painful or less so. As measured by PET brain imaging, the volunteers experienced either greater or lesser pain from the new stimulus in accordance with the type of suggestion they received. This suggests that the experience of pain can be modified at the level of perception.
2 Those who have experienced childhood violence or sexual abuse may find that relaxation techniques such as deep breathing may elicit feelings of anxiety. If this occurs, consider practicing meditation or relaxation under the supervision of a trained therapist who can help you process these feelings.