This Week's Questions
[posed by John F.]
Do you know?
Opening Comments: I have been curious about pain for a while now and have been trying to understand the effect it has on people. There are times, for instance, when I get angry and blame peoples' pain on the drug companies because they have yet to develop non addictive pain relievers. At times, I even fantasize that the drug companies have already developed such drugs but won't release them because they'll lose money. I realize most of this is just me blaming the drug companies. Even so, at times, I suspect it may be true.
Perhaps this bothers me so because I, myself, know what it is like to be in great pain and to need pain killers. I was once severely burned in a fire and had exposed nerve endings on twenty percent of my body. And while the initial pain of this accident was excruciating, the pain I endured during my recovery hurt far worse, especially the wet / dry treatments. During these treatments, nurses would glue cloth to parts of my burned skin, the parts which could not be manually removed. Once the adhesive dried then, they would rip off this cloth and with it, my burned skin.
Even with the drugs they gave me, the pain from these treatments was almost unbearable. Perhaps this is why I have so many questions about pain relief. Anyway, here are my questions.
[Question 1] Although I still have fears in and around being burned, over time, I have developed a tolerance, or an indifference, towards pain. At what point does the fear of pain turn into indifference?
First, there is our sense of what falls within, and outside of, our range of normal sensations. What I mean is, each of us has, for each area of our bodies, a level of sensation we experience as being within a range of normal physical sensation. Sensations which fall within this range, we perceive as normal. And potentially safe. Sensations which fall outside this range, we perceive as abnormal. And potentially harmful.
This range then determines the amount of attention we pay to what we sense. Thus, sensations which fall within our normal range, we pay increasingly less attention to, while sensations which approach the limits of our normal range, we pay increasingly more attention to.
In effect, we are programmed to monitor these levels for what we perceive to be the warning signs for potential injury. Inside the range. No warnings. Approaching the limits of the range. Warnings. Exceeding the limits of the normal range. High alert.
This then forms the primary baseline from which we interpret things as being painful. Sensations which deviate greatly from normal we perceive as painful. Sensations which fall within our normal range, we interpret as not painful.
Then there is the second source for our baseline range of tolerance to pain; the degree to which injury has distorted our range of normal sensation. What I'm saying is, we all suffer physical injuries during our lives. Some injuries are small, such as skinning a knee at age two. Some are not so small, like getting our tonsils out at eight, or getting our appendix removed at twenty.
Of course, eventually, we heal from the physical part of these injuries. However, in many cases, we are left with a permanently altered baseline range of physical sensation. This means, in some cases, our range of normal sensation expands, and we can then tolerate more sensation. In some cases, it gets smaller, and we then can tolerate less sensation. And in some cases, it gets altered in such a way as to make the interpretation for what we sense depend entirely on the circumstances we find ourselves in. In other words, sometimes, the very same injury can render us over sensitive in some circumstances, and under sensitive in others.
What further confounds this is the idea that the distortions we experience to our baseline range of sensation are cumulative. In effect, our injuries have both an individual effect and a cumulative effect on this baseline range. Thus, the cumulative total functions more as an overall distortion to to our ability to monitor sensation, while each individual injury will tend to distort only specific situations.
Finally, in cases like yours, John, wherein people suffer excruciating levels of pain, the experience can so severely alter peoples' pain scales as to make it extremely difficult for them to determine what is normal and what is painful. Often, these folks come to rely more on their psychological predictions of pain than on any actual physical sensations. In extreme cases, then, some folks come to so fear pain that they interpret just about any physical sensation as being the onset of pain, including sensations which originate entirely in their minds.
Now consider what determines peoples' ability to tolerate pain. What determines this? Essentially, it is the rate of onset; how quickly the pain begins. In other words, people's ability to tolerate pain is based largely on how gradually or abruptly they begin to feel the pain. For instance, when people feel pain come on gradually (such as in the case of muscle aches), they can usually tolerate significantly more pain before exceeding their capacity to endure it. Conversely, when people feel pain come on suddenly (such as when they get a hypodermic needle), they usually can tolerate significantly less pain before exceeding their capacity to bear it.
The point is, peoples' ability to tolerate pain varies greatly, and is largely dependant on how gradually or abruptly the pain begins.
Now for your question. At what point does the fear of pain turn into indifference? Here again, John, there is no simple answer to your question. What I can say is this. If you feel indifferent to physical pain, it means you have a blocked ability to sense this part of your body, either physically, or psychologically, or both. And while some folks might see advantages to feeling this way, in the long run, there are a lot of disadvantages as well, beginning with how this indifference would make you more vulnerable to additional injury.
For instance, let's say you severely twist an ankle. Over time, then, say this ankle heals. In all likelihood, even after your ankle healed, unless you did emergence on the wounding scene itself, you would still be left with either a noticeably decreased, or a noticeably increased, sensitivity to ankle hyperextensions.
Now let's say you are out playing ball. Can you imagine how easily you could be re-injured, simply because you had less feeling in your ankle?
Then again, you could just as easily injure yourself because you felt over sensitivity in your ankle too. How? By making you favor your other ankle, perhaps, leading you to injure it as well.
My point is, we develop tolerance to physical pain only when we develop blocks. Moreover, since pain is meant to warn us of possible impending injury, the inability to feel pain leaves us more vulnerable to injury. In the long run, then, an indifference to pain makes us suffer more, not less.
[Questions 2 and 3] At times, I wonder if my indifference, some of which may have developed through my martial arts practice, could be used as pain relief? What I mean is, could people in pain be helped by teaching them to be less conscious of their pain? Of course, I know there is a point at which this would not be practical. Still, I wonder, does my tolerance and indifference to pain indicate a good thing, for instance, that I have healed a wound? Or does it indicate a bad thing, perhaps, that I still am blocked?
Indifference never indicates healing. Ever. Healing always involves seeing the beauty in things. As well as becoming more conscious, not less conscious. Thus, if we were to use your injury as the example, the question would be, "Does putting your hand through an open flame make you feel indifference?" If your answer is yes, then you are still injured. Thus, even though you might like the fact that you can do this and not feel afraid, your lack of fear would more indicate detachment than consciousness. And you would be in more danger, not less.
If, on the other hand, your answer is that, while you do feel some slight fear, you love the sensation of putting your hand near and through an open flame, then, yes, indeed, you have healed this injury. In this case, though, your lack of fear would more be a sign that you can now witness this scene consciously and thereby, easily keep yourself safe.
Am I not being clear? Let me try again. Do you delight in passing your hand, say, into and through an open flame? Then you have probably healed your injury, at least the part of it involving your hand. However, if, while doing this, you feel indifferent to any possible danger, then in all likelihood, you are still injured. Moreover, your lack of fear is more detachment than consciousness.
My point is, even in cases wherein the pain of an injury was terrible, when you heal an injury, you experience delight when asked to recall it. Not from the suffering, of course. Nor from the simple fact that it has ended. Rather, you feel delight in the fact that you can now consciously witness the event. And remain safe.
What is important to see is, healing always involves reclaiming your ability to consciously witness an event. And this reclaimed ability always feels delightful. At the same time, conscious witnessing anything never involves feeling indifference. Thus, if you feel indifference while on the stage of an injury, you are simply blank, not healed.
As for your second question, should indifference be used for pain relief, here my answer would be, yes, it should be. But only as a temporary solution, and never as a permanent fix. Thus while people absolutely do deserve the mercy of anesthesia, we humans too easily get addicted to pain relievers to ever trust their permanent use.
Know I say this fully aware that there are some few people who daily live in terrible pain. And some who may well be able to control their drug use. In truth, my father is such a person, and he has told me his spine cancer hurts him terribly. At least, in the few cases wherein I can get him to admit it. He is, after all, a card carrying two. Still, he once told me he delayed taking his pain killers because he knew I'd be calling. I cried when he told me this. Need I say more.
How about non medical, psychological detachment though? Should we teach people to use psychological detachment to avoid pain? Here again, as a temporary solution, yes. We should. In fact, as you know, your wife and I have been working on ways to use detachment to help manage childbirth. Along with consciousness raising techniques as well.
The question remains, though, should we teach all people this method of dealing with pain? Here, my answer is, I'm not sure. I guess I worry that some people would not be able to prevent themselves from being seduced by the painlessness of what Carl Jung might have called, the "illegitimate suffering." In other words, I worry they would choose the illegitimate pain of avoidance over the legitimate pain of healing.
What would be so wrong with doing this though?
Detachment means you feel less. Period. Yes, you feel less pain, but you also feel less of the good in life. Less horror. But less delight. Thus, while teaching people psychological indifference would in some ways allow them to suffer less, they would also suffer the pain of living a lifeless existence, because indifference is simply a way to say unconsciousness. Not a state to remain in for any length of time. At least, not if you want to live a good life. Even if, like my father, you must endure great pain to live.
The question is, does this happen to all people? My answer. I'm not sure. Perhaps it is simply a protective mechanism built into us from our first year of life. What I mean is, in our first year of life, we all are ones. Moreover, at the time, this is a good thing and we need it to survive. What I mean is, think about how easily babies could die if they were to stop to consider the needs of others whenever they needed help? Not good. Perhaps then this same, first-year-of-life mechanism comes into play whenever we get seriously disabled, whether from drugs or alcohol, or from serious physical illness or injury. As a protective thing built into human nature, this would make sense.
[Question 5] As you know, I work with people who are physically disabled. Over the years, I have noticed that people who have been born disabled, or who have spent much of their lives handicapped, are usually "Ones," or big-me / little-you, "Threes." My question is, do people who become physically limited become incapable of experiencing the needs of others?
Something to consider would be the speed in which people become disabled. Thus, if people suddenly become disabled, then they are forced to rapidly adapt to their circumstances, including that they have to quickly learn to ask for their needs. Some will quickly adapt to this and learn to ask for their needs with no shyness. Others will quickly learn to hide their needs though. Thus, how people adapt to being disabled would largely on their character type at the time of the injury.
Now let me expand on this a bit. Say a baby is born disabled. Or say the baby gets injured in the first year of life. When this happens, they will have a somewhat higher chance to become a character type one. Even so, I have seen cases wherein people are born disabled but become twos and threes.
The thing to keep in mind here would be that character type is a valid test only under normal life circumstances. Moreover, the word normal as I am using it here applies even to disabled people, in which case, the test would be valid for them only after they have had some time to adjust to their disability. Even if this time last years.
By the way, something I've yet to mention is that, when people get addicted to pain killers, they live a "ones" no matter what character type they actually are. At least, until they have had time to recover from the addition. Thus, some of what you are seeing may more be the result of addiction than the result of becoming disabled.
Thus, would you expect your needs to met by a six month old baby. Obviously not. And although a thirty five year old woman who is a Character Type "One" looks much like every other adult, in reality, her ability to see the needs of others is profoundly inaccessible, even if theoretically possible.
Knowing this is meant to do two things. One, knowing about Character Types, and especially "Ones," First, it is meant to help you to non judgmentally lower your expectations to a reasonable level, reasonable to expect from a "one," that is. And second, it is meant to guide you in who you choose to depend on. A six month old baby? Of course, not, This is easy. But a thirty five year old going on six months? This is where it gets hard.
Accepting Character Types as a real part of human nature is the best way to see past the illusions that Ones can be there for you if only you find a way to ask them nicely. To put it in common language, it ain't gonna happen, John. So do your best to stop being so mad and try to accept that this is just the way it is, beginning with learning to picture them as being six months old in adult bodies.