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The Politics of Pain

Steven Wineman

It is possible to move away from a vast, unbearable pain by delving into it deeper and deeper.

-Barbara Kingsolver, Small Wonder

    Several years before my son was born, I was in brief relationship with a woman who liked to sing lullabies at night. The tunes were pleasant, and in the glow of getting to know her I cheerfully sang along.
    Then it hit me what most of these songs were actually saying: shut up and go to sleep. The words seemed sweet and gentle – “hush little baby, don’t you cry” and that kind of thing; and yes, the melodies were meant to literally lull you to sleep. But lurking barely below that saccharine surface there was an ugly attitude toward little kids, a reflection of how overwhelming it can be for dragged out parents to have to deal with crying babies, a narrative about whose needs count and how conflicting needs get resolved between adults and children, all kinds of cultural assumptions and norms, and just a hint of the tragedy of how kids learn to deal (and not deal) with emotional pain.
    At the time I didn’t think it through in quite so many dimensions, but I had a strong reaction. I thought about myself, my own capacity as a man to cry – something I treasure and feel incredibly lucky to have kept intact against the long odds of male socialization. If I feel safe enough to cry with someone, I’m certainly not looking to be told to quiet down and go to sleep. I want to be held; I want my crying, and the sadness or pain that underlies it, to be accepted; I want to feel the other person’s comfort with my feelings. I don’t want to be lulled out of it, or told that things aren’t really so bad, or advised how to solve the problem – among other things because crying as an expression of pain is not a problem!
    One of the great things about my reaction against lullabies was that it helped prepare me to be a parent. During my son’s infancy and well into his childhood, when he got upset I would hold him and tell him that he was doing a great job expressing his feelings, and he should cry as long as he needed to. He got that message not only from my words, but through many nonverbal channels – the softness of my voice, the relaxed muscle tone of my body against his, the emotional clarity that I fully meant what I was saying.
    Almost paradoxically, this acceptance of his crying helped my son to calm down. He would usually cry for a few minutes and go through a progression of steps to getting settled and peacefully nestled against me. Then he’d be ready to go on with his day.
    I say it was almost a paradox because, obviously, I wasn’t telling my son to stay upset forever. “Crying as long as you need to” also means stopping when you’re ready. But the point is that I wasn’t telling him to calm down. My focus really was not on trying to get him to move beyond his upset. There was no ploy, no reverse psychology. I was celebrating his expression of his feelings. That this was the exact thing that helped him to move beyond his upset, to restore equilibrium and regain a sense of rightness and peace with himself and the world, sure has the flavor of paradox.
    The mirror image is that telling kids to shut up – that it’s not okay to cry – can keep them crying for a lot longer. Or, more broadly, that resisting pain can cause a lot more pain.
    There is a whole range of things that adults do when kids get upset. “You’re doing a great job expressing your feelings” and “shut up” are at two ends of a long continuum. (Shut up is not even at the farthest point on its end, since of course there are still many adults who hit their kids.) It’s common to see little kids in public who are wailing in their strollers while their parents try to give every indication of ignoring them, or whose parents frantically shush them or just yell at their kids to be quiet. On the other hand there are lots of parents who comfort their crying children, but do it to get them to stop crying. They would never dream of telling their kids to shut up, and many don’t use the more sedate “quiet down”; children they love are in distress, and the parents want to make them feel better. But they don’t recognize or validate that there is something healthy and vital and right in the full throated expression of emotional pain. They want to make the pain go away, and for all of their kindness and love, they are still communicating to their kids that there is something intolerable about pain.
    Then there are the countless ways that adults try to distract kids when they cry. With a toy, or a tickle, or food, or music, or a smile, or a funny face. It often works, if by “working” you mean that the child stops crying and gets interested in something new and “positive.” But what does it teach kids to be distracted away from their pain? What are the costs?
    There are parallels to this in the ways that most of us use painkillers throughout our lives. Have a headache, a back ache, knee pain, shoulder pain, stomach ache, a rotten cold; take a pill and get relief. Make it go away. The term is both telling and ironic – painkiller. Telling because it reflects so literally the intensity, the vehemence and desperation in our attitudes toward pain. And ironic because it is so obviously impossible to kill pain; because drugs that numb pain for temporary periods are ascribed the power to annihilate; because attempts to annihilate can cause pain which is often worse than the problem they are trying to wipe out.

    Several years ago, during a period when I needed to be on the computer almost all the time at work, I started having pain in my wrists and then my forearms. It was persistent and got worse, and I ended up going to several doctors and getting several diagnoses, trying acupuncture, doing physical therapy and occupational therapy, using a lot of ice, taking a lot of ibuprofen, and then Neurontin, wearing braces on both wrists, using voice activated software, trying several different kinds of mice, and learning to use a mouse with either hand. Eventually I had an MRI of my upper spine, which I was told showed progressive disc degeneration, and surgery was recommended. Before going ahead with surgery, I thought I should get a second opinion.
    The second-opinion doctor looked at my MRI and said it was normal. He told me the disc degeneration was typical for someone my age and nothing to worry about. He said surgery was a really bad idea and would at best be a waste of time. He asked whether the pain in my arms was constant or came and went; whether it stayed in the same places or moved around. No other doctor had asked me that. I told him that it came and went, moved around, and the intensity fluctuated. He nodded knowingly and proceeded to tell me that there was actually nothing wrong with my arms except that I had misfiring neurotransmitters which were giving me pain signals when there was no actual injury.
    I wasn’t entirely convinced. The doc dripped arrogance, and by that point I had been told so many different things by so many doctors that it was far from clear why I should believe one story over another. But I decided to hold off on surgery.
    Then came the interesting part of the story: when my arms started to hurt I would think, well, this might just be kaplooey neurotransmitters, let’s see what happens. And what happened, with striking consistency, was that the pain would pass. Over time (maybe a year or so) I resumed typing, stopped icing my arms every day, stopped using the wrist braces. I was still on the computer just as much, and I was able to do my work with minimal, transient pain. In hindsight, I think the most important thing was that I wasn’t in a state of expectant tension all the time, waiting for pain to strike or get worse. When my arms did hurt, I didn’t clench up, but instead took a kind of inquisitive attitude; and later, as I gained confidence that the pain was not serious, I simply told myself that it would pass.

    Pain and painkillers are, of course, big business. USA Today reports that nationwide in 2010, pharmacies sold the staggering equivalent of 111 tons of pure oxycodone and hydrocodone, “enough to give forty 5-mg Percocets and twenty-four 5-mg Vicodins to every person in the United States.” (http://usatoday30.usatoday.com/money/industries/health/drugs/ story/2012-04-05/painkiller- sales-spike/54022528/1) Synthetic painkillers account for 70% of total pharmaceutical sales. (http://www.ucadia.com/me/m05/m053000.htm) We spend more than $1 billion annually on acetaminophen (http://www.uptodate.com/contents/acetaminophen-paracetamol-poisoning-in-adults-pathophysiology-presentation-and-diagnosis/abstract/8-12); $11 billion a year on antidepressants (http://survivingantidepressants.org/index.php?/topic/1025-us-antidepressant-sales-rise-to-11b-due-to-primary-care-docs/). And even those figures pale compared to alcohol sales, a very substantial portion of which surely serves to numb pain. Beer alone brought in almost $99 billion in 2011. (http://www.huffingtonpost.com/2012/02/14/us-beer-sales_n_1276300.html) Total alcohol revenue, despite a drop in 2009, has predictably increased since the start of the Great Recession. (http://www.huffingtonpost.com/2011/06/09/
    alcohol-sales-bounce-back_n_873921.html)
    Behind the big numbers of the pain trade sprawls the sheer volume of suffering in our society – physical, emotional, and the richly intricate interplay between the two. It’s scarcely possible that all of this pain could be the normally occurring downside of life in a healthy, functional society. Yes, unquestionably a portion of it is unavoidable, from stubbed toes to some (though not all) instances of cancer. But we know from our own mundane experiences of tension headaches and stomach aches that stress causes pain – and the reverse, that pain causes stress. The more severe the stress, the more intense the suffering is likely to be, other things being equal.
    The sources of stress in our society are so many, so varied, and so deeply ingrained that it’s hard to know where to begin. The ways that children are treated that crushes their spirits. The treatment of people in huge ranges of situations as less-than and “Other” based on their race, class, gender, sexual orientation, religion, country of origin, and any other pretexts people use to try to gain the upper hand. Epidemic levels of sexual abuse and other forms of physical and emotional violence. The organization of workplaces that strips most people of meaningful control over their work. The through-the-roof levels of incarceration and lengths of prison sentences, above all impacting African-American men. The extreme stratification of wealth and power. Pervasive economic insecurity and expanding levels of poverty since the onset of the Great Recession. Innumerable environmental toxins and the ongoing degradations of the environment, including the rapid escalation of extreme weather events driven by climate change.
    Then there is the largely ignored pain experienced by those who enact or benefit from oppression. In Born to Belonging, Mab Segrest quotes from the diary of a Southern white woman who wrote that, upon witnessing the grief of a family being separated during a slave auction, “It excited me so I quietly took opium.” Oppression is possible only when those who dominate can shield themselves from the raw reality of others’ suffering. The hazing rituals in military training, the elaborate trails of code words for demonizing and dehumanizing the Other, all serve the same function as opiates and other pain-”killers”: they numb us to our own felt experience, to our natural capacity for empathy, to the destruction of our own spirits that happens when we participate actively or complicity in violence against others.
    The whole picture is a maze of abuse and victimization, of intersecting power dynamics and roles, with pain swirling, snaking, smashing its way around the entire maze. And coiled around that is our learned aversion to pain, our clenching resistance, our conviction that pain is intolerable; an aversion driven by childrearing, by the spiderwebs of culture, by Big Pharma, by health professionals, by shame, by terror, by addiction, by the psychological imperatives of oppression. We learn to think of this as a normal state of affairs.

    Dr. John Sarno, in his book Mind Over Back Pain, contends that most people with chronic back problems actually have nothing structurally wrong with their backs. Sarno says that he has found indistinguishable back structures among people who do and don’t report back pain. He believes stress triggers most back pain, and that people who view themselves as having “back problems” reinforce the stress at the first sign of pain, assuming that it’s the start of a major episode. This becomes a self-fulfilling prophecy. It’s not that back pain is psychosomatic in the sense of being illusory. The pain is real, caused by physical constriction – a kind of clenching – in the affected areas that results from escalating stress.
    I have suffered from back pain for most of my life. Starting in my mid-thirties, and for a period of twenty-five years, I had episodes that were bad enough for me to go to the chiropractor, usually two or three times a year. Sometimes it was hard to turn my head; or I would have throbbing in my shoulder blades, or deep, intense pain in my lower back. A few times it was so bad that I could barely walk. Naturally I thought of myself as someone with a bad back. Just like the people John Sarno has treated, there were certain kinds of twinges, stiffness on waking, and abrupt pains that I associated with my back “going out”. When they happened I braced myself for the worst, and then the worst usually happened, reinforcing my beliefs that these were in fact warning signs and that I did in fact have chronic structural back problems.
    I read Sarno’s book reluctantly after it was recommended to me. I had lots of reasons for my reluctance. I’m wary of pop advice books. I feared that there would be some sort of daily exercises I would be told to do. After so many years it was hard for me to muster much hope that there was anything I could do to make my back better. And there was a place in me that wasn’t necessarily keen on the entire idea of giving up my back pain, which was after all part of my sense of self. An identity as someone who suffers is not the easiest thing to change.
    But I read the book anyway, and a lot of it made sense. In particular, the notion that expectations and fears can cause physical constriction, which in turn causes physical pain, rang true for me. And it turned out that there were no exercises, no regimen, no spiritual practices. All I had to do, when my back started to hurt, was tell myself that there was nothing structurally wrong, that the pain was not serious, and that this was not the start of an episode. Which I have done with stunning success. In about three years since reading Sarno, I have not needed to go to the chiropractor. I still have minor aches and pains in various parts of my back on a regular basis. But, simply, this is no longer a big deal.
    My experience with my back is so similar to what happened with my arms that you might think I would have reached the same conclusion on my own, without ever reading Sarno – assume that pain will pass and see what happens. But I didn’t. Instead I assumed that the results I got from relaxing rather than clenching when my arms hurt was unique to that one part of my body. Like personal identity, beliefs about pain are hard to change.

    Last year I read Jon Kabat-Zinn’s wonderful Full Catastrophe Living, which describes the use of meditation to manage pain and stress. The core practice is to breathe from the diaphragm and to focus your awareness on your breathing. I had read Thich Nhat Hahn a number of years earlier and tried mindful breathing for a while at that point; but it didn’t take hold.
    This time something shifted. Some of the reasons I don’t entirely understand; but one I do. Kabat-Zinn talks about experiencing your breathing (and your pain, which I’m coming to) without any ulterior purpose. The best way to achieve results, he says, is not to try to achieve any results at all. The results – which of course you do want, even if you are not trying to achieve them – may be relaxation, pain reduction, coping with anxiety or depression, enhancing the quality of your life, overcoming the debilitating impacts of stress and illness in order to regain the ability to function. But all you do is to be as fully aware as you can of your breathing and the accompanying physical sensations and feelings.
    Well: I can recognize a paradox when I see one. And not just any paradox. This took me all the way back to my first years as a parent, to holding my son when he was upset and telling him to cry as much as he needed to. It seemed to me that the wisdom I had stumbled onto as a father about affirming my child’s crying had taken me to the threshold of a deeper truth about stress and pain that I could also apply to myself. At least I thought it was worth a try.
    So I, who have had a lifelong aversion to spiritual practice or any kind of self-improvement regimen, started meditating every morning. I liked it right away, and found myself more relaxed, lighter – physically and emotionally – not just when I was doing the mindful breathing, but also afterward. At the same time, I ran into major challenges. At first I could barely feel anything in my belly when I breathed. That’s the area of my body where I was severely physically abused by my older brother when I was growing up. Then, when I started being able to feel sensations in and around my stomach as I meditated, it was staggering. I could feel, with depth and clarity, just how much stress I was carrying in my gut, and had been carrying for more than half a century. And I let myself feel it. I breathed with the feelings, with the stress, and didn’t try to make it better or anything other than what it was.
    I have broadened this practice to many other places of pain – physical and emotional. Pains in various parts of my back, in my hamstrings and thighs, my pelvis, ankles, intestines, hemorrhoidal pain. Fractures in my psyche, legacies of childhood traumas, places in me that got broken a long time ago and never have fully healed.
    In the last year, my entire attitude to pain has changed. In some ways this is a new stage in a longer evolution, from clenching at any hint of pain to shrugging it off, and then gaining confidence in the structural integrity of my body. But those phases were still ways of working around pain. I could tell myself that this twinge in my arm was nothing more than a misfiring neurotransmitter, or the ache in my shoulder would surely pass and not to get hung up about it; and sure enough the pains would pass. That was a good thing – way better than clenching myself into a state of surplus pain. But now, at least at times, I’m doing something that is neither clenching nor circumventing. I am delving into my pain.
    There are moments now when I have the space and attention to focus my awareness on my pain. I find I can do this without those old layers of worry or dread or self-fulfilling expectation that this is the beginning of something bad. I do it with curiosity and real affection for the part of me that is hurting. I actually embrace it – not in the sense of anything like masochism, any more than my embrace of my son’s crying was sadism. In my son’s case I was celebrating his ability to express his pain, not the fact that he was suffering. With myself, I am embracing my ability to feel, the very fact that I have a body that has needs and is hurting, and my understanding that by accepting and exploring my pain, I am taking care of myself. Jon Kabat-Zinn talks about being with your breathing – and by extension with your pain.
    There is an amazing release from fear through this kind of acceptance and active attending to my pain. For those of us who are survivors of physical and/or sexual abuse (and there are many, many of us), there is something of elemental importance about accepting and exploring our pain: we are reclaiming our bodies. In the moment of abuse, and in the traumatic aftermath, healthy connection with our bodies is exactly what we lose. We fluctuate between the loss of our ability to feel key areas of our bodies (dissociation) and being flooded and overwhelmed by unbearable feelings.
    Now I tell myself as I start to meditate, ‘However fragmented my “self” may be, I have one body. The same body houses all the parts of me. I’m breathing with one diaphragm, I have one belly that rises and falls, the same breath sustains everything inside me. I have one body that feels pain.’ Then I breathe and let the sensations in my body be what they are. It sounds simple and obvious, but believe me, it isn’t. It is a treasure of reconnection, of steps toward wholeness.

    Conventional wisdom says pain is a signal that something is wrong, and this seems obviously to be true. But on the ground, we so easily slide into viewing pain itself as the thing that is wrong. From there it is an easy step to try to deal with pain by wiping it out.
    If we can learn to tolerate our pain, to truly treat it as a signal, and to become inquisitive about its underlying causes, we would start asking all kinds of questions. How much of this pain has to do with something that is structurally wrong, and how much is surplus pain caused by clenching? How much pain will be left if I can unclench? When there is a structural problem causing my pain, how much of that is a function of stress? What is my body’s capacity to heal itself? How much can ease with my pain, and gently exploring it, nurture or simply unblock my body’s innate ability to heal or recover? What roles do larger social forces play in my pain? What role does the sense of being acted upon, that pain or stress or illness are things that happen to me, have in the frequency, intensity, and duration of my pain? How can experiences of agency – for example that I am able to tolerate pain, that pain offers me the opportunity to connect with and care for my body, that there are concrete things I can do to manage my pain and practice self-love – foster healing and recovery? What role (if any) should medical interventions play, and what types of interventions, and who should decide? When does pain become overwhelming to the point that it makes sense to numb it – and who decides? And what kind of numbing, if and when that choice is made (there are huge differences, for example, between ice, ibuprofen, and alcohol)?
    All of these are political questions, not just the one tucked into the list about the role of larger social forces. They are political because they all revolve around who assumes power in relation to each person’s experience of pain. Whether you define your own pain or have it defined for you – by health professionals, by corporate marketing, by internalized cultural values and beliefs – is a question of political significance under any circumstances, let alone in a society whose suffering is as pervasive and intense as ours. And there is nothing more profoundly political than the question of agency: the ability, as the old slogan goes, to make decisions that affect our lives.
    Thinking of these as political questions does not in the slightest mean that they are abstract. This calls up another fine old adage, namely that the personal is political. It’s hard to imagine anything more concrete and personal than how we deal with our pain. Choices about whether to get hooked on pain-“killing” drugs and the entire array of numbing devices are real issues of vital importance in people’s daily lives. So are choices about whether and how to actively inquire into the sources of our pain. This unfortunately is still not a conventional wisdom, but power relations are everywhere, and the more we can understand the interwoven relationships between power and pain, the better our prospects for dealing with both.
    Despite everything I’ve said about numbing pain, I do believe there are times and places for it. In the moment when abuse happens, often the best we can do is to dissociate as a means of psychic survival. At a very different place on the pain spectrum, I get dental fillings without Novocaine, but I would never willingly have a root canal unnumbed. There are always critical questions about managing pain that have to do with the exercise of power. How many dentists ask their patients if they want Novocaine rather than simply assuming it? How many of us walk into our doctors’ offices seeing ourselves – and being seen by the professionals – as decision makers? What is the actual range of options of someone who is being abused, or who has been abused? What are the mechanisms and supports we need in our lives in order to recognize our options and make active choices to deal with our pain?

    I want to make a confession: I don’t dance. I took a dance class in seventh grade, and through my early adolescence I did make an effort at parties where I tried to convince myself I was having a good time. But dancing became increasingly free form (this was the sixties), I was a socially awkward intellectual type, and I checked out.
    If you bear with me for a little while, you’ll see the point of this reveal.
    My (now ex-) partner Suzi was in labor with our son for a long time. We wanted to have a natural birth, we went to a birthing class, and Suzi chose a gynecologist who worked with a team of midwives. When her water broke it was around midnight but the labor came on slowly, and it was the next afternoon when we went to the hospital. We had a large, comfortable birthing room with a jacuzzi and lots of space to move around. Our midwife was great, and we had lined up two friends to be there as a support team.
    The first afternoon we did a lot of walking and waiting. By some point in the evening Suzi went into hard labor, but the dilation was still progressing very slowly. Then everything intensified and we all thought she was in transition until the midwife measured her and she was something like 5 centimeters. We were stunned, and of course it was hardest for Suzi, who was in excruciating pain during the contractions.
    For the rest of the night, there was a recurring theme, a kind of call-and-response which I’m sure has been repeated in the course of countless labors. During contractions Suzi would moan, “I can’t do this,” and we, her support team, would tell her, “You can do it, Suzi!” Eventually I began to feel that there was something not right about this cheerleading. But I didn’t know what else we could do. We were moving into the second day of labor, I’d had not a lot of sleep and was right on that edge between adrenalin rush and exhaustion, and likewise on the edge between excitement and deep anxiety. In short, I was not thinking especially clearly. I just wanted Suzi to dilate and have the baby. But the pace of her dilation remained glacial.
    Early the next morning we reached a crisis point. Suzi was sitting up, and the four of us – the midwife, our two friends and I – were arrayed in a semicircle in front of her. She yet again was saying that she couldn’t do it. But this felt different: partly because she was in between contractions when she said it; partly because of all the nonverbal cues, the tone of her voice, the desperate, defeated look in her eyes.
    This time, before anyone had a chance to tell Suzi for the umpteenth time that she could do it, I heard myself say, “It’s not whether you can, it’s whether you want to.”
    Suzi looked at me, mustered the energy to frown, and asked in a small voice, “What do you mean?”
    Without hesitating, and honestly without thinking, I said, “If you can find the place in you that wants to have this baby without drugs, then you’ll be able to do it. And if you can’t find that place, I’ll do everything in my power to get you drugs, I’ll argue with the midwives and go to the doctor if I have to, because you shouldn’t go through this kind of pain against your will.”
    Suzi got really quiet, and she seemed to go far away. That went on for a long time, though I have no idea what it measured in minutes. I remember at one point one of our friends gently asked her what was going on, and Suzi glanced up and said, almost in a mumble, “I’m trying to find that place.” Then she went away again.
    Another long stretch, until finally Suzi lifted her eyes and said, in a clear voice, “Okay, I can do this.”
    I think we all understood in that moment that we had come into a state of grace. I know for myself that what I was able to say to Suzi at that point of crisis was not something I did in any normal sense. It came through me. Of course there are things about me, my sensibilities to issues of power and self-determination, that helped to make this possible. But I was somehow tapping a wisdom that is surely more than who I am.
    One of our friends said, “Let’s give Suzi and Steve a little while to spend alone,” and our friends and the midwife left the birthing room.
    Suzi and I decided to play some music. We had brought a boombox and tapes, probably because some advice book had said that music can be a good thing during labor. We put on something up-tempo, Latin music.
    And then we danced.

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