By Dr. Stephen F. Grinstead, LMFT, ACRPS
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My Story of Learning To Live Life Without Armor
As I achieved 39 years in recovery from alcohol and pain pills and 38 years of living with chronic pain, I knew it was time to look back. My hope is that this article helps others to see that no matter what adversity or overwhelming life situations occur, we have a choice to face and thrive despite them or feel victimized by them.
In the early 1980’s I was dealt a major life blow that many people living with chronic pain may be able to understand. A construction accident left me without my livelihood and robbed me of a new career as a Karate instructor. In my mind life was over, and I seriously considered ending it. But I realized through the love and support of friends and several caring healthcare professionals that I wanted more from life than just being a chronic pain statistic. My acceptance process was just the beginning of overcoming adversity to discover opportunities for hope and healing.
The Early Years of My Armor Development
To understand how I overcame adversity, it’s important to share how I developed the self-defeating coping strategies and defenses that helped me survive. These defenses, or what I’m calling armor, helped to protect me from several painful realities. For the first 28 years of my life I didn’t even realize I was “Armored Up” and I mistakenly believed this armor would keep me safe. I was trapped, and I didn’t even know it. Today I understand this psychological armor helped me live through significant childhood trauma. I hope my story will help you to identify any protective armor you might be wearing that does not serve you well anymore.
My path has been one of progress, not perfection, as my old armor can still be triggered even after almost 40 years of being on my Spiritual Warrior Journey. The difference today is that I am much more aware, catch it sooner and make proactive amends very quickly for any harm I may have caused while armored up – especially because when I get defensive, I can become very offensive.
I believe too many people in our culture are “Armored Up” and convinced they must protect themselves. The most vulnerable and powerful aspects of what makes them unique and beautiful are hidden from themselves and others – they don’t have access to their empathy, compassion and connection that makes an extraordinary quality of life possible. I have observed many people suffering with chronic pain who are the most armored up of all. Over the years I have learned to replace my armor and offensive weapons of anger and violence with Spiritual Warrior Values, Principles and Practices, and so can you!
Daddy Said Real Men Don’t Cry – But They Really Do
An early decision I made at five years old led to my first suit of armor. I was on an exciting fishing trip in the Colorado Rockies with my Daddy and his buddies at a place called Pauline Creek, close to Gunnison Colorado. As the oldest of four boys (Mom eventually had 9), this was a very special occasion for me. I was having such a great time and finally getting the attention from Daddy I craved. I was running and laughing like a maniac as one of Daddy’s buddies chased me with a snowball. In my attempt to get away, I jumped off a cliff.
I was down at the bottom of the rock face which seemed impossibly high for a five-year-old, crying and holding my sprained ankle. Daddy rushed over and I felt relieved as he checked my ankle, but his next words stunned, shamed and paralyzed me, “You’re not hurt that bad so quit crying or I’ll give you something to cry about.” His next comment solidified my decision about vulnerability, “In this world you have to be tough Stevie – real men don’t cry.”
The decision I made as a result informed all my choices: I will never ever risk sharing my pain again – physical or emotional – because I needto be a real man and make my Daddy proud. I started to build my first suit of armor and began hiding who I was, what I felt and what I needed. I reinforced it over the next twenty-five years. My Armor started out as a hardened leather body suit that I mistakenly believed was protecting me, but I didn’t see the barrier I was building between me and other people.
I wonder how many of you reading this can identify with similar circumstances and the decisions I made. Situations, words, people, and actions may be different, but most people in our society receive similar messages from the day they are born about the need to be tough, safe and self-resilient, not trusting anyone with the truth. Self-defeating decisions are often made as a result of interpretations about a perceived hostile environment.
Let me be very clear here; these early defenses do help us survive very toxic situations. I would never suggest anyone drop their armor without having something in place that will serve them in a healthier way, such as Spiritual Values, Principles and Practices.
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Identifying The Obstacles
When confronted with issues that get in the way of effective chronic pain management, it is important to not linger too long in any phase of the healing continuum. Over the years I’ve seen many of my patients stop making progress and not transition through the following five phases.
In the sections below you will see the problem side of each transition point and the importance of moving through to a solution. Some of you may see where you have been or are currently stuck and need to move forward!
Out Of The Problem And Into The Solution
A point to remember is that the process is different for each person. Some people never experience any of these stuck points, while others may hit them all. Some of you may hit one or two or even three or four. That is why it is so important to understand the potential obstacles that can get in your way, and how, once you identify any one of them, you can then learn how to manage them by taking action and creating positive solutions.
Hopeless to Hopeful
Have you ever felt hopeless and helpless living with a chronic pain condition? If so, take yourself back to that time when you felt afraid and overwhelmed with a sense of hopelessness. Remember how that state of mind seemed to drain all of your energy along with hope for your future.
One of my patients, Sheena, had a workplace accident. She broke several bones and discovered over a year later that she also had severe nerve damage. Her doctors tried various pain medications and physical therapy interventions that first year. She kept trying to return to work as a carpenter, but ended up in so much pain that she had to stop working completely. She finally went on total disability and was told she would have to learn to live with the pain. Unfortunately, they did not explain to her how to do that and still have a functional, good quality of life.
Eventually she was referred to a pain clinic that I was consulting with. I worked with Sheena and her doctors to find out why nothing up to then had helped her pain. As I assessed her symptoms I noticed that nine of fifteen were neuropathic. I also discovered that she never received an MRI for her back; those results showed significant nerve impingements and damage.
Just know what was really going on was the beginning of Sheena’s transition from feeling hopeless to renewing a sense of hope for her future. Within six months she had adequate pain relief and was undergoing vocational rehabilitation in computer programming. Sheena was now very excited about her future, but without a healthy transition she would have been at high risk for getting stuck at the next transition: Demoralization.
Demoralized to Revitalized
When you get to the point of demoralization you may be at risk of wanting to quit or give up. At this point many people sink into a pit of depression that may lead to suicidal thoughts and even suicide attempts. This I what happened to one of my former patients, Jim.
Jim had been on total disability for over seven years when I first met him. He was referred to me after completing a mandated stay at a psychiatric hospital for an attempted suicide. At this point he was heavily medicated with antidepressants and other mood stabilizing psychiatric medications. His depression was still moderate to severe and he reported pain levels of 9-10 on a 0 to 10 pain scale on bad days and only 7-8 on his best days, even with his pain medication.
Our first step was for him to meet with a pain management colleague and to start on a medication that would address both his depression and pain symptoms.
As part of the solution Jim's doctor chose Duloxetine due to Jim’s significant neuropathic pain symptoms. I helped Jim develop a cognitive behavioral plan and within a few months he made the transition from demoralized to revitalized and felt as though he had his life back.
When people stay too long in a demoralized state, they often move to the victim stage. In this phase people can alienate and/or burn out friends and family. They are also at high risk for shifting back into hopelessness yet again.
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People living with an ongoing chronic pain condition often give up trying to explain to their healthcare providers or even loved ones, what living with pain is like! They get tired and frustrated of being told it’s all in their head, that they’re malingering, drug seeking, or that they just need to learn to live with it.
Then there are some people who try to seek help, but sometimes in ways that are not in their best interest. Others are on a quest to find the magic solution: the right pill, procedure, healthcare provider or technique that will give them the relief they want, or some kind of plan that will just stop the pain. They get fixated on the traditional Bio-Medical Model and for many it is not very effective as it often fails to identify and/or treat the coexisting psychological and medication use problems often occurring with people suffering with chronic pain.
First of all, there is nothing wrong with wanting pain relief. However, it may be unrealistic for some people with certain pain conditions to ever be pain free. In this instance I ask my patients: even if you had a certain level of pain, would it be all right if you never had to suffer with it again? This is why I wrote the book Thank You Adversity For Yet Another Test.
In fact, I often have to apply the information I write about to myself. Especially when I was recently experiencing acute pain flare ups that could keep me in bed, unable to work or participate in normal activities. For many years I have been dealing with my own chronic pain condition, but it had several decades since I felt this kind of intense pain. It would have been easy to obsess about my pain and become depressed as a result.
I almost slipped back into what I call the “chronic pain trance,” which is a state of mind that develops when someone has to live with pain on a daily basis over a long period of time. What is important to remember is that this state is an automatic and unconscious way of coping with chronic pain which can be self-defeating or sometimes even self-destructive. Fortunately, I did start to practice what I teach.
Developing A Positive Relationship With Your Pain Is Crucial
When working with patients, I ask them to examine their personal relationship with pain and how they currently manage it, as well as taking an honest look at their medication management plan. The more proactive people are, the more they will improve their ability to manage their pain condition. But no one has to take this journey alone. I encourage my patients to share their journey with the people who care about them so they can understand more about what it takes to cope with a challenging pain condition.
People living with chronic pain that are ready to, can learn how to more effectively manage it, end their suffering, and improve their quality of life. But here is the challenge—effective pain management is not only a right, it is also a responsibility. Patients must take responsibility for their health and healing. In fact, they are the only ones that can. The challenge is to help them decide if they are willing to do the work required for effective chronic pain management and to become free from suffering.
One important suggestion for anyone living with chronic pain is to stop making pain the enemy. This can be a challenge, but is nonetheless a crucial first step. When I talk to patients about living with chronic pain, I often hear statements such as “I have a bad knee” or “this stupid pain is killing me.” These types of statements make clear to me that this person is still at war with their pain. Unfortunately, this is an internal war — one that cannot be won through fighting it.
People have to stop fighting their pain and make peace with it—pain is a part of who we are, so we are really just fighting with ourselves. When we make peace with our pain and learn how to manage it more effectively, we stop suffering. We become empowered to create a life worth living filled with meaning and satisfaction. However, in order to make peace with our pain, we need to move beyond the “quick fix.”
Effective Chronic Pain Management is NOT a Quick Fix
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