Welcome to the current newsletter issue of
Advances in Medicine (AIM) - Take AIM against pain.
Feel free to send me an e-mail with your own thoughts
and experiences. Email: timsams@mypainreliefdoc.com.
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LOSING YOUR GROWN UP
With a mischievous smile, she said, "You know how sometimes
you just lose your grown up?" I burst out laughing. Maybe it
was late in the day and I was a little punchy, but that was one
of the funniest, and most insightful comments I'd ever heard.
Leah was a person in pain and we had been discussing some recent
episodes of frustration and acting out. Entire books and fields
of psychology have been devoted to that one, simple idea, which
she had so masterfully captured. Ellen DeGeneres would be proud.
Freud talked about the Id, ego, and superego in which the adult
ego mediates between the needs of the childish, instinctual Id
and the controlling, parent of the superego. Transactional
analysis spoke of the interaction between the child of one
person and the parent of another. Adult children of alcoholics
and codependency literature discuss the inner child vs. the
outer adult.
The bottom line is that we all have a continuum or hierarchy of
coping strategies from the most primitive to the most
intellectual-or from the most childlike (irrational) to the
most adult (rational). For most stressful situations, we begin
toward the top of the hierarchy with reasonably rational,
sophisticated, problem-solving strategies for coping. Only if
these fail, do we move down the hierarchy toward more primitive,
irrational behaviors. In the simplest situation, we might try to
talk a clerk into returning defective merchandise based on
notions of fairness and good business, gradually retreat into
veiled then direct threats, and later still, name-calling and
screaming. For some of us, that's a quick trip.
Generally speaking, the more intense the stress or the longer
the stress, the more likely we are to regress into more
primitive coping styles. Temper tantrums and intense social
withdrawal are two more primitive forms of coping. Freud called
other primitive strategies "defenses," very primitive ways
of changing the reality of a situation to make it more
palatable. Examples include repression; forgetting an event to
avoid psychic pain; and denial-denying that an event happened
to avoid psychic pain.
Physical pain is perhaps the most intense of all stress types,
and chronic pain that endures is probably the most stressful of
all pains. More sophisticated coping strategies can degenerate
into a stew of primitive strategies hurled against the wall with
little thought or plan, and with a predictable outcome-sloppy
bad.
My patient population is jam packed with primitive, less healthy
coping strategies. Not only do they hurt, but also they are
exhausted, intensely emotional, and medicated, with a sequella
of peripheral problems such as marital conflict or financial
ruin. The most common primitive and childish coping strategy is
the refusal to accept long-term pain as chronic and indefinite.
Chasing one doctor or one test after another in a desperate
quest for help, is another. You may act out with doctors or
staff, make unreasonable demands, or believe that your pain is
special. In ABC's of Pain Relief and Treatment: Advances,
Breakthroughs, and Choices, I devote an entire chapter to
difficult patients, usually people whose coping strategies have
devolved into the most primitive and childlike.
Frequently and commonly, patients end up blaming the people
around them for their misery, believing that if their friends
and family were simply more understanding or supportive, they
wouldn't be miserable. People in pain may tend to see things
in an all-or-none, black-or-white kind of way. They may begin to
personalize or mind-read the most harmless of comments. They may
catastrophize or fall victim to the fallacy of fairness-all
ways of making yourself more miserable than you have to be. All
childish ways interfere with the rational business problem
solving and persevering with the science of decreasing pain and
improving functioning.
When you hurt, it takes immense courage to say to yourself,
"If I'm going to feel better, it's gonna have to come from
me." When you feel weak, helpless, and vulnerable, the most
natural thing in the world is to take the childish way out and
over-rely on others, "grown ups," to get you out of the
situation. But realizing that "sometimes you just lose your
grown up" is the beginning of the search for finding your
grown up. And therein lies wisdom and pain relief.
Comments?
Good light,
Dr. Tim Sams
My Pain Relief Doc
www.mypainreliefdoc.com
Copyright 2007. Dr. Tim Sams and My Pain Relief Doc.
All rights reserved. www.mypainreliefdoc.com
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include the entire article, along with the web links
and copyright information. Thanks, Dr. Tim
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