Acceptance and Loss: Pain, Stress and Disability

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Adversities and setbacks are normal parts of our lives and we are challenged at various times by pain, stress, illness, mental difficulties or disability.

Much of what happens is outside our control and we vary greatly in our ability to manage these stresses effectively.

Our level of coping with these typical difficulties is an important factor in deciding how effective and content we are with our lives. A realistic approach with an achievable plan for dealing with the problems makes a successful outcome more likely.

Many of the adverse situations we face involve one particular occurrence which is difficult to cope with, loss. When we have no pain we accept the situation without thinking how and when pain intrudes and limits our world we feel the loss. Pains can affect everyday activities such a sitting in a pub or restaurant, going shopping or getting the housework and gardening done. It can be difficult even to accept the gradual reduction in our physical capacity which follows getting older, but if severe pain problems force significant changes upon us we find the sudden limitation of normality hard to cope with.

Other losses we can suffer are loss of a relationship, death of a loved one, loss of job, loss of role in life, loss of income, loss of a part of the body and so a loss of our sense of self and self-esteem. Loss of some kind which leads to the single most disabling condition in the world, depression. When we are depressed we undergo a change in our brain chemistry which causes us to think negatively and to apply a continual negative bias to all our thinking and conclusions. This is important for its own sake in terms of our mental state but also because a high proportion of depressed people suffer a pain condition of some kind.

We may not be that successful in coping with and coming to terms with these losses.

Hopelessness may be the result if we become depressed so we lose the motivation to take the required actions which would ameliorate our condition and situation. Cognitive therapy and antidepressant drugs can be used as required to kick start the improvement process of more realistic thinking and begin generating helpful approaches to our troubles. We can react in an entirely different manner to these challenges by fighting strongly against them.

Pain sufferers typically say I'm not going to let my condition beat me, making the situation a competitive one which they are going to win against the pain. This approach is a common one as sufferers try hard to keep control in adverse conditions, fighting to maintain their activity in getting things done such as their day to day chores and things they feel they should be able to do. This approach can however have a real disadvantage as the continual struggle against the pain can lead to a deterioration in pain, reduced activity and depression.

Conflict is one of the most important concepts here.

The conflict exists between what we think we should be able to do and what we can. We can feel aggressive towards the pain and towards the world which demands things we cannot supply. We can thereby develop a relationship of conflict with others and within ourselves which can obstruct us from generating alternative approaches to our problems and gets us stuck in a rigid behavior. These problems are all related to not accepting the reality of our situation and we cannot move forward as those actions are not acceptable.

The idea of acceptance is important and should not be mixed up with resignation.

In resignation we feel helpless and that we just have to accept everything, thinking that nothing much will change things for the better and we have to put up with the situation permanently in this way. This kind of very negative assessment of the problem will lead most likely towards depression and make it unlikely the person will take actions to get themselves out of their situation. It is undesirable to feel resignation and more functional to learn acceptance and so work at changing the future for the better.

It is easy to talk about acceptance but it is difficult to put into practice.

Accepting our recent inability to perform an important function that we feel we really should be able to do easily is hard for anyone to do. A chronic pain problem has no outward manifestation of its difficulties so other people typically assume there is no appreciable level of disability and expect us to perform normally. It is hard to accept functional loss and cope with the beliefs and attitudes of others about our ability and worth. Despite these problems there is no future in continuing with the conflict and we need to move towards acceptance of the reality of the case.

In most things we have to accept the reality of what we are and what the present situation is. We can in many cases make changes to our situation to improve things and get closer to what we want to be. However, in some cases we are stuck with the situation we are in and we have no option but the accept it or fight against it. Fighting it generates, as we have seen, conflict which has undesirable consequences. Gradually moving towards acceptance can free us from this conflict and allow us, finally, to work at our difficulties in a productive manner.

If we don't accept our situation we cannot let go of the conflict and so we are unable to take up suggestions we or others might generate to make things better. If I don't see why I should do things differently because I don't want to give in to the pain or let people down, I will not want to adopt a new method or accept a lower level of performance. So we block ourselves from making the changes we need to and in many cases want to make or improve our lives. Accepting This is where I am now and I have to cope with that is a big step and can open the gates to change.

The scripts we use, the words which we say to ourselves about our abilities or our desires, are important in how we act. They are often unconscious, these specific interpretations and ideas about ourselves. We might say My fitness is at a good level and I can manage social activities, sports and my life all together, which would be a good position to be in. If a person has a pain syndrome or low back problem their scripts will run in different ways such as My pain disables me and I don't think it is ever going to improve so I won't be enjoying any activities in the future. This is the underlying message a resigned person might have constructed for themselves.

However, very negative scripts, constantly going round and round in our minds, lead to negative thinking and depression. One approach is to consciously generate new scripts and an example of this might be Even though I do have a pain condition which limits my ability, if I manage my situation well I will be able to do many of the things I want to in a modified manner. This is a realistic description of the situation and more likely to lead to a realistic assessment of our situation and a more positive approach to any action which could be taken to improve it.

Realistic scripts have the benefit of being more positive than the typical negative ones although they should not really be positive as such as if we look through rose-tinted spectacles we will be disappointed pretty quickly when we really see where we are. A more positive approach allows us to participate in the management of our condition, perhaps with the help of a health professional, when previously any new ideas would have met with resistance.

So if we can accept the situation to some extent it is much more likely we will adopt adaptive measures to improve our condition. The typical behavior we adopt when we have a chronic pain problem, to push through the pain until the job's done can be altered.

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