"On Healing" November 2007

Posted on Mon, November 12, 2007
Adversity, great cure for anxiety
By Dan Gottlieb

Many of us feel more stressed out today than we did five years ago. Seventy-five percent of the people in a new American Psychological Association survey cited work and money as the leading cause of stress, up from 59 percent in the same survey last year. And half said costs related to housing - rent, mortgage payments - were significant sources of stress.

Clearly, a lot of us feel uncertain about our economic future. And anxiety is always about the future. We can't really feel anxious about what happened in the past, and as for the present - well, that just happened, too. Sometimes anxiety is adaptive: If you are worried about your personal finances, the anxiety could help motivate you to cut expenses or try to renegotiate a mortgage. But the best outcome would still only hedge your bets. It doesn't change that uncertain economic future.

Then again, everything about the future is uncertain - not just finances but our health, our children's welfare, even our lives. And stress is about our failed efforts to control something we cannot control. So how do we cope with the anxiety of not being able to control something we feel is critically important?

One evening my son-in-law Pat and I had a long talk exploring our different economic philosophies. I am much more conservative (economically) than he and Debbie, so I sometimes feel anxious about their future. After hearing my concern, he told me a long story about a successful business he had owned 15 years earlier. And how, through a series of misfortunes, he had to declare personal bankruptcy.

I interrupted: "Pat, I just told you about my anxiety and here you are telling me you went bankrupt. I'm not feeling better!"

With great compassion he responded: "That's the point, Dan. Look at where I've been and where I am now. Not only have I learned about bad decisions I wouldn't make again, I have also learned that I have the courage, the intelligence and creativity to come back from the bottom. Because of that experience, I'm confident I will always be able to care for my family, and you can be confident also."

What Pat was telling me was he had faith. Not faith that they wouldn't have problems; he couldn't know that. He had faith in his own resilience and ability to survive adversity.

How did he get that faith? Adversity. Adversity is not only how we learn about our resilience, it actually helps build it. Adversity is how we learn about who we are.

Now here's the funny thing: As good parents, most of us work as hard as we can to protect our families from potential adversity. Think about it: You have probably enjoyed your successes and accomplishments, but your great learning has likely come in the wake of adversity.

I rarely make predictions, but here's one: In your future something will appear unexpectedly and knock you down. You will be confused, frightened and hurt. And then you will get up and resume your life. It's happened every other time you've been knocked down, and it will happen the next time as well. Have faith.

Posted on Mon, November 26, 2007
Accepting a life with chronic pain
By Dan Gottlieb

When Jonathan first came to my office two years ago, I could see his problem before he said anything. He walked gingerly, shoulders hunched over, a look of anguish on his face that announced what he was feeling: six months of severe pain following an operation.

When he complained to his surgeon, he was told it would pass. When he could no longer bear it, he consulted other doctors. All of them essentially suggested that pain from his surgery takes a long time to heal. Jonathan was angry and scared. Some days he tried to live his life as he had before, but he was in agony. Other days he gave in to it, engaging in little physical activity; that didn't help, either. He continued looking for doctors who could tell him what was wrong and how he could make the pain go away.

This scenario is familiar to many of the nearly 40 million Americans living with chronic pain. When pain is acute, our bodies mobilize to find the source and fix it fast. With a chronic condition, the pain itself sometimes becomes the root the problem: The brain may not recognize that the cause has been eliminated; it persists, like phantom pain following an amputation. Other times, as with Jonathan, the problem cannot be remedied.

The natural reaction to pain is to brace up against it, says psychiatrist Sarah Whitman, an assistant professor at Drexel University College of Medicine. Yet fear and anxiety make it worse. Friends and physicians often do, too. When well-meaning people try to minimize the agony or offer simplistic solutions - "be strong," "look at all the good things in your life" - those who are in chronic pain feel frustrated, misunderstood and alone.

Perhaps this is part of the reason 30 percent to 50 percent of them become clinically depressed. Another reason, according to Whitman, is the anatomical similarity in how pain and depression appear in the brain. That's why antidepressants are often used to treat chronic pain.

There are other options. Hypnosis and acupuncture have good track records. Meditation, guided imagery, physical exercise and psychotherapy are helpful. Before, during or after any of these strategies, however, is an essential step: understanding and accepting that while pain can be diminished, it might not ever go away.

Jonathan continued to pursue a cure for his pain by consulting with various surgeons. During his sessions with me he expressed anger and great fear that he would never "get to the bottom of this." I encouraged him to entertain the idea that his pain might be chronic, but he could not; his search went on.

And then one day he came to my office with a different expression on his face. More peaceful. He told me he finally realized that there would likely be no cure for his pain, and that he would have to find a way to live with it.

Jonathan went through a long period of mourning. He gave up some of his athletic equipment, and many of his dreams. In the process, the pain became part of his life - rather than the focus of his life. Indeed, it was only after he accepted this fact of his life that he was open to taking antidepressants and learning meditation, both of which helped.

Not everyone is as fortunate as Jonathan was. Sometimes pain is so severe it's hard to have faith in tomorrow. Even as the population ages and the number of people in pain inevitably increases, however, researchers are finding other avenues with potential. Whitman describes one that uses a functional MRI to identify sites in the brain that are active during periods of pain. Patients learn techniques to diminish the pain while watching a live scan of their changing brain activity. Although not ready for pain relief in prime time, this intervention - an offshoot of biofeedback that is known as neurofeedback - shows much promise.

Jonathan gave up hope that his pain would be cured. He mourned what he had lost. And then he developed hope that he could once again enjoy the life he had.

Our Partners and Sponsors