An explanation of the quotation
"Pain is inevitable, Suffering is optional!"

"It is not necessary to change. Survival is not mandatory."       --W. Edwards Deming

      Pain is inevitable. If you are alive, you will experience pain. Pain is a very important ability we possess to help protect ourselves. Pain is often desirable. For example, you would want to know that the frying pan handle is hot before your skin started charring. People who have lost sensation in one of their limbs often lose the limb do to injury or infection that they have not immediately noticed. Pain warns us of dangerous situations. Pain also motivates us to change. For example, experiencing pain of an unhealthy relationship motivates us to seek counseling or leave the relationship if that is what is necessary. To paraphrase Zorba the Greek, “Life is pain! To be alive means you are out seeking pain!”

      There is a very important and significant difference between experiencing pain and suffering with pain. Many people feel that pain and suffering go together. If one is experiencing pain, one must suffer because of the pain. This is not true. Whereas pain is inevitable, suffering is a choice. Having fibromyalgia for over thirty-five years and suffering with it on and off for about the first twenty-eight years, I know the difference. I also know that it is possible to experience pain or other severe debilitating problems without suffering. When I stopped suffering, the quality of my life increased tremendously. Not suffering requires two things, understanding and choice. First the understanding.

      Let's define the words. As defined by the International Society for the Study of Pain, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. This definition of pain acknowledges that pain is often associated with bodily injury but pain can occur without an actual physical problem. The sensory system may be inaccurate. An analogy would be a rocket launch stopped because of a fuel leak but upon investigation, there is no fuel leak; it is just a sensor or computer malfunction. In the human body, pain may be experienced because the pain system, the sensory system is malfunctioning or overstressed with no underlying problem. It is also important to note that the definition describes pain as unpleasant, not necessarily unbearable.

      Suffering is defined as 1. to endure death, pain, or distress, 2. to sustain loss or damage, 3, to be subject to disability or handicap. Whereas pain is an experience, suffering is a perception. 1. An athlete running for a gold medal does not perceive himself to be enduring pain. A winning athlete just views the pain a necessary part of winning. 2. The athlete will also not view the pain to be related to loss or damage especially if he wins. 3. There are many people who have experienced extensive trauma or pain but who we admire as not accepting extensive disability or handicap, such as Christopher Reeve and John F. Kennedy.

      As a medical assistant, I often ask a patient to rate their pain on a scale from one to ten where ten is the worst pain imaginable. Sometimes the patient responds in a calm, normal voice with dry eyes, "Ten." I then explain that Senator John McCain describes that while he was a prisoner of war, several times his captors shackled his wrists behind his back, tied a rope between his elbows and twisted the rope until his elbows and shoulder broke with an audible 'crack'. He describes that while this was happening, he heard someone screaming blocks away and then he realized that screaming was his. I would imagine that pain would be a 10. In the book Shogun, James Clavell wrote about a sailor being placed into a giant cauldron filled with water. A fire was lit under the cauldron and the temperature of the water expertly brought up to a temperature that caused excruciating pain without causing a rapid death. Clavell wrote that the sailor's screaming could be heard throughout the entire town all night until the pour soul died in the morning. That clearly is a ten. Sometimes after listening to these explanations while quietly sitting in a chair, the patient states, "Yes that describes the pain I have. It's a ten." The patient would not be sitting calmly in a chair if the pain were truly a ten. This person is choosing to suffer needlessly. Specifically, the person is refusing to accept that his or her pain could possibly be any worse. If it can't be any worse it must be a ten.

      Often each time I ask a patient a question that can be answered with a short, simple answer, the patient answers each question with details of how severe the pain is and how much it affects the patient's life. This happens after we have already discussed these points in depth. Experiencing pain and fatigue for a long time, I know how frustrating it is to have employers, co-workers, neighbors, friends and even doctors not believe I am hurting. I too have heard, "It is all in your head", "You're crazy" and "I have found nothing wrong so you have no pain." I understand that when people don't believe us, we have a tendency to become more emphatic about our difficulty, even exaggerate our pain. However, this melodrama is very dangerous. We tend to believe what we repeatedly hear. This is the concept behind affirmations and advertising. Because of our mind-body connection, what we believe, we create in our body. In other words, when we melodramatically enhance our pain and problems, they become worse. In addition, what we pay attention to becomes magnified. Here is a simple demonstration of that. What model of car do you drive? How long have you owned that model? Do you notice passing other cars of that model more frequently than before you owned your car or considered buying it? Most people answer yes to the last question because we become more aware of what interests us. Therefore, when we become more interested in our pain and problems, our perception is that our pain and problems is worse. . Furthermore, the melodrama will cause others to disbelieve us even more.

      So how do we reduce our suffering? Step one is choice. We must choose not to suffer even if we are experiencing pain. This is probably the most difficult step because to choose not to suffer, you must believe that you have the ability not to suffer. You must understand that pain and suffering are not the same thing and believe that there is the possibility that you can have pain without suffering. It is not good enough to say to yourself, "I don't want to suffer." You must be able to say to yourself, "I choose not to suffer," and feel a conviction that you truly can make that choice. If you cannot make that choice, you must study pain and suffering more until you can clearly see the difference between the two. Once you choose not to suffer, there are techniques you can use to reduce your suffering.

      The first technique is to stop fighting the pain and accept it as a matter of fact and a part of your life. It takes energy to fight something. Fighting drains you of energy and gives that energy to what you are fighting. So fighting your pain only wears you out and creates more pain. I am not suggesting that you accept the pain and give up trying to do something about it. I am suggesting that you accept the pain is now a part of your life and you unemotionally, intelligently seek for and do the things that will manage the pain. You want to take the same attitude that a caring doctor would treating you. One exercise I have found very effective to create this attitude when I am experiencing very strong pain is to analyze it in depth. Visualize the pain; see it in your mind. What color is it? What texture? When did it start? When, by your experience, do you expect it to stop or decrease? (It is very important to recognize that it will stop or decrease.) How big is it? Where does it exist? Where does it not exist? Explore around the pain and find the edges of it. (It is very important to recognize that the pain does have edges and limits.) This concept of accepting is so important that many well-known psychologists, philosophers and writers have spoken about accepting. Here are a few:

             "In order to overcome something, you must submit to it first, to understand what it is you're to overcome." -- Juan Wa Chang

             "We cannot change anything until we accept it. Condemnation does not liberate, it oppresses." -- C. G. Jung

             "The first step toward change is awareness. The second step is acceptance."                              -- Nathaniel Branden

             "Life has no other discipline to impose, if we would but realize it, than to accept life unquestioningly. Everything we shut our eyes to, everything we run away from, everything we deny, denigrate or despise, serves to defeat us in the end. What seems nasty, painful, evil, can become a source of beauty, joy and strength, if faced with an open mind. Every moment is a golden one for him who has the vision to recognize it as such." -- Henry Miller

             "The first step toward change is acceptance. Once you accept yourself, you open the door to change. That's all you have to do. Change is not something you do, it's something you allow." -- Will Garcia

             "But I say unto you, Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you." -- Matthew 5

      The second technique is profoundly important. Realize that YOU ARE NOT YOUR PAIN. The pain is only a part of your experience. You are far more than just the pain. Remember the exercise of the first technique - visualizing where the pain does not exist? Explore the area where the pain does not exist. It is much larger then the area where the pain does exist. It probably extends out to infinity. You are visualizing the area with pain and the area without pain in your imagination. Your imagination is within you. So there is a huge region within you that is not experiencing pain. Here is another exercise. On paper, list the things that are important in your life. These are not your goals. They are the things that make you who you are. Some examples of things that might be in this list are family, friends, integrity, honesty, career, love, respect, health and God. Once you have created this list, test each item in the list with the question, "Does this define who I am?" Cross out and add things to the list as necessary to make it complete. Once you have a complete list, combine similar things to make your list more manageable. You want to have a maximum of five or six items on your list. This is your list of values. Finally, prioritize your values from most important down. I bet pain is not on your list. Pain does not define who you are. Pain is not important in your life. The key here is to remember what is important to you and center your life around those things that are important to you. Never sacrifice things that are important to you to things of lesser or no importance. As you pay attention to what is truly important to you, less will you notice things that are not important to you such as your pain. The father of behavioral psychology, Wilbert Fordyce has said, "People don't hurt as much if they have something else to do." To help you remember what is important in your life, post your list around your home and work place.

      The third technique is an extension of the second technique. Realize that YOU ARE GREATER THAN YOUR PAIN. Your pain is an obstacle. It may be a major obstacle but be assured that you are able to overcome it. Imagine the worse that could happen from your pain and then accept that. It may be that death in your perception or in reality is the worse that could outcome from the cause of your pain. You may die in your car or in your bathtub long before what is causing your pain takes you. Whatever causes your death, don't you want to live until it happens? Being afraid of pain or death is a death in itself. In holocausts and torture chambers, all over the world, throughout history, people have survived almost unimaginable pain and yet survived. The survivors say they survived because of luck and because they refused to succumb to the pain and despair. Throughout their ordeal, they chose to hold onto hope and maintain their values in life. If these survivors, surrounded by vast adversity, mistreatment and hate, have been able to maintain their optimism, do you think you can maintain yours? Recognize that these survivors did not have any miraculous skills that you do not have. You have within you what is necessary to overcome the pain.

      Lastly and most important, you must take responsibility and ownership of your pain and your life. Obviously, to go from pain to no pain or even less pain requires change. Also obviously, you cannot change what you cannot control. And obviously, you cannot control what is not yours and what you are not responsible for. Do you find that you use the following phrases? “Have to” (or “must”) as in “I have to work.” or “I must take care of my family.” “Can’t” as in “I can’t take the pain.” or “I can’t stop smoking, eating junk food, etc.” “Make me” as in “You make me angry;” or “Weather makes my pain worse.” “Should” as in “I should be able to do more.” or “My spouse, friends, or doctor should be more understanding.” Using these phrases are indications that you are passing the responsibility and ownership of your life and things in your control to people and things outside of your control. As a start, make a commitment to completely eliminate these phrases from your vocabulary. Here is a list of substitutes:

Have to or must:      Want to or choose to
Can’t:Able to or not ready to
Try toWant to, choose to or will do
Should:I would like to or please would you…
For example, “I want to work to make money to buy a roof over my head and food that makes my life more comfortable.” “I want to take care of my family because they mean so much to me.” “I am able to handle the pain.” “I am not now ready to stop smoking.” “I feel angry when you do that.” “I seem to hurt more when the weather is cold.” “I would like to do more.” “Please try to understand my situation.” When you say these sentences with these phrases, don’t you feel more powerful, more in control? If you want more control of your life and of your pain, choose now to change your vocabulary and choose now to look at where else in your life you are giving away your responsibility and control.

      I am sure you have not asked for the pain you are experiencing, but some of life's greatest opportunities are presented to us without our request. See your pain as an opportunity to learn about yourself. See your pain as an opportunity to display to yourself the depth of who you are

Some well known people who have experienced pain or other hardship with little or no suffering that you can use as models for your challenge with suffering:

Annette Funicello
Christopher Reeve
Ray Charles
Franklin Delanor Roosevelt
John F. Kennedy
Steven Hawking
Stevie Wonder

©2000 Nelson Hochberg

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