Achieving Pleasure Instead of Pain
"Crash, bang, pow!" Something happens, and suddenly, life does not just continue on as before. The outcome of traumas may include pain, and particularly, chronic, on-going, even insulting pain. Diseases and illnesses may also create physical sensations that are interpreted by the person involved and/or the health care team as painful. Some of the interpretation may be due to preconceptions held by the person with the problem, or simply be assumptions held by members of the culture.
Possibilities for reframing or creating other changes can sometimes turn pain into pleasure, or at the least, minimize the pain. This article reviews a case study, and presents ideas with strategies that may be worth a try. No guarantees are possible, of course, but ideas may help even the most difficult situations.
The Case of Mr. Green
The case of Mr. Green offers an illustration of the sometimes subtle results and the patterns that take place following an injury, trauma, or disease. Mr. Green was nearly fifty when he encountered peripheral neuropathy, leading to a diagnosis of Guillain Barré Syndrome, a neurological disorder.
Mr. Green was university educated, and worked for a large organization in a professional capacity. His family included a wife and one child. Hard-working and ambitious, he was involved and active, although he characterized himself as shy, acknowledged pre-existing problems in sharing emotions and verbal communication, and yet stated he wanted and enjoyed intimacy in family life.
Mr. Green reported a burning sensation in the bottom of one foot, which over several days spread to both feet and ankles and wrists. The major symptom was a loss of knee jerk and lower extremity reactions. This also appeared to be mirrored in a loss of reflexes in his elbows and wrists.
Mr. Green complained of intense fatigue, "electrical" or burning sensations, particularly in the extremities, and an overall listlessness. He consulted a physician, within a week of the onset. After various office procedures and lab tests, the physician told him that in all likelihood a virus attacked his system, and whatever was happening did not appear to be progressive.
Mr. Green had difficulty in orienting, and although he did not recognize it, his judgement and memory were impaired. For all intents and purposes, Mr. Green had acquired brain damage, although minimal in comparison with the traumas associated with automobile accidents. The physician, however, told him to ignore the sensations, and "just get on with things."
During the next few weeks, Mr. Green noted some respiratory distress, intense fatigue, and severe pains in his legs and wrists. Mr. Green did his best to ignore the symptoms for a year, and tried to "get on with things." Slight behavioral changes were noted by his family, and colleagues at work. In fact, Mr. Green was soon shunned by a number of people formerly close to him. These observers noted confusion, impaired judgement, and emotional changes. The sensations in his extremities continued to bother Mr. Green, and symptoms fluctuated, leaving him in fear that reoccurrences would take place. Gradually some slight improvement took place.
Mr. Green complained that his sleep was disturbed by the pain in his legs. These "deep muscular or bone" pains in his legs woke him up frequently. His knee jerk reaction continued to be absent. His relationship with his family deteriorated. His wife claimed he did not communicate, share feelings, or "try hard enough" to get along with her. Mr. Green was not able to explain why this was happening, but felt she would not and could not, listen and hear to what he was saying about his sensations, symptoms and feelings. Knowing that his body and neurological system were still under assault from the disease, he sometimes wondered if his brain and mind could have been directly affected.
In fact, Mr. Green lost a good deal of confidence in his abilities and in his overall health. He commented that "even though the physician said it was no longer progressive, I felt then that I had a near brush with death, and that scared me." He admitted that in retrospect, he was having problems with driving to and through town (getting lost), making decisions (afraid to risk and take charge), remembering, expressing feelings (he felt vulnerable and very sensitive to criticism), and talking (confusion, mispronouncing words and making grammatical errors).
Mr. Green reported that he found certain simple activities, such as typing, and repetitive hobbies, were particularly satisfying, although his complex and demanding professional work were "over my head on some days." Although no one said much to him about his performance, he was unable to fulfil the requirements of his previous job, and his supervisor and colleagues were extremely unhappy about his lack of ability. He was able to perform repetitive, well structured tasks that required little physical or intellectual or emotional effort. He did not have to risk, or innovate, or make decisions in these simpler activities.
After a year or so, Mr. Green returned for help to a different physician, who tried a variety of laboratory tests, clinical examinations and questions, then promptly referred him to a neurologist. The neurological interviews, clinical tests and laboratory findings resulted in a conclusive diagnosis of Guillain Barré Syndrome (Steinberg, 1989). The prognosis was that slight neurological problems would persist. Essentially, the peripheral nervous system was affected, and the nervous tissue would neither regenerate nor improve. However, neither would progressive changes add further problems. The specialists and physician had no real information for Mr. Green on "how to live" given their findings.
Mr. Green understood his situation better from this work-up, but still, two years later, had continuing problems with strange sensations in feet and legs which he sometimes described as "like insects crawling beneath the skin", weakness in wrists, leg pains, reduced energy levels, and fatigue. He continues to wonder about slight mental impairments. He feels that there were effects from the episode, some of which persist and some of which have lifted or are in process of lifting. He regards the relationship with his family as in jeopardy - and would like to "patch things up". He wishes he could do everything right, and fears rejection for taking risks and getting things wrong.
Mr. Green wishes his family were more supportive, but he hesitates to share his fears and worries. For example, he has not shared anything about the leg pains for a family member stated he was "faking" in talking about the pain. He is ineffective in his strategies to deal with strong emotions in both himself and others. He concludes only that "they do not seem to understand." He also feels that if they ever do understand, then they will reject him. He does not like to risk engagement with others and does not take initiatives easily.
Peripheral nervous system damage may affect more than legs and arms - indeed, in this case, central nervous system involvement is likely. This condition could reduce inputs generally. Indirectly too, the person could face a deficit of information as compared with previous functioning and this might lead to depression and an emotional impact.
On the other hand, the indirect reduction of input could be mediated and lead to reduced output - a difficulty in dealing with the environment. A third option is that the brain is directly affected, either with diffuse damage, or damage to particular locations. With Mr. Green, the problems are insufficient to precipitate a crisis - the situation drags on without resolution.
In conclusion on the case of Mr. Green, several important points can be noted. Physicians and others may dismiss mild symptoms - claiming that the patient will "grow out of it," or that "little that can be done." Also, even when identified, family and other colleagues may fail to understand that a person has a "mild" deficit. It is possible that attribution of problems may be made to "wilful intent."
Ideas and Strategies
A number of strategies are presented below, along with their applicability to the case of Mr. Green.
1) At some point following a trauma, a need emerges for the person traumatized to get on with living, rather than dwelling on the past and pain. When the pain does not depart, then eventually there comes a time to make the best of the existing situation. Although Mr. Green hoped that his physical sensations would cease, they did not. As the realization grew that change was unlikely, Mr. Green accepted that pain might well continue, and that he would have to function as best as he could regardless. Evoking this realization is a means of "getting on with life."
2) Mr. Green reported on "pins and needles" or "insect crawling" sensations, which he regarded as painful, debilitating, or at the very least, unpleasant. Another feeling reported was that of a continuing mild electrical shock. By changing the words used, these sensations were re-interpreted as "vibrations," with an occasional pleasurable and stimulating feeling.
3) Mr. Green's sensations were felt more powerfully in the morning, or when he tried to relax. These time periods were linked with a distinctly positive association - classical music. Every morning, Mr. Green would lie in bed, suffering. By plugging into a classical music station, with headphones so as to avoid disturbing others, he listened to the sounds of music he loved. In a short time, he began to look forward to morning and music, rather than dread the pain associated with lying in bed.
4) Often, people forget about their bodies, unless and until reminded, as with a sore thumb or a specific pain. Increased awareness of one's body can be a positive, not a negative experience. Mr. Green was able to maintain a steady awareness, through the nearly constant sensations he felt. Advantages of this awareness were similar to those gains from any increase in awareness - greater perception of and appreciation of life and the processes of living.
5) The presence of secret knowledge can offer a hidden strength. For example, a person quit smoking, without telling anyone about the change. The family, friends, and workmates of the person in fact did not notice the difference, for an entire week! During this time, the individual kept his knowledge secret, waiting to see when, not if, the discovery would be made. Although like a game, the experience gave him strength and something to look forward to, rather than focus entirely on the withdrawal symptoms. In the same way, Mr. Green's sensations were a secret, something that no one else would or could know about unless he shared this information with them. The choice of informing was up to him. By keeping silent about his secret, Mr. Green knew and yet did not have to tell others.
6) A counselor, therapist, confessor, reference person, or special friend, with whom one can share information freely, can be useful. Such a person may need to be paid, as in a therapeutic relationship. But such a person can take away the frustration of having no one who understands, or the many problems of complaining to family members or others. A reputation for "whining," complaining, or dwelling on pain does little good for anyone. By talking situations through with a designated person, the individual in pain can avoid the topic with others, and may reduce any focus on pain.
7) Secondary gains are sometimes present. It may be well for the person to note any secondary gains, and to share the information with the confessor or reference person. Counting how many secondary gains occur can bring about a better understanding of the role the pain is creating, and ultimately create strength.
8) Given pain, the challenge to get on with living is greater, but coping strategies can be effective. A person is just starting from a more difficult place than previously. It is as if one were from an less developed country, or if one had a poor education, or if one came from a "lower social class," yet in each and every case, life is still worth living.
9) One can learn how to fine tune one's energy expenditures to match very carefully the environmental demands. This fine tuning takes concentration and experience, yet results in a better matching and consequent well-being.
Countering or coping with pain is possible. A variety of strategies and ideas can be of value. In this article, a case study of a person with a neurological disorder is used to illustrate some ideas for countering the effects of pain. Although achieving pleasure is a goal and not always a reality, steps in that direction are significant and extremely important to the person involved as well as family and others.
Steinberg, Joel S. Guillain-Barré Syndrome: An Overview for the Layperson, Wynnewood, PA: Guillain-Barré Syndrome Foundation International; 1989.
Pain accompanies many diseases, injuries and traumas. Possibilities for psychological interventions which minimize pain, or even assist patients turn sensations of pain into feelings associated with pleasure are open. A case history of a person with diagnosed Guillain Barré Syndrome is used as an example to illustrate some strategies.
Guillain Barré Syndrome, pain, pleasure, intervention strategies
Robert J. Gregory, Ph.D.
Senior Lecturer, Department of Psychology
Palmerston North, NEW ZEALAND