The Chronic Pain Experience – Stage 4 – Depression
What Do You Have to Say for Yourself?
As we continue through our journey of grief, we are now discovering the purpose of each stage that grief serves.
The denial, anger, and bargaining served to protect us from the “Dark Valley”; the one thing that is experienced by over 21 million American adults every day according to the NIH 2020 statistic…Depression.
You have been learning how to grieve well, and have been moving through the phases of grief. This is your reward?
Really? Yes, it’s true. All the other stages of grief have been mechanisms that have protected you from depression.
Depression is a huge topic of discussion in our culture. I would need to write a book to completely explain all the nuances it comes with. Today is small a glimpse of it, as it relates to chronic pain. I trust it will be enough information to help you continue on your path of healing.
The dictionary definition of depression is simply feelings of despondency and dejection. Sadness or loss of interest. Basically, it is feelings of “low spirit and lack of courage.” It seems simple enough.
However, depression has many symptoms and those symptoms are very nuanced. This makes your experience with depression unique to you.
Depression is the time when we ask the seemingly unanswerable question…
Here are the Three Most Common ‘Why’ Questions
I would like to thank you for asking these questions. It takes courage to ask questions that are difficult to answer.
Even Jesus asked His Father “why” when He was placed on the cross. (Matt 27:46)
“I feel like I have been cut down in my prime.”
“I have so much of life that I want to enjoy.”
“Why couldn’t this pain have happened later in my life?”
“I would be content just sitting around watching the world go by.”
“I am still at an age where I want to embrace life, and now I can’t.”
It seems a natural response to chronic pain is to ask, “Why now?”
Many who suffer from chronic pain feel they are losing out on a valuable time of their life. You may be wondering why this is happening to you now when you still have so much you want to accomplish.
“Why do I have this type of pain?”
“I think a different type of pain might be easier to manage.”
“I see other people getting by okay with chronic pain.”
“Why can’t I at least have chronic pain that is less debilitating?”
People will put on a brave face and say “I guess I’m lucky, it could be worse”. However, when the guard comes down and the deeper feelings emerge, they often ask “why do I have pain in this part of my body?
Alice was a veteran. She had been through a few tours and had her share of injuries. She seemed to sail through recovery and was back on her feet in no time. That is why Alice was surprised to find herself suffering from peripheral neuropathy two years after having shingles. However, she was determined to put on that brave face.
Ultimately, Alice found it hard to understand that after everything she had been through, something like shingles could leave her living with chronic pain. You, like Alice, may be asking yourself: “after being through so much, Why this?”
“I see so many people who are living pain-free at my age and older.”
“People who may have taken greater risks with their health avoid chronic pain.”
“Why has fate, God, or the universe chose me?”
“What did I do to deserve this for the rest of my life?”
In the story, the protagonist, Job, experiences chronic pain, and his response is recorded as so…
“Satan left God and struck Job with terrible sores. Job was ulcers and scabs from head to foot. They itched and oozed so badly that he took a piece of broken pottery to scrape himself, then went and sat on a trash heap, among the ashes.” – Job 2:7-8 (MSG)
As the story continues and Job is deep into one of his monologues about his suffering, he asks God the question “Why me?”
“Even suppose I’d sinned—how would that hurt You? You’re responsible for every human being. Don’t You have better things to do than pick on me? Why make a federal case out of me?” ~ Job 7:20 (MSG)
It may be a comfort to know that these questions are not new. One of the oldest stories in the Bible discusses the issue of chronic pain.
The feeling that you have been struck down in your prime when you have so much more that you want to do, is also a theme that has perplexed humans since the beginning of time.
Looking at the most ancient texts we have, we find the story of Gilgamesh, the ancient Sumerian, king of the city of Uruk. It is an ancient poem that just happens to describe many types of loss.
“As Enkidu slept alone in his sickness, in bitterness of spirit, he poured out his heart to his friend. ‘It was I who cut down the cedar, I who leveled the forest, I who slew Humbaba, and now see what has become of me.”
Depression vs Despair
As mentioned previously, many adults in the United States deal with some level of depression.
The definition of depression:
“A mood Disorder that causes pervasive feelings of loss and sadness. It can affect the way that you feel and think.”
It is completely understandable that while facing the reality of chronic pain you become sad and feel a sense of loss. A problem arises if the depression that you are experiencing slips into despair.
The definition of despair is “A sense of sadness accompanied by complete loss of hope and desperation and anguish.”
The feelings of despair may come and go through the day, however, the person who is feeling a complete loss of hope often loses all joy in life. Thinking can become unreasonable and actions can become dangerous.
Living with Ambiguity: Answering the Why
For those of you who have been on the witness stand, often the most truthful answer to “Why” is… “I don’t know”.
Remember our dear friend Job? After many chapters of grieving his condition and not receiving much comfort from his friends – God finally answers Job.
Beginning in Chapter 38, God has a long conversation with Job and asked him some hard-core questions. If you read this conversation in THE MESSAGE version, it’s almost like God was being sarcastic…and maybe He was…but it opened Job’s eyes and called him on WHO is in charge.
After God finishes asking these questions, all the way through chapter 40, He confronts Job directly and asks him, “What do you have to say for yourself? Are you going to haul me, the Mighty One, into court and press charges?”
Job became speechless and in awe of Him…the very One that created the heavens and earth.
And in the end, Job understands the omnipotence of God, and God heals Job and gives him prosperity.
I would not stop reading there. Continue the story to see how God Restores Job and his household to a much higher level than he had before his “pain”.
When we look closer at this interaction between God and Job, we come to realize that God doesn’t answer Job’s question. We see that Job has a greater understanding of the nature of God, but he still doesn’t know why this misfortune has happened to him. He simply accepts that it did.
Living with Chronic Pain Thrusts You into the World of “I don’t know.”
“I don’t know if this is going to be a good day or a bad day.”
“I don’t know if I can complete the tasks that I want to accomplish today.”
“I don’t know how much pain I will be in tomorrow as I did too much today.”
One of the key skills of managing chronic pain is managing ambiguity – doubtfulness or uncertainty!
Skills to Manage Ambiguity
Looking at the serenity prayer, we see a three-step approach to managing ambiguity. This isn’t an exhaustive approach to managing the anxiety that ambiguity brings, but it is a nice start.
“God, grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.”
~ Reinhold Niebuhr
God Grant me the serenity to accept the things I cannot change
The first step to managing ambiguity is to understand that you cannot change your chronic pain.
You may never understand why this has happened to you. As Job understood, we will never know the mind of God. God’s answer to Job is echoed in Romans 11:34-35 (MSG):
“Is there anyone around who can explain God? Is anyone smart enough to tell him what to do? Anyone who has done him such a huge favor that God has to ask his advice?”
Understanding that you cannot change what is causing your pain can feel like a heavy burden. Jesus speaks about feeling anxious about the future and He lays it out clearly in Matthew Chapter 5–7. When He is giving the Sermon on the Mount, Jesus clarifies that ambiguity is difficult and causes anxiety.
He also makes it quite clear that we have a compassionate God who is attentive to us and cares very deeply about our struggles. After mentioning a couple of ambiguous things that cause anxiety, He draws our attention away from the anxiety of ambiguity and asks us to focus on Him.
Matthew 6:33 is the well-known verse, “But seek first His kingdom and His righteousness, and all these things will be added to you.” – NASB
We see how Jesus has just asked us to shift our focus away from ambiguous concerns and onto something/someone more stable. The only thing that Jesus asks us to change is where we place our focus. Jesus is asking us to move our attention away from the scary unknowns of the future and place our vision on something that is stable and predictable, Jesus Himself.
“For Jesus doesn’t change—yesterday, today, tomorrow, He’s always totally Himself.” Heb:13:8- MSG
The Courage to Change the Things I can
The first thing you may notice in the above quote is that it takes courage to change. Yes, even if it is something as simple as focus. We as mere human beings tend to develop patterns very easily. If we don’t keep ourselves “in check,” we may tend to develop feelings and thoughts that are not conducive to health. You may say that it is set in our nature to fall into unhealthy habits.
We tend to find comfort in the familiar. An example of this is: As a child, you may have thought that your mother was the best cook in the world. As you became an adult you realized that she wasn’t the best cook. In fact, her cooking was mediocre.
However, your familiarity with the flavor of her cooking has influenced you to keep making the recipe the way, “mom did it”. Even though you know there is a better way.
If you find yourself feeling a bit insecure as you are practicing shifting your focus from the instability of your situation to the security of our unchanging God, understand that this is part of the process. Remember that it takes courage to change, and you will need to practice.
The wisdom to know the difference
The Lord gives wisdom; “from His mouth comes knowledge and understanding.” Proverbs 2:6 NIV
Human beings are not built with a natural comfort for ambiguity. Ask any family who cares for an infant. They will probably have a story of how the child will only sleep in his own bed, or that she needs a specific blanket in order to relax.
For us to gain wisdom in navigating ambiguity, and discern what can and cannot change, we need to seek wisdom from the One who cannot change. God is the same yesterday, now, and forever.
As we shift our focus to the One who doesn’t change, we begin to see what we have control over and what we don’t. We find acceptance in the things we cannot change and the courage to change what we can.
Four Things You Can Do if You Find Yourself in Depression
1 Have patience with yourself – you are learning a new skill
Like any new skill, shifting your focus takes practice. There are many occasions in the Bible when we are reminded to focus on Christ. There are also dozens of verses referring to courage. I often tell people that if God didn’t have to repeat Himself, the Bible would be the size of a pamphlet.
You may have heard the saying “practice
makes perfect”. In this case “practice
2 Give yourself grace
The one thing I can guarantee is that you are no judge of perfection!
This is a time to shift your focus from perfection to grace. Remember that we serve God, the only One who can judge perfection is Him.
If you look at Psalms 103:8 you will find
God is “sheer mercy and grace; not easily
angered, He’s rich in love.” (MSG)
Following Christ’s example as we practice our new focus moves us to a place of “perfecting grace”
3 Stick to a self-care routine
“Plan the work and work the plan”
If there is any time to plan out a reasonable
self-care routine and then stick with it no
matter how you feel, it is when you are
Your life has value even when you feel that
chronic pain has robbed you of everything
that you once enjoyed.
Make a self-care plan, and follow it every
day, regardless of how you feel about your
situation. This will help you move through
the trough of depression.
4 Reach out for help
The most courageous thing you can do is reach out for help.
A good place to start is to seek help from a mental health provider. A psychotherapist will help you to address the issues that are keeping you stuck in depression, and help you shift your focus to healthier patterns.
Reach out to trusted friends and family who can be honest with you about your condition. You may want to consider nutritional/wellness coaching to learn how to eat and live in a way that can reduce symptoms of pain and depression.
Find a group of like-minded people. It is important to surround yourself with others who are on the same path of healing as you are.
If you learn more about the possibility of using clinical hypnosis to gain the skills to manage chronic pain, contact me here and we will strategize together to help you plan your path of pain management.