Saturday, July 27, 2013

on silver linings

Disclaimer: The Optimism Expressed In This Post Has Been Made Possible By Many Consecutive Pain-free Days (yay!). While Pondering These Silver Linings Has Felt Like An Important And Helpful Exercise, I Do Not Expect Myself Or Anyone Else To Be Able To Celebrate Such Things While In The Clutches Of The Pain Monster, Nor Do I Expect To Blog Extensively In The Future About The Wonderful Things Chronic Migraine Has Done For Me. That Would Be A Stretch. Also, Maybe You Should Get Some Chips And A Bum Pillow; This Is A Long One.

In "The Challenge of Pain," Ronald Melzack and Patrick D. Wall define chronic pain as a medical entity distinct from acute pain:

Chronic pain, which persists after all possible healing has occurred or, at least, long after pain can serve any useful function, is no longer simply a symptom of injury or disease. It becomes a pain syndrome -- a medical problem in its own right which requires urgent attention. Most important for diagnosis, treatment and prognosis is the recognition that treatments which are normally effective for most kinds of acute pain are not necessarily effective for chronic pain. Pain, which is normally associated with the search for treatment and optimal conditions for recovery, now becomes intractable. Patients are beset with a sense of helplessness, hopelessness, and meaninglessness. The pain becomes evil -- it is intolerable and serves no useful function. Recently, we have learned that chronic pain rarely has a single cause but is instead the result of multiple interacting causes. A variety of subtle physical and psychological factors all interact and contribute to chronic pain. (36)

Much of this definition rings true for me. So far, treatments intended to treat acute pain have provided very little relief. During most attacks, the pain feels very much out of my control (or "intractable") and I have definitely felt a sense of helplessness and hopelessness when lengthy or consecutive attacks have transformed my plans so completely. But I wouldn't go so far as to say that those experiences have felt meaningless. If I believed that, then I'd have to consider the better part of this past winter to be a total waste of time, and what's the fun in that? Don't worry: I'm not going to preach that a higher power has a divine plan for me, or that any part of this nasty pain is "meant to be," but even though chronic pain all by itself might not serve any useful physiological function, I'm pretty keen to believe that I am learning important things through this experience that will benefit me in a million ways regardless of how my condition evolves.

The bit about chronic pain being the "result of multiple interacting causes" is also spot on, but that'll be a whole other post.

Silver linings I have identified are as follows:

1) LEARNING THE DIFFERENCE BETWEEN IDENTITY AND ABILITY. Before the onset of chronic pain, I unknowingly held the belief that my identity was constructed by the things I did. I thought that singing in a choir, dancing and gaming with friends, being a hyper-organized over-achieving young teacher, and making my apartment shine like the top of the Chrysler Building all made me me. So when I was no longer able to do these things, I had a little trouble recognizing myself. A few other people had trouble recognizing me too and said things like, aw geez, how're you gonna manage when you can't do all the things that make you you?

Thankfully, it hasn't taken that long for me to learn that I am still that person who loves to sing; who loves to dance and play board games; who works really hard and cares about the kids-these-days; and who wants her floors to sparkle. None of that has changed, but the ways that I experience these things, and how often I get to experience them -- the things that inspire, motivate, and fulfill me -- have. And that's okay. Also, my perseverance in dealing with this migraine thing, whether that's by acknowledging my emotions (i.e. crying into an empty cake pan), swallowing another absurdly expensive Coq10 horse pill, cancelling my fun plans to sit cross legged on the floor, or trying alternative therapy #827, also makes me me, and I'm proud to have made it this far as happy and healthy as I am.

2) DEVELOPING HANDY COPING MECHANISMS. Early on in Migraineland, full-blown attacks left me feeling pretty desperate. They were debilitating, persistent, unlike anything I had ever experienced, and I flirted with depression more than once. Although the attacks have not been as severe these days (yay!), I think it's safe to say that I have developed many helpful strategies for coping in moments of pain, the most important of these being the ability to tell myself this will pass, it is temporary, it will get better, and actually believe it.

3) LEARNING TO BE FLEXIBLE. When I started teaching, I made elaborate lesson plans that included rigid timing and specific objectives. These lesson plans worked sometimes, but mostly they felt stilted and stifled by my determination to stick to the plan, regardless of the knowledge, interests, and questions that students brought to the lesson. By my second year of teaching, I made rough lesson plans that were more interactive with loose timing and more general objectives. Now, my lesson plans and units are more flexible than ever in an attempt to allow my students to guide the conversation and arrive at the objectives in their own ways. Sometimes they get to create the objectives themselves. This requires more energy than sticking to a rigid lesson, but it provides so much more room for curiosity, sharing, and meaning-making (sorry, that's teacher jargon, but I don't know how else to say it).

Having chronic migraines has resulted in a similar transformation, except the lesson plans are my life plans, and the students are my body (uh, that sounds weird, but you know what I mean). I can make loose plans, but I have to leave room for my body to have some input about what comes next. There could be big changes. Maybe even totally unexpected and exciting changes. Sure, I can allow myself to be upset about the plans I've had to abandon, but what's the use of dwelling on the things I might not be able do when there's so much I can do? That rigid plan to devote loads of time and energy to extra-curriculars and be a fancy choral conductor? Maybe I'll do some reading and writing and yoga instead. That wouldn't be so bad.

As an important side note, the people I love have been beyond accommodating of my nervous system's whims, and I couldn't possibly thank them enough.

4) LEARNING HOW TO PAY ATTENTION TO MYSELF. Probably nothing short of chronic pain would have made me slow down and address the levels of stress and tension I was experiencing. I know this because high levels of stress and tension seem pretty normal for most folks around me, and even with chronic pain it took a long time before I stopped to listen to what my body was telling me. Sure, I've done yoga and dabbled in meditation before. I've even seen a therapist to dig up old ghosts and deal with them, but never have I been as conscious of my physical state and emotions as I am now. It's a good thing.

5) CULTIVATING EMPATHY. Although my privileged middle-class white self works hard to cultivate an understanding of the challenges faced by people who do not benefit from the same unearned power that I take for granted, probably no one can possibly understand another person's experience unless they have lived it. So while I can't know what it's like for survivors of chronic pain who don't have access to the kinds of supports that are propping me up as I navigate my way through this thing, I am a bit closer to understanding that if I wasn't a member of a gigantic powerful union, or part of a family that acts as an emotional and financial buffer, and if I didn't have access to a team of diligent and compassionate medical professionals, there could be very little between me and things like unemployment, depression, and poverty. So if wasn't already a raving advocate of the welfare state before my run-in with illness, I am now.Even if the migraine monster gets up and walks away tomorrow morning (SEE YA LATER TURD BREATH!), loss and pain and change and confusion will still exist, I will still have to deal with them, and I'm better at it now. So there.

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