Trust What Hurts

How to give pain the space to speak

As a therapist, healer, and survivor, I often return to these central questions:

How do we trust and legitimize our pain? How do we give our pain the space it needs to speak, reveal, initiate, and transform us?

These are particularly tough questions amid acute crisis or chronic pain –whether experienced as mental/emotional or physical. Most of us were molded to believe that pain is a signal that something in our bodies or minds has gone awry, something pathological or dysfunctional is occurring and needs to be corrected. There very well may be something that needs to change, but I have always been skeptical of pathologizing the suffering itself, for example, considering depression or stomach pain a pathology in-and-of itself, instead of indicators of a deeper problem across the many domains of life.

At the same time, when I lean into the deep intuition that pain serves a purpose, that there is a message (often multiple), I am similarly skeptical of the idea that if we could just ‘figure it out,’ we’d be free from pain or debility. Both the drive to pathologize and the drive to find a singular meaning can stem from the desire for control, to get our body-mind to ‘behave’ how we wish, and often according to norms and standards that we didn’t consciously choose to measure ourselves against.

Still, I ask: how can we trust our pain in a society that often seeks to invisiblize, delegitimize, or rationalize it away?

Most of my clients, like myself, stand at the intersection of what we label as ‘mental illness’ and ‘physical illness’. Many have multiple diagnoses or no viable diagnosis that can explain their experiences. Many resent that their mental/emotional pain has been medicalized, obscuring the roots of trauma, societal norms, and structural oppression. Others resent that their pain has been waved away as psychosomatic, obscuring the biological roots such as a viral infection, autoimmune disease, or lifestyle factors that would dramatically change their health outcomes once they were taken seriously.

Not all pain should be medicalized or seen from a narrow lens of cells and synapses. Some types of pain are poetic and expressive. Other types of pain beg for an acute response. It's not always easy to decide on which level to intervene – cellular, functional, environmental, social, emotional. In any case, even with no guarantee of relief, I trust that pain serves a purpose. I trust that pain can alert, protect, and inform.

The Function of Pain

A lot has been said around the evolutionary protective function of pain (typically referring only to ‘physical’ pain). It’s a common notion that pain signals have adaptive utility in helping us avoid further harm and aid recovery. When we pull a muscle, it’s clear we overworked it, did something beyond our capacity. Pain is the nervous system’s signal that muscle fibers are torn or stretched, swelling and inflammation ensues, and it’s time to lay off it to protect our physical integrity.

But what of pain that accumulates from many factors, making causes hazy? Pain that migrates or changes? Pain that has a confusing quality of sensation? Pain that is felt as emotional? These too are adaptive, but often frustrating to understand.

When it comes to chronic pain, some researchers conclude that it’s simply ‘dysfunctional pain’. With no easily identifiable trigger, we too often consider pain that is extreme or long-lasting to be pathological. Perhaps at one time it had adaptively alerted us to damage, but the pain signals continued to amplify as a ‘malfunction’ in the body – a failure of pain signals that are overreacting or hypersensitive. This is more of a value judgement than a medical explanation. These are arbitrary parameters around how long we think is ‘normal’ to be in pain or how much pain is to be expected. Instead of gathering more information, blaming our tools, or reconsidering our measuring systems, we blame the body or the mind. And the consequences of delegitimizing our pain or having it deemed pathological is vast. When we can’t find a medically sanctioned reason for it, we tend to say the reason doesn’t exist. And the medical industrial complex delegitimizes the pain of marginalized people disproportionately, especially when it is rendered emotional or psychiatric in nature.

We treat emotional pain in much the same way. Depending on the orientation of the therapist, they may view extreme emotional states like depression, anxiety, or mania as having roots in dysfunctional childhoods, dysfunctional neurotransmitters, cognitive distortions or coping strategies. Most of the time, the pain itself is seen as unusually extreme or out of context and needing to be corrected. While may be true that something needs to change, we leave little space for trust that pain is valid, has more than one message and has potential to bring insight in more than one way.

To me, emotional pain is more like the swelling and inflammation, and less like the pulled muscle. It’s a response to something deeper, not the standalone problem. It’s adaptive, it’s information, it requests a deeper look at what’s compromising our integrity. To take a deeper look, however, we must be willing to suspend immediate judgements about what the ‘problem’ is.

To trust pain means to trust that while it pervades there is something unaddressed, something unsustainable or compromising our integrity. It may not always be possible to uncover or address it, yet the acknowledgement alone that there is reason and purpose behind pain allows the possibility to keep the questions alive even among no easy answers.

Part of a Larger Process

To say that pain has a function and has the potential to be informative and insightful is not to say that it’s simple or easy to interpret, nor that there’s only one way to do so. It’s not to say that we always have the tools or capacity to do so, and yet I believe it’s still worthwhile to remain curious.

I think we can often resist the idea that pain can hold insight and wisdom for several reasons:

1. Wellness culture has taught that pain or suffering is an individual issue, not a collective one. A such, it is often believed that it’s our fault if we can’t find and address the problem or don’t have what we need to change our circumstances. Wellness culture also teaches that cure is the only desirable outcome and if we are not cured then we haven’t done enough.

2. We worry that if we attribute anything positive or generative to pain, it’ll deny or denigrate the grief, loss, anger, and uncertainty we experience around illness or suffering. It can feel simply too vulnerable to relate to pain as adaptive, especially when it’s completely altered our lives in every way.

Yet, despite these reasons, I’m still inclined to hold complexity around the nature of pain. It’s devastating and adaptive, provocative and insightful. I seek to learn from pain and cultivate a relationship to my body-mind that opens room for all possibilities, not to find some fantasy of happily-ever-after or avoid looking at mortality or disability. I trust pain even when my body doesn’t do what I want it to and even when I am at a complete loss for what to do. I keep listening anyways without expectation of a quick solution.

I trust pain without romanticization or overidentification, without demand that it goes away nor the morbid expectation it’ll stick around. I trust pain to do what pain does: illuminate, pull my attention, and request necessary changes. I trust this to be true for all types of pain whether I want to label it as mental, emotional, or physical as these labels often obscure the soupy mess of the roots that underlie it. I trust it even though it often shape-shifts into different places in my body-mind, defines diagnoses, and is sometimes unresponsive to changes I make to address it.

While I trust pain, I do not trust the cultural narratives I am told about it nor the stories my thoughts tell me about it. My relationship with my being is too important to be denigrated with pre-packaged stories of illness or ability, of disease or function, of normal and abnormal. I trust the messy process of transformation itself and pain is often, if not always, a part of that process.