Chronic Pain and Spiritual Life

It’s estimated that just over twenty percent of Americans suffer from chronic pain. I find that to be a frightening number, and I am among them. There is no shortage of theories about why people suffer from chronic pain, and the theories transcend physical ressons. In truth, above the age of fifty most people have pretty rough looking spines on MRI exam, but a chunk of those people don’t have pain while others are in nearly constant pain – and nobody knows what determines which group a person falls into.

Medical interventions for chronic pain are primitive and ineffective. The United States Drug Enforcement Administration (DEA) often seems so preoccupied with finding some drug they can actually effectively interdict that they don’t really care what the impact of their restrictions are on the patients who legitimately need and don’t abuse pain medications. Consider that, having had some success making Opioids harder to get for both legitimate users and illegal abusers, the DEA is now interested in other, non-narcotic pain medications that addicts misuse for their sedating qualities. This means that patients who don’t abuse these medications (which were formerly viewed as “safe” and more effective alternatives to Opioids) have to jump through hoops to get and fill prescriptions. This is not because these medicines are controlled substances, but rather because they might be one day.

If it’s not a medication issue, it is the issue of so-called pain clinics staffed by interventional anesthesiologists. Generally speaking, patients have to go to these clinics to get narcotic pain medication prescriptions written, but the clinics make their real money by doing “procedures” such as epidural steroid injections. These injections used to be administered in a physiatrist’s office on an exam table for little more than the cost of the medication. Now they are administered at your pain clinic’s “operating room,” with x-ray guidance and multiple staff members in the room, as well as a “pre-op” check in area and a post-procedure “recovery” area. As you might imagine, the move from the exam table to the operating room means these are now relatively high ticket outpatient procedures. Unfortunately, to be effective a patient most often needs two or three injections and the injections are temporarily effective treatments rather than cures. Pain clinics are profitable to the extent that they convince patients to get on the procedure treadmill. Some studies have found that simply putting the needle into the affected area provides the same relief even if medication isn’t injected. Of course, insurance companies won’t pay for an injection that isn’t an injection, so patients are often injected needlessly.

There are other dehumanizing elements to pain clinic culture. While it’s understandable that a certain amount of controlling behavior on the part of clinic staff is necessary since some of the medications prescribed are controlled substances, most patients are made to feel like addicts even if they don’t abuse medications. For example, even medications in the same class as aspirin and ibuprofen are prescribed precisely thirty, or ninety, days from the last refill. Since most patients are on multiple medications, this means that the patient has to make multiple trips to the pharmacy each month to refill medications that have no abuse potential at all. If the patient is on a narcotic pain medication, they sign a pain medication contract annually, which is fine, but then at each appointment they are given a form to fill out asking if they are aware they signed a pain contract. We are in pain, not stupid or memory impaired. If these procedures are questioned, there is no opportunity for discussion but plenty of opportunity for suspicion that the patient is trying to get away with something.

There is no question that pain has a profound psychological component. Nearly all pain doctors will tell you that is true, yet most pain clinics do not have any psychological component to their treatment team. Why not? Could it be that the income per square foot of office space for a support group is minuscule compared with the income for an “operating room?” The other, likely unintentional, consequence of not having therapists on staff is that there isn’t a place to process the impact of the controlling environment on the patient, nor is there anyone on staff who is likely to recognize that it could be a problem and raise the issue at staff meetings.

When we have discussions in this country about our healthcare system and the out of control expenses therein, we need to talk about places like pain clinics. They aren’t the only place in American medicine charging exorbitant fees for (at best) temporary relief. Nor are they the only soul crushing places in the medical community that lack psychological or spiritual support systems. The pain treatment industry generates in excess of three hundred billion dollars for itself each year, and these procedure mills are a big part of the problem. Presently there isn’t an alternative, but with that kind of money rolling in there isn’t much incentive to develop one, is there?

The Fall of Jerry Falwell, Jr.

Many may be tempted to see the fall of Jerry Falwell, Jr. to be a tragic, isolated incident of one man gone astray. It’s anything but. This isn’t about Jerry sitting in the corner ‘observing” while the pool boy cum business partner frolics on the bed with Jerry’s wife. (As an aside, since these religious right types preach against masturbation they have apparently taken to calling it “observing?”) The age old attempt by Christian religious types to blame the woman, as old as the story of Adam and Eve, rears its ugly head once again as the event is described as Becki Falwell’s affair with a pool boy. In truth, it’s the three of them engaging in consensual sexual activity. If it was people in your neighborhood you might think, “it’s not my cup of tea, but if it makes them happy who am I to judge?” Or, you might think, “where can I get a pool boy?”

I’m less concerned about the fact that Jerry appears to be a cuck who likes to watch than I am about the wider trend he represents in White Evangelical Christianity. (As an aside, I don’t believe that White Evangelicalism has anything to do with Christianity.) Allow me to explain. Jerry’s father was a founder of the so-called “moral majority” around the time of the Nixon administration. While that group no longer identifies by that name very often, it still exists. You know the type. They tend to believe that if something feels good it must be a sin, which is why they don’t buy Q-tips. Back in the day they crawled into bed with political allies in the Republican Party, gradually increasing their political power in America. On the religious side, they became Televangelists and Megachurch pastors. What this latter group has in common is sexual misconduct of epic proportions. A close second is financial misconduct, and coming in a not too distant third is substance abuse. In case you think I am kidding, here is a short list: Jim Bakker, Jimmy Swaggert, Ted Haggard, Eddie Long, Bill Gothard, Tony Alamo, Bob Coy, Fred Phelps, Dave Reynolds, Robert Tilton, Marc Driscoll, Creflo Dollar, Bill Hybels, and the list goes on and on. Why?

Anything you repress will eventually come out sideways. It’s virtually guaranteed. Basic human needs denied don’t simply go away. If we are convinced that basic needs are abnormal, the shame we feel around them becomes overwhelming. Still they don’t go away. Eventually we act out, and the shame and guilt we feel for acting out intensifies our need to act out, and soon a classic addictive cycle sets in. Maybe the pastor is impregnating most of the Church. Maybe his repressed sexuality emerges in a cocaine induced frenzy with his gay meth dealer. Maybe he finds the only way he can express his sexuality is by flogging little Jerry in the corner while the pool boy bangs his wife – and we keep the pool boy in a diminished, more sexually satisfying state by continuing to refer to him as the pool boy long after he has become our business partner. Maybe the anti-LGBT Bishop is grooming teenage boys in his congregation to become his sex partners on his yacht. Maybe half of the choir tests positive for the pastor’s DNA. If you can imagine it, you can find it.

The problem is this: no spirituality that is based upon a poor understanding of human psychology can possibly be healthy. If our beliefs lead us to try to deny our psyche what it needs, our religion become soul killing. If our religion is constructed in such a way that questions and dissent are not allowed, we (and our religion) are doomed. The products of our religion will be unhealthy at best and outright pathological at worst. In my opinion, the entire prosperity gospel movement is the result of a religion that represses sexuality and pleasure. Those energies get twisted and redirected into the acquisition of wealth, which will never really satisfy the needs that have been repressed, and so there will never be enough money, never be enough external signs of wealth, because inside we are completely impoverished. Pastor needs a mansion, a private jet, a fleet of luxury automobiles, homes around the world, all because these things are justified as necessary to emulate a Jesus who by all accounts was impoverished and homeless. If that doesn’t strike you as odd, perhaps you should stop drinking the Kool-aid.

While I certainly don’t subscribe to a sacred/secular divide, I do believe that it is patently unwise for organizations that claim to be religious to covet power and wealth. In fact, a close, honest, and educated reading of the religious texts of any tradition will reveal that power and wealth are barriers to spiritual attainment, not assets. Wealth and power feed the ego, and the ultimate goal of spirituality and religion is first the development of a healthy ego and then the dismantling of the unhealthy ego. Climbing the career ladder, wealth acquisition, and accumulating power all stand in the way of those crucial spiritual goals. While some segments of the religious landscape believe that setting up their pastor with the trappings of a CEO reflects well on their communities, the truth is that such preoccupations are unhealthy and destructive. We create Jerry Falwells every day through our own skewed priorities and them refuse to look at our role in these tragedies, preferring instead to blame the monster of our own creation. It is time to look a lot closer to home.

Attachment to Outcomes

Attachment to outcomes is never a good idea, yet in our culture we receive messages from all sides telling us we are absolutely, personally responsible for the success of every movement that we support. The messages quite often are formatted in an “if, then” way. “If our effort doesn’t succeed, then disaster looms and so each of you are responsible!” Nonsense. If a movement or a cause requires a group of people working to achieve it in order to succeed, then no one person can be responsible for the outcome – good or bad. Moreover, believing that we are personally responsible for the outcome increases our stress level, making us more prone to all manner of illness and disease, and decreasing our levels of happiness satisfaction, and well being.

What we can control is our effort. We can do our best, but then to remain well we must learn to let go of how everything works out. When we consider all of the factors that must fall into place we can see that no one person is the fulcrum on which the success of the project rests. Believing that we are is a bit narcissistic, to be honest. Ask yourself, “am I really that powerful?” If you examine the situation closely, you will see that you aren’t (none of us are) and that blaming ourselves is factually inaccurate. When we hear someone say, “only I can fix this,” what we are hearing is the overreach of the narcissist. What is around the corner is that same person blaming everyone else for their failure to deliver on their messianic promises.

In these days of pandemic and isolation, what we can control are the choices each of us make on a daily basis to wear a mask, practice social distancing, avoid large gatherings, and to recognize that our actions do impact others. What none of us, even the best scientists, can do is cure this virus by ourselves or hasten the arrival of the end of the pandemic. All natural phenomena must run their course. In the middle of January we may wish we could hasten the arrival of summer, but winter must run its course. No one accuses another of personal failure for their inability to cause the seasons to change more quickly. Don’t let anyone succeed in making you feel responsible for what you cannot control.

Staying Present

It has been rightly said that the only moment we have is the present moment. The past is gone and cannot be changed. The future has not yet arrived and so is beyond our reach. It seems so obvious, so simple, yet how much time do we spend fixating on the past or dreaming of the future? How often does “if only I had…” cause us to completely miss new opportunity when it arises? Certainly there are things to be learned from past mistakes, but those learning opportunities aren’t a bottomless well. Most mistakes we make are relatively small and so offer a paucity of learning. Even our major mistakes only offer a few lessons. If we find ourselves ruminating about something months or even years after it has happened, we aren’t trying to learn, we are trying to avoid something.

I find it helpful when I am stuck to remember that the “why?” question is most often not very helpful. Most often we cannot know with any degree of certainty why things happen. When we allow ourselves to get stuck there, it may well be that we are actually trying to avoid moving forward. Why something happened or why someone did something is much less important that what we will do next given what has happened. What is the lesson in our experience? What is it trying to teach us? How can we avoid whatever mistakes we made in the future? We need to ask these questions not to berate or otherwise punish ourselves, but to learn. Once we have learned, it is time to move on.

The truth is that, no matter what a perfectionist might tell you, mistakes are a normal part of life. I believe that every experience, positive or negative, arises to teach us something. Our goal shouldn’t be perfection, it should be learning and growth. There are very few activities in which a mistake means we don’t get to try again, and most of those can be avoided. Mistakes are much less critical outside the arenas of sky diving and bungee jumping! Learn, and then move on. Don’t let life pass you by as you seek a perfection that doesn’t exist!

I am a strong person?

I have noticed something in the midst of pandemic life. I have seen many people interviewed who have expressed surprise they have contracted the corona virus. They often say some version of “I am a strong man/woman, I am really active, I keep really busy, and still I got this virus.” I find the number of folks who say some version of this to be quite intriguing. I started reflecting on the sentiment and have some suggestions.

Our culture equates busyness with strength. If we are constantly on the go, involved in many different things, dashing from here to there, we are strong. We confuse endurance with strength, but if you compare the physiques of marathon runners and power lifters it’s easy to see there is a difference. More importantly, there are important differences between physical strength and endurance and psychological strength and endurance. We really need to consider both kinds of strength to assess what constitutes a strong person – and then remember that a virus is no respecter of strength. All it respects is immunity, and we don’t have much when dealing with a new virus.

I am interested in why we are so busy. Could it be that we are busy because we are hiding or running from something? My father once counseled me that if you have problems the best solution is twelve to sixteen hours a day of hard work and a twelve pack of beer. That’s terrible advice, but it revealed his strategy of not solving his problems but instead being too busy and too intoxicated or hung over to think about them. That strategy isn’t unique to him. When I hear people with corona virus saying the worst part is having to sit in their hospital room, I can’t relate. When I am sick all I want to do is rest, I have no problem sitting still. What is going on with these people?

What’s going on, I suggest, is that sitting still allows all of the issues they have been running from to catch up with them. Those issues, even when ignored and repressed, increase our stress levels which in turn decreases our immune system’s ability to fight off illness. There are real physical consequences to our avoidance. We need to come to see that frenetic activity isn’t a measure of strength at all. We need to practice spending some time each day sitting still. When we do so, if we feel compelled to get up and dash around it might be time to sit longer – and consider finding a spiritual companion and a good therapist. Your health depends on it!

Cabin Fever?

solitary

One of the things I find fascinating about the experience of safer at home during the last several weeks is the number of people who are struggling with perceived isolation. I don’t refer here to people who live alone and cannot go to work. I refer to the rest of us. We have social contact. Perhaps we go to work, or visit with friends and colleagues virtually, we might work virtually, we go to the grocery store and other essential places, and yet to hear some people tell it you would think they were in solitary confinement!

I would like to suggest that if the above describes how you are feeling you would benefit

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from some self examination. If you are partnered, I would ask you to consider that maybe the only reason the two (or more) of you aren’t doing well is because the only time you can tolerate each other is when you are separated most of the time. If that’s the case, it might be time to ask some serious questions about your relationship and consider getting some counseling when this is all over. There are concrete steps you can take to improve things, and at this time you have a great opportunity to begin!

marathonThe third possibility is that you are hiding from yourself. There are things about yourself or your history that you don’t want to consider, and all this time with less to do than normal increases the possibility that they will surface. In normal times, you can keep nearly perpetually active, stopping only to collapse into bed at night and hitting the floor running in the morning. Now, however, when you are alone you may be experiencing anxiety and the need to find something, almost anything, to do. The answer is to engage in some grounding practices and just be present to what you are feeling. Running away isn’t going to help, it’s just going to kick the problem further down the road until you have no choice but to face it. That’s always more traumatic that choosing to face it. Don’t waste this valuable time. It may not come again until fall!

What Are You Doing…

…with all that toilet paper? This is a serious question. For weeks now, you have been buying every last roll of toilet paper you can get your hands on. I am trying to decide what you are doing that you continue to need more. Mind you, I have plenty. I bought assholeTPtwo nine packs about five weeks ago and we are likely good for at least another month. This brings me back to my question – what are you doing?

Is it that you are now forced to cook at home and are so horrendously bad at it that you have constant diarrhea? If that was the case you would have become critically dehydrated and died by now. Does it make you drunk with power to look at the massive collection of toilet paper you have accumulated? Do you sit at home just gazing at a shit paper pyramid with glee while slowly diddling yourself? Is this what you have been reduced to during these stressful times? If that’s the case then I feel compelled to tell you as a public service that you have lost your damn mind.

I understand that you are anxious, really I do. The problem is that the solution you have one flewarrived at to assuage your anxiety has nothing to do with the cause of your anxiety. You feel out of control and that is an uncomfortable feeling. I understand. There is nothing about stockpiling anything that is going to really cause you to regain control. You won’t feel you are in control until things have returned to normal. In all likelihood that is months away, long after safer at home orders have been lifted. By then you won’t be able to leave your house because you will have trapped yourself behind a pyramid of ass wipe and struggle to get to the door.

Get some help. Now.

That Which is Real

In each of us there is an essence that is real. The rest is just an accumulation of life over time that has been caked on top of the real, what some have called the true self. All betruetowhoyouarereligious traditions have found their own way of saying that life is about returning to that essence that is real. The challenge is that the job in front of us is neither obvious nor easy.

The job becomes even more difficult in times of crisis. We want to jump into action, solve the problem, and get on with life. When the problem is invisible to the naked eye and the solution elusive, we become afraid. When we become afraid, we tend to move toward anger pretty quickly. It’s natural, you might even say it’s an instinctive preparation for a fight – and there can be little doubt that right now the world is in a fight.

One of the problems with fighting is that we tend to put on armor in preparation for that trueselffight. Some of that armor is physical, but a lot of it is psychological. As we gird our loins, literally and metaphorically, we move away from our true selves more and more. When it is done, we may not even recognize ourselves. When this is true, we become a casualty of the fight, no matter who won.

During these times of crisis, it is important to be intentional about remaining connected with our true self. If possible, spend some time each day outside – even if it’s just on your porch. Listen to the wind, feel it on your face, and if you’re lucky enough to live in a place where it’s warm enough take your shoes off and feel the ground under your feet. No matter where you live, you can sit in a chair with your feet on the floor and your arms in a comfortable position and take three deep breaths. Repeat as needed. Your true self is what endures. All the rest will pass away.

Three People and a Goat

COVID 19, aka the corona virus, seems to have brought the world to its knees – with some notably stupid exceptions. In the United States, we have seen increasingly restrictive twatbumpmeasures taken by state and local governments as they try to control the spread of a virus that we still aren’t completely sure of its method of transmission. Some of the measures taken seem sensible, others seem profoundly silly if not outright stupid. Among those is the elbow bump, which we are told is preferable to the handshake for limiting transmission of the virus despite the fact that two people need to stand significantly closer – twice as close, in fact – to bump elbows than they do to shake hands. Given that transmissions seems to be droplet transmission, moving in closer to the potential business end of an unexpected sneeze doesn’t seem advisable.

Meanwhile, as government officials are finding new and better ways to look foolish, Americans have been panic buying and hoarding any number of products from toilet 3andagoatpaper to hand sanitizer. Oddly enough for a flu virus, kleenex doesn’t seem to be the object of hoarding, which is only one of any number of things about this virus and our government’s response to it that makes very little sense. Public gatherings were restricted first in a general sort of way, then to groups smaller than fifty, then to groups smaller than ten. Tomorrow I would expect the restriction will be groups no larger than three people and a goat. Meanwhile the twenty-four hour news cycle rolls on, and people are becoming increasingly overwhelmed by seemingly endless and endlessly changing information.

If you are feeling overwhelmed, I have some suggestions. The first would be to limit your news intake to thirty minutes a day. You can break that up however you like, but once origamiyou hit your thirty minutes you are done with any news source until the next day. The second thing is to decide what you can control. You cannot control the spread of the virus, but you can control your own activity and behavior. If you really don’t want to contract the virus, stay in your house and don’t have guests over. Between Amazon, services like Door Dash, and other delivery services, we can now have everything delivered. Choose “no contact” deliveries so you don’t have to expose yourself to the delivery person. The virus can’t get in your house unless it is riding in someone who has it. Finally, distract yourself. Read a book, watch a TV show or a movie on Netflix, go for a walk, bake a cake, take up origami, perfect the paper airplane. This will not last forever, and some perspective mixed with distraction will make the time pass much more comfortably.

You should know…

You should know that you will meet many people who will purport to be your friend for precisely as long as it is to their advantage. The moment you do something they don’t like, they will disappear. They were never a friend. True friendship weathers disagreement.