Developing an Observational Self: How to Cope with Pain Series – June 2016 – Murray J. McAllister, PsyD
This maxim – “Know thyself” — and others similar to it were not uncommon in the ancient world. Indeed, a few thousand years previously, early Hindus and later Buddhists practiced a form of moment-to-moment self-knowledge, later coming to be called mindfulness
The directive inherent to this maxim has two components. The first is to pay attention. In other words, slow down and observe what’s happening.
In today’s language, we might express the maxim as something like, “Get out of your head and notice what’s going on around you.”
When we carry out such a dictum, we become observant and reflective. We see or otherwise perceive things that we might not have heretofore noticed. We subsequently create opportunity to consider what it is we observe.
So much of life goes unnoticed because we are simply and persistently reacting to whatever thoughts, feelings and needs that pop into our attention.
Whatever pops into our heads tends to have a sense of immediacy to which we react impulsively, without thinking in the sense of thoughtful consideration. It’s just a never-ending chain reaction of stimulus and response, like billiard balls knocking into each other.
When we react to whatever thought, feeling or need that pops into awareness at any given time, it’s as if the reaction that we have is the only possible thing to do at the time.
However, it’s not really true, and this point brings us to the second good thing that happens when we get out of our heads and start to observe what in actuality is happening in any given moment.
Namely, we become liberated from being a passive recipient of what happens to us to an active decision-maker of a well-informed life.
By observing what in actuality is happening in life, and by considering the various possible ways we might respond, we exercise choice.
Here’s the catch – your only choice may be between two extremely undesirable options. For example, to jump out of the 98th story window or burn to death (as in Trade Center attacks).
I’m not sure that simply having a choice is a benefit unless you also have an opportunity to influence what your choices are.
No longer is our life dominated by the apparent ‘must’ and ‘have to’ and ‘got to’, but rather we are free to choose.
When we pay attention, we recognize that we do not have to simply endure things happening to us. We are not victims.
We have the power to choose among a number of different options as long as we slow down enough to recognize and consider the options that are available to us.
The simple maxim – “Know thyself”, then, is a truth that sets us free.
the second good thing that happens when we observe what’s happening is that we become intentional about
- what we do,
- how we react to things, and even
- how we perceive the things around us.
This ability to observe life and intentionally choose how to respond to the things that come up from moment to moment is the main goal of psychotherapy.
Do such “intentional” responses include muscle spasms due to pinched nerves or limping due to hip pain? At what point does a reflexive action become a chosen action?
What does developing an observational self have to do with pain?
The development of the ability to step out of the moment and reflect on how to react to pain is the initial and most important thing to do in pain management. Everything else in pain management follows from this skill.
How I react to pain is to hurt. When a muscle spasms or nerve is pinched, I feel the unpleasant sensation of pain and I hurt.
If the pain is severe, the physical sensation intrudes on mental processes, interfering with or even overriding all other thinking.
Pain has a sense of immediacy about it. It’s a sensation that is inherently emotionally alarming and to which we automatically react with avoidance behaviors – we stop what we’re doing, pull away and guard.
This sensory, emotional and behavioral experience happens all at once, of course, and it happens automatically. We don’t typically choose any of it. The sensation just is alarming and we pull away and guard without ever intending to do so.
However, if you had chronic pain, and you set out to pay attention to the pain that occurred with activities, you could learn to make the whole experience more intentional.
You would do so in a multiple step process.
You would first simply pay attention to the pain that occurs and not be taken by surprise by it. Chronic pain often has a degree of predictability that the pain of an acute injury doesn’t have. So, by paying attention, you could practice the skill of not being taken aback by the pain. Just as importantly, you could recall that you have chronic pain and that you’ve had it for some time and you know what it is.
In most cases, chronic pain is the result of the nervous system having become highly reactive to the stimuli of activities that are normally not painful to do – like walking, sitting, standing up, laying. You could consider that, even though it is painful, these activities are safe to do– that you are not injuring yourself even though it is painful.
From this new-found perspective, you can also choose how to behaviorally react. You intentionally choose to engage in the activity and have the sensation while practicing remaining calm.
Good coping is not getting rid of pain, but getting so good at reacting to pain that it is no longer as problematic as it once was.
It requires the development of an observational self from which you can have pain, remain aware of how you are reacting to it, and intentionally attempting to remain grounded and active while having pain.
Many pain patients do exactly this.
We climb stairs, drive cars, run errands, all the while experiencing various pains in various locations. We don’t hide from pain, we confront it every day in our lives and struggle to function despite its unpleasantness.
Every time I’m active my pain increases, so, like some rat in a behavior experiment, I’m being “punished” for being active and “rewarded” for remaining inactive. Over more than two decades, this has created a negative operant conditioning effect.
Operant conditioning is a type of learning in which the strength of a behavior is modified by the behavior’s consequences, such as reward or punishment
It is becoming increasingly difficult to overcome this strong aversion to pain that has developed, which is reinforced and gets stronger each time I again feel extra pain due to some activity.
When pain becomes too consistent or too severe, it is no longer beneficial to push through it because it will only trigger more pain and eventually become truly unbearable.
If I accept that my pain is severe today, I cannot simply proceed with my activities as usual.
I have to work with my pain, carefully calibrate how much I can afford to aggravate it through activity without sending myself into a full blown pain crisis.