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Setbacks and Digging Deeper

Post #5 in the series "Reprocessing Chronic Pain"

They say to expect setbacks on this healing path. Healing is not linear. I know this. I tell this to others all the time.

I just didn't expect a setback this soon. Let's see if it can be an opportunity to go deeper.

Just when it seemed like I was on the verge of becoming pain-free, life happened, in the form of a major medical crisis in my family. It came out of the blue and needed to be addressed immediately. I am the one in the family who knows how to navigate the health care system so I snapped immediately into gear, making calls, setting up appointments, and communicating with the care team. I was gripped with fear, triggered into fight/flight mode. I was frustrated with the system, feeling rushed and anxious, and worried and scared about what might happen. So the pain came back. When pain has been the default stress response for over 30 years, it doesn't reverse in a couple of weeks - not when the you-know-what hits the fan.

Along with the family medical crisis came the drama of family dynamics. My family comes together pretty well in times of stress, but inevitably some of the old and not-so-helpful patterns emerge. Disagreements. Poor communication. Hurt feelings. So, I got to see that fear is not the only emotion that can get paired with chronic pain. Anger, frustration, resentment, and shame get right there into the mix too. As it became clear that this medical situation may go on for a while, I got really scared that the pain would stay along with it. I tried to use the PRT tools but they center on reassuring myself that I am safe. Nothing about this situation is safe, consciously or subconsciously. And I felt too tired, distracted, and discouraged to really focus on the practices with the same energy that I had access to before.

But I'm determined to find a way to navigate stress without it going straight to my back. Just because it's my habituated response doesn't mean it's my only option. So here is what I am working on.

Expanding the Somatic Tracking

The somatic tracking taught in PRT is directed at the physical sensations of pain. The practice is to notice the sensations without assessment, judgment, or alarm. I've learned from Somatic Experiencing and Buddhist meditation that the same thing can be helpful with emotions. Physical pain and emotional pain are processed in the same part of the brain. They produce the same alarm response. So it makes sense that working with the felt-sensation of emotion, in a calming way, would help to turn the alarm down. I started paying close attention to my heart rate, my breathing, and the muscles in my stomach. Those are my early warning signs of emotional dysregulation. Then comes tension in the shoulders and neck. When these signs go unnoticed (which is most of the time if I am on auto-pilot) they trigger a stress response, which my brain tends to react to with pain. To reverse this habit, I am pausing - as often as I can - to check in with my heart, stomach, breath, shoulders, and neck. It only takes a couple of minutes to unclench, release, and take a few deep breaths. When I have more time, I have lots of guided meditations to give me a reset. I now take my earbuds everywhere I go. And I start each day with a calming practice.

Emotional Expression

I'm kind of a feelings-stuffer. I got the message as a kid that a lot of feelings weren't safe to express. I also had other people telling me how I felt (or how I should feel), and so I stopped trusting my own felt-sense of my emotions. This is a common (and pretty serious) disability. When we can't accurately read our mind/body to determine what we are feeling, we cannot craft an appropriate response. It gets messy really fast.

I'd say anger is the most challenging for me. If anger arose, a voice in my head would quickly say "you can't get angry at that. She didn't mean it." Or "you can't get angry at her right now. She's already upset." I learned to automatically talk myself out of feeling anger, even before it could register consciously. My body knows I'm angry (the body always knows) but my mind has a whole set of stories as to why there can't be anger -- and therefore there isn't anger. It's kind of like gaslighting myself. To complicate things further, anger got subconsciously coupled with fear - fear of how someone else would react, fear that I'd hurt someone, fear that I'd be left alone. To protect myself from the fear, or the actual consequences, I just didn't do anger. But without anger we can't protect ourselves. We can't set boundaries. We can't be genuinely compassionate.

So I'm trying to reconnect with it. It helped enormously to notice how frequently I was irritated or annoyed. Once I started to pay attention, I could see it was pretty much my default reaction. Sometimes it was just the background hum in my mind even when nothing had happened. I couldn't identify what I was annoyed with - it seemed like stupid little things, like the dog being under my feet when I'm in the kitchen (that's not so little actually - have you ever tripped over a 40-pound dog?) Or my husband's seeming incapacity to put his dirty dishes in the dishwasher. Or the fact that my checking account balanced last month but for some reason it just won't balance this month. Yes, those things are irritating. But I'd feel a surge of rage, which would then settle into general grouchiness.

For me, the anger at the deeper stuff is hard to access (never mind express) so it shows up as everyday irritability. So I'm trying to be more mindful when something has happened that's not ok with me. This means overriding the dismissive voices saying I shouldn't or can't be angry at that. I try to feel the anger arise in my chest or belly. I pause and track it - where am I feeling it and what does it feel like? Can I let it stay, get big? Then I look for ways to express or discharge the energy of anger. Anger's job is to mobilize us to act. It creates potent energy to fight, flee, or yell. (Many people feel anger in their throat - those are the words of protest, trying to get you to SAY them!) So if anger arises and I don't express or move with it, it gets stuck, and whammo - I'm cursing at the dog again.

I'm experimenting with ways of getting it out of my body. Getting in my car and yelling is a good one. Playing certain loud, thumpy, angry songs and singing along to them is another (bless you CeeLo Green). That one really scares my dog - she hides under the dining room table. (I'm really trying to be more tender with her. She has a trauma history too). Or I use my imagination. I read somewhere that the brain doesn't really know the difference between an imagined experienced and a real one. So I imagine that I am smashing something or beating a club on the ground like Fred Flintstone. The whole cartoon thing seems to work for me. No damage -- to me or others -- but I do get some energetic discharge. Sometimes journaling helps. The other day I was violently typing in an 18-point, bold, red, angry-looking font (it was kind of fun picking one) and I filled several pages with words of rage. Then: delete.

Understanding My Stress Responses

Have you ever noticed, in a crisis, that you can go quickly from running around like a chicken-with-its-head-cut-off to collapsed sobbing on the couch? That's how our response to danger works. There's the activated state of the stress response, when all systems are firing on high. This is good if you have to make an appointment at a hospital or fight with an insurance company. But there's also the freeze - or collapse - state of the stress response when the body slows down or stops to go into radical conservation mode. This is the "playing dead" instinct. In animals, it can deter predators who prefer their prey alive and moving. In humans - especially children - freezing can protect you from what is going on around you. At the very least, it numbs your experience of the bad stuff. The body generates natural opioids when it's in a freeze state - literally anesthetizing you if you're about to be hurt.

Activation and freeze are both perfectly normal and highly adaptive responses to stress. Your brilliant body knows which one to choose in a given situation -- the one that's most likely to ensure your survival. But in my system, activation has felt unsafe and so I've been much more likely to freeze. Most of us habitually go to one or the other. There are the screamers and yellers who flip over tables, and there are the freezers and shrinkers who try not to be noticed. These folks also tend to be appeasers -- trying to say or do something that will de-escalate other people's emotions. (I suspect there's a gender correlation here but I can't say for sure.)

So on days like today, when I am low and slow, I'm trying to give my people-pleaser self permission to refuse calls, leave texts unanswered, and stay off of email. I don't smile because I think the other person needs me too. It's ok just to be flat. This was hard for me. I learned as a kid to interpret my healthy freeze response as pathological passivity or depression ("what's wrong?" I was asked, if I was quiet or spaced out. "And why don't you just DO something about it?" Don't feel it. Fix it! That's my conditioning). Then I was actually diagnosed with depression in my 20s, after the failed surgery. From then on I lived in vigilant dread of it coming back. I cannot emphasize enough how important it is to distinguish between an adaptive and healthy freeze response (on the one hand) and passivity or depression on the other hand. It takes the pathology out of the equation. Instead of "what's wrong with me?" I can say "of course you're sluggish - you're overwhelmed and shutting down. This will pass."

Other times I notice the activation - the physical sensations of it - and I pause to inquire what's up. My habit, with activation, was to take a deep breath to immediately stop it. It felt that dangerous. My therapist once watched me do that and pointed it out to me. "See how quick you are to try to get rid of the anger?" she asked. "What would happen if you let it be there, just for a moment, before taking the deep breath?" That was a breakthrough moment for me. And it's something I've had to learn and relearn many times.

These are works-in-progress, skills I've been cultivating for a while now. But I really, really need them now to continue the work of disentangling stress from physical pain - which is, of course, the whole point of this healing path I'm walking.


In case you missed them, you can read the first four posts in this series here. You can also explore my earlier blog posts on chronic pain and food and body image, going back to 2019. To be notified when a new post is published, please subscribe. You can learn more about me on my website. And you can reach me at I'm also on Facebook and Instagram. And please forward this to anyone else you know who is dealing with chronic symptoms of any kind.


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