For the purposes of this exercise everything that follows applies to persons seeking to heal from chronic illness. The chronic illness can be physical, psychological, spiritual or all of these. What follows is less likely to be relevant to diagnosed terminal chronic illness. People with a diagnosed terminal illness are in an emergency situation. The emergency can engender behaviours which are less likely to occur in cases of nonterminal chronic illness.
I also want to make an arbitrary distinction between pain and hurt. The words are often used interchangeably but I have noticed, in our culture, that when we talk about emotions e.g. the jilted lover, and when we talk about spiritual matters e.g. a tragic loss in life, we almost invariably use the term hurt. I don't think this is an accident. I believe that what we call pain really refers to the physical realm and hurt lies in the metaphysical. Of course, because each person is a total system, there is an interplay between hurt and pain. Pain in the physical realm can trigger emotional hurt and strong emotional or spiritual hurt can trigger physical pain. In chronic illness there is both pain and hurt. For the physical pain we often seek alleviation through modern medical treatment in the form of medical drugs. For the hurt we may seek alleviation through e.g. counselling, meditation or spiritual practices. However, in the main, these treatments are not cures otherwise the illness would not remain chronic. This does not mean that cure isn't possible, cures do happen it's just that it is often difficult to provide the definitive explanation when they do. The reason for this is that what is really occurring is very individual in nature and individuals are extremely complex systems. It is this overall complex system driven by the individual themselves that effects the cure. Faced with this situation I think it is useful to look at the interplay of pain and hurt to unlock aspects of our being that can aid us in our healing task.
I believe that the key to change in chronic illness is all about hurt. Hurt that will not go away despite everything an individual tries. I also believe that all chronic illness has physical pain associated with it. In some cases the physical pain can be excruciating, especially during an attenuated acute cycle. The enduring hurt of chronic illness, regardless of its source, doesn't affect only the physical but beyond. Individuals with chronic illness also experience mental and emotional hurt. When the chronic illness debilitates and therefore prevents the person from engaging in many of life's activities, the emotional hurt, ranging from sadness to frustration to anger, can be profound. Fear is also involved. Anyone suffering an enduring chronic illness will have to face and navigate through the fear cycle at various times.
The ill person has a lot to deal with. They will endure mental anguish merely from the knowledge of what they were once, and what they are now. Seeing their friends and family still participating in a full and well life can be hurtful. I do not imply that a chronically ill person resents the health of others. This is almost always untrue, however the social aspects, that is the way our society treats chronically ill people, are isolationist and unacknowledging. I do suspect that most 'well' people are fearful of chronic illness and would rather not engage directly and meaningfully with it and hence the general societal response. Of course there are two sides to the relationship and chronically ill people do often need to withdraw. However they also need to feel and receive positive uplifting company from people who are not chronically ill.
Many people with a nonterminal chronic illness will not have experienced an authentic sharing, with their friends, concerning their illness. If you have a chronic illness it is more likely that you have lost contact with many of your friends and associates. It isn't likely for a person with a nonterminal chronic illness, to be approached and asked, "What is it like for you? How do you cope with your situation? Does it hurt a lot? Where does it hurt and how does it hurt? Do you miss your well life. Our joint situation is now different, what can we do together to remain in a sharing friendship?" The lack of a recognised valued societal place for people with chronic illness stems from deep fear and results in an unacknowledgement. This is odd because most health practitioners learn their deep practice skills and develop their real artistry, through interacting with chronically ill individuals. This lack of a valued societal place, leaves chronically ill persons in a state of spiritual impoverishment for the waking hours of their corporeal lives. Spiritual impoverishment occurs, because the spirit needs to interact as much as possible to gain nourishment and to learn. So a person enduring a chronic illness, has the potential to hurt deeply, profoundly, and spiritually. Such hurt however can open aspects of their heart crying out for acknowledgement.
If you have a chronic illness you will be engaged in a search for and a personal practice of healing. You will call upon all your current knowledge and put this into practice. However, because the illness endures, you will be looking for new information, new practice or both. So how do you do this?
It may be a simple statement - but I believe that people with chronic illness seek health by engaging all aspects of their being. They learn about their bodies, and they learn about their emotions, and they learn about their minds, and they learn about their spirits. They put all of these learnings together into practice. They look at the outcomes and they continue with things that they found beneficial and they engage again at all levels and so on. The effort required is substantial because there is a mission to discover something which is deep and elusive. Deeper discovery than that which is asked for in most other aspects of life. It requires substantial effort because all aspects of their being must be engaged rather more fundamentally, than would be the case in wellness. Great courage is requested and needed to transform great hurt. The search and the practice is actually an accelerated form of learning. This requires so many resources directed at it, that it can leave a paucity of energy for previously usual everyday pursuits, such as fulltime work.
The learning is by the individual. Others are also recruited to the effort. However, these others can only offer their knowledge and skills to the cause. They cannot learn for the individual, each person must do their own learning. So each individual must accept helpful gifts that others offer and apply these gifts themselves. Many gifts will be offered that are inappropriate or unhelpful, and at times it can be difficult to differentiate. Ken Wilber in his book Grace and Grit develops a model in which he claims that all illness has a psychological component. He eventually decides that the psychological component, across all illness, is roughly 20%. Ken was considering a diagnostic and treatment model for all illnesses. He would, I imagine, be concerned if anyone was to take his model and apply it specifically to any case of illness. The model actually has little or no practical utility for anyone with a chronic illness. When you are engaged in discovering health, you are already learning and doing with respect to psychological aspects of your being. The extent to which these aspects have any direct bearing upon your illness and what percentage that may be, is not a practical path to healing. Unfortunately, and as Ken acknowledges, others often see these aspects as crucial, claiming to possess understandings of your illness that you don't. Ken's wife Treya describes an incident where a well intentioned caring person asked her (words to the effect), "What is it that you find so unacceptable in yourself, that you give yourself cancer?" This seems to be an example of someone attributing almost 100% to psychological causes. It may also be an example of an attempt to displace fear. The person making the causal attribution is, perhaps, trying to understand something they fear and their process of doing this, offers a negative evaluation to another. Be careful of the gifts others offer. Don't accept their issues. Trust your intuition - it will let you know.
Intuition is your friend. In chronic illness we are dealing with extremely complex phenomena which affect all levels of an individual, and are likely to have multiple causes and multiple healing responses. For me, intuition can be described as, "The ability of human beings to consider enormous quantities of information across the entire range from totally unconscious to conscious. To make a decision based on the information, and then inform the conscious mind of that decision". The more conscious rational decision making processes are not good in very complex areas, and especially where things are often changing. This is the realm of intuition which can then inform the more conscious processes. I believe that one task confronting a person with a chronic illness, is the development of their own intuition.
Another reason why intuition is so important, is that the causes of chronic illness itself are generally unknown. It is possible to recover from chronic illness without ever consciously knowing the cause. So healing and learning can, and often do, occur in the realms of the unconscious. It is here that we need our intuition.
As I stated earlier, I believe that, in chronic illness, the real key to change and to healing is all about hurt and there is more than one realm in which people can experience hurt. There is:
- A physical realm;
- A mental realm;
- An emotional realm;
- A spiritual realm.
You may feel actual pain only in the physical realm but hurt is rather more pervasive across the realms. Either hurt or pain will trigger a search for healing and a healing response in any realm will have effects across all other realms. Two examples will illustrate this.
Example 1: Pain as a Trigger
You may have chronic arthritis. In a particularly acute phase of your illness you may experience a lot of physical pain and feel sad and depressed. You may decide to try a new herb or medical drug. The medicine may reduce the pain markedly and the resultant good feelings may easily dispel the sadness. This is likely to allow you to be more active, and the doing and outcomes of the doing, can engage all levels of your being. Active engaged living, is a tonic across all realms. In this example the initial trigger was actual physical pain. The healing response produced outcomes across all realms.
Example 2: Hurt as a Trigger
You may have recently lost a loved one. In an especially poignant moment it may be difficult to function. You are preparing a meal but find it is difficult to make decisions or even think clearly. Your pulse is racing and you feel a tightening in your chest which produces an actual physical pain similar to angina. Recognising the effects of grief you sit and breathe deeply. You burn some calming lavender oil and telephone a friend to talk. After the conversation you notice that the pain in your chest has disappeared, your pulse is no longer racing and you feel capable of preparing a meal. In this example the initial trigger was the hurt of grief. As in example one, the healing response produced outcomes across all levels.
Pain can only be felt in the physical realm but hurt is more ubiquitous. The causes can range anywhere on the entire continuum from totally unconscious to conscious. The chronically ill person's healing response, will also range across this same continuum. I believe that, in chronic illness:
- healing is a response to hurt that engages all levels of an individual's being;
- healing occurs after an individual has created conditions which encourage it;
- healing comes from many places but human beings receive it in measure with their own honest efforts;
- and for many reasons, physical healing or 'a cure' may not necessarily occur in an individual's particular lifetime but their efforts at healing will have positive outcomes.
I have intentionally omitted pain from the above list. This is because I believe that the locus of your real leverage, the areas where you can produce change and thereby potentially effect healing, is in the hurt not in the pain. Because the illness is chronic then the doctors have not been able to cure the pain and certainly not able to cure the hurt. You can explore the hurt and learn from it and effect change. The outcomes of this learning can range from becoming better able to cope with life that includes a chronic illness to a complete cure. I am not suggesting that you ignore the pain, instead I would urge you to continue to do everything you can in this area, but if you give it all your focus then I do feel that your learning progress will be impeded. If this does occur then you may find it more difficult to create the overall conditions which do encourage healing. Remember that when conditions for healing are created that healing will occur and that this applies across the spectrum from pain to hurt. Remember also that the process of healing is largely unconscious and we tend to see only those aspects which are detectable by our conscious senses. The old saying that, "the body heals itself", is commonly applied only to physical pain but it also applies to hurt. We, however, drive the process and must first create the conditions.
The ideas presented here are summarised in the diagram below.The four realms of chronic illness are the Physical, Mental, Emotional and the Spiritual. Pain, a physical construct, operates only in the physical realm. Hurt, a metaphysical construct, operates in the metaphysical realms. Through the interplay of pain and hurt, pain can produce symptoms of hurt in the metaphysical realms. Through the same interplay, hurt can produce symptoms of pain in the physical realm.
Healing tools strictly in the physical realm are Chemical and Physical Therapies e.g. medical drugs, physiotherapy, chiropractic. These tools can be effective in acute illness - if you have a headache and you take some aspirin the headache may disappear. The tools are less effective in chronic illness - if you have arthritis and you take some aspirin it may diminish the pain to some extent for a short time but the arthritis will not be cured and the pain will return. So in chronic illness the strict physical therapies are best used as tools to manage the pain of the illness.
As you begin to move away from the physical you encounter healing tools which are both physical and energetic in nature to tools which are entirely energetic. Acupuncture is both physical and energetic. It can, by itself have a direct effect on the physical body, alleviating pain. It can also help to raise psychological aspects to a persons consciousness so that the individual may deal with them. Healing tools more in the energetic realm e.g. reiki, prayer and other spiritual practices and even counselling can either raise psychological issues into consciousness or move them unconsciously so that they, and their associated behaviours, change in some way. These more energetic tools can be used as chronic illness management strategies and also as tools of discovery to change aspects of self that may be impacting directly upon the chronically ill state.
I believe that it is because of the nature of operation of the more energetic tools that people with chronic illness tend, after a time, to gravitate towards them. They provide a mode of exploration of self to discover meaning in the chronic illness, they are not harmful to the physical body, they are expressive rather than suppressive such as the medical drugs, they can change things that, through the interplay of hurt and pain, have a direct effect upon the chronic illness, they offer hope, and they are more readily under the direct influence of the individual than either medical drugs or strict physical therapies. It is because of these characteristics that the more energetic tools engage the real abilities of the individual to leverage their illness rather than be leveraged by it and others. As stated earlier, my belief is that we do not know cause and cure in chronic illness and that much change happens unconsciously, so I also believe that the best tools to drive real healing lie in the realms of hurt but tools in the realm of pain are also a necessary management strategy.
Lastly, I could, for example, group in the far right of the diagram together with spiritual practices and spiritual healings such things as acknowledgement, gratitude & love, forgiveness, compassion, acceptance etc.