I have just finished six weeks of radiation therapy for my esophageal cancer. This treatment caused severe burning of my esophagus and stomach, leading to pain 24-7. My escapes from the pain have been narcotics and dissociation, (picturing my body as a separate entity, so that I can distance myself from the pain - a nice break). My meditation practice has been extraordinarily useful. I have also used an interesting technology for pain and anxiety management called The New Reality, Personal Achievement Device wich uses a combination of audio and visual stimulus to relive pain and control anxiety.
This process has been an interesting lesson, not about pain management, but about how pain affects your life and psyche. After my cancer diagnosis, my life became "about me" in a positive way. Everyday I would receive cards, sweet emails, and hugs. Everyday, I would take care of myself with meditation, exercise, and various therapies. However, I was still able to empathize with others, and "see outside of myself," mostly because I was feeling OK.
Suffering daily pain has been a game changer. Each moment, I am drawn from whatever I am focusing on (a task, a relationship or conversation) to my bodily discomfort. Burning and cramping interrupts every conversation. Every activity becomes a struggle. Every moment becomes about me. I no longer find it easy to "see outside of myself" and the world inside my thoughts. My empathy for others has faded; my ability to relate has suffered.
As a physician, we are often confronted with chronic pain patients. They are difficult for us to deal with, as we are often powerless to make their symptoms better. This is highly frustrating to people who are driven to see positive results. More than that, it is a challenge to help them to step outside of their world-view (or personal view) that they are wrapped up in, and even invested in. After six weeks of pain, I am just beginning to understand this.
When your body screams at you every few minutes, it is hard to be a social animal. It is hard to listen to others as you are constantly being distracted. And, most importantly, it is hard to empathize when your suffering is loud. It's easy to say, "Oh Lee, you have cancer. That's okay." But is it okay? I have to say; it doesn't feel okay in that I enjoy being with and connecting with others. I enjoy good times and laughs, and I enjoy being there for friends in need. I miss this. My only consolation is that my pain is likely to be short lived, and it is predictable that I will feel well again in the next few weeks. The chronic pain patient doesn't have the blessing of a "light" at the end of the tunnel.
We usually think of the narcissist as one who is so in love with themselves that they can't see, connect or experience others. Isn't the pain patient a narcissist of sorts? Their acute attention to internal noise is a form of narcissism, taking them away from relationships with others and decreasing their ability to see outside of themselves. They are not occupied with their 'positive attributes.' They are occupied with pain and the inner world that this creates.
Empathy connects us to the world, and for physicians, to our life purpose. Without empathy, we fatigue, we disconnect, and we feel worthless. Can we help our patients and ourselves with chronic illness or pain, by seeing them as situational narcissists, and use psychotherapeutic interventions to re-engage them with others and with life? This would be healthier than just writing them off as crazy or unable to have a life.
Maybe when we see a chronic pain patient, we can ask about relationships. Are they getting out with friends, is there love in their lives? If not, maybe we should seek group support environments where they can learn to re-connect with others, and/or psychotherapy, not because they are "nuts," but because they may be missing out on what gives most of us meaning in life: social connection and love.
Another approach, in addition, would be to teach the person with chronic pain how to meditate. Meditation has been shown in multiple studies to decrease a patients' reactivity to pain, especially chronic pain, but also enhances empathy and a sense of inter-human connection. It is also a pro-active positive approach, which can give them a sense of mastery over time and allow them to mastery other skills. There are plenty of good meditation CDs available (I am a fan of Jin Kabat-Zinn's CDs and Martin Rossman's CDs) so this can be a cheap and easy, study at home process.
If my six weeks of pain is enough to create this self-absorbed being I can only imagine what a year or more of pain can do to one's life!