Psychological Pain and Suffering

Pain Defined

Despite it being a fundamental part of the human experience, our scientific understanding of physical and emotional pain is not yet fully developed. This is due in part to the fact that the experience of pain cannot be measured objectively. There is no test to tell us how much pain something will cause, nor how the pain will be perceived. The experience of pain is entirely individual, and even with the exact same injury - what is unbearable for one person may be tolerable for another (Biro, 2010). 

Research has shown that there is an area of the brain that processes the sensation of pain (where it is, how it feels, and the severity) that is entirely distinct from where we process our emotions about the sensation. Not only are these areas physically separate, they are able to disassociate. Meaning that there may be a verifiable sensation of pain occurring in the brain without the manifestation of pain symptoms (Biro, 2010).

We also know that psychological pain, for example social exclusion, produces the exact same pattern of neuron transmission as being poked by a needle. The more extreme the distress caused by social exclusion, the more active our brain’s pain centers become. This phenomenon is true for patients experiencing depression and grief as well (Biro, 2010).

The subjective nature of pain is captured in the accepted definition from the International Association for the Study of Pain (IASP). Scientists currently agree that pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Tossani, 2012). The IASP also acknowledges that pain is reported for purely psychological reasons that can cause the same levels of distress as physical pain. Therefore, physical pain and emotional pain are effectively indistinguishable from each other (Biro, 2010). 

Physical pain, like our other senses, creates a pathway through which we experience the world around us. Though unpleasant, acute pain serves the following critical functions (Pearson, 2019):

  • Notifies us that damage to our body has occurred.
  • Encourages us to take immediate action to prevent more damage from occurring.
  • Activates our fight/flight/freeze/fawn system, causing our bodies to experience an increase in blood pressure, pulse and respiration rate to help us remove ourselves from the painful stimuli with a goal of self preservation.
  • Encourages us to slow down and take time to treat ourselves and heal.

Once we complete the process of treatment and recovery, the acute pain we experience typically resolves (Pearson, 2020). 

Because psychological pain and physical pain are considered indistinguishable, it stands to reason that both serve a similar purpose. It is no great leap to argue that acute psychological pain serves to (Biro, 2010):

  • Notify us that damage to our psyche and sense of self has occurred.
  • Encourage us to take immediate action to prevent more psychological damage from occurring.
  • Activate our fight/flight/freeze/fawn system, causing our bodies to experience an increase in blood pressure, pulse and respiration rate to help us remove ourselves from the psychologically painful stimuli with a goal of self preservation.
  • Encourage us to take a step back and engage in mentation exercises that provide us with treatment options designed to reduce the burden of our pain and suffering.

Because the discomfort caused by psychological pain is as ‘real’ as pain caused by injury, treatment for psychological pain includes traditional pain interventions, as well as treatments for emotional distress (Pearson, 2020).

Current best practices for medical professionals treating psychological pain is to accept it as it is reported, without passing judgment or making conditions, and provide whatever method of pain relief is effective and safe (Biro, 2010).

Suffering Defined

Suffering is understood to be the result of pain, manifesting itself through other mental and physical states including fear, depression, anxiety, fatigue, hunger or a sense of loss or grief. It is an entirely internal experience, and differs widely from person to person (Tossani, 2012). While pain describes our sensory experience, the term suffering is used to describe the burden of pain on our brain, body, mind and spirit (Potter, 2020). 

When we suffer, we are in a state of severe distress caused by events that threaten our ability to remain whole and complete. Suffering begins when we first perceive that the intactness of our personhood is threatened physically, psychologically or socially. This condition alienates us from ourselves and our community, creates a crisis of meaning and dissolves our sense of hope for the future (Tossani, 2012).

When we are suffering psychologically, our minds can manifest pain in the body - called somatisation. For example, we may experience depression as exhaustion. We may feel our grief as visceral pain in the stomach or chest. This phenomenon is so impactful that over half of all people with depression report related physical symptoms of pain (Biro, 2010). 

Reciprocally, our physical pain can cause emotional suffering by generating overwhelming feelings of fear, helplessness and isolation (Biro, 2010). Chronic pain can lead to withdrawal, resignation and passive acceptance. If uncontrolled, we can experience sleep disruptions, loss of appetite or overeating, decreased oxygen saturation in the bloodstream, and even an increased risk of life threatening illness (Pearson, 2020).

Origins of Psychological Pain and Suffering

Psychological pain may develop as a result of mental challenges including depression, anxiety, anger or depersonalization. We may feel pain when we experience guilt or shame, panic or terror, or when we try to cope with chronic emotions like worthlessness, emptiness and loneliness (Tossani, 2012). Psychological pain can result from a loss of a loved one, or may develop due to acute or chronic illness (Biro, 2010). 

Our bodies are able to adapt to such pain over time, masking and disguising our symptoms until they are nearly impossible to detect (Pearson, 2020). 

How we experience pain and suffering is deeply tied to how we were socialized to do so. Our culture and past encounters with pain can serve to increase or decrease physical and psychological pain receptors within the body and in the brain (Biro, 2010). 

Consider the following influences of socialization, when attempting to understand perspectives on pain (Potter, 2020):

  • Expectations of how the pain will lead to disability.
  • Coping methods used within our families.
  • What we designate as the cause of our symptoms.
  • Our personal definition of pain.
  • The society we were raised in and it’s definition of pain.
  • Our ideas about the process and potential progression of pain.
  • Our understanding of our pathways toward recovery.
  • The rights we feel we have, and actions we feel we can take.
  • Our attitude in general.
  • Expectations about what we will gain or lose as a result of pain.

Overcoming Psychological Pain and Suffering

The goal of treating psychological pain and suffering is to decrease the occurrence and impact of distressing symptoms, restore and enhance daily functioning, and grow a sense of wellbeing and hope for the future (Potter, 2020). 

A roadblock to the goals of treatment develops when we take a self-deprecating or defeatist outlook on our pain. This mindset has been shown to actually increase our level of suffering. One way to move past this perspective is by working to understand what triggers us to feel painful emotions as well as the origin and meaning behind the emotions themselves (Potter, 2020). For information on how to accomplish this through enhanced emotional regulation, click here.

Additionally, we can work to positively alter our frame of mind surrounding our suffering through the use of cognitive behavioral therapy (CBT). At the root of this approach is the use of a short term, goal oriented perspective focused on identifying, challenging and altering damaging patterns of thinking, maladaptive attitudes, and internally held beliefs that exacerbate symptoms. Once such patterns of thought are identified, CBT offers a time constrained, structured strategy to replace them with more constructive thoughts which then encourage more constructive behaviors (Potter, 2020). For more information on CBT, click here.

Alternatively, we may be able to reduce symptoms by taking the time to understand what our experience means to us in the context of our lives, imagining what we want our outcomes to be, and defining what success means to us on a personal level (Potter, 2020). One way to accomplish this is through the use of a  worksheet on motivation, which is available by clicking here.

It is important to note here that the placebo effect actually works to reduce pain. So much so in fact, that between 15% and 30% of people report an alleviation of pain after taking a sugar pill they were told contain pain relievers (Biro, 2010). This information is provided in this context in an effort to communicate that the simple act of attempting to relieve our pain can offer psychological benefits regardless of tangible outcomes.

Helping Someone Cope with Psychological Pain

One of the most important things we can do for those close to us who are in psychological pain is to listen to them empathetically and without expectation or judgment. Consider the following strategies when supporting a loved one who is struggling with painful emotions (Gortner, 2015):

  • Engage in ‘Thought Empathy’ - this technique allows us to mirror the other person and demonstrate that we both hear them and understand. We may paraphrase the language they use or repeat keywords they share with us.
    • ‘You feel isolated and lonely after the accident.’
    • ‘Work has been more challenging since you were denied that promotion.’
  • Engage in ‘Feeling Empathy’ - here we take the words, tones, and body language they use and determine the emotion that is beneath them. We then verbalize that emotion in a compassionate and understanding manner back to them to ensure our understanding is correct. If not, we allow the other person to correct us.
    • ‘It must be exhausting to have a new baby, and even more so since the older one hasn’t adapted well.’
    • ‘You’ve lost your support system with this move and feel apprehensive about starting all over again.’
  • Verbalize a Positive - we must be careful not to employ a platitude or dismissive statement here. Instead, we consider something from the present moment that we can share with them as an observation about a positive trait or characteristic. Engage with curiosity and respect. 
    • ‘It took a lot of strength to leave what wasn’t working, and courage to seek out something new.’
    • ‘It wasn’t easy to share that with me. Thank you for trusting me to help.’
  • Ask Kind Questions - use open-ended prompts to seek out their understanding of their condition and the meaning they place on it. The focus here is to open up the conversation and encourage them to share what they are feeling. 
    • ‘How come?’
    • ‘How did that make you feel?’
    • ‘What did you think when you heard that?’

It is important that we take a step back and reassess our intentions and the words we use to convey those intentions. Those in psychological pain are uniquely vulnerable and unkind phrasing from us can cause harm and encourage them to shut us out. Be sure to avoid the following pitfalls in communicating with someone in pain (Gortner, 2015)

  • Minimization - take care not to imply their pain is not as difficult as they imagine it to be, or remind them that others have it worse. The suffering olympics is a game everyone loses. 
    • ‘It was only a pet, it's not like your parents died.’
    • ‘At least your cancer is treatable.’
  • Platitudes - we should be sure to avoid commonly used phrases that serve to ease our own discomfort at their expense. 
    • ‘It was God's will.’
    • ‘It was the universe testing your resolve.’
    • ‘Get back on the horse.’
    • ‘This too shall pass.’
  • Predicting the Future - this pitfall leads us to set expectations for the person in pain that sets them up for a sense of inadequacy. 
    • ‘You’ll feel better in the morning’
    • ‘It gets easier with time.’
    • ‘They’ll get over it in a week or two and come around.’
  • Making It About Us - this can come from a misguided attempt at relating to the person in pain, where we offer our painful stories to another. This is hurtful because it makes their suffering about us, and adds to their emotional burden in the moment. 
    • ‘I knew someone with this diagnosis…’
    • ‘I felt this way when I lost…’
    • ‘After my tragedy, my family rallied around me and it really helped.’
  • Attempting To 'Fix' Things - this is another attempt at trying to reduce our emotional burden at the other’s expense. It leads us to assume their thoughts, feelings and needs without giving them space to make those known and then taking actions that remove their sense of agency.
    • Instead, ask them what they think, feel and need. 
    • Ask if they want to problem solve right now, or just vent.
    • Be prepared to listen and to make good on whatever help and support was offered to them.