Category Archives: pain

Imagination and Hope Forever Intertwined

First food at new house straight from A's hand in an effort to win Peppa's heart.
First food at new house straight from A’s hand in an effort to win Peppa’s heart.

Hope begins with a belief in an ever-changing world. It requires us to imagine a state of being other than we currently experience. Now some days, hope is a wish for things to stay the same, like the first time seeing a look of affection in a lover’s face. Some times hope is for a change in our existence, even if the chances of such a change happening is slight. I think of the lottery, aka, “the stupid person’s tax” as a prime example of such hopes. Some times our situations lead to hopes of both types simultaneously. Every time I refuse to wish away the pain of my MS, it is because of hope. I hope the feeling of pain means I might one day feel as much pleasure as my current pains. Of course, this hope is also a fear of change as my real fear is losing all sensation. Therefore, my refusal to wish away the pain is in part a hope for beneficial change and a fear of a change that would preclude the better alternative.

Still, all hope is rooted in a belief in the world’s change. I will always remember my two lunches five years ago with Michael, the homeless man who had no concept of what would make his life better. (Michael).  He remembered having a family, but both times did not even think of having them around again as something that would make his life better. He was not particularly unhappy as I would expect somebody without hope to be, but this is instructive too. Those who have truly lost hope can no longer imagine “better.” So long as one knows the opposite, despair, one knows what is missing. The truly hopeless lose the concept of change. For Michael, “the world is good because the word is good, and the word is good because God is good.” That mantra was his guiding philosophy as he lived on the street, and a concept of change was nowhere in it.

I think of this some days as I ponder the question of “acceptance.” Should I just accept the limitations my MS places on my life? So often, I read and hear of MS patients having to grieve for, but ultimately accept, their new limitations. I know the psych 101 answer always has acceptance as the last stage of a healthy grieving process, but I keep coming back to it as the warning sign above the gates of Hell in Virgil’s Divine Comedy, “Abandon all hope, ye who enter here.” For me, acceptance of “what is” means giving up hope for a better alternative than what I currently face.

Acceptance is forgetting the possible alternative experiences and no longer acting on their possibilities. Yes, often the efforts are a complete waste. They probably seem foolish risks to many as the outcomes are easily predicted. The costs of abandoning hope may be more subtle, but are they any less?

As parents, I often think hope is one of those things for which we are most responsible when it comes to teaching our children. My oldest daughter still hopes to do many of the things her friends find easy, like monkey bars or math or… These are things with which the smart bet would be she would probably struggle. Still, I look with pride every time I see her falling from the monkey bars or using a number line. When she came to us, we did not know if she could grow to be more than a blob, but now she is a nine-year-old girl nervously making her way through life as best she can.  If she tries and fails but continues to try, who is to say she will not  succeed in some of things she wants to do that seemed impossible.

For months, we knew our neighbor’s dog with which A had slept for the past 10 months would be leaving us. The anxiety attacks she has had lately have been escalating, and in truth, she had reason. Two colonoscopies/endoscopy procedures and a ton of laxative meds in the last couple of months to try to determine the source of and treat her slow motility is a lot to endure. Even before our neighbors dog went back to her owners, A began asking for a dog of her own, who would love her and could rely on her. Her hope was to have the best bond with a new dog. Of course, we let her pick the dog, so there was no shoebox of poo. In a moment of humor to me, she did bring up the story in conversation. Part one of her hope, to get a new dog, has been realized. Part 2, to be well bonded with the dog, is a work in progress.

It seems crazy to bring the canine census in our home back to three, but there is much we are willing to do to preserve the hope and mental well-being of family. I have no desire to see any of us retrace Virgil’s trip through the gate.

One birthday wish came true.  A got a new dog to sleep with her by night and train by day.
One birthday wish came true. A got a new dog to sleep with her by night and train by day.

 

As a side note for all those dealing with either their own disability or a family member’s disability, there is a new web site dedicated to promoting places with good access and services for the disabled.  http://www.disabledonthego.com/ 

It will only be as good and useful as we make it, but how many of us dealing with disability wish we knew ahead of time about possible destinations?

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Dangerous Knowledge

Mama-no-fun and I chilling on the couch.  She hates cameras and seems to know when the phone is about to be used as one.
Mama-no-fun and I chilling on the couch. She hates cameras and seems to know when the phone is about to be used as one.

Problem: We Have the Answer

Throughout the centuries, there have been various attempts to ban knowledge thought to be dangerous, but I posit the most truly dangerous knowledge is that which we stop questioning. The knowledge our experience reenforces is extremely hard to replace. Compare this with knowledge gained by efforts to prevent exposure to opposite views.

The Catholic Church had the Index Librum Prohibitorum, a list of works deemed heretical until 1966 when the pope abolished it. Still, subsequent Church leaders and an eventual pope remind us of the moral obligation to avoid books thought dangerous to our faith and morals. I have to admit I have looked at the list to try to find interesting reading in my contrary teenage years. Truth told, I was already familiar with many of the authors like Galileo, Darwin, Voltaire, etc., and I think my education better for my exposure to their work. Lest one think this desire to repress thoughts and literature are a Catholic thing, I note the more modern Satanic Verses which lead to a fatwa issued against Salmon Rushdie in 1989. I read the book solely to see what thoughts could merit death threats. Attempts to repress knowledge almost always seem to have the opposite effect. We all want to know who is the man behind the curtain.

However, there seems to be an ironic flip side. We seem to have an extremely hard time questioning “truths” which have seemed confirmed by experience. I was reading this week about chronic pain and the changes in our thoughts and behaviors which accompany it. In one study on dogs, when a group of dogs begins to believe nothing they do will change their pain, they stop trying to find ways to avoid it. Even when they are presented an opportunity to avoid the pain, they do not take advantage of it. They are no longer looking for the pain-free solution. http://psychology.about.com/od/lindex/f/earned-helplessness.htm

Personal/Micro Example:

In many ways, I find myself fighting against this loss of hope for a pain-free time. I no longer remember what it is to be without pain. I find myself behaving like the dogs no longer looking for a solution. In my defense, I have found things I still find extremely pleasurable, to the point where I do not wish to lose sensation even if it involves some continual pain.

I want the pain in my legs from a long run because it displaces the pain in my head and forearms. I want the pain because it means I am not numb. Finally, I want that pain because I can follow it with one of the most exquisite feelings I know. The moment after the run when I turn the cold water in the shower and it beats down on the back of my head. The cold shock spreads as the water goes down my shoulders and almost always makes me shudder as it hits my butt. Still, the ecstasy isn’t complete until I’ve shifted my shoulders to send some of the chilled water down my chest over that most sensitive spot just inside the hip bones. In trade for that first 30 seconds in the cold shower after the run, I will gladly overheat and tire my entire body.

Those positive physical sensations are probably all that separates me from those dogs in the experiments above who no longer look for ways to stop the pain. My experience is still giving me reason to hope and try, even as the length of time with pain a constant companion decreases my expectations for relief.

Societal/Macro Example:

I see a similar pattern emerging with our healthcare. We have been taught for generations about “American Exceptionalism.” Our strength comes because we are different, and surely this makes us better. There seems to be a perception amongst many the Affordable Care Act will make things worse for us as it hauls us toward similarity with foreign medical systems/markets. Outside of politically biased sources looking for reasons to deny Obama credit for anything, the most common things I see are concerns about change and being the outlier negative case in a system geared more towards helping “others.”  Still,  as a  guy who favors utilitarian beliefs of “greatest good for the greatest numbers,” I look at and follow publications like http://www.commonwealthfund.org/~/media/files/publications/fund-report/2…

I note the U.S. was last amongst the 11 countries studied in healthcare performance measures. This study included patients and physicians. Without a single payer system, it is not surprising that we rate low on access to care. What surprised me was our low rank on outcome, quality and efficiency measures as well. For this “great” system so many seem hell-bent on preserving, we pay more per person and more as a percentage of our total GDP than the other 10 countries studied.

I think it is natural to fear change if you think you are being well served, but are we as a nation being well served? Most of the quantitative research I have read says no. The problem is hearing this flies in the face of what we think we have experienced, example after example of our medical system as “American Exceptionalism.”  I even recognize I am one who has benefited from the differences between our healthcare and other healthcare systems as I doubt I could have been placed on Tysabri as quickly as I was in any other system.  So it would seem natural to believe we have it as good as it is possible to have.  Why change?  We have a natural tendency to imitate the dogs who believe nothing they do will improve their lot in life.  It seems a very natural problem, recognizing the possibility of “better” because it flies in the face of knowledge seemingly reenforced for years.

The hardest things in life are often difficult primarily because they involve risking a challenge to areas we think a strength or truth.  The most dangerous knowledge is that which we no longer question.

 

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