How to Live Well with Chronic Pain and Illness

by Toni Bernhard

  It helps to remember that when we see our always-cheerful neighbor or our in-love friend, for the most part, we’re only seeing their public faces. We don’t know what their inner life is like. If we did, we’d see that it’s not so different from our own. The Buddha pointed out that we are all subject to illness, injury, aging, and separation from those we love. No one gets a pass on this.

  In addition to being subject to the inescapable vicissitudes of life, each of us has been conditioned by our life experiences in ways that often remain at a subconscious level. For example, if a parent repeatedly told us that nothing we did was good enough, we’re likely to have internalized that message. Such conditioning can show itself unexpectedly at any time in the form of painful thoughts and emotions — either of which can trigger the blues.

  I’ve learned to be okay with not knowing the source of my blues. What I do know is that they’ll intensify if I engage in comparing mind by telling myself how blues-free everyone else must be.

  Treat the blues with friendliness and compassion.

  When the blues are particularly intense, I can feel as if I’m on the verge of tears all day. Part of the reason for this is that, although I may not be physically alone when the blues come calling, they make me feel isolated nevertheless. This calls for self-compassion, not self-judgment. Trying to force the blues away by telling myself that I shouldn’t feel blue never works; this is because ordering myself not to feel a certain way almost always guarantees that I will feel exactly that way. So the best we can do when the blues come calling is to be mindfully aware that they’re present and to let compassion for ourselves arise over any suffering we’re experiencing as a result of their presence.

  I have a strategy that sometimes catches the blues off-guard and, in doing so, disarms them: I treat them as old friends, maybe even saying silently or softly to myself: “Hello blues. Come to visit, have you?” Exposing them in this friendly way to the sunlight of awareness can reduce their intensity. I don’t need to love those blues, but treating them with friendliness allows me to hold them more lightly until they run their course.

  Sometimes I might even throw myself a short pity party, but I have to be sure I’m engaging in pity with compassion as opposed to pity with aversion. Angry pitying, such as “I hate the blues,” or threatening thoughts, such as “These blues better not hang around all day,” are not in the party spirit! By contrast, pity with compassion means that we’re looking after our well-being even though we’re feeling pity for ourselves. I sometimes say to myself (I might even whine it — this is, after all, a pity party): “It’s not fair that I feel so blue on top of being sick.”

  A properly held pity party — one held with compassion not aversion — can help turn the confused and painful thoughts that can accompany the blues into simple sadness. And sadness can open our hearts to our mental suffering. A good test of whether a pity party is accompanied by compassion is to check and see if it feels right to stroke one arm with the hand of the other while speaking your “pity party” words.

  Change the environment — physical or mental.

  Doing something — anything (nonharmful of course) — can take a blue day and help us see it from a different, brighter perspective. This is not the same as trying to force the blues away. On the contrary, with a friendly attitude toward them, we’re letting the blues accompany us as we change our environment. (Doing this might throw them so off-guard that they’ll make a hasty exit!)

  My go-to change of physical environment is to sit in the backyard for a bit. The outside air is refreshing, and the sights and sounds of the neighborhood fill my senses. It makes me feel part of the larger world around me. Sometimes I ask my husband to take me for a drive. We’re fortunate that it only takes a few minutes for us to be on a country road. The scenery may only be the flat Central Valley of California, but I enjoy looking at the open sky and watching the parallel rows of crops go by.

  There are many ways to change our mental environment. One of the best ways is to invite a friend over. Many years ago, my husband and I were fighting about something — I can’t remember what. We both wanted to end the argument and move on with the day, yet neither one of us was willing to give in first. Then a friend unexpectedly came over for a visit. We both jumped at the opportunity to chat with her, and — just like that — we were no longer angry with each other. Our friend unknowingly changed our mental environment and, by doing so, changed our mood. A dark day became a light one.

  Another way to change the mental environment is to do something that’s just plain fun. For instance, I have a few movies that I watch over and over: Groundhog Day, Best in Show, Gosford Park. When the blues settle in, I put on one of them. The characters are like old friends, and with their company, I can patiently wait out my mood. Quite often, by the time I’m finished indulging in my little pleasureful activity, those blues have lifted and blown away.

  Finally, doing something creative is a good way to change the mental environment. The activity doesn’t need to be earth-shatteringly skillful or original. Some internet friends of mine have coloring books. You can get beautiful ones at reasonable prices, and crayons are still cheap. Or try journaling or singing along to music. My creative outlet is crocheting.

  Even if these physical or mental changes don’t magically turn a blue day into a bright day, they’re a soothing balm that help make the blues manageable until they’ve run their course.

  Remember that the blues, like all moods and emotions, are impermanent.

  Reflecting on the impermanence of all mental states can keep the blues from intensifying and can also help us patiently wait them out. Because all phenomena are in constant flux, there’s no reason to worry that every day from now on will be a “blue” day. I call this reflection on impermanence “Weather Practice.”

  Moods and emotions are as changeable and unpredictable as the weather. They blow in and they blow out. This metaphor is a helpful reminder that, like the weather pattern of the moment, the blues are subject to change. Right now, life may look gray, but at any moment a bit of brightness — maybe even a rainbow — may break through.

  This reflection is tremendously helpful to me when the blues settle in like a dense fog. It reminds me that I don’t know what tomorrow may bring. It very well might be something warm and welcoming.

  Reach out to someone who’s having a tough time.

  Pema Chödrön said that sorrow has the same taste for all of us. I think the blues do too. Connecting with someone else who is struggling can help us realize that we’re not alone. Reaching out to another person also takes us out of our self-focused thoughts. The impulse to turn our focus inward to our sick and pain-filled bodies can be a strong one. Indeed, it’s understandable and, at times, skillful; we want to do everything we can to find the most beneficial treatments and maximize our functionality. That said, this tendency to turn inward can make us more susceptible to the blues.

  Reaching out to others eases my blue mood. The gesture can take the simplest form: a short email to someone or a supportive comment on Facebook. It doesn’t take much to brighten another person’s day, and that sunlit brightness may kick up a breeze and blow those blues away.

  There’s no reason to be afraid of the blues. People in excellent health get them, so of course we do too. Our blues can be intense at times because they often center around the frustration and hopelessness we feel about our medical condition. But even if they’re intense, they’ll change — just like the weather.

  It might help to keep these suggestions nearby because, if your life is like mine, the blues are never polite enough to announce ahead of time that they plan to spend the day.

  15

  Surviving a Bad Mood with Grace

  Use your own problems to remember that others have problems too.

  — KATHLEEN MCDONALD

  THANKFULLY, I don’t get in bad moods very often, but when I do, it feels awful. Unlike when I have the blues, I don’t feel melancholy. And I’m no
t on the verge of tears. Who can be bothered with tears? I’m too busy being cranky and irritable. I’ve isolated three types of bad moods, the last one exclusive to those with chronic illness.

  The first type takes me by surprise; it shows up for no apparent reason. When it happens, I’m feeling fine one minute; then suddenly I’m in a bad mood, and every little thing annoys me. When a bad mood descends on me inexplicably in this way, I’m at such a loss to explain its cause that sometimes I think it must be due to something I ate!

  The second type of bad mood comes on when a host of life’s little irritations adds up. A recent bad mood of my mine was set off in just this fashion. I misplaced a screw I needed to fix our doggy gate. I was having trouble untangling a cord to a bamboo shade. I couldn’t figure out the instructions for programming a kitchen timer that my husband had recently bought. The final straw was the most innocuous (and perhaps common) of life’s irritations: I could not find a sock in the dryer. All were minor irritations, yet they added up until there I was, in a bad mood. This particular bad mood was so bad that it qualified for what we (un)affectionately refer to in our household as a foul mood.

  Finally, there’s the bad mood that’s unique to those with chronic illness. We can become weary that every day, year after year, we’ve been sick or we’ve been in pain… or both. Sometimes, the relentlessness of it all understandably triggers the irritation and crankiness of a bad mood.

  This chapter offers some suggestions for surviving bad moods of all varieties.

  Make an effort not to inflict the mood on others.

  I try hard not to inflict a bad mood on those around me. When I slip up, I push myself to apologize even if I don’t feel like it. Not only is an apology a nice gesture toward another, I’ve also noticed that it can lessen the intensity of a bad mood. I think it’s because when we apologize, we’re forced to reach out to another person and that takes us out of our self-focused mindset.

  Don’t be self-critical about the mood.

  I’ve yet to spend time with anyone who hasn’t been in a bad mood now and then. In a May 2010 interview with Time magazine, the Dalai Lama said that he still gets angry; I assume this means that he still can get in a bad mood. Many years ago, I had a Buddhist teacher who was wise and insightful… and subject to bad moods. I never knew what mood I’d encounter when I met with him.

  If these two people can be in a bad mood, we should cut ourselves some slack when it happens to us. Why should being chronically ill make it inappropriate for us to ever be in a bad mood? That would be holding ourselves to a standard we’d never expect of others. Adding a negative judgment to a bad mood, such as “I shouldn’t feel this way,” serves only to increase the likelihood that the bad mood will turn into a foul one.

  So instead of being self-critical when a bad mood hits, be okay with it — what’s a little crankiness and irritability now and then? They’re simply two among the seemingly infinite emotions that everyone experiences in life.

  Investigate the mood.

  Recall that in chapter 8, on patience, I set out a four-step approach for working mindfully with an unpleasant mood or emotion. The third step was to investigate it. Sometimes this can yield surprisingly fruitful results. A few years ago, in the days leading up to Christmas, I was in a bad mood. My husband seemed quite cheerful, so I resolved not to inflict it on him. Instead, I decided to investigate why I was in such a funk.

  I know that I can be a bit sad during the holidays. Even so, I couldn’t recall ever being this cranky and irritable, so I began to consciously think about my life at this time of year. Doing so, I uncovered a negative association I have with Christmas: I associate it with loss — one loss after another.

  When I was ten years old, my father fell ill and then died just before Christmas. I felt his absence every Christmas after that until I met my husband and began to spend the holidays with his family. My father-in-law, Huey, took the place of my dad. They were both kind and good-natured men. I even remember telling my husband that his dad had become my Santa Claus because Huey embodied good will and the cheerful spirit of Christmas. Then Huey died when I was thirty-seven, and Christmas lost its luster again.

  For several years, I took refuge in the traditions we developed with our children, Jamal and Mara. Then they grew up, had families of their own, and started their own holiday traditions. We know we’re welcome to join them — Mara at her house in Los Angeles and Jamal at his in-laws near San Diego — but I’m too sick to travel. Another loss associated with Christmas.

  This reflective investigation led me to see that the mild sadness I tend to feel when the holidays roll around had turned into a bad mood this year simply because of the cumulative effect of all those losses. As soon as I realized that I associate Christmas with loss, my bad mood turned into a sad mood — a familiar sadness that softened my heart and made it possible for compassion to arise over how hard this time of year can be for me. When I compassionately accepted those losses as part of my life story, the sadness slowly lifted, and I was able to make the best of the Christmas that lay before me.

  A good way to investigate a bad mood when you know its source is to challenge the assumptions behind it. I recall a day, several years ago, when I was in a bad mood as a result of my mind churning with a list of grievances about being sick day in and day out. Inspired by Byron Katie, I decided to see what would happen if I turned my grievances around (a practice I described in chapter 13). I picked up a pen and told myself to list everything I liked about being sick.

  I started this little exercise without much faith in its ability to improve my mood. However, by the time I put the pen down, I was surprised to find that forcing myself to think about what I liked about being sick had wiped out that bad mood altogether. Here are four of the twelve items that were on my list: I don’t answer to an alarm clock; I’m never stuck in traffic; no more awkward cocktail party silences; my to-do list is very short.

  Investigation is a valuable tool for uncovering what might lie behind a bad mood and for challenging any faulty assumptions we might be making about our lives.

  Put the mood in perspective and consider reaching out to someone in need.

  Thinking about how a bad mood seems minor when compared to the suffering in the world can put the mood into perspective, although I should be clear: the purpose of doing this is not to blame ourselves for being in a bad mood. As I pointed out earlier in the chapter, everyone is subject to them. So don’t be hard on yourself; we’re simply putting a bad mood into perspective to lessen its intensity.

  What would it be like to be raising children in a war zone, never knowing when explosives may hit our houses? What is life like for refugees who live in tent cities because of civil unrest or natural disasters? Sometimes if I’m in a bad mood and see a news story about how others are forced to live, I turn to my husband and say, “I may be sick, but I am so lucky,” and my bad mood subsides.

  Putting a bad mood into perspective like this can also inspire us to reach out to someone in need. As Kathleen McDonald suggests in the epigraph that begins this chapter: “Use your own problems to remember that others have problems too.” As is the case with the blues, turning our attention away from ourselves and reaching out to others is a skillful way to lessen the intensity of a painful mood.

  I used to worry that a bad mood was the sign of a “new me” — that it was here to stay — but no bad mood has ever taken up permanent residence in my mind. This is because a mood is a mental state that arises due to the coming together of causes and conditions, and those causes and conditions change.

  As with the blues, it’s better not to try and force a bad mood to go away. That kind of command can set up a stubborn resistance in our minds, which invariably makes a bad mood worse. It’s much more effective to disarm the mood by greeting it with friendliness, even though, like the blues, it’s an uninvited guest.

  Then, remembering the impermanent and fleeting nature of all our moods, we can simply let the bad mood be
, while at the same time treating ourselves with compassion over how unpleasant crankiness and irritability feel. Knowing that a bad mood is only a temporary visitor helps us hold it more lightly. We can remind ourselves, “It’s no big deal,” and then patiently wait, without aversion, until it runs its course and passes out of the mind. While we’re waiting, we might do something nice for ourselves, like cuddling a pet or making a favorite hot drink.

  16

  Shedding the Burden of Embarrassment

  You are taught that there is something wrong with you and that you are imperfect. But there isn’t and you’re not.

  — CHERI HUBER

  I SUSPECT THAT EVERYONE reading this knows what it’s like to feel embarrassed. Embarrassment is the awkward self-consciousness that arises when we think we’ve said or done something that makes us look foolish in front of others. Although it differs from shame in that shame can be experienced over something known only to ourselves, like shame, embarrassment carries with it an element of self-blame. It’s a painful emotion because, when we’re embarrassed, we feel intensely uncomfortable with ourselves.

  Embarrassment has two root causes, both of which may be the result of conditioning from early childhood. The first is our tendency to set unrealistically high standards for ourselves and then feel embarrassed when, inevitably, we can’t meet them. The second is our tendency to evaluate ourselves based on what we assume other people are thinking about us. Even though those assumptions are often erroneous, we convince ourselves that we’re not living up to others’ expectations, and this leads us to feel embarrassed.