A few winters ago, I broke my toe when I rammed it into the corner of my couch. I knew I had injured it, but promptly went into denial. I ignored it for a few days, walking on it, exercising, jamming my feet into snow boots (gotta love Chicago winters), till the swelling and pain became so excruciating that I could hardly walk. I got it checked out and was given one of those open-toed orthopedic shoes to wear. Turned out, I had probably started off with a small fracture but made it worse by continuing to bear weight, jump, run, kick, etc.
I was PISSED. I would stew on how pissed I was as I hobbled down the street, furious and impatient with myself for taking twenty minutes to walk a mere two blocks. I griped about having to “waste” money on cabs and bus fare for distances I normally could walk. I cried with frustration about not getting to exercise or do yoga, and I felt SUPER antsy. I cursed my body for failing me and cursed myself for being such a klutz. I went back over the scene of crime dozens of times, each time agonizing over how I “should have” been more cautious, should be more coordinated, should be smarter. The thoughts in my brain made me feel like a total idiot for messing up the simple act of walking across a room. I have a tendency to be pretty harsh towards myself. After all, in the scheme of things, it was just a few weeks of my life where I was inconvenienced while healing an injury.
Reflecting on that incident, I can see just how silly and irrational all of those nasty thoughts were at the time. But that didn’t stop my brain from giving me all of that BS. If you’re a fellow human, you can probably relate to the feeling of RAGING against yourself when you make a mistake or get hurt. Maybe you can relate to raging against your body for experiencing pain at an “inconvenient” time. Have you ever been upset that you got sick right before a big event and had to miss it? Or run outside to catch the bus, only to see it pulling away, then started cursing everyone and everything for your bad luck? Or guilted yourself for getting upset at something that “isn’t a big deal?” We’ve all been there.
In Acceptance and Commitment Therapy (ACT), this is explained by the concepts of “Clean Pain” and “Dirty Pain.” Clean pain is natural. Pain is a part of being human. We fall and scrape a knee, and it hurts. We get broken up with, and the rejection hurts. A pet or a loved one passes away, and it hurts. The fact that these experiences naturally create pain is not BAD or WRONG. It’s just an inevitable part of life. Clean pain is any pain that arises from the experiences we have as humans moving through the world.
So to recap: we experience pain, and there’s nothing we can do to change this fact. However, us humans like to be TOTALLY IN CONTROL of everything, everywhere, all of the time. So we get upset when pain happens because it reminds us that there are things we can’t control. We naturally fight against our pain, either by getting caught up in thoughts about how it’s NOT FAIR that we are dealing with pain, or looking for someone or something to blame for it happening. We get stuck in beliefs about how it is BAD or WRONG that the pain happened. We beat ourselves up for being human (e.g., when that bully in your brain starts saying stuff like “I’m so stupid! I’m such a failure. I’m never gonna get it right. I’m overreacting. Other people have it much worse than me. This is really not a big deal at all. It’s ridiculous that I’m upset by this”). Or we blame others for causing us pain, and we stew on feelings of resentment or even hatred (“How could he do this? Who does she think she is? He only cares about himself. Why do they keep screwing me over? I hope he gets his heart broken”). We get sucked into feelings of anger, frustration, shame, impatience, sadness, and hopelessness. We look for ways to “solve” the pain, by numbing out through drinking or drugs, making efforts to control our bodies and minds through self-harm, restricting, binge-eating, purging, and exercising, ignoring or distorting reality, or trying to avoid any situation we think might cause us more pain. Does any of this sound familiar to you?
When pain happens, we try to comfort ourselves by looking for ways to prevent future pain. We try to regain that false sense of being “totally in control” of everything. Our brains don’t think we “should” experience pain, so we treat it as something “wrong” with us or consider ourselves “weak” (especially if the pain comes in the form of a difficult emotion that we were taught we should not have). These responses to “clean pain” are examples of what’s called “dirty pain.” Dirty pain is any reaction to clean pain that we inadvertently create, like beating ourselves up mentally for being so clumsy, ignoring an injury and making it worse, or self-sabotaging in our next relationship out of fear of getting hurt again.
If you’re familiar with my whole philosophy on human experience, you know that I talk a lot about how we can’t control what thoughts or feelings arise in us. So you might be wondering, “If we can’t control what we think about or how we feel, how can we ‘stop’ our unhelpful reactions to pain?” That’s a fair question, and a good point. We can’t stop the thoughts or feelings from popping up, but we CAN start seeing them for what they truly are: unhelpful reactions (often in the form of commentary from that “bully” voice inside our brains). That bully or inner critic has a field day every time something unwanted happens to us.
The key to dealing with those dirty pain reactions is to practice acceptance. Acceptance doesn’t mean you like, want, enjoy, or welcome something. After all, who WANTS to feel grief and sadness when they suffer a loss? Acceptance just means we are allowing something to be a part of our current reality. It means we are willing to tolerate something uncomfortable, painful, or unpleasant for the sake of getting to be alive. Accepting clean pain helps us to disengage from the dirty pain, and as a result, the clean pain naturally feels a little less “painful.” It becomes a little less intense and overpowering. The key though is that you have to stop trying to make the clean pain go away in order for this to work, which can be tricky.
In numerous research studies, when folks with chronic pain learn to practice mindfulness and acceptance, they become more functional and they experience their pain as subjectively less distressing and less intense than it was before they accepted it. The SAME pain felt LESS painful because they changed their relationship to the pain. Cool, right? (Click here to check out a randomized controlled trial on ACT with pediatric pain, and click here or here for some correlational studies).
When I work with people on clean/ dirty pain, we talk about all of the ways they’ve tried to control or avoid certain internal experiences (thoughts, feelings, memories, sensations, or physiological pain) and how each strategy has worked for them. Often, people realize that they’ve spent so much energy trying to make pain go away or trying to make sure they never experience a certain type of pain (like rejection or embarrassment) that it’s taken over their lives and has become a central focus. Learning to let go of efforts to control or prevent pain can be challenging (it means you have to FEEL the pain, which can be pretty intense or uncomfortable), but the trade-off is that you gain freedom. When you accept that “it is what it is,” you allow yourself to invest your energy into things that will actually have a payoff. It takes practice, but through mindfulness and acceptance, you learn to have a different type of relationship with pain.
That winter with my broken toe, what helped me let go of the “dirty pain” was gratitude. I realized how much I took for granted the fact that I had ten functional toes that supported me every day, and allowed me to balance and move my body with ease. I realized how lucky I was to only be inconvenienced for a couple of months, when plenty of people have injuries far more debilitating and permanent. I tried to challenge my restlessness by finding moments of joy in stillness, and exploring other forms of meditation instead of my preferred physical activities. I challenged thoughts from my inner bully that were urging me to ignore hunger cues or change my eating behaviors to “compensate” for being more sedentary than usual. I listened to my body’s cues and forgave myself for being human. None of these responses were my natural, instinctive reactions, but I got there eventually.
Nobody is perfect, and even the most mindful and self-aware people will struggle at times to let go of their “dirty pain.” Be patient with yourself and with others. Remember that I am always here to help you strengthen that mindfulness muscle and would be honored to join you in your journey towards acceptance.