Accepting “clean pain” and letting go of “dirty pain”

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.

Book Review: “I’m Fine… and Other Lies” by Whitney Cummings

Reading tends to be very “all or nothing” for me—I’m either totally consumed, turning pages for hours on end and ignoring the world around me and internal cues for food or sleep until I’m done, or I’m noncommittal, absent-mindedly skimming paragraphs until I inevitably abandon it to collect dust on my nightstand with all of the other “I’ve been meaning to finish that!” novels. To me, the sign of a good book is not “I can’t put it down until I KNOW what happens!” and it’s not “I’ll finish it eventually, if I have the time.” It’s that healthy middle ground, much like romantic relationships. Neither codependence (“I can’t live without you!”) nor too much independence (“I’m not even interested in connecting with you”) is consistently satisfying.

Perhaps you’ll find it ironic that I was able to enjoy a book about codependency while (for once) maintaining my healthy dependence and independence needs. As a story, it contained just enough psych-y content to appeal to my inner nerd, and just enough comedy to appeal to my inner self-care coach. It was engaging, satisfying, but not so consuming that I lost all ability to stay connected to my own priorities and identity. As far as book-relationships go, “I’m Fine” quickly became a lasting, rewarding love. So I wanted to share the love, by writing my first-ever book review. Here goes!

In case you’re not familiar with her work, Whitney Cummings writes, produces, and does stand-up comedy.  I’ve been a big fan of hers for several years. What’s always endeared her to me is her tendency to “plug” therapy (thanks for the free marketing, girl!) and to use humor as a way of coping with the dysfunctions of the human condition.

A lot of memoir-type books I’ve read have bugged me (and ended up as ex-lovers in the dusty nightstand pile) because the author tries too hard to sound self-actualized, taking on an annoying “wannabe-wise” tone in an effort to artfully conclude the general storyline of “I used to be naïve in how I handled life, and then I overcame some challenges.” Whitney writes like she’s in her 30s, and she is in her 30s. She’s not pretending like she’s 80 years old and has it all figured out, nor is she dwelling in adolescent insecurities. She takes semi-frequent breaks from her “I used to be so clueless” shtick to actually give herself credit for the growth and insights she has worked to gain, but she doesn’t succumb to the urge to tie it up neatly with a happily-ever-after type ending.

Whitney (I can’t bring myself to get formal and call her Ms. Cummings, sorry) demonstrates what happens when someone moves from being a blind, passive recipient of life experiences to being a self-aware, active shaper of her own reality through intentional choices. As a psychologist, I am grateful for her honest account of her experiences with several types of therapies. She also admits several times that she often rejected an idea or treatment approach (especially in her adolescence and early 20’s) because she wasn’t yet ready to have her defenses challenged. THANK YOU FOR OWNING THIS! I get so irritated when people say, “I tried therapy, but it didn’t work for me.” People, it works if you work it! So if someone’s in denial, nothing’s gonna change. Psychologists aren’t psychics or magicians. Though Whitney has apparently tried her hand at consulting psychics and magicians, too, which made for some fascinating early chapters. Anyway, I digress.

I also enjoyed her evaluations of what worked and didn’t work for her in the process of healing from various hurts. After all, mental health treatment is not one-size-fits-all. There are so many theoretical models and approaches out there. Vera, the therapist with whom she ended up finally forming a meaningful therapeutic relationship, sounded like a total badass; she was clinically well-versed, and fluent in Whitney’s language, helping her recognize the “addictive” patterns of her codependency and eating disorders.

Self-acceptance is a major theme in “I’m Fine.” Whitney’s exploration of how she developed and then healed from an eating disorder will hopefully shed light on an often-misunderstood constellation of symptoms, and the unhelpful thinking and mixed messages that are so easily internalized. Her honesty about struggles with “ED” is beyond refreshing. The media masterfully perpetuates an absurd mixed message, glorifying the woman who acts so totally chill and just LOOOVES eating carbs, and yet is constantly pulling up the waistband of her roomy size zero jeans, equating slimness with chillness and worthiness. I have lots to say about this ridiculousness, but I will have to save my rant for another time to stay on topic.

My point is, Whitney doesn’t fall for the BS of mixed messages and she actually talks about the monster life-sucker that is the “quest for physical perfection.” She calls herself out for sometimes buying into a disempowering cultural norm, and gives us all a reality check in the process. Her overall message is that it’s not only allowed, but truly vital for us all to meet our own basic human needs for food, water, love, and self-respect.

Speaking of basic human needs, Whitney also gives a shout-out to “inner-child work,” which is an element of therapy that can be so powerful in developing self-esteem. Basically, the premise is that humans actually age like trees. Remember how they taught us in school about how to tell how old a tree is? When you cut the trunk horizontally, you can see all of the “rings” in its cross-section. Each ring grows around the one within it as the tree ages. We’re like trees; every age contains every previous age within it. If we go down really deep, we’re all housing an inner five-year-old. When there’s a control-type issue (addiction, eating, OCD, perfectionism), it can often be traced to unmet childhood needs, so the inner child is still scrambling to get “adult you’s” attention.

In Whitney’s case, she learned to deny her needs from a young age, so as an adult she only felt in control if she was denying her needs. She learned that this was the only way to be worthy of love and belonging. For example, food is a basic need. Believing it is “bad” or “wrong” to eat is not only self-destructive, it’s downright mean. When she learned to “re-parent” her inner five-year-old, she was able to live more wholly and let go of old insecurities. That’s why I love this framework: most people can get on board with the fact that it’s pretty atrocious to act like an asshole towards a five-year-old. When you start to see that’s what you’ve been doing by self-punishing (forcing yourself to exercise, cursing yourself for eating the extra slice of pizza, forcing yourself to stay at the office till 11pm instead of getting much-needed sleep) you’re more inclined to soften up. A five-year-old doesn’t care about her weight; she just wants to enjoy life. She doesn’t care about your promotion at work; she just wants you to come home and play with her. We can all benefit from the reminder that we’ve each got a little kid living inside of us, just looking for love and acceptance, so we don’t need to be so damn hard on ourselves or each other.

One area left me wanting more: I still have so many questions about the specifics of her childhood. If she had chosen to share more details about what went down in her early childhood, it could have given the reader a richer picture of how her core beliefs were shaped. However, at the end of the day, my insatiable curiosity about the human condition aside, she certainly exposed insecurities and fears that most of us lack the courage to reveal, so I can’t blame her for choosing to gloss over some details. She gave us enough info to connect the dots, and I respect her decision to not be a completely open book. Yeah, pun intended, I couldn’t resist 🙂

I often struggle as a relatively young psychologist with “imposter syndrome,” fantasizing about the day when I’ll feel like an “expert.” Stories like Whitney’s remind me that I actually hope the opposite is true. I hope I never wake up one day thinking I know exactly how to handle things. That would feel robotic. I’m human and therefore I’m a messy work in progress. I struggle to practice what I preach. I get whispers from the demons in my head. I get caught up thinking I need to be “fine,” and thinking it’s my job to make other people “fine” as well, which it’s obviously not. Insecurity and self-doubt are all just part of the deal, and that’s okay.

“I’m Fine” is a hilarious and raw reminder that life gets ten billion times more rewarding when you stop pretending to be fine. I hope this book will serve as an example of the awesomeness that can come from authenticity, owning your shit, and opening up about mental health struggles. If you read it and want to share your reactions, please feel free to do so in the comments below! Oh, and if this book made you realize you’re not “fine” or it inspired you to seek therapy, I’m here for that, too.

New Year, Same Fear (Part 2)

In honor of the New Year, I’ve been reflecting on the passage of time and the ways that time becomes distorted by our perceptions. In my last post, I talked about some of the ways we (humans) unintentionally (yet oftentimes, very determinedly) keep ourselves feeling stuck. The key to freeing ourselves from our “control agendas” is acceptance.  So Part One was about how we are all, to some degree, plagued by avoidance, and Part Two is about swallowing its antidote, acceptance.

“Acceptance” means making space for all of the feelings and experiences that are natural parts of life, without trying to change them or make them go away. It means opening up to the feelings of fear that naturally arise. It means acknowledging that we can’t predict the future or change the past. It means owning that we are imperfect and messy. It means that we will sometimes feel rejected, inadequate, or unlovable, and it means that we are REAL and ALIVE. It takes courage to practice acceptance, because you have to be willing to sometimes feel like crap.   Perhaps you already try to do this, or perhaps you think it’s a load of BS. After all, why would you choose to “just feel crappy?” Keep in mind that you don’t have to want, enjoy, or welcome an emotion in order to be willing to have it.

The idea is that our efforts to change or fix the “problem” of unpleasant emotions only serve to amplify and intensify those emotions. If I hate broccoli, I can choose not to buy it at the grocery store and refrain from ordering it on a menu. That’s a great way to deal with the problem of “I hate broccoli,” because broccoli is an external stimulus. If I hate feeling guilt, I might try applying the same strategies that solved my “I hate broccoli” problem to the “I hate guilt” problem, by trying to make the guilt go away. Clearly, this does not work, because guilt is a transient and subjective internal experience, rather than a concrete, external object. We naturally try to solve our internal problems in the same ways we solve our external problems, but the strategies that are successful in the external world are pretty ineffective when applied to the internal world. Our efforts can get discouraging and just plain exhausting. Acceptance is about letting go of the struggle to “fix” everything, and learning to see what’s inside of ourselves not as “things that need fixing,” but just as “things that are there.”

What gets in the way, usually, is fear. Fear that if I let myself feel the joy of a new relationship, I’ll be vulnerable to more sadness and disappointment if it doesn’t work out. Fear that if I let myself feel worried or scared or cry, I won’t be able to handle it. I will sink into crappy feelings that will last forever, and it will be awful. The man who felt anxious at work had a bunch of different choices in how he related to his anxiety. One choice, besides drinking, would have been to feel his anxiety, say to himself “I’m feeling anxious,” and still go to work and survive his day. He just didn’t realize that letting himself be uncomfortable without trying to make the discomfort go away was even an option, because he was caught in what Tara Brach calls “the trance of fear.” The trance of fear is what sends us into problem-solving mode, and it can happen so quickly that we don’t even know we’re doing it. As a therapist, I’ve seen this time and time again, and in my own life, I’ve experienced it time and time again. It’s in our nature as humans to want to change, fix, or solve things we don’t like. We like to control, but it is our very efforts to control that draw us into struggle and suffering.

What’s so fulfilling about accepting all of the yucky stuff going on within ourselves instead of trying to make it go away (and yes, “yucky stuff” is the clinical term) is that it makes more space for the full spectrum of emotions to exist. Life includes pain, insecurity, and self-doubt, but inevitably, it also includes the pleasant and pleasurable, the warm and joyful, the loving and compassionate.

It is NOT easy to practice leaning in to the full spectrum of emotional experiences. When we get stuck, we can take comfort in the fact that we are working through what is a natural human process, because it means that we never have to walk the journey alone.

If you find yourself needing support in your efforts to open up to in fear in 2016, I may be able to help. Call or email me and we can work together toward a greater sense of support and balance.