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.

Why is language so trippy?

Have you ever done that thing where you start saying a word over and over and over again until it sounds sort of singsongy and you forget what it even means? When I was little, I used to do this a lot  with random “simple” words, like “awhile” and “because.” Yes, I was apparently born a word nerd. I don’t recommend doing it in public unless you really want to annoy everyone around you, but try it out and you’ll see just how nonsensical and strange words become when you repeat them. Language is trippy, and the unconscious process we have for interpreting language can be fucking weird. Think about how right now, your eyes are automatically scanning the shapes on this screen and making sense of the shapes based on how they are structured and combined with one another. Really, stop reading and think about that…

It’s kind of mind-blowing, right? We have these intricate webs of connections between words and what they represent, and our minds are constantly on autopilot interpreting those connections. It’s the process that lets us communicate with each other, and the reason we can remember something that happened years ago. We do this without being guided to do it. Okay actually, we are guided early on, but it quickly becomes second nature.   While we aren’t born with the ability to read written language, we are born with innate “reading” abilities that then get shaped and developed as ways for us to survive in a language-based world.

Unless you’re a word nerd like me who grew up thinking words and letters were just as fun to play with as Legos and dolls, you probably don’t notice language doing its thing on a regular basis. If you start to think about it and notice yourself thinking in words, and notice the associations you make with whatever the words bring up for you mentally, you get sucked into kind of this “meta” space.

The Lemon Exercise is a great way to illustrate the power of verbal associations and sensory experiences. Close your eyes and picture a lemon.  The bright yellow color of it, the bumpy, textured peel, the round, footballish shape… imagine slicing into it and noticing the way it looks, the pinwheel design with seeds in the middle, picture the juice dripping onto your fingers as you hold a slice, inhaling the fresh, citrusy lemon scent… now imagine yourself putting the slice in your mouth, feeling your mouth salivate as the sweet, tangy tartness of the lemon hits your tongue…

Without the presence of a physical lemon, you can conjure up a “lemon reaction” in your brain and body just by visualizing its properties. If you had never heard the word lemon or seen a lemon, let alone tasted a lemon, it would literally just be a sound to you when you heard the word, and this exercise wouldn’t be possible. That’s why foreign languages sound so, well, foreign (duh); we don’t have any context for interpreting the sounds we’re hearing until we attach a meaning to those sounds. Collectively, we give words meanings, and then based on our life experiences, those meanings become implicitly fine-tuned to the degree that they can even evoke strong reactions inside of us without us realizing it.

What does this have to do with mindfulness? EVERYTHING. I like to use my little repeating game with clients who have a hard time recognizing that thoughts are just words in the brain. Usually, the culprit is a thought along the lines of “I’m worthless/ not good enough/ not smart enough/ can’t do it/ never going to get what I want.” Most of the time, we don’t notice our thoughts because they act like a continuous inner dialogue, our brain’s voice sort of narrating things as we live life. We don’t usually stop to reflect on this narration– we just take it at face value, as a fact of life, and keep going on with our days. This isn’t always a big deal, but it can get messy when our brain’s little narrator voice is saying stuff that’s bullying, judgmental, or not serving us in some other critical way.

When we have a particularly troubling or unpleasant thought, we sometimes get “hooked” on it.  For many of us, it’s usually fears, worries, areas of insecurity, or that growing to-do list. When thoughts of this flavor come up and start to bug us, that’s where the mindful pause is helpful. If you can slow down and go to that trippy “meta” place where you notice yourself interpreting the words your brain is saying to you, you can step away from all of those subconscious associations between words and their meanings and instead see them as just words.

This is an example of what happens when a thought is mindless: the brain-voice says “You look stupid today,” and you instantly, automatically react, sometimes in the form of a flurry of additional thoughts (“ugh, I always look like such a mess,” and “I hope I don’t run into anyone I know”), feelings (self-conscious, embarrassed), and/or memories (of a time when you felt more confident in your appearance, for example).  Here is what happens when a thought is mindful: the brain voice says “You look stupid today,” and we start to react but then notice what we’re doing and SLOW DOWN for a second. Maybe you say back, “that’s an interesting thing to say, brain, what’s up with that?” or maybe “that’s one thought, what’s another one? What else do you have for me?” And see if the brain gives you anything else. If the brain voice doesn’t come up with any new material, we can start to more intentionally repeat it over and over until it loses meaning. If you say “I look stupid” enough times, you realize you’re just saying words, and okay, so what does it really mean then, if the words are true? How can you be SURE? Why do you care? What do you want to DO about it?

As a side note, mindlessness (and mindFULness) applies similarly to how we experience emotions and behaviors, but I will save that little ramble-fest for another time.

Given all of this, that old playground chant of “sticks and stones may break my bones, but words can never hurt me” seems incomplete. Of course words can be hurtful, who are we kidding here? But only in certain contexts.  Stupid is just a word. And words are just sounds that we put together to mean something. But when we slow down, we don’t have to mindlessly go with those meanings. Perhaps we should be teaching kids that sticks and stones may break my bones but words can never hurt me because I choose how much I buy into their intended meaning.  Less catchy, but more accurate! What does your brain-voice say about that?