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With a Master of Fine Arts in Creative Nonfiction degree (Goucher College, August 2014), I am looking at a new phase in my life. From 1992 to 2009, I served as Founding Executive Director of Miriam's House, a residence for homeless women living with AIDS. I left this position when Chronic Migraine Disease overtook my ability to do my job. Now I hope that a writing career will both accommodate the migraines and give me a creative, productive outlet. And soon, September 4, I will launch my Inkshares author page in a bid to hit the 1,000 pre-order goal in 90  days. The book I want to publish is "Nowhere Else I Want to Be," a memoir of ten of my years at Miriam's House.

25 April 2012

Accept and Bear Reality: Five Stages of Grief

One last post about Kubler-Ross' Five Stages of Grief before I return to my current series on Eckhart Tolle's The Power of Now.   My previous post discussed how I relate the theme of accepting and bearing reality to the Five Stages: denial, anger, bargaining, depression, acceptance.  But theory and discussion can be nothing short of maddening when we are in pain.  So, today I want to get to some practicalities of pain management in the context of the Five Stages, or the grief model

FIRST: There is no shame in bobbing around in the lake of emotions that accompany chronic pain.  We do not have to become worried and upset when currents of depression overtake us just as we were sure we were ready to quietly tread the calm water of acceptance.  But that is enough of the water metaphor.

Without shame and without worrying about what is wrong with me?, we understand and accept that the Five Stages are not fixed, but are fluid (hence the overwrought water image of the preceding paragraph).  I discussed this in an earlier post

SECOND: Shame, worry and low self-esteem being cast aside -- if only for the moment -- we are able to simply admit where we are Now.  We have studied and understood and felt some relief about the Five Stages; now they are helping us to listen to our emotions and thoughts without judgment:

"Ugh...so depressed today I don't want to get out of bed." **  "#^&% this pain." **  "Well, if I just skip my exercises/medications/diet this once, I should be okay.  I deserve some fun."  **  "Here is the pain, today.  Breathe deeply and relax."

THIRD: Having accepted our reality, we can turn to the pain management tools we have learned, and about which I have posted before (use the Labels list in the right-hand column, click on breathing, methods, meditation, relaxation and tools and you will be directed to these posts).  I have always found that pain management practices are more effective when I have accepted where I am in the moment.  Emotions like anger or depression, mental gymnastics like bargaining with life only distract me from the task at hand: to deal directly and honestly with both my emotional and physical pain.

To summarize: I find the Five Stages useful as a preparation for settling into pain management practices like deep breathing, meditation, deep muscle relaxation, and others.  Seeing our all-too-human tendencies to pop between stages as inevitable, understanding what each stage means for our pain, and thus being able to go beyond it gets us closer to accepting and bearing our reality.

Next post, back to the Eckhart Tolle Power of Now series.

I would love to hear from you.  Please use the Comment link below, or email me at carold.marsh@gmail.com.  Thank you.

20 April 2012

Elizabeth Kubler-Ross' Five Stages of Grief and Pain Management

In my previous post, I discussed how Elizabeth Kubler-Ross' Five Stages of Grief might be applied to living with chronic pain.  Specifically -- and in conjunction with my current series on Eckhart Tolle and his book, The Power of Now -- how this model might be of use in helping us come to the point of accepting and bearing our reality.

The first step is to see the relevance of Kubler-Ross' teachings to living the life of chronic pain.  They help us name and acknowledge our natural emotions.  In this discussion of the Stages, you will notice that I am not giving examples of each one, but instead examining how they relate to my theme, accepting and bearing reality.

1. DENIAL: We all have times when we pretend the pain is not affecting us physically, mentally and emotionally, and spiritually as much as it is.  This leads us to keep working (as I did) long after we have lost our effectiveness; to act as if our mental faculties are not affected by the pain and thus to make poor decisions for ourselves and others; to die a small spiritual death because we have not understood the toll denial takes on our spirits.

2. ANGER: If we do not allow our anger to surface to our awareness in order to be dealt with, it's inevitably going to come out in other ways.  And thus cause us stress: "In terms of physical health, it doesn't matter if you tend to lash out in rage or repress your anger."  Without going into all of the ways that lashing out and repressing affect our health, let's just say that unless we are honest about our anger and willing to assess its affect on us, we are raising our stress levels and making our health -- and thus, our pain -- worse.

3. BARGAINING: For me, bargaining has affected my ability to accept and bear the reality of living with chronic pain by making it harder for me to keep to practices I know are good for me.  I say to myself: "I have been strict in my diet and so confined for the past months: I can just drink this glass of wine for once."  But the glass of wine does not really help me to feel better, and often enough there soon comes a migraine because of it.  It's the same with certain foods I know I should not eat: fresh, warm yeast bread, for example.  "Just this once," becomes a day in bed with the blindfold on.

4. DEPRESSION: One of the side effects of many medications is depression -- it also is reality for anyone living with chronic pain.  Compounding the difficulty is that other therapies for depression -- such as exercise, a regular sleep schedule, get out with friends -- are made problematic or even impossible by our chronic pain.  We lose perspective, we retreat, we have no ability to see the beauty or joy in life.  Even writing about it is depressing. 

5. ACCEPTANCE: It is important to honestly, and with just the appropriate amount of whining, admit that pain has taken a good deal away from us.  We have died many little deaths in our relationships, our inability to hold a career, and greatly restricted lives, even aside from the sheer physical misery of chronic pain.  To accept these hard truths as facts of our lives keeps us out of what I call "victim mode", which is its own small death in and of itself.  With acceptance, we regain control.  We can choose whether or not to wallow in self-pity.  We can learn how far we can go before we have stepped over the line between healthy honesty and unhealthy self-pity.

Okay, so this post is a quick assessment of what the Five Stages might look like for someone with chronic pain.  In my next post, I will take the discussion further into more constructive, practical tools.

I would love to hear from you.  Please use the Comment link below, or email me at carold.marsh@gmail.com  Thank you.


14 April 2012

Chronic Pain and Kubler-Ross' Five Stages of Grief

In my previous post, I wrote my way into an idea for this post while discussing acknowledging and allowing our feelings.  The idea is to relate our feelings about chronic pain to Elizabeth Kubler-Ross' Five Stages of Grief.  It has been explored before, here, here, and here, for example, but I found that I wanted more out of the discussions, so this is my attempt to add to what is already out there.

To begin, these are the Kubler-Ross Five Stages of Grief:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Kubler-Ross said that these stages are fluid:

"Also known as the ‘grief cycle’, it is important to bear in mind that K├╝bler-Ross did not intend this to be a rigid series of sequential or uniformly timed steps. It’s not a process as such, it’s a model or a framework. There is a subtle difference: a process implies something quite fixed and consistent; a model is less specific – more of a shape or guide." (from the Elizabeth Kubler-Ross Foundation website)

There is enough information available at the click of a mouse that I do not need to go into basics about the Grief Cycle.  Using the links in the paragraphs above will get you good, basic information if you want it.

So, what about this Grief Cycle vis-a-vis the life of chronic pain?  It's different than grieving the death of a loved one because death is its own closure.  Like all humans, I have grieved death of loved ones.  But, like fewer of us, I have also grieved the debilitating presence of pain as well as the life changes it causes.  So I am going to make a comparison, but I am in no way saying that one kind of grief is worse or more noteworthy than another.  I just want to explore the grief cycle and the concept of closure together, as a way to enter into a discussion about the Five Stages model and chronic pain.

There is no closure with chronic pain: we cycle through bad days and not-so-bad days and celebrate the occasional good day; we try new medications or alternative therapies that do not deliver as promised; we hope for cure and suffer the inevitable disappointment.  Chronic pain doesn't die, obviously.  Its sneaky, beady little eyes peek out from behind every bit of relief we might find, assessing the optimal moment to pop up and smack us upside the head yet one more time.

When a loved one dies, there comes a point at which we are able to take comfort in the knowledge that the knife-edge of our suffering will be blunted.  (Others often try to force or coerce us to this point with well-meaning but maddening phrases like, "you'll feel better after a while," but that is another topic.)  Although we will never forget, never lose that core of sorrow, the intensity of our grieving will change, becoming more and more bearable.

The question is, how do we use the Five Stages when what we are grieving is an endless cycle?  The pain does not naturally, over time, become more bearable.  (It strikes me as I write this that there are other instances of endless grief: the disappearance of a child and the MIA soldier, for example.  Frankly, I would rather have chronic pain, the hell of that sort of limbo being unimaginable to me.)

Interestingly enough, I come, unexpectedly yet quite organically, back to one of the discussion points in my current series on Eckhart Tolle and his book, The Power of Now

This endless cycle of pain has one redeeming feature: it affords us the opportunity to come to terms with it and thus to accept and bear the reality of our lives.  It teaches us that what we can control is our reaction to the pain. 

In my next post, I will go further and more practically -- meaning less theory and more tools -- into the uses of the Five Stages of Grief in helping us come to the point of accepting and bearing our reality.

I would love to hear from you.  Please use the Comment link below, or email me at carold.marsh@gmail.com.  Thank you.

11 April 2012

Reading "The Power of Now": The One Thing I Can Control

Seventeenth in a series

After we have taken our medication, followed our physician's instructions as to diet, exercise and other life style changes, researched (what did we do before the internet?) all the ins and outs of our painful condition, and listened patiently to all the well-meaning advice from others who do not suffer as we do ("Just take an Advil."), what if the pain is still there?  What if everything we do has only minimal, if any, effect?

It's depressing, upsetting, frustrating and maddening to do everything right and still be in pain.  We tend to feel like failures.  We blame ourselves when we are not blaming modern medicine, our physicians, or the Fickle Finger of Fate.  We turn to food, alcohol, drugs for relief.  We mourn the loss of independence, careers, social lives. 

All this is natural.  In my own experience, I find that acknowledging and allowing those feelings is an necessary part of the process of coming to terms with a life of chronic pain.  In a way, it's like the Elizabeth Kubler-Ross stages of grief: denial, anger, bargaining, depression, acceptance.  As a matter of fact, that's a great blog post: working with these stages of grief vis-a-vis our lives of chronic pain.  But that will be for next time.

Today, I just want to refer to a sentence from my previous post:

"I bring my attention to [the pain].  I explore it, feel it. Somehow, that takes its power away. Not that the pain recedes automatically, but that I control how I relate to it."

"...I control how I relate to it."  Really, what control do any of us -- pain-free or pain-full -- have in our lives, aside from what our delusional, wishful thinking tries to convince us we have?  We have control over how we react and relate to the circumstances and situations that life brings us.  For those of us with chronic pain, that means we only have control over how we relate to our pain.

I have blogged before about the practice of exploring pain as a pain management tool.  This is one of the ways I control how I react to the pain.  Granted, I often take time for a bit of whining before I get to the actual practice, although I feel better if I keep the whining to a minimum.  But having exercised some authority over the situation of my pain by deliberately and consciously turning my attention to it rather than running away from it, I have rejected the victim role so easily assumed, I have taken control over myself, my Self: ultimately, as I said above, the only control any of us have.

Here is how Eckhart Tolle teaches us to be in the Now.  These are suggestions and skills that apply to pain management as well, so I include this quote from page 63 of The Power of Now as a way to close this post:

"Use your senses fully.  Be where you are.  Look around.  Just look, don't interpret.  See the light, shape, colors textures.  Be aware of the silent presence of each thing. Be aware of the space that allows everything to be."

In exploring your pain, use your senses fully.  Be where you are - look around at the room you are in, feel the bed or chair beneath you, breathe slowly.  Look around without allowing the irritation of the pain, the frustration of your situation, to take you into negative thinking.  Let yourself see beyond the pain to the light, shapes, colors and textures.  Let your body feel beyond the pain to its own silent, peaceful presence and let that feeling expand: this is the space within.  That feeling of spaciousness is the context in which to explore and be present to your pain.

That feeling of spaciousness is your spirit's ability to relegate the pain to its proper place: not in control.  That feeling of spaciousness is your doorway to allowing you to choose how you relate to the pain: in control of your Self.

You cannot do any better than that.

I would love to hear from you.  Please use the Comment link below, or email me at carold.marsh@gmail.com.  Thank you.

06 April 2012

"The Power of Now" and Pain: Make Some Room

Sixteenth in a series.

In this post I want to dig into the following sentence from my previous post:

"When we are focused on our pain, making it an emotional and mental problem in addition to it being physically distressing, "there is no room for anything new to enter, no room for a solution. So whenever you can, make some room, create some space, so that you find the life underneath your life situation." (page 63, The Power of Now by Eckhart Tolle)

That phrase -- "make some room" -- speaks to me today.  I awoke at 3:30am with a migraine that I treated with medication, a cup of tea and homemade muffin.  What I am thinking now ( a bit fuzzily, due to the after effects of the migraine and the side effects of the medication), is that such homey little rituals, these small comfort measures, are one of the ways I have learned to make some space around my pain.

I like to revert to simple, practical tools and methods after several posts that are mostly discussion and theory, so today I'm making a list. 

These are the things I do to make some room around my pain; they help me "find the life" underneath my life situation.  Most of these things I have posted about before: you can find links to these posts in the column to the left by clicking on these tags: methods, tools, relaxation, inhabit the body.

I do love a good list.  This one provides several examples of how I make some room around my pain.
  1. I have already mentioned the cup of tea and a homemade muffin.  Scones and biscuits do just as well.  These comfort measures make room around the pain by doing for myself what my mother used to do for me when I first began getting migraines at age 13.  I feel nurtured, cared for, and that I am doing it for myself keeps me out of victim mode.
  2. As counter-intuitive as it may seem, the idea is not to flee from or deny the physical pain.  The idea is to inhabit it, befriend it.  Having offered myself some comfort and felt the space begin to open around the pain, I bring my attention to it.  I explore it, feel it.  Somehow, that takes its power away.  Not that the pain recedes automatically, but that I control how I relate to it.
  3. Another way to befriend the pain is to breathe into it.  There is nothing so common, so commonly taken for granted, and yet so wonderful for our spiritual health as is breathing.  I have posted often about this practice; use the column at the left and click on the label, breathing.
  4. Meditation and deep relaxation are the best for creating space around pain.  Yet a migraine robs me of my ability to concentrate, sort of a requisite for meditation.  Thank goodness, there are plenty of CDs out there with guided meditations, relaxing music and the like.  Look at all the examples here (guided meditation) and here (meditation music).

That's all for today.  It's time for another cup of tea.  And perhaps a muffin.

I would love to hear from you.  Please use the Comment box below, or email me at carold.marsh@gmail.com.  Thank you.

02 April 2012

"The Power of Now" and Pain: Exercising our Power

Fifteenth in a series.

In my previous post, I said this:

Our life circumstance, chronic pain, can become a doorway to our spiritual enlightenment. We can choose to let our pain teach us to live in the Now, to open our hearts to reality, to show us the freedom of accepting what is. And all of the spiritual teachers I know say that this is the path to inner peace, to a loving heart, and to becoming a compassionate presence in this hurting world.

It took me a while to take it in, but the distinction that Eckhart Tolle makes between one's life circumstance and one's life is edifying.  Here is how it goes for those of us with chronic pain (in the list below, I am paraphrasing from The Power of Now, page 62-63):

  1. Our life is different from our life circumstance (or life situation).
  2. That means that our life is different from the suffering of chronic pain, which is a situation or circumstance of our life.
  3. Our life is Now: our suffering exists in time in that we pile what Tolle calls "mind stuff" on top of the physical pain.
  4. Our life is real: our situation, which is to say our suffering, is created in our mind and as such is unreal.
  5. When we are focused on our pain, making it an emotional and mental problem in addition to it being physically distressing, "there is no room for anything new to enter, no room for a solution.  So whenever you can, make some room, create some space, so that you find the life underneath your life situation." (page 63)
These concepts are not to be understood intellectually, and Tolle stresses this in his Introduction when he says, "Don't read with the mind only."  (page 7)  There is some danger in me trying to express these things in my clumsy way, and so I again urge you to read the book.  I do not claim to be a Tolle expert who can speak for him or get you to understand what he is saying.  My sole purpose is to explore and share how Tolle's teachings have helped me both spiritually and in living with chronic pain.

In my next post (this one is short because of this migraine), I will get to some practical methods for bringing these teachings into the life of chronic pain.

I would love to hear from you.  Please use the Comment link below, or email me at carold.marsh@gmail.com.  Thank you.