"Cogito ergo sum: I think, therefore I am."
Descartes used this phrase when discussing his epistemology. Simply put, epistemology is the study of knowledge. Descartes was concerned with how much the human mind was actually capable of knowing. He was concerned that the mind is capable of being deceived, like it is when we're dreaming. He became convinced that there was no way of knowing whether any of our perceptions exist external to ourselves, and that ultimately the only thing a person can know irrefutably is that they exist (since there's no way to think that we don't exist, since something must be doing the thinking in the first place.) From here, Descartes posits that we know that we have perceptual experiences. We don't know the cause for these perceptual experiences (i.e. if an actual computer exists outside of you, of if you're just dreaming it up in your head) but we can't refute the fact that we experience something. So for Descartes, we're only capable of knowing two things: that we exist, and that we perceive. We're absolutely incapable of knowing anything beyond these two irrefutable facts.*
Thinking about pain within the Cartesian perspective helps take a lot of weight off my shoulders. When you understand that your perception doesn't necessarily mirror anything "in the real world" you can begin to accept your body as you feel it. As someone who has struggled for years to get a diagnosis-- I have blood-work which repeatedly shows up clear of inflammatory markers and yet have autoimmune arthritis which plagues me with pain and deformity-- it helps to understand that the act of diagnosis is intrinsically devoid of logic or merit. Whether something shows up on a piece of paper or not, the only things which I can be sure of are the things I experience: joint pain.
Afflixerim ergo sum: I hurt, therefore I am.
I've talked in the past about how to communicate with others about your pain, but it's equally important that you have internal dialogue about how your pain interacts with your perceptions and your life. Pain has a multifaceted influence on your views of the world; the way you look at a sunset, your perspectives on political issues, your viewpoint on your family. While we shouldn't feel guilty or ashamed of these interactions, understanding when and where they occur can help us frame them differently in the future. After spending the last couple weeks with pain that was MUCH higher than normal due to an injury, I've thought of several questions the chronic pain patient should ask themselves about how their perception of pain influences their life.
•Has your pain changed your outlook on life? More realistically, this question should be, "How has pain changed your outlook on life?" It's inevitable. These changes can be both positive and negative. Maybe you always used to be a cup-half-full kind of person, but find yourself looking at things in a more negative light now. Maybe you find yourself more appreciative of the small things in life now, like a nice cup of tea with a friend.
•Who do you see less now that you're in pain? Who do you see more? Why do you think that is? Pain changes relationships. It's not anybody's fault, it just happens. Recognize which people have stepped up and become more supportive, and who has fallen by the wayside. If there are relationships with people you'd like to rekindle, try to recognize why they may have deteriorated in the first place. It's a hard conversation to have with yourself, but so necessary.
•What have you learned from being in pain? I'm a firm believer that each experience we have teaches us something. Pain is no exception. Pain has taught me that I'm capable of surviving much worse than I ever would have thought possible. What has it taught you?
•When do you decide to push yourself despite the pain? When do you know it's time to rest? When dealing with chronic pain, you realize that life must go on. There are days when you have no idea how you're going to make it out of bed, and yet still manage to get yourself to that appointment, feed the kids and gas up the car. Try to identify what it is that drives you on those days, what makes those days different. Oftentimes, it's the urgency-- you can't just skip a Dr's appointment-- and it's okay if the answer is caffeine/adrenaline. It's also important to recognize that pushing yourself isn't always a good answer; it can decrease your actual efficiency and make you feel freakin' rotten. Understand when your body is telling you to rest; try and notice the signs that you're pushing yourself too far.
•Where can you go that helps lessen your pain? Distractions help lessen pain. What places distract you with their beauty, curiosity, or absurdity? Sensory distractions like soft blankets, relaxing music, and scented candles/incense help you experience things other than pain. Find what works for you.
*(Later in his writing, Descartes comes up with a cockamamie idea that we can eventually justify other sensations through the existence of a supremely powerful god... there we diverge in beliefs.)
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