Living Amidst Pain and Suffering: Lessons from ACT

August 8, 2022

The Jewish Psychiatrist and author of Man’s Search for Meaning, Victor Frankl, distinguished between what we may call two levels of pain and suffering. In any experience of suffering there is the original painful experience or suffering and the subsequent distress or despair that arises because of the individual’s attitude toward the painful experience. Frankl theorized that meaning was central to the experience of growth amidst suffering. He then verified through his own experiences in a Nazi concentration camp that individuals who find meaning amidst their suffering survived while those who could not often invest their suffering with meaning fell into despair and did not survive the camps. Subsequent work in humanistic and existential psychology has uncovered some of the inner mechanisms for this meaning-making process.

Drawing upon ideas from Acceptance Commitment Therapy (ACT), we may describe the difference between pain/suffering and distress/despair this way. Pain is ubiquitous. All human beings feel pain as a natural part of living as organisms capable of language. If we use the terms or distress/despair to refer to one’s relationship to pain, then an interesting idea emerges.

A central feature of distress is a rejecting or avoidant relationship with pain. We despair to the extent we are at war with our own experiences of pain. Our own efforts to escape from or eliminate pain only exacerbate the problem. First, eliminating pain is futile and such efforts create frustration. Second, avoidance itself creates additional sources of pain. A fearful situation or thought or behavior becomes increasingly more so precisely because of the avoidant behavior. Consequently we now have the original pain AND additional frustration or anxiety about the pain.

Using the metaphor of quicksand, the authors of ACT recommend that we stop fighting. The efforts one makes to escape quicksand cause one to sink faster. In the words of the computer in the film War Games, the only way to win is not to play.

This does not mean resigning ourselves to eternal suffering. Rather, we are invited to accept the fact of pain in order to decrease our suffering. Also, it does not mean rejecting all attempts to reduce pain. It does not mean throwing out the pain relievers or anti-anxiety meds. Rather, we are invited to withdraw from the battlefield so that we can go on living. Often enough it is in the process of living a valued life that we can best manage, reduce or remove pain.

It’s all in the attitude we adopt toward pain and the relationship we have with our own experience. They keys to that new relationship are two-fold. First, a parent correcting a child strives to correct behavior without rejecting the individual. So we may seek to change the intensity or occurrence of pain without rejecting the experience, which is after all part of ourselves. Second, a loving intervention is one that offers help without trying to control the outcome. Outcomes are things over which we have limited if any control and, when dealing with human beings, to be overly controlling is to deny human freedom. So we may gently and lovingly seek to reduce the experience of pain without acting in an aggressive or overly controlling manner. Our gentler efforts may be successful or they may not. If they are, great. If they are not, then we are just left with the pain but maintain the capacity to go on living. Our more aggressive efforts however will likely not succeed, and in addition to the original pain we have added the frustration, anger, resentment or despair that comes with trying to control things we cannot.

If, adopting the gentler approach, we can allow the experience of pain to be there, we can also maintain awareness and connection with other pleasant or meaningful aspects our present world. This puts the painful aspect in a bigger context. This sadness or anxiety is not the whole of me. I am much more than this uncomfortable experience. We can also allow the experience of pain to enter into the flow of time or stream of conscious living. This puts the pain in a narrative context in which the discomfort may be relativized by more pleasant or meaningful or higher goals or values. Either way, the pain looses it’s sting, if you will.

There are two principles underlying this analysis of pain and distress: cognitive fusion and experience avoidance. We are fused to our ideas and feelings when they dominate conscious awareness and take up so much space that we feel identified with the thought or feeling. In this sense we take them literally and give way to a form of magical thinking. We commonly experience the tendency to take thoughts and feelings literally when we verbalize an idea and then feel an urge to knock on wood or toss salt over a shoulder. A baseball commentator may be appalled at the idea of mentioning in the seventh inning that a pitcher has so far thrown a no hitter, as if uttering the phrase will somehow affect the outcome. At the level of immediate experience, the experience for instance of a very small child, thoughts and things are not yet differentiated. The realities toward which thoughts and feelings intend are identified with the thoughts and feelings themselves. With the advent of language, children begin to differentiate or discover the difference between words by which we mean something about the world independent of us and the objects in that independent world. The child learns that thoughts can be about objects that are not present. We can intend objects that are past, future or imaginary. The acts or operations of thinking and feeling are not identical to the reality of the objects intended by those operations. Even in adulthood there is some more or less subtle pull in the direction of this primitive form of immediacy, as evidenced in the hesitancy to call attention to a possible no-hitter.

Experiential avoidance refers to a subsequent flight from experience. Fusion generates anxiety. If my thoughts and feelings are my reality, then it becomes necessary to either control my thoughts and feelings in order to gain control over my world or avoid or suppress those thoughts and feelings in order to prevent them from structuring or influencing my world. Experiential avoidance refers to any effort to reduce or avoid unwanted or uncomfortable experiences. It is one thing for a commentator to try to avoid talking or even thinking about the no-hitter, is quite another for the pitcher to try to do so. The effort to try not to think about something is doomed to failure. Quite simply, I give myself the instruction, “Don’t think about a no-hitter”, I must paradoxically keep the idea of a no-hitter in mind if only to check to see whether I have succeeded in not thinking about the proscribed phrase. Flight from experience is likewise entangled in a paradox. “How far am I from the-experience-which-I-shall-not-name?” I must also be vigilant about signals, cues, or triggers in the environment that might evoke in me the forbidden thought or banished feeling. “If I agree to go to the concert, what if somebody says or does something that causes me to experience that-which-shall-not-be-named?”

The way forward is through wisdom and acceptance. Wisdom notices and respects the differentiation between immediate experience and the objective world. Acceptance allows experience to be what it is, not a copy of or cause of things in the world independent of me, but a flow of bodily and psychological events that occur for a myriad of reasons of their own and that have little to do with the course and meaning of my life. The course, meaning, value, goal of my life puts into perspective uncomfortable experiences. The pitcher who is not afraid of or controlled by thoughts and feelings about his or her own performance is free to get on with the business of playing the game. Let them come; they are not relevant to the work I am intending to do right now.

That the flight from experience is antithetical to subjectively meaningful living is the common wisdom of psychology and psychotherapy. The way forward is commonly formulated as acceptance of experience for the sake of change. Why this is so is a very big question. We may at present know more about how avoidance prevents change than we do about how exactly acceptance promotes change. For many people finding answers to these questions is not half as important as just getting unstuck. But if you are interested, stay tuned.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s