Shame and Chronic Pain
This post assesses what is possible when we get stuck in an accumulation of shame (and fear), two very difficult emotions. It attempts to put into words some of the complications that come with living in and embodying the combination of the two at an extreme intensity. Shame is framed here as subjective, interior, individual, and personal (as emotion), as well as exterior, collective, socio-political and contagious (as affect). It asks, what does it mean for certain people to live in chronic pain when they are framed by society as shameful? If shame is felt as physical pain, we have to start reframing how and to who, we project it. Because what this means is that we are forcing certain people to hold our collective pain which they experience as physical pain, even when the pain is emotional distress. Almost always, these are people already overburdened by pain and stress in their everyday lives. They are the most likely to become sick or die due to health complications. Not always due to any fault of their own, but mostly because of the way the game was set up against them. By game I mean, life.
What is not spoken about enough is how coming into consciousness, “doing better”, raising our vibrations, transforming and ascending, these processes and practices are extremely painful, and for the reason that they strike immense shame in and around us.
Assessing what activist Angela Davis identifies as ‘the state in me’ was a gruesome process. Finding commonality with that which oppresses me was painful. Frantz Fanon (1965) shared that decolonization would be violent and that it had to be because colonization itself was violent. I just never realized how much of it would play out in my mind-body. How much violence would express itself as shame, and just how painful shame reads to the body already living with and in chronic pain.
Shame is painful. We have to stop underestimating this fact. And it is a fact. Other researchers like Melissa Harris-Perry, Brené Brown, Elspeth Probyn, and Jennifer Biddle speak of shame as a painful encounter.
I was not anticipating that self-reflexivity would be felt in such agonizing ways physiologically and at the somatic level. I hadn’t expected it to reach so deep into my bones. I hadn’t prepared for shames’ intensities to be so stressful that it altered chemicals and hormones in my body. That it could contribute to more neurodiversity (is that a thing?), changes that subsequently impacted my mental health.
The emphasis here was on what shame and fear do to the mind-body. Of particular interest is how contagious shame and the intensities of fear intertwined with it push the mind-body beyond thresholds, resulting in pain and discomfort that play out on and in the body as chronic pain.
I ask: How do experiences of chronic pain that go un-diagnosed or that are difficult to diagnose get read as delusion/al. How does this influence how extra/multi/ and hyper-sensory feminists perceive and make sense of these challenging emotions. What are the stories we make up and tell ourselves about shame and fear, and how does this amplify our pain?
While it is easier to make sense of chronic pain as physically painful, emotional pain associated with shame is not always conceptualized as such. Yet, shame is felt as agonizingly painful psycho-somatically. Perhaps more than any other emotion, shame (and the fear associated with it) “hits close to the boneConstant interaction with what Sara Ahmed calls, unhappy objects, like shame and fear can come at a cost for feminists who accumulate them the most.
As Brené Brown (2011) identifies, shame is “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging” (n.p.). For Melissa Harris-Perry (2011), “shame is among the most physically painful human emotions because it cuts to the core of one’s sense of self-worth [through] repeated acts of misrecognition” (120;107).
We frame emotions as soft and weak, but shame is no joke. It doesn’t play around. It will eventually drag you to your grave if you avoid sorting it out. This is not hyperbole, though an extreme exaggeration.
At the psychosomatic, physiological, and physical levels, shame is embodied as a warm sensation, a heat that envelopes the body. A build-up of excess shame can result in health complications. Energetically, it reads as cells in rapid motion. It brings warmth to the surface of the skin. And disorganizes organs, causing bellies to turn and hearts to palpitate and sink. Shame moves blood to flow differently and shifts heart rates to beat irregularly. It presses on muscles and bones, its accumulation an added weight on already dense bodies.
Research has shown that shame is connected to depression and anxiety, suicide, and aggression that result in harm or death, as well as chronic pain. Here, I want to focus on chronic pain. According to Robert Gatchel et al (2007: 581) over 50 million Americans live with chronic pain, accounting for more than 80% of all physician visits and costs more than $70 million per annum in healthcare costs.
Unlike acute pain, which is adaptive, short-lived, and easily treated biomedically, chronic pain persists for more than three months consistently and is more complex in nature. Toronto-based naturopathic doctor Hanifa Menen writes about this in, Healing Emotions, Healing Pain, as do Christilynn Guerin, Samah Hassan, and Kieran Cooley in An Integrative Medicine Approach to Chronic Pain.
Through George Engel’s (1980) biopsychosocial framework, chronic pain is “multi-dimensional” in that it is “modulated by a complex interaction” between biological, psychological, sociological, physiological, neurological, emotional, spiritual, and holistic symptoms/variables/and factors.
What this means is that psychological illnesses such as depression and anxiety can and do intensify the pain. Sociological factors such as isolation, loneliness, stigma, and discrimination, as well as ableism and sanism, can further amplify pain. As do spiritual disconnection, frustration, and personality traits (Menen 2018; Azab, 2019). In addition, people who suffer from chronic pain can develop secondary conditions such as depression or anxiety, conveying an affective component to pain that triggers emotions such as shame, fear, anger, and sadness (Azab, 2019; Menen, 2018; Guerin, Hassan, and Cooley, 2018).
Research shows that chronic pain can emerge as a result of some of the following: 1) trauma to a particular region such as the low back, head, pelvis, etc.; 2) as a co-morbidity linked with other conditions such as cancer, diabetes, or depression; or 3) without any known or identifiable reason (Guerin, Hassan, and Cooley, 2018; Menen, 2018).
According to Hanifa Menen (2018:39), biologically and physiologically, trauma can damage nerve fibers that cause them to become hypersensitized, creating physical pain. What is otherwise known as neuropathic pain consists of “damage to the nervous system, including peripheral nerves, the spinal cord, and certain central nervous system regions” (Gatchel et al, 2007:585). Neuropathic pain can also occur spontaneously (Gatchel et al, 2007:585). At other times, it can cause individuals to feel excessive pain (i.e. pain from a stimulus that would otherwise not cause pain such as a soft touch) or produce an exaggerated response to something that is only somewhat painful (Gatchel et al, 2007:585).
Malfunctioning nerves and damaged tissues highlight the sensory component of chronic pain that connects it with neurons and the brain, the spinal cord, and the nervous system (Menen, 2018; Marwa Azab, 2019, The Neuroscience of Pain). Menen (2018) draws our attention to Lorimer Moseley’s Ted Talk titled, Why Things Hurt where Mosely (2014) identifies that the more neurotransmitters that produce pain run, the better they get at producing pain, which in turn increases the felt perception of pain.
Shame and fear and pain, it can all play out as physical chronic pain because the human mind-body translates emotional and psychological pain as physical (Azab, 2019).
In her Ted Talk titled, The Neuroscience of Pain, neuroscientist Marwa Azab (2019) suggests that emotional pain and physical pain have “much in common”, and shares that neurologically there is a “shared activation for both that results in the same areas of the brain lighting up” (n.p.). According to Azab, emotional pain hurts just as much as physical pain does. The professor in human behavioral psychology adds that painful feelings associated with social rejection will light up the same areas of the brain associated with emotional pain as well as physical pain, hence why shame is embodied as physically painful.
The brain perceives no distinction between the differences in kind. This is because according to Moseley (2014), all pain is an illusion, a function of the brain playing tricks on us. For Moseley (2014) “pain is a construct of the brain” which “both produces and projects pain” in an attempt to protect us from injury and harm (n.p.).
Why do so many women suffer from chronic pain? What role does shame play in real and tangible terms? I want to work with neuroscientists to better understand this. Because as an extra-sensory being, I know without a shadow of a doubt that shame plays a major role in my sciatica. Stress triggers my sciatica in similar ways as shame and fear. Shame limits my mobility and restricts my capacity. This makes sense for me through the social sciences, but I am also interested in how those in the hard sciences make sense of all this pain and shame.
I close this post by reminding you that in the past, chronic pain has cost the American government $70 million per annum in healthcare costs. I am no expert in economics, but that is a lot of money. For the fiscally responsible conservatives obsessed with cutting costs, maybe, attend to this shame issue we all have on our hands. I reckon that dealing with our collective shame will help to minimize these costs.
But, what do I know?
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Until next time, in solidarity.