WHEN WE HURT by Philip Yancey

Philip Yancey's books have been translated in 25 languages and have sold over 14 million copies since he was first published in 1977. A former journalist and writer by vocation, Yancey spent many of his adult years in Chicago, writing for a wide variety of magazines, including Readers Digest, Saturday Evening Post, National Wildlife, and Christianity Today.
Paul Brand was a world-renowned hand surgeon and leprosy specialist. Former Surgeon General C. Everett Koop said, "As a surgeon, scholar, investigator, and philosopher gifted with rare insight, Paul Brand has lived and worked among the pain-afflicted. His extraordinary experiences have a strong thematic unity which allows him to present a rather startling perspective on pain. He opens the window onto new ways of looking at pain, and that translates into something of worth. Paul Brand offers an opportunity to look at pain not as your enemy, but as your friend." Dr. Brand died in 2003 from complications after a fall.

Arlo: The following thoughts are either quotations or summations found in Yancey's book, "When We Hurt," which are excerpts taken from "Pain: The Gift Nobody Wants" by Dr. Paul Brand and Philip Yancey. Dr. Paul Brand looked at pain, not as an enemy, but as a friend. He spent 25 years in England, and of Londoners, he said, "Londoners suffered gladly for a cause during World War II." He spent 27 years among the people of India, and of them he said, "These people expected suffering and learned not to fear it." He also lived more than 30 years in the United States, and of them he said that "American people suffered less, but feared it more."

There is great danger for those (like leprous individuals), who have lost their ability to feel pain. That loss, has and continues to lead to a disastrous destruction of body parts, or even death! "A larynx that never feels a tickle does not trigger the cough reflex that relocates phlegm from the lungs to the pharynx, and a person who never coughs runs the risk of developing pneumonia." Nevertheless, pain is a gift nobody wants! A medicated pain loses it power to instruct the body that something is dangerously wrong in the body's functioning ability. "First, listen to your pain. It is your own body talking to you." Don't over-medicate your body in your earnest desire to rid it of pain!

"Pain is a priceless essential gift---of that I have no doubt. and yet only by learning to master pain can we keep it from mastering us." "We cannot live well without pain, but how do we best live with it?" He divided the experience of pain into three stages: First, there is the pain signal, an alarm that goes off when nerve endings in the periphery sense danger. At the second stage of pain, the spinal cord and base of the brain act as a "spinal gate" to sort out which of the many millions of signals deserve to be forwarded as a message to the brain. The third, or final stage of pain, takes place in the higher brain (especially the cerebral cortex), which sorts through the prescreened messages and decides on a response. In fact, "pain does not truly exist until the entire cycle of signal, message, and response has been completed."

There are three stages of pain: A girl is running, and falls. As she scrapes her knee, there is a signal of the injury of the knee by pain. On the ground, she rolls over to avoid further contact between the injured knee and the ground, this is an emergency maneuver ordered by the spinal cord. Half a second passes, and the girl becomes conscious of the stinging sensation from her scraped knee. How she then responds will depend on the severity of the scrape, her own personality makeup, and what else is going on around her. The girl looks at the knee, sees blood, and now the conscious brain takes over. Fear enhances the pain. But the comfort of a parent, or a friend replaces the fear with reassurance. As the adult fusses over the sore, washes away the blood, covers the wound with decorative adhesive bandage, the child soon goes back to play. The girl forgets about the pain. In the case of an adult, the larger pool of experience and emotions results in the mind playing a greater role in the thinking process within the brain in coping with the pain.

"I would probably rank the stages of pain in the reverse order, giving prominence to the third stage first. What takes place in a person's mind is the most important aspect of pain---and the most difficult to treat or even comprehend. If we can learn to handle pain at this third stage, we will most likely succeed in keeping pain in its proper place, as servant and not master." In considering the whole issue of pain, the circumstances and the thoughts of the mind have made a great difference in the awareness of pain and the treatment of injury. In the case of the injury of soldiers in a war zone: Only one in four soldiers with serious injuries, (such as fractures, and amputations) asked for morphine, though it was freely available. They simply did not need help with the pain, and indeed many of them denied feeling pain at all. In the wounded soldier the response to injury was relief, thankfulness at his escape alive from the battlefield, even euphoria. In contrast, 80% of civilian patients recovering from surgical wounds begged for morphine or other narcotics as these patients considered major surgery as a depressing and calamitous event. Obviously, the mind plays an important role in pain.

A Dr. Hans Selye said, "Gratitude is the single response most nourishing to health." In view of Dr. Selye's research into the impact of emotions on health, begins with gratitude as his first suggestion in making preparations for pain. He spoke of the negative effects of such emotions as anxiety, depression, vengeance and bitterness. Conversely, he concluded, gratitude is the single response most nourishing to health. "I find myself agreeing with Selye, in part because a grateful appreciation for pain's many benefits has so transformed my own outlook. People who view pain as the enemy, he has noted, instinctively responded with vengeance or bitterness---why me? I don't deserve this! It's not fair! We should think of pain as a speech our body is delivering about a subject of vital importance to us. The body is using the language of pain because that's the most effective way to get our attention."

"The path to health must begin by taking pain into account. Instead, we silence pain when we should be straining our ears to hear it; we eat too fast and too much and take a seltzer; we work too long and too hard and take a tranquilizer. The three best-selling drugs in the United States are a hypertension drug, a medication for ulcers, and a tranquilizer. Such is the case in that, for the most part, we look upon pain as the illness rather than the symptom." Continuing it was said, "I rarely feel grateful for the fact of pain, but I almost always feel grateful for the message that it brings. I can count on pain to represent my best interestes in the most urgent way available. It is then up to me to act on those recommendations."

"During the Middle Ages---a time of chaos and great suffering---religious orders devised a series of contemplative exercises. Most of them included prayer, meditation, and fasting, all disciplines directed toward the inner life." "I have found that disciplines of the spirit can have an extraordinary effect on the body, and especially on pain. Prayer helps me cope with pain, by moving my mental focus away from a fixation on my body's complaints. As I pray, nourishing the life of the spirit, my tension level goes down and my consciousness of pain tends to recede. It did not surprise me at all to learn recently from a medical researcher that people who have strong religious faith have a lower incident of heart attack, arteriosclerosis, high blood pressure, and hypertension than those who do not."

"The best single thing that I can do to prepare for pain is to surround myself with a loving community who will stand beside me when tragedy strikes. Wherever we have lived, we have sought out and have had the good fortune of finding a caring church." "Death is the one sure fact of life, of course. I trust the words of the psalmist, 'Yea, though I walk through the valley of the shadow of death, I will fear no evil, for You are with me.' I have learned the best way to disarm my fears about terminal illness, and about the possibility of great pain, is to face them in advance, before God, and within a community that will share them."

One of these authors tell of feeling urgent pain signals (stage one) from his upper abdomen, he had no idea as to what danger these pains were alerting to him. He knew that the pain was too severe to indicate indigestion. His age being right for cancer to appear, so by the time he visited the doctor, he had worked himself into a churning state of fear. An X-ray revealed that he had gallstones, not cancer, a painful condition to be sure, but one easily treatable with surgery. The abdominal attacks kept occurring, but right away they seemed less painful. Although the pain signals themselves did not diminish, his perception of them (stage three) surely changed as his anxiety lessened. Surgery was delayed, so he had many opportunities to practice his mastery over pain.

"Researchers have discovered that the body manufacatures its own narcotics, which it can release upon command to block out pain. The brain is a master pharmacologist. To stimulate the brain's own painkillers has nearly unlimited potential. We know that a person's response to pain depends to a very large degree on "subjective" factors, such as emotional preparedness and cultural expectations, which in turn affect the brain's chemistry. By altering these subjective factors, we can directly influence the perception of pain." Barbara Wolf in her book, "Living with Pain," recommends "work, reading, humor, hobbies, pets, sports, volunteer work, or anything else that can divert the sufferer's mind from pain. When pain strikes with fury in the middle of the night, Wolf gets up, maps out the day ahead, works on a lecture, or completely plans a dinner party." One specialist at a chronic pain center said that many patients want to wait until the pain subsides before they resume normal functioning. But he has learned that coping with chronic pain depends on a patient's willingness to exercise and increase productive activity despite the feeling of pain.

One of these authors use the term, "pain intensifiers" for responses that heighten the perception of pain within the conscious mind. He identifies these intensifiers as being, fear, anger, guilt, loneliness, helplessness. He speaks of fear as the strongest intensifier of pain. When an injured person is afraid, muscles tense and contract, increasing the pressure on damaged nerves and causing even more pain. Blood pressure and vasodilation (the constriction of blood vessels)change, too, which is why a frightened person goes pale or flushes red. I encourage patients to talk about their fear so that together we can relate the fear to the pain signal. Fear, like pain, can be good or bad. Fear stops me from taking foolish risks when I drive a car or go downhill skiing. Problems only develop when fear (or pain) grows out of proportion to the danger.

A Californian, Tim Hansel, by name was injured when he fell headfirst into a crevasse, striking a rock at the bottom. A Medical Specialist, upon examining him, said, 'You'll just have to live with the pain. Surgery can't help.' He lived with the fear of reinjuring himself, paralyzed by that fear, he said to the specialist, 'Tell me specifically, what must I avoid?' The Doctor's reply, 'The damage is irreversible. I suppose I would recommend against painting eaves---that would put too great a strain on your neck. But as far as I can tell, you can do whatever else the pain will allow you to do.' According to Hansel, that word from the doctor gave him a new lease on life. He went back to climbing mountains and leading expeditions. Tim Hansel's pain did not go away. But his fear did, and he found that with the reduction of fear, his pain eventually decreased as well. He learned to master pain because he no longer feared it.

Bernie Siegel said, 'To hate is easy, but it is healthier to love!' A horrendous act was perpetrated by a husband against his spouse. You can read about it on pages 86-89 of "When We Hurt." One of these authors said, "Too often I have seen the physiological effect on people who became angry with their employer, or the driver of the other car, or the previous surgion, or a spouse who lacked sympathy, or God. The anger must be dealt with, of course; it does not go away on its own. But if it is not dealt with, if it is allowed to fester in the mind and soul, the anger may release its poison in the body, affecting pain and healing."

Christopher Isherwood said, "By helping yourself, you are helping mankind. By helping mankind, you are helping yourself. That's the law of all spiritual progress." Paul Brand, when in medical residency during World War II, saw proof of the positive benefits that can result when patients feel useful. Britain was suffering heavy casualties on the European front, and the military ordered a sudden call-up of nurses. With a shortage of staff, patients were asked to fill in. A nursing supervisor assigned duties to every patient who could walk, and even a few in wheelchairs. They fetched bedpans, changed sheets, distributed food and water, and took temperature and blood pressure readings. The system worked well, and it produced one rather extraordinary side benefit: patients got so caught up in caring for each other's suffering that they forgot about their own. There was a 50% drop in demands for pain medication. On Paul Brand's rounds at night, he found that patients who usually needed sleeping pills were peacefully asleep by the time he came around. After a few weeks of this emergency program, the hospital recruited more nurses and relieved the patients of their volunteer duties. Dosages almost immediately went back up, and the usual atmosphere of helplessness and lethargy wafted in.