Meeting pain with pain

I burn with shame as the A&E doctor asks me how I hurt my hand. I really don’t want to tell him. I really don’t want to be here. But I am here – in this stark, blue-light cubicle, with a blue curtain pretending privacy, with a blue blanket and me, blue jeans, blue top, as if to blend in, perched on the end of the blue bed, holding my hand to be examined – because I don’t want to be in trouble. I am here because I wasn’t ‘here’ earlier. And I’m here because, if I’m honest, my hand hurts way more than I think it should.

An X-ray later, the break is confirmed. Not a bad break: mainly just a chip on the bone along the outside edge. But boy does it hurt now, the pain flaring in mockery at me. You stupid idiot, it seems to be screaming at me. And the shame burns brighter.

So now I need to nurse my hand without looking like I’m nursing my hand. It’s exquisitely painful – it feels as if mere air will hurt it – but I’m so appalled at myself for the whole episode that I’m just relieved it doesn’t need a cast and I get away with some protective strapping. The nurse bandages it up with look-at-me blue tape and tries talking to me about the recent election of Barack Obama. Barack who? My world at this time doesn’t extend to international news. My world at this time is about pain, and managing pain with pain, and the shame of all the many ways that I manage pain with pain.

So then here I am, a week later, and back in the therapy room where I managed pain with pain and by doing so broke my hand. In shame I wanted to cancel, but this woman is not for cancelling. And therapy is a lifeline right now, even though I don’t always handle it well.

I tried doing without the strapping but it’s still so tender that I need something to remind me not to touch it. I try to shrink my arms up my sleeves. But there’s no hiding it, and her eyes lock onto it even as I walk through the door.

‘Broken?’ asks the therapist, and there’s a strange tension in the room, like we’re both swollen with emotion and neither of us is sure that it won’t burst forth like pus from a wound.

‘Broken’ sounds so dramatic, and anyway I don’t want to admit to it. I’d rather drift somewhere else in my head. But I sense that this session is going to be about me being here and taking responsibility for being here, and I daren’t dissociate it all away.

‘Kind of,’ is all I offer and I try deftly to manoeuvre the chair into position one-handed but fail, and so end up looking like I’m trying to manoeuvre the chair into position one-handed.

So this is therapy. This is the place for sympathy and ‘poor you’ and ‘tell me about it’. Right?

Yeah, right.

‘Shall we start with your hand?’

No, let’s not start with my hand. Let’s not finish with my hand. Let’s not even mention my hand in passing, in the middle, or on the side. Let’s talk about anything other than my hand. This voice on the inside wants to come out swinging. I don’t let it. Instead, I try to find the-therapist-I-know-is-for-me. I peer up at her, looking towards her rather than at her, avoiding eye contact and – again – trying to look like I’m not avoiding eye contact.

‘What are we going to do?’ she says, quietly, calmly, but oh so firmly.

‘What are we going to do?’ I echo, but with even more of an upward inflection, because I’m genuinely confused by the question.

Perhaps start with ‘how are you?’, ‘how’s your hand’, ‘ouch that looks painful’, ‘have you had a difficult week?’ another voice inside pipes up. Or even perhaps, ‘how on earth do you wipe your bum with a broken hand?’ Anything other than what I think is coming.

And I’ve worked with her long enough to know that it’s coming. And I’ve worked with her long enough to know that it won’t help if I get defensive, make excuses or blame-shift. And I’ve worked with her long enough to know that she asks questions for my benefit, and that she’s committed to my wellbeing – even though her way of showing it is invariably uncomfortable.

‘It wasn’t a great session last week,’ she offers, trying to get me to speak. I know she’s not going to let it go. I know she shouldn’t let it go. But I still wish she would let it go.

‘No,’ I say, and shame is a stench in me like the burning of flesh. I would give anything right now to atomise to dust. Parts of me want to run. Parts of me literally want to die.

It’s like we’re both holding the same memory, out in front of us, between us: me last week in distress, dissociated, desperately trying to ride the wave of liquid pain that was cresting me. And something that had triggered it – I can’t remember what – and this explosion of emotion that I didn’t know how to handle. And pain. Just pain. That’s all I can remember: pain. Pain that I needed to handle with pain. And so once, twice – however many times – I struck out with my hand against the brittle, bony edge of the table, she objected, I flared, and then there I was afterwards in A&E. The memory is murky like mountains clothed in fog.

She looks at me long and slow and hard, with eyes that pierce right into me, but in a warm way, not critically.

‘I want to tell you to never do that again,’ she says, measuring out each word slowly and carefully, like she’s pulling a tangle out of a ball of wool. ‘But saying ‘stop it’ won’t work, will it? You don’t know why you’re doing it. You’re not fully present to yourself with your front brain online while you’re doing it.’

That’s right, I think, on the inside of me, shook through with relief. I feel instantly purged by this one simple moment of empathic attunement. She gets it. On the outside I just nod, feeling understood, but not wanting to reveal it. It feels too dangerous still. She continues.

‘If I say ‘stop it’ to you, you will feel in trouble – told off – and it will activate your shame. And it will put us into conflict – you wanting to do something, me not wanting you to. We’ll be on opposite sides. It may rupture our relationship.’

She knows me. She knows me so well. I sit awkwardly, stuck in my own dilemma.

Then, almost imperceptibly, she straightens a little in her chair.

‘But allowing you to hurt yourself, to avoid that rupture, isn’t an option either.’ There’s a quiet, humming authority about her, as if her words are coiled around with grace and sternness. ‘It’s unethical of me. It’s dangerous. It pushes me out of the green zone, with anxiety over what will happen to you – will you seriously damage yourself? – as well as what will happen to me.’

I twitch, surprised slightly. I hadn’t considered how my actions would affect her. I’m intrigued, and feel slightly afraid, with a smearing of guilt on the inside that I hadn’t once thought of her.

‘Will I be deemed unfit for practice if I don’t manage this well?’ she continues. ‘If I can’t stop you self-harming in a session? Should I be doing what I do if I can’t even keep you safe? And if I’m not in the green zone, pushed into amber with anxiety about you like this, how can I help you be in the green zone?’

She pauses, letting the silence rub the words into my brain.

Then eventually: ‘So what to do?’

It’s a strange mixture of feelings as I sit there. The air is quiet and there’s a softness in the room, like the light is landing like a layer of dust. I feel engaged as a partner in solving this dilemma. Despite my earlier dread, somehow I don’t feel told off. There’s no rupture: just an obstacle that, shoulder to shoulder, we are both trying to shift. I know her question is no mere rhetorical form: she really does expect me to help her find a way forwards.

There is a slight zing of exhilaration in me, because I’ve not been patronised, and I’ve not been blocked. I’ve been understood and respected and involved in the solution. This is new to me. This is adult-to-adult, despite the child-like drive to my actions.

But what to do? Oh, what to do?

The silence works easily between us, like oil swirling in a beaker, lubricating our thoughts. I am open to whatever comes next, because something about her tone and her voice and her face and her body tells me that she is for me. I see the ache of the situation. Somehow I feel safe with her. And my empathy for her dilemma – our dilemma – stirs me to collaboration, not conflict.

‘Shall we think about what might be going on for you when you want to hit your hand?’ she offers, in a voice light and easy and inviting.

I nod. It’s everything I want: to be able to explore what was going on in me, to dissect it, to understand it. I want to understand and I want to be understood, and I feel restless to wreak change into my reactions, and not be at the victim of my dissociated emotion.

‘I don’t want to hurt myself,’ I say, my olive branch proffered. ‘I mean, I do – obviously I do, or I wouldn’t be doing it. But it’s more complex than that. Part of it is that I hate myself. In that moment, when the feelings come up, they come up with such a force of self-hatred that it feels like the only right thing to do is to destroy myself. It’s sheer hatred. At myself.’

I glance at her and there is sadness on her face, and I feel it in me too. It’s so sad, so very very sad, to feel this way about myself. I get it, in that reflection in her face, that this isn’t the way it should be, and it’s not the way I want it to be. It’s the outworking of all those people who really did hate me, who hurt me, who despised me, who rejected me, who took pleasure in my pain. But deep down I don’t want to hurt myself. Not really. If I did, I wouldn’t be here.

She nods. ‘Go on.’

I dig around inside to find the next layer. ‘When I’m in pain,’ I offer, hesitantly, trying to grasp it. ‘When I’m in emotional pain, when a feeling comes up, like it did in the session …’

I’m not sure I should admit to this. I glance up at her, to check it’s okay. The softness on her face convinces me to go on.

‘When I’m in pain, it’s like I need to hurt myself. I don’t know what else to do.’

‘You don’t know how to handle it?’

‘Yes. It’s like I feel somehow that it’s so wrong to be in pain, to feel painful feelings, that I punish myself for it. Instantly, reactively. To try to stop myself feeling those feelings. To manage it. Pain leads to pain. Pain is handled with pain. It’s all I know how to do …’ I trail off, feeling sad and twisted up with the reality of it.

‘Go on.’

‘And it’s like, if I hurt myself – if I feel physical pain, then it takes the edge off the emotional pain. It’s easier to handle. Because it’s there’ – I gesture to my hand – ‘it’s finite and clear. It has edges. It hurts. But it’s so much easier to deal with than pain in here’ – and I point to my chest. As I do, the pain bleeds against me, ragged and raw.

She nods and sighs, and gestures again with her head for me to continue.

‘If I hurt myself, it’s like a warning.’

‘A warning?’

‘To myself. To expect pain. To choose pain. To make sure I don’t reach out, for comfort or soothing, or anything like that. Just to accept that pain is what I’m going to get. So if I hurt myself, I’m in charge of it. I’ve chosen it. It feels easier.’

She’s about to say something, but the dam has broken inside me.

‘And anyway, it’s what you want!’ I say, exploding slightly, redness bursting to the surface, challenging her, daring her to disagree with me.

But she does disagree. She is surprised, and sits straight suddenly.

‘It is most definitely not what I want,’ she says, warmly, peering right into me. ‘I do not want you to be in pain,’ she says, more quietly, but fervidly, like her honour depends on it.

I believe her, and yet still the accusation rises from within, with a force that surprises me. ‘But you do,’ I say, conflicted, ‘You do.’

‘Explain …’ she says, and we both seem to realise at the same time that this is transference, not reality. This is a memory from the past overlaying the experience in the present, like voile on a window. She has stopped being the therapist and has become the mother, as the past becomes the present and I lose context and perspective.

‘The only way I can get close to you is if I’m in pain,’ I say, and I’ve become younger suddenly, and surly, and cross. ‘The only way you like me is if I’m in pain.’

There’s such a weight of sadness in the room right now, like it will crush both of us. But she just waits and waits and waits, an endless waiting of waiting, until the wave rolls back a little.

‘You think it thrills me to see you in pain?’

Yes. That’s exactly the word, and it skewers me right in my guts to hear it. I can see the mother now, in my mind’s now, glee in her eyes, thrilling at my pain.

‘Yes.’

The therapist lets out some noise, primal and deep, but softly, and measured. It says, ‘I hear you. I see you. I feel the pain of your statement. And it hurts me too.’

Images flash before me and I remember. Just snatches, glimpses of memories, but I remember. In sensations, in smells, I am small and scared and I reach out for mummy and there is something in her eyes – excitement? – something that energises her and pleases her, and I realise it is my pain. And then I remember last week, the emotion that surged up through me as we talked, the lurching inside, the sense of loneliness and abandonment, the wanting to be held, the longing to be soothed. And so pain. The only way I can come close, be acceptable, is if I’m pain. So smash, smash against the edge of the table. Here is my pain, my hand was crying, here it is, like a sacrifice. Is this enough, or do you need more? How much pain until you’ll love me? Is this enough? This? And so smash, smash. smash.

But oh so confusing. The therapist, voile-covered mother, was saying, ‘No!’ and trying to restrain me. No? Doesn’t she want my pain? Isn’t it enough? So smash, smash, to make it more. But ‘No!’ And I don’t know how to get her to soothe me. I am in pain, and I need to offer pain – a guilt offering, a sin offering – and perhaps my pain isn’t sufficient to draw her close. Smash, smash. And then, voile removed, I see the therapist as she is and see that she doesn’t want my pain, that it pains her to see my pain. It doesn’t thrill her at all.

As a child, I looked into the eyes of my abusers and I saw my pain reflected there. But in them it was reflected as pleasure. It delighted them. Now, in therapy, in the eyes of my therapist, my pain is reflected as pain. So there’s no hiding from it now, no dissociating, no pretence: pain hurts. This is the ineffable, unbearable reality of pain: pain hurts. And meeting pain with pain will never, ever, lead to pleasure. There has to be another way.

I sit, floundering in my confusion at all of this. It hurts to remember the eyes of glee. It’s confusing now to see the empathy come back at me. How do I get close to this attachment figure, in this room, in this here-and-now-ness of voile-less reality? How do I reach out for nurture and soothing and support, if it’s not through pain?

The silence works thoughts into my head. At last, I speak.

‘You don’t want me to be in pain?’ I offer, half-statement, half-question.

She weighs up what I’m saying, as if trying to understand the whole of it before answering.

‘No,’ she says, sadly, softly. ‘No, I don’t. That’s the old way. It’s not the new way.’

‘What is the new way?’ I say.

‘Do you know?’

I nod. At least, I think so. ‘We talk out our feelings,’ I say, mimicking one of her mantras, ‘we don’t act them out. We ask directly for help, with words. We don’t hint or manoeuvre or manipulate. We just ask.’

She nods, eyes smiling.

‘But …’ my objection comes. My objection always comes. Whatever I accept at one level needs accepting at every level within me, and not all of me works at the same speed or with the same degree of insight. ‘But it feels wrong to ask for help. And it feels scary. And it feels pointless.’

‘Because?’

Out streams another fizzle of feeling. ‘Because you might mock me, or hurt me, or reject me, or say no. You might use my pain to cause more pain. You might …’

The accusation sits in the air between us like jags of light.

‘I might …?’

I breathe through my discomfort. Oh it hurts, all of this. It hurts. It hurts to bring to consciousness, like this, all my traumatic expectations, all the myriad ways in which I generalise out to the present day all my experiences from the past. My fears are so instinctive that they erupt onto the surface of my mind and colour every interaction before I’ve had time to assess them. But here, in the therapy room, the slowness and the calmness and the safety and the space insist that I consider them, that I reflect rather than react. Spurts of self-hatred shoot up through me, that I’m so reactive like this. I don’t want to generalise. I don’t want to jump to conclusions. I don’t want to tar everyone with the same brush, least of all this therapist, kind and gentle and honourable and true. And yet of all people she is the one I am most likely to demonise, and believe in her badness. Of all people, undeserving, she is the one I am most likely to fear will hurt me, and mock me, and reject me and humiliate me. The voile of my mother wraps around her in every session and it’s not her fault. I wonder at her willingness to endure such injustice, when all she is trying to do is help me.

‘No,’ I say at last, breathing out the frustration at myself, but relieved at least that I have caught myself. ‘No, you won’t. You never have done. I’m just dumping on you what other people did to me.’

Aaah. I get it. For this moment at least, I get it.

‘You don’t want me to be in pain,’ I say, this time a statement rather than a question. ‘I just think that’s the way to be close to you. But it’s not. The new way, with people that don’t abuse, is to meet pain with empathy. The old way, of people that abuse, was to meet pain with pain, and even to be thrilled at it. But that’s them. It’s not you.’

‘No,’ she says, as if releasing an hour’s worth of tension. ‘No, that’s not me.’

We sit, companionable and kind for a few moments, allowing the voile to draw back.

‘How is your hand?’ she asks, and for the first time I feel no shame. I proffer it tenderly, waving it in the air with a gentle grimace.

‘It hurts,’ I admit. ‘It hurts a lot. I chipped the bone on the side. So it’s very tender, but it’ll heal.’ She grimaces back in sympathy. ‘I won’t be doing that again,’ I say, slightly downcast inside, but feeling cleaned out, as if absolved and renewed. ‘It’s stupidly inconvenient for one thing. But now at least I know why I did it. The answer to pain is not pain,’ I say, grasping it even as I say it. ‘The answer to pain is kindness and empathy. That’s what I need to show myself.’

She nods. I nod. Perhaps easier said than done, when I have a lifetime of habits, but the first step is always understanding.

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