A narrative therapy approach to dealing with chronic pain

by Laurel Phillips

Laurel Phillips is a private practice therapist, writer and volunteer

community worker who lives part-time in both Mexico and Canada.
Laurel can be contacted at laurelewen@hotmail.com

Abstract
This article outlines a narrative therapeutic approach to working in collaboration with people
experiencing chronic pain. This approach was created in concert with 13 co-researchers who
were experiencing, or had partners who experienced, varying degrees of pain. Contributing
therapeutic conversations spanned a ten-month period. Outcomes were achieved through
the application of various narrative therapy principles including externalisation, mapping the
influence of the problem, remembering practices, developing an experience-near definition
of the problem, double listening, alternative or preferred story development and the use
of collective documents and definitional ceremonies What emerged from this were two
themes: The identification, importance and use of personally constructed strategies, and
the reduction of pain experiences by addressing self-identified problems that were more
pressing than pain. Narrative therapy was successful in helping to re-establish valued ways
of living that chronic pain often sidelines. We found that it is possible to reduce experiences
of pain by addressing more pressing problems.

Key words: Narrative Therapy, chronic pain, depression, anxiety, PTSD,

marginalisation

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The problem of pain
The International Association for the Study of Pain (2016)
defines pain as an ‘unpleasant sensory and emotional
experience associated with actual or potential tissue
damage’. Pain is classed as chronic if it persists for more
than 3 months, often after healing should have occurred
(Surah, Baranidharan & Morley, 2013).
The National Institute of Health (2010) reports that ‘Chronic
pain is the most common cause of long-term disability’.
It affects over 70 million Americans (Mayday Fund, 2009),
with some estimates reaching100 million (Ehde, Dillworth
& Turner, 2014). One-third of people in pain report that their
pain is disabling (Mayday Fund, 2009).
As a narrative therapist and someone who suffers from
chronic pain, I am interested in helping people to cope in
ways that reflect important hopes, dreams, values and
beliefs, and in aiding the development of individualised
strategies that fit with a preferred life. It is my contention
that chronic pain can negatively alter identity (Charmaz,
1983), making it difficult for people to live life according
to their valued intentions.
During a 10-month co-research study (Epston, 1999) with
13 people experiencing chronic pain and through the
application of narrative therapy principles and practices,
two significant themes emerged:
1. the importance of developing personal strategies
2. the importance of addressing problems that are
presented as being more pressing than pain.
Theme 1: Personal strategies
against pain
People develop and use strategies in response to their
experiences of pain, to mitigate pain or to bring about healing.
These strategies are similar to those that White called ‘acts
of resistance’ (White, 1997; see also Peterson, 2015; Yuen,
2007; Yuen, 2009). People respond to the hardships of life
in ways that reflect closely held values, beliefs hopes, goals
or dreams (Yuen, 2009).
When it was realised that co-researchers had developed
individual strategies in resistance to their experiences of
pain, I introduced the term ‘acts of resistance’. However,
people reacted negatively to this term as a description for
their strategies. They chose instead to hold to their initial,
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experience-near definition of ‘strategy’. For most, the term
‘strategy’ carried with it an intention of having agency
over pain.
Several strategic acts were identified:
• acts of distraction
• acts that shift focus
• acts of investigation
• relational renegotiations.
Acts of distraction
Acts of distraction were first described by Robert, one
of our co-researchers (all co-researchers are referred to
by pseudonyms). He helped uncover the importance of
distraction in diminishing chronic pain. Robert described how
he would purposefully distract himself by petting his dog,
Scamper, and that the time he spent distracted from pain was
nearly pain-free. Together we investigated what it was about
this strategy that made it so successful and we uncovered
the importance of touch in Robert’s life. Robert went on to
describe how he would sit with his children when they were
young, holding their hands or brushing their hair. He also
described how his wife could calm his pain through rubbing
his back.
The idea of the importance of distraction as a type of
analgesic led to the exploration of other acts of distraction
that Robert had developed and was using. We discovered
that learning new computer software, watching favourite TV
programs and driving were also effective distractions from
pain’s influence. We investigated the importance of each of
these using narrative practices. Through this, we found that
these acts had embedded within them important ways of
living and being that Robert held dear.
To uncover these strategies of distraction, we investigated
the influence of pain on facets of Robert’s life, such as his
relationship with himself and others, his daily living and his
goals for the future. We then evaluated this influence and
Robert was quick to say that it was unwanted. I asked him to
describe why this was unwanted and he said it was because
he couldn’t travel anymore. Travel is an important way of life
for both Robert and his wife.
This conversation about travel was held in Robert’s home in
Mexico. He and his wife flew there annually from the west
coast of Canada. Travelling to Mexico on a yearly basis
seemed like an exception to the dominant story that travel
was over for Robert and it demonstrated that he had some
influence over pain. We investigated this exception with
questions about how he was able to accomplish this particular
travel and we looked for other ways that Robert might still
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travel. I discovered that Robert also drove his motorhome to
campsites in Canada during the summer months. This meant,
although pain had managed to interfere with some aspects of
Robert’s desire to travel, it had not extinguished it.
Through further enquiry into times when Robert had influence
over pain and was able to travel or otherwise distract
himself, we uncovered other stories. These stories contained
strategies, which we explored in search of additional
commitments for living. These, in turn, were plotted to expose
a theme. Robert’s acts of travelling, driving, and watching
travel documentaries and mechanics programs were
connected to a lifelong theme of adventure, a theme that
Robert was striving to keep alive.
Driving, and an appreciation for fast cars and motorcycles,
was a large part of this theme of adventure. Robert described
how, when he was driving, he took in the scenery and looked
at other cars on the road. Using a 0 to 100% scale, I asked
him what part pain was able to play when he was driving. He
told me that pain was only able to claim 5% of his attention,
leaving Robert pain-free for 95% of this time free of pain.
Understanding this was critical and made adventure and
travel highly relevant as an analgesic for him.
Acts that shift focus
When I introduced the term ‘distraction’ to co-researcher
Sandy, she felt it denoted a kind of uncontrollable occurrence,
and she preferred the term ‘shift in focus’. For Sandy, shifting
focus meant deliberately taking control of efforts used to
effect experiences of pain. Sandy made clear how she would
shift her focus onto a book, not just to move her attention
away from pain but also to expand her experience of life.
Pain has a way of diminishing life, and this can happen
in a number of ways. Sandy had undergone many painful
surgeries, often involving significant amounts of recovery
time. This added to daily experiences of chronic pain, limiting
her ability to live life according to her plans. At more than
70 years old, the experience of ageing, along with the effects
of chronic pain, led Sandy to feel that life was ‘shrinking’.
Each subsequent surgery caused a new shrinking of life and,
at times when she was recovering from one surgery and
had to undergo another, she experienced what she called a
‘shrinking of the shrinking’.
In one conversation, after Sandy had undergone eye surgery,
we investigated the influence of this particular surgery on
life. Some of Sandy’s descriptions included, ‘going down
the tunnel with it’, ‘discombobulated business’, ‘shutting
me down’, ‘making my life smaller and smaller’, ‘crowding
out everything else’, ‘worry’, and ‘a big unknown’. Having
obtained this description of the influence eye surgery had on
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her life, and having formed an experience-near definition of
this as ‘the eye problem’, Sandy evaluated how she felt about
these developments and concluded she wasn’t happy.
To investigate her influence over the problem, and to find
an exception to the dominant story of pain, worry and a
diminishing life, I asked for a story about a time when ‘the
eye problem’ didn’t get to crowd things out, take things
away or cause worry. In response, Sandy recalled sitting
in a chair ‘when the light was just right and losing myself in
reading’. I asked what her intention was in reading – why
does she read? She told me that reading was a way to give
herself pleasure through a connection with and participation
in other worlds and lives, and during this time she was ‘not
overwhelmed by the eye’.
We talked more about this, expanding on what was
happening during reading, and investigating why this act was
effective in thwarting the eye problem. I asked what Sandy
thought was happening when she read. She reported that
reading ‘enlarged’ her world, ‘expanded’ her life and mind,
‘increased learning’, ‘pervades my whole life’, ‘connected’ her
to other worlds and lives, and ‘engaged’ her. While reading
she felt that she was not alone. Reading was a strong and
effective strategy against pain and its ability to shrink life.
In an attempt to ‘thicken’ (White, 2007) the story about
reading, we undertook an historical investigation into how
this had become an important and expanding part of her life.
Sandy recalled the following:
• c urling up in a chair during Christmas with a candy cane
and a book when she was a child
• wanting books for Christmas
• reading to her husband as they travelled
• w
 orking with the Canadian Broadcasting Corporation as
an audiobook voice
• h
 er mother always reading to her and her brother when
they were children, especially when her father was away
at war
• the library being a big part of her life, especially the
discovery of biographies
• she frequently read to her two children
• s he wrote a book for her grandchildren as a way of
passing along a part of herself
• through books, she was participating and creating
a storyshe didn’t mind waiting when she had a book
with her.
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I asked Sandy what she thought was happening to ‘worry’
when she was reading? She said, ‘When I’m reading,
I’m reading. I’m in the present. Worry is in the future’.
Although reading helped to quiet worry and pain, it required
uncovering and honouring through narrative conversations for
Sandy to realise its importance, and to give herself permission
to more fully take up this creative, life-expanding practice.
Later, Sandy emailed an article titled ‘Neil Gaiman on why
we read and what books do for the human experience’
(Popova, 2016). She wrote: ‘I don’t know if you remember
our talk about how reading is a positive force in my life and
helps with pain, etc. This article is long and has a lot of other
stuff in it, but zeros in on what I think and feel about reading.
Since “reading” it I have been acknowledging to myself (and
others) just how important it is for me. I’ve always felt slightly
guilty about how much I read (Sandy get your nose out of
that book and DO something) but now I feel validated and
can embrace it.’
Acts of investigation
Acts of investigation bring hope and understanding. They
are purposeful enquiries into the cause of pain and what
is available as a cure or solution. These investigations
can contribute to life continuity and diminish the power of
suicidal thoughts. Many people in our group undertook
acts of investigation into cures, new medications and diets.
They read books on the problem or attended seminars.
For example, Robert and Jane attended a seminar on
chronic regional pain syndrome (CRPS) to learn more about
options and new developments on neuropathic pain. Cindy
investigated diets that might help relieve her pain. And Don
heard about and tried pregabalin as a pain reliever.
In a therapeutic setting, these acts of investigation can be
uncovered through enquiry into what hopes people have for
the future, and how they are able to hold onto these hopes.
People often express a hope to live pain-free. Narrative
therapy practices, such as enquiring into the steps people
have taken to maintain hope, uncover the commitments to life
that are embodied in these acts. As therapists, we can help to
define these acts as strategies that can be relied upon in the
future when hope is shaken by unrelenting pain.
Relational renegotiations
Relational renegotiations are used by couples to counteract
the influence of pain on their relationship. These acts are
about maintaining the relationship in the midst of changes
brought about by chronic pain and altered ability. They can
be founded on shared or individual values, goals, beliefs,
intentions and dreams, and are uncovered through an
investigation into exceptions to pain’s negative influence
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on the relationship. They can be aided by externalising the
‘relationship’ as an entity struggling with the problem, and
through conversations that deconstruct cultural messages
that support role expectation and dilemmas surrounding
unmet expectation.
When working with couples around the problem of chronic
pain, using a transitional metaphor can be helpful. A ‘rite of
passage’ metaphor (White, 1995), consisting of the three
phases: separation, liminan (otherwise known as ‘betwixt
and between’) and re-incorporation or aggregation (V.
Turner, 1964, p. 4) can be introduced into conversation as
a framework for navigating transitional states imposed on
a relationship by chronic pain. Envisioning the relationship
as having entered an imposed liminal state, and working
together to transition out of this state, offers an opportunity to
see that no one person is to blame for the problem, and that
steps may have already been taken to increase the health of
the relationship. These steps can be framed as a relational
renegotiation.
For example, each time Robert’s wife looked at the unpainted
patio, she would feel anger and resentment towards him
for being unable or unwilling to help. In the past, they did
this task together, but, since Robert’s accident, it seemed
that most of the work had fallen onto Jane’s shoulders.
Jane revealed that they had decided to hire a painter. I took
this opportunity to ask her what she thought would happen
to anger and resentment if she were looking at the newly
painted patio. She said there would be no room for anger and
resentment. I wondered aloud if this move to hire a painter
signalled a renegotiation in the structure of their relationship?
She thought this was true.
The above strategies can also be thought of as ‘unique
outcomes’ (White, 2007). These exceptions to the dominant
story of pain are windows through which can be seen a
preserved and preferred world unfolding alongside the new
world created by chronic pain. Sometimes these exceptions
or strategies are unknown or unavailable to those suffering
with pain and their partners. They are there nonetheless.
Either consciously or unconsciously and without exception,
co-researchers were employing strategies. Not only did these
lead to an opportunity to strengthen preferred ways of living
and being, but acts of ‘distraction’ and ‘shifting focus’ also
had an analgesic effect. Once made visible, these strategies
could be purposefully taken up and used against experiences
of pain.
People are very different in the development of hierarchies of
values that constitute important commitments for living and
that are found embedded in personal strategies. What works
for one person may not work for another, but what we found is
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that the most successful strategies are those that contain the
values, dreams, goals, intentions, purposes and commitments
for living that people hold dear.
Theme 2: Addressing problems
that are more pressing than pain
‘Would you like to talk about pain or is there something more
pressing you would rather talk about?’ This is an important
question for two reasons. First, it allows the client to direct
therapeutic time and the creation of a context that supports
the development of personal agency. Second, this invitation
gives people an opportunity to talk about problems more
pressing than pain and that might be contributing to pain
outcomes.
Frank, the childhood trauma and post-traumatic stress
disorder (PTSD)
At the age of three, Frank, now in his late 60s, developed
polio. His parents were advised to take him several hundred
kilometres into northern Canada and leave him at a polio
solarium. During his time at the solarium, Frank suffered
abuse by doctors, nurses and other children. In one
particularly heartbreaking story, Frank described being told
by the nurses that there was a party planned for him upstairs.
All he needed to do was take his medicine and they would
take him up to join his family. Three-year-old Frank took his
medication and it knocked him out. When he awoke there
were wires sticking out of the ends of his toes. There had
not been a party waiting for him. He had been lied to and
operated on.
Frank also spoke of eventually returning home at age four to
find his mother and father in ‘dysfunction’; of trying to fit into
public school and of struggling under the ‘floaty’, ‘fuzzy’ and
‘dizzy’ experiences brought about by PTSD.
When we began working together, Frank wanted to discuss
his childhood experience in the solarium and the PTSD with
which he was struggling. This was a more pressing problem
for him than the post-polio syndrome pain in his legs. Frank
had a clear agenda of his own for our conversations which
included the discovery of ‘who he was’. I thought it was
possible that he had lost touch with important and valued
expressions of living that contribute to a sense of identity.
Together we set about making his preferred ways of living
more visible and available, in order that he might experience
greater agency, a stronger sense of identity, and a possible
ignition of empathy, which he believed he has lost during
the solarium years and which he described as ‘a burned
out empathy fuse’. He also spoke about rage, anger and an
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inability to maintain connection in his intimate relationships,
and the abuse he experienced in his current relationship.
We initially externalised PTSD and other outcomes from those
years and investigated the influence these had on Frank’s
life. By evaluating these I learned that Frank was not content
with how his time in the solarium continued to affect his life. A
justification of this evaluation brought forth important values
of respect, connection, love and trust, and it became evident
that these were diminished by his experiences. We then
investigated areas of life where these valued ways of living
were still available in the hope of thickening their presence.
We continued to uncover other important beliefs, values and
commitments.
In one conversation, Frank related a recent move to end a
seven-year long relationship in which he felt ‘marginalised’.
This move was termed ‘in favour of myself’ and against the
marginalisation, and it involved slipping a note under his
partner’s bedroom door that stated his intention to leave.
PTSD, rage, anger, a lack of connection, feelings of being
unloved and disrespected had all been making a strong
appearance during this relationship.
Directly after leaving the note, Frank felt a release of ‘the
PTSD energy’. We talked about what this might mean
regarding what was important to him and what the relationship
may have been suppressing or marginalising.
We also talked about how this move had affected the
presence of PTSD.
Frank informed me that he had moved into his motorhome
and that after doing this he felt a reduction in his experience
of pain and PTSD. He stopped taking his pain medication
because he felt he no longer needed it. By separating himself
from a source of difficult emotional pain, and by putting
himself in a ‘safe place’, Frank had affected his experience of
chronic pain.
After each conversation, I sent Frank ‘notes’ intending
to reflect his words and safeguard the new story he was
developing about himself and his life. Below is an example.
A move in favour of self
You identified Mary’s behaviour as abusive – the recent
event in which you felt ‘blatantly excluded’, ‘avoiding being
dishonest’, marginalisation, – a whole thing about ‘exclusion
and not inclusion’, a disqualification of your voice. This
experience encapsulated one of your ‘big issues’. It triggered
the PTSD (dizzy, fuzzy, floating stuff), and you realised you
needed to act. You made your declaration: ‘I don’t want to be
here anymore’, and an inner commitment of ‘I’m not going to
stay here to get abused anymore’. These were the acts
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I thought came from choices in favour of yourself; choices that
reflected valued ways of living that you gave expression to
through this choice.
The distance you have created – buying and moving into
the motorhome – also created ‘safety and security’, ‘relief’
and ‘freedom’, a separation from being ‘overwhelmed’, and
a detachment that facilitates ‘logical thinking’. It has also
allowed you to practice other important themes of life, namely
‘being able to help’, ‘compassion’, ‘generosity’, and the use
of your logical, knowledgeable and wise self in helping Mary
work out some of the details of this transition. I can see how
this would feel good to you.
I asked if your intention with the letter, slipped under the door,
was a discharge of the PTSD energy? You said no. You were
‘standing up for yourself’. You stood up for yourself and this
gave you a release from the PTSD energy and allowed you to
sleep. You stood up for yourself and that was an antidote (of
sorts) to the PTSD experience. Did I get this right?
Leaving a relationship in which he felt disconnection,
disrespect, marginalisation and exclusion created a sense
of safety and security and a reduction in experiences of pain.
This move also gave him the opportunity to practice other
important commitments, values and beliefs. In subsequent
conversations we historicised these important beliefs and
we deconstructed cultural discourses that got in the way of
fully embracing them. It became evident that Frank’s father
and grandfather practiced a counterculture lifestyle, one that
Frank also appreciated.
These conversations with Frank, and other co-researchers,
led to an investigation into how pain correlates with
trauma and negative emotion. This, in turn, led to a better
understanding of why addressing emotional problems
changed experiences of pain.
Emotional pain alters experiences of chronic pain
and vice versa
The connection between emotional states and pain has long
been established in research on the subjects of pain and
depression (Apkarian, Balik, & Geha, 2009; Bair, Robinson,
Kato, & Kroenke, 2003; Fishbain, Cutleg, Rosomof, &
Rosomoff, 1997; Kroenke, Wu, Bair, Krebs, Damus, & Tu,
2011; Marks, Shah, Patkar, Masand, Park & Pae, 2009;
Reid, William, & Gill, 2003; Songer, 2005), pain and anxiety
(Brooks & Tracey, 2005) and pain and PTSD (Sharp &
Harvey, 2001; Spitzer et al., 2013; Department of Veteran’s
Affairs, 2015). Depression, anxiety and PTSD were among
the more pressing problems that emerged in our study
and, when addressed, had an effect on pain experiences.
Below are examples of this connection in the lives of
Don and Sandy.
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Don and anxiety
Don, another co-researcher in his 70s, needed to return to
the USA from Mexico for two weeks to see his doctors and
refill prescriptions. Before he left he told me he was not
looking forward to going because it meant being away from
his familiar routine, his dogs and his home. As the day of
departure approached, anxiety built and this exacerbated
his COPD (chronic obstructive pulmonary disease), making
breathing more difficult.
Don related the importance in his life of ‘happiness’ and
‘being liked’ and how these play a part in his fight against
neck and back pain, rheumatoid arthritis and sciatica. In
our conversations we investigated what acts supported
‘happiness’ and ‘being liked’ and Don spoke of visiting people
in his neighbourhood, taking his dogs for a ride in his golf
cart, drinking beer, laughing, going to the beach, and chatting
with friends. During these acts, pain had less influence.
However, none of these is available to him when he is away
from home. Travel can be a difficult and painful time.
Sandy and depression
When Sandy and I first began to talk about chronic pain,
I asked if there was something more pressing she would
rather address. She chose to talk about depression. Using
narrative practices we developed a better understanding
of depression and its influence on life, and we talked about
what depression might indicate with regard to an absent but
preferred way of living.
Sandy felt that depression created a ‘physical block of
energy and everything aches’. During these times she was
feeling ‘defeated’, ‘abandoned’, ‘alone’, that depression
‘keeps you from doing things you enjoy’, and that her body
ached. During our time together, Sandy returned to her
doctor to adjust her antidepressant medication. This helped
balance her sleep. She also reported that ‘every once in a
while you get this fleeting wellbeing – an intense emotional
and physical wellbeing’. Although we did not determine
whether the change in medication, narrative therapy, or a
combination of these, was contributing to fleeting wellbeing,
it was certain that depression and the pain she experienced
were somehow connected.
Shared pathways of pain
When the connection between pain and emotional states
surfaced, it became important to investigate what might
have been occurring in pain pathways. This investigation
helped make sense of why addressing more pressing
emotional problems can alter experiences of pain.
Pain has the potential to solicit negative emotional
experiences that can, in turn, contribute to a
heightened experience of pain.
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Responses to pain occur in many areas of the brain
associated with the interpretation and formation of somatic
and emotional responses (Garland, 2012; Merskey & Bogduk,
1994). Some of these brain areas are used in both chronic
pain and emotional responses (Garland, 2012). Research
into these connections, and their shared neurotransmitters,
helped shed light on why tackling more pressing problems
contributes to altering experiences of pain.
A narrative approach to addressing more pressing problems
Offering people in pain the option of addressing whatever
it is they feel is more pressing can honour the individual’s
assessment of, and insider knowledge concerning, what
may be making a negative contribution to life and pain
experiences.
A narrative therapeutic approach to working alongside people
who have expressed more pressing problems could take the
form of:
• identifying and externalising the pressing problem
• investigating the influence of this problem on various
aspects of life
• a
 sking for an evaluation of this influence: ‘Is this
influence OK with you, not OK, or a bit of both?’
• a
 sking for a justification for this evaluation: ‘Why is this
not OK with you?’ or, ‘Why is this OK with you?’
• a
 sking about times when the problem has not had
influence over the person
• r eferring to experiences of pain when the problem
subsides.
A justification of an evaluation offers hints as to what
is absent in the presence of the problem (Carey, Walther
d Russell, 2008; Freedman, 2012; White, 2007). This helps
uncover values, beliefs, goals and intentions that indicate
important ways of living – ways that may be restricted in their
expression by the presence of the problem. Questions about
times the problem has not had an influence help identify times
when important ways of life have been expressed despite
the problem’s presence. These ‘unique outcomes’ (White,
2007) mark exceptions to the dominant problem story, and
they open space for alternative story development. Further
investigating histories around unique outcomes helps thicken
alternative stories and preferred ways of being. Using pre-
and post-intervention scales to determine if this approach
has had an effect allows for an analysis of efficacy by
both the therapist and the person in pain. Scales can
be as simple as a 0 to 10 evaluation.
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During conversations that aid in the development of
alternative and preferred accounts of life, it may become
necessary to deconstruct cultural discourses that inhibit
going forth. One example of this is the alternative story Frank
developed. It became important to support Frank’s preferred
way of living, which he termed ‘doing things differently’, by
deconstructing cultural ideas aimed at conscripting him into
being in a relationship, buying a house, raising a family,
and working until he ached and was exhausted. In a later
conversation, Frank concluded that it was important to say
‘no’ to some work and to stay off the ‘hamster wheel’, his
metaphor for nine-to-five employment. This, he reasoned,
would help him better care for his physical needs.
In another example, Sandy uncovered the importance of
reading in her life. There were many times when she chose
to retreat to her bedroom, rest and use reading to quiet
experiences of pain. The development of this preferred life
was obstructed by ideas regarding ‘healthful living’ that came
from well-meaning friends. These friends would visit and
encourage Sandy to get up and go outside. When we looked
more closely at these messages, we found that they were
attached to cultural discourses regarding what it meant
to be a healthy and successful retired person. Sandy chose
to sidestep these messages and reframe her bedroom
as a ‘sanctuary’ where she could go and escape pain
through reading.
Alternative and preferred storylines that contain valued ways
of living are strengthened by uncovering how they have been
historically and socially developed. In another example, Frank
and I investigated the histories of other family members who
‘did things differently’. We found a history of men going back
two generations who lived as Frank was now endeavouring
to live. Frank’s son also lives a similar way of live. When
Sandy and I reviewed her history, we found a rich cache of
stories that affirmed the importance of reading, writing and
the spoken word. Historic accounts can be brought from
memory to help thicken preferred stories. They also aid
in strengthening strategies used against pain by situating
the development of strategies in an historic context and
identifying contributions of significant others.
The silencing and isolating effects of chronic pain
It is important to bring language and sharing back into
experiences of pain in resistance to pain outcomes. In her
book, The body in pain, Elaine Scarry writes, ‘Whatever pain
achieves, it achieves in part through its unsharability, and it
ensures this unsharability through its resistance to language’
(1985, p. 4).
Pain can rob people of speech. ‘Language not only
disappears, but you can actually chart its disappearance
across the sudden reaching for monosyllables or for the kinds
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of cries and whispers that one made before one learned
language’ (Smith, 2006, p. 224). Similarly, Robert found that
when pain hits 12 out of 10, he could only rock and moan.
Don’s experience of pain reduced him to moaning.
Pain can silence people. Scarry writes, pain’s ‘resistance
to language is not simply one of its incidental or accidental
attributes but is essential to what it is’ (1985, p. 5). Not only
does pain interfere with speech production, but cultural
messages regarding pain’s normative place moves its bearers
to the outskirts of society. People are obedient to conditioning
that disallows conversations about pain experiences. Pain is
something we just don’t talk about. Robert calls chronic pain
‘the elephant in the room’.
Pain causes isolation. People in pain become shut into
their homes, unable to shop or even sit outside in the garden.
At times, people self-isolate so as not to burden others,
such as when Amy, another co-researcher, contemplated
ending her life to unburden her family from her pain and
physical limitations.
It is necessary to address pain’s isolating and marginalising
effects. To minimise these effects it is important to find
ways to connect people in pain with one another. We used
collective narrative documents (Denborough, 2008; White,
2007) to connect people and to diminish pain’s ability to
isolate, silence and marginalise. These documents were
double-storied, containing both the story of the problem and
the strategies used against it. They helped weaken social
constructs that defined ‘success’ or ‘normal’ (Denborough,
2008; White, 2002). These documents accomplished this
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