Posted on Jan 5, 2018
What do you believe hurts more, physical pain or mental pain? How do you deal with each of these?
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If we have been told anything after having served, we all understand that there are definitely both physical and mental/emotional injuries. Which do you believe are more painful? How do you tend to deal with these experiences?
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Resiliency
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I know this post is a bit old now, but an interesting phenomenon that far too many veterans do not often think about is how physical pain and mental pain are inherently linked. They feed off of each other and have a certain dynamic that makes their sum total exponentially worse if EITHER escalates. I have personally dealt with both varieties and have seen this first hand. I have also discussed it with many other veterans and civilians alike.
Take physical pain for example, if we cannot control that pain for one reason or another it results in lethargy, depression, anxiety, insomnia, and/or other psychological conditions that will only limit our ability to be more mobile. The resulting decreased mobility causes weakness and potentially even diminished core strength. That results in even MORE physical pain than we started out with!!! That increased physical pain subsequently exasperates our emotional pain!!! It’s certainly one hell of a vicious cycle. I call it the “Pain Triad.”
The “answers” are unfortunately far more easily said than done as if you asked me 5 or 10 years ago, I would have simply said that “attitude is everything” and to not sound cliché, “we each have the choice to be happy.” Over the past few years my physical disabilities went into overdrive, enough to get rated from 0% to 100% in just 9 weeks! That was also 20 years POST discharge! Thank goodness for the PACT Act as it was truly a lifesaver in many regards, but while it should have opened many more doors at the VA, my longtime primary left and I feel as the resulting providers have truly failed me. That said, it’s very difficult to maintain a bona fide positive attitude when so much is stacked against you. I could say with certainty that my Zoloft and VA Psychiatrist that prescribes it have made a ton of difference, allowing me to keep my head above water! So, this phenomenon is far more dynamic than I originally thought.
That brings me to say that, well, they BOTH suck, it’s hard to quantify which one is actually “worse” when they’re so intertwined. We also perceive things differently and what one person feels could never truly be felt by the next individual because we all perceive pain in our very own unique ways. So, one type may be perceived as worse by one person, but not by the next, and yet another realizes the delicate balance making them suck together. What I could hopefully offer to bring to the table is that we could hopefully make it suck a bit less by (1) actively being cognizant that both types of pain really do feed off of one another. (2) Behavioral healthcare must be a PRIORITY as it could break the cycle or at least help enough to keep us moving forward. We also do need to be mindful that behavioral healthcare is a very sensitive topic and getting the right providers is an absolute must as the wrong providers or medications could backfire and segue into a negative outcome. (3) We need to advocate for ourselves because NOBODY could advocate better! (4) Increase “mobility” on our terms and as per our own capabilities. And, finally (5) it may be difficult, but at least TRY to “choose happiness,” because nobody could ever take it from us without our explicit consent! It may even take antidepressants to help get there, but again, this is a complex triad with many complex parts. I need to keep reminding myself of this, so I do recognize how difficult such a mind shift could be. Some may even say that perpetual happiness is not natural, but to each their own.
Ultimately, I know that these things have kept me personally going when both physical and emotional tolls have been stacked against me. I certainly wish that I had better answers, especially for myself, but this is how I’ve perceived the sum total and hopefully it will help someone else that may not have these minimal answers to even work with.
I’d love to hear any thoughts! Be well!
Take physical pain for example, if we cannot control that pain for one reason or another it results in lethargy, depression, anxiety, insomnia, and/or other psychological conditions that will only limit our ability to be more mobile. The resulting decreased mobility causes weakness and potentially even diminished core strength. That results in even MORE physical pain than we started out with!!! That increased physical pain subsequently exasperates our emotional pain!!! It’s certainly one hell of a vicious cycle. I call it the “Pain Triad.”
The “answers” are unfortunately far more easily said than done as if you asked me 5 or 10 years ago, I would have simply said that “attitude is everything” and to not sound cliché, “we each have the choice to be happy.” Over the past few years my physical disabilities went into overdrive, enough to get rated from 0% to 100% in just 9 weeks! That was also 20 years POST discharge! Thank goodness for the PACT Act as it was truly a lifesaver in many regards, but while it should have opened many more doors at the VA, my longtime primary left and I feel as the resulting providers have truly failed me. That said, it’s very difficult to maintain a bona fide positive attitude when so much is stacked against you. I could say with certainty that my Zoloft and VA Psychiatrist that prescribes it have made a ton of difference, allowing me to keep my head above water! So, this phenomenon is far more dynamic than I originally thought.
That brings me to say that, well, they BOTH suck, it’s hard to quantify which one is actually “worse” when they’re so intertwined. We also perceive things differently and what one person feels could never truly be felt by the next individual because we all perceive pain in our very own unique ways. So, one type may be perceived as worse by one person, but not by the next, and yet another realizes the delicate balance making them suck together. What I could hopefully offer to bring to the table is that we could hopefully make it suck a bit less by (1) actively being cognizant that both types of pain really do feed off of one another. (2) Behavioral healthcare must be a PRIORITY as it could break the cycle or at least help enough to keep us moving forward. We also do need to be mindful that behavioral healthcare is a very sensitive topic and getting the right providers is an absolute must as the wrong providers or medications could backfire and segue into a negative outcome. (3) We need to advocate for ourselves because NOBODY could advocate better! (4) Increase “mobility” on our terms and as per our own capabilities. And, finally (5) it may be difficult, but at least TRY to “choose happiness,” because nobody could ever take it from us without our explicit consent! It may even take antidepressants to help get there, but again, this is a complex triad with many complex parts. I need to keep reminding myself of this, so I do recognize how difficult such a mind shift could be. Some may even say that perpetual happiness is not natural, but to each their own.
Ultimately, I know that these things have kept me personally going when both physical and emotional tolls have been stacked against me. I certainly wish that I had better answers, especially for myself, but this is how I’ve perceived the sum total and hopefully it will help someone else that may not have these minimal answers to even work with.
I’d love to hear any thoughts! Be well!
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SGT Joseph Gunderson
The connection you've made to the two categories is an interesting one. The fact that one feeds off the other and in turn worsens both makes the need to approach both simultaneously imperative, unless one can simply understand and interrupt the process.
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PO3 Jay Rose
Thank you for the kind words! There’s no doubt that the two are linked in a symbiotic sort of way and although there’s research on this, and Cognitive Behavioral Therapy for Pain (CBT-P) even tries to merge these constructs in a beneficial sort of way, I have definitely experienced it firsthand and have seen how drastic the ups-and-downs will become when mental health factors into physical health and vice versa.
This is why I do agree with part of what the VA says regarding pain management, specifically that pain psychology could be highly beneficial. I absolutely disagree that it’s a “cure all” (it’s simply not!) as some VA providers are trying to frame it as one, but take someone giving birth, she needs an epidural because guided meditation alone will fail in all but a handful of cases! The biggest issue that I’ve seen with the 2022 VA/DoD Guidelines is how they remove the individual from the equation, as in literally, being that everything is becoming rigid algorithms and flowcharts that are meant to guide patient “care” or lack thereof. I think that the heavy use of such tools patronizes those providers that want to actually help make a difference and in-turn only contributes to their already shamefully high turnover rates! Frankly, if I had a provider that actually “needs” flowcharts to tell them how it’s appropriate to prescribe, they probably never should have been given an authorization to prescribe in the very first place! My point being that it’s not just the VA who are taking the personalized approach out of what once was healthcare, but when the VA does it only leads to widespread problems in our community that will only get worse over time.
All of this is why I feel it’s imperative for every vet to understand themselves and their pain, because they are truly their best advocate and nobody knows yourself better than you! Providers may have specialized medical knowledge, but that doesn’t help with knowing you! Now, you may be limited on many things, especially due to VA policy, but the one thing that NOBODY could ever take without your express consent is your willingness to be happy. It’s far more powerful than most people will ever realize and had got me through some pretty tough times. I only wish that I could listen to my own advice better because it’s far too easy to forget when tensions rise!
This is why I do agree with part of what the VA says regarding pain management, specifically that pain psychology could be highly beneficial. I absolutely disagree that it’s a “cure all” (it’s simply not!) as some VA providers are trying to frame it as one, but take someone giving birth, she needs an epidural because guided meditation alone will fail in all but a handful of cases! The biggest issue that I’ve seen with the 2022 VA/DoD Guidelines is how they remove the individual from the equation, as in literally, being that everything is becoming rigid algorithms and flowcharts that are meant to guide patient “care” or lack thereof. I think that the heavy use of such tools patronizes those providers that want to actually help make a difference and in-turn only contributes to their already shamefully high turnover rates! Frankly, if I had a provider that actually “needs” flowcharts to tell them how it’s appropriate to prescribe, they probably never should have been given an authorization to prescribe in the very first place! My point being that it’s not just the VA who are taking the personalized approach out of what once was healthcare, but when the VA does it only leads to widespread problems in our community that will only get worse over time.
All of this is why I feel it’s imperative for every vet to understand themselves and their pain, because they are truly their best advocate and nobody knows yourself better than you! Providers may have specialized medical knowledge, but that doesn’t help with knowing you! Now, you may be limited on many things, especially due to VA policy, but the one thing that NOBODY could ever take without your express consent is your willingness to be happy. It’s far more powerful than most people will ever realize and had got me through some pretty tough times. I only wish that I could listen to my own advice better because it’s far too easy to forget when tensions rise!
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SGT Joseph Gunderson: I have suffered more from my emotional injuries....I have cried, and cried, and cried.
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I got blown off the top of a bunker in Vietnam requiring a ten day stay in the USAF (A++ treatment) hospital at Cam Rhan Bay. The greater pain, however, was the Dear John I got four months into my tour. That is the pain I remember most.
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