The 7 psychological stages of chronic pain. # 3 is anger

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By Jennifer Martin, PsyD, Columnist

Have you ever wondered if other people with chronic health conditions feel the same as you?

Throughout my years with chronic pain and illnesses, along with the hundreds of patients I have advised, I have found that, although everyone faces their own way and experiences their condition in a unique way, there are common feelings that most of us share.

When I began counseling patients with chronic pain, I often used the “Five Stages of Pain” by Elizabeth Kübler-Ross to help them understand what they were going through.

But as time went by, I reflected on what I experienced with my own chronic diseases and also with those of my patients. It seemed that these stages, although very useful, did not fully explain the wide range of emotions experienced by people with chronic diseases.

After all, Kubler-Ross developed them to explain the responses to pain and loss. Having a chronic illness can be seen as a type of loss, but they were not specifically developed to explain the emotions of people experiencing chronic diseases.

I used the Kübler-Ross stages as a model to develop the seven psychological stages of chronic pain and disease:

1. Denial

At this stage, we are in a state of shock and rejection. We wonder how our life will change and how we will live with those changes. Denial and shock help us cope and make survival possible.

This stage can be dangerous for people with chronic pain and illness because, if they refuse to know their disease, they may not take the necessary measures to get the treatment they need.

Example: “It’s not a big problem, it will disappear” or “The doctor is wrong, I don’t have diabetes.”

2. Lawyer, Negotiation and Despair.

This is the stage in which we want more than anything to make life what it once was. We look at anything that can make our illness and our pain disappear, or anything that can give us an appearance of life we ​​once had.

We can find fault with ourselves and what we think we could have done differently. We can even negotiate with pain or illness because we would do anything to not feel them anymore. Guilt is common when negotiating.

Example: “Please, don’t let this ruin my life” or “If you make the pain go away, I promise you I’ll be a better person.”

3. the anger

After we conclude that our plea and negotiation will not change the diagnosis, the anger begins.

Anger is a necessary stage of the healing process. The feelings of anger may seem endless, but it is important to feel them. The more you truly feel anger, the more it will begin to decrease and the more you will heal. Your anger has no limits and can be extended to your doctors, family, friends and loved ones.

Anger is often felt later when illness and pain progress, or prevents us from doing the things we would like.

Example: “This is not fair! I did nothing to deserve this! “Or” Just give me something that makes me feel better! “

4. Anxiety and depression.

The feelings of emptiness and pain appear at a very deep level. This depressive stage feels as if it will last forever. It is important to understand that this depression is not a sign of mental illness. It is the appropriate response to a loss or a life-altering situation.

We can withdraw from life and ask ourselves if there is any reason to continue. Depression after a loss is often seen as unnatural or as something that must be eliminated. Being diagnosed with a chronic illness or experiencing chronic pain is a loss, a loss of life you once had.

Having a chronic pain or illness can also cause feelings of anxiety; anxiety about what the future holds, anxiety about not living up to expectations, anxiety about social situations, anxiety about medical bills, etc.

Example: “I’m going to hurt forever, so why bother?” Or “I’m going to borrow forever.” How will I pay these medical bills?

5. Loss of self and confusion.

Having chronic pain or illness can mean giving up some key aspect of what we did to ourselves. It can mean an inability to be physically active as we once were. It can mean not being as social as we would like or it can even mean giving up a career.

You can wake up one day and not recognize the person you are now. You can question what your purpose in life is now. This stage can occur at the same time as anxiety and depression, or it can be separated.

Example: “I don’t even recognize myself” or “My career was my identity. Who am I without it?

6. Reassessment of life, roles and goals.

Having a chronic condition often means giving up a lot. We are forced to reevaluate our goals and futures. We are forced to reevaluate who we are as a husband, wife, mother, father, brother or friend. While we once had a successful career that gave us a purpose, we can begin to question what we can do to work in the future and how we can contribute to our families.

While we were able to do everything once, we are now reassessing what needs to be done during our days and how we can achieve these goals while still being in a positive mood. Reassessing your life, roles and goals is a crucial first step in accepting your condition.

Example: “Maybe I can no longer be a nurse, but maybe I can teach a couple of times a week” or “I can no longer be so physically active with my husband, so what else can I do to show him that I love him?

7. Acceptance

Acceptance is often confused with the idea of ​​being “good” with what has happened. This is not true. Many people never feel good about having to live with pain or illness for the rest of their lives.

This stage consists in accepting the reality of your situation and recognizing that this new reality is permanent. We will never like this reality and it may never be right, but eventually we accept it and learn to live life with it. It is the new norm with which we must learn to live.

We must make adaptations and alterations to our lives. We must find new things that bring us joy.

Example: “I will not let this define me. I will learn to deal with this as best I can. ”

It is important to remember that these stages are not linear. While some people begin in the denial stage, go through each stage and end with acceptance, many people jump from side to side throughout the stages. I hope that these stages give some comfort to those who experience chronic diseases.


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