“Sensations are not symptoms,” I tell myself as I place one blue-sneakered foot tentatively onto the concrete pavement. The words of my first psychiatrist return to me, though I can’t remember his precise phrasing. “How many times will you tell yourself you can’t do it before you do?”
“Anxiety and fear do not provide solace for our pain but aggravate it, leading us to a kind of breakdown in courage and strength because it appears that our pain has no possible remedy.”
~ St. Francis de Sales
On this blog, though I recount forthrightly my struggles with depression and anxiety and I unabashedly discuss my recovery from binge eating disorder, there remain one or two subjects so steeped in self-judgment and shame that I continue to carefully avoid them. These issues are important parts of my identity, and I process them in-depth with my dietician, my therapist, and in my personal writing. Otherwise, I keep the stories to myself, with the persistent belief that, “There are some things that people just won’t understand.” The way that my mind processes thought through physiologic responses in my body is one of those topics that I eschew. It’s hard to describe the stress-induced symptoms that I can develop. They aren’t manifestations of an overactive imagination or an overwrought psyche, and I don’t suffer from what is commonly characterized (and stigmatized) as “psychosomatic” illness. Over-worked neurons send misdirecting signals into the muscles of my body, which contract irregularly, and – voila! – a knot in my shoulder or in my stomach, a rushed trip to the restroom, or a flare-up of an old tendinitis. Did you ever have a lump in your throat, tightness in your chest, or butterflies in your stomach when you were particularly anxious about something? In some people, that mind-body connection is a little over-developed. Different people may experience this process in a manner of ways, but for me, it is just that easy… and complicated.
My response to stress through these non-specific physical manifestations didn’t emerge out of nowhere. When I was in sixth grade, I was the target of some fairly serious bullying. (Those were the days before cell phones and social media. I can’t even fathom what children go through today.) By the end of the year, I was suffering from such frequent stomachaches and nausea that my pediatrician was convinced I was lactose intolerant. When all the tests returned with normal results, the symptoms eventually resolved. I was always a sensitive child and easily prone to worry. As I transitioned from elementary to middle school, the dysthymic depression that would persist for the next 20 years settled more concretely upon me. I began to experience intermittent knee pains, which continued off and on throughout high school and college. I was diagnosed with patellofemoral syndrome, attributed to soccer and tennis. Before every tennis match, I lined up by the athletic trainer’s office so that he could tape my knees, but my ruminations about the sensation of pain only exacerbated and amplified the subjective experience. After college, I found my stride – literally and figuratively – becoming a short-distance runner and entering races. I completely forgot about my history of patellofemoral syndrome, and then I developed my first significant injury of adulthood. It was the fear more than the pain from the shin splints and possible stress fracture (I couldn’t afford the diagnostic test) that caused my depression and anxiety to spike. My thoughts lingered obsessively over my injury. In my fear and anticipation of pain, I could interpret almost any physical sensation in my legs as “hurt,” and my recovery extended beyond the expected six weeks into the range of six months. Eventually, when my bewildered doctor told me, “Either you are going to run, or you aren’t,” I screwed up my courage and forced one foot in front of the other. My mind reeled, but there wasn’t any inflammation in my extremities. When I forced my way through my dread and apprehension, both the emotions and their physical manifestations slowly melted away into… normalcy.
It wasn’t until nearly five years later, while I was recovering from my gastrointestinal illness and plantar fasciitis, that my therapist and I started addressing the role that my thought process was playing in my over-interpretation of physical stimuli. Anytime I noticed the slightest suggestion of a feeling in the area of my abdomen, I began to focus all of my attention on my stomach. As I over-analyzed every gurgle and squelch, I descended into self-blame, and my head swam with alarming and catastrophic thoughts. “Am I relapsing again? What did I do? I must have done something to cause it! What should I do? What if I really am getting sick again?” While my mood tanked, my stomach twisted into aching knots. At the same time that I was recovering from the terrible trauma of that prolonged GI disease, I was also in physical and emotional agony over a lingering case of plantar fasciitis, which made it difficult to enjoy many of the activities I once loved. The onset of the injury occurred during the peak of the colitis, at a time when I was weakened, malnourished, and desperately depressed. When my therapist and I discussed this history, I began to see how my anxiety and perseverations were understandable. It was so obvious when it was all laid out as if we were discussing the life of some stranger. Of course, I would be hyper-vigilant to any cues that might alert me to impending danger from these two conditions which, together, upended my entire existence! With my therapist’s coaching, I practiced responding to my pain and my fear with acceptance, gentleness, and self-compassion. “There’s that pain again,” I acknowledged. “There’s my brain worrying that something is wrong. But nothing is wrong, and I am ok.” As I gently closed my eyes and relaxed the little muscles of my jaw, I repeated to myself, “Deep breath. Ground myself in the breath. Ground myself in anything other than my stomach or my feet.”
Turning to principles of operant conditioning, I trained myself to act opposite my emotions. Rather than modifying my behavior to “protect myself” from further exacerbating the “pain,” I did exactly what I was afraid to do, within what a wise mind might consider moderate and safe. Instead of staying home from a bike ride, I would set out for a gentle cycle around the block, just to stretch my legs and prove to myself that I was capable of spending 10 or 15 minutes on a bicycle without hurting myself or causing some sort of massive GI upheaval. Instead of sitting on the couch and nursing my poor feet, lamenting my “disability,” I would tell myself softly that walking through the grocery store was not enough to trigger any sort of severe injury from which recovery was impossible, and off I went, frequently deep-breathing the whole way along while squinting my eyes tight and forcefully redirecting my attention again and again to anything other than the focus of my worry.
“The best way out is always through.”
~ Robert Frost
During these days of rewiring my mind-body connection, I developed several mantras: “Just because I feel pain does not mean I am injured. // Sensitivity is not the same as pain. // There is no way that this moderate level of (x,y,z) activity is causing permanent damage. // In the whole long course of my life, this will not last forever! I am ok, and I am going to be ok. // All of this is going to work out. // No matter what happens, God has a plan for my life.” I also expanded the vocabulary that I used to describe my physical sensations. From one word, “pain,” my lexicon multiplied to include pressure, twinge, niggle, rub, ache, sting, tenderness, smarting, soreness, prickle, tingle, pinch, throb, burn, and irritation. Sometimes, there was still no word that fit. “I just feel it. It’s just there,” I would tell myself. Just because I was aware of the presence of my feet, did not mean that there was anything amiss.
“Don’t trouble yourself. God didn’t make us to abandon us.”
So… why am I now reflecting on a desensitization process that I undertook almost two years ago? Well, I still develop physiologic responses to stress, and I still rely on the same tools and skills to redirect the automatic thoughts that alarm my mind with fears that my body isn’t right. With my trip to Paris quickly approaching, I am discovering that there is much more to this jumble than I originally perceived. There are some fearsome monsters still slumbering peacefully in a dark corner of my closet. Until recently, I didn’t even know they were there. Now, they are yawning wide, stretching their claws after their long hibernation, and showing their fangs. They are knocking on the door, and I am timidly letting them into the room.
The truth is, by God’s grace I am blessedly able-bodied, and I always enjoyed a very active lifestyle. I grew up running, jumping, and playing. At parties, I loved to dance! I lived in New York City and Washington, DC and constantly walked everywhere. Until a couple years ago, my job was incredibly active, and I was on my feet for 12 to 16 hours a day. Where did she go, that girl who used to clomp and shuffle and skip and scurry? She never gave her feet much of a thought. “This trip is going to be good for you on many levels,” my therapist predicted during our most recent session. She was referring to the myriad ways I was finding myself hurtled out of my comfort zone. Her underlying assumption seemed to be that I would emerge intact and healthy from my visits with the beasties in the closet. She foresaw us all pleasantly sipping thé and eating gateau at some Parisian sidewalk café in May. I reminded her that there were only four months until my departure – not much time to rehabilitate myself. “And here I was thinking, ‘Wow, we have four whole months! Think of all we can do in that amount of time!’” she replied.
Ironically, it was my mother who offered me the centering words of reassurance that anchored me in acceptance and self-compassion. “If it hurts to walk, just sit down,” she spoke to me over the phone. I was so overwhelmed by how much walking I would have to do after I landed in Paris, that I never stopped to consider I didn’t actually have to do any of it. “There will be so many places to sit! There will be places to sit everywhere! You don’t have to go everywhere and see everything. Just do what you can, and then take a break.” I was a little stunned that these words of balance and wisdom were coming from the same driven woman who instilled my perfectionistic, neurotic restlessness in me. This was the bold, fearless mother whose sense of adventure and curiosity could never be dissuaded until she explored every nook and cranny of every city, street, neighborhood, beach, field, house, museum, shop, or parking lot into which she ever stepped foot. She never saw a “Do Not Enter” sign that applied to her. As I contemplated her message, I remembered that she was also the same one who gently told me, “Let go of your pride,” when I blushed with shame as I maneuvered a motorized scooter through Disney World two years ago. In both instances, she reminded me that it was ok to be flexible, that I was more than I imagined myself to be, and that in the acceptance of reality, there was nothing to fear.
“If we are intended for great ends, we are called to great hazards.”
~ Blessed John Henry Newman
“Do what you can. It’s going to be ok.” Both feet are planted on the sidewalk now. I close the front door behind me, turn the key, and drop the little brass ring into my jacket pocket. Unravelling a set of earbuds, I jam them into my ears, wedging them in extra-securely. I thumb through my music and hit the “shuffle” button on the same playlist that comforted me during those early days of transition after my partial hospitalization discharge. Pat Benatar blasts into my tympanic membranes, reverberating down my auditory canals into my brain, drowning out any other thoughts. Off go my feet – one, two, one, two – and I consciously slow them as I count my inhales and exhales. Clenching my fists and singing softly along with the lyrics, I turn the corner, and I lose sight of the house behind me. “My body can do this! My body wants to do this,” I think. “It is my mind that is weak.” At the end of the next street, I turn back. The loop is about a mile, all-told, and I finish it in about 30 minutes. I am ok. “It’s going to be ok.”
“It’s a dangerous business, Frodo, going out your door. You step onto the road, and if you don’t keep your feet, there’s no knowing where you might be swept off to.”
~ J.R.R. Tolkein, The Lord of the Rings