Separating Pain from Shame: Therapy Notes (Pt. 6)

They Are Two Different Things

Hello ♡,

We are continuing our series Therapy Notes: Small Bits of Wisdom From Inside the Room. This week we are looking at an essential part of therapy work: understanding what is pain versus what is shame.

Have you ever heard of the therapeutic concept of clean pain versus dirty pain?¹ Clean pain is the painful incident or feeling. It is hard, hurts terribly perhaps, but it is unmuddled. Dirty pain is when the clean pain gets all muddied with our shame, false narratives, old beliefs, self criticism, blame, or self destructive behaviors. Dirty pain is what we shamefully think about our suffering and ourselves in it, or what we do to avoid the clean pain. We don’t get to choose if clean pain comes our way, but we do have more choice in whether or not we dirty it with more. In therapy we are often trying to move from dirty pain to clean pain.

Photo by Jennifer Burk on Unsplash

We will all have pain. But it is often the stories we are telling about ourselves in that pain that cause us to feel like we are drowning. I am going to share a personal story to illustrate this difference. When I was younger, in trying to start a family with my husband, I struggled to get pregnant. I was so sad. I was going through the process of looking into it medically to see what was happening when I saw the difference between my own shame and pain, between my own clean pain and dirty pain.

I sat in a small dark room in a hospital. It was just me and the doctor. I stared up at the screen we were both looking at. A picture of my insides with iodine injected. It was ghostly, shadowy, black and white. 

And there it was. A clear picture that showed half of my insides all lit up, while one whole side of my ovaries and fallopian tubes were dark, black, as if there was nothing there. The iodine couldn’t get there. I kept staring, blinking my eyes, thinking something might appear. It was so odd to see it. Oddly factual.

There was a moment of quiet as we both stared up at that screen together, strangers only moments before. We were both united now in the silent surprise of what we were seeing. “There is still hope,” the doctor awkwardly fumbled. I appreciated the sentiment, even though I wasn’t sure he believed it.

One whole side of my reproductive organs were blocked, unable to do their job, explaining why I hadn’t been able to get pregnant. There it was. Right there. In black and white.

The doctor said he was going to try to open the blocked side, the shadowy dark on the picture. I closed my eyes and felt like I might die from the pain. It was searing, and I felt like I might explode from the inside. We didn’t know if it worked, but I appreciated the attempt.

The doctor left and I looked up at the screen, alone now in the dark little room. All by myself I took in the reality of what I was seeing. There it is. All this time it was you, I thought to myself as I looked up at the shadowing empty side of the screen.

After I got dressed and gathered my things, I walked down the bright hospital hall. Hot tears started to run down my face as I got closer to my husband waiting for me. I cried as we hugged. I was crying partly from the shock of the pain I had just endured, partly from the relief of seeing him, but mostly from the revelation of what was occurring to me.

Damn it, I thought. “Damn it,” I said out loud. All this time. All this time! I thought it was me. I thought it was my fault I couldn’t get pregnant. And all this time, all this time, there was a part of my body not even working.

As we drove home, I thought about all the things people had said to me as I had vulnerably shared my struggle: Just relax. Have a glass of wine. Go on a vacation. It won’t happen it you’re worried. I know someone who got pregnant after they adopted and they weren’t trying anymore. Just stop trying and then it will happen. Maybe it’s your diet. Oh and my favorite, maybe God is trying to teach you something, and when you learn that lesson you’ll get pregnant.

The implicit, or explicit message in all of this “advice” was: Maybe it is because you are doing something wrong.

All of their shaming advice had a not so subtle subtext: maybe it’s your fault. Maybe this struggle, this pain, this disappointment is caused by your failure.

And I am sad to say, I believed them, partially at least. Now of course I wrestled with their words. And I appreciated my husband’s eye rolls at their “advice.” But I still listened, and I wondered. And just like a puzzle piece fitting perfectly into it’s spot I quietly accepted in my grief that this pain was somehow my fault.

That is, until that dark room with the doctor and the shadowy screen above our heads. In that room I saw in black and white clarity something I had never even considered! Something all of that unhelpful advice had never even considered: there was something happening in my body. There was a whole other story, another reason entirely for what I was experiencing. It wasn’t my fault.

Now I want to be clear here, that even if there wasn’t a physical picture, this sadness was still not my fault. People are uncomfortable with the pain of others, and in their discomfort they try to find reasons you’re suffering because it is just too scary for them that you might just be in pain. We often blame one another for pain because that makes it all seem more tolerable. Now sure, there are times when our own choices have caused us pain. But I am referring here to all of the times we are in pain just because it is pain.

What I saw in myself in this experience I see in therapy all the time. When we are in pain we often double our suffering by believing the shame story we’re told or we’re telling ourselves.

There is a developmental stage that happens for children when they believe every hard thing is their fault unless they are taught a more balanced appraisal of life. Kids are egocentric by nature, and in order to understand the world, without help from a grown up, they often assume pain that they see or feel is because of them.

And many of us never outgrew this.

And many messages we may be hearing, culturally or relationally, point to the sufferer of pain as the only cause. At the root of all of this is often shame. Shame² is global, it is like a cloak that you throw over your whole being. It is very non-specific. It sounds like: you’re bad, you’re too much, you’re a failure. They won’t like you, you’re not accepted, you’re not acceptable, something is wrong with you. It’s all your fault. You are stupid for thinking something good could happen for you.

Shame says you are bad. It is all encompassing about your identity. And shame or a cousin of shame often comes for us when we are hurting, or have been hurt.

And so I wonder about you. I wonder about pain you may be experiencing. Where do you need clarity? Where do you need a metaphorically quiet room and an xray of your pain to see it all with new eyes? Your pain is valid, but I am guessing all the narratives you are hearing in your head about it (and you) are not so accurate.

Photo by Amy Parkes on Unsplash

Finally, I want to leave you with this: In therapy we sift. We sift out the lie from the truth. The pain, valid and hard, from the shame story. Where do you need to sift? Where do you need to let your pain, your grief, your loss, your disappointment be what they are. Hard, painful, sad, yes. But different from who you are. Where can you move from dirty pain to the clarity of clean pain?

With you in the sifting,

Monica

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Book Update:

My dear book, which will someday soon be every reader’s dear book, has made it through copy editing and is on to typesetting. Going through all the copyediting was an intense process. I like to spend hours at a time on a project, it helps me focus more. I poured through every single word, comma, period. The copy editor was so smart. I nodded my head in gratitude at the little and bigger things she caught. It is getting so real now. And gosh, I keep thinking everyone says it is so hard to write a book. The writing feels like only one piece of it, there are so many layers and steps. It is really something. I have so much awe and respect for each author of each book I have casually read. What went into that!! Wow.

I am in the processing of asking for potential endorsements. This is excruciatingly vulnerable. More vulnerability! I just wanted to hide. I was impressed at the non essential tasks I cam up with around the house to avoid sending the requests. But I did it and I am so grateful for each person that has agreed to read my book to endorse so far. I get quite emotional with gratitude about it. It is a big ask. And so each yes feels equally huge.

I will keep you posted as we get closer!!

1. I first read about this concept in the incredible book My Grandmother’s Hands, by Resmaa Manekam. I can’t recommend this book enough. Clean versus dirty pain is also a concept in Acceptance in Comittmment Therapy.

2. My definition of shame is informed by all the research and work of Brené Brown. If you haven’t read her books yet, run to get them!