Survival of the Unfittest II

Those with severe Central Pain will recognize the oxymoron in the lead title. “Survival” of the person who once was, is not possible in endless, terrible suffering. Yet, we address the difficult question: What is the best attitude in whatever identity remains, for survival of severe Central Pain? Similar principles probably apply to any type of longstanding torture, so we draw from that literature.

Do you hate philosophy? We do too, MOST of the time. But you are going to need one to confront Central Pain. So here is hoping the headache of weighing ideas will be less than the headache which appalling pain heaps upon you. Deep thought takes energy, but sound philosophy teaches you to conserve energy. Consider the following:

With pain, stress is inevitable. As Buytendijk says, whatever chronic pain teaches us comes at a usurious price. Depletion of resources is frequent. One must preserve energy sufficient to meet the pain. The problems encountered in handling pain are both those of a universal nature (pain hurts) and those which flow from individual personality characteristics.


In Hawaii, there is an old expression used to describe those who have gone crazy. It refers to a huge current that exists off the south point of the Big Island. The force of the current travels perhaps eight or nine hundred miles, well on the way to Tahiti, an extended trip which will find the person short of provisions. The phrase suggests there is no way back. If a boat finds itself in the current, without power to move out of it, the only hope may be to make for Tahiti, however difficult that may be. There is an aspect of CP which is like being lost in the Ka’u current. The forces of pain carry you along. Maybe it is time to accept the changes, rather than fight against it. Give up what you must, and hold onto what matters most.

Like insanity, CP is not where anyone wants to go. Those who find themselves in its grip cannot live in the manner of others. They must reinvent life, including priorities, associates, requirements, and what must be accepted. Even in this appalling loss, strengths will appear. One must make do with little.

There is a caution. Since pain tends to create a singleminded urgency, the person who tends toward preoccuptation may find no attempt to fight back too drastic. The persistent personality, like all other types, must scale back the natural attributes or there will not be enough energy left to meet the pain. What we are tryng to avoid is a sense of defeat so great that the person cannot maintain himself/herself. If most of your time is spent trying to convince others that CP is horrible, which it is, you will come up short when you must decide if you can go on. Pilots who fly twin engine aircraft must balance fuel on both sides of the aircraft. Like them, you should not become imbalanced between activism about CP and coping with the pain of CP. If we merely reinforce what the public already believes, it is a downhill task. If we must go against conventional ideas of pain, it is truly an uphill battle. If the rate of climb becomes too steep, our engine will stall. We may fall from the skies.

Pain draws a surprising amount of energy. As Buytendijk has stated, exhaustion is one of the most difficult aspects of chronic pain. One often fruitless task is trying to persuade laypersons that CP is real. They have never heard of it and will have no place to put it. You should ask yourself, “Am I trying to convince someone”. If you are, you should stop. You are tipping too far in one direction. It is perfectly alright, and perhaps obligatory to present the FACTS of CP, but it is not your job to convince anyone.

YOU and YOU alone must pace yourself. You must deny others when necessary, even if the reasons for your refusal may not seem obvious and may give rise to resentment. In this article we are concerned with the search for another kind of validation, an acknowledgement of what the CP sufferer is enduring. Since others do not and cannot comprehend what a dis-integrated pain system is like, there will be no no acknowledgements given.

Everyone would attempt to help someone on fire, if they could only see it. Even elementary school children know not to run and to smother the fire by rolling on the ground or wrapping themselves in a blanket. Where are the helpful instructions for assisting a human being whose nervous system recreates a similar sensation of burning, without the flames?

We have pointed out before that the non-fiction literature dealing with physical suffering is surprisingly small. The late Dr. Patrick Wall, the originator of the Painonline project, regarded Primo Levi as the ONLY author ever to deal well with the topic of suffering. Since Dr. Wall was also a great fan of Buytendijk, we think he meant Levi excelled in a literary sense, for Buytendijk does a masterful job of addressing the problems of chronic pain from a clinical perspective. Where it seems appropriate, we will therefore draw from Levi