Emotional Aspects

Constant pain, no diagnosis, or treatment failure usually causes intense frustration, anger, denial, agression, depression, anxiety and other emotions. This receipt of bad news is all part of a perfectly predictable and normal pattern. It is nothing to be ashamed of or feel guilty about. But if it’s never happened to you before, you may not recognize the pattern for what it is, and become trapped in a downward spiral of inability to deal with your problems. This pattern causes the average person to begin thinking irrationally and behaving abnormally.

The pattern is called the Cycle of Acceptance, which is also sometimes referred to as the Cycle of Grief, or the The Kübler-Ross grief cycle. Entering it is unavoidable upon receipt of bad news. How long it takes you to complete the cycle is critical. The longer you are in it, the less likely you will ever fully complete the cycle, the more likely you will be unable to manage your condition wisely, and the more likely you will be terribly unhappy.

For many years, people with terminal illnesses were an embarrassment for doctors. Someone who could not be cured was evidence of the doctors’ fallibility, and as a result the doctors regularly shunned the dying with the excuse that there was nothing more that could be done (and that there was plenty of other demand on the doctors’ time).

Elizabeth Kübler-Ross was a doctor in Switzerland who railed against this unkindness and spent a lot of time with dying people, both comforting and studying them. She wrote a book, which is now world famous, called ‘On Death and Dying’..

In the ensuing years, it was noticed that this emotional cycle was not exclusive just to the terminally ill, but also other people who were affected by bad news, such as losing their jobs, divorce, pain or anything else being negatively affected by change. The important factor is not that the change is good or bad, but that they perceive it as a significantly negative event.

There are two diagrams of the Cycle of Acceptance, that may be helpful in understanding it more accurately. Many of us have gone through this. Take heart. Nearly all of us have emerged from this unpleasant but common phenomenon okay. We can help you through it too, if you will just honestly acknowledge what is happening to you.

• Shock stage: Initial paralysis at hearing the bad news.
• Denial stage: Trying to avoid the inevitable.
• Anger stage: Frustrated outpouring of bottled-up emotion.
• Bargaining stage: Seeking in vain for a way out.
• Depression stage: Final realization of the inevitable.
• Testing stage: Seeking realistic solutions.
• Acceptance stage: Finally finding the way forward.

Getting stuck

A common problem with the above cycle is that people get stuck in one phase. Thus a person may become stuck in denial, never moving on from the position of not accepting the inevitable future. When it happens, they still keep on denying it, such as the person who has lost their job still going into the city only to sit on a park bench all day.

Getting stuck in denial is common in ‘cool’ cultures (such as in Britain, particularly Southern England) where expressing anger is not acceptable. The person may feel that anger, but may then repress it, bottling it up inside.

Likewise, a person may be stuck in permanent anger (which is itself a form of flight from reality) or repeated bargaining. It is more difficult to get stuck in active states than in passivity, and getting stuck in depression is perhaps a more common ailment.

Another trap is that when a person moves on to the next phase, they have not completed an earlier phase and so move backwards in cyclic loops that repeat previous emotion and actions. Thus, for example, a person that finds bargaining not to be working, may go back into anger or denial.

Cycling is itself a form of avoidance of the inevitable, and going backwards in time may seem to be a way of extending the time before the perceived bad thing happens.

Note that the Cycle of Acceptance phenomenon can cause people to engage incomplaints (due to frustration), arguments (due to frustration and agression), andattacks (due to agression). This is perfectly normal behavior, but it is unproductive and distracting. Therefore these are unacceptable types of behavior unless those you are communicating with are prepared to deal constructively with your behavior.

If you do not honestly acknowledge the Cycle of Acceptance and try to get to the acceptance stage, you will be emotionally vunerable and

probably undergo tremendous emotional suffering. Three extreme forms of this are pathological behavior, severe depression, and emotional breakdown.

1. Examples of pathological behavior are prolonged vicious arguments, verbal attacks, verbal abuse, physical abuse, and substance abuse. Pathological means behavior that is habitual, maladaptive, and compulsive.

2. The second form, severe depression, is similar to emotional breakdown, but is less healthy because it lacks the tendency for self repair that occurs when breakdown causes the mind to take a rest. There are many theories. One is that depression centers around being subconsciously convinced a problem is insolvable no matter what you do. This makes the conscious mind feel trapped, hopeless, and full of despair. Insolvability is a rational, normal, initial conclusion, but is often false, due to misperception of the problem or unawareness of a solution or a problem solving path to at least a partial solution. The depressed mind is muddy, while the one in breakdown has gotten away from the source of the problem and is thus cleared up a little.

For these reasons and a host of others that are little understood, severe depression frequently leads to thoughts of suicide. Despite strong taboos, this is a perfectly normal response and nothing to feel guilty about. All the mind is doing is examining alternatives. In fact, due to the prolonged intense pain of PN and the way this disrupts one’s normal lifestyle and happiness, if you never consider the option of suicide for at least a little while, you are probably in the minority and are not examining alternatives. The drawback to suicide is it’s an inflexible, permanent alternative.

The first step to get out of depression is to acknowledge it is happening and is a normal, expected part of the Cycle of Acceptance.

3. The third form, emotional breakdown, is the mind’s way of dealing with inability to find a rational way out. Instead of continuing to take action that is leading nowhere, the mind does nothing for awhile. While this is called a breakdown, it is actually a reliable coping mechanism that almost always leads to a return to a normal existance, and understanding and acceptance of the “problem.” The mind is simply taking time off to repair itself.

In many cases the “problem” is not the original problem, but a new one you became emotionally vulnerable to while suffering from the first problem. For example, those suffering from stress or pain are much more vulnerable to psychological abuse, also called verbal abuse.

Therefore we must help our members though the Cycle of Acceptance not just to help them help themselves, but to preserve a healthy community.

For more on the emotional effects of pudendal neuralgia, see Violet Matthew’s article on Taking the Shame Out of Pudendal Neuralgia.

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 The following poem was written by one of pudendalhope’s forum members.  Thank you, Sadie, for letting us post it on the pudendalhope.org website.