My Hierarchy of Pain Needs

I mentioned yesterday that I had finally broken down and bought some supportive bras for non-gym use.  (I already have heavy duty sports bras that are great for the gym).  I was nervous that I would have to not only increase my cup size, but my band size as well and that would hurt my self-image.  Well, I have been a 36 for as long as I can remember and I am now comfortably a 36/38 while still being a DDD cup.  While I could do without the extra letters on that cup size, I feel good fitting into my own size clothes again.  (Although I cannot wear my medium t-shirts because there is no way they are fitting over my chest).  I felt good enough to actually buy a couple shirts (on sale!) that help me feel like my old self.  I would like to be a little more toned still, but it was really a good feeling to be in normal clothes even while I'm still getting my hormone shot because that is supposed to cause major weight gain.  

All of this reminded me of one of the first things we learned about in my college psych class: Maslow's Hierarchy of Needs.  I'm not going to give you a lesson; you can click the link for Wikipedia's brief description.  Basically, the theory is that you need to take care of certain basic human needs before you can become a self-actualized person.  His hierarchy is a pyramid, with basic physical needs as the base, then human safety needs, then emotional needs, then your own self-esteem needs and finally, you can reach self-actualization.  I am not going to start a seminar or anything, but it got me thinking that chronic pain, at a serious enough level, really does drop a person back to the very bottom of his pyramid and to the basic physiological needs of the body. There have been changes made to his theory and it has grown and is used in various different ways, but I think the basic model below applies the best for my purposes.

I think it actually would change that pyramid because safety is always important (more-so depending upon where you are living in the world) but in the United States if you are above poverty level, safety is pretty much taken care of, or can be.  Beyond that, when I first developed pain, I didn't really care if I ate, I wasn't able to sleep much and my focus was solely on dealing with pain moment to moment.  I don't know exactly what a chronic pain pyramid would look like, but I think I would say that assuming you are safe (which I understand may be a big assumption depending upon how much your disease takes over your life), a big step for people with endometriosis, or any chronic pain illness, would be becoming pain-free and beginning to care again about your physical health outside of stopping the pain.  For instance, eating well, getting sleep regulated and for me, on a constant schedule, and even feeling able to shower regularly or work out.

I have recently, because of being able to take WAY fewer pain medications, as well as getting some control back over my life, begun to try to reconnect to people emotionally.  Obviously getting connected to my family outside my immediate family was my first step.  I felt more able to talk about my diagnosis of endometriosis, I don't feel embarrassed to talk about my reproductive organs anymore or to give people a run down of my history or surgeries.  That open dialogue helped me feel love and belonging again and allowed me to re-establish relationships with friends with whom I had lost touch and not because I do not consider those relationships important, but simply because my physical needs had taken priority and I was unable to stay in touch with more than a few of my closest friends.  I just couldn't think about explaining everything I was going through to everyone I knew, so I insulated myself.  I think for a time that was helpful.  I also think that time has passed and I am ready to try to put the work in to jump-start some of my relationships with good friends who I lost touch with.  So my emotional needs seem pretty taken care of.

It was buying some clothes, along with accepting I needed new sizes in my bras that opened my eyes to this process and sparked something in my brain that opened my eyes to the fact that I was revisiting the levels of Maslow's pyramid all over again.  For the past couple years, I did not buy anything that was not essential for me physically.  You may think I am exaggerating.  Well, I am not.  If it wasn't food, medication, or fluids so that I could take my medication, I did not buy it.  I wore some clothes from family members and that was fine with me.  I wore the same pajamas for a week because I did not care for one second what clothes I was wearing as long as they were loose and did not cause any extra pain.  No clothes, no makeup, no jewelry, no shopping, and nothing I didn't absolutely NEED.  I did buy food for Lily (my cat) but I file that under necessities because she needs that to survive and she was helping me to survive.  If I received a gift from someone that wasn't something necessary, it felt fantastic!  If someone gave me a pair of socks, I was touched for a very long time.  Not being able to work obviously played a part in that but my point is that I didn't WANT anything.  All I wanted was for the pain to go away.  And then all I wanted was to stop taking so many medications.  And finally, for the first time since I was diagnosed, I bought some fitted shirts, some fun tees, and of course, my awesome VS bras.  And I felt excited about these "frivolous" purchases!  And then it clicked - I have worked my way all the way back up that pyramid to where I can care about my own self-esteem.  That's pretty huge.

In a way, this gives new meaning to the idea that an illness can "knock you down."  Heck, it knocked me right off the pyramid and made me crawl back up relying on very few people, a medical professional I trust completely, and myself.  And that pyramid feels a lot taller the second time because it is a totally natural progression in almost all humans the first time around.  If someone asked me if I had this all to do over, would I do it again, I would not say yes.  That just seems insane and masochistic.  But I have grown even as I've lain in bed.  I can say "no" to people who are negative influences in my life.  I can advocate for myself, my body and what I know to be true, even if I am the only one who knows it.  I can handle a serious amount of pain, so I have something that few people have.  I have the knowledge that I've felt pain worse than I could imagine and I'm okay.  I do not have to imagine what would happen if searing pain ripped through my body.  I already know.  I know my body much more intimately than I did before my endometriosis.  And hell, I even know a lot more about endometriosis than I ever cared to know.  I understand why some sick people have a strong attachment to their pets and how pets could provide a valuable service in hospitals.  I have also learned to empathize with other people living with invisible illnesses.  I think that is something that is so hard to do without going through it yourself.  I have a new understanding and appreciation for what others are struggling with on a daily basis that most people around them will not understand.  It's almost like I learned to speak a new language or became a citizen of a tiny club.  I also know who has struggled with me to maintain relationships in the midst of something I didn't even really know how to talk about.  For me, that just elevated those friends to family.  

I hope that for all you psych majors out there, this helps you understand serious chronic pain in a more "real" way.  And for those of you who don't know Abraham Maslow, I hope you will look at the pyramid he proposed that is usually so easy for most people to climb and think about what would happen if you were thrown off it and had to start climbing from the bottom again without a ladder.  You would have to look for rocks and crevices and create your own new path to get all the way back to where you started from.