The face and identity
Chewing, talking, smiling, brushing your teeth, refreshing yourself with a cold drink, these are ordinary human activities; but, when you have facial pain, they can trigger pain. Because your pain involves the face, it is unique among chronic pain disorders because the face is the organ of self-expression. We show our emotions through facial expression. Even when we try to hide our feelings, those who know us best can read them on our faces. We talk with our faces, sing with our faces, cry with our faces, laugh with our faces – to a very great extent we communicate and experience our humanity through our faces.
In a psychological sense, it doesn’t get more fundamental than this. It is not exaggerated to say that facial pain tears at the fabric of identity. You may understandably think of your life as divided into two parts: the part before facial pain, and the part after. Before your facial pain, things generally make sense. It is possible to ascertain cause and effect relationships in your life, allowing you to avoid those that bring pain while enhancing those that bring.
After facial pain, cause and effect relationships as you have always understood them break down. There is no longer a clear, predictable relationship between your effort, and the outcome of your effort. Things make much less sense. You struggle to control your life only to experience bouts of lancinating pain that are intense enough to distract you from everything else.
Losing a sense of self
It can feel as if your body – now an alien force – has turned against you. This is where the real tragedy of facial pain begins. With facial pain, there are forces at play that, over time, threaten to distort the way you see yourself. Bit by bit you lose yourself to the disease. You gradually let go of important relationships and activities as you become more and more paralyzed by fear of pain. Before facial pain, your identity was made of blended roles: you were parent, grandparent, child, brother, sister, friend, employer, employee, democrat, republican, churchgoer, golfer, ball-room dancer. After facial pain, you may feel reduced to being mostly a patient, who remembers being a person. Having pain and avoiding pain becomes the defining features of your life.
Self that has been distorted and weakened by pain and the fear of pain. It is possible to do this reconstructive work and in the process put facial pain in its place, but moving it off centerstage is complicated. In the beginning of psychotherapy, it is natural to “borrow” hope from the therapist, who has seen others like you succeed in their effort to overcome the personally destructive effects of facial pain.
All the same, good psychotherapeutic work is highly individualized; there is no one else quite like you. The work of psychotherapy is a shared journey of discovery. Real losses should be appreciated and grieved. Real sources of strength and renewal can always be found and they should be celebrated. New meaning must be created in a way that accommodates not only physical suffering but also physical pleasure.
The majority of facial pain sufferers experience some pain-free time; days, weeks or months may go by without pain. It is obviously best not to contaminate the pain-free moments with the fear of pain’s return, but this takes genuine courage and an equally genuine belief in your capacity to endure pain without being destroyed by it. Like a Sherpa who has climbed Everest many times, a good psychotherapist travels the way of adversity with you alerting you to dangers and reminding you of your strength when you most need it and are least certain of it.