Pain Denial Syndrome (PDS)

One of the best kept dirty little secrets

By Bradford F. Spencer, Ph.D.     (Fall 2015)

Yes, I just made up the term… There is no such thing in the DSM-5, the bible of psychological disorder diagnosis. But tell me it does not exist, and I will point to several contradictions. Recently a “medical historian” reviewed 14,000 pages of medical texts and journals. He found only 17 pages that referenced pain! (Why do you go to a doctor if not to alleviate or avoid pain?) If doctors don’t deal with it out loud, then who does?

It occurred to me, as a behavioral consultant, that I have read hundreds of books and thousands of articles on issues related to management, organizational and leadership effectiveness in the past 30+ years. I cannot remember one reference to avoiding/alleviating executive pain in one of them … and that is at the heart of what many of these books were attempting to address and certainly a major part of our practice.

At best, they refer to disappointment, frustration, being upset, or in rare cases even admit to being angry. My clients mimic this language in our initial discussions. We do not admit (and even energetically deny/rationalize) these are forms of pain because then we would need to confront the root cause.

Just because you reach the C-suite in no way means you are free of suffering. In fact, contrary to the belief of so many who are not on executive row, the titles, pay, perks and power in no way prevent, and may even increase the performance/family-related anxiety and problems resulting in deep mental anguish. Contrary to the myth so resentfully held by so many, those that do not have time to join the bowling league often have more anxiety and pain than those who struggle to make ends meet. It may not be more, only different, but there is little acknowledgement it even exists.

This is not an apology for those in powerful positions; they chose their fate. And few would voluntarily change places with many, but the reality is that much of my work is helping them deal with or avoid suffering. That is, when they recognize it. This may sound like a strange comment, but much of their unconscious energy is spent denying or repressing the “feelings” that are the manifestation of the issues they face. The attempt to be logical and “explain the issues away” is the antithesis of dealing with (working through) the suffering.

It would not be right to imply that all pain is equal in intensity or duration. Common sense bears mentioning – there are clearly degrees and a gall stone is a dramatically different threshold in both intensity and duration from a stubbed toe. Having to lay off a number of long-tenured employees is different than cutting expenses.

Suffering is divided into four distinct categories by those who have made a career of studying it.* You want nothing to do with any of them. And each of them can be debilitating.

The first type of suffering is pain. This refers to physical suffering, the kind of thing that takes you to the emergency room. If you have ever had a broken arm or appendicitis, you recognize it. Even a splinter or back pain is something that can capture your undivided attention. This is truly the place for the physician.

The second type of suffering is psychological. Again, if you have ever been deeply distressed, had your heart broken by a high school sweetheart (yes, you feel life-as-you-know-it can never go on), or, at the end of this very long continuum, lost a loved one, you do not need to be told what this type of suffering is. It can vary from deep depression to feeling rejection or not competent enough. It hurts and often causes you to obsess on the areas of discomfort. The executives and football coaches I deal with are often subconsciously obsessed with avoiding the pain of “not being competent.”

In a fruitless effort to avoid that feeling, their compensating behavior induces pain in others who are over-controlled or trying to figure out what is really expected, but never quite able to jump over the constantly shifting bar. Nothing is ever good enough to please the boss or themselves.

This repression is, of course, complicated by the fact that businessmen and businesswomen believe they need to be stronger than others. Part of this strength comes from making hard decisions “rationally.” That is not the issue; the true problem comes to the fore when they do not deal with the hurt they experience for all the families affected by the plant closing (that must occur for all the right reasons).

The third type of suffering is spiritual. That is: “Am I committing a ‘sin?’” You do not need to be religious to experience this type of pain. The moral boundaries for dealing with others (often encoded as corporate value statements) are manifestations of these questions. The issue faced in dealing with promotion/layoff decisions often fall into this arena. Am I really doing the right thing by all involved; is meritocracy really at work?

It is not usually as black or white as cheating on one’s expense account, but we all have issues at home or work that cause us to doubt our righteousness. In organizations, we often call it “integrity.” And we all admit to falling far short of the ideals we set for ourselves. For my American and European clients with a strong Judeo-Christian value system, this is where guilt** raises its ugly head to compound the suffering immeasurably … ”What have I done to deserve this punishment?” For my Asian clients with a Buddhist-Shinto value system, shame*** is the underlying issue that magnifies the question, “Why could I not be more worthy?”

The fourth form of pain carries this continuum to its least day-to-day, moment-to-moment arena. That is existential pain. The most abstract of the four, this is an attempt to leave this Earth with a meaningful footprint. One of the things that separates man from other life forms is the search for a meaning of our existence. And then, if we finally articulate what it is, are we accomplishing it?

At a recent workshop, when a hardnosed GM in a major corporation got in touch with the legacy he wanted to leave, and where he stood on the continuum, he broke into tears in front of his amazed staff. The suffering was palpable as he came to grips with the reality that if he held his current path, he would go to his grave not leaving the legacy he so longed to create.

So what would happen if you were to label something as suffering rather than simply trying to label it in a way that minimizes your responsibility to change it? The first step is to start talking about it and ‘languaging’ it correctly, rather than ignoring it as pretty much all the literature does (or sweeping it under the carpet as though it did not exist).

Yes, language matters and it matters most in self talk. If a friend describes themselves as frustrated, we assume it is a human condition they must live with. If they tell us they are in pain, we are more likely to take an action to alleviate it. And while we recognize this how we treat others, we often deny this is true for how we deal with it ourselves. The way you describe it will truly make difference in the burning platform of dealing with it.

* The basis of “total pain theory” goes back to an incredible woman, Dame Cicely Saunders.

** I define ‘guilt’ as thinking/feeling I have done something profoundly wrong.

*** I define ‘shame’ as thinking/feeling there is something profoundly wrong with me.

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