Anxiety, Pain, Faith, and the Tunnel

A Little About the Person Behind the Therapist PART TWO

Human beings are formed in relationship. Marriage, family, friendship, and the people who know us best keep shaping who we become.

There is another part of my life that has shaped the therapist I have become. I know anxiety professionally, but I also know it personally, and there is a considerable difference between understanding anxiety from a textbook and waking up with it in your own body.

Therapists can explain the sympathetic nervous system, catastrophic thinking, avoidance, exposure, acceptance, and psychological flexibility. Those ideas matter, and I use them, but eventually life has a way of taking some of the things we know intellectually and asking whether we can actually live them.

Chronic pain has done some of that for me.

Pain has an extraordinary ability to command attention. When something hurts long enough, the mind naturally begins organizing life around it: Will this hurt? Will that make it worse? How long can I do this? What if tomorrow is worse? Maybe I shouldn’t go. Maybe I should wait until I feel better.

Anxiety is more than happy to join that conversation. I sometimes think of anxiety as entering a tunnel. Outside, there is a whole landscape—roads you might take, things worth noticing, places you might go—but the farther you travel into the tunnel, the less of that landscape remains visible. Eventually there are walls on either side and only a small patch of road ahead. Nothing outside the tunnel has disappeared; you simply cannot see it from where you are.

Anxiety can do something like that to a life, and so can chronic pain. They narrow the field of vision until the immediate question—How do I make this stop?—begins crowding out other questions: What matters to me? Where was I going? What kind of life do I want to live? Before long, avoiding discomfort is making more and more of our decisions for us.

One of the things Acceptance and Commitment Therapy has helped me articulate is something life was already teaching me: sometimes waiting to feel better before living better means doing an awful lot of waiting.

Acceptance is easily misunderstood. It does not mean liking pain, resigning ourselves to suffering, or pretending anxiety is not frightening. If something can reasonably be treated, changed, repaired, or relieved, by all means let’s do that. Acceptance means something more modest: I do not want to make the absence of pain or anxiety a prerequisite for taking part in my own life, because there are simply too many things I love.

I want time with my wife and family. I want to be Pops. I want to walk in the woods and stand in rivers with a fly rod. I want to read books that lead me to other books. I want dogs underfoot. I want to write, work, travel, learn, laugh, and remain curious about this strange world for however much of it I am given.

Chronic pain gets a vote in how I do some of those things, but I do not want it to get a veto. Neither does anxiety.

Sometimes we can see the light at the other end of the tunnel, and sometimes we cannot. There are periods of life when all we can see is the next several feet, and the temptation is to stand still until certainty arrives—to wait until the anxiety subsides, the pain improves, the circumstances become clearer, or we finally feel courageous enough to move. But courage is often considerably less dramatic than that; sometimes courage is simply taking the next step while still being afraid.

That is one reason I practice therapy the way I do now. I am less interested in promising people a life without anxiety, pain, grief, uncertainty, disappointment, or fear because I do not know anyone who has such a life. I am much more interested in helping people create lives large enough that these things do not get to occupy all the available space.

Dr. Murray Bowen and Acceptance and Commitment Therapy arrive at this from different directions, but I find an interesting kinship between them. Bowen asks whether I can remain myself and stay connected while anxiety moves through the relationships around me; ACT asks whether I can make room for what is happening inside me and still move toward what matters. Neither requires me to wait until I feel perfectly calm before I begin living.

And for me, what matters turns out not to be terribly complicated: marriage, family, being Pops, faith, rivers, books, dogs, meaningful work, and people I love. These are not ways of escaping the tunnel. They are reasons to keep walking through it.

Much of what I know about psychology has worked that way. I encountered something first—in marriage, grandparenthood, anxiety, pain, faith, or thirty years of sitting with people—and only later found language that helped me understand what I had been seeing. Bowen gave me words for some of what families had already taught me; ACT gave me language for things anxiety and pain had been teaching me considerably less politely.

Maybe that is the simplest way to explain what I hope to do here: life first, psychology second. I am less interested in using life to illustrate psychology than in discovering whether psychology can help us see the lives we are already living.

Faith

Faith has been another constant in my life, although my understanding of it has changed over the years. I studied Biblical Literature alongside Behavioral Science as an undergraduate and have continued reading theology and spiritual writers ever since. I am particularly drawn to older voices—ancient writers; not because older necessarily means wiser, but because they remind me that human beings were wrestling with fear, desire, suffering, distraction, love, and the difficulty of becoming a good person long before psychology gave these things clinical names.

One word I have increasingly appreciated is formation. Psychology often asks why we are the way we are and what might help us change; formation asks a slightly different question: What are we becoming?

None of us is standing still. What we repeatedly give our attention to, the relationships we cultivate, the stories we tell ourselves, the habits we practice, what we love and fear, even the ways we respond to disappointment—all of these are quietly forming us.

My Christian faith gives that question a particular meaning for me, but I do not assume it has the same meaning for everyone who walks into my office. I have worked comfortably for decades with people of different faiths and people who have no religious faith at all, and therapy should never be an exercise in making another person see the world as I do.

If faith matters to someone, however, I am comfortable allowing it into the room rather than treating it as something that must be checked at the door. Psychology has not always known what to do with religious faith; at times it has too easily dismissed it as a crutch, an escape, or something psychologically sophisticated people ought to have outgrown. Faith can certainly be used to avoid difficult realities, but it can also be one of the places where people wrestle most seriously with meaning, suffering, responsibility, hope, forgiveness, and what kind of person they are becoming.

Increasingly, the part of spiritual formation that interests me most is presence. We spend remarkable amounts of our lives somewhere other than where we actually are. With the words What if?, anxiety carries us into a future that has not happened; regret and shame pull us backward into a past we cannot change; distraction allows us to be anywhere except here. Meanwhile, the person sitting across the table, the dog waiting at our feet, the child asking us to look at something, the river moving past our legs—or simply this ordinary day—can go unnoticed.

Years ago, I encountered Brother Lawrence, the seventeenth-century monk whose simple spirituality came to be known as “practicing the presence of God.” I especially appreciate the little abridged volume Nearer Than We Imagine, because its title captures something essential to my faith, and the book is tangible enough to read when my mind is abuzz or when I cannot sleep.

Presence is not merely my effort to become attentive to the moment; it is awakening to a Presence that, I believe, is already here. In fact, it is impossible for an omnipresent God not to be present. That distinction matters to me. Mindfulness can remind me, I am here, in this moment. Brother Lawrence reminds me, I am here, but I am not here alone.

His spirituality was remarkably ordinary. The presence of God was not reserved for church, retreat, mystical experience, or those rare moments when life feels particularly spiritual. It was practiced in ordinary work, conversation, fatigue, distraction, and daily responsibility. God is not Someone to be reached by escaping ordinary life, but Someone to be noticed within it.

Psychology has arrived at something similar through mindfulness, acceptance, and the study of attention. I do not think these traditions are saying precisely the same thing, and I do not need them to. Psychology can teach me something about becoming present to my experience; faith asks me to become present within a relationship. One says, Notice where you are. The other adds, Notice Who is already here.

Perhaps that is another thing my grandchildren keep teaching me. A child who stops everything to examine a beetle has not mastered a sophisticated theory of presence; he has simply noticed the beetle. A fly fisherman studying the flow of a river is doing something similar. For a few minutes, yesterday and tomorrow become considerably less interesting than what the water is doing right now.

Presence begins with noticing, but presence matters most to me when the landscape is not beautiful.

There are periods of life when we find ourselves in the tunnel—when pain, grief, anxiety, loss, or despair narrows the world until we cannot see very far ahead. I have sat with many people in that darkness, and I would never reduce suffering like this to a lesson or suggest that faith makes such darkness disappear. It doesn’t. The tunnel can be terribly dark.

My faith makes a more modest and, for me, more important claim: darkness and aloneness are not the same thing.

There have been tunnels in my own life as well. Brother Lawrence’s old practice does not necessarily show me the exit, and sometimes there is only enough light for where I am standing. But it reminds me that even there—especially there—I need not confuse being unable to see the way ahead with being abandoned.

My faith tells me there is something sacred about that kind of attention; psychology tells me there is something healthy about it, and experience has taught me that I need it. For me, this captures a word—and Something bigger than a word—ABIDE: not escaping the human condition, but learning to inhabit it without losing sight of God, other people, or the life that is still here.

The tunnel has taught me something else as well. Moving toward what matters requires more than determination; it requires attention—learning to notice where I am, what is still here, and what I may have stopped seeing.

In the next blog, I want to follow that thread into some less clinical territory: rivers, books, hobbits, dogs, grandchildren, and the serious business of play. They may seem like an odd collection, but for me they have all been teachers of the same thing: how to pay attention.

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