Pain as Punishment

By Douglas Nelson
[Table Lessons]

“I found something when I was cleaning my office yesterday, and I think you will enjoy reading it. I put a letter and two other articles of interest in this envelope.”
“Thank you,” I replied to my client. “I’ll be sure to look at this later this evening.”
In the blur that is my daily life, “later this evening” turned out to be many days later. When I finally opened the envelope and read the enclosed letter, I was absolutely stunned. The contents stopped me in my tracks, and I read the letter multiple times to digest its contents.
The letter was written by a friend of my client, someone to whom he had given a copy of my book, The Mystery of Pain (Singing Dragon, 2013). She expressed her gratitude for the gift and outlined several ways the book had a profound effect on her life. I share two of her insights with you now because they are so pertinent to our understanding of pain and how that understanding profoundly affects our experience.
After expressing her thanks for the book, she stated the following: “My aha moment came as soon as I read the first chapter regarding pain as punishment. I have both consciously and subconsciously felt I deserved every moment of pain I have encountered for my inability to make my mentally ill mother well and for its effect on the family. No punishment was too great for my failure at love!”
“I deserved every moment of pain.” The full gravity of that statement is hard to wrap my brain around, even now. Imagine the burden she was carrying! In the first chapter of the book, I explored the impact of the Latin derivation of pain, poena, meaning “to punish.” In this interpretation, pain is an appropriate punishment in response to an offense committed. In the world of acute pain, this can make sense. Foolishly play with a sharp object and the resulting wound is a painful reminder to be a bit more careful in the future, but applying the rules of acute pain to chronic conditions can be seriously problematic—and pain as punishment is no exception. What offense has the person who suffers with migraines, lupus, or any number of chronic conditions committed?
If the person experiencing pain believes pain is a punishment, then that person not only feels bad, they feel bad for feeling bad. Worse yet, if the people around them, either consciously or unconsciously, believe that the pain is an appropriate response to some offense, then their treatment of the person in pain is likely to be far from empathetic. (Think back to the story of Job. His “friends” kept asserting that he must have done something terrible to offend God so deeply.) In this case, it is even more devastating that the writer of the letter felt such responsibility in response to her mother’s mental illness, which she was likely powerless in affecting.
At the heart of this dilemma is our innate need to have a reason that explains what we experience. We have all probably treated clients who have a pressing need to understand why an unexpected episode of pain surfaced. Sometimes, there are clear reasons that need to be addressed. Other times, pain is the result of a confluence of factors—a perfect storm that is unlikely to be reproduced. Obsessing about an exact cause won’t be helpful unless the pattern continues. Reasons, however, are much more satisfying. If no obvious one is available, one will be provided. Over the years, I’m sure we’ve all heard some whoppers.
Later in the letter, the writer went on to share this: “Too often people in pain receive very little validation. This was one of the greatest obstacles in our attempt to save our beloved daughter.”
Wow, what a statement! I don’t know the details, but this is an unfortunate story too often repeated. Patients explain to providers what they are experiencing, but if the symptoms don’t fit nicely into a box the provider feels comfortable about, the problem is likely thought to be psychosomatic in nature or summarily dismissed. At some point in time, it is often revealed that the symptoms were part of a syndrome not previously understood. The patient, if still alive, is now validated.
Over the years, the health-care system seems to find new and better ways to invalidate people—all with a deep belief that, as educated professionals, providers understand what patients do not. That model is changing, but all too slowly.
Finally, her letter reminds all of us that you never know the impact you have on anyone who crosses your path. As massage therapists, our genuine kindness, caring touch, and engaged listening can have a profound effect on those we are privileged to serve. It is my sincere wish that these columns have positively affected you as well.

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at