Episode 19: Partners in Pain (Part I) - The Invisible Burden

In this episode of 'Mind Your Body,' Dr. Zev Nevo explores the profound impact of chronic pain on relationships. He highlights how chronic pain can build an invisible wall between partners, creating a shared struggle where both individuals feel isolated. Dr. Nevo introduces a three-part series called 'Partners in Pain' aimed at addressing these challenges. Through personal anecdotes and insights from Brene Brown's research on empathy, sympathy, and compassion, Dr. Nevo distinguishes between responses that drive disconnection and those that foster connection. He discusses the multiple burdens carried by individuals with chronic pain, including the emotional labor of protecting their partners from discomfort. The episode underscores the importance of empathy over sympathy and sets the stage for learning practical empathy skills in future episodes.

00:00 Introduction: The Hidden Struggles of Chronic Pain

00:48 Welcome to Mind Your Body

01:11 The Invisible Burden on Partners

01:48 Understanding Co-Regulation and Neuroplasticity

02:35 Exploring Empathy vs. Sympathy

04:04 Sarah's Story: The Seven Layers of Suffering

06:13 The Partner's Perspective

09:31 Empathy Misses and Their Impact

13:51 The Power of Empathy

16:26 Conclusion and Next Steps

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 19 | Partners in Pain (Part I) - The Invisible Burden

[00:00:00] What if the most heartbreaking symptom of chronic pain isn't the physical ache itself, but the invisible wall it builds between two people who love each other. What if the real struggle isn't just carried by the person in pain, but equally by the partner watching helplessly from the sidelines, desperate to help, but not knowing how?

[00:00:26] What if the very responses we think show love - sympathy, trying to fix, offering solutions - are actually the things driving us further apart. Stick with me, because today we're going to step into the shared experience of chronic pain and challenge the idea that this journey must be walked alone.

[00:00:48] Hey everyone, and welcome back to Mind Your Body. I'm Dr. Zev Nevo, your source for pain and trauma-informed psychoeducation and the exploration of Mind Body Rehabilitation. [00:01:00] Today we're starting a three-part series called Partners in Pain, a topic that is absolutely critical to long-term healing, yet rarely addressed in traditional pain management.

[00:01:11] I spent years watching patients walk into my office and almost every time there's a ghost in the room. The invisible burden carried by the spouse, the partner, the caregiver. They're exhausted, confused, and often guilt-ridden, wondering, am I doing enough? Why can't I fix this? Why do they seem so distant?

[00:01:34] And for the person in pain, the experience is equally crushing. Why don't they believe me? Why do they look so frustrated when I mention my symptoms? Do they still see me? Or just my pain? This dynamic, this constant push and pull, is what happens when co-regulation goes sideways. The nervous system of the partner often gets just as dysregulated [00:02:00] as the person experiencing the chronic pain.

[00:02:03] We know that chronic pain induces neuroplasticity. It rewires the brain to get better at producing pain. But here's what's fascinating. Chronic relational stress also induces neuroplasticity in both individuals, reinforcing patterns of threat, disconnection and suffering. Let that sink in. The emotional pain of feeling unsupported can be just as real and just as destructive as the physical pain itself.

[00:02:35] Over this three part series, we're going to use insights from Brene Brown's groundbreaking work on empathy, sympathy, compassion, and pity from her book Atlas of the Heart. We'll integrate real experiences from an anonymous patient of mine living with chronic pain who graciously shared her story with me.

[00:02:55] And we will explore how to move from a place of chronic sympathetic threat, [00:03:00] that frustration, helplessness and anxiety into the ventral vagal state of safety, connection, and co-regulation. In today's episode, part one, we're going to explore the invisible burden, what it's really like for both the person in pain and the partner.

[00:03:18] We'll uncover why well-intentioned responses often backfire, and we'll learn the critical difference between sympathy, which drives disconnection and empathy, which fuels connection. 

[00:03:32] In part two, we'll dive into empathy as a learnable skillset, giving you the exact four attribute framework you can practice immediately. And in part three, we'll bring it all together with compassion plus boundaries, the key to sustainable support that doesn't lead to burnout. Because here's the key: you can't heal alone, and the most powerful medicine you have is the sense of safety and validation [00:04:00] you can offer each other. Let's begin. Let me share something that came up in a recent conversation with a patient. We'll call her Sarah. Sarah has been living with chronic pain for years. She's a mother of three in a long-term relationship, and from the outside she looks completely normal. She's mastered the art of masking her pain so well that even her partner often doesn't know when she's in an active flare.

[00:04:28] Here's what she told me. "I just pretend that I'm okay. I can be in an active flare and I'm still just a normal person on the outside, you know? And I know that's one thing he tells me all the time. Well, I don't know when you're in pain because you look normal, you're smiling, you're talking."

[00:04:47] Think about that for a moment. Sarah is carrying two burdens, the physical pain itself and the emotional labor of managing how her pain affects her partner. She's [00:05:00] not just fighting her symptoms. She's fighting to protect her relationship from the discomfort her pain creates in him. She described it perfectly.

[00:05:10] "It's enough that you have to deal with the symptoms, but then on top of that, it's like you're trying to not make your symptoms a burden on somebody else." This is what I call the seven layers of suffering.

[00:05:23] You have the physical pain, that's layer one, but then you add layer two. The shame of being in pain. Layer three, the guilt of feeling like a burden. Layer four, the fear of being pitied or treated differently. Layer five, the exhaustion of masking. Layer six, the isolation of not being able to be authentic. And layer seven, the resentment that builds when you can't express any of this.

[00:05:56] And here's what makes this so insidious. [00:06:00] You don't really have a place where you can authentically be yourself. Your physical boundaries are constantly interrupted by pain, and your emotional boundaries are violated by the need to protect others from your reality. Now, let's flip the script. Imagine you're the partner.

[00:06:18] You love this person deeply. You took vows through sickness and in health, right? But every time they mention pain, you feel this wave of helplessness crash over you. You can't fix it. You can't pay your way out of it. You can't make it go away no matter how hard you try. So what happens? Your nervous system interprets this helplessness as a threat.

[00:06:44] Your sympathetic system activates, and that activation can manifest in ways that look like indifference, frustration, or even dismissiveness when really it's fear. Sarah's partner would respond [00:07:00] with, what do you want me to do? Or he'd say things like, you're always overstimulated, which would make her shut down completely.

[00:07:09] She told me: "That makes me kind of shut down, like, oh, maybe I'm saying this word a little too much." Here's what's critical to understand. The worst thing you can do to a person is appear indifferent. And sometimes that appearance of indifference is actually masked fear, frustration, or the profound discomfort of not knowing how to help.

[00:07:32] Sarah said it beautifully. "Sometimes people just say what they think the other person needs, but my understanding is people just want to feel like they're not going through it alone, and they don't necessarily need you to fix them." Now let's bring in Brene Brown's research because this is where things get really interesting.

[00:07:53] In her book, Atlas of the Heart, Brown makes a critical distinction that most people miss. Empathy [00:08:00] fuels connection. While sympathy drives disconnection. Let me explain what's happening here. Sympathy is when you say, I feel sorry for you. It's standing at a safe distance. Looking down into someone's pain and saying, oh, that poor person. Sympathy is what Brown calls a near enemy of empathy.

[00:08:26] It sure looks like connection, but it's actually an act of self-protection and distance keeping. The subtext of sympathy is: not me. These things don't happen to me or people like me, but I sure do feel bad for you. For someone with chronic invisible pain, this response doesn't land as support. It lands as you are a person to be pitied, and that confirms their deepest fear, that they're flawed, they're broken, or they're less than.

[00:08:59] Sarah told me, [00:09:00] "I don't want to feel pity from people because I feel like people are going to treat me differently if I tell them I'm in pain. So I just mask it ." This is the sympathy trap. Well-intentioned partners offer sympathy thinking it's helpful, but what it actually does is create a hierarchy. It positions the partner as above or separate from the person's suffering.

[00:09:26] It strips them of their dignity and reinforces their isolation. Brown identifies what she calls empathy misses. Those are responses that unintentionally disconnect someone from their emotion. Let me walk you through the most common ones in chronic pain relationships. First, there's the sympathizer or pitier who says, I feel so sorry for you. Why it fails.

[00:09:54] This creates distance. It says, I'm up here, you're down there, and I'm [00:10:00] grateful I'm not you. Then there's the minimizer or silver liner who says things like, at least it's not cancer, or it could be worse, or look on the bright side. Why it fails. This is toxic positivity. It refuses to engage with the pain because the speaker is uncomfortable.

[00:10:23] It communicates that the person's pain is an inconvenience and their feelings are invalid. Sarah's partner would expect her to work out despite being in a flare, saying things like, well, you know, there's something you can do. This is the minimizer in action, implying that if she just tried harder, she wouldn't be in pain.

[00:10:45] Next is the fixer who offers unsolicited advice. Have you tried yoga, acupuncture, this supplement I read about? 

[00:10:57] Why it fails. A person [00:11:00] with chronic pain has likely tried everything. This question implies blame. You must not be trying hard enough. It's the opposite of staying out of judgment, which is one of the core attributes of empathy. Sarah said it perfectly. "All I need you to do is just listen." Then there's the comparer or hijacker. 

[00:11:26] You know that happened to me too. Let me tell you about my back pain. Why it fails. This is comparative suffering. It hijacks the conversation and centers the speaker's experience, forcing the person in pain to now comfort or listen to them. Brown calls this out explicitly.

[00:11:45] You can't connect by competing. Finally, there's the avoider. Some partners just don't bring it up at all. They changed the subject. They act like if you don't talk about it, it's not there. [00:12:00] Sarah's partner took this approach. His approach is more like you don't talk about it, it's not there. It's not going to trigger the pain or anything like that.

[00:12:09] Why it fails. Silence communicates abandonment. It tells the person in pain that their reality is too uncomfortable for you to handle, so they need to hide it. Now let's talk about pity, because this is even more insidious than sympathy. Brown identifies pity as the near enemy of compassion. Here's her four-part definition of pity.

[00:12:35] First, a belief that the suffering person is inferior. 

[00:12:40] Second, a passive self-focused reaction that does not include providing help. Third, a desire to maintain emotional distance. And fourth, avoidance of sharing in the other person's suffering. Pity sees the person as fundamentally different from you. [00:13:00] It says, oh, that poor person. I feel sorry for people like that.

[00:13:04] It creates a social hierarchy and strips the other person of their dignity. Sarah's concern about pity is why she's never told anyone outside her immediate family about her pain. She wants awareness without differential treatment. Here's what's fascinating. Pity is actually a defense mechanism for the person feeling it.

[00:13:26] It allows them to distance themselves from the terrifying reality that chronic pain could happen to them. It's affirming and gratifying to the self. It lets you feel grateful that you're not like that. But for the person receiving pity, it's devastating. It reinforces the belief that they're broken, less than, and fundamentally alone in their suffering.

[00:13:51] Let me give you Brown's most famous analogy on empathy. She describes empathy as climbing down into the hole with someone. [00:14:00] Imagine someone is at the bottom of a deep, dark hole. They're in pain, they're scared, and they're alone. Sympathy stands at the top of the hole and yells down, oh wow, that looks really bad down there.

[00:14:15] I'm so sorry. You're going through that. It maintains distance. It keeps you safe at the top. But empathy climbs down into the hole and says, I know what it's like down here, and you're not alone. It's vulnerable. It requires you to go to that place in yourself where you've felt pain, fear, or isolation. Pity stands at the top and says, oh, that poor person, I'm so glad I'm not down there.

[00:14:45] Sarah described this perfectly when talking about what she needs. She says, "I think at the end of the day you have to learn how to validate your own feelings. You have to learn how to go through the motions together because not only is it hard for you as the [00:15:00] individual going through the pain, but I think it's also difficult for a partner to understand how difficult it is to live with pain." Go through the motions together.

[00:15:11] That is empathy. That is feeling with, not feeling for. So here's what we've learned today. The person in pain is carrying seven layers of suffering. Not just the physical pain, but the shame, the guilt, the fear, the exhaustion, the isolation, and the resentment that comes with it. They're masking to protect their relationships, which only deepens their isolation.

[00:15:39] The partner is drowning in helplessness and that helplessness activates their threat response. What looks like indifference is often masked fear. What sounds like minimizing is often an attempt to regain control. What feels like withdrawal is often self-protection. And the well-intentioned responses [00:16:00] we think show love: sympathy, fixing, comparing, avoiding, are actually empathy misses that drive disconnection. Sympathy says, I feel sorry for you from a safe distance. Pity says, I'm glad I'm not you, and creates hierarchy. But empathy? Empathy climbs down into the hole and says, you're not alone. The question is, how do we practice empathy? How do we climb down into that hole without drowning ourselves?

[00:16:33] How do we support someone through chronic pain without burning out? And that's exactly what we're going to explore in part two of this series. We're going to learn that empathy is not a feeling, it's a skill. And like any skill, it can be learned, practiced, and strengthened. I'm going to give you Brene Brown's four attribute framework, and I'm going to show you exactly what Sarah said she needs from her partner, [00:17:00] the Golden questions that create partnership instead of hierarchy.

[00:17:05] We're also going to explore the critical distinction between cognitive empathy, which is sustainable and affective empathy or enmeshment, which leads to burnout. Because here's the truth: If you're drowning alongside the person you're trying to help, you can't be their anchor. You just become two people drowning together.

[00:17:26] Until then, I want you to sit with this. The worst thing you can do to a person is appear indifferent, and sometimes that appearance of indifference is actually masked fear, frustration, or the profound discomfort of not knowing how to help. Your feelings are valid, whether you're the person in pain or the partner.

[00:17:49] Both experiences are real, both are legitimate and both deserve acknowledgement. In our next episode, we'll move from understanding the [00:18:00] problem to learning the solution. We'll discover why empathy is a skill, not a feeling, and I'll give you the exact framework for practicing it. Until next time, protect the sacred mind body connection, and remember:

[00:18:13] The body embodies the mind. The mind embodies the body. It's the only one we've got. Nurture the mind and heal the body. This is Dr. Zev Nevo, and you've been listening to Part One of Partners In Pain. See you next time.