While it is important to use problem-solving approaches whenever possible, we must also realize that there are many adverse situations and events in life that offer few if any opportunities for problem solving. Pain, suffering, disease, old age, and death are inevitable parts of human existence. No matter who we are, how healthy or physically fit we are, or how much money and power we have, we will all eventually die. Nothing can really prevent the physical aging process, erase unpleasant events that have already occurred, change who our parents and children are, alter our genetic make-up, or end reality of pain. For many, chronic pain and associated physical limitations are not so much problems to be solved (i.e., made to go away), but rather they are realities to be accepted. In fact, whenever you are faced with an unsolvable problem or an adverse situation that will never go away, you are forced to wrestle with the issue of acceptance.

Acceptance of pain and related problems is a significant stumbling block for many. This may be due to confusion and misunderstanding regarding the meaning of acceptance. First of all, I am not suggesting that you must accept needless suffering.  In particular, I see no need to accept having to live with constant severe pain.  Many pain medications are available which can lower your pain to a more tolerable level.  However, it may not be reasonable to expect that these drugs will make you totally pain free.  Therefore, acceptance does mean having to accept living with a certain amount of pain.   Second, acceptance does not mean that one has to give up all hope and feel defeated. Rather, one can maintain hope for a better future while accepting today's unpleasant realities. Third, acceptance does not mean that you have to accept someone else's version of your condition. For example, some pain patients have been given bleak prognoses by their doctor and subsequently proven the doctor wrong. Finally, acceptance has nothing to do with apathy and not caring. You don't have to like the situation you are in. Certainly you would prefer that things were different. Healthy acceptance means recognizing the futility of struggling against the unpleasant realities that are beyond your control. It means recognizing that no amount of agonizing over and bemoaning your fate is going to make things any better. True acceptance means coming to terms mentally and emotionally with your unpleasant reality. It means coming to peace with the adverse reality that you are currently facing. You can say to yourself, "I don't like having this chronic pain condition, but I'm going to do everything I can to make my life as best as I can despite the pain."

Healthy and peaceful acceptance of unpleasant realities like pain and disability is one of the most important things that you can do mentally to reduce stress and maintain peace of mind. Remember that acceptance is not a one-time decision. Rather, it is an ongoing process which must be re-experienced every day.

Acceptance as a Way of Coping with Pain

The tendency to fight and resist pain at a physical and mental level may seem like an automatic reflex process.  Unfortunately, the chronically elevated physical and mental tension that results from this ongoing struggle usually takes its toll on your body and mental functioning.  Muscles and joints become stiff and rigid.  Mentally and emotionally you become tense and irritable, or you simply become exhausted by the continual battle against the pain.

Acceptance as a coping method means learning to tune into your body and move your body while relaxing at the same time.  Techniques to accomplish this involve focused breathing awareness and passive body scan.  With practice you can learn to breathe into and through painful areas of your body, maintaining awareness of the relaxing breath while allowing pain sensations to ebb and flow in a non-judgmental manner.  Rather than labeling the sensations as bad and fighting against them, you simple note them, accept them, and return to your breathing meditation.  Likewise, you can learn to gradually and gently stretch your muscles and joints while maintaining the breathing awareness. Rather than trying to move or stretch while simultaneously tensing and contracting your muscles when you experience discomfort, you learn to remain mindful of the relaxing breath.  It becomes so much easier to stretch and move your body when you are relaxed and not fighting against yourself.

Spiritual Surrender

At a deeper level, acceptance may take the form of spiritual surrender. Throughout this manual and in the pain coping literature, emphasis is placed on finding ways to increase your control over pain. Nevertheless, it must be recognized that sometimes the more you struggle to control pain or other life difficulties, the more frustrated and discouraged you become. Spiritual surrender is a paradoxical approach to control that is recognized and advocated by nearly all the major world religions, including Christianity and Judaism. Spiritual surrender, which may be accompanied by a powerful and profound religious experience, involves relinquishing one's futile efforts to control unpleasant reality (adverse situations) by turning the situation over to God, higher power, or some other transcendent reality. This may be especially relevant when faced with personal crises that offer very few options for constructive problem solving. The concept of surrender is also repeatedly found in AA and other 12-step recover programs. For example, in the AA phrase "let go and let God" it is recommended that one "let go" of personal efforts to control use of alcohol or drugs and instead surrender by letting God or one's higher power take over one's life. The same process can apply to efforts to control chronic pain. Spiritual surrender, like acceptance, does not mean passive resignation or avoidance of personal responsibility. Rather, spiritual surrender is often associated with a experience of relief and peace of mind. Paradoxically, the increased clarity of thought that follows spiritual surrender can actually enhance your ability to cope with pain and other adverse situations in life.

In the process of surrendering, the person not only gives up futile efforts at control but often experiences profound peace of mind by realizing connection with a reality (God or higher power) that transcends one's personal self.  Even in a non-theistic religion like Zen Buddhism, true spiritual surrender is experienced as enlightenment. Surrender should not be seen as a one-time experience. Rather, surrender is typically associated with efforts to live one's life on a daily basis in accordance with one's concept of God, higher reality, or moral values. Furthermore, through practices such as prayer or mindfulness meditation, the process of surrender can be reinforced and renewed.

Aids to Acceptance of Unpleasant Reality - Reframe and Redirect

Reframing refers to altering the meaning of the negative reality in one's mind by casting it in a positive light or at least trying to find something positive about the situation. Extreme examples of attempts at reframing are sometimes found in people's response to the death of a loved one (e.g., "he is now freed from further suffering," or "she has gone to be with God"). Is there any way that you can reframe the meaning of your chronic pain condition or the fact that you have physical limitations?

Healthy acceptance also becomes easier as you redirect your efforts and energies to problems which can be solved. The key to acceptance, is to refocus on things you can do or situations where you do have some control. For example, you can tell yourself, "I can't eliminate the reality of my pain, but I can find ways to reduce its intensity or keep it from dominating my life." Another positive self-statement might be, "I can't eliminate the fact that I have certain physical limitations and can no longer do things the way I used to. However, I can make the most of all the physical capabilities that I do have and find ways to keep myself active."

Those of you who are spiritually inclined will find that the self-management approach to life problems is nicely summarized in the "The Serenity Prayer," the first verse of which is also frequently used in 12-step recovery programs. Although this prayer is commonly attributed to a theologian named Reinhold Niebuhr, Niebuhr himself reportedly gave credit to an 18th century theologian named Friedrich Oetinger. This prayer also captures the essence of spiritual surrender as discussed above.