I was a nurse for 20 years. I worked mainly in mental health, but I also did some acute medical/surgical nursing as well.
Over the years, I’ve assessed and facilitated healing for many physical and emotional wounds.
There are differences between the two for sure. For instance, I can see, touch, and smell a physical wound, but I can’t do those things for an emotional one.
The senses I use to assess and treat a physical wound, help me understand what’s required. But I can’t put those same senses to use for emotional wounds.
Many say, that because physical wounds are tangible, they’re easier to treat. And this may be true, but it’s not the whole truth.
The challenge facing many people with invisible illnesses speaks to an underlying belief in medicine — if you can’t see it, you can’t treat it.
This means that many invisible wounds go on to fester and take over.
Did you know that there are many similarities between physical and invisible emotional wounds? It’s true, but it’s rarely talked about.
The first time I really saw this similarity was when I was working with a woman in a mental health unit about 10 years ago.
She had severe, intractable depression. This means that every treatment they had tried for over a decade wasn’t helping her. Her depression got so bad that she was unable to leave her house and as such, developed severe cellulitis (skin infection) in both legs.
I was assigned to work with her for that whole week. Every day we would talk, as I bathed and dressed her wounds. As each day passed, she began to improve, but it took steady and consistent work to debride, disinfect, medicate, and dress her legs several times a day.
One day, as I sensed we developed a good relationship, I began to ask her about her wounds.
“Do you know how the cellulitis got so bad?” I asked her.
“Well, I was so out of it that I didn’t even know that there was something wrong,” she said.
“Oh, do you mean, because of the depression?”
“I suppose. I mean, I forget that I have that too, I guess because it’s always there. I think over time, everything just meshes together into a big pile of, well pus!” she said, pointing to her legs as if her wounds and the depression were the same.
As I began to debride the wound, she winced in pain. Debridement consists of gently removing dead or heavily infected skin so that new skin can get oxygen without being hindered by the infection.
When she first arrived, she didn’t want anyone touching her legs because the pain was excruciating. But I had built a good enough relationship with her that she finally accepted the painful treatment process. Every session was agony for her. She was also embarrassed by the pus, the smell, and the swelling.
“I hate people seeing the state I’m in,” she said to me, “I would have preferred to just stay at home where I felt safe, and no one would poke or prod me.”
“True, but then, you might have died from this, you know that, right?” I said.
“Well, that’s not the end of the world, we’ll all die someday. I’m used to keeping things under the covers. My depression, my experiences, these wounds, everything. It’s just better that way.”
I decided not to probe too much and just listen to how she felt about her situation.
Each day, I’d help her through the pain of her wound treatment, and each day, the wounds showed improvement. I would point out that her legs were less swollen, the pus was drying, and new skin was growing. She’d smile a little then shrug her shoulders as if resigned to accept whatever fate was in the cards for her.
When I asked her if she was happy that her legs were getting better, she said, “I guess, but I don’t know if the pain was worth it. Maybe that’s why I didn’t do anything about it at home, deep down, I knew it would hurt like hell.”
This is a reality that we rarely like to talk about; healing hurts.
Most of the time, when there’s a wound, healing requires a bit of digging and disinfecting. Leaving it alone will only cause infection. We can bandage it, douse it in solution, take a painkiller, and hope for the best. But really, the wound will continue to fester until we open it up and clean it out.
It really hit me after this experience how similar this is to our emotional wounds. We may not be able to see them, but they’re present underneath our skin, festering and hurting. The only difference between emotional and physical wounds is complexity and visibility.
Perhaps the complexity is because our emotional wounds aren’t visible. I suppose we feel limited in how we can assess, measure, and label them if we’re unable to see, touch, and smell them.
But the pain of our physical wounds is no different than our emotional ones; they hurt because we say they hurt.
The only reason the pain of the physical is given more validation is that those, who do not possess the wound, provide it with validation through their external assessment.
Somehow we’ve bought into the fact that if others can validate the wound, then they confirm the reality of that wound. And because the wound was confirmed, only then, will we validate the pain.
But we don’t need anyone else to confirm the pain because pain is always, always subjective.
This is a fundamental teaching in nursing. The patient’s pain is what they tell us it is. We ask patients to rate pain on a scale of one to ten, and then we treat the pain accordingly.
Here’s another reality about pain treatment and wounds — to treat a physical wound, it’s going to hurt, and there’s no way to prevent the pain completely.
Emotional wounds are no different. We have ways to prevent pain from taking over and overwhelming the person. But unless, and until, the wound is opened and cleaned, it will likely never heal.
Perhaps because emotional wounds are invisible and thus complex, it’s easier to pretend they don’t exist. We seem reticent about whether to open them up or not. We don’t think the pain is real or justified and certainly, we don’t want any more discomfort than we’ve already got.
So what do we do? Many of us take the same view as my patient, we shrug our shoulders and resign ourselves to whatever fate may befall us.
But what if we took a different route? What if we accepted that to heal our emotional wounds, we need to accept the pain as real, even if we can’t see it.
Also, we need to accept that there will be pain.
.Instead of chastising ourselves and our pain, we can allow it to be there. We can use the tools we have available to keep the pain from overwhelming us. But we can accept that we won’t be able to get away from pain completely.
How do most of us move through painful physical illness? We gather our supports, we pray, we ask for help, and we take the best care of ourselves as we can.
Most of all, we commit to the healing process; we take our medicine, clean the wounds, rest when needed, and do our best to be resilient in the face of our pain.
Healing is not leaving a wound covered up to fester, spread, and become gangrenous because we’re afraid of the pain. I mean, it’s a choice we can take for sure, but it’s not a life-supporting choice if that’s what we’re hoping for.
As supports to our loved ones, we know we can’t take the pain away, but we can validate, be present, and help when needed.
If we don’t leave our loved ones to sit alone with festering physical wounds, then we don’t leave them with rotting emotional ones either.
As the carriers of emotional wounds, we accept that much pus may seep from the holes in our psyches. But we try not to give up in the face of our pain.
Understanding this helped me not only be a better nurse, but it empowered me to accept the pain and subsequent healing process of my own emotional wounds.
Accepting pain as part of the healing process can help us do the work of uncovering our wounds, digging them up and cleaning them out; piece by painful piece.