It is common for people with chronic pain to feel their injury was unfair.

This belief can detrimentally impact physical recovery, and increase the risk of serious depression.

To expedite healing, targeted psychotherapy regarding perceived injustice is warranted.

I was in an auto accident over six months ago, when an Uber driver ran a red light at an intersection and totaled both our cars. I sustained a serious neck injury. I didn’t think it was such a big deal at first, but as time passed, the pain intensified to the point where I could barely move. And so began the round robin of doctors, physical therapists, medical imaging, injections, and drugs that seems to take up most of my life now.

If you asked me, however, I would tell you that this neck injury isn’t the worst pain I’ve ever known. That dubious honor would have to be reserved for major depression—surely the closest a human being can ever get to hell while still alive. I thanked God that my mood seemed to be stable despite the injury to my body. I was irritable, sure, and maybe more than a little scared, but I wasn’t in the throes of real depression.

Until months passed and the pain didn’t yield to any of the multitude of treatments my doctors were trying; it only got worse. I finally realized it wasn’t just the physical pain that was consuming me. It was the whole ungodly unfairness of it all.

In the space of a second, my entire life had been upended. One person’s negligence had robbed me of the serenity I had fought so long and hard to achieve, in the face of a lifelong history of mental illness. I had been happy; now I was not. I thought this was completely unacceptable, and manifestly unfair.

Unfairness has always been a huge trigger for my depression. Ever since I was a little girl, I demanded justice from the universe. “But that isn’t fair!” was my inevitable whine when I felt life wasn’t going my way. “Whoever told you life is fair?” was always my parents’ retort, and for the split second it took for them to say that, I hated them.

But I think it was more than a child’s pique or entitlement that made me crave justice. Long before the word “bipolar” ever entered my consciousness, I’d suffered from wild, erratic mood swings that made life feel like a queasy carnival ride. I never knew who I’d be each morning, or how I’d function from day to day.

Justice, on the other hand, meant predictability: if you work hard at school, you’ll get an A. If you work hard at life, you’ll become successful. How marvelous, to know exactly what was going to happen next! Maybe that’s why I became an attorney, to do what I could to enforce cosmic fairness (although I soon learned that the law and justice don’t necessarily equate).

I also learned that my parents were right: justice is not guaranteed. But that didn’t stop me from getting depressed whenever I felt life was being unfair to me. I’ve worked hard in therapy to get past this childish obsession, and I thought for the most part I’d managed to put it behind me.

Now I have to be as careful about my mood as I am about my fragile neck. But it’s helped to discover that I’m not the only person who wholeheartedly believes in the unfairness of chronic pain. As one study observed, “Clinical anecdotes abound of people with persistent pain who feel that they have been caused to suffer unjustly either as a direct result of their injury, or indirectly by [its] sequelae.”

There’s even a term of art that a slew of pain studies use: “perceived injustice.” Understandable as this perception might be, it’s actually self-sabotage, because it can detrimentally impact the chances of a full physical and mental recovery: “Perceived injustice is increasingly recognized as a risk factor for problematic recovery, with a growing body of evidence documenting its association with heightened pain, disability, medication use, anger and post-traumatic stress,” according to another study.

I was disturbed to learn that this is particularly true of musculoskeletal injuries caused by another person’s error or negligence, like mine. But the scariest discovery I made was this: “Individuals who experience high levels of perceived injustice are at risk for experiencing more pronounced or persistent symptoms of depression.”

No. Not me. Not again.

This finding shocked me into an essential truth: that the medical treatments I am receiving are not enough to fully address my injury. I have to focus on the perceived injustice that lies behind the pain. That’s not such an easy task for someone to do alone. Justice is a notorious shape-shifter, heavily dependent on socioeconomic factors, and different for every person and situation.

To truly heal, I need to engage in targeted psychotherapy, specifically directed at my feelings of unfairness. While no one modality has been recognized as best, studies suggest that helpful approaches include cognitive behavioral therapy, acceptance and commitment therapy, anger and forgiveness interventions, and mindfulness.

Bring it on. I’m open to it all, to anything that will reduce my chances of getting severely depressed again. I can’t picture yet what justice will look like for me, after all these months of suffering. But that’s the joy and challenge of therapy. It clarifies your vision, and along the way, it can lessen your pain.

https://www.sciencedirect.com/journal/the-journal-of-pain/vol/22/issue/6

https://journals.lww.com/clinicalpain/toc/2012/07000

https://onlinelibrary.wiley.com/doi/abs/10.1155/2012/501260

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