Dear Dr. Gottlieb:

I need to know how to pick up the pieces of my life following an injury in a car accident. I'm injured seriously enough to be in constant pain and unable to work without tears, but not seriously disabled. It is difficult to make long-term plans when your physical abilities vary daily, monthly, yearly, etc. Please discuss how to deal with a traumatic event and its repercussions.

Dear Carol:

I don't pretend to have the wisdom of Job, but, unfortunately, I too was in an automobile accident. Mine took place 12 years ago and left me a quadriplegic. Traumas like the ones we have experienced have a significant impact on body and soul.

Part of what makes pain worse - and this applies to any kind of pain - is the feeling of isolation we experience. We live in a world where near perfection is perceived as the ideal and anything less is shameful. We feel, for example, that we must be the right weight, strength, income bracket. When we are not, our imperfections become a source of shame.

Nothing creates a sense of isolation more powerfully than when we are embarrassed about who we are or what we feel. When I first had my accident, I hated myself (read shame) because I was not who I thought I should be.

In addition, most of us "learned" in our families that to feel pain is to be weak. We heard things like, "Be strong - don't give in to it. " So, not only do you feel the physical pain, but you may also feel weak and not entitled to the support you need.

Carol, please understand that your body has been assaulted by an automobile accident over which you had no control. As a result, you suffer unavoidable pain. You are entitled to your fears, anger, sadness, and resentment; there is nothing to be ashamed of. Hiding or withholding your pain can make it worse.

Fortunately, there is much work being done on pain management in this region. Many rehabilitation hospitals have programs designed to help people in chronic pain. I spoke with Clarinda "Coco" Margolis, of Margolis Associates, a well-respected pain program in Philadelphia. She suggests that a comprehensive pain program has available neurologists, psychologists, physical therapists, and psychiatrists who can address the many different aspects of pain. Some treatment options include relaxation exercises, biofeedback, medication, and group and family therapy.

The impact of this type of trauma on the soul is difficult to wrestle with. There's a Sufi saying I'm fond of, "When the heart weeps for what is lost, the soul rejoices for what is found."

Carol, you lost more than a healthy body. We all have expectations of our lives and our futures; these are the most significant losses. I lost Dan Gottlieb as I had known him for 33 years. I had to mourn the death of a future in which I would play golf and racquetball and be powerful and graceful. I also lost the trust that I would be safe in a benevolent world.

I shed many tears over these losses. When I was ready, I found the truth in that Sufi saying - I gained the opportunity to be comfortable being a vulnerable man, free of a good deal of the shame I had always carried. Therefore, I gained a greater access to intimacy with more people, and I gained the wisdom that comes from being disenfranchised.

We have known for many centuries the ingredients required for healing both body and soul: time, air, sunshine and water. Please be generous and tolerant enough to allow time for healing. Give your wounds plenty of air; don't hide them from others. When you are ready, share your injury with people who care - that provides both air and sunshine. Water represents the nurturing from both ourselves and the people who love us.

I am learning to live with my paralysis and pain and navigate this beautiful and fragile life. I wish the same for you.