I’ve been hanging out with an old friend today and, as usual, we’ve been talking. She went through a traumatic brain injury in a car accident a few years ago and has struggled with nerve pain since. I had an unusually high level of pain in the birth and afterwards, so we end up having a lot to compare and contrast, and when it comes up in conversation, we talk about it.

Pain is subjective and hard to observe–there’s your first problem. You can’t look at somebody and tell how much pain they’re in. That’s as true of emotional pain as physical, and since emotional pain often lightens immediately upon taking Tylenol, for example, there’s a lot of reason to suspect that the same part of the brain is affected for both. But some people are just better at functioning with high levels of pain than others. Some scream, some go incoherent, some pass out at extreme levels. You can literally die from pain–you can stroke out, among other things. But some people just go very quiet.

A lot of this is also true of depression and anxiety issues, by the way. You can’t tell by looking at someone how depressed or anxious they are. Some people function well at crazy levels of anxiety, levels severe enough to literally double or triple your risk of a cardiac event from the sheer stress on your body. They function anyway. Some people can manage to perform at high levels at school or at their jobs despite incredible levels of depression too, or PTSD, or any number of other issues. Another friend with a “hidden” physical disability posts on my Facebook stream constantly about her frustration with people’s judgements. She’s not required to “perform” her disability, she says.

We also don’t seem to have sympathy for ongoing or intractable pain in our society, physical or emotional. Buck up, we’re told. Or it’s assumed that we’re to take a pill and get over it. I was fortunate enough to heal over the course of months and to reach an end to most of my physical and emotional pain, but my friend didn’t get that lucky. She’s still looking for the right treatment protocols. She ends up doing a lot of her own research to bring to the doctor with questions.

Healthcare itself is also a barrier sometimes. Where it’s hard to find pain meds that the insurance will cover that will still let you work–or where you limp by on insufficient Tylenol and ibuprofen, watching your kidney and liver numbers and hoping they stay good. Where the treatments that work aren’t available to everyone, or the doctors’ visits eat up too much of your workday–or you can’t find childcare, and you can’t bring your children. Worse, for the people who can’t afford healthcare insurance now, or can’t afford the out of pocket fees. Or can’t find a doctor willing to listen. There’s a reason that fibromyalgia was only considered a real illness in the last few years–doctors have a long-standing habit of dismissing women’s pain as “hysteria,” a habit that continues well into the modern era.

When it comes to pain, then, we need to be slower to judge and faster to help. But as the current opioid addiction crisis shows, help is not always a quick prescription for the cheap meds (the addictive ones) and move on with your day. Help is sometimes listening, and believing. Help is biofeedback and mindfulness meditation, and yes, the correct meds at the correct dose–but ideally the safer ones, with clear guidelines on how to use them and how not to. Sometimes help is just being there, and talking. The only thing I found useful from all the books on natural labor was this: pain is sometimes required, but suffering is not. The experience of pain, the “buck up” and disbelief or uncaring, is often worse than the pain itself.

We need to get better about pain, emotional and physical. We need to get better as people, and we need to get better as a country.