In mental health, we spend a lot of time evaluating a person's mood (what they're feeling, how they're feeling, if they're happy or depressed --or any variety in between) and their affect (how they appear). Most of the time, in the general population, people reflect how they feel. So if they're happy, they're smiling; if they're sad, they're not necessarily smiling. In the field, in these cases, we say that someone's mood is congruent to their affect.
But sometimes, people who are happy do not reflect this. Or they may not appear to be much of anything, but they report differently. In these cases, we indicate that this person's mood and affect is "incongruent". (Yes, spellcheck, that really is a word.)
In my 20+ years of living with chronic pain and invisible illness, I learned that I don't want to live in the pain. I'd rather be smiling and laughing. Humor tends to be my default. (And I'll be the first to make jokes about myself.) Anyone who's ever been in one of my trainings or spent time with me as a supervisor knows that I have a dry sense of humor and I'm not afraid to use it! (But only when appropriate of course. :) )
But I also tend to use it with my medical team. I tease my acupuncturist that he's my monthly torture appointment (those cups hurt!) and I joked with my rheumy the other day that my pain spike is related to the seasonal change that we have yet to have, but that my body says we should be having. Humor also tends to be my mask.
I've become so practiced at wearing my mask that the only people who see me not wearing it are those who are the closest to me. The ones who know me really well can see through the cracks in my mask when I'm not doing well. They can see past the humor.
But the doctor I've just met for the first time? They only get to see my mask. I might not make jokes with them, because they won't realize I'm joking, but they get my pleasant affect and demeanor. And yes, I get double takes when I present as pleasant, smiling, and report an '8' on the traditional pain scale. Or I receive looks of disbelief.
What a lot of people don't realize is that handling an 8 with humor--when possible--makes that pain feel better than handling an 8 with depression or anger. It's still an 8, but with a little bit of humor and pleasantness, I can fake my body into believing that the pain is actually a 7, even if it's just for a few moments at a time.
This incongruence is why I have such a difficult time when medical professionals attempt to rate someone's pain only by how they're presenting, rather than asking for a self report. What someone else's definition of what a particular pain level should be based on what an individual presents as--particularly if they have never experienced said pain level--isn't an accurate reporting tool. The pain scale is really a self-reporting scale. It's my experience of the feeling of pain in my body. That experience--the sensations of pain, the location, the quality, the severity--will change from person to person. My "8" might be someone else's "10" or it could even be someone else's "4". But I've dealt with this so long that there are extremely few medical professionals who could come close to evaluating my pain level by studying my facial expressions and body language.
Now, as a caveat, are there people who will report high pain levels to get the "good stuff"? Absolutely. But even those people should not be criminalized; addiction is a disease and should be treated as such. And by assuming any person who reports a high pain number with an incongruent presentation is simply drug seeking? That's just doing a disservice to individuals experiencing chronic pain.
A link to the definitions of conditions I have in my medical chart.
