I recently realized that the way I think about chronic pain and the way I think about depression are a lot more similar than one might expect. I think of both painful sensations and painful emotions as outputs of the brain, and my first reaction to both is to ask myself, “Does this pain make sense?”
A little history: there are two things I think of as significant turning points in my struggles with back pain. The first is when a physical therapist I was seeing told me there was nothing wrong with the tissues of my back – that it was almost certainly a brain thing. The second was when I bought and read through Explain Pain by Lorimer Moseley and David Butler, which is a book about how pain is a product of the brain, not just the tissues of the body (and I cannot possibly recommend it highly enough for anyone dealing with chronic pain).
I recently had a spread of maybe one or two months where I considered my back pain largely defeated. I was able to imagine, for example, taking a plane flight to New Zealand (an 18 hour plane flight is one of the worst scenarios imaginable for exacerbating chronic pain quickly and powerfully), without worrying about the risk of being suicidally depressed (on account of the pain the flight would result in) by the time I stepped off the plane. This, as a measuring stick for how my pain is doing, has proven to be a useful metric.
I attribute that recovery (and the fact that I’m not doing nearly as badly as I could be given my recent back pain flareups) to my having absorbed the knowledge and the implications of my pain being a brain problem and not a back problem.
Take another example: I had shoulder pain for about a year, up until a couple of months ago. This pain, which I supposed was a physical injury, was such that I would get nervous about whether or not turning the steering wheel of my car was perpetuating the “injury”. I haven’t had any problems with shoulder pain since I decided it was probably a brain problem, and started doing weightlifting again — exactly the same regimen that had caused the problem in the first place (although, to be on the safe side, I started it at a very low weight). I don’t experience shoulder pain at all, now. It was, as far as I can tell, entirely a brain problem. It may have been an injury, initially (there was a clear starting point where I may have been weightlifting overzealously), but it probably was only an injury problem for a maximum of six months or so.
My brain is prone to pain problems, even when there is nothing somatically wrong with me. These days, when something hurts, my reflex isn’t to assume that I’ve injured something. My reflex is to say, “Hang on a minute, does this pain really make sense? Or is it just my brain being weird.”
Does this sound familiar to anyone who has dealt with depression?
It’s almost the same thought process I use when dealing with depressive feelings. I think of both physical and emotional pain as happening in three parts: the trigger, then the pain, then the explanation. Ideally, in a well-functioning brain, the explanation correctly identifies the trigger. With depression or chronic pain, however, it is important to operate under the assumption that the explanations your brain likes may not have anything to do with the actual triggers.
The explanation that my brain likes for my back pain is that I’ve injured my back, but the things that trigger back pain for me are not injuries. My shoulder pain made me feel like I had an injured shoulder, but whatever was triggering that shoulder pain wasn’t an injury (at least for the majority of the duration of the pain). The explanation that my brain likes for my depressive emotional pain is that I don’t add anything of value to the world, but in actual fact the triggers for emotional pain for me are almost always stress, and only sometimes is that stress related to my sense of contributing to the world.
I treat physical and emotional pain in almost exactly the same way these days. Both of them are products of my brain. Both of them are things that my brain is historically very bad at attributing to causes that make sense. Therefore, the explanations that my brain comes up with for both of them are worth eyeing with a healthy dose of skepticism.