“What Happens After?”, the Anti-Catastrophizing Game

One of the strategies that a therapist of mine once recommended to me to stop catastrophizing is a game I call “What Happens After?”.

The thing about catastrophizing is that catastrophe narratives almost always end with the catastrophe. If you’re worried about failing a test, then catastrophizing means imagining that you’ll fail the test, and failing the test is the horrible Worst Thing in the World end of the story. If you’re worried about a breakup, then the relationship being over is the horrible Worst Thing in the World end of the story. I’ve borrowed the “worst thing in the world” phrasing from Cliff at The Pervocracy blog, who writes eloquently about this kind of thinking:

I remember when my first “I love you” relationship ended.  I couldn’t abide the thought.  I screamed.  I cried.  I tried to seduce him.  (While still crying. Sexxxay.)  I threatened to harm myself if he didn’t come back.  I called him until he stopped taking my calls.   The ridiculous thing is, I didn’t even like him that much.  It wasn’t about getting the joy of the relationship back.  It was about avoiding TWTITW [The Worst Thing in the World].

At some point I bawled myself to sleep, and the next morning I woke up and had to pee.  Because even in the wake of The Worst Thing In The World, you still have to pee.   I peed and went to work. It was the day after the end of eeeeeverything, but the bus still picked me up at 7:08 and I still got a half-hour and a chicken sandwich for lunch.  I was in pain, I was in bad pain, but I had thought it would be infinite pain, and it was finite.  It was only a six-foot cockroach.

I can’t say “and then I never believed in TWTITW again,” but it was the start of a journey.  Failing a class helped too, as did getting fired from a job, as did very messily breaking up with a very close friend.  Not because these things weren’t bad.  All of them sucked, all of them cost me opportunities I would never get back, all of them caused real and irreparable harm, yet the morning after… I still had to pee.

The “What Happens After” game is a pretty simple idea: if I’m ever worried about a particular worst-case scenario, I try to imagine what will happen after it. It doesn’t have to be a “plan” for what I will do after the thing happens (although making plans against worst-case scenarios can sometimes also be a helpful tactic) so much as the creation of a narrative, any narrative, that doesn’t stop with the catastrophe.

If I go through a breakup, then the day after that I’m going to have to make myself breakfast, and then I’m going to have to call that friend I haven’t been in touch with, and then I’m going to have to get some writing done or some coding done. The week after that I will have that swing dance thing to go to, and the week after that there is a conference…

The idea is that you just keep writing the story out until you realize that no matter how horrible it might be, the catastrophe that you’re worrying about will not be the end of the story. Somehow, moving catastrophes to the middle of their narratives from the end of the narratives has an ameliorating effect on the anxiety associated with them, at least for me.

Sometimes it happens that I forget to do the “What Happens After” thing, and then situations come up that prove the truth of the exercise to me. That is, something that I’ve worried a lot about happens, and then a bunch of stuff happens afterward, and I realize that the narrative doesn’t end at the disaster’s edge. This happened to me in a relatively minor way just recently.

One of the things I tend to worry about a lot is whether or not I have sufficiently established consent for the things I do with people. My pattern is pretty much to always explicitly ask for things, but it’s not uncommon, even in those cases, for me to worry like this: “I can ask, but this is a thing I really want to do, what if she isn’t interested, but she can tell that I really want to do it and feels pressured and then OH GOD I HAVE PRESSURED SOMEONE INTO A THING?!”

Recently, I had the experience of making out with two friends of mine for the first time. With the first friend, it went very well. I asked if she wanted to make out, she said yes, and then we enthusiastically did just that. With the second, I asked, and she said yes, but when it came to actually making out, I didn’t get a very strong sense that she was into what we were doing.

With the first friend, we made out for a while, and it was awesome, and I felt really good about it afterward. With the second friend, I got an uncertain impression, and decided to hold off on asking or initiating again. This may seem like the obvious way things like this would go, but in my brain it was a bit of an epiphany: “Oh! If I get the impression that maybe someone isn’t as into doing something as I thought, then instead of “OH GOD, DISASTER HAS HAPPENED AND THE WORLD EXPLODES”, what actually happens is I gather some data and use that data to inform how I initiate or don’t initiate things in the future.

Where before, the narrative ended in disaster, it now ends in my having more information and using that information to better understand the situation. Now, with that new narrative, the whole situation is a little less scary. This is how the What Happens After game is supposed to work, and I have found it to be very helpful at times for getting my head out of the “What if the world explodes?!” headspace, and into the “Well, then it will explode, and tomorrow I will still have to pee.” headspace.

Breaking Up Is Hard to Do

Breaking up with people is hard.

I follow a strange pattern when it comes to ending relationships or friendships. I can’t remember ever breaking up with someone and then regretting it later. There have been many, many times when I’ve broken up with people and wished it hadn’t been the right decision, but by the time I’ve decided I need to break up with someone, I’m usually sure.

There’s usually a moment. After a period of stress and worrying and wondering what I should do, something happens and suddenly the dike breaks — a kind of intuitive critical mass is reached, and apprehension and uncertainty transmute into diamond-like clarity. It’s like hearing the chink of a shovel on metal when you’re digging for something – it isn’ t so much making a decision as discovering a decision that was already there, already made. It just had to be found, and now that it has been all that’s left to do is follow the directions on the card.

Once, when I was in college, I was venting to a friend about the relationship I was in at the time, and she said something like “Well, it’s okay if you don’t know what you want to do.”, and for some reason, in that moment, I did know. There was something about her putting in just that way, and suddenly I knew I didn’t want to be in that relationship anymore.

I’m not sure I will ever know what it was about her saying that particular thing at that particular time, but I know that was the moment. That one statement was the eight ball in the corner pocket in the chaotic system of my brain. After that moment, I knew how the story ended, and all that was left was to deliver the news.

You would think that sort of clarity would help in the aftermath, but I’m not sure it does. Maybe my experiences of breakups would have been worse if I hadn’t been sure about them, but when I’m in the middle of the aftermath, the difference between wondering if I was really sure and wishing that I wasn’t really sure doesn’t feel all that important. No matter how the cards fell, it’s just different ways of wishing things had been different.

Just Friends

The other day, I was listening to a conversation about how to talk to children about poly and partners. One of the people in the discussion said that she introduces all of the people in her life, friends or partners, as friends when she introduces them to her kid. Some of them are more significant parts of her life, and some of them are less, some of them stay the night, and some don’t, some of them sleep on the couch when they stay the night, and some of them don’t, etc., but the thing they have in common is that they are all friends.

I really like this idea, partially because I think it’s a good way to be honest without being complicated, and partially because I’ve been seriously thinking about starting to use this type of language for all of my partners and friends in my life in general as well. Labels are complicated, and the majority of my experience has been that they cause more complications than they solve. I don’t think I’ve ever had a situation with someone where I felt like it fit perfectly into a particular box.

“This is a Friends-With-Benefits thing, case closed!”

Things never fit perfectly. Another idea that came up in the same discussion: in friendships or relationships, sometimes you want to spend a lot of time together and sometimes just a little. Sometimes you’re incredibly attracted to a person and sometimes you’re not very attracted to them. Sometimes you’re incredibly emotionally attached to a person, and sometimes you’re not. There are all of these different spectra on which relationships with people can vary, and they never seem to fit perfectly within labels.

Just about all of them fit neatly into “friendship”, though, so I wonder if it might be less stressful and more useful just to refer to all of them that way, and let the rest be whatever it is. I wonder if that might help me let things be whatever they are instead of wasting time sorting through a pile of inadequate boxes.

Life Update

Life lately has been pretty intense. I’ve been seeing some new people with respect to my repetitive stress issues, and has apparently determined that they are not, in fact, consistent with a diagnosis of tendonitis. The running hypothesis is that it’s a nerve problem caused by muscle tension — that is, muscle tension causes nerve compression, which causes the physical symptoms. I have been experimenting with different types of exercise, and discovered that I am capable of doing more types of exercise than I thought I was without aggravating my symptoms. That said, I still seem to get about the same level of symptoms when I don’t move around for a while, so I’m not sure if the root of the problem is getting any better, which is pretty frustrating.

My voice does seem to have been getting consistently better, which is a huge relief, and may mean I’ll be able to blog regularly again. We’ll see.

I went on a date this past weekend which went very well, and I’m curious to see if that goes anywhere, friendship or otherwise. I’ve noticed that my dating instincts have shifted recently, erring further on the side of caution than they used to. I had a pretty complicated situation implode recently, and I think the aftermath of that may have made me a little bit slower to be up for jumping into things with people. I think this is probably a good thing.

Basically, I’m processing a lot of things right now. I find myself sad about some things, and happy about others, and as per usual, my mood is most powerfully influenced by whether my symptoms seem to be getting better or not changing. Being able to do more things is better than nothing, but it only goes so far when they are still dozens of things I have to choose not to do over the course of a day on account of my body. I really hope one day I’ll get over all this stuff, and my body will end up being something I can dive into and enjoy, rather than just being a list of things I can’t do.

I’ve been feeling sad today. It’s actually a nice feeling, because it’s not the kind of sad that I’m used to — it’s not depression-sad, it’s not the-world-is-futile-and-pointless sad, it’s just things-are-sad sad. Which is natural, and fine, if unfamiliar.

Being Skeptical of Your Brain, Part One: Introducing the Model

I’ve decided I’m going to try to put together some ideas that might eventually end up as a conference talk. I have some ideas in my head for a basic outline, but they’re not very organized, so my plan is to write about them until they organize themselves.

The talk is going to be about how to be skeptical of your own brain, and is going to mainly center around a model for thinking about our experiences that helps with this. I want to do more research on the model, because while I know there is good science backing it up when it comes to the perception of pain, I haven’t done as much research on it with respect to other forms of perception. At present I feel completely comfortable calling it a “useful” model, but I’m hoping to get to the point where I can call it both “useful” and “pretty well substantiated by research” with respect to all of the ways I apply it.

This post is going to be what I presume will end up being the beginning of the talk. It is an outline of my basic mental model for how tactile sensory experiences (pain in particular) occur and how they can be inaccurate or be misinterpreted.

Here we go:

I think of any experience of pain as a three-step process: trigger, feeling, and explanation. In the first step, the trigger, something activates danger sensors in the skin called “nociceptors” that respond to heat, pressure, or acidity, and those signals are sent to the brain*. For example, when you sprain your ankle, the resulting tissue damage will activate nociceptors in your ankle.

The second step is the translation of those signals into a sensory experience — the feeling: the brain receives nociceptive signals, and makes a decision about whether or not you should feel anything as a result. That decision is based on putting the signals in historical context — has the brain gotten signals like this before? Have they generally been dangerous? Not dangerous? Is it likely they are dangerous now? — essentially, the brain takes your whole life, all of your lived experiences, into consideration and makes a decision about whether or not to produce the conscious experience of pain. When you sprain your ankle, your brain should, if everything is working correctly, decide to produce some intense ankle pain in response to the triggered nociceptors.

The third step is the explanation. A person has a sensory experience and comes up with an explanation for it (e.g. “My ankle hurts therefore I injured it in some way.”).

If everything goes perfectly, then the way that the system works is: the trigger occurs, the brain interprets the significance of the trigger correctly and causes an appropriate and proportionate sensory experience, and then the explanation for that sensory experience correctly identifies the trigger. When you sprain your ankle, your brain should translate the resulting nociception input into a painful sensory experience, and your ideal conscious response is, “Shit, I sprained my ankle!”

In the real world, however, the system does not always work so perfectly. In reality, the first step isn’t even necessarily required. The activation of physical sensors in the skin is neither necessary nor sufficient to produce an experience of pain. Pain can be produced in completely healthy people solely by creating a context in which their brain interprets a situation as dangerous — for example, if you hook someone up to a device and tell them it’s running electrical shocks through their brain, they will experience more pain the more you turn a dial higher, even if the device and the dial do not actually do anything.

Pain research rockstar Lorimer Moseley tells a fantastic story from his own life about how this system can go terribly wrong: he was hiking with some friends one day and felt a mild twinge on his leg, thought nothing of it, and ended up in a hospital having been bitten by an incredibly poisonous snake. One of the effects of snake venom is that it locks nociceptors into an activated position, so the amount of danger signals sent to the brain would have been massive, and yet when those signals got to the brain, the brain had no historical context to indicate such signals were dangerous, and so did not create a correspondingly massive pain experience. In fact, it created almost no sensory experience at all. As a result, Lorimer nearly died. About six months later, however, Lorimer was hiking again and experienced a sudden, massive pain on his leg in the same place as before, and very nearly ended up taking a trip to the hospital until one of his friends took a glance at the leg and discovered that it was only a tiny scratch from a twig.

In both of those cases, the system failed. When the trigger was a snake bite, the brain did not produce a sensory experience that felt anything like a snake bite. As a result, the explanation for the sensory experience did not correctly identify the trigger, and that mistake was nearly fatal. Later, when the trigger was only a twig, the brain interpreted it, mistakenly, as incredibly dangerous, presumably because it then had the context of the near-fatal snakebite informing the sensory interpretation. In both cases, neither the sensory experience nor the resulting conscious explanation of that experience usefully corresponded to the event that triggered the nociception in the first place.

In dealing with chronic pain, the lesson I have needed to learn is this: sometimes my pain has nothing to do with the state of my tissues. Sometimes my experience of pain happens solely because my brain has decided, mistakenly, that something threatening is going on. Sometimes, I need to be skeptical of my own lived experience of pain. Sometimes my pain is a lie.

Additionally, even when my sensory experience is a proportionate response to the state of my tissues, I can get the explanation wrong. For example, the experience of repetitive stress injury often manifests for me as an itching sensation. Occasionally, I will get an itching sensation in an arm and assume it’s RSI symptoms, and then later discover a bug bite. The sensations of mild RSI and bug bites are completely indistinguishable to me.

So, to review, the experience of pain is a three-step process: first, there is the trigger that activates nociceptors (e.g. an ankle sprain, a snake bite, a repetitive stress injury, etc.), then there is the feeling – the physical sensation your brain decides to produce in response to the trigger (e.g. a twinge, a sharp pain, itching, etc.) — and then there is the explanation — your brain’s assumption about what the trigger was (e.g. an ankle sprain, a snake bite, a repetitive stress injury, etc.). If the system works correctly, then the physical sensation corresponds well to the trigger, and the explanation thus implicates the trigger successfully (e.g. “It feels like I hurt my ankle, which probably means I hurt my ankle.”). The system fails when the trigger is not accurately identified. This can happen either because the physical sensation is not sufficiently specific to the trigger to make a reliable determination (e.g. when an itching feeling could be either RSI symptoms or a bug bite), or because the physical sensation does not correspond well to the trigger at all (e.g. a snakebite that feels like a scratch from a twig or vice versa).

This is the mental model that I used to think critically about my experiences of pain. It helps me to make a determination, when I am experiencing pain, about whether that pain represents a trigger that is worth my doing something about (e.g. I actually injured my back and should stop exercising), or I should be skeptical of it (e.g. I have chronic back pain and should probably assume nothing is wrong with the tissues and keep exercising). In the next post, I’ll talk about how I apply this same rough model to other experiences.

If anyone has any thoughts or questions on any of the above, I’m interested in refining it as far as possible, so any input is appreciated.

* Actually, there are some modulation steps between the sensor and the brain, and some other steps in the overall process, but I’m simplifying for the sake of brevity.

Reframing Thoughts about My Partners’ Sex Lives

Note: not sure if I’m going to be returning to blogging full-time anytime soon, but my voice is doing a little better, and, well, I wanted to write, so here is a short post:

A few months ago a partner of mine spent a weekend out of town, and told me when she returned that she had hooked up with someone over the weekend. I felt a pang of jealousy, as I often do, and then my brain did something unexpected — something it’d never done before: after the usual catastrophizing, “Oh God, what if this person is better than me and my partner leaves me?!”, it thought, “Wait, that’s not the only way to think about this…”

I realized that there was a nifty alternative way to frame the situation: every time my partner hooks up with someone else and comes back is evidence that the catastrophizing oh-god-what-if-that-person-is-better-and-my-partner-leaves-me scenario won’t happen. Because every time my partner hooks up with someone else is an opportunity for Catastrophe Scenario to happen, and every time they still want to be my partner after a hookup is another to add to the list of times that Catastrophe Scenario has consistently not happened.

This new framing — where partners hooking up with other people is an opportunity to gather evidence that I am awesome rather than an opportunity for my partner to discover someone better — has been really helpful for me recently, and seems to have had a not-insignificant impact on how often I end up feeling jealous. So I thought I would share.