Psychology and Neurological Pain
Nov. 17th, 2025 01:51 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
johnpalmerSo, I have a hypothesis about how Cognitive Behavioral Therapy (CBT) works. Ordinary people, who are facing depression, have their perceptions turned toward despair, or, sometimes all the way there. You want to do something difficult, and you start to expect failure, or maybe even become certain of failure.
Well, first, you challenge the BS your depression is feeding you. You think you’re likely to fail; okay, why? You force yourself to acknowledge it’s just a feeling. It’s real, but not reality. So you push yourself, as if you expect success. This step is important, because, when you say “I don’t think I’ll succeed,” well, that’s your most trusted voice saying that, right? In the end, you listen to your own internal voice over anyone else – though sometimes your internal voice must admit it’s wrong :-). That’s why you need to challenge that voice… it’s feeding you depression-BS, not reality.
CBT also teaches you to act in accordance with how you’d like to be. Are you too depressed to go bowling, or out for drinks after work? CBT suggests you push yourself to try to go, when you’re ready, with plans for any contingency, because sometimes your brain doesn’t really believe a change is happening until you follow up thoughts with actions. That means, you make plans, maybe say you’ve been feeling poorly, so you might bail early. That’s enough cover for a lot of depressed folks.
Now, if you do this, you take those broken perceptions, and you move them towards more accurate ones, away from the despair-bias that you had when you were tending toward depression. There’s a model for you, and a claim I’m making: I think CBT causes people, through mental processes, commitment to changes, and possibly meditation or spiritual stuff, to take their perceptions that are making everything look like crap, to being more in line with our ordinary reality, where good things are good, and bad things are bad. I’m saying that it changes you from one state of consciousness, to another one, one that’s similar, but represents our ordinary reality. If that happens, CBT has effected a cure… if not, what then?
I realized a long time ago that CBT couldn’t help my depression; I’ve been able to improve my model over the years and I think it’s more accurate now. I believe that my neurological pain can cause a mood crash, from happy, to awful. I don’t remember “happy” so much any more, but I do remember the mood crashes! When stuff like that happens, sure, I used CBT-style techniques, and others, to handle the emotional trainwreck, but I can’t ever learn to avoid them, because I can’t control the pain. Worse, sometimes my neuro pain leaves me so exhausted, I can’t manage the emotional overload, so I turtle up and hide from everyone.
What if I didn’t know better? What if I lost all my emotional control resources, while out-and-about? Fun fact: my neurological pain can either trigger my PTSD, or mimic PTSD in a horrifyingly realistic way. I could look crazy to an outsider. If someone thought I was crazy, they might note confusion, aphasia, agitation, extreme fear or anxiety, delusions, or some symptoms of schizophrenia.
And each and every one of those apparent symptoms are caused by my neurological pain. In fact, I can go into a weird state, where I appear to be seizing, but, I can pull myself out of that state (so it can’t be a seizure). If someone thought I was seizing, they might have administered something to end the seizure, but the change in my state of consciousness (caused by the drug) would probably pull me out of the seizure-like state in any event.
Anyway: to me, this means there’s a whole lot of psychology that needs to consider “but you might also be in pain, and it might be mimicking some or all of these symptoms.” There are many people with “intractable depression” who need pain relief. There are people being drugged to treat symptoms they might learn to live with, once they understand their pain, and concomitant brain malfunctions. There are people called crazy who aren’t; and there are people who are called angry, aggressive, violent, dangerous, just because they’re in a huge amount of pain, and are trying the best they can to maintain control… but none of the normal control-crap is working. Similarly, there are people who have “anger management” issues where their anger would be much more easily managed with pain control.
The other side of this, is, did any drugs used on patients, who exhibited these symptoms, did any help the neurological pain? Could antipsychotics actually provide neurological pain relief? What about mood stabilizers? I know anti-epilepsy drugs sometimes help with neurological pain, and I recall some of them being used as mood stabilizers, and, to enhance antidepressants. We might learn a lot more about that if we studied psychology, plus neurological pain.
Hah. “We,” I say, as if thousands will read this. Still: if you happen to have come across this page, yes, neurological pain can mimic a lot of symptoms. It can also ruin your sleep, which can add a lot of other symptoms, including (hypo)mania. So if you’re in neurological pain, you may be finding a big part of your answers. I hope so – I felt awfully lonely, when I had to live, without knowing that it really was pain all along.
Well, first, you challenge the BS your depression is feeding you. You think you’re likely to fail; okay, why? You force yourself to acknowledge it’s just a feeling. It’s real, but not reality. So you push yourself, as if you expect success. This step is important, because, when you say “I don’t think I’ll succeed,” well, that’s your most trusted voice saying that, right? In the end, you listen to your own internal voice over anyone else – though sometimes your internal voice must admit it’s wrong :-). That’s why you need to challenge that voice… it’s feeding you depression-BS, not reality.
CBT also teaches you to act in accordance with how you’d like to be. Are you too depressed to go bowling, or out for drinks after work? CBT suggests you push yourself to try to go, when you’re ready, with plans for any contingency, because sometimes your brain doesn’t really believe a change is happening until you follow up thoughts with actions. That means, you make plans, maybe say you’ve been feeling poorly, so you might bail early. That’s enough cover for a lot of depressed folks.
Now, if you do this, you take those broken perceptions, and you move them towards more accurate ones, away from the despair-bias that you had when you were tending toward depression. There’s a model for you, and a claim I’m making: I think CBT causes people, through mental processes, commitment to changes, and possibly meditation or spiritual stuff, to take their perceptions that are making everything look like crap, to being more in line with our ordinary reality, where good things are good, and bad things are bad. I’m saying that it changes you from one state of consciousness, to another one, one that’s similar, but represents our ordinary reality. If that happens, CBT has effected a cure… if not, what then?
I realized a long time ago that CBT couldn’t help my depression; I’ve been able to improve my model over the years and I think it’s more accurate now. I believe that my neurological pain can cause a mood crash, from happy, to awful. I don’t remember “happy” so much any more, but I do remember the mood crashes! When stuff like that happens, sure, I used CBT-style techniques, and others, to handle the emotional trainwreck, but I can’t ever learn to avoid them, because I can’t control the pain. Worse, sometimes my neuro pain leaves me so exhausted, I can’t manage the emotional overload, so I turtle up and hide from everyone.
What if I didn’t know better? What if I lost all my emotional control resources, while out-and-about? Fun fact: my neurological pain can either trigger my PTSD, or mimic PTSD in a horrifyingly realistic way. I could look crazy to an outsider. If someone thought I was crazy, they might note confusion, aphasia, agitation, extreme fear or anxiety, delusions, or some symptoms of schizophrenia.
And each and every one of those apparent symptoms are caused by my neurological pain. In fact, I can go into a weird state, where I appear to be seizing, but, I can pull myself out of that state (so it can’t be a seizure). If someone thought I was seizing, they might have administered something to end the seizure, but the change in my state of consciousness (caused by the drug) would probably pull me out of the seizure-like state in any event.
Anyway: to me, this means there’s a whole lot of psychology that needs to consider “but you might also be in pain, and it might be mimicking some or all of these symptoms.” There are many people with “intractable depression” who need pain relief. There are people being drugged to treat symptoms they might learn to live with, once they understand their pain, and concomitant brain malfunctions. There are people called crazy who aren’t; and there are people who are called angry, aggressive, violent, dangerous, just because they’re in a huge amount of pain, and are trying the best they can to maintain control… but none of the normal control-crap is working. Similarly, there are people who have “anger management” issues where their anger would be much more easily managed with pain control.
The other side of this, is, did any drugs used on patients, who exhibited these symptoms, did any help the neurological pain? Could antipsychotics actually provide neurological pain relief? What about mood stabilizers? I know anti-epilepsy drugs sometimes help with neurological pain, and I recall some of them being used as mood stabilizers, and, to enhance antidepressants. We might learn a lot more about that if we studied psychology, plus neurological pain.
Hah. “We,” I say, as if thousands will read this. Still: if you happen to have come across this page, yes, neurological pain can mimic a lot of symptoms. It can also ruin your sleep, which can add a lot of other symptoms, including (hypo)mania. So if you’re in neurological pain, you may be finding a big part of your answers. I hope so – I felt awfully lonely, when I had to live, without knowing that it really was pain all along.
no subject
Date: 2025-11-17 10:33 pm (UTC)In that case, I could remember that it was OK, my regular habits had already solved the problem. That redirect might not have worked if I'd been late, but the doctor had also been running late. That feels like it's the sort of thing CBT works well for.
The therapist also gave me some techniques to distract myself from those loops by focusing on something else, but I suspect "find a tree to look at" wouldn't have worked with physical pain.
Also, I am currently taking gabapentin, which was originally an anti-seizure drug. I'm using it to deal with other neurological weirdness, but a previous doctor prescribed it because he thought some of my pain was neurological, and thought that gabapentin would be useful for that.
no subject
Date: 2025-11-20 12:43 am (UTC)