Rewriting The Pain Narrative: Narrative Plasticity and the Pitfalls of Overthinking.
The following is by Dr. Trevor Campbell, Author of The Language of Pain
As a physician working with people in chronic pain, I have seen that bleak and sad narratives can torpedo any attempt at treatment. The pain narrative, the story we tell our family, friends and consulting physicians, is a major issue in chronic pain, though seldom addressed. The bleakness can arise from a lack of insight, but also be influenced by factors such as poor mood, ongoing fatigue, and frustration. Bearing in mind the insight from neuroscience that ‘the neurons that fire together wire together’ (neuroplasticity), the danger of constant repetition of such a negative narrative should be readily understood.
The longer the narrative stays the same, the more it becomes locked in, and it can become our life’s blueprint. History, rather than character, as the well-known saying goes, now becomes our destiny. With time, we become the story that we keep repeating to ourselves in the form of negative internal dialogue. Socially, this narrative eventually gains traction among our network and its reach and influence only increase with time. It ultimately becomes widely accepted as new normal for us and changes the way that relatives, friends, and co-workers react to us.
Neuroplasticity, a key concept in this situation, is the ability of the central nervous system to change itself structurally and functionally under certain conditions. It allows us to learn, create and heal. The non-pharmacological interventions that I teach and recommend for chronic pain depend on this phenomenon.
Narrative plasticity, however, sounds at least somewhat suspect. Could it imply that we allow ourselves to be casual about the facts, or about truth itself? If benefit or advantage are able to lurk somewhere in the notion, should they also apply to the study of history? Can evidence ever be plastic? Perhaps, but then that would obviously not be the type of evidence in which one could have the fullest confidence.
Memory itself is certainly plastic and malleable. Just ask three siblings to briefly describe their early home life, and the variation in description can at times dispel the belief that they are even related. In the ancient oral tradition, narrative changed according to narrator, location and time period, hence a story could be re-told countless times and yet appear fresh and still entertain. But memory is also impacted by many factors, not the least of which is motive, as in whether or not we want to score an event or phase of our life favourably, in order to more conveniently bury it as a ‘success.’
Like it or not, plasticity, together with uncertainty and varying probability, are essentially at the heart of our very existence, so we can go ahead and help ourselves to another ‘yet to be determined’ quantum. After all, we live a life that is often paradoxical and anachronistic, swimming in a soup of duality, the reality of which is increasingly being described as a multiverse.
From the point of view of functionality, narrative flexibility is not only necessary in dark, gloomy narratives, it is arguably essential. In every concretized wasteland that we may find ourselves marooned, there has to be at least the creative conception and later the recognition of some sort of an escape hatch to more favourable outcomes.
Several years ago I had the misfortune to be exposed to mold. Up until that time, even as a physician of many years standing, I had little knowledge about mold exposure and did not know anything of its effects outside of the respiratory and immune systems. Mold related illness, like chronic pain, is poorly taught in medical school and misinformation abounds. Worse, I later discovered that, like 20% of the population, I also had the genetic makeup that all but guaranteed a particularly severe expression of the symptoms. Without giving a blow-by-blow account of my seemingly endless ‘break dance’ through the symptom gauntlet, suffice it to say that my symptoms were multiple, persistent and life- intrusive. Although I managed to continue working, my days became increasingly exhausting and fragmented.
The treatments I had undergone did not appear to significantly change my situation. My sleep was disrupted, and I became progressively more isolated and ruminative. I simply had to find a way out of my situation, as well as my narrative. While I don’t at all believe that the narrative was the cause of my problems, it certainly did not help the situation.
I have had a good deal of experience with CBT (cognitive behavioral therapy), a psychotherapy that deals with how our thinking and behaviors influence our mood, and how any one of these can change another. I knew that the solution lay buried somewhere in this domain. But how would I change my story when I knew that I couldn’t buy into a cure or solution that wasn’t plausible, having had the privilege of my training?
The eureka moment came unexpectedly one day while driving to work. I recalled a movie by Del Toro, The Labyrinth of Pan, a surreal work that depicts a child in civil war-torn Spain, who finds respite from the horrors she witnesses by escaping into her imagination. Almost magically, I figured that if only I could pull off something like that, I could possibly find a way out. I would have to do it alone, as this was not the type of strategy that I could comfortably discuss with my physicians, colleagues or friends.
The problem was that I really couldn’t imagine what a cure would entail. With time, I came to realize that since I couldn’t predict the future in this case, perhaps I needed to return to my past. Then, by some or other knight’s move of thinking, I had this notion that if I could only remember some of the emotions I had felt before I became exposed and symptomatic, I could somehow fluff those feelings up into a solution, and fluff is exactly what it appeared to be at the time. This tenuous strategy carried the advantage of not having to surf the realms of the reasonable or plausible, as it was rooted in the shifty underworld of mood and emotion, that bubbling, changeable, but all- pervasive primal stew. I am not sure what later gave me the conviction that this could be the seed to my recovery, but I simply knew I had to cling to that thought, and having a no other firm foothold or grasp, that is exactly what I did.
Then it happened.
Almost ten months later, I can still acutely remember walking back to my office from my favorite sandwich bar at about noon. I suddenly became suffused with elation, recognizing a sprinkling of long forgotten emotional fragments from earlier days before the onset of my condition, unremarkable at the time because they constituted normality. Unlike the poet Wordsworth who found himself surprised by joy after grieving over his daughter’s death for a long time, I was surprised more by recognition.
It was the faint recognition of an earlier, more integrated self, as if momentarily passing by in a cab, oblivious and untouchable, but still a reassuring reminder that my goal lay a little more within reach. It might have been nice to have exchanged a few words, like asking how things were going, or a simple nod that I was at least on the right track. Was it the apparent unity and sanity of an earlier self, devoid of sourness, or the chilling pinch of time that rendered me mute?
Quite apart from the silence, there had been no exchange of gestures and no trace of a grin or a frown. If only the chimera had at least thrown something my way, I recall at the time aching for a clue, but soon after consoled by the certainty that in any case words, opinions and narratives are potentially as binding as they are liberating. Fleeting and silent though the event unfolded, it was a deeply moving experience that was mercifully, at least partly obscured by my sunglasses.
Over time, these emotional elements coalesced into more familiar and durable forms. I am convinced that this was the herald of my recovery in ways that I cannot fully explain. Was the anticipated recognition of an earlier, more robust self and then the later manifestation enough of a personal success to ignite further hope, confidence and effort? I do know that from that day on, I became more energized, open and grateful for what had still prevailed in me, diligently collecting and accumulating the small advantages that moved both my narrative and recovery forward. As to the neurological explanation of the healing itself, I have to leave that to more knowledgeable minds.
I offer but a personal anecdote, realizing that few may deem it compelling, let alone riveting, despite the gravitas with which it is welded into my memory. I in turn am astonished that time has not even vaguely bleached its significance, notwithstanding my decades long, eye-rolling familiarity with the medical adage that “anecdotal ‘evidence’ is worse than no evidence at all.”
And yet, what remains are neuroplasticity and our endless fascination disguising the profound awe that the marvel endlessly wrests from us. Would it be a stretch to imagine that countless potential benefits and treatment possibilities remain uncaptured by our discipline’s committee approved scrutiny and its fiercely defended treatment algorithms?
I am convinced that we should attempt to escape our own negative narratives, whether a toxic workplace, financial melt- down or the implosion of a relationship. Because I felt that I had nowhere else to go, I made a choice to entertain the existence of a Houdini tunnel, a yet to be discovered exit through the thicket of my narrative tangles. Then, by repeated mental visitation of emotional memory, rather than visualization, I became increasingly aware of the probability of an escape route and ultimately expected its appearance, even though what exactly I was waiting for remained unknowable for the longest time.
By taking action, we can change narrative and shift the lid off the opportunity coffin, and before long it could curiously transform itself into a get-away canoe, open, available and paddle ready for calmer waters.
For more information on neuroplasticity, you can find The Language of Pain on Amazon.
Dr. Trevor Campbell is a family physician who studied medicine at the University of Cape Town, South Africa, before emigrating to Canada, where he became interested in treatments for chronic pain. He has worked in multidisciplinary pain management and opioid reduction programs, and has served as medical director for a leading pain management provider in Western Canada. When not involved with medical matters, he enjoys literature and is an avid hiker, cyclist, and traveler.