Chronic pain and an antifragile system

This is the second post from ‘Everything is F*cked: A book about hope‘ , By Mark Manson. It also got me thinking.

He talks about fragile, robust and antifragile systems. (Page 182) Referring to a theory by Nassim Taleb “some systems become weaker under stress from external forces, other systems gain strength under stress from external forces.” (pg 182)

Robust systems handle change very well. It has some serious endurance. Fragile systems, obviously, handle little stress before combusting.

Antifragile systems

An Antifragile system gains ‘from stressors and external pressure.’

He says the human body can go either way. If we seek out pain, such as when we do a crapton of exercise, it is an antifragile system, ‘meaning it gets stronger the more stress and strain you put on it.’ If you avoid pain and stress muscles atrophy and you become weaker. Same with the mind. Use it or lose it. When we avoid pain and stress ‘and chaos and tragedy, we become fragile.’ Basically making us less resilient to adversity as he says ‘Our tolerances for day-to-day setbacks diminishes-‘ (pg 183)

Chronic pain

So I was thinking where does that put someone with chronic pain?

I think with chronic pain we would be an antifragile system in theory but not reality.

The pain is inflicted on us. We use the coping strategies life has given us- both the good and the bad to try and cope with the constant stressor on our lives. I think we start as a robust system or a fragile system and over time we adapt, we cope and we develop more resiliency as we do becoming closer and closer to an antifragile system… perhaps becoming one, I couldn’t say. I doubt if we do ever attain such a state and if we do, we don’t remain in it.

Robust system (Robust systems handle change very well. It has some serious endurance.)

I do think I had both before started off differently. I started off as a robust system and I powered through the pain and nothing would stop me from doing what I wanted to do, felt I needed to do, or any damn thing and damn the consequences. But the consequences was a massive painload toll and emotional toll.

Fragile system (become weaker under stress from external forces)

That flipped me over into a very fragile system where I couldn’t seem to take Any More stress at ALL. And I eventually crashed and burned out. But even when I recovered from that I was still a fragile system. I still couldn’t handle stress of any sort because I had obliterated my self-worth. I was extremely sensitive to any stress-load above my existing stress-load.

Antifragile System (meaning it gets stronger the more stress and strain you put on it.)

I have moved more and more towards what he could call an antifragile system… when it comes to physical and mental pain that is… but I don’t think when it comes to chronic pain it’s entirely attainable. I mean, our resiliency, our prevalence, our endurance under some intense pain and stress. We have a high tolerance to setbacks. A high tolerance to constant stress and strain.

He says pain and suffering would make us antifragile and I don’t think we are all the time. I don’t think we are of the get go. And I don’t think we make it there or get close very quickly. I think it takes time, which varies with us all, to get close to that point and I don’t know if we stay there.

His antifragile system is our acceptance, to a point. One thing I know about acceptance is that it’s an awesome stage of coping but we do not always Stay there. Coping is a constant flux that depends on levels of illness, life stresses, external factors, and internal factors. One thing we know is that illness changes and downturns happen which can throw our lives into a massive chaotic flux, sometimes past the level of resiliency we have at that time, which throws off our coping for an indeterminate amount of time.

However, nothing is That simple is it? Because pain is biological and it does neurological things to the brain. If I thought coping were so easy, hell, we all would have nailed it by now. We would get through the stages, hit acceptance and settle in. Done. Good to go.

But we have to deal with a lot of neurological fallout at the same time. The more complicated examples of that are depression and anxiety. They are common comorbids that are complicated with pain. That have nothing to do with strategies for coping but sure as hell complicate them. Depression sure had a way of twisting every thought I had into a knot. But it also sucked every ounce of motivation and energy from me too. Made it harder to cope with pain I could cope with before.

So the suffering- the emotional and mental toll is brutal. And that is hard to get a grip on. As anyone would with any common sense would comprehend if they thought about it. It one has to deal with a massive painful stressor inflicted on them 24/7… yeah, it is going to take a toll on you. But, again, over time, who even knows how long, resiliency does grow stronger and stronger and we do cope better and better. So yeah we do become more antifragile assuming the chronic pain or illness doesn’t then Also get worse in a way that then makes us play catch up, as it often does. And assuming we do not develop comorbid conditions of any kind, which we often do. And assuming actual life stressors do not significantly compound that pain stressor and it sure can.

Chronic pain in the vast long term broke me. Then made me. And then broke me. Made me. Some people bend with pain and we do, we work with it, and bend. We are robust. But some of us break, because it is not managed and we push through it and the stress is out of control… we are in survival mode too long… and no one can last long like that… then we just break down and burn out. And that too is a pretty predictable response to long term unmanaged pain when you are exceeding your limits. So maybe I think pain has a little more impact than some think… maybe we never achieve an antifragile state because the impact is so severe on our lives and bodies and minds that the best we can do is cope better than we did yesterday. And learn from the times it broke us. So we do not do that again.

I think this because neurologically and biologically pain affects our system. Which affects our coping. And I think we can never underestimate the impact of chronic stress long term on the body. No matter what we do to cope or how we cope. It is a massive tsunami we try to ‘tame’ every single day. Still, I would say we move beyond his robust/fragile system into something close to an antifragile system years into coping with chronic pain. A more stable, resilient, acceptance we gain as time goes on. Maybe we even stay in it for a time.

And he asks ‘Will you engage your pain or avoid your pain?’

Now this question is very valid even for us. I like it because it is important.

We can’t avoid our pain, obviously. But we can sure TRY to. We can sure avoid a whole lot of things to avoid the possibility of increasing our pain. We can avoid socializing. We can avoid going out and leaving the house as much as humanly possible. We can choose to avoid activities and events because we fear the consequences. Because, like he says, we tend to avoid pain, as human nature. (Which by the way, this makes sense with completely unmanaged, untreated severe pain. So not entirely our fault when we have no effective, or mildly effective even, treatment of any sort. Just saying. There is such a thing as Unbearable pain.)

It is human nature to stay in our comfort zone. When we are in a lot of pain, constantly coping with that pain and the suffering that comes with it, we are just as likely as anyone to fall into patterns of getting stuck in a comfort zone of avoiding things that we know cause us more pain or more suffering.

But if we do that too much, we avoid a whole lot of life. And that means a whole lot of isolation. And lack of activity which can lead to muscle atrophy. That complicates our maintaining a balance and exercise. It can be hard to maintain when we don’t get enough activity. Hard to get into any limited exercise when we haven’t for a long time. I know that for sure.

Anyway, when I was severely depressed I was awesome at avoidance. I didn’t want to socialize. I didn’t want to do anything other than sleep for as long as humanly possible. And, yeah, I was extremely isolated. And friends disappeared. It made pain harder to cope with. It made the depression harder to cope with.

When I began to recover I made the decision to slowly put myself out there, within my limits and pacing, of course. And that level of modest socialization is what I do now and it does extremely boost life satisfaction and mood. I no longer avoid things. I choose based on what it is and my level of well-being that day. I choose based on the recovery time needed and whether I have that recover time available to me. Obviously, now, my functionality is very limited but that doesn’t mean I do not do some limited things, for short durations… just means a lot less and shorter times.

I just want some life in there somewhere. Like my psychologist once told me; I will be at pain at home and I will be at pain if I go play cards with some friends- might as well have some fun and enjoy myself for a short time, because pain will be there regardless. And I can always leave it becomes unbearable. No one said I can’t.

So avoidance can definitely be an issue. Not of pain itself but of anything that might make it worse. The fear of making it worse even. I like to engage my pain so that I have a small life in there. Whatever I can get anyway. But all within limits. And pacing is a must. Not on severe days though-we are not insane. No one mucks about on severe pain days. Those are rest days. And this naturally presupposes some sort of pain management.

See also

Reprint from brainlessblogger.net

Chronic pain and Suffering