Who are you? Oh, it's me.

Here we reprise the earlier article, “Insane in the Membrane”.

This is a submission from one of the doctors here at painonline. Our thanks to the medical professionals who contribute:

“I remember giving a history and physical to my chief resident and including the comment that the patient was insane. The chief resident said, “You don’t have to include that. I can tell it from the history you are giving.” Do we sound any different in describing our central pain? In my thinking, it sometimes seems as if Central Pain induces a type of insanity. Either that, or the world itself becomes insane, so the person just struggles on. Perhaps it is really just exaggerated stress, rather than insanity, but there is clearly something wrong.

From what I know, and I study brain function, EVERY thought and brain function can be reduced to some chemical reaction. Chemoarchitecture of the brain is more important than anatomical structural architecture, although both are linked. Saying this, I believe the chemical processes of the pain system ARE insane in central pain. They do not make sense, they are disordered to the point of being counter to logic. If this is not insanity, it is close to it. So we become partners with some insane part of the nervous sytem, inside our own body.

This is not the same as loss of sensation, which would be a nothing. It is an active presence, which must be dealt with in thought and mental prioritizing. Since the pain is just a construct, which does not exist in the exterior world, it is a special enemy, rather than an imaginary friend. We cannot come to terms with it, because it does not want us to. Pain does not call for inaction nor being ignored. It sends alien voices to our happiness and reasoning. All these phenomena show how insane pain is acting in a damaged nervous system.

It is only natural to express pain openly or subconsciously. Yet, what we are expressing is an insanity. Hence, no one likes to deal with it.

Other than in very limited circumstances, I have never found that talking about it is helpful to anyone. It is not a message we can give them. And so, in general, we must live pretend lives. This permits those around us to grow and proceed on their ways as they must. We sit as flies on the wall, in agony, hoping for the best for others, although our preoccupation with suffering virtually guarantees that our active participation in their good will be minimal. We can only hope it will be enough. We attempt to constrain the insanity within ourselves, so that it will not harm our loved ones.

For us, this passes as righteousness (whatever that is), although inspired living is most difficult, if not impossible in the severe cases. This is because there is a focus on death when one is in longstanding terrible pain, which runs counter to the proper attitude toward life, and the gratefulness we should feel for blessings. Our gratefulness is miniscule, like the widow’s mite, but how are we to counter the evil.

When we are lost in the current of pain, it will carry us away. It does not help to think back to familiar territory. When we are in its grip, we must find a way to gain a little steerage, to deal with the situation we are in now. We must try to find something buoyant and hang onto it. This is different from directed travel. In this position, how does one choose right or wrong effectively. How do we find balance in life. I suspect that we do not, in fact, do this, in an objective sense. Loss of choice voids some of the accomplishment we feel in exercising our agency in life.”