Why am I so tired? and a deeper dive into the stuckness…
This is not usually the kind of tiredness experienced after a late night or some exertion or the end of a long day.
The tiredness described by people suffering fibromyalgia is a deep, heavy fatigue that has a strong bodily presence inseparable from a lack of motivation.
I have no energy, is a common description.
Familiar?
How would you describe your feelings of tiredness?
Perhaps take a few moments and jot down some words that capture what it is like.
Notice how it feels when you focus on them.
Be aware.
There is a reason why you feel this way, and it is to do with how your body systems are managing your energy and your experience of it.
Your body systems are generating all your experiences, including pain and feeling tired
The main systems generating your experiences are your nervous system, immune system and endocrine system.
They work together as an ensemble. Like an orchestra making music.
Others are involved as well, because we are one rather than a bunch of different and separate systems.
This is why our experiences are influenced by so many factors and why focusing on one limits the possibilities for getting better.
Your body systems are generating your feelings of pain and tiredness.
These are what we now call predictions, or best guesses, to explain what is happening for you in any given moment.
They are predictions about the possible causes of the current sensory flow of information in your body, based on prior experiences (things that have happened before) and context (where you are and what you are doing). Here is a TED talk on this by Professor Anil Seth.
So, as strange as it may sound, you don’t experience the world or your body directly. Instead, you experience a version being generated in that moment.
Put another way, you experience the map, not the territory.
With some experiences, you can get stuck. For example, pain and other symptoms.
Your body systems get good at generating pain and tiredness. They look out for all the evidence to support this as an explanation, even ignoring information that says you are ok.
Now, you don’t feel all this processing of information and predictions about its causes. You feel the ever-changing bodily sensations and thoughts.
This is known as the stream of consciousness, i.e./ things just appear to you without any effort such as what you see, hear, think and feel.
Protection and survival
There is nothing more important for your body systems than to keep you alive!
This is their main role, however it maybe experienced.
This means that there need only be a small amount of evidence that there could be a threat to your integrity for you to be in a protect state, felt as pain, anxiety, or on alert.
If you have experienced a great deal of stress in your life, your systems reset themselves to expect more threat.
Even if there is none.
This uses a lot of energy and is one of the reasons for fatigue.
Your body systems expect the world to be dangerous because of prior experiences and remain on alert until you update their day to day functioning.
Many people don’t realise this and continue in this state for much of their time.
Biologically, this means inflammation that sensitises your systems and is one of the ingredients for chronic pain.
Consistent inflammation in your body systems results in a whole host of signs and symptoms, including a general malaise, feeling unwell like the flu.
Learning how to shift states, like changing gears, is a key skill.
For example, moving from a threat state to a thrive state.
You just need to know how.
Getting stuck
With pain, feeling tired, anxiety, depression and other experiences, you can get stuck.
Similar kinds of feelings over and over.
Not the same, but similar.
They can never be the same because each moment and experience is different — this is called impermanence and is a key insight.
I will talk about impermanence from Buddhism in due course. Here is a conversation about it on the Plum Village podcast.
The description of how our systems predict comes from a large body of work in neuroscience called predictive processing (PP). This is helping our understanding of how we have the experiences that we do and how we can shape them. One of the major contributors to this work is Professor Andy Clark who recently wrote The Experience Machine.
In his book, Clark mentions a British doctor who wrote an article in the British Medical Journal about her experience of chronic pain and our work together with Pain Coaching. She recently spoke on ABC radio in Australia for pain week.
Coming through the PP lens, we can understand the symptoms you describe and offer you practical ways forward. In particular, PP helps us to explain your experiences when there is nothing to see on a scan result or blood test or other investigation.
One of the common scenarios in fibromyalgia is when tests show little, yet the symptoms are real. The biomedical model does not have the explanatory power for chronic pain or persistent symptoms because it requires something observable and measurable. Pain and tiredness are neither. A different model is needed such as PP, which can explain pain and feeling tired.
Getting stuck (persistent symptoms) seems to happen when the systems are generating similar experiences and not updating. How does this happen?
Typically when first noted there is an expectation you will get better. For a number of reasons this may not happen as expected or in expected time frames.
Doing worse than expected over and over seems to be a main contributor to stuckness. This can happen because you don’t understand what is happening (stressful and cultivates fear), the timelines or expectations are unrealistic (not your fault BTW) or treatments do not work.
This points to the need to understand what is happening and the possible routes ahead as soon as possible from the outset. It is easy to follow the wrong path, especially with pain myths, inaccuracies and beliefs that anatomy explain pain.
In the light of not doing as well as expected, body systems update to the new level – “we are not getting better, so maybe this is it”.
And so on.
Stuck with tiredness
Your body systems have now pulled in the budget.
You are doing less so you don’t need so much energy…
Now you are more tired and do less. Motivation drops.
More budget cutting.
And the spiral goes on, until you create some new patterns.
Insight: what got you here won’t get you there.
In other words, the results you are getting right now are from what and how you are doing things.
If you want different results, you need some new patterns, skills…habits.
Forming new habits to get better results.
Firstly by deciding you want more energy.
You want to build my energy.
Managing and building your energy are skills.
You can’t push through and graded approaches don’t work, i.e./ week one this, week two that.
No, no, no.
Protocols do not work. Why?
Because they assume everyone is the same and at the same point.
Neither are true.
You need principles. Principles to follow so you follow your own oath and meet you own needs moving forwards.
That is personalised care, and the essence and spirit of Pain Coaching.
Meet you where you are and walk forward together until you have the knowledge, skills and know-how to continue independently and confidently.
You can get unstuck.
More in day 5.
Hope that is helpful.
See you tomorrow.
r.s.
By the way…
We released our second short film on chronic pain this week.
A conversation.
Andy, lived experience of chronic pain, and me, founder of Pain Coaching.
Check them both out here.
