# [Beneath Psychology] Chronic pain challenge part 2: the solution

In the [last post](https://www.lesswrong.com/posts/tGGPgazwd9MKJFbsa/beneath-psychology-case-study-on-chronic-pain-first-insights-1), I introduced an example where I was talking to someone suffering from chronic pain. Today we will dive into the rest of the transcript. Interspersed are annotations describing my thought process as the interaction unfolded. I cover what I did which seemed to work, and what I did that a cringe at in hindsight. Ten thousand foot overview at the bottom, for those who don't want to wade through the whole thing.

This might be a little difficult to follow, at this point. Originally, I was planning on posting this at the end of the sequence so that you would have the entire 17 posts worth of explanation to put my moves here into context and help understand where they came from and what I mean when I say jargony things like "bid for attention". You might want to revisit at the end of the sequence, and see if you pick up on more of what is going on. 

I decided to move it to move it to the front for two reasons. One is that it can help to be primed with examples of the thing to be explained so that you more easily recognize the explanation when it fits. The other is just to demonstrate that when I say things that are very counterintuitive and difficult to believe, *there's reason to believe it*. It actually works.

  
Picking up where we left off...

> other-guy: I suppose I have time now to consider what career path I want to take now and other hobbies to get into.  
> 
>   
> Jimmy: Assuming you can get your nerves and shit working again.  

  
Up to this point I have just been indulging in my curiosity. What’s going on here? What kind of hurt is he, and is his relationship to pain actually causing him problems or is it just injury that I can’t really help with?

Often, the way to help people complaining about “pain” is to understand that it’s not about the pain, and address the injury (forget the finger, look at the moon to which it points). Accept the pain’s bid for attention, give it, and watch their suffering ease as they follow). My cousin’s burn is an example of this, where people were trying to fight the pain because in *their* minds they had done everything needed to address the injury, and all I needed to do was make sure that in his mind that was true too. The generalization of this that I’ve learned is that generally it makes more sense to stfu about your theories how things work and just focus on being the best person you can be. Care about your friends and family, try to solve their real world problems, and the "psychological" follow.

I didn’t have to tell my cousin my stance that pain doesn't feel like an issue once you've listened to it, I just offered to listen with him. I didn't have to explain CBT to makeup girl and that she shouldn't take irrational feelings seriously, I just realized that her insecurity wasn't rational, and didn't take it seriously. By expecting a lack of suffering, suffering becomes surprising, and you get curious about what's causing it. By the time you walk that road to the end with them, your maps of reality have been updated together so that their expectations and reality can meet again, which is another way of saying "there's no more suffering". So usually I just do that.

This one was a little different. After getting the basics, I had mostly just run out of curiosity. I wasn't surprised that he was suffering, and I kinda felt like “I get it. And yeah, that sucks”. That's not to say that continuing down the road of examining what exactly is causing his suffering would not have worked, just that I wasn't curious so I'd have to fake it and force it. Asking questions when you aren't actually curious what the answer is, because you think you "should" because it will "help" with the psychological problem, is failing to notice the hint from reality that *this information isn't important*. This is not the way. That's what a lack of curiosity means; it isn't important to you, so far as you can tell.

Since I was out of curiosity, and still wanted to see him get relief, that must mean I think I have something to say. But what do I have to say? It's not "You've integrated this information already, and can safely move on" -- because how the heck do *I* know. And I can't switch back to "Oh, I should *ask*, because how the heck is he supposed to know? "Have you learned your lesson?" and "Have you done what you need to do?" aren't particularly productive questions because what the heck did he do wrong? Allow the doctors to treat a condition he had? That's hardly a dumb thing to do, and what are you gonna do, *not* get the treatment you need? And what the heck is he supposed to do? He *tried* going to the doctor, and it didn't work, and there isn't exactly an obvious next step that he's avoiding. So far as I could tell, the man had done everything he could see or reasonably be expected to see, and was just trying to get the pain to *shut the fuck up* for a while so he could rest. Which is completely understandable and completely reasonable.

So I can't "Just be curious, and care about his suffering" because it was too predictable. Can't "Just tell him that he's okay and did everything he needed to" because I don't know that. Can't *ask* him if he has, because I already know he thinks he has -- and for good reason. I also have a *pretty good guess* that he's wrong -- which is something it's probably important for him to know, and something I should therefore explain.

Okay, great, so it's my turn to talk. And the thing I need to convey is that he needs to actually listen to the pain and take his problem more seriously, and that he's wrong in thinking he already done that. How do you expect simply saying *that* to go?

Probably similarly to what I anticipated. It wouldn't make sense. He wouldn't believe me, because he had no place to put such concepts. He might keep the idea "I'm *supposed* to believe this", which might come out as "I believe you", but it wouldn't be a belief -- it wouldn't be what his brain thinks reality *actually is*, and therefore wouldn't be the experience his brain constructs for him. Hypnosis is all about getting pieces considered even when they don't fit, so going hypnotic is one option. In context, it would probably mean explaining that the thing I was going to tell him is going to seem *very* weird, and leaning hard on the importance of suspending disbelief -- which, to a degree I did end up doing a little.

More importantly though, why work so hard to create room for a thing that doesn't fit, which is of limited use when it doesn't fit because he wouldn't even know how to use it to navigate, when I can just *explain* and *create* a way for it to fit? That way I don't have to lean so hard on "faith in the apparently absurd" and he'd actually know what to do with it.

So that's what I aimed to do, and that's *why*, in this case, it did come out looking a lot like "explaining the framework" rather than simply "doing the framework". It just happened to be that in this case, doing the framework involved teaching the framework, because the problem that I was interested in solving wasn't "this guy is suffering" but rather "this guy doesn't know how to navigate his suffering, and is therefore stuck".

  
So here's what I said.

> Jimmy: I should give some more context about why I'm interested in what's going on with your issues there, and in particular the pain.  
> 
> Jimmy: I've spent some time studying hypnosis and what that actually tells us about our brains and how to get what we want out of them. Pain is an especially interesting topic because it is *simple*, which means that failures aren't as muddied by "complex problems are complex."  

  
Rather than simply asserting things at him without justification for why he should care or what my motives are, I'm framing it as explaining where I am coming from, so he can better understand what is interesting to me about it. I frame it this way to him because that's the frame I was operating from. That's just *what's true*, so far as I can tell.

I don't think he has to stay suffering, and I notice that he is, and I *am* curious about what it takes so that he ends up navigating out of this stuckness -- which is another way of saying I actually intend to help, if I can, and learn why I can't if I can't.

So I continue on with this explanation of where I'm coming from.

> Jimmy: Hypnosis is pretty effective for pain, but what I've found is that it's not really necessary, and the—ugh, this is getting hard to explain, gimme a sec.  
> 
> Jimmy: I'll suppose I'll start with an example. Some of my extended family and I were camping out in the mountains, and I went off to hunt for a bit. When I came back to camp, I found my little cousin sitting by the fire, holding his hand, and clearly fighting back tears.  
> 
> Jimmy: Someone told me he had been playing with a piece of rebar in the fire, charring his initials into the log benches we had on our property out there, and that he inadvertently picked up the wrong side one of the times.  
> 
> Jimmy: When I walked up to him, I didn't really know what to expect. I didn't know if he needed any medical attention or what it might be. I didn't know if he was worried that he would, or if he was going to be able to get whatever treatment it might need, or anything else.  
> 
> Jimmy: My guess, based on the situation, was that it was just that it hurts. So I walked up to him, squatted down to his level as he was sitting on the bench, looked him in the eye, and asked, "Hurts?"  
> 
> Jimmy: His eyes lit up immediately, and he replied, "Yes!" as if someone finally got it, finally saw what he was going through, only to *immediately* cut himself off and say, "Actually, no."  
> 
> Jimmy: "When my brain feels pain, it interprets it as ticklish. It just tickles."  
> 
> Jimmy: And just like that, the kid was happy and smiling, no tears in sight—just didn’t hurt.  
> 
> Jimmy: Which is a bit of a mind fuck, and people there had a hard time even noticing that he wasn't hurting anymore because how the fuck could he *not* be? Did you see his hand?  

  
I feel a little embarrassed reusing the same stories, and I will give a more direct explanation later. But it's a good one, and goes to demonstrate the extreme difference between the boring reality and the seeming impossibility (before we notice how boringly normal it is). I start here because "Pain actually isn't a problem, and *can't* be" is a super important part of my perspective that informs my curiosity and therefore must be conveyed.

It does conflict with how we normally see pain though, so I try to bridge that gap by explaining how it's actually congruent with how we normally treat pain without necessarily realizing it.

>   
> Jimmy: But we all feel pain that doesn't bother us, and the context and how we take it makes all the difference in whether it registers as a bad thing or whether we don't care or even maybe like it. Spicy food, massages that "hurt in a good way," etc.  
> 
> Jimmy: But it applies everywhere.  
> 
> Jimmy: My friend who went through natural childbirth said the pain didn’t bother her at first, but at a certain point, it got hard to bear.  
> 
> Jimmy: I asked her what that point was, and she said, "Oh... yeah, the point where complications came up and I was no longer comfortable in the knowledge that it was all going to plan."  
> 
> Jimmy: My kid cousin had the benefit of growing up with a couple of older brothers (and a lot of older cousins), so he got "beat up" a lot in a loving and playful—but *still rough*—sort of way.  
> 
> Jimmy: "When my brain feels pain, it makes it ticklish" was in reference to this rough play where it *was* tickling, and painful, and his brain had just noticed that even things that are quite painful can be safe.  
> 
> Jimmy: And when things are safe, it's okay to relax and rest and enjoy the play.  
> 
> Jimmy: His brain had made that connection in a context where "safe non-concerning pain" was essentially "tickling," hence the pain becoming "ticklish" when he noticed.  
> 
> Jimmy: The reason he hadn’t noticed earlier is that no one else there had given him space to. It was all, "Oh man, that must hurt!" "Get this kid some ice, because he *needs* it!" "When I burned myself like that, I was suffering all through the night and couldn’t sleep."  
> 
> Jimmy: This all told his brain that he was expected to be "not okay" and to suffer, that it wasn’t appropriate to laugh and smile and play in times like these, that these couldn’t be "mere tickles."  
> 
> Jimmy: What I did was *ask*, "What is the problem, exactly? Is it that it hurts?" And when asked, and given space to find the answer to be, "Nothing, I guess," his answer was, "Nothing, I guess. Pain isn’t a problem; it just tickles."  
> 
> Jimmy: Our culture can be pretty bad at helping people in pain find ways of living with it—can actually pressure people into continued and unnecessary suffering, unwittingly—and I find that really interesting.  
> 
> Jimmy: Like, what are the limits? My cousin’s hand was all blistered up, and that didn’t bother him.  

The natural childbirth example serves to illustrate that the same principles apply even in supposed "extremes", and in natural cases with someone who hasn't been "hypnotized" or had any other "intervention" tried -- just a mentally resilient woman who is preferring to face reality so that she could better mitigate actual damage to her body. I then went on to explain that a lot of what leads pain to cause suffering is anxiety over not knowing what to do about it, and that the way to not suffer is simply to listen to the pain.

I really wanted to avoid coming off like a delusional "all problems solved with one simple trick!" weirdo, so I made sure to emphasize that I actually do recognize the apparent difficulty and am not flinching away from reality here. It's an *open question* to me, which I demonstrate by sharing some of the bits which have informed my perception when facing this open question.

> Jimmy: One time I sprained my foot so bad my radiologist aunt was convinced it was broken—and that went from "so painful I can’t focus on work" to "completely and utterly non-bothersome. Like the feeling of one’s tongue in one’s mouth; only in awareness when you’re explicitly thinking about it, and unintrusively in the background otherwise."  
> 
> Jimmy: That was the big eye-opener for me when I tried a certain changework protocol to address the pain (to my wife’s credit, she’s the one that called me out and said, "You claim to be able to help people with this stuff, but you’re clearly suffering. Do something about it").  

This is the ["acknowledgement routine"](https://wikihyp.com/theory/acknowledgement-part-1-the-basic-conflict-and-the-formula/), and I put a description of what it actually entailed in this case into this footnote.[^vpnocurkl4]

> Jimmy: My friend with her childbirth fell off due to anxiety issues, but it wasn’t an issue for her before that, and she actually *wanted* the pain because it helped her know when she needed to slow down to avoid tearing.  
> 
> Jimmy: My wife’s situation with our first was similar, where pain wasn’t an issue until... I dunno, 24 hours of being in the hospital with complications, when fatigue set in and she no longer had the mental resources to contextualize the pain and hold it in what felt like the proper place.  
> 
> Jimmy: I’ve encountered some situations like those where pain drugs have become helpful and useful, and situations where pain can be overwhelming and hard to orient to—partially intentionally, partly not.  
> 
> Jimmy: But I haven’t really found a limit where pain itself is an insurmountable problem or one that can’t be addressed by disentangling the mental blocks that are preserving the discordance we call "suffering."  
> 
> Jimmy: I also haven’t had a chance to untangle *chronic* pain yet, or anything so unusual as actual nerve damage. That’s why I’m interested in what your experience with the pain is like, exactly.  
> 
> Jimmy: I want to know what that experience is like, how you’re thinking about it, what happens when you play with things on the edges, etc.  

I gave the best examples I could think of to demonstrate the limitations (and therefore my awareness of the limitations) and in doing so also validated feelings he might have of "I'm not just a little bitch, I don't know this will work, and if it doesn't that doesn't mean it's my fault" -- which I expected him to have because *I* would have them and they're very reasonable given the situation. So this serves to preserve security, by giving him a way to make sense of a potential lack of results without having to push back against me.

> Jimmy: Anyway, sorry for the barrage of text. I just felt I should explain, and I don’t know how to do so any more concisely.  

This is probably unnecessary, but I did want to err on the side of being delicate about what might be a sensitive situation, especially because 1) he seemed sensitive about overwhelming me with long stories about this stuff if I might not be interested, and 2) knowing that I'm about to turn sadist on him and need him to feel safe facing overwhelming pain without flinching. Again, mostly addressing security concerns here by conspicuously showing willingness to not threaten too much.

> Jimmy: I guess I feel like... if I try to put myself in what I imagine to be your shoes... It certainly feels *scary.* And probably overwhelming both emotionally and physically, and I imagine I’d just want it to *stop.*  
> 
> Jimmy: I could see feeling drained, and not-okay, and not really up to "playing" with the sensations that clearly aren’t a joke and aren’t the result of harmless play with big bro.  

This is "pacing", to use hypnotist lingo. This is preemptively addressing "Am I missing anything?" so that when it's time to bid for attention, he has fewer objections to voice and more assurance that if his remaining objections were important I'd have noticed them and have taken them into account.

It's also more "security" stuff, working to attenuate any perceived pressure to face feelings he doesn't want to face. I anticipated (correctly) that this might be an issue, because we're so used to being bossed around by others and ourselves about what we're "supposed to" do, and accepting it. "Here's what you need to do to fix your pain problem" is something this all easily rounds to, but is very different and wouldn't actually help.

The fact that he *doesn't* need to do anything is actually an important active ingredient. He can do whatever he wants. That's what security is. That's what play is. It's what allows you to actually look at reality and figure out what you *want* to do given the situation. If you have to follow pre-prescribed rules either way then there's no place to look at reality and decide anything differently -- but it is exactly that decision that actually provides the update that does the work here. So if I'm not going full hypnotic and saying "here are your new beliefs", then it's important that he doesn't feel *compelled* to do anything.

> Jimmy: I also really wonder what would be the resulting experience if I were to take a moment—or an hour, or a few days/weeks—to like... "recenter," I guess.  
> 
> Jimmy: Like, on the "moment" timescale, "<Deep sigh>. Fuck. I guess this is my situation," and like... tune into the feelings a little bit. Feel them intentionally and really try to get a sense of the *texture* of the experience. What it’s like to just be in that pain. And then take the next dose of drugs 30 seconds later than I might have, or whatever.  

Here's my "payload" curiosity. This is the question I *am* curious on his answer to, now that I've given the context to understand it, and potentially find a real solution -- coming from his *actual embodied beliefs* \-\- rather than reciting what he thinks the answer is [supposed to be](https://www.lesswrong.com/posts/NMoLJuDJEms7Ku9XS/guessing-the-teacher-s-password).

> Jimmy: I guess I wasn’t done rambling yet. It’s just really interesting to me. Thanks for indulging me.  
> 
> Jimmy: I guess the question I have—which I don’t expect you to *have an answer to*, to be clear, but maybe we could find one—is, "What would it take for your brain to categorize the pain as ‘just more sensations,’ no longer a sign of ‘something bad,’ because the bad has already occurred and been factored in, such that you can move on with your life to the extent possible with the current physiological damage without also being hindered by no-longer-functional warnings of something bad distracting you and getting in the way of doing what you could be doing and want to be doing?"  
> 
> Jimmy: Okay, I think I’m done now.  

More "walking on eggshells" for security until I get the green light, restating the payload question in different words to try to hit the same thing from a slightly different angle. On reread, those sentences might be a bit hard to follow. Oh well.

> other-guy: I’ve noticed something like that with my niece. When I’m watching her and she has a fall or something, I usually don’t react like "gasp, OMG." I must be evil, ’cause I’ll usually laugh, but she won’t cry.  
> 
> other-guy: When her parents are here, though, and they worry and gasp and ask if she’s okay, she cries. I wondered if it’s just ’cause she wants attention, and she knows I don’t give it easily. Like I’ll play with her and stuff, attention like that, but I don’t hold her often and stuff like that.  

Good, he recognizes the thing I'm pointing at. He may not understand all the nooks and crannies yet, but he's found the thing and has an existence proof.

> other-guy: What you’re saying makes sense. They overreact, in a sense, which triggers her brain to think it’s supposed to hurt. But since I don’t and I laugh, her brain thinks everything is okay and doesn’t feel anything. It at least doesn’t interpret it as pain.  
> 
> other-guy: I’ll have to try messing with it. My pain is like a burning pain, road rash, it’s a cutting kind of pain, it’s a pins and needles pain, it’s like every kind of pain all at the same time.  

"Try" is a red flag word. "Try" proves that they're tracking the distinction between intending to do a thing and succeeding in doing the thing, which shows they have some expectation of failure. You don't say "I'll *try* to get myself a glass of water" when you know you can do it, so he's showing here that he has reservations. This can be a passive problem in that he just doesn't get it yet, or it can be an active problem if the expectation is actually pulling him away from success.

> other-guy: I’m wondering if my brain doesn’t know how to interpret it, so it feels like everything constantly. The worst is when I shower. Heat and cold on my back sends me into orbit; showering really sucks. Interestingly, though, I hurt more after eating. Usually increases the burning feeling everywhere.  
> 
> other-guy: Walking, after 5 minutes or so, increases the deep muscle pain, almost like it’s my bones that hurt but similar to if you’re squatting and your legs burn and you’re trying to get one more rep in. Eventually, my legs give out. I literally couldn’t move my legs anymore at the store and slowly started to fall. I had to have someone grab the electrical cart, and I managed to crawl into that.  
> 
> other-guy: I went from doing 500+ pushups a day to barely being able to lift a gallon of milk overnight and lost about 40 lbs of muscle in like 3 weeks, like something was eating the muscle.  
> 
> other-guy: The pain that shoots from my shoulder to my hand, at one point I even described it as if it feels like my hand is dying. It’s really hard to explain that pain.  
> 
> other-guy: This is really interesting. I’ve sat in silence just focusing on the pain before, trying to convince myself "pain don’t hurt," like from the classic *Road House*, lol.  

Yep, there's a problem. "Trying to convince myself" is ineffective, because if you're not immediately buying what you're selling, you need to be listening to why not. "Trying" just proves to yourself that you're not worth your own trust.

> other-guy: I wouldn’t say it helped, but it really made me think about my situation and how I just need to overcome it. The day it happened, in the hospital, they gave me so many drugs they couldn’t believe I was even conscious, and the pain was still there.  

"I wouldn't say it helped" shows that he's going to lose respect (in the meaningful sense of actually valuing my perspective -- I don't think he'd be "rude" enough to confront me on it) if I don't manage to show how this is congruent with my perspective actually becoming useful to him. So I gotta keep that in mind.

I get the impression that he doesn't expect what I'm saying to be of any help, but he doesn't want to sound dismissive or unappreciative of the effort.

> other-guy: They eventually gave me ketamine, and that didn’t take the pain away, but it made me not care. I remember during it still feeling the pain but just not caring about it, so I stopped grunting and screaming for a bit and got in a nap for a few minutes until they woke me up again.  
> 
> Jimmy: Haha, doesn’t it feel like you’re trying to gaslight yourself with the "this doesn’t actually hurt"?  
> 
> Jimmy: I’m just imagining what that would be like coming from a doctor: "This doesn’t actually hurt, what you’re experiencing isn’t pain."  

This bit was a little forced. It is amusing, but a little too predictable to be as genuinely humorous as I tried to play it off as. This is an unforced error on my part. Oops.

> other-guy: That reminds me of my neighbor. One of the toughest people I’ve ever known.\[...\]
> 
> Jimmy: I’ll get back to this when I have the spare brainpower to give a worthwhile response.  

This isn't just a casual chit chat thing here. It's one thing to "do techniques" where you can rely on canned answers and "recite a script", but I'm trying to actually figure out what the truth is on many layers/objects, and therefore what is the action at each step that will bring about the best expected outcome -- so it's cognitively demanding. If you've been through similar cases many times before then you get good priors to lean on and things get easier[^c5b6h05wu7], but here it's new to me and I actually care about getting results rather than a per hour paycheck, so it takes some thought.

Specifically, I have to figure out exactly where he must be coming from to say this, what it takes to get him to where he needs to be, and what I don't know yet. And it's not a one sentence description like "he's coming from a place where he thinks X", it's an ability to put myself in his shoes and simulate his likely responses to things I could say by thinking about what *I* would say if I were in what I estimate to be his shoes.

> OCT 18    
> Jimmy: What you’re noticing with your niece is exactly what I’m talking about. When her parents gasp and worry, this shows her that this is something to worry about.  
> 
> Jimmy: When they ask if she’s okay, it suggests that she might not be. But even if they were to try to say, "It doesn’t actually hurt, you’re fine," when they’re coming from a place of being freaked out about seeing their kid hurt, they’d just be showing the kid that they can’t handle facing it, so they have to try to pretend it isn’t real.  
> 
> Jimmy: Which isn’t a super reassuring thing to see from your parents.  
> 
> Jimmy: It goes well for you because you actually aren’t freaked out by seeing her hurt. Whether you say, "Oh no, I think we need to take you to the hospital!" or "Nah, you’re fine, kid," the message that comes through is "this is actually fine" because it doesn’t look like you mean the former and it does look like you mean the latter.  
> 
> Jimmy: You’ve been there, done that, and if it were your own knees, you’d be singing the same tune because your brain *genuinely* recognizes scraped knees as something that is okay and not some big deal that needs solutions we don’t have.
> 
> Jimmy: Which is why it can be really hard to do this for yourself because you *know* what it’s like for you, making "This doesn’t hurt" an even harder sell.  
> 
> Jimmy: Whatever is happening with you doesn’t feel like "no big deal, everything is fine," and given your description of losing 40 lbs of muscle and falling over when shopping, that sounds *completely fucking reasonable*.  
> 
> Jimmy: So "Doesn’t hurt, even" is a non-starter, really. It’s gonna feel like something bad happened because it sure seems like something bad happened.  
> 
> Jimmy: This is why I generally don’t recommend trying to get to any specific outcome, and rather just explore what’s there.  
> 
> Jimmy: If you were to "overcome" this, I don’t even know what that would look like. Do you? Because I don’t think it’s "remembering to just road house it," like it was for my cousin in a much milder circumstance.  
> 
> Jimmy: And even there, I didn’t have to tell him how to feel, and neither did he; once there was space to ask the question, he just looked, and that’s what he found.

Just trying to explain that it's not about telling it's about listening

> Jimmy: I could be wrong—and feel free to disregard anything I say if it doesn’t fit—but it doesn’t seem to me that what you need is *more* encouragement to devalue the pain and push through with things. I get the impression that you do enough of that already and know what it’s like to function under healthy levels of discomfort.  

Three things going on here.

1) More caution on all levels, showing that I'm not trying to push my ideas but genuinely offer them to the extent that I think he'll find them true and useful.  
2) Validating his mental strength and willingness to put up with suffering. Often men like this are willing to put up with pain and suffering essentially as long as people expect them to, and need to be told when it's okay to stop.  
3) Pointing at the idea that he might be better off actually pushing less, and therefore listening more.

> Jimmy: I’m just curious what a solution would even look like.  
> 
> Jimmy: Last time I said I was curious, "What would it take for your brain to categorize the pain as ‘just more sensations,’ no longer a sign of ‘something bad’ because the bad has already occurred and been factored in, such that you can move on with your life to the extent possible with the current physiological damage without also being hindered by no-longer-functional warnings of something bad distracting you and getting in the way of doing what you could be doing and want to be doing."  
> 
> Jimmy: I don’t mean to suggest that the answer is "nothing" or "next to nothing." It usually isn’t. When I sprained my foot, it was "acknowledgement of my wish to not be injured, allowing in the full degree of suck that actually being injured meant, and then coming up with a plan for what to do differently next time (nothing, in that case) and what else I needed to do to take care of it this time (get an X-ray, stop running on it like an idiot, etc.).  
> 
> Jimmy: Often, it’s something along these lines, where it’s some sort of increased attention to whatever the error signal is pointing at—even if we think "we know already."  
> 
> Jimmy: Because it feels like "obviously I know I hurt my foot, what do you want," it’s easy to get misled off the track and miss why your brain is still calling for your attention in the way that it is.  
> 
> Jimmy: So the question isn’t really about what you currently think from the outside looking at the part of your brain that is generating the pain alarms, but for the part of your brain that is actually generating the alarms.  
> 
> Jimmy: If we were to speak with it, metaphorically, what would *it* say?  
> 
> Jimmy: Or another way of bracketing what I’m gesturing at, if you were to "sleep on it" and wake up with an answer, what would *that* answer be?  

> Jimmy: Because that’s the kind of place the interesting answers are going to come from. From rolling around in the back of your head until new connections are made and just kinda come out on their own, rather than attempting to reason things through from things you already know.  
> 
> Jimmy: I’m not sure if that makes any sense.  

Just trying again to accurately articulate the question I'm intending for him to face, and inviting him to tell me if I'm doing it poorly.

> OCT 19    
> other-guy: Sorry, had to read it a couple of times to understand. So with me, my niece doesn’t cry because I don’t treat her like something is wrong.  

Yes! "I had to read it a couple times to understand" is a *great* sign. It means they recognize this as a non-obvious thing that requires more extreme attention ("going into hypnosis", to an extent) to grasp, and that he expects that he might have been successful in understanding.

> other-guy: Kind of like how you can unknowingly cut yourself and not feel it until you see it or see blood.  
> 
> other-guy: In my case, legs stop moving and get weak, freaks me out, and IDK what is wrong or what’s going on.  
> 
> other-guy: If I were to talk to that part of my brain, I imagine it would just tell me something isn’t right, something is off, and that pain is its way of telling me or getting my attention.  
> 
> other-guy: Hurting more at night I think comes from relaxing and being able to think about it more, so my mind goes back to the pain rather than during the day when I have stuff to do and it’s not focused on it as much.  
> 
> other-guy: Maybe I hurt from \[redacted\] because I think, "I hope I can do this, I hope I don’t hurt much," so I’m focused on that—focused on the problem I didn’t have a solution for yet—and it triggers pain.  
> 
> other-guy: I always thought I hurt more at night because of everything I did during the day—overdoing it in a way, like a workout.  
> 
> other-guy: Perhaps I need to stay busier, stop resting so much. Maybe try to work out again, and as more days go by, the more I forget to think about it—much like a breakup, which I’m also kind of going through at the moment.  
> 
> other-guy: The breakup hurts now, but the more time that passes, the less it hurts, the less I think about her.
> 
> OCT 22    
> Jimmy: Having to read a couple of times isn’t a bad thing. What I’m trying to get to is just past the seams of perception, which necessarily makes it non-trivial to grasp.  
> 
> Jimmy: Right, if your brain doesn’t know there’s a problem, it can’t react like there’s a problem.  
> 
> Jimmy: And yeah, your legs not moving seems like a problem, and that shit’s freaky.  
> 
> Jimmy: Something isn’t right. Something is off. The pain is telling you and begging you to attend to this.  
> 
> Jimmy: I know what you mean about things hurting more at night—both physically and emotionally. At night there’s no more distractions; just you and your thoughts and your feelings.  
> 
> Jimmy: You could try to keep busy and keep yourself distracted. I know a guy who does basically that. Drinks a lot, falls asleep with the TV on every night. Trying to get away from the quiet where problems are laid bare.  
> 
> Jimmy: There are even some techniques for PTSD (e.g., EMDR) that seem to rely on distraction to keep things bearable enough to proceed with the technique.  

Basically confirming his understanding, and preemptively "Am I missing anything?" on the "distraction" bit so that I can highlight an alternative.

> Jimmy: The thing I’m trying to point at is that you don’t necessarily have to get away from it.  
> 
> Jimmy: Sometimes—well, I think people often miss the fact that pain isn’t a bad thing. It’s a sign of bad things, yes. And it can be overwhelming to be blasted in the face with the firehose of bad news.  
> 
> Jimmy: But there’s also this place where it’s like... okay, yeah, it hurts. A lot, lol. And yet there’s room to be at peace *simultaneously.* 
> 
> Jimmy: Like... I wish it weren’t that my body is all fucked up. *Of course* I wish it weren’t that my body is all fucked up. And here I am, with my body all fucked up. *Of course* it hurts.  
> 
> Jimmy: I’m still figuring out what to do with it all. Still all the pain, almost like when you were on the ketamine and "didn’t care," only instead of "I don’t care," the weight of the caring is still there. It’s just "I know."  
> 
> Jimmy: There’s no "other side" against which the pain can pull you apart, because you wish you weren’t all kinds of fucked up *and* you’re feeling out what’s there. Sorta "surrendering to the pain" so that you can explore it, if you will.  

This is another important "payload", this time pointing at a truth rather than a question: "Pain isn't a bad thing". After delivering the suggestion I go on to build more context to help make sense of it so that it's something he knows how to respond to it an also how to hold onto it.

> Jimmy: I don’t know if that’s a place you’re ready to approach, nor do I suggest that you should push yourself to if you’re not. There are reasons we flinch away from such things.  

I don't know for sure he's ready to accept this suggestion, so I'm explicitly giving him the choice. Furthermore, since I anticipate that this might be one of those decisions like "just don't be afraid" that feels outside of our control due to poor representation of our reasons to choose one of the potential options, I'm going out of my way to explain why maybe he *should* take the option that seems obviously wrong. This preserves the ability to weigh the pros and make a reflectively endorsed decision.

> Jimmy: If someone is picking on you, calling you fat, for example, it really takes the wind out of their sails to respond, "I know."  
> 
> Jimmy: It’s hard to keep making fun of someone who just keeps agreeing with you, like, "Haha, yeah, I’m pretty big. They even gave me my own zip code."  
> 
> Jimmy: The cost is that it means affirming the perspective that you’re a fat kid and it’s okay to make fun of you.  
> 
> Jimmy: And if you affirm that unthinkingly, now you’ve taken on the identity as "the fat kid" and have established a precedent of not pushing back.  
> 
> Jimmy: Until you know how and when to reverse these decisions, it can make a lot of sense to refuse the labels, even if they have some truth.  
> 
> Jimmy: It can be easy to miss that the possibility is *there,* though, and I’m wondering if that might be why you’re seeming stuck.  
> 
> Jimmy: Does it feel more like "It’s just an overwhelming pile of emotions, and I’m not ready to deal with them all" or more like "I didn’t realize there was an option, and I don’t entirely see what the options even are"?  
> 
> Jimmy: I’m sorry to hear you’re going through a breakup too. That shit sucks.  

Basically explaining the costs of acting secure without excess clarity, so that he can feel secure choosing insecurity rather than closing his eyes to that facet of reality and fighting against his own reasonable desires.

> other-guy: The ketamine and "calling you fat" are great examples. It makes more sense that way.  
> 
> other-guy: For me, it’s like the latter: "I didn’t realize there was an option, and I didn’t entirely see what the options even are."  
> 
> other-guy: The pain sucks and is constant, and I think I’ve accepted this new me, and this is my life now. Well, maybe 75% accepted it.  
> 
> other-guy: The pain really just makes me mad and I haven’t found a way to release that emotion, I guess, and always try to distract myself with TV or YT or \[redacted\] or whatever.  
> 
> other-guy: Before I was even on anything for my RA, I could still work at the time, but the RA pain was pretty bad. To deal with that pain, I started drinking after work, then drinking more, then drinking before work, and it turned into a problem. But it was the only thing that helped the pain.  
> 
> other-guy: Everyone thought I became an alcoholic, trying to get me help and didn’t believe me that I’m not—it’s just pain.  
> 
> other-guy: I finally saw a doctor that gave me some meds and a steroid shot, and two days later, I stopped drinking because it didn’t hurt so bad anymore.  
> 
> other-guy: I can deal with pain usually, but when it hits a certain level and becomes constant, that’s when I get mad and frustrated.  
> 
> other-guy: The breakup kind of sucks—\[>decade long\] relationship gone. No attractive girl will want a cripple with no job, lol.  
> 
> other-guy: Thank you so much! I can’t tell you how much I appreciate you.
> 
> OCT 24    
> Jimmy: "For me it’s like the latter: "I didn’t realize there was an option, and I didn’t entirely see what the options even are.""  
> 
> Jimmy: Great. I thought that might be the answer. Now we can have some fun. I can be kinda a sadistic shit and enjoy talking people into pain ;)  

This is what I expected. It might not be 100% true and missing here derails everything, so it's worth making explicit. Also, here's where I feel confident enough that I can push him into the experience of pain and that if I overstep it will be recoverable because it will make sense to him in context.

> Jimmy: Sounds like you’re not too happy with your new identity as "fat kid," and are kinda pissed at life for pushing you to accept it.  
> 
> Jimmy: I’m gonna go out on a limb and predict that the reason you’re pissed and haven’t fully accepted it is that "accepting it" kinda feels like "accepting your fate."  
> 
> Jimmy: You don’t want *the rest* of your life to be this way. The time you already spent messed up is fine. Spending a few more years recovering is *fine*. Shitty, yes, but fine.  
> 
> Jimmy: It’s the idea that it’s over, and all you got to look forward to is being a cripple in pain *forever* that pisses you off, and which you don’t want to accept.  
> 
> Jimmy: Am I wrong?  
> 
> Jimmy: Because if that’s the case, then yeah, *fuck that*. I wouldn’t accept that shit either, and being pissed off sounds like approximately the right reaction.  
> 
> Jimmy: It’s not time to accept that which hasn’t been determined.  

Okay, I think this is the important piece. This is the piece of truth that he could sense but hadn't integrated which would have been lost "just accepting" the pain and feeling okay without doing something with the message. This is why he pushed back, rather than "just" treating pain like any other information. To him, the pain seemed to be saying "Your life is over. You're a cripple now", so if he says "okay", then it's "Okay, I'm a cripple", an expectation of being a cripple, and therefore no ability to work towards *not* being a cripple. At least, not with his heart in it.

This is also what would be lost if we had decided to "use hypnosis" to "not feel so much pain" -- or any other technique[^bwyxt2zdkbe] with that same Goodharted goal. It's a pretty significant thing to lose, which is one of the reasons I don't advocate for trying to use hypnosis, and is why I'm fairly opposed to "using technique" in general. It risks putting the cart in front of the horse.

> Jimmy: I’m actually pretty optimistic. Enough to be legitimately excited to see how things might change for you.  

This was (is!) genuine excitement. Positivity is great, so long as it's actually justified and not inadvertently teaching that you aren't optimistic enough to look at reality. The amusing bit about this optimism is that it can coexist with remarkably low expectations.

> Jimmy: Again, correct me if I’m wrong, but it seems like you’re at quite the low and not even hung up on the fact that you got there but just want to get shit better.  
> 
> Jimmy: And the cool thing about that is that even situations like "in serious pain only half the day" start to sound exciting. Having twenty pounds less muscle than you used to starts to be a motivating picture.  
> 
> Jimmy: I don’t know what kind of recovery is possible, but I poked around a bit on the first page of Google Scholar results for "hypnosis rheumatoid arthritis" and found \[this\](https://sci-hub.se/https://www.tandfonline.com/doi/abs/10.1080/00029157.1975.10403784). There were a few studies showing improvement too.  
> 
> Jimmy: I don’t even know where to begin looking for stuff on the nerve damage from the infusion, but the fact that you’re feeling so much and describe it as "feels like everything" / "my brain doesn’t seem to know what to feel" makes me wonder what would happen if you were to go into the pain and begin to embrace the sensations as separate from thoughts of future limitations.  
> 
> Jimmy: I obviously don’t know what would happen, but I wouldn’t be surprised by either a shift in perception or nerves actually finding their connections and healing. From what I understand about the place you find yourself, it seems like it would be exciting to find out.  

To be clear, this is a declaration of maximum entropy priors. I have no idea what would happen and make zero claims. I've just been surprised enough times by weird physiological changes that I stopped expecting impossibility without evidence.

> Jimmy: \[Breakup stuff\] is the only thing that tempers my excitement to push you towards the pain and "finding out."  
> 
> Jimmy: You’re going through a lot. This is a lot for *anyone*, even without the loss of a long-term relationship.  
> 
> Jimmy: I could certainly see needing some time to process that kind of thing.  

Just guarding against pressuring him into things he's not ready for again. Especially since I am excited about how it could go, and he probably doesn't want to disappoint me after I've put in work trying to help him. But it's not about me, so *my* excitement isn't a valid driver, and I'm trying to make sure that if he pushes himself it's because *he* is excited about the potential pay off.

And that's it. That's the intervention that did the work.

> OCT 25    
> other-guy: You are 100% right about it all. I’m pissed off, mostly because it’s not my fault. If I was speeding and crashed, I could accept it easier because that was my fault.  
> 
> other-guy: It’s interesting though. I spent the other night only focused on the pain, like you said "as if I could talk to it," and it was weird.  
> 
> other-guy: Like I told it, "I know something is wrong, it’s okay, I’m fixing it, I’m working on it," and the last two days, I haven’t needed the pain meds as much.  
> 
> other-guy: I even did a couple of pushups today. That increased the pain a bit, but I didn’t mind it because I actually did some pushups finally.  
> 
> other-guy: It’s like I understood the pain and accepted its presence, as if we’re both sharing this body, and we have to learn to get along for now.  
> 
> other-guy: I know that’s really weird. It wasn’t easy, it took maybe two hours of me focusing on it, and it’s not a huge improvement by any means, but it is to me because I feel a little more free, a little less stuck.  
> 
> Jimmy: Hey, when was the last time you increased your pushup count that much in 2 hours of work?  
> 
> Jimmy: Sounds like a worthwhile pay rate to me.  
> 
> Jimmy: As to it sounding weird, you have no idea.  

Which interestingly enough, he didn't immediately find very helpful. However, later here's how he spoke of the difference:

> Jimmy: Still taking the pain drugs?  
> 
> other-guy: Not nearly as much. I still take the Norco, but the crazy strong stuff is at most once a day right now instead of 3x a day.  
> 
> Jimmy: Has it leveled off or still improving?  
> 
> other-guy: It’s leveled off. Hasn’t gotten better since the night I spent 2 hours. I’m just happy it’s not been so miserable.  
> 
> Jimmy: Ah, that’s good. Do you think that if you were to spend 2 more hours, you’d improve further?  
> 
> Jimmy: In other words, is it that you feel like you’re up against a wall on that front, or just that your motivation is elsewhere at the moment?  
> 
> other-guy: It might. I’ve tried once and fell asleep lol. I haven’t tried more mostly because I already feel more free and just been enjoying that, but I do need to try again.  
> 
> Jimmy: Haha, okay, good. Just want to make sure you aren’t stuck.  
> 
> Jimmy: No need to rush these things. If you’re enjoying only being in as much pain as you are, then enjoy it for as long as you need to.  
> 
> Jimmy: Kinda funny how these things work.  
> 
> Jimmy: I gotta admit I’m cracking up thinking about "I still take the Norco \[and\] the crazy strong stuff \[up to\] once a day" being *relief*, but I totally get it.  

Okay, this one I was genuinely cracking up about. It still makes me smile to think about.

> other-guy: Haha, right?? Like there’s still a bit of pain, but it’s a huge relief compared to what it was.  
> 
> other-guy: Tonight or tomorrow night, I’m gonna try again. Spending another 2 hrs if I need to.  
> 
> \[...\]
> 
> other-guy: Hey, my friend. Just a quick update. Still working out a little without pushing it. I tried another 2-hour thing and didn’t really get better, but I still feel light-years ahead of where I was last month.  

> Jimmy: Cool.  
> 
> Jimmy: I looked back over the chat, and the one thing I noticed is that there seems to be an inconsistency between how you describe things now and how you did right after the first 2 hours you put into it.  
> 
> Jimmy: "It wasn’t easy, it took maybe 2 hours of me focusing on it, and it’s not a huge improvement by any means" vs "Like there’s still a bit of pain, but it’s a huge relief compared to what it was," and now "light-years ahead."  
> 
> Jimmy: Which is interesting in contrast to "It’s leveled off. Hasn’t gotten better since the night I spent 2 hours."  
> 
> Jimmy: Do the "not a huge improvement" words feel foreign now? Or do you have a good feel for why you were describing it in a way that seems different then despite also describing it as "hasn’t gotten better"?  
> 
> Jimmy: (This stuff can be weird. I think I mentioned how confused I was when I injured my foot and couldn’t figure out when it got better or how it did because it also felt the same.)  
> 
> other-guy: I think before spending the 2 hours, the pain was so intense. When it got better but still with some pain, I didn’t realize how much better at the time.  
> 
> other-guy: Maybe I’m just reflecting, looking back at doing very little to small workouts every day. It felt like it was going to take forever to get to this point, and it almost happened overnight.  
> 
> Jimmy: So you’re saying that you think it did get better right away and level off, and it just took you a while to recognize how big the improvement was?  
> 
> other-guy: Yeah, I’ve been trying to not push it but trying to do more and more and still not hurt like hell is showing me how much better it actually got.  
> 
> Jimmy: Is it a delayed thing, where if you do too many pushups you’re feeling it later more than during the pushups?  
> 
> Jimmy: And is it still a weird hard-to-understand "feels like everything" sort of pain? Or something more understandable?  
> 
> other-guy: Mostly. If I do too many pushups, I start to feel it within a half hour or so.  
> 
> other-guy: Otherwise, pain is barely noticeable while I’m active. Hurts more when I start to rest, but it’s bearable.  
> 
> other-guy: When it hurts, it is still more like "feels like everything."  
> 
> other-guy: My apologies, man. I just looked back at the messages earlier and just barely understood the envelope part. Thank you again and again. I can’t begin to tell you how much I appreciate everything, especially helping the pain.  
> 
> other-guy: You helped more with a couple messages than doctors have in over a year.

  
After a bit more chatting,

> other-guy: I honestly thought I had at least 2 more years of this before I could be at this stage. This level of improvement already is amazing. Thank you.

Interestingly, that intervention proved to be quite helpful to him despite not feeling like much at first. It reminds me of my own realization with the hurt foot, just on a larger scale. It can be weird to feel the same pain, and also really not want it to be there at time and be motivated to do something about it, and also not be suffering in the same way. We're not used to having to treat pain/suffering/meta-suffering as distinct things, so it takes some time to figure out what's going on.

He still doesn't have perfect solutions to everything, but it actually doesn't make sense to solve everything perfectly, and at some point you gotta go live your life. This is where we left it. If he wants a better solution I can help him find it, and he's just happy to have the solution he has in the meantime. My ego would definitely prefer a more complete solution, but also that's not a good reason, and trying to act on such things isn't a thing that leads to good results in the most meaningful sense.

  
**10,000 foot overview**
---------------------------

The way it looked to me is like this:

He didn't know that this kind of suffering could be resolved, so he didn't know that he had something to figure out. So of course he didn't put much work into figuring it out. If he understood this, he'd be motivated to figure out how.

He didn't understand the structure of this suffering, so he didn't know where to look for a resolution. If he understood that the place to look is where the pain is pointing, he'd be motivated to look.

I didn't know if that motivation would be enough on its own, or if his object-level reason for not looking was going to need addressing, but once he had that motivation any obstacle that needed addressing would become more clear because it'd be in the open.

This all turned out to be more or less correct, which is why it worked out the way it did. It did turn out that there were important reasons for him to not simply yield to the pain, which wasn't surprising and was factored in to the approach I took. In hindsight, I feel like I probably should have seen those reasons coming, but hey, what're ya gonna do.

My first response did hit the nail on the head, and in response he explicitly told me that it's why he can't accept it. I immediately pivoted to giving attention to the reasons he couldn't accept it, obsoleting part of the reason he couldn't accept it. I just didn't see the rest of it clearly enough to continue this approach until the whole thing to dissolved without intentional work towards dissolving.

In both this case and the case of my kid cousin with the fire poker, the suffering was resolved with a clear picture of what was going on. With my cousin, all he had to notice is that there was actually no problem.

Chronic pain guy had more things to notice:  
"Suffering can be resolved by working through what's going on" -> "This probably means listening to the pain" -> "There are actually good reasons to not listen to the pain" -> "His particular reason is that he thought listening to the pain means accepting that he's crippled forever" -> "He doesn't actually have to accept that in order to listen to the pain".

Once he saw that, there was no longer anything blocking the default path of attending to information that was important to him.

UPDATE: I talked to him some more in September 2025, so just under year later:  
 

> I've cut way back on the pain meds, I really only take them for these intense migraines I started to have like once a week. Usually not for the regular pain though. 

  
 

[^vpnocurkl4]: In that case, the chain of wishes/explanations went like this "I wish it wasn't that it hurts" (this one felt like "just words"), "It hurts because I broke my foot", "I wish it wasn't that I broke my foot" (this one felt meaningful, which immediately stood out as interesting. "Do I not actually care about the pain!?"), "I broke my foot because I was playing football and shit happens". At that point, the "do you wish it weren't that <cause>?" was no longer "yes". I don't wish that I didn't play football. I like playing and having fun with my family, and a broken foot is a fine price to play for all the physical play of this nature I have done. So no, I do not wish I didn't play football. Similarly, I did not wish that shit didn't happen. That felt like too ridiculous a thing to wish for.So of course shit happens, and of course I played football. So of course I broke my foot. And of course it hurts. What do you want? Nothing? I still feel the pain. But I don't wish I didn't? It just feels okay now? Somehow? Weird. 

[^c5b6h05wu7]: This is one way of conceptualizing "technique"; technique is the prior belief that these responses will be appropriate. 

[^bwyxt2zdkbe]: This is also what is lost when you rely on pain killers.