I think people do not respect psychosomatic symptoms and that setting an intention and showing your body “we can do it” can address psychosomatic symptoms. This was part of me recovering from depression. Sometimes there will be other reasons you are sick, or sometimes that will not address your real need driving the psychosomatic symptoms.
The fact that some physical symptoms are psychological in origin doesn’t make them fake or less important. They just need to be treated in different way, often by treating the whole person, changing intolerable life circumstances, or by conquering a fear.
Great essay, and I hope you continue to feel better!
Reminds me a lot of similar things people report with back pain. The phenomenon of “central sensitization” involves becoming heightened to all sorts of minor signals from your nervous system, which can keep the pain cycle going; in contrast, sometimes resolutely deciding to do stuff (not necessarily “pushing through” pain, but also not being overly protective) can help symptoms. I resonated a lot with your description of constantly monitoring health symptoms, etc There’s so much we don’t understand about chronic issues.
Thank you for this kind and thoughtful comment. I am mulling your note on "pushing through," as I've been already trying to understand what language best describes the approach I've been taking. I do find the "pushing through" concept to be motivating to me and to accurately describe my experience, but perhaps it's worth qualifying what that has looked like for me - specifically that the challenging aspects of the experience (pain/fatigue/fear) tend to yield throughout the activity, as opposed to worsening. More to think about as I'm planning another post where I'll write more about the tack I've taken through this recovery process and hope to communicate this aspect well.
Completely unrelated but I've been interested in learning more about what's going on in academic cognitive science / AI research, and your recent blog posts look very interesting! I subscribed and look forward to reading.
I’m really glad this worked for you. The painful truth of complex diseases and the internet is that everything worked for somebody, nothing works for everybody, and most things you read about probably won’t work for you. The other painful thing is that every story that reads as “how I overcame my disease through willpower” is unfortunately victim-blaming if it’s presented as something that will work. So while I’m glad you shared your story, I’m also sad because there are 100% people who are suffering now who will read this and take it as proof that they’re only sick because they’re doing something wrong.
And people who know them will take it as a sign that they’re not trying hard enough. My most recent post is about this! Beautiful story as long as people understand it’s not 👏 universal 👏
Argh this freaks me out! The whole area is so complex and mysterious so who knows why an approach for this might work for some and be properly dangerous for others but I wonder if your history as a physically active person may be a big reason why you had the positive response. I have read research saying the fatigue of long covid and ME/CFS at least is not deconditioning, and so your previous capacities remain waiting for you if you can find your way out of the fatigue. But also, who as a layperson can know what meaningful differences there are between the different fatigue disorders. I read your thing and make a hugely hopeful 😦 face, but then also feel it would be too dangerous to try in my case. (ME/CFS, started maybe 5-10 years ago, no history of intensives physical activity.) I leave this comment partly in case anyone else with a fatigue disorder reads this and has a similar reaction. And I say this as someone who started out with chronic pain and found HUGE help from learning about/working with central sensitisation, then spent ages theorising that fatigue disorders may operate similarly, but I couldn’t find almost any science in support. Absolutely thrilled for you that it has worked, equally thrilled how carefully and with how much good faith you articulated your account.
Here's an extra n=1: I read your article one week ago, in a coffee shop. Inspired by it, I marched home (walking with a backpack at full speed), for about 1 hour and 20 minutes. No issues, felt good. Next day, I lifted weights, for an hour, which I haven't done in one year. And so on. One week later, still feeling good.
Previously, I had PEM, fatigue and brain fog, for about 1.5 years. I initially had other symptoms, but those went away eventually and I was left with these three.
Yes!!! I am so stoked to hear this! I hope you continue feeling better and better, and would be happy to hear any updates as time goes on.
FWIW: it's now three weeks out for me and things keep improving - still feeling good, ramping up exercise, and the lingering fears I mentioned at the end of the essay are basically no longer part of my experience.
By the way, I found an interesting (preprint) paper about how our bodies might be going from “energy” at mitochondria level to "energy” (or fatigue) at body level: https://osf.io/preprints/osf/ekj54_v3 via @Martin Picard
Thanks for this perspective. I have chronic migraines and noticed a couple years ago that I could improve my symptoms with intensive exercise. If I get the timing right, I can hold a migraine off completely. Yours is the first discussion I have seen about this type of approach to chronic pain and fatigue. I love your data collection as well, good luck to you.
Fascinating! I’m currently on month 3 of some complicated post-viral immunological weirdness and it’s encouraging to read stories like yours even if I’m not at a point where I know whether it’s safe/healthy for me to go run these days. I hope I can get to the point where I can knock out a 10k again. I miss it.
From one recovering outdoorsy person to another, thank you.
I had meningitis at the start of the year and everyone has been acting like I'm absolutely nuts for trying to reintroduce exercise to my routine. While our recoveries and symptoms look different, my experiences with fatigue is similar. When I'm doing not much, it's a landslide. But if I get myself up and go out, ignoring how the first 10 minutes feel, it's almost always better.
This bit especially is what I've been trying to explain to people:
"The plan is to keep at it.
As long as my symptoms do not exceed what I experienced this week I will proceed to treat them with “aggressive contempt,” as Chapman put it. I will continue the current exercise routine, and if that keeps working I will expand it until I’ve reached my ideal pre-fatigue cadence, with respect to the gradual approach required to recondition muscles (especially in weightlifting)."
I hope we both get good access to our bodies back.
🙏 great to read your comment and to hear that you are feeling better after the first ten minutes of exercise. It can definitely be hard to explain such complex situations to people. Maybe that’s part of the benefit of writing a post like this :) When people ask I just say “here’s the post explaining everything” haha.
This was so validating and encouraging thank you! Part of my management has been putting myself on 3 week “focused/hard” sprints of biking, focused mobility/yoga work, strength training and then on the 4th week just doing less intensity but keeping the same activities. I then repeat this. I can mostly maintain without crashing or feeling really sick AS LONG as I can keep other life stresses in check. It’s been really important to me to orient my available energy around the activities I want to do, rather than using all my energy for work or other people. I’m so stoked for you to keep feeling good by sticking to keeping yourself moving 💜💜💜
Hi Di, glad you found this encouraging, and thanks for sharing about your sprint/rest cycles! That seems like a reasonable approach to me, something I might incorporate into my own life too. It does seem that rest on both large and small time scales can be very helpful, and glad to hear that's working for you.
> It’s been really important to me to orient my available energy around the activities I want to do, rather than using all my energy for work or other people.
A good note too. Since my physical activity stuff has been going well I'm now ramping up other work-related responsibilities. That's all pretty new, so I hope to approach that in a gradual way too if possible.
"It’s hard to describe. My felt experience of making health-related decisions is one of deep, complex uncertainty. As if I am dealing with a tangled ball of thoughts and feelings that spans multiple miles, so large that I cannot bring it into view and cannot think straight about it. The main component of the ball is fear, which suffuses everything."
Damn, this hit me. Can 1000% relate with all the health stuff ive been dealing with this past year and it's really hard to put into words. This nervous system stuff is really no joke!! Stoked to hear you're slaying the demon and very excited to hear how progress goes
I very much appreciated the parts like "ended up walking a fair amount". This is fitness content I can relate to!
I don't think I've had exactly the kind of post-viral fatigue you're talking about, but I definitely find that doing exercise helps to shift a head cold better than just resting through it.
Clicked for the arboretum waterfront trail, stayed for the pink send. Which SBP??? I don't have chronic pain and would rather die than run six miles so respect
I think people do not respect psychosomatic symptoms and that setting an intention and showing your body “we can do it” can address psychosomatic symptoms. This was part of me recovering from depression. Sometimes there will be other reasons you are sick, or sometimes that will not address your real need driving the psychosomatic symptoms.
The fact that some physical symptoms are psychological in origin doesn’t make them fake or less important. They just need to be treated in different way, often by treating the whole person, changing intolerable life circumstances, or by conquering a fear.
Great essay, and I hope you continue to feel better!
Reminds me a lot of similar things people report with back pain. The phenomenon of “central sensitization” involves becoming heightened to all sorts of minor signals from your nervous system, which can keep the pain cycle going; in contrast, sometimes resolutely deciding to do stuff (not necessarily “pushing through” pain, but also not being overly protective) can help symptoms. I resonated a lot with your description of constantly monitoring health symptoms, etc There’s so much we don’t understand about chronic issues.
Thank you for this kind and thoughtful comment. I am mulling your note on "pushing through," as I've been already trying to understand what language best describes the approach I've been taking. I do find the "pushing through" concept to be motivating to me and to accurately describe my experience, but perhaps it's worth qualifying what that has looked like for me - specifically that the challenging aspects of the experience (pain/fatigue/fear) tend to yield throughout the activity, as opposed to worsening. More to think about as I'm planning another post where I'll write more about the tack I've taken through this recovery process and hope to communicate this aspect well.
Completely unrelated but I've been interested in learning more about what's going on in academic cognitive science / AI research, and your recent blog posts look very interesting! I subscribed and look forward to reading.
I’m really glad this worked for you. The painful truth of complex diseases and the internet is that everything worked for somebody, nothing works for everybody, and most things you read about probably won’t work for you. The other painful thing is that every story that reads as “how I overcame my disease through willpower” is unfortunately victim-blaming if it’s presented as something that will work. So while I’m glad you shared your story, I’m also sad because there are 100% people who are suffering now who will read this and take it as proof that they’re only sick because they’re doing something wrong.
And people who know them will take it as a sign that they’re not trying hard enough. My most recent post is about this! Beautiful story as long as people understand it’s not 👏 universal 👏
Argh this freaks me out! The whole area is so complex and mysterious so who knows why an approach for this might work for some and be properly dangerous for others but I wonder if your history as a physically active person may be a big reason why you had the positive response. I have read research saying the fatigue of long covid and ME/CFS at least is not deconditioning, and so your previous capacities remain waiting for you if you can find your way out of the fatigue. But also, who as a layperson can know what meaningful differences there are between the different fatigue disorders. I read your thing and make a hugely hopeful 😦 face, but then also feel it would be too dangerous to try in my case. (ME/CFS, started maybe 5-10 years ago, no history of intensives physical activity.) I leave this comment partly in case anyone else with a fatigue disorder reads this and has a similar reaction. And I say this as someone who started out with chronic pain and found HUGE help from learning about/working with central sensitisation, then spent ages theorising that fatigue disorders may operate similarly, but I couldn’t find almost any science in support. Absolutely thrilled for you that it has worked, equally thrilled how carefully and with how much good faith you articulated your account.
Here's an extra n=1: I read your article one week ago, in a coffee shop. Inspired by it, I marched home (walking with a backpack at full speed), for about 1 hour and 20 minutes. No issues, felt good. Next day, I lifted weights, for an hour, which I haven't done in one year. And so on. One week later, still feeling good.
Previously, I had PEM, fatigue and brain fog, for about 1.5 years. I initially had other symptoms, but those went away eventually and I was left with these three.
So thank you for the inspiration!
Yes!!! I am so stoked to hear this! I hope you continue feeling better and better, and would be happy to hear any updates as time goes on.
FWIW: it's now three weeks out for me and things keep improving - still feeling good, ramping up exercise, and the lingering fears I mentioned at the end of the essay are basically no longer part of my experience.
By the way, I found an interesting (preprint) paper about how our bodies might be going from “energy” at mitochondria level to "energy” (or fatigue) at body level: https://osf.io/preprints/osf/ekj54_v3 via @Martin Picard
Final paper coming soon
Thanks Roland for the pointer. I read the abstract, may read more soon and excited to see the final paper when it's out.
This is similar to how my dad recovered from his experience with long covid. Thanks for sharing!
Thanks for this perspective. I have chronic migraines and noticed a couple years ago that I could improve my symptoms with intensive exercise. If I get the timing right, I can hold a migraine off completely. Yours is the first discussion I have seen about this type of approach to chronic pain and fatigue. I love your data collection as well, good luck to you.
Fascinating! I’m currently on month 3 of some complicated post-viral immunological weirdness and it’s encouraging to read stories like yours even if I’m not at a point where I know whether it’s safe/healthy for me to go run these days. I hope I can get to the point where I can knock out a 10k again. I miss it.
Thanks for the comment, good luck with your recovery!
Glad you got out to run the Arboretum. Seward is another great loop
From one recovering outdoorsy person to another, thank you.
I had meningitis at the start of the year and everyone has been acting like I'm absolutely nuts for trying to reintroduce exercise to my routine. While our recoveries and symptoms look different, my experiences with fatigue is similar. When I'm doing not much, it's a landslide. But if I get myself up and go out, ignoring how the first 10 minutes feel, it's almost always better.
This bit especially is what I've been trying to explain to people:
"The plan is to keep at it.
As long as my symptoms do not exceed what I experienced this week I will proceed to treat them with “aggressive contempt,” as Chapman put it. I will continue the current exercise routine, and if that keeps working I will expand it until I’ve reached my ideal pre-fatigue cadence, with respect to the gradual approach required to recondition muscles (especially in weightlifting)."
I hope we both get good access to our bodies back.
🙏 great to read your comment and to hear that you are feeling better after the first ten minutes of exercise. It can definitely be hard to explain such complex situations to people. Maybe that’s part of the benefit of writing a post like this :) When people ask I just say “here’s the post explaining everything” haha.
This was so validating and encouraging thank you! Part of my management has been putting myself on 3 week “focused/hard” sprints of biking, focused mobility/yoga work, strength training and then on the 4th week just doing less intensity but keeping the same activities. I then repeat this. I can mostly maintain without crashing or feeling really sick AS LONG as I can keep other life stresses in check. It’s been really important to me to orient my available energy around the activities I want to do, rather than using all my energy for work or other people. I’m so stoked for you to keep feeling good by sticking to keeping yourself moving 💜💜💜
Hi Di, glad you found this encouraging, and thanks for sharing about your sprint/rest cycles! That seems like a reasonable approach to me, something I might incorporate into my own life too. It does seem that rest on both large and small time scales can be very helpful, and glad to hear that's working for you.
> It’s been really important to me to orient my available energy around the activities I want to do, rather than using all my energy for work or other people.
A good note too. Since my physical activity stuff has been going well I'm now ramping up other work-related responsibilities. That's all pretty new, so I hope to approach that in a gradual way too if possible.
"It’s hard to describe. My felt experience of making health-related decisions is one of deep, complex uncertainty. As if I am dealing with a tangled ball of thoughts and feelings that spans multiple miles, so large that I cannot bring it into view and cannot think straight about it. The main component of the ball is fear, which suffuses everything."
Damn, this hit me. Can 1000% relate with all the health stuff ive been dealing with this past year and it's really hard to put into words. This nervous system stuff is really no joke!! Stoked to hear you're slaying the demon and very excited to hear how progress goes
I very much appreciated the parts like "ended up walking a fair amount". This is fitness content I can relate to!
I don't think I've had exactly the kind of post-viral fatigue you're talking about, but I definitely find that doing exercise helps to shift a head cold better than just resting through it.
Clicked for the arboretum waterfront trail, stayed for the pink send. Which SBP??? I don't have chronic pain and would rather die than run six miles so respect
SBP Poplar! Here's the location if you wanna try it :) https://imgur.com/a/etfbhC2
This is an amazing story! Thank you for writing about your experience and congrats on pushing through
Thank you Maia!
Wow bravo, thanks for sharing. What a way to capture the fear spirals associated with deciding when to do more exercise. I relate personally