Memory, Pain, and the Self

Reflections Inspired by this quarter's Pain Geeks book club selection: The Making of Memory by Steven Rose

by Laura Rathbone

Super Geeks book club discussion: Monday 16th December 2024 20.30 (CET)

I love having a slow read alongside my regular journal reading and this quarter we decided to link the journal club readings with the book club and so we have spent 3-months really diving into the role of memory in chronic pain. The Making of Memory is quite a dense and foundational text on how we encode, store, and retrieve memories.

If you haven't already started, this is your cue to open this book today!

The Making of Memory

Steven Rose's The Making of Memory dives deep into how memory affects not just what we know, but who we are. One of the key themes in the book is the how memory situates us within our world and body over time.

"...memory is the glue that holds our mental life together. Without its unifying force, our consciousness would be broken into as many fragments as there are seconds in the day."

Eric R. Kandel, The Disordered Mind: What Unusual Brains Tell Us About Ourselves

Looking at it from the angle of pain therapy and neuropsychology, I'm really intrigued by how memory connects with our identity, our body's wholeness, and our sense of self.

Just like chronic pain isn't something physical, memory isn't only cognitive—it's an experience that's personal and integral to how we build our sense-of-self and feel our body in the world.

Memory and Identity: The Stories We Tell

This book is a wonderful bringing-together of our readings this quarter, and reminds us that memory is not a passive storage or filing system, but an active process. Each act of remembering is a reconstruction, weaving fragments of the past into narratives that give our lives coherence. This resonates powerfully in pain therapy, where we are working not only with the memory of events and pains over time, but also the current experience of this pain as they sit with us in the moment.

In chronic pain, the body becomes a site of struggle and memory plays a pivotal role in combining that struggle into a person's identity. A patient might say “I am broken”. This statement reflects not just the current experience but years—sometimes decades—of pain memories building upon one another. This may indicate a change in the person's sense of bodily integrity, leaving people feeling disconnected from a body they no longer trust.

But just as memory is malleable, so too is identity. Therapy provides an opportunity to reframe these narratives. By gently challenging the stories of pain and loss, we can help patients rediscover aspects of themselves that transcend their suffering.

Just like how our memories can change, who we are isn't set in stone either. Therapy gives us a chance to look at our stories from a new angle, to reframe the narrative from different perspectives.

The Body in Time: Memory and Integrity

Rose’s handling memory’s biological underpinnings highlight how closely it ties to our sense of physical self. The amygdala, hippocampus, and cortex don’t just encode external events—they also register the body’s internal states. Over time, these stored perceptions of pain and vulnerability may , in-part, lead to a distorted map of the body. One where certain areas are marked by fear, vulnerability, and/or dysfunction.

This could have profound implications for how we support people with chronic pain. It may help us to understand why someone recovering from an injury may still feel pain long after the tissues have healed. And me even help us empathise more with patients living with conditions like fibromyalgia, when they describe their bodies as alien or unfamiliar. Their memories of pain—layered with the emotions of frustration, fear, and sadness — may contribute in a causally relevant way to their internal experience of their bodies in the present moment.

“In art, as in science, reductionism does not trivialise our perception - of colour, light, and perspective - but allows us to see each of these components in a new way.”

Eric R. Kandel

Therapy, whether it's physiotherapy or other, is and has always been a space to help patients reconnect with their body-self. Practices like mindfulness, body awareness exercises, and graded movement can be a useful opportunity to slowly restore a sense of bodily integrity. By creating new, positive memories tied to the body, we can challenge the dominance of pain memories and rebuild trust in the physical self.

Memory, Pain, and Self-Knowledge

Perhaps the most profound takeaway from Rose’s book is the idea that memory is the foundation of self-knowledge. Who we are, what we believe, and how we see ourselves are all shaped by what we remember. Chronic pain often disrupts or dominates this process. It seems to pull focus, turning the narrative inward and making the pain experience central to a person's identity.

As therapists, I often think our role is to help patients expand their self-knowledge beyond pain. We have the privileged role of supporting them to reconnect with forgotten joys, strengths, and experiences that remind them (and ourselves) they are more than their suffering. Through this work, we do not erase pain memories, but we may be able to soften their edges disrupt their dominance. In doing so, the person may place them within a broader, richer context of selfhood.

Final Reflections

The Making of Memory brings us full circle in our reading this quarter. In our first two journals, we were excited about the biolgical underpinnings of memory - a phenomena that had for years been considered an abstract and un-knowable human skill. But Rose invites us to see memory as much more than a biological process. He understands memory as a force that shapes our lives, biology and identities.

In chronic pain care, this understanding is both humbling and hopeful. It reminds us that while pain can dominate a person's story for a time, the memories we make and sample can be flexible, and the sense of self can show enormous resilience and adaptability. By working with memory—through reframing, mindfulness, and compassion—we may help people rewrite their stories, rediscover their bodies, and reclaim their sense of self.