Professor Denny Borsboom, University of Amsterdam, and others, have proposed a network theory of mental illness based on a network which is a small departure from the traditional ideas about the relationship between a group of symptoms and its underlying disorder.
So the conventional idea of mental illness is that symptoms appear due to the disease and therefore we ultimately need to treat the disease. For example, if you have an infection, this might cause fever, pain and fatigue. However, it would NOT be a good idea to tackle this infection to just take ibuprofen and caffeine. Yes, it would eliminate some of the symptoms, but the underlying cause or problem still remains.
The conventional model, according to Borsboom, is a problem when there are complex conditions that have multiple causes. An example is depression and anxiety. They are usually always linked to a variety of other negative symptoms including fatigue, insomnia, pain and addiction. However, when all these symptoms group together, what exactly is the underlying disorder?
Let’s take anxiety, for example, which can make you avoid social interactions that lead to loneliness which can cause depression, which can make you drink and that makes it harder to do your job.
This then makes you anxious which makes it harder to sleep and so you are tired and can’t work out so the extra weight starts piling up and then you become self conscious and more anxious! Whew!!
Now, we are looking at obesity, alcoholism, anxiety, insomnia, unemployment and depression are all grouped together where each one reinforces the other.
What is the “REAL” problem causing all these others? Your parents? Your genetics? Everything else?
Borsboom says the problem is not some hidden factor, let’s call X, that is causing all the symptoms. It is actually the way the symptoms mutually support one another in a network of relationships and that is the real culprit.
So, with that being said, it is really that intertwining network itself that is the disease and the goal of treatment should be to destabilize it or break it down by eliminating one or more of the key “nodes.” It could be that one of the “nodes” plays a more dominant role than some of the others.
This is how I think of it. In my youth, I belonged to a young adults group formed through the local church several of us attended. We had a big group of friends that gathered together socially. Debbie seemed to be the so-called glue holding this group together. She eventually moved and the group began to fall apart. However, if our group was more stable and we were closer friends with everyone else, it might have stayed together.
The failure to not get enough sleep might be the key factor connecting all the other problems in the case of mental illness. However, in this case, if we treat the one factor or symptom, we just might help treat the whole disorder.
These concepts can be applied when treating persistent pain which is properly understood as being multi-causal and involves similar networks of relationships including many of the exact symptoms as we have already discussed.
With someone experiencing pain, this lowers their mood which reduces physical activity and leads to poor sleep and often pain is what wakes us up during the night. This then feeds anxiety and leads to believing the worst of every and any situation which then leads to reduced physical activity and then you’ve lost any conditioning you’ve previously done.
In 2004, Sleep Medicine Reviews published a clinical review on how sleep disturbances and chronic pain inter-relate and they found from their studies that sleep disturbances and pain may be reciprocal. In other words, poor sleep further exacerbates pain. Cognitive behavioral therapies for either pain management or insomnia for patients with chronic pain have shown promise in reducing the pain severity and improving sleep quality.
So, yes, pain may cause sleep disturbances and poor sleep may cause persistent pain.
Ok, great, now what does all this mean?
Many people can treat their persistent pain by improving their sleep, exercise or just moving more, managing their stress, facing their fears and being realistic in their thoughts and emotions even though there is no identified issue with their tissues.
In other words, we can break up one or more of those “nodes” in the network to see improvement. But, let’s remember to keep focused on the future and sleep one night at a time.