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People who can’t imagine



The 2024 Global Year will examine what is known about sex and gender differences in pain perception and modulation and address sex-and gender-related disparities in both the research and treatment of pain.

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When I remember primary school, I remember one of my teachers cutting snot out of his nose with a pair of scissors when he thought no-one was looking. When I remember high school, I remember teachers saying two things, mainly.  “Lorimer, LORIMER, are you with us?” and “Well you certainly have a good imagination…”  In fact, imagining things is something I have always enjoyed and I guess I have taken for granted.  Until recently.  I have now seen a few patients, and heard from a few others, who claim to not be able to imagine moving, or, in a couple of cases, not able to imagine anything.

Current theories on perception and on consciousness and on motor control and in social psychology all suggest that the brain is constantly running scenarios and only picking one of them to implement, so I would expect that ‘imagining’ is somewhat fundamental to the living human. If one can’t imagine, I guess it does not preclude all that stuff, but it certainly raises the interesting question (and the bleedingly obvious one) of why not? Does anyone know the answer to this question? I guess if one cannot imagine but does have dreams, that would implicate the volitional aspect of it. Also, if one can make left/right judgments of body parts but can not imagine movements, that too would implicate the volitional aspect.

I have seen a couple of patients who report that they USED to be able to imagine moving and doing things, but since their CRPS they can not. One of those patients could not even recognise a left hand, let alone imagine it.  I would hold my left hand in front of her face (standing behind her so it was from her perspective) and ask her “What hand is that?” to which she would respond without any delay “Right”.  I would leave my left hand there and put my right hand there as well and she would jump and say “WOW! You have two right hands!”  Now there is some dodgy cortical processing.   I would be interested in how often other people have come across this inability to imagine, either within the context of graded motor imagery, which involves imagining movements and activities, or otherwise. If you have got some tricks, share them?  Either here, or on an excellent blog site called How To Cope With Pain, which has a discussion going on it at the moment. I found the discussion really interesting and helpful – it made me write this.

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