Pain Points with Max Shen

This past weekend, inspired by a recent preprint from Thomas Pollak, Mike Levin, et al, I gave a talk on how cybernetic models (predictive processing, dynamical systems, homeostasis/allostasis) are a hugely powerful lens to understate the current epidemic of the recent rise in chronic illness.You can watch the video while looking at the slides here, or read the essay version below:Here’s the essay version (generated by Claude from my transcript). It is less good than the talk, but faster to read:Chronic Illness as a Stuck Set PointIn 1910s Vienna, one in five young men had syphilis. The medical community was helpless—a deep nihilism pervaded as they watched patients die from this bacterial infection that would spread across the body with devastating mortality rates.Then a German psychiatrist noticed something strange: some of his late-stage syphilis patients got better after getting more sick. Specifically, after contracting malaria.In what seems like utter insanity in hindsight, Julius Wagner-Jauregg began drawing blood from his malaria patients and injecting it into those dying from syphilis. There was even a criminal investigation involved.But here’s the thing—it worked. Even though 10-15% died from the malaria, a larger fraction survived what was previously a death sentence. Wagner-Jauregg won the Nobel Prize in 1927.Nobody could explain why it worked. Medical research today still does not have a biomechanistic account. But it clearly worked.The Wrong Level of AbstractionThis shouldn’t make sense within the biomedical model that dominated (and still dominates) medicine. How do you give someone something that makes them more sick, yet they become better?The biomedical reasoning is straightforward: diseases have specific causes, specific dysfunctions. Diphtheria —> Kill the bacterium. Clogged arteries —> Widen them. We find and fix the broken part of our biomechanical bodies.But the malaria example isn’t unique. If you look at long COVID and other post-viral syndromes, there are well-documented cases of secondary infections leading to resolution. In the case of MDMA trials for PTSD, the drug doesn’t remove some “PTSD toxin” but somehow resets the entire system. In my own research, we have increasingly hard to ignore evidence about the widespread efficacy of nervous system reprocessing resolving chronic pain.This is still the dominant approachIn 2021, Congress gave NIH $1.5 billion to research long COVID—all focused on biochemical pathology, systematically excluding researchers studying nervous system approaches.Bodies as Problem-SolversWhat if we stopped seeing the body as a collection of chemical pathways and started seeing it as a multi-scale collective intelligence solving problems at different layers—from cell to organ to your whole being?Your body wants to keep you in a range of safe values. Try this experiment—on your next exhale, stop yourself from inhaling. Feel that rising tension, that panic. Your throat tightens, blood vessels dilate, emotional systems activate. That’s the homeostatic impulse, happening across multiple scales simultaneously.Normally, you breathe at 13-15 breaths per minute. If you start jogging, that set point shifts higher. If you work a chronically stressful job, your breathing becomes shallow and fast, and paradoxically, tissue oxygen can decrease over time.The key insight here is that sometimes our bodies get stuck in these maladaptive states.Try clenching your abs like you’re bracing for impact. Notice how hard it is to breathe? Now relax. Feel the difference—the ease, the fuller breath, the sense that more of your body is available. If you walked around with clenched abs all the time (as many do under chronic stress), your breathing would be persistently altered. You might even forget you’re clenching at all.The Reset MechanismRemember when your computer freezes and nothing works except turning it off and on again? That’s the metaphor driving this new understanding of chronic illness.We already use resets in medicine without calling them that. During a heart attack, emergency responders shock the heart with high voltage—not to teach it the proper rhythm, but to create a perturbation that allows the tissue to recalibrate. Fecal transplants work similarly—overwhelming the sick person’s microbiome with healthy bacteria, then allowing repopulation in better proportions.Think of it like this: imagine illness and health as valleys in a landscape. In chronic illness, the valley walls are steep—it takes enormous energy to climb out. But during a reset, those valleys flatten temporarily. The body can move between states with less resistance.Maybe that’s what happened with Wagner-Jauregg’s malaria cure. Maybe that’s what’s happening when a secondary infection resolves long COVID, or when MDMA allows PTSD to lift, or when nervous system work dissolves chronic pain. The perturbation creates a window of plasticity where the system can reconfigure.What This ChangesThis isn’t just semantic reshuffling. If our bodies are intelligent problem-solving systems that can get stuck, then treatment becomes about creating the right conditions for reset—understanding not just the magnitude of perturbation needed, but the context before and after.The questions now are practical: What variables actually define these states? How does conscious attention affect plasticity? (There’s something here about how becoming aware of your body’s defensive patterns might itself flatten the landscape.) What makes a helpful reset versus a harmful one?We’re at the beginning of something. The patterns are here for us to explore. And for someone who spent months unable to type, watching my own pain system reset through understanding and careful perturbation, I can tell you—this paradigm shift matters.In four images: This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit essays.debugyourpain.com

We’ve known for decades about culture-bound syndromes that just seem so weird and only occur in a small subculture. Like men in South Central Asia who get the idea that they have semen loss and their semen loss is making them weak and tired... and we go ‘that’s crazy’. But how do we know that back pain isn’t our culture-bound syndrome?Today I’m talking with Dr. Howard Schubiner, who’s one of the creators of Pain Reprocessing Therapy (one of the most important and exciting new modalities for addressing chronic pain). We met at a conference in Boulder, and this conversation was a chance for us to explore how he got into this space and his stance on where it’s going.Dr Schubiner is one of the pioneers of modern pain science. After being a professor at Wayne State University for 18 years, he now directs, advises, and supports many of the key initiatives around understanding pain through this neuroplastic lens.Timestamps00:00:00 – Intro00:02:00 – Meeting Dr. John Sarno00:06:00 – From MBSR to Mind-Body Medicine00:13:00 – The Evolution of Somatic Tracking00:21:00 – Predictive Processing and the Brain’s Need for Certainty00:35:00 – The Cultural Epidemic of Pain Syndromes00:38:00 – Long COVID and Neuroplastic Conditions00:43:00 – Healthcare System Reform Vision00:47:00 – The Future of Neuroplastic ResearchResources:* Howard’s book, Unlearn Your Pain, just had a Fourth Edition update.* Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain.* Correction: I mentioned anorexia and The Geography of Madness, but the correct book is Crazy Like Us. Here is a good book review.* All the Rage (Saved by Sarno) - documentary featuring Dr. Sarno* ATNS (Association for the Treatment of Neuroplastic Symptoms)Questions and comments welcome! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit essays.debugyourpain.com

If there is a sharp knife pressing into my hand, and let’s call it pain, if I resist, resist it, and hate it and want it gone, I stick the knife deeper in my hand.Try to push it away, okay. Deeper. Now if I relax my hand, okay, it’s a totally different experience. Now, this is like the ABC of dealing with pain. Not focusing on the pain, but focusing what you do against the pain. Because the general attitude of people is pain is the enemy. Pain is bad. Pain is the devil. When people are experiencing pain, they immediately contract and stop breathing. Those two actions push the knife more into the body because you take away the respiration, the person doesn’t breathe, or his body doesn’t have enough energy to deal with the pain.He contracts muscles, he blocks the energy flow in the body. Now the pain can only accumulate.” My guest today, Avi Grinberg, is a deep practitioner. He started out as a paramedic and traveled around the world to learn from different indigenous heals. I was particularly excited to talk to Avi because, in my own journey of exploring pain, I’ve come to a set of intuitions that’s hard to articulate about the role of awareness and how we generate the pain in our own way.When I saw Avi speak, I felt there was a deep connection that we were coming from the same place and seeing things, and so naturally I reached out to have a conversation. While I might not agree with all of Avi’s conclusions. I found a lot to learn from him in this conversation and I hope you will too.00:00:00 Introduction and Early Encounters with Healing00:04:00 “Most People Don’t Know How to Experience Pain”00:08:00 Pain Is Energy Seeking Completion00:12:00 Indigenous Healers in the Middle East and South America00:36:00 Demonstration of the Exercise: Relaxing Into Pain00:44:00 Trying Hard Breeds Chronic Tension01:04:00 The Danger of “Easy Healing”01:17:00 Closing ReflectionsGrinberg method websitehttp://www.grinbergmethod.com/YouTube channel: https://www.youtube.com/@GrinbergMethod This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit essays.debugyourpain.com

David Chapman, a former AI researcher turned writer, dives deep into the complexities of chronic illness and the healthcare system. He shares his personal journey with debilitating fatigue and food intolerances, including an unexpected six-mile run that cured his long COVID fatigue. Discussions touch on the failures of American healthcare, the importance of community support, and the concept of meta-rationality in debugging personal health. Chapman also highlights how bright light therapy can alleviate seasonal depression, challenging mainstream treatment norms.

In this episode of Pain Points, I’m speaking with Jozef Frucek, a dear mentor of mine and a pioneer in the world of movement.He uses embodied cognition to combine ideas from Tai Chi, wrestling, and physical theater to create a wholly unique approach to movement that he calls the Fighting Monkey Practice. We recently finished a paper called Beyond Biomechanics, Fighting Monkey and the Enactive Inference Approach to Health and Movement.I'm really excited about this interview today because Jozef is, as you'll hear, an incredible storyteller. But more importantly, through his work he is articulating one of the most inspiring visions of health, which of course relates to my own work on pain. We begin by discussing his background, learning Tai Chi for 20 years in an experimental slovakian movement community before explicitly discussing our paper. (You can read the transcript online)“ Health is not absence of illness. Health may be described as your capacity to be connected to people . That's also being healthy, right? That's very important. I think we are too obsessed by staying healthy, trying to do everything right. We force our bodies and we stress our bodies enormously. We constantly follow some sort of protocol. We are constantly hearing what we should be, what exercise we should be doing, but we really forget how to listen to ourselves.We rarely find our authentic voice. We only follow ideas of others, but we do not sense what actually is happening in our physiology.”[00:00:00 - 08:00] Origins and Early Movement Journey* Transition from basketball to acting* Discovery of movement community in Slovakia* Meeting Tai Chi masters and the 20-year journey with Ming Wong[08:00 - 14:00] Philosophy of Teaching and Permission* The importance of teacher permission vs. open learning* "Stray dogs" approach to students* Evolution doesn't create solutions, it creates problem-solving[14:00 - 22:00] Theater, Sports, and Asian Philosophy* How Tai Chi informed theatrical practice* Table tennis and father-son relationship* Journey through Taoism, Zen Buddhism, and Korean traditions[22:00 - 33:00] Existential Pain and Storytelling* Childhood encounters with mortality and darkness* Theater as simulation and agency creation* "I have something and I'm afraid of losing it" - the core of suffering[33:00 - 45:00] The Question Dance* Interactive dialogue experiment* Exploring meaning, perception, and embodied understanding* The power of questions over answers[45:00 - 58:00] Scientific Philosophy and Embodied Practice* Active inference and nested agency* Extended mind and embedded cognition* Breathing as autonomous intelligence[58:00 - End] Health, Agency, and Creative Healing* Health as agency rather than absence of disease* Joy and pleasure as guides to healing* The vision for more accessible creative movement practiceLinksShen, Max, and Jozef Frucek. "Beyond Biomechanics: Fighting Monkey and the Enactive Inference Approach to Health and Movement." (2025). LinkFighting Monkey website, IGAbout the HostMax Shen is a former machine learning researcher turned pain and cognition researcher. After facing chronic pain in grad school, he now uses computational tools at MIT to explore pain from a systems and somatic lens.🎧 Listen to all episodes:* Substack: essays.debugyourpain.com📬 Get in touch:* Email: maxkshen@gmail.com* Twitter: @maxkshen This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit essays.debugyourpain.com

Michael Levin, director of the Allen Discovery Institute at Tufts, is a pioneer in regeneration and bioelectricity. He delves into the concept of agency in living organisms, revealing how chronic pain can act as an agent impacting physiology and psychology. The power of social contagion in health behaviors highlights how collective influences shape healing. Levin challenges conventional notions of pain, suggesting it may exist at molecular levels, while discussing innovative approaches to regenerative medicine and the fusion of AI with health intelligence.

Bren’s documentary is out! Watch here More on health, movement, and becoming the whole collective intelligence you are at essays.debugyourpain.com00:00:00 Introduction — Movement Without Reductionism 00:01:00 From Stanford Biochemistry to Movement Coaching 00:03:00 Traditional Training: Isolate, Integrate, Improvise 00:06:00 Why Transfer Fails in Traditional Models 00:09:00 Ecological Dynamics in Combat Sports 00:18:00 Constraints-Led Approach and Skill Transfer 00:21:00 Enactivism vs. Ecological Dynamics 00:26:00 The Role of Intention and Meaning in Movement00:31:00 What is Beautiful Movement? 00:35:00 Movement and Evolutionary Mismatch 00:41:00 Nested Agency and Biological Intelligence 00:47:00 Rehabilitating Without Rest: A Proactive View on Pain 00:56:00 Changing Paradigms in BJJ and Movement Instruction 01:01:00 Teaching With Tasks, Not Moves 01:07:00 From Theory to Practice: Bringing CLA to New Disciplines 01:12:00 Workshops, Collaborations, and What’s NextBeyond Biomechanics: The Enactive Inference Approach to Health and Movement – Shen & FrucekRamstead, M., et al. “A tale of two densities: Active inference is enactive inference.” Adaptive Behavior, 2019.Varela, F., Thompson, E., & Rosch, E. The Embodied Mind. MIT Press, 2016.Lehman, G. “Recovery Strategies.” Greg Lehman’s WebsiteFighting Monkey Practice: fightingmonkey.netBren Veziroglu studied biochemistry at Stanford and worked in molecular imaging before pivoting to the world of movement and rehabilitation. He now teaches and practices using the constraints-led approach, integrating ecological dynamics, somatics, and martial arts to train human beings — not just athletes.Max Shen is a former machine learning researcher turned pain and cognition scientist. After facing chronic pain in grad school, he now uses computational tools at MIT to explore pain from a systems and somatic lens.🎧 Listen to all episodes:Substack: debugyourpain.com Get in touch:Email: maxkshen@gmail.comTwitter: @mxslk This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit essays.debugyourpain.com

essays.debugyourpain.com## Timestamps00:00:00 Introduction - The Coming Paradigm Change in Biology  00:02:00 The Biomedical Paradigm: Materialism, Reductionism, and Dualism  00:05:00 How Pain Is Usually Explained (And Why It's Wrong)  00:07:00 Problems with Materialism, Reductionism, Dualism00:12:00 Pain Without Damage, Damage Without Pain  00:15:00 The Alternative: Biological Computation and Collective Intelligence. 00:26:00 Health as Problem-Solving Ability, Not Statistical Norms  00:30:00 Pain as a Control Signal and Skill  00:32:00 The Somatic Scientists - Ida Rolf, Moshe Feldenkrais, FM Alexander  00:37:00 Why RCTs Don't Work for Complex Therapies  00:42:00 Bridging Science and Practice ## Key Figures Mentioned- **Michael Levin** (Tufts) - Biological computation and collective intelligence- **Karl Friston** (University College London) - Active inference and free energy principle- **Dennis Noble** (Oxford) - Biological relativity and heart pacemaker cells- **Ida Rolf** - Developed Rolfing, emphasized fascia connections- **Moshe Feldenkrais** - Physicist turned movement therapist- **FM Alexander** - Alexander Technique founderResources- Ashar, Yoni K., et al. "Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial." JAMA psychiatry 79.1 (2022): 13-23.- Noble, Denis. "A theory of biological relativity: no privileged level of causation." Interface focus 2.1 (2012): 55-64.- Wampold, Bruce E., and Zac E. Imel. The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge, 2015.- Beyond Biomechanics: The Enactive Inference Approach to Health and Movement: https://osf.io/preprints/psyarxiv/uqcs4_v1About the HostMax is a former machine learning researcher who pivoted to studying pain and cognition after experiencing chronic pain during graduate school. He now uses computational tools to study chronic pain at MIT.---- Substack: debugyourpain.substack.com**Get in touch:**- Email: maxkshen@gmail.com- Twitter: @mxslk- Substack: debugyourpain.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit essays.debugyourpain.com

The conversation dives into how people often carry learned behaviors that lead to self-loathing and conflict avoidance. It explores the contrast between aiming for what we want versus running from negativity, particularly seen in pessimistic views about AI. The importance of unlearning toxic patterns for happier lives is emphasized, along with how positivity can foster healthier relationships. Additionally, there's a focus on harnessing intentions for personal growth and the beauty of navigating life's tensions to achieve greater emotional well-being.