At some tipping point, this becomes the new trajectory of your life. Life’s challenges continue to come at all of us. As life becomes easier to navigate, your body is exposed to less threat (stress) physiology and more to safety. Safety is where fuel moves into cells, and your body regenerates and heals.

The metaphor for this navigated course is the ski slope. No matter what your skill level, you must get down the hill. If the ski run is above your skill level, you may not be only stressed, it can be terrifying. The goal is become an expert at life skills and learn to feel safe a higher percent of the time. Here are the prerequisites.

• Have a working knowledge of The DOC Journey course.
• Understand the natural resistance to change.
• Review the “circle of life” with the “ring of fire.”
• Begin to connect to your vision of what is possible.
• Your healing emanates from feeling safe and creative.
• Constructing your new home (life) is the final focus of the journey. Enjoy!!

Overview

First of all, congratulations for reaching this level. The key to healing is persistence and you have already shown a willingness to fully engage in learning to create and live the life you want. Before you began this journey, that may not have seemed possible. But to be clear, your journey is not about completing a course or believing in David Hanscom. It is about connecting your own capacity to heal. Healing of any part of the body is nothing short of miraculous, but so is the gift of life.

Many people arrive at this point of their journey and they feel better. So, being back to their baseline, they quit. “I am good enough,” and they move on with their life. I think that it is tragic to stop now. Your creative brain is coming alive and the potential for future learning and growth is unlimited. Why would you want to stop?

There are actually a few reasons why this happens so often.

• Humans are programmed by every second of their lives. Our brains unconsciously memorize everything. Familiar patterns are not noticed since not only are they embedded in our brains, but they are our version of reality. Any new or unusual data catches our attention and stimulates some level of threat physiology. We feel anxious and instinctively resist change. So, maybe you are back to a comfortable baseline state. Why would you wish to continue?
• There is a lot of anxiety with success, if you are used to simply trying to survive. When is the shoe going to drop? A classic example is golf. It is remarkably predictable that when you have shot well for three or four holes that your anxiety levels rise. Of course your muscle tension increases, and suddenly it seems like you don’t which end of the club to hold. The same scenario holds true in any performance arena at home, work, or even relaxing.
• Examples are present in every kind of performance. Maybe you have been promoted and have a higher profile in your sphere of influence. More eyes are on you, and many people might jealous of your success. They may look for any opportunity to cut you down. There is a term for this phenomenon called “Tall Poppy Syndrome.” It is easier to just blend in with the crowd.
• Understand that the shoe will always drop. That is life. If your goal is to be in an endless state of bliss, you’ll fail. Life presents an endless number of daily challenges and at some level of stress, your body will respond with threat physiology. Maybe it will last for an hour or even days. It is what your body is supposed to do – protect you. But you now have choices regarding how long you wish to remain there.
• A different problem arises in that now you have tasted what it is like to be in the green center, and you don’t want to leave. Additionally, when you are triggered and in the red, the contrast is sharp and you may get more frustrated about what is possible compared what you are experiencing in the moment. I call this, “the curse of awareness.” What you want to do is nuture emotional flexibilty, be present with whatever state you are in, and move in the direction of your choice.
• I experienced a common scenario in that I had no idea that there were other possibilities about the way I negotiated my life. All I ever knew was anger and chaos. Although, I attended workshops, read self-help books, and underwent extensive counseling. I did not connect with how angry I was until I was 50 years old. It was an incredibly unpleasant experience and I did not have the tools to deal with it. Healing happens with connection – to yourself and then to those around you. Not wanting to experience unpleasant emotions may be a major reason why people don’t engage in this process or pull up short of really moving forward. One of my friends has often quoted the phrase, “you have to feel to heal.”

The ”circle of life” containing the “ring of fire” is the signature tool of this journey. A version of it was created by Dr. Paul Gilbert, who was the founder of compassion-based therapy. Compassion (love) as defined by Anthony DeMello in his book, The Way to Love, is awareness. Anxiety blocks awareness. But as you nurture awareness, you’ll actually feel more anxiety, and it requires tools to tolerate it. This is a bidirectional interaction. So, this final level is focused on not only learning to nurture joy, but also to better tolerate anxiety.

The metaphor is building and decorating a new house. Each room represents an aspect of your life that must be addressed. Use it daily as a quick mental checklist as you go from room to room in your own home. The “lot” is the green center of the circle of life. With repetition, you’ll create the life you want. “To have a good life, you must live a good life.”

Books to read

Art of Living: The Classical Manual on Virtue, Happiness, and Effectiveness

Happiness and freedom begin with a clear understanding of one principle: Some things are within our control, and some things are not. It is only after you have faced up to this fundamental rule and learned to distinguish between what you can and can’t control that inner tranquility and outer effectiveness become possible. The Stoic philosopher Epictetus was born on the eastern edges of the Roman Empire in A.D. 55, but The Art of Living is still perfectly suited for any contemporary self-help or recovery program.

The healing journey progresses from “reaCtive to Creative”. You must first see where you are at before you can change direction. You can’t heal by focusing on problems. Healing occurs with creativity and moving away from unpleasant neurological circuits. The wisdom of the Stoics is remarkable in that it is as, or more, relevant as it was 2000 years ago. Regaining a healthy life perspective is the definitive solution to decreasing your suffering.

On the slopes

A world class skier can ski anything humanly possible if the conditions are reasonable. I used to think I was a double black diamond skier until I was exposed to US Ski Team skiers who were far above a level than I ever imagined. They not only possess a high level of skill, but they are supremely confident as a result of putting in thousands of hours of practice.

Many years ago a group of us where on the back side of mountain at Alta Utah. It was a gorgeus day with a lot of new soft powder. We were all “expert” skiers. We were standing in a narrow line waiting to head down the hill and my son, who is a US Ski team level mogul skier was on another transverse about 30 feet above us. We wondered what he wanted us to do. What he wanted was fresh untracked powder and he took off and jumped over all of us. It must have been a 40-foot drop and he landed about 50 feet down the hill. There was no hesitation. He kept going until the bottom skiing at a high speed. I realized that his was a reality I was not familiar with.

But consider any performance from art, music, dance, athletics, mechanics, business, and work. Every endeavor can be manifested at the highest level. You might be thinking, “I could never accomplish this level of expertise, and in a given field, you probably won’t. Or maybe you already have. However, life skills are accessible to everyone and anyone who wants to commit the living an excellent life. All that is required is a willingness to continue to learn and practice. The DOC Journey presents a foundational set of concepts and tools and there are endless additonal ways to enhance your journey.

The only “goal” of this course is to allow you to connect to the moment you are in and with awareness can be in any color of the “circle of life” on your terms. You have the choice to remain there or move in any direction.

Why not attain the highest level of expertise in living your life? The focus is on attaining skills and not reaching for perfect, where you beat yourself up for “failing.” It is about just learning to execute what you know regardless of the circumstances. Outcomes are usually beyond our control, but you can up the odds of success.

This level is a jumping off point for living the rest of your life. Let yourself think big and enjoy your day.

The post Be an Expert at Living life first appeared on Back in Control.

The post Be an Expert at Living life appeared first on Back in Control.

A chaotic, even abusive upbringing predicts a long and harsh life. There are many chronic mental and physical health issues that occur that shorten lifespan and also markedly compromise quality of life. Raised in this environment, a child cannot reach his or her full potential when so much energy is consumed by trying to survive. Consider a young plant in rich soil with plenty of sunlight and water. Compare it to the same plant in poor soil, limited sunlight, little water. It may even look a different species.

Feeling unsafe

When we don’t feel safe, we’ll do whatever we can to achieve it. Feeling unsafe drives many, if not most destructive behaviors. Feel trapped causes us to react aggressively to solve the situation. The physiological response is called anger, which represents the body’s powerful last-ditch effort to regain control.

Since the most stressful problems are ones we can’t solve, sustained anger (threat physiology) turns into rage, destructive behaviors, and chronic illnesses as the body breaks down. Consider how many life situations are unsolvable. One of the deadliest and universal problems is feeling trapped by our thoughts.

We cannot escape our thoughts. Suppressing unpleasant thoughts fires up the threat response even more than experiencing them. Suppression causes the hippocampus (memory center) of the brain to shrink¹ and increases craving for opioids.²  Distracting ourselves with experiences, pursuing pleasure, adventures, and achievements also fires up the immune system.³

So how do we behave?

ADDICTIONS

Addictions create a sense of safety while engaged in the activity, but obviously are not long-term solutions. The reason addictions are so destructive is they temporarily mask mental and physical pain, and pursuing relief is compelling.

POWER

A deadly outcome of feeling chronically unsafe is the relentless pursuit of power in order to gain more control. It can’t and doesn’t work, but few of us are taught alternatives. The manifestations are almost infinite and infiltrate every domain of our lives and relationships with others. People closest to us are the most affected. No one wants to be controlled, yet trying to control others is almost universal. Anger is generated in those being controlled and also in those exerting control. There is never enough to assuage the unconscious brain. Unfortunately, anger is intentionally destructive, as it is your body’s last-ditch effort to survive emotionally or physically.

The data is deep, beginning in the schoolyard. We try to avoid anxiety, or – if we already have it – we try to get rid of it. Nothing enhances our feeling of control more than by gaining power in some way. This need is expressed in our interactions with each other; in fact, it dictates much of human relations.

Every child has significantly increased anxiety when they leave home to begin school, regardless of their family situation. They want to be accepted but there is also the greater need to diminish their fear. The need to get rid of fear and gain power is played out in forming cliques, excluding others, and overt bullying.

Researchers did a study of students who have been bullied versus the bullies to see if there was any difference in their physiological makeup. ⁴ They looked at the levels of a substance called C-reactive protein (CRP), which is elevated in the presence of inflammation; it’s often drawn to determine the presence of a hidden infection. Chronically elevated levels also indicate a stressed and overactive immune system. It is not desirable to have an elevated CRP.

The study revealed that children who had been bullied had significantly elevated levels of CRP compared to those who had not been bullied. Being bullied as your introduction to the real world is not a great start. What I find even more disturbing is that the levels of CRP in bullies was lower than the norm. As it turns out, there is both a social and physiological reward for possessing more power. How all of this plays out in adulthood is not subtle. Why would you want to give up power and control? Especially when feeling the pain of anxiety is the other option.

Every child has a strong need to be accepted, yet what should we make of the fact that it gives him or her more power (and self-esteem) to reject someone else? This is an endless loop, the root cause of which is the solvable problem of anxiety.

SELF-ESTEEM

The other as futile effort to counteract these deeply upleasant survival sensations is to pursue more self-esteem. This is problematic for seversal reasons. First, it is a gross mismatch of your unconsious brain overpowering your conscious brain by about a million to one. Anxiety and anger are hardwired automatic survival reactions over which we have absolutely no control.

Second, the unconscious brain never stops for a millisecond and is always on the lookout for danger. It is why we evolved and stay alive. The conscious brain’s attention is not sustainable and we quickly develop cognitive fatigue trying to stay happy. We also become physically tired as 20 to 25% of your entire body’s energy is used to run your brain.

Third, we are programmed by everyone around us about who we should be or not be. These voices in our heads become as concrete as any object and we act on them. Unfortunately, the “stories” in our heads are essentially all cognitive distortions. Self-esteem represents a huge distortion of labeling. We expend a tremendous amount of energy building up our ego, and then spend endless efforts defending it. The relentless pursuit of self-esteem disconnects us from the reality immediately in front of us. In other words, you lose awareness of other’s needs and relationships are compromised. Look at the human experience of how terribly we treat each other as individuals and societies. We have the resources to create a planet that could thrive yet we are at the mercy of our personal and societal “stories.”

What can you do?

Learn vulnerability. Being vulnerable is at the core of meaningful human relationships, but there is no reward in nature for being physically vulnerable.  Since emotional pain is processed in similar regions of the brain as physical pain, there are penalties for being emotionally vulnerable. Language creates a massive problem causing emotional pain that is much more complex than in other mammals. Anger, as unpleasant as it is, is powerful, addicting, and masks being vulnerable. Anger creates a sense of emotional safety, but no one around you feels safe. How do you learn to be vulnerable when you are used to dealing with a lot of anger?

DYNAMIC HEALING

Needing to pursue the above-mentioned destructive behaviors drops as you address the root cause of sustained threat physiology. You cannot control the survival reactions but there are numerous ways to regulate your physiology. When your body is bathed in safety physiology, you feel safe, connected, and incredibly relaxed. We use the term, “dynamic healing”, which addresses factors affecting your physiology.

• Input – dealing with life’s challenges in a manner that less impact on your nervous system.
• State of the nervous system – calm or hyperactive
• Output or the physiology – can be directly regulated from threat to safety.

The details of the Dynamic Healing model are beyond the scope of this discussion. The focus is on you and learning skills in each category to create “cues of safety”, and not on fixing or solving your pain. It is a healing process, and not “self-help”.

RUTs (repetitive unpleasant thoughts)

Regarding the onslaught of unpleasant thoughts, consider the metaphor of a hornet’s nest, with the nest being your brain, and the hornets your thoughts. At rest, the hornets are busy collecting food, building the nest, cleaning house, and reproducing. If the nest is shaken, the hornets will become aggressive and defend themselves. When your nervous system is inflamed and hyperactive, your thought patterns become intense, since your conscious brain interprets your internal physiology.

The usual approach is to use cognitive rational techniques to counter bad thoughts with good thoughts, which is an impossible task. Then we put up our “shield” (self-esteem, self-affirmations) to protect us. It also overwhelming and wears us down. Exerting increased control (suppression) is also futile. Then the more attention you pay to the thoughts your brain is fired up even more. It is a bi-directional process.

The answer lies in “quit shaking the nest.” The hornets will calm down and return to their usual activities. As your nervous system calms down, your unpleasant thought patterns will lessen, which in turn helps calm your brain. Although cognitive approaches lower the input into the nervous system, calming it down is a separate skill. There are endless other ways besides unpleasant thoughts that fire it up.

There are four aspects of creating a safe relationhip with your thoughts.

• Thought separation
• Calming the nervous system (processing anger)
• Creativity – stimulating new neurological circuits away from the unpleasant ones.
• Dissolution of the ego – once you learn to feel safe, there is less need for it.

Calming your nervous system allows you to feel safe. It allows you to break free of ruminating thought patterns frees you up to create and live life on your terms.

References

1. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9
3. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
4. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.

The post Our Need to Feel Safe first appeared on Back in Control.

The post Our Need to Feel Safe appeared first on Back in Control.

Anxiety, Power, and Bullying

To be connected to other people is one of the strongest human drives. Humans evolved by interacting with other humans. We also have a deep need for acceptance. This sets up a serious contradiction because our even deeper need is to avoid anxiety.

We try to avoid anxiety, or – if we already have it – we try to get rid of it. One common method we use is to increase our sense of control. Nothing enhances our feeling of control more than by gaining power in some way. This tendency comes out in our interactions with each other; in fact, it dictates much of human relations.

Every child has significantly increased anxiety when they leave home to begin school, regardless of their family situation. They want to be accepted but there is also the greater need to diminish their fear. The need to get rid of fear and gain power is played out in forming cliques, excluding others, and overt bullying.

Researchers did a study of students who have been bullied versus the bullies to see if there was any difference in their physiological makeup. They looked at the levels of a substance called C-reactive protein (CRP), which is elevated in the presence of inflammation; it’s often drawn to determine the presence of a hidden infection. Chronically elevated levels also indicate a stressed and overactive immune system. It is not desirable to have an elevated CRP.

The study revealed that children who had been bullied had significantly elevated levels of CRP compared to those who had not been bullied. Being bullied as your introduction to the real world is not a great start. What I find even more disturbing is that the levels of CRP in bullies was lower than the norm. As it turns out, there is both a social and physiological reward for possessing more power. How all of this plays out in adulthood is not subtle. Why would you want to give up power and control? Especially when feeling the pain of anxiety is the other option. (1)

Every child does have a strong need to be accepted, yet what should we make of the fact that it gives him or her more power (and self-esteem) to reject someone else? This is an endless loop, the root cause of which is the solvable problem of anxiety. The myth of self-esteem

Sartatoga Teen Hangs Herself

I don’t know how you can measure the impact of bullying on our society. The suffering encountered at such an early and innocent age is deep and it’s rampant. Three 16 y/o boys raped a young girl in the Bay Area. What is much more disturbing is that instead of rallying to support her in a time of extreme distress, her classmates turned on her. A photo went viral. She was verbally abused both directly and over cyberspace. “Slut”. “Will you have sex with me?” She is now dead from hanging herself.

I was talking to a patient who was a middle-age school teacher. She was experiencing total body pain. She was clearly a broken woman and could hardly lift her head to look at me. She had been severely bullied throughout middle and high school and couldn’t shake it. The conversation with her was incredibly discouraging.

One of my colleagues had her son bullied badly beginning at age seven. Nothing seemed to work to stop it. Finally, at age 25 he simply gave up. He could no longer tolerate the relentless anxiety engendered by the experience. As sad as his mother was telling me his story, she felt that he was finally at peace. It was an intense moment to hear her say that about her own son.

Some observations

First, most bullying occurs at a level well below the teachers’ radar. Just being excluded from a group can be devastating. It is not going to be possible to put the responsibility solely on the their shoulders.

Second, our children are at an age where they are discovering and creating their identity. Most of it depends on some type of approval from their peers. For some reason the approval usually needs to come from the person or group who is the least likely to give it. When someone else defines your identity, that person has power over you.

Third, people wring their hands and point out that all of this should be done in the family. There are several significant problems with this thinking. I resent the term “dysfunctional family”. That implies that there are functional families. I have yet to see one. Humans consistently have significant problematic behavioral patterns, and is most deeply played out in the home setting.

Even if a child comes from a less dysfunctional family, they may become targets for the bullies. They are similar to a domestic animal turned loose into the wild. They either fold or become tough. Neither is great.

Fourth, the argument goes that school is an important socialization process. Really?? Going into an environment where peace, love and joy are hammered into the ground does not create a person who is loving and compassionate. They are just learning dysfunctional survival skills. Behavioral patterns set before age 12 are permanent. Bullies as children have a high chance of exhibiting aggressive behavior as adults as well as experiencing chronic pain. Many children with their egos destroyed will live the rest of their lives in fear.

Fifth, home-schooled children have been shown to do well later in life. My observation of several families that have taken it on is the their children are more creative and thrive without the hierarchy of the schoolroom. Here is an example of the work of some close friends of mine. They have been home-schooled and creativity oozes out of them. Beautiful

Sixth, look at what is happening to our society. We have a life that any generation prior to a hundred years ago could not imagine. Are we happier and more loving? We are passing along peace and love to our kids – especially in school. External possessions and accomplishments don’t change human nature. The incidence of chronic pain has skyrocketed in adolescents. (2)

Finally, there is a high correlation between the ACE score (Adverse Childhood Events) and disability. As pain drives anxiety and frustration and vice versa this shouldn’t be a surprise. These pathways are linked. We are not going to solve the chronic pain problem, which is crippling our society, unless we tackle it beginning in kindergarten. (3)

Solutions

Human behavior and survival revolves around avoiding anxiety. We’ll do anything to avoid the feeling, including holding on to our pain. Any change creates more anxiety. The key is learning to process and live with anxiety, so as to not have such a need for power.

Neuroscience research has shown us the powerful full body reaction that creates anxiety. You can’t control it, but you can calm and re-direct it. It is the core of the DOC process. Anxiety is the pain.

We’re also observing the power of the family in programming behaviors. Were you ever a bully? Do you still intimidate your co-workers, colleagues or family? Could your child’s bullying be learned from you? Were you bullied when you were younger? What effects of it might you be bringing into your current life? Are you often frustrated, angry or upset? What effect do you think it’s having on your quality of life? Do you even want to give up the power of your pain? You might have a legitimate reason to hold on to remaining upset? But who’s continuing to suffer?

Awareness

I think almost everyone agrees that bullying is a problem. However, we may not be aware that we might be part of the problem. The first step is understanding how your behavior might be perceived by those close to you. I can tell you it is a humbling exercise. A book given to me by a close colleague has had an impact on me. It is called, The Way to Love, by Anthony DeMello. He defines love as “awareness.” How can you meet someone’s need without understanding them or getting to know who that person is. Bullying would be the antithesis of awareness, as you are meeting only your own needs. I read a few pages weekly to remind me of the concepts.

Treating anxiety and anxiety with the correct approach on a widespread basis would have an effect on bullying, your child’s quality of life, and on your life. Commit to your own healing and reach out to heal your family. Watch the impact.

Although bullying is physically healthier than being bullied, it destroys the essence of life, which is healthy, thriving relationships. Bathing your body in reward chemicals emanating from giving back, a sense of purpose and play is a much better way to live.

1. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.
2. Simons L, et al. “Pediatric Pain Screening Tool: rapid identification of risk in youth with pain complaints.” Pain (2015); 156: 1511-1518.
3. Anda RF, et al. “The enduring effects of abuse and related adverseexperiences in childhood. A convergence of evidence from neurobiology and epidemiology.” European Archives of Psychiatry and Clinical Neuroscience (2006); 256: 174–186.

The post Bullying is Good for Your Health first appeared on Back in Control.

The post Bullying is Good for Your Health appeared first on Back in Control.

Here is a famous quote from Gabriel Garcia Marquez.¹

It is not true that people stop pursuing dreams because they grow old.

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

This is a wonderful quote except I have a different take on it.

People grow old because their dreams are crushed by anxiety.

Stress

Stress is the sum total of the obstacles we face every minute to stay alive. When your body is in a flight or fight state, the sensation is called “anxiety.” This reaction is present in every living species, but humans have language and can name it. It is challenging to achieve your dreams and experience the life you wish while feeling stressed. Your creativity and choice are compromised while you are in a survival mode; the blood flow in your brain shifts from the neocortex (thinking centers) to the limbic system (flight or fight).

The Holmes scale², developed in the 1960s, quantifies levels of stress connected with life events, and you can calculate your own cumulative score. A score of 300 points or more correlates to an 80% chance of a health breakdown within 24 months. In spite of overwhelming data connecting chronic stress with illness, disease, and early mortality, we are generally taught that stress and anxiety are “psychological” issues. Nothing could be further from reality. Why does chronic stress cause mental and physical illnesses?

One of my close friends and colleagues were discussing the role of stress leading to health problems and we decided to assess ourselves with Holmes scale. He had been dealing with an unspeakable number of challenges for several years. His score was 435 and then he told me that he had been diagnosed with cancer a few months earlier. Fortunately, he did well with treatment.

Safety

We want to feel safe. In this state our body’s chemistry consists of anti-inflammatory molecules called cytokines. Fuel consumption is lowered (metabolism). There are about 80 billion neurons in your brain that communicate by molecules called neurotransmitters. When feeling safe, these molecules are calming. Hormones include dopamine (reward), serotonin (mood elevator), growth hormone, and oxytocin (social bonding). Emotions represent feelings generated by your physiological state (how the body functions) and safety creates a sense of connection, contentment, and joy. Another term describing this state is “rest and digest.” Your body must refuel, regenerate, and heal in order to sustain life and health.

Threats

What happens when you don’t feel safe? Your body goes into various levels of threat physiology (flight or fight) to optimize survival. It is designed to deal with acute threats effectively and quickly, but it doesn’t do well when your challenges are unrelenting. At the core of all chronic mental and physical disease is being in a sustained stressed state.³ Here is what is going on.

Activated inflammatory cytokines fire up your immune system. In addition to fighting off viruses, bacteria, and other foreign materials, your own tissues are attacked.⁴ Neurotransmitters switch from calming to excitatory and your nervous system is hyperactive. Fuel is consumed from every cell in your body, including your brain. Chronic disease states cause physical shrinkage of your brain.⁵ Fortunately, it regrows as you heal. Stress hormones include adrenaline, noradrenaline, histamines, and vasopressin, which shift your body from thinking to fleeing. This situation can be likened to driving your car down the freeway at 65 mph in second gear. It will break down more quickly than if you are cruising in 5^th gear.

The driving force behind chronic mental and physical disease is sustained exposure to stress physiology. The solution lies in using approaches to increase “cues of safety” and allow your body to rest and regenerate whenever you can.

Dynamic Healing

Sustained stress translates into threat physiology, which creates symptoms. In mainstream medicine, we are just treating symptoms instead of addressing the root cause being the interaction between your stresses and nervous system. We don’t have time to know you, understand the nature of your circumstances, or how we can help you calm down. Treating only symptoms is similar to putting out an oil well fire with a garden hose. It is no wonder that the burden of chronic disease and suffering continues to skyrocket.⁶ In fact, you often feel more stressed while interacting with the medical system. We introduce the concept of “dynamic healing.

Dynamic Healing is a framework that categorizes interventions that decrease exposure to threat and increase safety. The three portals are:

• Input – processing your stresses in a manner to have less impact on your nervous system
• The nervous system – there are ways to lower its reactivity
• The output – directly stimulating your body to go from stress to calming physiology.

This model organizes known research to both clinicians and patients. You can regain control of your care and create a partnership with your provider.

Why not become a “professional” at living life?

Consider the process as becoming a “professional at living life.” It is similar to acquiring any skill such as playing the piano. You must learn the basics, incorporate them into your daily life, and then continue to deepen your expertise with practice. Mastery is critical, and as they become habituated and automatic, life becomes easier to navigate.

Additionally, the power of neuroplasticity (changing your brain) is powerful and unlimited. You can program your brain in whichever direction you wish, away from unpleasant survival circuits.

Modern stresses

Times have changed since 1962 regarding the Holmes-Rahe scale. The industrial revolution occurred only about 200 years ago. In light of over four billion years of evolution, this not even a drop of water in the ocean. The level of daily sensory input dramatically increased. Now we are in the information revolution that began in 1980’s forcing us to process magnitudes more information. Smart phones came online in 2007, and along with the barrage of social media, we are on a massive sensory overload. The human brain has not evolved to keep up with it. So, we have ongoing stress levels that weren’t present even several hundred years ago. It is somewhat perverse that we have so many anxiety-related problems when we have access to more physical comforts than any generation in history. One fallout is that of teen suicide, “deaths of despair”, have risen dramatically correlating with the advent of the bi-directional smart phone.⁷

A healing sequence

The DOC (Direct your Own Care) Journey course teaches skills to optimize your capacity to enjoy life by effectively dealing with adversity and nurturing joy. These are two separate, but linked, skill sets. As you lower your time feeling stressed and increase your sense of safety and joy, your body will regenerate and heal – mentally and physically. Your brain physically changes (neuroplasticity), pleasurable circuits strengthen, and pain (mental and physical) regions atrophy. You can reprogram your brain away from almost anything with persistence and repetition. The exciting aspect of neuroplasticity is that at some tipping point, your healing continues to build on itself and there is no limit as to what life (brain) you wish to create.

What do want out of this life? Decrease your exposure to threat physiology, increase time in safety, enjoy your life, heal, and thrive.

Homework

1. Take the Holmes-Rahe stress assessment test.
2. Write down the details of each category affecting your life.
3. Consider what percent of your time you spend fighting off stresses compared to nurturing joy. Where is your brain developing?
4. The most stressful stresses are the ones you can’t solve. It is why you must learn techniques to minimize their impact, calm your nervous system, and spend less time exposed to threat physiology.
5. What is one aspect of your life that is the most important to you? Write it down. Are you willing to pursue it?
6. Your body is a complex powerful survival machine. It has evolved to seek safety, deal with threats, break loose, and thrive. Allow it to do its job.

 References

1. Gabriel García Márquez. Cien años de soledad (One Hundred Years of Solitude. 1967. Editorial Sudamericanos, S.A., Buenos Aires.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Furman D, et al. Chronic Inflammation in the etiology of diseases across the life span. Nature Medicine (2019); 25:1822-1832.
4. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
5. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.
6. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.
7. Miron O, et al. Suicide rates among adolescents and young adults in the United States, 2000-2017. JAMA (2019); 321: 2362. doi:10.1001/jama.2019.5054 – Connection with cell phones made by Dr. Rob Lustig lecture on 12.1.21 – https://drive.google.com/drive/folders/182pygqTnS2GPQ4LUmioO06zkRf4-jpIH

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Anxiety is the manifestation of flight or fight physiology (how the body functions). The sensation evolved to be incredibly unpleasant, as life forms that ignored these signals didn’t survive. Humans additionally possess language to label these sensations, “anxiety.” We will do anything to avoid it. Suppressing it has even more severe consequences with an increased chance of opioid craving² and the hippocampus of the brain (memory center) shrinks.³ So, the only choice left is to mask it, which actually works – while you are masking. Opioids work well to diminish mental pain, as well as physical, and have been used for melancholy since ancient times.⁴

My perspective

Almost forty percent of my surgical practice was devoted to treating patients with infected spines from IV drug abuse. The problem arose from bacteria entering the blood from contaminated needles. The bacteria lodged in the disc space, which has a limited blood supply. Since there was no way out, the bacteria are trapped. This environment is ideal for growth and an abscess forms. Adjacent vertebrae are destroyed and break. Surgery entailed draining the infection and stabilizing the broken spine with screws, rods, and a fusion. These operations were complex, expensive, and risky. Occasionally, a patient would become paralyzed from the infection clotting off the blood supply to the spinal cord.

A minimum of six weeks in the hospital were required after surgery for IV antibiotics. I knew them well, and I learned some lessons from them.

• He or she would often shake in bed from crippling anxiety, which worsened their pain.
• Instead of increasing pain medications, anti-anxiety drugs were much more effective in lowering pain.
• No one chooses to be an addict – no one. Addiction begins with a need to relieve mental or physical pain and then the drug itself has addictive qualities.
• The destruction wreaked on every aspect of people’s lives is devastating.
• Once he or she calmed down, conversations were much easier.

What’s currently being done?

We are currently approaching the epidemic from almost every possible wrong angle. Why is this happening?

1. Not addressing the root cause

The biggest and most obvious problem is that modern medicine isn’t providing viable solutions to chronic mental and physical pain. We are focused on structural problems being the source of pain, and if we can’t find the “cause,” we just treat symptoms. Not addressing the root cause of a sustained flight or fight state, is a disaster. The reality is that everything is wrong in that every cell in your body is bathed in stress chemistry, on high alert, and your body breaks down.

2. Inadequate training

Physicians are remarkably well-intentioned, work too hard, and enjoy seeing their patients improve. But our training is woefully inadequate and not connected to ongoing scientific advances. Recent neuroscience research has provided answers to chronic pain but the knowledge hasn’t penetrated into mainstream medicine. The current definition is that chronic pain is, “……an imbedded memory that becomes connected with more and more life experiences and the memory can’t be erased.”⁴  It’s a complex neurological problem and we are treating it as a structural issue. It can’t and doesn’t work.

Your doctor doesn’t have the correct tools to solve your chronic illnesses. Both patients and providers are frustrated. It affects the doctor/ patient interactions. About 20% of physicians are comfortable treating chronic pain, and only 1% enjoy it. Many patients in pain feel labeled and discriminated against by many physicians. They are correct. The labels include, “drug seeker”, “malingerer”, “have secondary gains”, “difficult”, “addict”,and the list is endless. Once you are labeled, the person who placed the label has lost awareness of who you are. They can longer hear important details to help you heal. When a patient pushes to be heard, the situation may become unpleasant.

Even worse, many of the “mainstream” interventions have been demonstrated in numerous research papers to be ineffective and often cause harm.⁵ Many proven effective treatments are not readily available because they are not covered by insurance plans.⁶  Why do you think we have such an epidemic of chronic if we were treating it correctly? A significant percent of a medical system’s revenue is driven by these expensive and risky interventions.

3. Known data is ignored

Modern medicine is pretending to treat your chronic pain and is arrogant in dismissing deep research that reveals answers. A 2014 paper documented that only 10% of orthopedic and neuro spine surgeons are assessing and addressing the well-known risk factors for a poor surgical outcome prior to recommending surgery.⁷  You trust your doctor to implement a best practices approach and you’re repeatedly disappointed. With increasing frustration, your stress physiology remains elevated, and your pain worsens. Repeatedly dashing hopes also induces depression.⁸

4. No one is listening

A safe trusting healing relationship with your doctor is at the core of care. Other treatments have limited benefit without it. Physiology shifts from threat to safety, which induces healing. With short visits and huge demands from the system (the business of medicine), your physician doesn’t have enough time to know you.^9,10 Family, social, interpersonal, and work dynamics predictably overwhelm almost any treatment plan. Conversely, addressing these situational dynamics is a powerful way to enhance healing.

Chronic mental and physical pain is complex and layered on the uniqueness of each person. How can you solve any complex problem without knowing details? Major life-altering decisions are commonly made on an initial visit. Few people would build a house or even purchase a car with extensive research. The consequences of an ill-informed choices about your body can be devastating.

5. It’s the mental pain

Another problem is that mental and physical pain is processed in similar brain regions, and mental pain is even less tolerated than physical pain.¹¹ About fifteen years ago, I was perplexed by the severity of symptoms reported by many patients with essentially normal spines. I began to ask questions about their lives and discovered that most of them were dealing with unusual amounts of stress. I began asking patients, “If I could get rid of your pain or your anxiety, which one would you choose to address?” Most of them quickly answered, “ I can’t deal with the anxiety.”

A fallout of the the government’s focus of restricting access to pain medications is that patients are more stressed, which is inflammatory and further increases pain. Physicians fear prescribing even low-dose pain meds.

I recently saw two different successful businessmen for ongoing leg pain after each having two low back operations and their pain was much worse. I couldn’t see much wrong on the original MRI scans done prior to their first operations and the most recent scans didn’t reveal a cause for their ongoing pain. Finally, I remembered to ask them about their anxiety compared to the pain. Neither of them appeared to be particularly anxious. Both of them immediately said it was the anxiety that was the much bigger problem and they could deal with the leg pain.

Most my patients who have infected spines from IV drugs are overwhelmed beyond words with anxiety. They have been dealing with it for so long that they make no pretense of it being otherwise. It often began to be problematic in their early teen years and magnified by family and school dynamics. Opioids help mental pain. Even when on their usual doses of medications to prevent withdrawal symptoms, they are frequently physically quivering in bed from anxiety. Most physicians, historically including me, don’t ask many questions about anxiety and frustration.

6. Simplistic thinking

Successfully eliminating polio and smallpox epidemics, took a widespread public health effort at many levels, costing billions of dollars. But it was accomplished with an extensive cooperation between the government, private sector and medicine. The opioid epidemic is a far bigger problem cutting across all age groups and levels of society. Limiting access to opioids as the main focus isn’t going to make the smallest dent in the problem and, as already mentioned, is going to make it worse. Anyone can and will turn to illicit sources for medications. When you’re in unrelenting pain, you’ll do whatever it takes to survive. Getting drugs from marginal suppliers or from the streets is becoming a common occurrence amongst people who never remotely would have considered it. What else are you going to do, in light of fact that medicine is not providing alternatives to solve your pain? Many people have their lives consumed by the pursuit of drugs and pain relief. Patients have laughed at us when we ask about where they are obtaining their opiates. From their perspective it’s fairly easy and it feels like it is becoming somewhat of the norm.

Finding relief any way that he can

One typical case was that of middle-aged carpenter with low back pain, who had been able to work for years by taking a stable low dose of narcotics. He needed to keep working, so when the local pain center shut down, he felt he had no other choice but to use IV heroin. I met him in the hospital where not only was his spine infected, but it had spread deeply into his pelvis. He was extremely ill. He required three operations to drain almost a gallon of pus and stabilize his spine.

The viable solution

In defense of the current efforts, the opioid epidemic has caught the attention of everyone. However, they are working from a flawed paradigm regarding the driving force behind chronic mental and physical pain like they did when working on eradicating a specific viral infection with vaccines. Yet the answer is right in front of us.

The core answer is for the medical profession to embrace and implement what we learned in medical school. Sustained stress causes chronic illness and disease because of the body’s physiology, and not from structural causes.

These reactions are automatic, emanate from the powerful unconscious brain, and aren’t controllable with rational interventions. So, what is the solution? Lower your threat physiology. The treatment model is called, “Dynamic Healing” and threat physiology is regulated through three different portals. Your stresses (input) are processed in a manner to have less impact on your nervous system. Secondly is calming your nervous system. Finally, there are strategies to directly regulate your physiology from flight or fight to safety.

The reason there is a viable solution to the opioid epidemic is because most of the strategies used each portal are self-directed. They should still be in the context of good medical care. The details are beyond the scope of this discussion, but the bottom line is that as you attain the skills to lessen your exposure to stress/flight or fight physiology and increase your time in safety (rest and digest), your body knows how to refuel, regenerate, and heal.

References

1. Beyer, Don, Chairman. JEC (Joint Economic Commission Dems), 2021. https://www.jec.senate.gov/public/_cache/files/67bced7f-4232-40ea-9263-f033d280c567/jec-cost-of-opioids-issue-brief.pdf
2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9
3. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
4. A.R. Mansour, M.A. Farmer, M.N. Balikia and A. Vania Apkarian. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014): 32:129-139. DOI 10.3233/RNN-139003.
5. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
6. Heyward J, et al. Coverage of Nonpharmacologic Treatments for LowBack Pain Among US Public and Private Insurers.JAMA Network Open. 2018;1(6):e183044. doi:10.1001/jamanetworkopen.2018.3044
7. Young AK, et al. Assessment of Presurgical Psychological Screening in Patients Undergoing Spine Surgery. J Spinal Disorder Tech (2014); 27: 76-79.
8. Love at Goon Park: Harry Harlow and the Science of Affection. Deborah Blum. Perseus Books, Philadelphia, PA, 2002.
9. Presented by Daniel Alford, MD. Lecture: Challenges in Physician Education, Kaiser Pain Symposium, October 20, 2018.
10. Alford DP, German JS, Samet JH, Cheng DM, Lloyd-Travaglini CA, Saitz R. Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. J Gen Intern Med. 2016;31(5):486-491.
11. Lane RD, at al. Biased competition favoring physical over emotional Pain: A possible explanation for the link Between early adversity and chronic pain. Psychosomatic Medicine (2018); 80:880-890. DOI: 10.1097/PSY.0000000000000640

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There is no reward for being vulnerable for any species of life from one-celled organisms to homo sapiens. Consequences are severe and often swift. It is never safe to be off-guard, and different species create ways to be safe. They need to replenish fuel to fight another day. For example, a dolphin sleeps with one eye open. Many species form protective groups. Consider the number of ways creatures hide or camouflage themselves. Many species simply have thousands of offspring, so a few will survive. When these strategies fail, the final phase is whatever aggressive response they have available to them. The more strength and power, the better.

The added dimension of language

Humans have language, which creates another level of issues around seeking safety. We possess abstract thinking that allows us to engage in the arts, create coordinated societal actions, and have complex relationships with others. We rose to the top of the food chain because of our capacity to cooperate with each other. We have a strong evolutionary need to have close connections and relationships. For example, being socially isolated or lonely has the same effect on your health as smoking 15 cigarettes a day.¹ Look how much effort is put into seeing close friends and family during the holidays. We want to be with each other and the closer the better.

But one of the most perverse aspects of being human, is that successful thriving relationships require vulnerability and trust. These traits are the antithesis of feeling safe. Additionally, emotional/ mental pain is processed in a similar manner as physical pain.² “You hurt my feelings” and You broke my heart” reflect this phenomenon. So, we don’t like pain in any form, yet we have to become vulnerable in order to have deep and satisfying relationships. It is a huge problem, and it is not playing out well for the human race.

By definition, every interaction with another person requires taking a risk of being rejected or hurt. Even checking out at the grocery store involves trusting him or her to accurately document your purchases and help you with your bags. It is nice if they are in a good mood and are friendly. But what if they are having a bad day? Then there are deeper relationships such as being on a team, doing a project together, starting up any type of relationship, and living together. Being rejected at some level of the interaction is not only common, but also the rule. As you become more and more trusting, at some tipping point the level of vulnerability for that relationship will be reached, and one person will pull back or even reject it.

Your options

At this point, your choices are to 1) quit taking risks associated with interacting with others 2) engage but experience social anxiety 3) use whatever power you possess to control others 4) learn to be vulnerable. Since we don’t inherently possess the ability to feel vulnerable, the other less functional strategies are more commonly utilized.

Some form of anger is universal. Why? It keeps you safe. It protects you from both emotional and physical pain. Even if you don’t actually have the power to change the situation, you may feel like you do. Raw anxiety is intolerable and why we hold on to anger.

Why let go of anger?

• The main reason is that you simply cannot heal or thrive when you remain angry. The essence of healing is normalizing your body’s neurochemical state to that of a safety profile, which is profoundly restorative. If your whole system remains fired up, how can that happen? It can’t and won’t.
• Your brain structurally adapts to your focus of attention. You cannot move forward until you let go of the past, especially your deepest wounds. Most people in chronic pain remain angry at the situations or people who have harmed them. The more legitimate your gripe, the harder it is to move on. But how does holding on to the past make your life more enjoyable?
• Anger is destructive, as it is supposed to be. It’s your body’s last ditch effort to escape threat. It is destructive in every direction, including self-destruction. It is the reason why many people completely neglect every aspect of their health. It is tantamount to slow suicide.
• Anger is abusive and destroys relationships. The key element of successful human interactions is awareness of your needs and others’ needs. How else can you constructively interact with those close to you? Anger completely blocks awareness.
• Anger destroys families. Human consciousness evolved through language and social interactions. The ability to cooperate took homo sapiens from the bottom to the top of the food chain. The need for human connection is deep. Unfortunately, close connections are also the strongest triggers. Why would you ever be unkind to someone you care for so much? Why is the incidence of domestic abuse so high? It is maybe the most disturbing paradox of our human existence.
• Anger is the manifestation of the fight mode of the survival response. All organ systems are affected. The blood supply to your gut, bladder, and the frontal lobes of your brain diminishes and is shunted to your heart, lungs, and skeletal muscles. You can’t think clearly, although it might feel like you can. It is critical to, “Take no action in a reaction.”

Interacting with others involves taking the risk of being rejected or even hurt. There are physical risks, such as trusting a business partner who might run off with your money. What about your partner or spouse, who takes off with another person? These are deep ones, but simply reaching out to another person in friendship creates some level of anxiety.

Train your brain

You can use avoidance, suffer from chronic social anxiety, or resort to power and control to feel safe. The healthiest and most satisfying option is learning to be vulnerable and process rejection. In other words, being with anxiety. Being or feeling rejected is inherent to relationships, and unless you understand this, your world will become progressively smaller. Training yourself to lower your threat physiology (anxiety) instead of fighting it allows you to navigate life more easily. BTW, social connections are anti-inflammatory and lower anxiety.³ Addressing social anxiety is a bi-directional process. You can nurture joy, more easily interact with others, feel safer, and create the life you desire.

.

References

1. Cigna US Loneliness Index. Cigna: 2018.
2. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.
3. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42.https://doi.org/10.1016/j.bbi.2018.08.010

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“The gift of the unconscious “– life

The interoceptive nervous system is intertwined with every cell and organ in your body. The interpretation of these internal signals gives rise to consciousness. The warning signals evolved to be intensely unpleasant so as to compel the organism optimize function and act in order to survive. Conversely, sensations of safety became equally as powerful to drive cooperation and reproduction. The reward and warning system are both always active and in a delicate balance. This finely tuned interaction allows immediate action in either direction. However, since survival is clearly the primary need, unpleasant sensations will be more frequent. Most of the time, your actions will minimize them quickly, and avoiding physical pain and unpleasant sensations is how we are programmed to stay alive. This incredibly powerful complex unconscious system is the “gift of life.”

“The curse of cognitive consciousness” – RUTs

Language allows us to possess “cognitive consciousness”, and the capacity to describe these sensations. Meaning is given to the feelings generated by these neurochemical reactions reflecting danger and safety. Since we are always on some degree of alert for trouble, there is an endless stream of RUTs (repetitive unpleasant thoughts). Since physiology (how the body functions) affects every cell in your body, it is all encompassing, feels like who you are, and becomes a core part of your identity. So, the “gift of life” translates into the “curse of cognitive consciousness.”

Our brains become inflamed and hyperreactive with excitatory neurotransmitters and inflammatory cells when in flight or fight physiology. Humans describe these sensations generated from an activated threat response, “anxiety and anger.” They are physiologic states and not psychological.^1,2 Blood flow in the brain shifts from the neocortex (thinking centers) to the limbic system (fear and survival regions) so you cannot think as clearly when you are under real or perceived stress. An inflamed brain fires up even more RUTs, which are also perceived as dangerous and there is no end to this cycle.

                                                                     Goodtime/Adobe Stock

While we have an automatic withdrawal response (nociceptive system) for acute physical pain, there is no such response for mental pain. Suppressing RUTs only fires up threat physiology more and further creates more RUTS. There is no end to this loop, and we have no protection from mental pain.³

We attempt to create “good thoughts” from our conscious brain to counter the “bad” thoughts. This is an impossible task, as the unconscious brain continues to remain “fired up” and the bad thoughts continue to fly. Cognition requires conscious mental effort, consumes energy, is a gross mismatch of power, and is not sustainable. The unconscious brain processes between 20-40 million bits of information per second and our conscious brain deals with only about 40 per second. This interaction is why RUTs are so common, miserable for many, and the consequences are often severe.

Consequences of RUTs

One consequence is that well-intentioned people are more affected in that they may view themselves negatively because these thoughts are such a dark contrast to who they perceive they are or what they stand for. They don’t realize that these thoughts are interpretations of feelings generated from the unconscious brain. Efforts to combat RUTs often border on heroic, but the fallout is that people who potentially could significantly contribute to the common good are often crippled by anxiety (threat physiology) or just get worn down.

Less well-intentioned people may simply act out these thoughts and impulses without a lot of self-judgment. Hence, history is replete with tyranny and control. There is actually a physiological reward for power and control. Bullies have been documented to have lower inflammatory markers than average, whereas those who have been subjected to being bullied have higher inflammatory markers.⁴

Not only do humans expend a lot of energy fighting bad thoughts with good ones, but we also create “stories” to feel better about ourselves. We call it ego, self-esteem, or identity. As the powerful unconscious brain continues to keep us alive regardless of what we think or feel, there is no end to our efforts to create an identity that is bulletproof.

Another, more primitive solution, is exerting power and control based on these stories. The solution to anxiety is control, but without a way of decreasing RUTs, there is also no limit to what we do to control ourselves and others. These “stories” are often the basis evil actions. Once we label someone or a group of people as “less than” than we can justify any action in order to “bring them in line” or exterminate them. Labels are cognitive distortions that destroy awareness of details and the needs of others.^5,6

“The gift of cognitive consciousness” – choice

Anytime you are anxious or frustrated, you are reacting to something that was perceived as dangerous from the past. You are no longer in the present and cannot clearly see the details of the situation in front of you. You can will your way back to neutral or better for periods of time. But you have now lost choice, which is the gift of consciousness. It is truly a gift in that you can use the body’s property of neuroplasticity to create any brain (and reality) that you wish. But you cannot access it while you feel under threat. It is simply not possible.

The gift of our unconscious is life, and it keeps us alive at any cost. RUTs reflect this effort and are the curse of cognitive consciousness. Separating our identity from them and regulating our physiology from threat to safety allows us to access the gift of consciousness, which is choice. There are no shortcuts. You must  separate your identity from your survival reactions with awareness create choices. You are “letting go” (“Cing” first) in order to proactively move forward into creating the brain (neuroplasticity) and life you desire . Our lives can and will transform from reaCtive to Creative.

Why has this not been figured out long ago? Maybe it is because anxiety and anger have historically been placed into psychological/ mental categories instead of understanding they are such powerful activated physiological states. Avoiding the sensation of anxiety (vulnerability) drives most of human behavior. Much of it is dysfunctional and destructive. Medicine has not collectively acknowledged threat physiology as the driving force behind chronic mental/ physical symptoms, illness, and disease. It is no wonder that the burden of chronic disease continues spiral out of control.

The human race is a reactive species that knows how to physically survive. We have choice but can’t seem to access it with enough regularity to proactively create a thriving life and planet. Awareness allows choice and is where mental and physical healing begins.

References

1. Teed AR, et al. Association of generalized anxiety disorder with autonomic hypersensitivity and blunted ventromedial prefrontal cortex activity during peripheral adrenergic stimulation. JAMA Psychiatry (2022); doi:10.1001/jamapsychiatry.2021.4225
2. Takahashi A, et al. Aggression, social stress, and the immune system in humans and animal models. Front. Behav. Neurosci. (2018); 12:56. Doi: 10.3389/fnbeh.2018.00056
3. Wegner, DM. Ironic processes of mental control (1994); 101:34-52.
4. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.
5. Burns, David. Ten Days to Self-Esteem. Harper Collins, New York, 1993.
6. De Mello, Anthony. The Way to Love: The Last Meditations of Anthony De Mello. Doubleday, New York, NY,1992.

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Your Hand Over the Heat

If you were to put your hand close to a hot burner on a stove, what would happen to your level of anxiety?

• It would quickly escalate.
• You would withdraw your hand.
• You would protect yourself.
• Anxiety would be alleviated.

What would happen to your anxiety if you were forced to leave your hand over the burner?

• It would go through the roof.
• You would feel trapped and extremely angry.

I don’t believe you’re OK.

Anxiety is a Programming Problem

The changes to the central nervous system during chronic pain represent a programming problem rather than a psychological problem.

• Anxiety gains strength with time and repetition.
• Anger is a powerful force that covers up the feeling of anxiety
• Anger spins anxiety-inducing neurological circuits more quickly.
• We deal with anxiety by exerting some form of control.
• If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
• Without control, you become frustrated or angry. Anger = loss control

With chronic pain, you have, metaphorically, lost your ability to “withdraw your hand from the red hot burner.” How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain alone would be enough to destroy the quality of your life.

There are several other stress factors to consider with chronic pain.

• People in chronic pain don’t see an end to their suffering. They lose hope in returning to a pain-free life.
• Chronic pain patients are truly victims of pain. So it’s more difficult to let go and not have anger run your life.
• When chronic pain patients suppress anxiety and anger, these negative feelings become much stronger. (2)  White Bears and ANTS.

Being Pain-Free is a Basic Need

We all deserve to live free of constant pain. Being pain-free is a basic need. It has been shown that the impact of chronic pain on a person’s quality of life is equivalent to having terminal cancer. (1) We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies. I discuss this in “Maslow’s Miss”  and in the video: “Your Hand Over the Stove.”

“The Link Between Pain and Anxiety”. Inspire, January 21st, 2013

1. Fredheim OM et al. “Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients.” Acta Anaesthesiologica Scandinavica (2008); 52: 143 – 148.
2. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.

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In 2003, a neurosurgeon performed a laminectomy of his neck. That’s an operation where the lamina or the bone over the back of the spinal cord is removed to relieve pressure. He seemed to improve for a little while. In 2005, his symptoms worsened, and in 2009, he underwent a fusion through the front of his neck between his 5^th and 6^th vertebrae. Again there was a slight improvement but two years later he was in my office with crippling pain throughout his whole body.

Normal studies

As I talked to him, I could see how desperate he was for relief. He also wasn’t sleeping and his anxiety and frustration were a 10/10 on my spine intake questionnaire. I couldn’t find any neurological problems on my physical exam. When I looked at his neck MRI, I could see where the two prior surgeries had been performed, but there were no pinched nerves. The alignment and stability of the vertebrae were also fine. He also had undergone several workups of his brain and the rest of his nervous system. Everything was normal.

When I explained to him that I did not see a structural problem that was amenable to surgery he became understandably upset.  He was stuck on the idea that the prior surgeries had helped and that I was missing something. It didn’t matter what I said or how I explained the situation to him. He wasn’t buying it.

What I didn’t tell him was that I had also looked at his scans he had prior to undergoing each surgery. Telling a patient that they did not really need a prior surgery is a very unproductive, unpleasant interaction; I didn’t see why this patient’s prior surgeries were performed. On the first MRI of his neck, there were no bone spurs and the spinal cord was completely free. There wasn’t a structural problem that could have been corrected by surgery. On the scan before the second operation, there also wasn’t a hint of anything that could be causing any symptoms of any type.

The power of placebo

What’s difficult for patients (and physicians) to realize is that the placebo rate for any medical or surgical treatment is between 25-30% or even higher. The response and improvement is not only real but is powerful. It is the result of your body’s own healing capacity. It is a desired response, and you feel less pain.

The pain-killing effects of a placebo are reversed with Narcan, which is the drug used to reverse the effect of narcotics. There is a part of the frontal lobe of your brain that shuts off pain pathways for short periods of time. Another example is the placebo effect of cardiac medications causes the heart rhythms to actually change. Just because a prior surgery or procedure on normal age-appropriate anatomy might have been temporarily effective is irrelevant. It should have nothing to do with current decision-making. I tell my patients “If I can see it, I can fix it” and  “If I can’t see it, I can’t surgically correct it.” It’s critical to have a specific structural problem with matching symptoms before surgery becomes an option. Surgery: The Ultimate Placebo

I suggested that he take a look at the DOC website and I would be happy to explain the whole program to him in as much detail as needed. He was so angry that I didn’t think I’d hear from him again.

Early engagement

Over the next couple of months, I received a couple of emails and had a telephone conversation that seemed to go pretty well.  He was willing to engage in the DOC protocol and began some of the writing exercises. I had a second phone conversation with him a couple of weeks later that seemed to go even better. He was able to recognize that his thought of me “missing something that needed to be fixed” was an obsessive thinking pattern. I was encouraged and thought that maybe I had been able to break through his “story.”

Time went by and our third and final conversation was dismal. He couldn’t let go of the thought that “something was being missed” and that his seventh cervical vertebra was “out of alignment.” I assured him it was OK. As a surgeon, I am also quite obsessive about not missing problems that I can fix. At this point, it didn’t matter. He’d found a surgeon who was going to fuse his neck.

Injury conviction

Physicians use the term “injury conviction” to describe this phenomenon. It is the relentless pursuit of a cause for your symptoms that is well beyond reason. My concept has changed in that I feel this pattern of thinking becomes its own irrational set of neurological circuits. It is similar to phantom limb pain and my term is “phantom brain pain.” Regardless of whether the original source of pain is there, the symptoms are the same. Rational arguments have absolutely no effect.

Hell

I wrote a post Anxiety and Anger: The Highway to Hell. Unfortunately, if you’re in this pattern, you’re in Hell, and the only way out is through you. The deep tragedy is that if you don’t realize you’re in Hell, you’ll remain there. I never give up, but I have learned to let go when I can’t penetrate that firewall of obsessive thinking. For those of you that have let yourself out this hole, I am open to suggestions as to what gave you the insight to move forward. Awareness is the basis of the entire DOC process and is always the first step.

I don’t know how many more tests and surgeries he’ll undergo over the next 30 years. The personal cost to him and society will be enormous.

What’s puzzling is that if any of the surgeons who’d chosen to operate on this man’s essentially normal anatomy were examined by a board examiner about their indications for his surgeries, they’d be failed immediately for giving a “dangerous answer.” It’s our medical responsibility to you to not offer risky procedures that have been documented to be ineffective.

Video: “Get it Right the First Time”

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• Connect mainstream medicine with existing science – most symptoms, illness and disease  are created by the body’s physiology (how it functions), and not structures.
• Establish the necessity of a trusting dynamic relationship with your clinician. Feeling heard and safe is not a luxury. They are healing modalities in that they shift physiology from threat to safety. Also, if we don’t know you and understand the details of your situation, how can we make accurate decisions.

Most chronic mental and physical disease is caused by the body being in a sustained state of flight or fight (threat physiology). The fallout of treating most diseases from a structural paradigm isn’t effective and causes harm. It is particularly damaging in spine surgery, and the rates of spine surgery for chronic low back pain continue to skyrocket. It eventually became clear that we were performing low back fusions for anxiety (sensation created by threat physiology) with a success rate of less than 30%.¹

Understanding chronic symptoms, illness, and disease

My efforts evolved out of my own 15-year struggle with chronic mental and physical pain. Most of my approaches failed and then some began to help. As I pursued treatments that worked and abandoned the ones that didn’t, I inadvertantly escaped out of this Abyss in 2003. All 17 of my symptoms resolved and continued to improve. However, I still had no idea why I become ill and why I healed. I was shocked, as many of my fellow clinicians, that the answers have been in literature of over 60 years.

In 1962, two researchers clearly documented that stress causes illness, disease, and early death.² I was aware of this data, but I did not connect the dots. I treated my patients from the paradigm that it was my responsibility was to find a structural cause of pain, and I felt badly if I could not find a reason to perform surgery. I aggressively performed fusions for low back pain for the first 8 years of my practice. When a paper out of Washington State³ showed a success rate of less than 25% for low back fusions for pain, I stopped doing them, but did not know what to do.

The healing journey

My current approach represents what I learned from my struggles, witnessing what helped hundreds of my patients heal, and now understanding the science behind these concepts. The DOC Journey course and app and my other efforts are simply a framework that presents documented science in amanner and sequence that is accessible by patients and clinicians. My vision is to connect medicine with known science of chronic stress causing illness, with the fundamental idea being that the doctor patient relationship is at the core of healing. If a patient can’t feel safe with their health care provider, the rest of the treatments are of limited value.

Many people heal with just these self-directed concepts, but outcomes are always better and more consistent with added resources. This framework is intended to allows patients to take charge their care, the clinician can leverage his or her efforts, and provides a long-term template for ongoing learning and healing. It evolved out of my busy practice with increased efficiency, effectiveness, and enjoyment. It is inspiring and energizing to witness patients emerge from hopelessness to thriving.

An important aspect of these concepts is the clinician learning and implementing these approaches in their personal and professional life. A dynamic working partnership can  then be created when both parties understand these healing principles. These resources are an adjunct and/or foundation for other clinical practices, and not an alternative.

Anxiety is a physiological state

It took me many years to realize that anxiety is not primarily a psychological issue. It is the intentionally unpleasant feeling generated by your body when in flight or fight. Avoiding this powerful sensation is the driving force behind human behavior, and much of it is dysfunctional. We are not taught how to regulate our body’s danger response. Our conscious brain is no match and our efforts to control it create a lot of misery for us and those around us.

It is actually a gift that keeps us alive. This survival warning signal is necessary, and the key is developing a “working relationship” with it. It is what you have and not who you are.

This is an article I wrote for Psychology Today regarding the mental health crises.

Obsessive thought patterns and OCD

Crippling anxiety is what almost took me out. It initially manifested with panic attacks and progressed to severe OCD (Obsessive Compulsive Disorder) for over 15 years. The hallmark of OCD is repetitive intrusive thoughts that for me became quite intense. I had “internal OCD” which consists of a disturbing thought following by a compensatory counterthought. There were no external behaviors. So, I had no idea of what was going on, and there seemed to be no endpoint.

OCD is relatively common,⁴ and variations include nail biting, hoarding, body image disorder, skin picking, hair pulling, and eating disorders. Additionally, many if not most people are bothered by disruptive thought patterns or ruminations, which detract from quality of life. One could also consider addictive behaviors in light of efforts to escape these repetitive unpleasant thoughts. Much of the mental health world views OCD and ruminating thoughts as unsolvable and the approach is to manage them. The missing link is that threat physiology is not being adequately addressed. Half the brain consists of glial cells, which have cytokine receptors and are part of the immune response.  A fired-up brain fires off a lot of thoughts.

My hypothesis is that RUTs (repetitive unpleasant thoughts) are a major driver of chronic mental and physical disease by stimulating sustained threat physiology. Humans are trapped by unpleasant thoughts with the main variables being frequency and intensity. They are a universal function of human consciousness. They may be a significant factor in driving teens to commit suicide, “deaths of despair.” However, I am seeing RUTs create misery in every age group, and as young as 6 years old. RUTs were the main source of my misery followed closely by social isolation.

I no longer suffer from OCD, and I escaped from this Abyss over 20 years ago. I don’t even have the disruptive thoughts I had before I became ill. It has taken many years to figure out how and why I escaped from these obsessive thought patterns. High level achievers are particularly prone to them. This is a link to the section I created on my website that presents my concepts of a solution.

This RUTS section is a rough outline of my upcoming book. Solutions are discussed first and the background of the problem later. There is a large body of research of the mental mechanics of the brain, physiology, consciousness, and effects of stress. I learned a sequence of healing while helping many other people out of this hole and it continues to evolve.

Action needed soon

The burden of chronic disease continues to rise in the US and lifespans are dropping compared to other developing countries. We spend almost four times as much per capita as any other nation.⁵ The business of medicine has essentially kidnapped all of us – clinicians and patients. How can thoughtful decisions be made without patients feeling heard and clinicians not understanding all of the dimensions of their lives generatingthreat physiology (anxiety)?

Performing risky and expensive interventions that are not data-based are causing a lot of harm. “First do no harm.” Individually and as a society, do we embrace this core manifesto or is this just rhetoric? I feel there is some urgency for change as the fabric of our society is coming apart.

Clinicians allied with patients are the only possibility of taking back our medical care. It will require ongoing collaboration from all parties. Whether my resources or another similar set are utilized, we have to treat people in a manner that honors the body’s physiology and capacity to heal. We have the data. Let’s implement what we already know!

References

1. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
4. Carmi, L., Brakoulias, V., Arush, O.B.et al. A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC Psychiatry22, 190
5. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.

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