10 years in a wheelchair

Jane, a woman in her early 60s, was exactly such a patient. She’d lived with severe scoliosis all her life. Then, in 2001, she was rear-ended while driving, and the following year, she had a bad fall while grocery shopping. By the time she came to see me, she had severe pain everywhere. She’d been using an electric wheelchair for nearly a decade. She was taking over 200 mg of morphine per day and high doses of anti-anxiety drugs.

When I examined her, she was tilted forward and to the left, barely able to stand. Her spinal curve was severe enough that I recommended surgery but I warned her that the treatment had a high rate of complication.  Because of this, it was unsafe to do the operation until her medications were stabilized, her pain significantly diminished, and she was more mobile. The term we use is “prehab” or rehabilitation before surgery to optimize the outcome.

I gave her my book, Back in Control and referred her to a colleague to coordinate her care. She was not that interested and they mutually agreed to not continue care. Eight months passed and I saw her on my schedule. I was curious because I knew the size of her curve and the severity of her pain. High-dose narcotics makes it all the more difficult because they sensitize the nervous system. I did not have high expectations…

Out of the wheelchair

I was shocked when I walked into the room and there was no wheelchair, walker, or cane. She was standing up to greet me. She was off all of her medications, had no pain, and was working out in the gym three times per week. She was animated, smiling, and engaging. I ended up an hour behind in schedule, as I wanted to find out what had turned her life around.

Jane admitted that she had spent the last 10 years sitting alone in her house stewing over all the wrongs that had been done to her. She only went out when necessary. After understanding the linkage between anger and the pain pathways, she decided to forgive. She forgave her ex-husband, the person driving the car that had hit her, the people involved in her legal battle, and the medical system that had not helped her. This process took several months to work through – but within weeks of doing so, her pain began to abate.  She still had scoliosis but as her pain diminished, she stopped stooping over protectively to guard her back. She now could stand up straight and tall.

Reconnecting through forgiveness

Forgiveness researchers, such as Dr. Fred Luskin, have shown how rumination and anger influence central and autonomic nervous system function and impair functioning of the hypothalamic-pituitary adrenal cortical axis (stress system). While forgiveness is seen as a coping mechanism that helps to relieve the stress of anger, it also has direct and indirect effects on health and nervous and endocrine function.

It has been my position that anxiety-induced anger is the driver of chronic pain. The manifestations of unrelenting anger are profound and one of them is becoming socially isolated. Now you have all the time in the world to think about your pain and all the ways you have been treated badly. You body is full of adrenaline, which decreases the blood supply to the frontal lobe (thinking area) of your brain. Indeed, it is well-documented that patients’ brains shrink in the presence of chronic pain. Between the adrenaline and not using the creative part of your brain, that would make sense. Fortunately, your brain will re-expand with resolution of the pain. (2) Anxiety, anger and adrenaline

Social isolation

Besides moving too fast, our modern societal structure does not encourage us to interact with each other in a meaningful way. I read a US News & World Report article several years ago, which reported that the average number of close friends that person in the US had was 2.2. That means that many people have essentially no close friends.

I am a pretty social person but when I was in the midst of my own burnout I became isolated. It wasn’t that there weren’t people around. I had so many intensely negative thoughts about myself whirling around in my head that I couldn’t believe that anyone would want to hang out with me. The loneliness was crushing. When I arrived back in Seattle in 2003, a close friend invited me over for a barbeque and I was shocked. I have not forgotten that day and it was the beginning of my re-entering life.

People being with people

We have held three five-day Omega workshops and this year we will be putting on a weekend seminar with Dr. Bernie Siegel, author of Love, Medicine, and Miracles. My priority was to create a safe environment where people could be with other people and share experiences. One of the most effective ways to re-connect is play and as people began to relax and laugh their pain would disappear. Of course it, returned when they returned to the real world and their triggers. But most of the participants learned the skills to consistently remain out of pain. The more satisfying aspect of the process though was that as the pain abated many re-engaged with their lives in a much more powerful way. Play

As we presented our material throughout the week, I realized that we did not have to do much. It was the participants being with other people that created healing. It was remarkable. Dr. Louis Cozolino wrote an exhaustive review in his book, The Neuroscience of Human Relationships. (3) He points out that humans evolved by interacting with other humans. Therefore, the consequences of becoming isolated are consistent and often severe. Studies out of Australia have shown that there are damaging mental health effects when workers become disabled and out of the workflow of the day. Sitting around the house without a sense of purpose is not a great way to thrive. (4)

One of the first Omega participants sent me this video link. She experienced profound healing after being in pain for over 35 years and has been a true inspiration. TED talk: Our lonely society makes it hard to come home from war

This Fox segment was filmed with another one of our Omega participants. She has a great story amongst many others. We never anticipated the power of people healing people.  Video: Write your way out of pain

Jane was in a wheelchair for over 10 years and on high dose narcotics with a severe spinal deformity. It was by her working past her anger, getting out of the house and re-connecting with her friends did she heal. No medical treatment can replicate the power of the body to heal itself. Anger disconnects – play connects.

1. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.
2. 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.
3. Cozolino, Louis. The Neuroscience of Human Relationships. Norton and Co. New York, NY, 2014.
4. Waddell, G and Kim Burton. Is Work Good for Your Health and Well-Being? TSO. London, England, 2006.

Listen to the Back in Control Radio podcast Social Isolation and Chronic Pain

The taste of freedom – Omega 2017

Social Isolation and Chronic Pain

The post The Pain of Social Isolation first appeared on Back in Control.

The post The Pain of Social Isolation appeared first on Back in Control.

• Social isolation is both a contributing factor to anxiety and also a result of it.
• When you are suffering, it is challenging to reach out to others in a meaningful way.
• The physiological effects are devastating, with significant mental and physical consequences.
• It even affects the expression of your genome (DNA) in forming aggressive inflammatory cells that destroy your own tissues.
• The loneliness and isolation that many people experience is one of the worst aspects of the whole experience of dealing with chronic illness.
• Conversely, reconnecting with your family, friends, and colleagues is a powerful force for healing.
• The catch-22 is feeling good enough to begin reaching out. It is one of the reasons that there is a sequence to the healing journey. Each person is ready at a different point along the way.

Loneliness and social isolation may some of the worst aspects of suffering from any chronic illness. Over 50% of Americans are socially isolated regardless of where they live or the size of the town or city. It is ironic in that social isolation is such a significant contributing factor to poor health in this modern era. It is also dangerous. It is estimated that the effects on one’s health is equivalent to smoking about 15 cigarettes/ day.¹ Sadly, the age group that is the most affected are those in college and in their 20’s. This stage of your life has the potential to be the best of times.

 Consumed by suffering

When suffering from crippling anxiety and other physical symptoms, you spend a lot of your conscious hours looking on the Internet, seeking medical care, trying different treatments, and discussing your problems with anyone who will listen. Why wouldn’t you? Your life has been consumed and you want it back. Unfortunately, in spite of your best efforts to move forward, from a brain development and physiological perspective, you are moving the wrong direction. Here are some of the effects:

• Unpleasant circuits in your brain are reinforced.
• Pleasant one become less active with disuse.
• You drive people away that you used to have fun with and bond with others who are in a similar condition.
• Eventually, many people are so drained from the endless battle with their suffering, they become isolated, even in the midst of their own family.
• Oxytocin is a hormone that causes social bonding and is also powerfully anti-inflammatory. Lack of connection drops it down and your inflammatory state becomes even higher.

Some data

The effects of social isolation are deep. They go right down to the expression of your DNA directing the production of proteins that are the essence of life. There are about 20-30 genes that effect the production of certain white blood cells called monocytes. White blood cells are at the core of fighting foreign material in your body, including cancer cells, viruses, and bacteria. There is an over-active form of them called, “warrior monocytes” that are too aggressive and also attack your body’s own tissues creating many diseases states and symptoms. Anxiety is one of these inflammatory states. The most powerful factor causing the creation of these cells is social isolation. The second factor was chronic stress (anxiety).²

Dr Dantzer wrote an extensive review paper³ looking at the social influences on inflammation. There are many factors that affect inflammatory markers, and he presented the top four factors that lowered inflammation.

• A sense of control
• Hope/ optimism
• Positive affect/ attitude
• Social connection

Humans evolved by having language and being able to cooperate through social connection. It is the reason we are so tribal, and unfortunately, we haven’t evolved enough as a species to view every person as part of the human tribe. There is an evolutionary basis for excluding groups of people, as we compete for resources. That being said, social connection is a deep need, and it is expressed in your physiological state.

Another paper out of UCLA reported on a study where a volunteer was placed in a special MRI scanner called a functional MRI (fMRI). It highlights area of increased brain activity. The volunteer then played a computer-based video game where he or she was in a game of three-way catch. The computer was programmed at a certain point to exclude the volunteer and the ball was “tossed” between the remaining two players. The volunteer did not know the other two players were just the computer. Guess what? Even though it was just a computer game, and the volunteer could not physically see the other players, the centers of the brain that are active in chronic physical pain lit up. In other words, emotional pain is processed in a similar manner. ⁴

The catch-22 of social isolation

I will only say that becoming socially isolated and feeling lonely was one of the worst aspects of my 15 years of suffering. The only word that slightly described the feeling was, “crushing.” I began to experience deep self-deprecating thoughts that revolved around, “why would anyone want to hang around with me?”, and “I don’t have anything interesting to say.” These thought patterns were endless. This occurred despite me generally being very social person. Just the feeling of being lonely felt like an Abyss and was paralyzing with regards to re-engaging. I really could not see an end to it.

Healing

I noticed very early on that my patients would check off, “re-engaging with family and friends” as part of their healing. Social interactions are tricky in that you be rejected sometimes and hence one of the reasons people have social anxiety. It is greatly magnified when you are already experiencing chronic mental and/or physical pain. So not only do you not have the energy to reach out to others, feeling inadequate may also contribute. Here are some suggestions.

• Be kind to yourself. You are doing the best you can.
• People who you used to be friends with may not have as much in common with you and you may be rejected.
• Others you have bonded with through your pain may also reject you as you heal. You are no longer validating their suffering, and as you heal, they are confronted with their own inability or unwillingness to pursue the same journey.
• So, the first step in returning to a normal life, is to be prepared for these kinds of interactions.

Then just move forward in any way that you can.

• Call old friends or family members. Many of them are in the same condition you are. It is remarkable how common it is to be trapped by anxiety and pain. However, as mentioned many times, conversations around these topics are counterproductive for all parties.
• Re-engage with old skills such as art, music, and hobbies.
• Read interesting books or watch inspiring movies. They are great topics for conversation.
• Join a club. You don’t need to be an expert. There are numerous choices such as birdwatching, Scrabble, ping pong, book, movie, and history clubs, walking with friends, and music.
• Find ways to give back and there are endless options. One of my successful patients was “trapped” in a nursing home and spiraling back down into the Abyss. She decided to become an advocate for other patients who had dementia. Within a few weeks, her whole mood and outlook dramatically improved.

Recap

Loneliness is crushing and both a contributing factor to chronic illness and also a result of it. A significant aspect of healing is reengaging with those around you. What makes this all the more difficult is that while you are suffering, you may not have the interest or energy to reach out to others. Then if you are still in the mode of discussing your troubles, you will push people away who can nurture you, or attract others who are also frustrated with their suffering, and they will pull you deeper into The Abyss. This cycle is deadly.

That is why you must empirically make decisions to keep reaching out and connecting regardless of how you feel. You will feel awkward, especially when you have taken medical conversations and complaining off of the table as topics. The connections can be as simple as a phone call, reaching out to old friends, or joining a book club. The key is doing something – anything to reach out and break out of your patterns.

Humans and language evolved through language and social connection. It is one of the most basic of needs. Actively reaching out and giving back is a powerful move to stimulate your brain to rewire and heal. To have a good life, you must live a good life. It requires practice.

 Questions and considerations

1. You might be sitting here and feeling overwhelmed by the thought of even trying to reach out. That is OK and understandable. You can’t just flip this one around on a dime.
2. Just do something. Anything. You have heard the term, “baby steps” many times.
3. The problem is that when your brain has been barraged with negative thought patterns, you may feel people may not want to be around you. That is a classic common cognitive distortion of, “mind reading.” Maybe they don’t and you also have to be OK with that. Maybe they are in the same situation as you are and don’t have the energy to engage.
4. I can personally vouch for how distorted thinking patterns become from my own experience. For a long time, even after I was much better, I was still quite self-conscious.
5. Humans evolved by interacting with other humans. Somehow, re-engaging with life has to be part of your healing journey.

References

1. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
2. 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

3. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42. https://doi.orgl/10/1016/j.bbi.2018.08.010
4. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.

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Feeling safe

The DOC Journey is based on our three and five-day workshops that we have held since 2013. From the beginning we were amazed how many people would break free of their pain within time frame of the workshop. We always warned them that they would dive back into The Abyss when they returned home to their “triggers.” But somehow they had reconnected to the part of their nervous system that was safe and relaxed. Once they tasted that deep sense of peace and connection, they had a sense of what was possible. They would learn their own ways to return to that state. Many moved on to a life they had never before experienced.

I had not expected such a response and did not understand what had happened. But every workshop was a similar experience. I finally concluded that I wasn’t doing that much, but the shift was because people were learning and sharing enjoyable experiences in a structured and safe environment. Several participants described it as being in an adult summer camp.

Research shows us that loneliness causes many physical symptoms including chronic pain and, of course, being in pain is isolating. (1) Social connection is a deep basic human need and the foundation of how we developed language and human consciousness. It is tragic that over 50% of Americans are lonely and socially isolated. (2) Social isolation is crushing to your soul.

Characteristics of success

There is never an exact answer to a given person’s specific situation, since each one of us is so unique. However, there are some patterns that have emerged in patients who have done well.

• Back in Control: A Surgeon’s Roadmap Out of Chronic Pain provides a foundation and framework for moving forward.
• The sequence of learning is critical in that you have to understand the nature and parts of a problem before you can solve it.
• You can’t move forward until you have broken the links to the past.
• It is critical to implement the strategies that work the best for you into your day-to-day life. They are not difficult, but just passive learning doesn’t work.
• Re-engaging with friends, family, and your community is a powerful aspect of healing.

All these variables are important. Chronic pain is a complex problem and simplistic isolated treatments can’t and don’t work.

Our online Q&A

What I again did not anticipate was how effectively a community could be created online. It almost seems have had more impact than our in-person workshops. Here is one participant’s email.

The Q&A sessions I attend 2x per week are such an important part of my support system as I’ve started navigating The DOC Journey. I’ve suffered with chronic pain for over three years, and after two spine surgeries that provided no relief of my symptoms, I felt very alone and confused. I found this special community during a time when I felt little hope, and I know the timing was providential. As I process my journey with others that understand what I’m going through, I am able to give and receive support and encouragement, along with obtaining many tools that are making a significant difference in how I am able to show up in my life. This community is something I will always be grateful for!

Overview of the sessions

The Q&A format is a powerful force in creating change. We know that human connection is essential for health and that being socially isolated has detrimental effects on your health. One of the consequences is chronic pain. There are other manifestations and the effects are estimated to be equivalent to smoking 3/4 of a pack of cigarettes per day. (2)

Rules of Engagement

Much of the effectiveness of The DOC Journey is stimulating the formation of new circuits in your brain that bypass those that are creating pain. Your brain will develop wherever you place your attention and one of the reasons that any patient of mine was never allowed to EVER discuss his or her pain with ANYONE except their medical providers.

• The cardinal rule of participating in this group is never discussing your pain or medical care – even if asked.
• Ask yourself what you can do to be of help to others on the Q&A.
  • Specifically, please be mindful that each person in the small group breakouts of 3-4 has a chance to share.
• Understand the concept of mirror neurons-your mood has a direct mirror neuron effect on others. The term is called “co-regulation.” (3)
  • I have personally found that a little expressive writing, active meditation, or breathing exercises before the session is a big help if I am a bit out of sorts.
• Although your participation with comments and questions is welcomed, please don’t feel obligated. We want you to feel comfortable with the group.
• The sessions are intended to deepen your skills and answer questions. It is not focused on teaching. Reading my book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain will provide the framework for you to move forward.
• The DOC (Direct your Own Care) Journey provides a sequence that will keep you moving forward and it is based on our workshops. The sequence is:

• • Awareness
  • Hope
  • Forgiveness
  • Play

Meeting Agenda

• 11:50 – noon – Informal discussion/ catching up
• 12:00-12:05 – Relaxation exercise
• 12:05 to 12:15 – Didactic session/Sharing successes and challenges
• 12:15 to 12:30 – Open discussion and questions
• 12:30 – 12:50 – Small group breakout sessions – discussions will be based that day’s topic or what may have been brought up in the sharing session.
• 12:50 to 1:00 – Closing discussion

I will be prompt regarding time and will stop the didactic/ sharing at 12:15 – 12:20 and we will begin the open discussion. Please email me at dnhanscom@gmail.com with questions you’d like addressed or if you would like to share your perspective. You don’t have to be pain free to share. Small victories are the key to all of this. We would like to find out what you have found useful.

Letting go

The DOC Journey is a paradoxical one at almost every step. Repeated conversations are helpful in learning to process your environment in a different manner. Hearing about other approaches is helpful, but the best part is sharing your challenges and success with others.

References:

1. Cacioppo, John and William Patrick. Loneliness: The Need for Social Connection. Norton, New York, NY, 2008.
2. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
3. Porges, Stephen. The Polyvagal Theory. Norton, New York, NY, 2011.

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Loneliness causes many physical problems including a higher mortality rate equivalent to smoking 15 cigarettes per day. Mental health problems continue to increase and approximately 1 in 6 adults suffer from a mental health condition. Most also suffer from loneliness. (1)

Anxiety is the driver

I have observed from working with many patients and my own experience with loneliness during my ordeal with chronic pain, that there is a circular interaction with anxiety, anger and becoming isolated.  For many, I feel the starting point is anxiety, which is the pain.

There are an endless number of reasons for humans in this day and age to have disruptive anxiety. This has been endlessly discussed in the media. However, once it kicks into gear, there is no turning back and it will become relentlessly progressive. Since is an automatic unconscious survival response that is much more powerful than your conscious brain, you can’t control it or solve it with rational means. You also will never be rid of it, since without it, you would not survive for more than a few minutes.

The key to lowering anxiety is learning to assimilate it into your life. It is intended to be unpleasant, since it is your basic warning system. As you learn to work with it and quit fighting it, you will be able to lower your stress chemicals and de-energize it. Anxiety both protects you and also allows you to navigate new challenges.

OCD

The interaction I experienced while in pain was that I was crippled with anxiety in the form of disruptive unpleasant thoughts that evolved into an obsessive compulsive disorder (OCD). I had become a major spine surgeon by suppressing anxiety and wasn’t connected to it. I also thought anxiety was a psychological problem when it actually is simply a physiological reaction to a mental or physical threat.

As my anxiety progressed, I became more isolated. My patterns of thinking changed dramatically, and I was consumed with thoughts of self-deprecation and why would anyone want to hang out with me? This was occurring in spite of me historically being a social person to a fault. I had a wonderful group of friends from middle school on. There was no new activity I was not up for trying. In college, I took more than a full academic load, worked heavy construction 10-20 hours a week, played intramural sports, and spent a lot of time with my friends. I don’t remember sleeping much.

Trapped

As I spiraled down with progressive anxiety, I became severely depressed. I now know that depression is a group of symptoms driven by anxiety. The isolation progressed rapidly over five years, in spite of having warm and very nice people around me. I couldn’t connect. I was so busy trying to survive, I couldn’t reach out to others. As others tried to reach out to me and failed, they eventually quit trying as hard, which only made it even harder for me to. I don’t have the words to describe the feeling, but it was crushing, suffocating and one of most intolerable experiences I have ever had and, even worse, there did not seem to be a way out. I use the word, “Abyss” to describe being in chronic pain. I think the loneliness was a step beyond or below. Even thinking about it 20 years later is causing my stomach to knot up.

My depression became severe. I lost all hope in spite of aggressively seeking professional help and reading many self-help books. One that I picked up was, Darkness Visible: A Memoir of Madness, where the author described his own struggle with major depression. (2) What struck me was that he was famous, wealthy, and had recently received a lifetime achievement award for his literary excellent. In spite of it all, he was miserable. What struck me about his story, is that he didn’t find or offer a solution. He  had nowhere to go and just remained in one spot. I couldn’t explain what happened to me but I felt a deep shift. That is all I can say. I did not immediately begin to heal, but I somehow realized that I was on the wrong track in my endless pursuit of a cure. The answers where inside of me. In an odd way, I gave up, which turned out to be the eventual answer.

It is OK to be on “The Bottom”

It is OK to be depressed. Anxiety is normal and fighting it gives it more power and it does become disruptive. Your brain will develop wherever you place your attention, especially if you are suppressing. By remaining still, I gave myself some space to heal. I become aware of many aspects of my life and experience that weren’t possible while I was traveling so fast. I quit trying to fix myself and inadvertently allowed my brain to heal. I became more connected to me.

This song is written and performed by my nephew, who I have spent many hours talking to about anxiety, depression, and life. His struggle with it was epic but he not only made it through, he is thriving. One of his gifts from the ordeal is having insights into the magnitude of the problem and has a deep appreciation for life. This song, The Bottom, reflects his perspective.

Alex Hanscom – The Bottom

Learning to be with yourself, including your fears, is key to moving forward in life on your terms and not at the mercy of other’s opinions. It is also much easier and you are able to reach out to others and be aware of their needs. It works the other way around in creating an upward spiral. I have rekindled many friendships because I have healed, but my connections are also part of the healing journey.

1. Cigna U.S. Loneliness Index. Published survey results, 2018.
2. Styron, William. Darkness Visible: A Memoir of Madness. Random House, New York, NY, 1990.

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For some, the holidays are synonymous with a strong sense of familial closeness and love. However, this is not the case with many family gatherings, where relatives trigger each other, and chaos quickly ensues. If this describes your experience with the holidays, then this article is for you.

I’ll never forget one Christmas break during my second year in medical school. I hadn’t been home for two years because of study and work demands. I was excited to see my family. Within five minutes, my mother launched into a fight that had started two years earlier. She picked it up almost to the sentence. I was both dumbfounded and upset. This wasn’t part of my vacation plans.

This isn’t an uncommon occurrence.  You’ve waited all year to be with those who you love, and people aren’t getting along. It goes both ways in that loneliness is also magnified. The medical wards are usually full because many patients have increased problems around drugs and alcohol. It doesn’t make sense, except it does if you understand the mismatch between the conscious and unconscious brain and the nature of triggers. So what happens?  Happy holidays – not

Triggers

Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.

The reason why family dynamics can be so volatile, is that most of your reactions are programmed by your parents during the first 12 years of life, especially the first two. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from an abusive family, your reactions to the present will be intense, although the present “danger” might be minimal. It is well-documented in the ACE (adverse childhood experiences) studies that the incidence of chronic pain, anxiety, depression, obesity, heart disease and suicide are higher than the norm. You needed to be hypervigilant as a child and it doesn’t change as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.

During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder they can be problematic. Landmines are everywhere.

How did this happen? I watch parents with babies and young children laugh, hold and play with them. It’s a precious time and they would do anything for them. Yet by five or six years-old, there is often a lot of arguing and fighting between parents and children. Suffering from chronic pain doesn’t help. I don’t have to detail what frequently happens during the teen years. The household can be a battlefield — a war without any hope of an end. I don’t how common this scenario is, but I am seeing it frequently in my practice. I only need to ask a few questions and be observant. Many family situations are intolerable.

Learned behaviors

The problem is that we program our own triggers into our offspring. They watch their parents become upset with them or each other and they learn their own behaviors in response to similar stressors. Then they become the cause of deep reactions in their parents. Why else would you yell at this person who used to be this incredibly wonderful child you brought into this world? But you are the adult and you are now in the same boxing ring as your 12-year-old. It’s your role and responsibility to provide a safe environment where your family can feel safe and nurtured. Only then can your child connect with his or her creativity and thrive.

You also may be critical of them. Really?? Anytime you are critical of someone, you have projected your view of you onto them. Remember that you are the one who taught them these behaviors that are now upsetting to you. It is remarkable the number of friends we have whose parents continue to be incredibly critical of them well into adulthood. The negativity is often intense and occurs in the face of the son or daughter doing the best they can to help and be supportive. The intensity of the verbal barrage is unbelievable to me and seems to worsen with age.

So, you have planted your own landmines. Would you yell at a stranger with the same intensity that you talk to your child or spouse? How do you think you appear to them when you are upset? Is that what you want your children to see?

Now it’s the Christmas season, and these deep triggers are coming back into your world. You have missed your family and want to be with them. What are you going to do? How are you going to handle being triggered, because it is inevitable you will be set off at some level. The two faces of Christmas

Here are a few suggestions, most of which I have learned the hard way.

• Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
• Don’t give any unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent’s criticism at any age?
• Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
• Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
• If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
• Be curious and genuinely interested in what your family is up to.
• Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.
• Read Parent Effectiveness Training by Dr. Thomas Gordon. It is a classic and the most influential book that I have ever read on any topic.

I want to re-emphasize the powerful irrational nature of being triggered. It is only you and not them that is responsible for your anger. (I well-know that it still feels like it is him or her that upset you). Own it. It is yours.

You’re the one who created the behavior in your child that is now upsetting you. Own that too! Remember how excited you were when they came into the world. Remember the good times and don’t spend time on past differences. Why? It’s done.

A Cigna insurance study in 2018 demonstrated about 40% of Americans feel socially isolated.(1) During my pain experience, loneliness might have been the one most crushing aspect of my ordeal. It was brutal. Connect with gratitude and remember how lucky you are to have friends and family. If you are someone reading this who is socially isolated, work on finding a way to re-connect with someone or give back. I am aware how terrible a feeling this is, and I’m really sorry. The Holidays do make it worse. But by being aware of the impact, you have a higher chance of dealing with it.

Make a commitment to enjoy your holiday season and if you detonate a landmine, use the situation as an opportunity to practice your own tools of staying connected and centered. Become the source of Holiday cheer!

1. Cigna U.S Loneliness Index (2018).

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Learning to enjoy life

We have been evolving for millions of years and human consciousness began with the cognitive revolution about 70,000 years ago. (1) Additionally, the unconscious brain is a million times stronger than the conscious brain and although we often know our behavior is less than ideal the behavioral patterns always win. We are not designed to have a good time. That is a learned skill.

Dr. Luskin, a friend of mine and author of Forgive for Good has taught me a lot about anger, forgiveness and the body’s need to protect itself. One of his points has been that the human organism has only one function – and that is to survive. So, your brain is constantly scanning the environment for danger, analyzing every sensory input.

There are few times and places where you can feel safe. Life is competitive and it’s challenging to get a break. School has many layers of stress. Bullying is rampant. Close friends often turn on each other. Social media has intruded on privacy and quiet time. Research has shown that only about a third of families are relatively free of chaos. Other stressful arenas include sports, music, the arts, employment, and social status. Where’s there a place to rest?

Additionally, when you are suffering from chronic pain you are really trapped. You’re being attacked by your own nervous system. As your body is subjected to sustained levels of stress chemicals, such as adrenaline, cortisol, histamines and endorphins you will experience a myriad of other physical symptoms. It has been shown that the impact of chronic pain on your life is equivalent to suffering from terminal cancer. (2) The problem with chronic pain is that there usually isn’t an endpoint. It is a terrible state of being.

Connection

The Omega weekend is focused on re-connecting people with each other, which helps a person in pain connect to themselves. It is tightly structured with a lot of sharing of enjoyable experiences. Many of the activities are held in small groups of four or five. Participants can feel safe and it’s remarkable how quickly healing occurs. Much of the weekend is spent in play, which is a great venue to feel safe. We quickly realized after the first seminar in 2013 that we didn’t have to do much after we set up the weekend. Participants healed each other. It is also a remarkable experience for us being in the presence of those who are so supportive of each other.

Here is an overview of the workshop and the link to the course registration.

The seminar is based on:

• Awareness – You have to understand a problem before you can solve it.
• Hope – most people in pain have lost hope of a solution. We’ll share many success stories.
• Forgiveness – You have to let go before you can move forward.
• Play – We all have the capacity to play but it often gets buried in the morass of life and pain. It is the most powerful way to move forward.

Many of the participants experienced significant shifts in their pain and mood during the weekend. The hope is that you’ll reconnect to the part of your brain that already knows how to enjoy life. The solution to pain is not trying to fix it but to first learn to be comfortable with it, separate and then move away from it. As you quit fighting the pain, it will lose its energy and diminish. This process is the main focus of Saturday morning –  “The ring of fire”.

Family dynamics and pain

Human connection is a basic need and how consciousness evolved. People who are socially isolated have a similar area of the brain light up as in being in pain. It’s common, if not the rule, to become progressively isolated when in pain. You just don’t have the energy to interact with others. Then the loneliness becomes crushing. People will often endure terrible domestic abuse just to avoid being alone. One of the most perverse aspects of the human experience is that we turn to our family for meaningful connection and the deeper the relationships the better – except the closer the relationship the more powerful the triggers that set off anxiety and anger. At the same time the family can provide the deepest sense of safety, it is also the most vulnerable and most unpredictable area of life. Saturday afternoon will be focused on the role of the family in both healing and exacerbating pain. I warn the group that once you’re home and back amongst your triggers, the pain will return. But you have tasted freedom and will continue to evolve the tools return to it more and more quickly.

We request that the participants become familiar with the DOC concepts and be actively engaged in using the basic tools. The intention is to deepen your healing journey and support each other. Commonly, the process provides the needed push to propel you onto your new life. The group will be limited to 30 people to keep it interactive.

Some of the stories

We have dozens of great stories emerging from the weekend. One remarkable story is about a young man who flew in from Toronto to the Seattle workshop. He had been struggling with substance abuse problems for over 10 years and had been clean for about 8 months prior to the workshop. He had been through three stints of comprehensive rehab and desperately wanted to get on with a productive life. He was quiet but interactive and asked great questions. I wasn’t sure how much of an impact all of this was making on him. I talked to him a few months later and he had returned to a difficult situation where his “friend” and roommate had stolen money from him. He said that historically he would have remained angry and probably would have gone back to the drugs. He was able to use the DOC strategies to calm down and come out of his reactive mode quickly. I had a great conversation with him. He said the crux of his success was that, “I let the pain in. I’m no longer on the run.”

A middle-aged businesswoman had been experiencing pain in her right tailbone for over seven years and had difficulty sitting. She also was experiencing over 20 other symptoms of a fired up nervous system. I looked over her intake questionnaire and wasn’t sure she would benefit from the course. Over the last two days of workshop she experienced a marked decrease in her pain and it disappeared over the following weekend. She is continuing to thrive, got married and returned to part-time work. We have stayed in touch with her triumphs and struggles.

One woman had been experiencing chronic headaches for over 10 years. She had also developed abdominal pain and right leg pain that was persistent for a couple of years. She shared with us that she had been walking in the Omega garden on Tuesday, when her whole body seemed to have a deep reaction. She was passing by some rocks that others had written on. They were short tributes. She stopped and wrote a short poem honoring a stillborn baby that died two years earlier. She had never gotten to see her before she was buried. She woke up Wednesday morning without a headache for the first time in 10 years, her leg pain disappeared, as well as her abdominal pain. Needless to say, the whole group was stunned. She had no pain the rest of the week and has continued to enjoy life for the last four years.

We are looking forward to meeting this new group and have enjoyed remaining in touch with many of the alumni.

1. Harari, Yuval Noah. Sapiens. Harper Collins, NY, 2015.
2. O’Connor AB. Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009;27(2):95- 112.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143-148

Listen to the Back in Control Radio podcast “Connecting with Your Capacity to Heal.”

The post A Safe Haven – Omega 2018 first appeared on Back in Control.

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Loneliness

There is an even more destructive aspect of it that has been looked at in numerous research papers – loneliness. Most of the data I will be quoting is from a government-sponsored review, “Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms”. (1)

The first point of the article is that loneliness is a “perceived social isolation” and social people can still feel isolated and many can live solitary lives and feel quite content. They define loneliness as, “……. a distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or especially the quality of one’s social relationships.”

What caught my attention was “the quality of the social relationships.” There are many social consequences of suffering from chronic pain. One of them is feeling trapped and frustrated. It is difficult to be aware of other’s needs when you are upset, which is the essence of relationship building. You will also attract people with a similar energy and patients in chronic pain often spend a lot of their time talking about their pain. First of all, your pain is not that interesting to other people and those that you might want to spend more time with will gradually wander out of your life. Secondly, the ones who remain with you wallowing in your misery will help keep you in your misery. Third, my wife and I have saying that, “Anger isn’t attractive.” I wish it were a joke. The problem really is that I can only see it from my perspective and cannot really see how I appear when I am upset. (I am sure it can’t be that bad………). Finally, while you are angry creates a scenario for abuse. I have written many posts on this topic. You get the idea. Chronic pain has a high chance of creating or increasing loneliness with severe consequences. They include:

• Elevated blood pressure, overweight, coronary artery disease, higher cholesterol
• Higher mortality from all causes
• Suicide
• Impaired judgment, decreased cognition, depressive symptoms. personality disorders, psychoses, dementia/ Alzheimer’s, cognitive decline with aging,
• Impaired self-regulation
• Impaired quality of sleep with all the attendant problems connected with poor sleep
• Higher levels of stress chemicals such as cortisol while at the same time decreasing the body’s responsiveness to the cortisol.
  • This sequence leads to poorly regulated inflammatory response.

I am cutting this list short. There did not seem to be an end to it and the physical symptoms are so similar to those being produced in chronic pain with the body’s sustained levels of adrenaline and cortisol. Which is first – the loneliness or pain? Not sure it matters, as the solution is the same.

The DOC (Direct your Own Care) process allows the patient to understand the parts of their chronic pain so as to eventually solve it. It must be implemented by the patient. Most of the process is self-directed and addresses some of the blocks to social interactions, which includes a hyper-vigilant nervous system. But it goes both ways in that I have noticed for a while that part of many of my patients’ healing is re-connecting with family and friends.

Omega 2017

When I was given the opportunity of hold another workshop at the Omega Institute this summer, I realized that we could add another dimension to the healing process – feeling the healing power of others. I have seen that once your brain connects with part of you that knows peace, love, joy and connection you will instinctively learn the (your) way to return to it. The Way to Love

The Omega Institute is a well-known retreat center in Upstate New York. We have witnessed many remarkable turnarounds in participant’s pain and quality of life during three prior five-day workshops we had held in 2013 – 15. This year we were asked to hold a weekend session beginning Friday evening, Saturday, including the evening, and ending Sunday at noon. We weren’t sure what could be accomplished in such a short period of time. It turned out to be as powerful as any of the others.

Faculty:

• David Hanscom, MD
  • Orthopedic Spine Surgeon, Seattle, WA
  • Author of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain
• Bernie Siegel, MD
  • Pediatric General Surgeon
  • Author of:
    • Love, Medicine and Miracles
    • The Art of Healing
• Jasmine Yohai, MA
  • Expressive arts therapist

•  Babs Yohai
  • Movement artist, professional tap dancer

The workshop

Since time was limited, we stayed focused on accomplishing one goal; that was to create an environment where people could feel safe, relax and share the experience with others. Somewhat surprisingly, that atmosphere was created within the first hour. Maybe one of the reasons was we all knew time was short, people had traveled from all over the world and they were ready to fully engage.

The small groups immediately got to know each other and I had to “break them up” to get on with the evening. When I announced the ground rule of not discussing pain the room went silent.  Not only were they not to discuss their pain this weekend, they were never to discuss it with anyone ever again. They could write it down. We did have the room do the expressive writing for five minutes and we collected the torn up pieces of paper.

The weekend included lectures on the nature of chronic pain, structured conversations, rhythm, “The Cup Song”, mindfulness, drawing, sharing, and support. The details are not important but the group’s commitment to each other to creating a safe place was remarkable and we did it – in a weekend!! I think that all of were surprised (shocked) how enjoyable it was.

Comments from the class

“I’m still high from the weekend at Omega. And off all pain meds (even Advil) after 10 years on opioids…………..    Interesting how the class responded to my hooping. I can see Babs and Jaz doing a session, maybe a half-hour?  What do you think? Neuroplasticity, endorphins, fun!  Whether people catch on right away or not, laughter will be a result.  It could take practice, just like learning the cup song.  And for any resistant males, emphasize that it will improve their sex lives!”

“The program has been enormously helpful and I can only conclude that it’s helping me to live in a more authentic way, which I feel makes my unconscious happy! I think when you have an abusive parent you have to suppress your feelings so much that suppression, avoidance and denial become your coping mechanisms. But as you know, it’s no way to live your life.

It’s possible I may still need surgery eventually, but if so, I feel that thanks to following the program, I’d be able to do it in a conscious and aware manner. Before, I felt very strongly that It would be a mistake.”

“………….  My family and co-workers are amazed at my progress. I am especially committed to no longer talking about my pain and to writing on a regular basis. I am getting (have gotten) my life back!”

Several commented, “I feel like I just spent a weekend away at camp.”

You can’t outrun your pain

I don’t want to give you the impression that we were just trying to have a good time to distract ourselves from pain. The atmosphere was created by people taking risks and being vulnerable. I was relentless in pointing out that you cannot run from your pain or even solve it. In fact, the goal of the DOC process is to not get rid of your pain. It is to live a full life with your pain and only then will it begin to lose its power. I challenged them to live their life now – this weekend with pain. The connections that were made were clear and deep. There is no other way to move through your pain. It is the same pathway you will use to re-connect with yourself. The ring of fire

Tasting freedom from pain is powerful. Every cell in your body is created to survive and thrive. If you allow yourself to be open to possibilities, it is a matter of time before you find your way to healing.

1. Hawkley LC and JT Cacioppo. Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Ann Behav Med (2010); 40: doi:10.1007/s12160-010-9210-8.

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• Without the distractions of work, pain is more noticeable.
• It’s usually not known when the patient can go back to work, which is anxiety-inducing.
• Being labeled a “chronic pain patient” by everyone, including the medical profession, begins early.

NBC News Post

NBC News last week reported that with the recent economic downturn, many Italians are committing suicide. Here are excerpts from the notes left by the victims:

• “I decided to end it because I am a failure. I can’t live without work.”
• “I can’t live without a job.”

This feeling of failure and loneliness is at the heart of acts of desperation among the business community in Italy. These messages left are the same mantra repeated by workers and businessmen who either tried to kill themselves and lived to tell the tale or by those who thought about trying, but found other reasons to live.

Another excerpt:

• “My business is like my family. I feel responsible for each of my employees. If my business fails, I fail with it.”

(This article was called, “In debt or jobless, many Italians choose suicide,” by  Claudio Lavanga. NBC News World Blog, May 9^th, 2012)

My old attitudes

I can speak only for myself in mentioning some of my old perspectives. However, my old attitude might generalize to how some physicians currently think about this issue.

• I had the impression that many patients wanted to stop working.
  • Only some wanted to stop working.
    • Most did not.
• I did not understand how devastating it was to a patient and his/her family to lose a job.
• The mental health consequences of being home and disabled are severe.
  • Social isolation creates the same symptoms as chronic pain
• It is often easier for me just to take a person off of work.
  • It’s time-consuming to go into the details of light duty, etc.

My approach changed

• There are major implications of losing a job.
• Being out of work creates further health problems.
• Any time off work should be for as short a duration as possible with specific dates prescribed to return to work.
• If a patient is already off of work, broach the subject of returning to work very quickly.
• If they have no intention of returning to work, the issue has to be clearly discussed and an alternate plan implemented.

People inherently want to be a part of society and contribute. Being active in the workforce is an important part of that need.

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