• Honor your suffering. You are trapped by physical and mental sensations without an apparent way out.
• You feel extremely isolated but many people in this hole (The Abyss) are also suffering badly. You are not alone.
• Your rightful frustration (rage) fires up your symptoms even more.
• Systematically learning and using tools to calm your body, will allow you to heal.

The Depth of Your Suffering – Darkness

All of us seek safety – physically and mentally. When we don’t feel safe, our bodies switch to a flight or fight mode, and we feel stressed. Another descriptive word is “anxious”, which is simply the feeling generated when you sense danger. We yearn for safety and detest anxiety, and when we can’t resolve the problem causing us to feel uneasy, we feel trapped. The word for this more intense bodily response is anger. It is our last-ditch effort to regain control and feel safe. When we still can’t escape a real or perceived threat, our bodies break down with the outcome being chronic mental and physical diseases.

Anxiety and anger are not psychological constructs; they are your body’s warning signals, and they evolved to be intentionally unpleasant. They are the pain and are manifested in many ways. Even with physical symptoms, the cause is unclear. There are reasons. Chronic stress translates into threat physiology (how your body functions), which causes symptoms, illness, and disease. Unless you know how to effectively process stress, you are trapped.

Feeling trapped causes deep suffering, creates many problems. BTW, everyone suffers. There are degrees, and not having basic needs met such as safety, food, shelter, and companionship creates havoc with every aspect of your health and life. I do not want to dishonor this level of suffering. For example, the incidence of significant anxiety issues is 100% if your income level is less than 19,000/ year.¹ This is 1994 data that translates in approximately $38,000 in 2024.

We are also trapped by being a species with language, abstract thinking, and awareness of the finite nature of life. We can’t escape death. In addition to our physical challenges to staying alive, we cannot escape our thoughts. We have no protection from mental pain and suppressing unpleasant thoughts inflames the brain even more. These translate into RUTs, (repetitive unpleasant thoughts). They are universal varying in severity and frequency. The range is:

• Occasional unwanted thoughts
• Repetitive thoughts
• RUTs
• Repetitive disruptive thoughts
• Invasive thoughts

 “The Abyss”

One afternoon, I was listening to a patient attempting to describe the depth of her suffering and it hit me how deep and hopeless this hole is for most people. I realized that words were inadequate to encapsulate the degree of misery. Since no one seemed to have any answers, there was no apparent way out. The description that seemed to fit for this dark, bottomless pit was “The Abyss”.

A recent research paper documented that the effect of chronic pain on one’s life is similar te the impact of terminal cancer.² You hadn’t anticipated the possibility of your life being consumed by pain. The paper showed that chronic pain was worse in that with cancer, you at least know the diagnosis and there is an endpoint, one way or the other. This statement might sound harsh in that suffering from terminal cancer is horrible, but ongoing pain (mental and physical) without knowing if there is an endpoint is even worse.

A stark example of how uncertainty can eat away at you is illustrated in Dr. Viktor Frankl’s book, Man’s Search for Meaning.³ He was an Austrian psychiatrist who was imprisoned in a concentration camp during WWII. He lost several close family members and experienced unspeakable horrors. As he describes his personal experience, it is difficult to imagine anyone enduring even a fraction of what he witnessed and endured. Yet, he points out that the worst part of it all was not knowing when it was going to end. 

Life in The Abyss

In addition to other life stresses, patients are trapped by unpleasant mental and physical symptoms, illnesses,and diseases. You are also trapped by the medical system, which is not consistently showing you a way out. Over time, you become discouraged (despondent). My equation for it is:

The Abyss = Anxiety/Anger x Time

Why isn’t pain part of this equation? It is because anxiety is the pain. When you are stuck in a whirlpool of relentless anxiety and frustration, life goes dark.

How deep is this hole? Here is a short list of the suffering I have encountered both personally and witnessed in my patients.

Losses include:

• Independence
  • Financial
  • At the mercy of the disability system
• Capacity to enjoy good music, friends, fine food, and hobbies without the experience being marred by pain
• Peaceful family life
• Feeling good – there are over 30 symptoms created by a chronically activated nervous system. There are also many other mental and physical disease states. Your body breaks down.
• Integrity – people don’t believe you and often the harder you try to convince your friends, family, peers, employers, and health care providers, the less you are believed.
  • Being labeled – malingerer, drug-seeker, lazy, not motivated, and difficult
• Unlimited physical activity
• Peace of mind – RUTs are relentless and may be the worst part of the ordeal.
• Hope – this may be the worst aspect of it all. Repeatedly having your hopes dashed induces a depression.

No Way Out

Consider the depth of “The Abyss.” Your soul is being pounded into the ground by a pile driver of anxiety/anger as you remain trapped in your body, riddled by mental and physical pain. Your life is being systematically destroyed, but in some cruel cosmic joke, you’re alive to bear witness – without hope. This dark place in your mind is unusually deep – bottomless. And no one is listening………

Recap

Allow yourself to comprehend the depth of your suffering and degree of damage your pain has inflicted on your life. Awareness is the first step in successfully reversing this downward spiral. Right now, you are at the bottom, except there is no bottom……

Chronic illnesses are complex and random treatments can’t and don’t work. It is necessary to break your unique situation into its component parts and systematically deal with them. There is a way out of this incredibly dark place, but you cannot go from the depths of suffering to better health with willpower and belief. As you methodically acquire knowledge and skills to deal with each aspect of your situation, you’ll be able calm and re-route your body to break free and heal.

Questions and considerations

1. First, give yourself a break. You are suffering badly. Many treatments have failed, and you may even be worse. No one seems to be able to show you a way out or even offer hope. There is no reason to have positive feelings about any of this. Allow yourself to feel the depth of your suffering and frustration. Express it a piece of paper and immediately tear it up. A few people have difficulty processing the feelings released with this exercise, and if you feel uncomfortable, immediately stop.
2. Consider what is important to you in life, but you can’t access or experience them. Write down two or three things you would like to experience. Not being in pain is not one of the choices. You’ll see why as the course unfolds and it is also a given. None of us want to be in pain.
3. List three to five of your most intolerable symptoms. For many people, the relentless onslaught of unpleasant thoughts is the worst aspect of it all.
4. Give yourself credit for staying on your feet long enough to keep trying. A willingness to learn and practice is the number one factor predicting success.

 References:

1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of dsm-iii-r psychiatric disorders in the united states: Results from the national comorbidity survey. Arch Gen Psychiatry. 1994; 51(1): 8-9.
2. O’Connor AB. Neuropathic pain: quality-of-life impact, costs, and cost effectiveness of therapy. Pharmacoeconomics (2009); 27: 95- 112.
3. Frankl, Viktor. Man’s Search for Meaning. Beacon Press, Boston, MA, 1959,1962,1984, 2006.

The post “The Abyss” – Honour your suffering first appeared on Back in Control.

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The worst part of my ordeal was the mental pain and being bombarded with unpleasant and intrusive thoughts. It was the most disturbing aspect of it all and the more I did battle with them, the more intense they became. I had already slipped into an “internal OCD” (obsessive compulsive disorder) five years earlier. It  manifested with repetitive disturbing thoughts that I countered with positive thoughts. Internal OCD does not have external characteristics such as hand washing and counting.

I had begun the expressive writing about six months earlier with a lot of success. My anxiety and other physical symptoms had diminished but I was still struggling on many fronts.

“I am a victim”

On Mother’s Day of 2002, I suddenly realized what being a victim entailed and saw that I was deeply enmeshed inthat role. Up to that point, I had no idea that I was even angry. I was just “right” and “frustrated.” But since I had so many legitimate reasons for feeling this way, I never considered myself as angry. In fact, my concept was that I had dealt with anger and had moved on. Nothing could have been further from the truth.

I felt a deep shift and over the next six weeks, more of my physical symptoms began to resolve, with the most unexpected one being that the ringing in my ears (tinnitus) decreased dramatically. After 25 years of dealing with it, I had assumed that it was a permanent symptom. However, many of the disturbing thoughts persisted and were interfering with my capacity to enjoy my life. I felt stuck.

The circus mirrors

One day, I suddenly had an image of myself standing in front of the kind of reflecting mirrors that you see in the circus. I was staring at repeating versions of  myself, going into infinity. I could see the battle playing out in my brain – a disruptive thought followed by a  counterthought – without an end. This had been playing out in me for years. I realized that there was nothing I could do and I “gave up.” I had reached a point where I had to let go. I truly became deeply discouraged yet at the same time, this realization was accompanied by a deep physical feeling of release. I was perplexed.

I continued to use all the tools of writing, mindfulness, forgiveness, etc. But with my new outlook, I began to move forward with my life and within six months most of my physical and mental symptoms (Including the obsessive thoughts) had dramatically abated. I didn’t realize it at the time, but it turned out that letting go and moving on was the definitive answer. This was well before I understood the concepts of neuroplasticity. Your brain develops whereveryou place your attention and I had been reinforcing the problem by trying to fix it.

Take a break

My patients and I frequently discuss the idea of taking a break from The DOC Journey. They have been diligent in reading, writing, not discussing their pain or medical care, meditating, processing anger, and even working hard at play. But they continued to be frustrated because, even though their pain had diminished, their anxiety levels remained too high, upsetting thoughts continued to bombard them, and they still didn’t have the quality of life that would allow them to thrive.

Perfectionism came into play in that he or she wanted to be the best student and really do it right. But the harder they worked at it, their neurologic energy was still directed at themselves. Inadvertently, by stimulating neuroplastic changes towards the problem, they were reinforcing these unpleasant neurological circuits.

Remember that the victim role (including perfectionism) is so powerful, you will never want to give it up – even afteryou have felt how free you can be. It is too strong of a survival need. The  decision to let go of the victim role is a day-by-day decision, sometimes a minute-by-minute one. Being triggered is inherent to being alive, and you have to decide if and when you want to let go, and when you are ready, just do it. I have not found an alternative and logic doesn’t work. I call it, “flipping the switch.”

Bill

Occasionally, at the end of an office visit, I asked my patient to sit in the exam room and not leave until they committed to “letting go” of the victim role. They may have sat for 10-20 minutes before they left. Walking out the door was symbolic of them stepping into their new life. It was surprising how effective that simple action could be.

Bill was a middle-aged, small-business owner who had been in chronic pain for over twenty years. He had done quite well with the DOC principles, along with the help of one my colleagues. One day Bill was triggered by one of his business partners and fell deeply back into the Abyss of pain and despair, to a depth he had not experienced before. He was becoming suicidal. Unfortunately for me—but fortunately for others— through my own experience, I gained extensive insights into suicide and realized that anger is what pounds your soul into the ground. Bill was in an extreme victim mode. I called him out on it during an extremely intense conversation. Although it was nerve wracking for both of us,  it clicked. He sat in the exam room for about half an hour.  When I saw him back a few months later, he was achanged man and re-entering the workforce.

A friend sent me this poem:

“She Just Let Go”

She let go. Without a thought or a word, she let go.

She let go of the fear. She let go of the judgments.

She let go of the confluence of opinions swarming around her head

She let go of the committee of indecision within her.

She let go of all the “right” reasons. Wholly and completely, without hesitation or worry,

She just let go.

She didn’t ask anyone for advice.

She didn’t read a book on how to let go….

She didn’t search the scriptures.

She just let go.

She let go of all of the memories that held her back.

She let go of all the anxiety that kept her from moving forward.

She let go of the planning and all of the calculations about how to do it just right.

She didn’t promise to let go.

She didn’t journal about it.

She didn’t write the projected date in her day timer.

She made no public announcement and put no ad in the paper.

She didn’t check the weather report or read her daily horoscope.

She just let go.

She didn’t analyze whether she should let go.

She didn’t call her friends to discuss the matter.

She didn’t do a five-step Spiritual Mind Treatment.

She didn’t call the prayer line.

She didn’t utter one word.

She just let go.

No one was around when it happened.

There was no applause or congratulations.

No one thanked her or praised her.

No one noticed a thing.

Like a leaf falling from a tree,

She just let go.

There was no effort. There was no struggle.

It wasn’tgood, and it wasn’t bad.

It was what it was, and it is just that.

In the space of letting go, she let it all be.

A small smile came over her face.

A light breeze blew through her.

And the sun and the moon shone forevermore.

–Rev. Safire Rose

This poem “She Just Let Go” by Reverend Safire Rose beautifully conveys the essence of The DOC Journey. Letting go is the simplest and simultaneously the most difficult aspect of the healing process. Our anger is powerful and often legitimate. We are accustomed to fixing others and ourselves, but our attention is still on our flaws and those of others. Too much attention to shortcomings inadvertently strengthens our unpleasant neurological circuits.

The DOC Journey provides guidance and tools to get to a place where you are able to let go. The freedom you will experience is remarkable. For me, it was unlike anything I had ever experienced in my life. Watching people enter this realm is inspiring and is a major factor in motivating me to keep me moving forward with this project.

Reconnecting with Your True Self

On Saturday, November 6th, Dr. Les Aria, a friend of mine, and I are holding a workshop that is being hosted through The Open Center in New York. We will be discussing both the process of letting go using specific strategies to connect to the best part of who you are. The intention is for you to leave with a clear concept of the power of the unconscious survival mind, how to develop a “working relationship” with it, and move forward into the life you desire. Click this link to take a look at the course and register.

The post “She Just Let Go” first appeared on Back in Control.

The post “She Just Let Go” appeared first on Back in Control.

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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Anger

There is a a “genealogy” of anger that is important to recognise.

• Circumstance
• Blame
• Victim
• Frustration/ anger

Anger is the set of sensations generated by an intense fight or flight response and it is damaging to your body when it is sustained. There is a set of tools that I call, “anger processing” that calm down this response and it is a set of skills you must use many times a day. Life keeps coming at us. Unfortunately, the more legitimate your anger, the more difficult it is to process – but it still damages your body. Being trapped in mental or physical pain is one of those situations.

Carol

Carol is a woman who contacted me about ten years ago. She had read Back in Control and began to use the strategies outlined on my website to calm her nervous system. She had been severely disabled with pain throughout her body. Within a few months she began to improve and was markedly better by the time she connected with me.

I have since learned that all chronic disease, mental and physical, is caused by chronic stress, which means your body’s chemistry is in sustained activated threat physiology. She had already developed a significant set of medical problems by the time I had met her with many physical setbacks. She kept moving forward and her efforts were inspiring.

Then she had to be put into a nursing home on the other side of the country, and she was truly miserable. I did not have any suggestions and was also a bit discouraged by her situation. Then a few months ago, I received this letter.

Her letter

Dear David,

Just a note to let you know your DOC Journey has pulled me through yet another trip back to The Abyss. Since moving here last June, I have felt I have been in a “third world country,” also known as an Assisted Living Facility. It’s bad enough being 83 and sick, but it’s even worse when the facility you live in is way below par in every way, Staff, food, medical needs, activities, cleanliness, and caring. Add that to that the frustration over my loss of hearing. Closed Captions are now a part of my TV world and I find myself wanting them everywhere. I cannot afford the doctor who recommended hearing aids right now because I am working on yet another expensive “fix it” project, my teeth. What else can go wrong? The depression/anxiety and pain were also taking over my life again.

However, rather than just sit here and play the victim, I thought; what can I do to make this better? I remembered a conversation you and I had after I read his book, Back in Control and about helping others. That is what I felt he did for me. He took his knowledge and experience and has helped me and others understand how we can apply it to our own situation with his book, the weekly newsletters, various posts, and podcasts, the Q&A sessions and other educational material. He shared what he knew and paid it forward! How could I make this work in my own situation?

I remembered the experience I had of working with my mother back in 1977. She had Alzheimer’s. I knew nothing about that, Medicare, Medicaid, and elderly living. I moved in with her, turned her 3^rd bedroom into an office and worked on getting her proper care and eventually, into a lovely Skilled Nursing Facility. It was an exasperating experience as I was suffering from a recent divorce, depression/anxiety, chronic pain, and Fibromyalgia. But, as I look back on it now, I realize it was very also very educational. Several years later, when I was the Executive Secretary for both the Director and the Administrator of a 27-story health care facility in San Francisco, it occurred to me that I could use that expertise and knowledge as well, and act as an advocate for residents who could not be an advocate for themselves.

Subsequently, living here for a while, I realized that most of the residents have some level of dementia, and no one is paying much attention to them. Unfortunately, their families have just dumped them off for someone else to look after. I knew how good it made me feel when I talked with you because you validated me as a real person, not just a number. For such a long time I felt that no one understood what I was talking about. His understanding and willingness to share gave me so much hope and began to restore me as a human being. I learned that this is what people want most, to be recognized, cared for, and loved.

As bad as this place is (and it’s bad), I felt that perhaps God had placed me here for a reason. Before moving here, I lived in a fabulous Assisted Living facility in Washington, so it gave me something to compare this to. Maybe I could make a difference. I found out where to complain, the State Health Care Facility Complaint Board, and contacted them. I also contacted the Ombudsman for this district. I wrote to and talked with both parties, plus Administration heads and some of the board members of the place where I live and pointed out nearly 20 complaints. The more I have worked with these residents and staff, instead of thinking about my problems, the better I’ve felt. And, I am pleased to say that because I was willing to stand up and pay it forward, the facility is making some real changes that have made a major difference in most of the resident’s wellbeing.

–Carol

Trapped – or not

People often use the term, “stress management” to deal with adversity. What is overlooked in this phrase is that at the situations that are the most stressful are the ones you can’t control. So, the approach needs to be flipped. You must learn to calm yourself first, which requires learning the skills and practice (there are plenty of opportunities). Positive thinking doesn’t work. You have to address each scenario head on. If you can change it, do it. If you can’t, then use your tools.

Paradoxically, as you are not burning up energy on situations you have no control over, you’ll have more to actually solve more of your problems. If you are dependent on your circumstances for your peace of mind, you are at the mercy of them.

She was truly trapped, and actually still is. Many, if not most of us are in similar situations, whether it is finances, difficult work environment, lack of opportunity, racism, or family dynamics. She chose to relate to her circumstances differently, which allowed her body to reconnect to its capacity to heal. You will be surprised to see how many more of your problems are solvable when you can calm down first. She continues to be an inspiration for me.

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It’s because every human being is attached to being a victim since it feels so powerful. It also masks feelings of anxiety and vulnerability, which we hate. Even after many years of being out of pain and practicing the DOC concepts, I frequently still dive into being a victim. It is a core pattern for me, and I finally realized that it isn’t going to ever disappear. The greatest obstacle to solving chronic pain is the willingness to learn about the nature of it and use the strategies to solve it. We become addicted to the power of pain. But here’s the problem.

A few years ago I labeled myself as “enlightened”, which meant in my mind that I was above going into the victim mode and could maintain a sense of tranquility regardless of the circumstances. It was a bad idea and it turned out that my “enlightenment” was just another form of suppressing negative thinking. Suppressed anger and labeling both block awareness and my relationships suffered.

The problem is that when you’re in the victim mode, it is a complete package of behaviors and the behavioral patterns are much stronger than your conscious brain. Every time you’re upset you are now a real or perceived victim. By definition you’ll engage in destructive behaviors, including self-destructive ones. Even though you “know better”, it won’t stop you. The conscious brain is no match this energy.

My List        

I have a list of various behaviors I do when I am upset. They include: a) stopping my own practice of expressive writing b) quit exercising c) eating poorly and at irregular hours d) feeling in a bad mood and making sure those around me are fully experiencing it with me, e) making excuses for not getting things done f) blaming others. There are many others that are subtler and some that are quite destructive. These actions are just a small aspect of my anger response. I was truly a victim of a chaotic family and unfortunately this pattern is a significant part of my core behavioral patterns.

If you feel that you aren’t angry or don’t exhibit this kind of behavior think again – or seriously ask those close to you what their observations are? Every human has this problem whether he or she recognizes it or not.

What Do You Do?

I’ve finally given up trying to not be angry. It takes too much energy and it is an inherent part of life. I am continually working on approaches to deal with it.

First, it’s critical that I am aware that I’m angry. There are many ways to disguise it, including rationalization. Since I’m “right” then what I’m experiencing really isn’t anger. My default disguise is just “feeling frustrated.” It works both ways. I may not feel angry or frustrated, but I am engaged in self-destructive behaviors. As I mentally work backwards, I can usually see that I’m upset and what the trigger was that set me off.

Second, I’ve accepted that I like the power of being a victim and after over 20 years of recognizing and watching it, that the role isn’t ever going to disappear. I will never wake up one morning and ever want to give it up. I focus on becoming more aware when I have gone into that mode and more importantly, observing people’s reactions to my words and actions.

Third, since I teach about the consequences of anger and benefits of forgiveness, I become upset with myself for being angry. It’s a double-hit. I work on “failing well,” since it’s inevitable that I’m going to behave badly. Being a self-critical perfectionist magnifies the problem.

Finally, a strategy I’ve adopted with some success is minimizing destructive behaviors while I’m upset.

Cut Your Losses

Logically, minimizing the destructive aspect of anger is my only choice. Some examples that I am working with include:

• Eating a lesser amount of junk food.
• Exercising even for five or ten minutes, regardless of how I feel.
• Re-engaging with the expressive writing exercise– even if it’s only a couple of sentences.
• Not making anyone the target of my frustrations, especially my family.
• Looking at what set me off and how the situation might look from his or her viewpoint. What may I have said or done to start the reaction?
• Recognizing that my anger response is often out of proportion to situation. Just being aware of it has helped me step back and not take action while I am in this fired up state of mind.

I’m making progress in cutting my losses. Some weeks are better than others.

Addictions

I have an extensive experience in weaning patients off of high doses of opioids and other addicting drugs. My view is that an addiction is an addiction regardless of the form it takes. They all inflict varying forms of damage to your body and life. The problem with drugs is that the toll is so high. The general approach to rehabilitation is structure and control, which is effective for many people, but often isn’t sustainable.

The key is to understand that the driving force behind addiction is anxiety. No one wants to be an addict, but unrelenting anxiety is intolerable. Anxiety is an unconscious neurochemical survival response and necessary for survival. When you can’t escape it, you’ll produce more stress hormones and become angry. Since it isn’t primarily psychological, it’s not subject to isolated rational interventions.

So, when a patient goes into the self-destructive role, I ask if there is a set of  “victim behaviors” that are less destructive? Instead of feeling guilty about “failing,” can you connect with compassion for yourself? There is a much higher chance you’ll come out of the hole more quickly and move forward towards the life you really want. One of the approaches is to learn how to “fail well.”

What about You?

What is your “anger package?” What self-destructive and other destructive behaviors do you engage in when you are feeling sorry for yourself? Is being angry and acting badly so much a part of your life that you don’t even feel anger is a problem? I frequently see patients who tell me they are not angry but it is clear that he or she has not taken one step to care for his or her health. Self-neglect is one of the ultimate self-destructive anger-based behaviors that is akin to a slow suicide. There is no other explanation for it. You have to be aware you are in this mode before you can address it.

What can you do to minimize the damage when you are in your victim mode? Can you contain yourself when you feel like yelling? Are you able to simply eat less when you feel like binging? What about having just a few cigarettes instead of smoking for a week? Are you able to allow yourself to fail and get back on track quickly? Is there something you can do besides jumping back into your full drug habit? Even if you completely fail, how quickly can you let yourself off of the hook?

Anxiety and anger will always be a part of your life? What can you do to limit the damage?

The post Anger: Damage Control first appeared on Back in Control.

The post Anger: Damage Control appeared first on Back in Control.

The essence of curing chronic pain is connecting to your own body’s capacity to heal. When you are trapped by any circumstance, especially chronic pain, first your anxiety escalates and then you become angry. Your body is full of stress chemicals and you’ll experience many physical symptoms. Once or twice a year we hold a retreat for people that have been suffering from chronic mental or physical pain.The intention of the workshop is for you to experience a weekend of sharing enjoyable experiences in a structured safe environment and relax. Relaxing is challenging in the context of suffering.

The faculty includes my wife, Babs Yohai, who is a professional tap dancer and movement artist, and my daughter Jasmine Yohai, who is an expressive arts therapist. The weekend begins Friday evening and ends Sunday at noon. We spend Sunday afternoon relaxing by the lake with many of the participants. The core concepts of the workshop are:

• Awareness – It is important to understand the nature of chronic pain and your relationship to it.
• Hope – We enjoy sharing many success stories – and some will be returning.
• Forgiveness – Processing anger is the tipping point of  becoming pain free.
• Play – Relaxation and play are the essence of what Babs and Jaz bring to the weekend.

Jasmine

Jaz has an unusual background in that she graduated as a dance major, has a Masters in psychology, spent extra time learning expressive arts therapy and is currently working for a non-profit organization in Oakland, CA housing homeless people. She is relaxed, although she’ll tell you that she often doesn’t feel as relaxed as she appears.  She exudes concern and compassion and loves to be of service in whatever capacity she can. Her role is putting us through different shared exercises that are calming, and she is excellent.

Babs

When I first asked Babs to be a part of the workshop in 2013, I was becoming aware of the power of play in addressing the power of pain. Chronic pain is a result of memorized neurological circuits in your brain. The more you try to fight and fix them, the stronger they will become because you’re paying too much neurological attention to them. One approach is to create alternative circuits by stimulating new connections in your brain – neuroplasticity. Learn another language Another is to shift back on to your play circuits, which is a more rapid and powerful strategy. Although, that may seem like a forgotten word to you after so much suffering, it is one of the basic foundations of the development of human consciousness. Play exists deeply in all of us even if we can’t consciously connect to it.

In addition to tap dance, Babs is accomplished in Tango, Salsa and Balinese mask dancing. She has a lot of depth in rhythm and movement. I asked her to be one of the faculty, as these types of practices can quickly reconnect and create new neurological circuits. She was apprehensive about her role but agreed to give it a try.

I wasn’t asking her to teach us to dance. I was interested in re-connecting the mind with the body through music and movement. She began with a simple song combined with stepping and clapping. Then she introduced The Cup Song. She and Jaz led us in learning a new language of rhythm, causing a shift from pain to play circuits. We began to relax and laugh.

The Cup Song

A shift in pain

My original concept of the workshop was that I had five days to give an intensive course in teaching the DOC concepts, and then people would learn to implement them at home more quickly than when learning in the office setting. What happened was completely unexpected in that many people experienced a shift their mood and the pain would drop – sometimes dramatically during the workshop. I think it happened for a couple of reasons.

First, it is common, almost the rule, that people in pain become socially isolated, which is a terrible way to live. In fact, research shows that the pain of social rejection shares similar brain circuits to that of physical pain.  One of my goals was to create a structured environment where the participants could be with others in a safe place and share enjoyable experiences. What I eventually realized was that my main function was to create and maintain the structure, and that people heal each other. By connecting to others, you are able to find your way back to you.

Secondly, “neurons that fire together, wire together” is a common phrase among neuroscientists. Anger, anxiety and pain circuits are tightly intertwined, and stress usually fires up the pain circuits. Shifting to the play area of the brain unlinks them and pain drops.

Third, anxiety is an indicator of elevated levels of adrenaline, cortisol and histamines. You are on high alert and one of the results is that these hormones increase the speed of nerve conduction and you’ll feel more pain. The weekend gives you a chance to feel again what it is like when your system is full of chemicals that are elevated when you are at play.

Omega 2019 

The workshop is now three instead of five days and we were surprised to see that it was equally as effective. It feels like the participants are more focused and dive in quickly. Much of the work is done in small  groups of four or five.

It was at Omega that we learned about the deadly effects of people discussing their pain with their family, friends and colleagues. One basic ground rule is to never discuss your pain or medical care with anyone or complain. Your brain will develop wherever you place its attention. Research even shows that belonging to a pain support group or keeping a pain diary is counter-productive. You might as well place your hand right into a large hornet’s nest. You are reinforcing the pain circuits, not moving away from them. I didn’t realize how much time people in pain spent discussing it or endlessly searching for a solution. It is completely understandable.

Although, many mindfulness-based pain programs have impressive results, it is unusual to experience such a shift within a couple of days. What has happened is that the group has tasted freedom from pain. They now have the knowledge and tools to get back to that spot. With practice, a high percent of participants can break free of chronic pain and re-create their life.

The Cup Song or the gym?

Here is an email from one of the participants who has made steady progress over the year after Omega. He had been experiencing quite severe back and leg pain for about five years:

Ah, the victim role, that is me seemingly all the time. All of David Burn’s (author of “Feeling Good”) cognitive distortions are helpful to recognize in myself, but victimhood is the reminder most useful for me. I fall into it so easily!

I had a bad evening with the lower back several days ago. Instead of my usual hour+ strengthening and stretching routine, I practiced The Cup Song for 45 minutes, and most of the tension in my back went away. I’m starting to synch the lyrics with the percussion! I’ll need to go back to Omega for The Natural Singer In You to work on my tone and pitch!

At no point during my career would I have ever anticipated play being a major healing modality.

Enjoy your day today

The post “The Cup Song” first appeared on Back in Control.

The post “The Cup Song” appeared first on Back in Control.

My creative artist friend, Ernesto, endured a rough couple of years and for a while he “disappeared”. The details are not important. What is important is that he is back and thriving. This piece is a statement of his time in the “Abyss.”

I spend over eight years in darkness. There are many terrible aspects of the experience but one of the worst is that much of what you are experiencing cannot be seen. No one really believes you, although many try. Even more frustrating is that you cannot express the depth of your suffering with words. His sculpture instantly spoke to me and I love the name he gave her. She now occupies a space in my office.

There is not a day or minute that passes that I am not grateful to be able to be here and actually thrive. For years I did not think it was possible nor did I have any shred of hope. In the end experiencing this depth of suffering turned out to be a gift that has allowed me to guide many others out of their physical and emotional pain.

ILOHLA  (ee-LOH-lah) “to become strong” (Southern Africa)

In making this sculpture I wanted to represent the power of the human spirit. In spite of — or perhaps because of — the traumas of life: pain, emotional scarring, inner turmoil, suffering, we are all capable of inner growth. Seeing oneself not as a victim of external circumstance but as a survivor, allows one to view adverse personal experiences as a path to renewed inner strength and power.

In creating this piece, I asked myself “How can I express physical and tangible suffering, as well as the growth and strength a person may have gained from experiencing them?”  To accomplish this I used the body as a landscape. Similar to reading a road map, one only has to look in order to see the pain of the experience.

My goal is to create art that touches the heart and spirit of the viewer and is a vehicle for self-discovery and personal growth.  I hope you enjoy “ILOHLA.”

— Ernesto Sanchez, August 2013

The post To Become Strong – “ILOHLA” first appeared on Back in Control.

The post To Become Strong – “ILOHLA” appeared first on Back in Control.

Pain pathways are permanent. So are the intertwined anxiety and anger circuits. I am personally reminded of this fact on a daily basis. It happened in a particularly dramatic fashion while on vacation in Italy.

Florence

My wife lived in Florence, Italy from 1983 to 1990. She is fluent in Italian and we have a wonderful group of friends in the area. We try to get back every year to spend some time with them. It is always a remarkably enjoyable experience.

Relaxing is not one my most highly developed skills. But I did it. We had been staying in a small apartment in the lower part of one our best friend’s house. It had a beautiful view. We had shared some great meals with them, met some new friends, and I had stayed off the computer. I remember lying in bed towards the end of the trip thinking how nice it would be to be in this state of mind more often.

Ugolino

We had decided to play nine holes of golf together at one of the oldest golf courses in Italy. It was in a spectacular spot. My wife learned to play golf a couple of years ago and she was very excited to be able to play in one of her favorite places in the world on a beautiful day. Those of you who play golf with your spouse know that is a tricky adventure. Somehow it brings out the deepest issues in a relationship quickly (and consistently).

Our game at Ugolino

She had a great shot off of the first tee. The second shot was excellent and reached the green but in the right sand trap. I waited for her to hit out the trap once, then twice. After the third attempt I suggested that maybe she could pick up the ball. Additionally we had two local Italians behind us who were beginning to yell at us. She said, “No!!”

The second hole went pretty well except there were a few extra shots. Nonetheless she was playing pretty well as I was working on letting go of our less-than-ideal interaction on the first hole.

I was a little anxious on the third hole in that our pace-of-play was a little slow. I admittedly have a strong reaction to being held up on the golf course by groups in front of me but I really don’t do that well when I am part of a group that is holding up the rest of the course. A tale of two golf holes I suggested that maybe we could let the people behind us play through. That was met with a “No”!

The 4^th hole was fine while I again worked on enjoying my day. On the 5^th hole she hit the shot of her life on a long par three on to the green and the round began to pick up.

Fairway 9

#6

The tee shot on the sixth hole was across a pretty wide ravine. She decided to pull her driver. I said, “Honey, you have not missed a tee shot with your three-wood all day and you can easily cross this hazard.” Three shots and three balls later with the driver we were finally in play. We hit our second shots pretty well. Then she needed to find the restroom, which was nowhere to be found. There were now two groups playing up on us. As she was “coaching” me on how to drive the golf cart back to the clubhouse my brain exploded and I went into my infamous, highly developed victim mode. It came out as clenching my jaw and saying nothing. However, my body language was not subtle. She was not quite sure why I was so upset.

Gone

The rest of the round is not worth describing. I will only tell you that I was the only one playing the ninth hole and my golfing partner was walking.

Here I was after being incredibly relaxed, on a wonderful day in Italy, with my beautiful wife in the worst mood you can imagine. I intellectually knew that the anger/victim pattern has nothing to do with the person or situation that set it off. I was triggered, but I could still not stop the reaction. Knowing this made it even worse as I also get a little hard on myself when I fail.

At least one of us was sane

She was thinking, “What kind of person am I married to?” However, she is a remarkably wise and understanding wife. She was able to see me separately from my reaction and did not engage with me until I calmed down. Historically this encounter would have wiped out the rest of our vacation. I did recognize my temporary insanity and in about 30 minutes I was fine. We had a wonderful lunch and evening.

I hung a picture of the golf course in my office to remind me that victim patterns are universal and permanent. It does not matter how great your external circumstances might be, they have little effect on what goes on in your head.

Anger will always be with you

This experience was extremely humbling and enlightening. I used to think the goal of the DOC project and somatic work was to “conquer” anger and never go into the victim mode. That thinking actually makes things much worse in that you are actually just suppressing anger. It is a disaster. Since that day I have committed to being more aware and honest with myself of when I dive into that hole. Paradoxically it does occur less often and although the sequence is always the same the duration is shorter and the intensity is diminished.

Make no mistake about this fact. Every human has a deep victim pattern. That is because we are limited in what we can do to influence our environment and we truly are victimized on a regular basis. It is how you relate to this reality is what deeply affects the quality of your life. The advantages of victimhood

“You don’t need surgery”

Any time a patient comes in with chronic pain and rates him or herself as a zero on anxiety, depression, and irritability our whole staff recognizes we are in for a difficult interaction regardless how hard we try to be of service. As soon as I point out that I don’t see anything that I can do surgery on he or she often explodes. It is usually very intense and they can be verbally abusive to my staff. They don’t dare take me on. The more we try to calm them down the worse it gets. We have learned to let go very quickly and offer to see them back if they wish. We feel upset in that we know what is possible for them but they don’t have the capacity to engage. Anger simplified

Your circumstances don’t make that much difference

I have one patient, who has experienced an extreme amount of stress in the form of domestic violence, financial disasters, and a poorly done spine surgery. Even though my surgery solved the structural spine problem his pain did not abate – at all. Pain and anger are so entwined that you cannot experience pain relief until you can truly let go of your legitimate anger. That includes your anger at the surgeon who screwed up your surgery, the employer who do not have adequate safety guards, or the person who rear-ended you at a high speed and was drunk. He keeps explaining to me how great his life is now with better finances, a great relationship, etc. but he still has pain that now envelops his whole body.

I am reminded of Ugolino. Your life can be perfect. Your victim pattern is not going away. Unless you can let your anger go your pain will always be with you.

The post Ugolino first appeared on Back in Control.

The post Ugolino appeared first on Back in Control.

I tried everything to get rid of these things. I would shave them down with a razor, which I did several times a week. I tried multiple medications. I had them frozen off, but they always re-appeared. Through college and medical school, it was ongoing battle. They gradually seemed to get larger and more numerous regardless of my efforts. I became more self-conscious of them as I progressed through my medical training. I felt very awkward examining patients with what felt like were pretty disfigured hands. Of course, no one noticed them nearly as much as I did.

Orthopedic Residency

My first year of orthopedic training was stressful. I had done two years of internal medicine residency instead of the usual two years of general surgery. I was thrown right into the fire trying to catch up with the other residents. I honestly don’t know if stress was the issue, but my hands were worse with four or five large warts. I went to a skin specialist who used liquid nitrogen to burn them off. Not only was the initial burning very painful it continued burn for a couple weeks. It felt like an underground fire. I could not sleep well with the pain and I was getting increasingly frustrated. A friend gave me the name an older dermatologist who supposedly had experienced success with difficult skin problems.

My elderly dermatologist

He was nice and also really old. He looked at me and said that he didn’t think that there was much that could be done. He suggested that I rub some fresh aloe vera plant over them and that might help. I looked at him in disbelief and was now pretty despondent about ever getting rid of these things. As he handed me a couple of aloe vera stems he proceeded to say that, “I don’t really think it works. It is just probably some type of placebo effect.” At that point I become really upset. Even if the placebo effect was possible it seemed like he was even taking that option from me.

 “I’m done”

I remember standing there and I felt a profound shift deep inside of me. I recalled the recent suffering I had experienced after the last attempt of burning them off. The feeling was intense. I could almost re-experience the pain. I was “done” and simply wasn’t going to put up with it anymore. My whole being said, “No!!!”

I rubbed the aloe vera stems over my hands a couple of times and tossed them. Two weeks later the warts completely disappeared and six weeks later my skin looked as if they were never there. I have never experienced another wart in over 30 years. Clearly some type of immune response occurred. I don’t know what precipitated the healing response, but I could feel it and still can recall almost exactly what it felt like.

 “I’m done” – round two

The only other time I experienced that feeling was in 2002 after being stuck in a severe burnout. One of the worst parts of being depressed was feeling sorry for myself. It was endless and manifested itself in endless conversations and racing thoughts. Somehow, I became aware for the first that I was actually in a victim mode. I realized that there was no answer to being in the victim role. It was too powerful. I experienced the same deep feeling of mixed desperation and determination that I was no longer going to live this way. I was simply done. Within the next few months I began to heal. Many of my physical symptoms I had suffered with since childhood disappeared and over the next year essentially all of them resolved.

My Battle with Neurophysiological Disorder (NPD)

Also “done”

Janet had been suffering from chronic pain for years and seen by several dozen doctors. By the time she saw me, she was ready for surgery – except there was no surgical lesion that I could address. When I told her that her spine looked fine, she flipped out and began to yell at me about the whole medical profession and then some. I briefly told her about my book and website and asked her to return in a couple of weeks to discuss her options. I honestly thought I would never see her again. Much to my surprise, she not only returned, she was free of pain (and remained that way). She related a similar story to mine in that she was fed up and just going to move on without the help of doctors. She also described a deep shift that she couldn’t put into words.

Another story

I recently received this email from a reader.

Dear Dr. Hanscom,

“I was just told by a neurosurgeon today that the only way to stop my back and hopefully nerve pain in leg is surgery. I have a herniated disc at L5-S1 and he thinks it’s cartilage that is pressing on my S1 nerve. Anyway, I came back to my hotel and started googling and found your backincontrol.com site.  I really connected with it as I have started a mindfulness-based stress reduction course 2 weeks ago and am feeling some benefits already.

But what really connected me was your story on warts. When I was a young teen I also had warts on my hands. Tried the freezing and burning by physicians, but they always came back and sometimes more. One of my mom’s friends told me to steal a neighbors dishcloth and bury it in the garden, as for some reason it has worked.  I thought she was nuts!  I contemplated doing it but just couldn’t steal from my neighbors or anyone for that matter. But it got me thinking why that might work; it was using your mind. So, I started something where every night at bed I would visualize the warts going away and I have to say that I still remember the intense feeling I got in my body – something I have never again experienced.  I don’t even remember how long it took but my warts went away and never came back.

I now am trying that for my back, but not getting quite the same feeling this time. Reading your info on your Website had me motivated to try again as I really don’t want surgery if I don’t have to. I am going to follow your steps as well and already let my family know that there will be no talk about my pain.  If it works I will let you know.” Best regards, Janet

The formula??

I wish I could give you a formula to re-create the phenomenon at will. In both instances there was a deep sense of resolve that I was finished living in this manner and I said “no”. What I can’t figure out is why that feeling suddenly went so deep and was so strong. It was well beyond just willpower.

We know that the placebo response is the most powerful “drug” in existence. (1) You are simply connecting to your capacity to heal. It is the desired response. Somehow the perception of it has been distorted to be that there must not be anything really wrong if the body responds to a placebo. Every drug has a placebo effect and we also know that the bigger the intervention the greater the response. For example, and injection is stronger than a pill and surgery is even more powerful. The response tends to decrease with time. The problem is that you don’t want to incur harm while eliciting this response and unfortunately that is what often happens with spine surgery. Major adult deformity operations have a complication rate well over 50% and many of them are serious and permanent.

It has also been documented that you don’t have to “believe” placebo works to be effective. A powerful healing effect has been demonstrated even when patients are aware there are no active ingredients in the pill being administered. (2)

I have known for a while that DOC process presents creates structure and clarity for a given patient’s situation so he or she can take charge of his or her own care. There is not one answer to a complex chronic pain scenario and this is not a “how to” program. Freedom occurs when you’re able to calm down your nervous system enough to connect to your own healing powers. Each successful person has a different journey. You’re the only one with the key to unlock the door and move forward.

1. Dispenza J. You are the Placebo: Making Your Mind Matter. Hay House, 2015
2. Carvalho C, et al. Open-label placebo treatment in chronic low back pain: a randomized controlled trial. Pain (2016); 0: 1-7.

The post Healing Power Within—Warts first appeared on Back in Control.

The post Healing Power Within—Warts appeared first on Back in Control.

I talk about how anxiety and stress can lead to certain obsessive tendencies. Some of the tools from the DOCC project are laid out, specifically those that can help break down the circuits that fuel anxious and stressful thoughts and behaviors.

For more, see Your Demons are Robots.

BF

The post Video: Anxiety and It’s Demons first appeared on Back in Control.

The post Video: Anxiety and It’s Demons appeared first on Back in Control.