• 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.

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Here is a famous quote from Gabriel Garcia Marquez.¹

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

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

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

People grow old because their dreams are crushed by anxiety.

Stress

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

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

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

Safety

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

Threats

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

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

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

Dynamic Healing

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

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

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

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

Why not become a “professional” at living life?

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

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

Modern stresses

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

A healing sequence

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

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

Homework

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

 References

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

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• Mental and physical pain are processed in similar regions of the brain.
• Our inability to escape from RUT’s relentlessly drives flight or fight physiology, and people may become ill.
• There is a healing sequence to solve them – separation of identity, thought diversion, lowering anger, moving into creativity, and dissolving your ego.
• It is a dynamic process with all of these happening daily. Eventually, as it becomes automatic, and you are free to live your life.

Obsessive Compulsive Disorder (OCD) is manifested by extreme anxiety that is driven by Repetitive Unpleasant Thoughts (RUT’s). Most people associate it disruptive compulsive behaviors such as hand washing, climbing up and down stairs, following a rigid daily regime, and the list is endless. However, there is also a form of OCD called, “internal OCD” where a person has an unpleasant thought and “counteracts” it with a pleasant thought. Either form has no endpoint and is considered a diagnosis to be managed and not solved. That is simply not true.

RUT’s are universal

Essentially every human being has some level of RUT’s. At what point do they become severe enough to be considered OCD? Why not discard the diagnosis and consider the process on a spectrum of human consciousness. The classic definition of OCD is when the thoughts/behaviors interfere with your capacity to carry out activities necessary to live a functional life.

What about enjoying your life? With internal OCD, there are no outward manifestations, but your quality of life might range from unremarkable to miserable. There also many “acceptable” behaviors such as working hard, overexercising, “passionate pursuit” of a hobby or vocation. All of these can be just fine, but what is driving them?

As I have talked to patients carefully over the 40 years, I gradually learned that mental pain is a much bigger problem than physical pain. I would ask patients that if could get rid of their physical pain with surgery and they would still have their ongoing anxiety versus resolving their anxiety and living with the pain, the majority of people wanted to get rid of the mental pain.

Related behaviors

There are also come cousins of OCD. Consider them in the context of behaviors to cope with the unpleasant sensations created by anxiety (threat physiology). They include:

• Hair pulling
• Nail biting
• Eating disorders
• Excessive attention to physical appearance
• Hoarder’s syndrome
• Skin picking
• Cutting
• Extreme convictions regarding religion, politics, or any social issue
  • Imposing these “ideals” on others is the next step because control lowers inflammation. The more power the more control.

Any addiction is an attempt to mask anxiety.

Avoiding anxiety (threat physiology) drives most human behavior

Avoiding anxiety is the driving force keeping all living creatures alive. It is the result of stresses and challenges, not the cause. Amongst the many stressors in our lives, the inability to escape from our thoughts is a major one, maybe the worst. Although we cannot control our thoughts, many activities create sense of control. Suppressing RUT’s just makes them-worse.

“Worrying” seems normal to many people. But is not particularly enjoyable. Why do we spend so much time worrying about so many things, many of which we have no control over? One reason is that it provides a feeling of control. Somehow, worrying enough will help solve the problem. What it does is that it keeps your brain and body fired up and you have less energy to effectively deal with challenges.

Or maybe you have an “anxiety disorder.” Everyone has anxiety, so why would we call it a disorder and why would you personalize these intentionally unpleasant sensations that evolved to keep you alive. It is what you have, not who you are.

What about those who don’t have any of these behaviors. Even many well-adjusted people living normal enjoyable lives can experience a level of RUT’s that interfere with their quality of life. Actually, when life is relatively calm, these repetitive thought patterns can significantly increase. Then as one pursues pleasurable activities to distract themselves, it doesn’t work and is actually highly inflammatory. The data shows that a hedonistic lifestyle creates aggressive inflammatory cells called “warrior monocytes.” In addition to attacking viruses and bacteria, they also go after your own tissues. The other factors that stimulate their formation is social isolation and CHRONIC stress.¹ Your body knows how to effectively deal with acute stress, but it needs a break to rest and regenerate.

Degrees of OCD

Obsessive thought patterns are inherent in human cognitive consciousness. There are degrees of intensity, and they vary day-to-day depending on the level of your stressors and the state of your nervous system – calm or hyperactive. Again, even if your life is relatively calm, they can also be problematic.

OCD, the extreme manifestation of this situation is considered a diagnosis to be managed and can’t be solved. However, medicine has not consistently addressed the body’s physiology. When you are in a flight-or-fight state, your brain also becomes inflamed and these thoughts will fly out like clay pigeons at a shooting range, except there are trillions of them. The medical profession has also not acknowledged the seriousness of the effects of less intense RUT’s on people’s sense of well-being and health. They still drive threat physiology. They are often referred to as a “monkey mind” or he/ she is just having a nervous breakdown. These thinking patterns are a problem and our inability to escape them is even more problematic.

Solution principles

There are four aspects of solving RUT’s and each of them will be discussed in detail in future posts. They all happen simultaneously and indefinitely. Eventually, as your brain evolves away from them, you no longer have to “work at dealing with them. They are:

• Diverting, not controlling, them – mindfulness, expressive writing, cognitive behavioral therapy (CBT)
• “Turning down the heat” – when you are trapped by anything, your threat state fires up even more, and you are angry. Anxiety is activated and anger is hyper-activated threat physiology.
• Nurturing creativity and joy. This is where the real healing occurs as you move away from these spinning circuits.
• Dissolution of your ego – we work hard to attain enough self-esteem to feel better about ourselves. However, most of it is based on cognitive distortions that drive RUT’s even more. Without an ego to defend, these racing thoughts will abate – often dramatically.

This set of approaches evolved from my own 15-year ordeal with severe “internal OCD.” Not only do I not experience these vivid, almost visual thoughts, I don’t seem to have the random distracting thoughts I had before I became ill. There is also a vast amount of research looking at the mechanisms of why and how they occur, and now there is lot of neuroscience data supporting these ideas. The challenge is to present them in a manner so you can pursue your own healing journey. No one else can do it for you.

As your brain heals, your body heals. As your body heals, your brain will heal. The reality is that they are just part of one unit – you.

Recap

Our inability to escape our unpleasant thoughts is inflammatory. Since half of your brain has inflammatory receptors, it also fires up. The diagnosis of OCD is considered to be relatively uncommon, except many people suffer from RUT’s that interfere with the quality of their life. Obsessive thought patterns are considered to be unsolvable and just managed. However, medicine is not generally addressing the physiology. There are four aspects of dealing with OCD that will lower the intensity of these thoughts:thought diversion, lowering anger, moving into the creative part of your brain, and allowing your ego to dissolve. They are solvable.

 Questions and considerations

1. What percentage of your waking hours are you occupied with racing thoughts?
2. Do you find yourself avoiding thinking about certain things? Do you notice how often they keep popping up?
3. Are you aware how common they are and how many people are bothered by them?
4. The medical world doesn’t consider OCD a problem that can be solved and the lesser issue of RUT’s is not often addressed. By using all of the approaches presented, they are not only solvable, but you can move into a wonderful life
5. RUT’s are a function of the mechanics of the mind. Talk therapy alone is ineffective and it can be likened to having a conversation with the engine of your car.
6. It is important to understand that these “stories” and thoughts become embedded in our brains as concretely as any physical object. The problem is that since this is your frame of reference, how can you really see the problem? They become normalized.

 References

1. 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

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Common links to all chronic illnesses

Chronic mental and physical diseases are caused by common problems occurring at the genomic (DNA) and mitochondrial level (energy generators in each cell). These are the most basic components of evolution and maintaining life. Basic science research has brought this to light in numerous papers. The problem is the lack of communication between these silos of knowledge and clinicians to bring these critical concepts into the clinical domain.

This is short list of symptoms, illnesses, and disease states caused by exposure to chronic stress (threat), which is catabolic (consuming fuel) and inflammatory (attacking tissues). It is the reason that “stress kills.”¹ The variables are the intensity and duration. The sources of threat come in an infinite number of forms and can be real or perceived.

Symptoms

• Anxiety
• Obsessive thought patterns
• Carpal tunnel syndrome
• Migraine headaches
• Tension headaches
• Facial, neck, thoracic, and low back pain
• Pelvic pain
• Irritable bladder syndrome (interstitial nephritis)
• Irritable bowel Syndrome (IBS)
• Migratory skin rashes
• Tingling/burning sensations
• Tinnitus
• Insomnia
• Chronic mental and physical pain

Illnesses

• Fibromyalgia
• Chronic fatigue
• POTS disease (postural orthostatic hypotension)
• Asthma
• Hypertension
• PTSD
• Eating disorders
• Reflex Sympathetic Dystrophy (RSD)
• Temporomandibular joint syndrome (TMJ)

Diseases

• Cardiovascular disease
• Dementia/ Alzheimer’s disease
• Parkinson’s Disease
• Renal failure
• Autoimmune disorders
  • Crohn’s disease, colitis, rheumatoid arthritis, SLE (systemic lupus erythematosus), dermatomyositis, psoriasis, and ankylosing spondylitis
• Early mortality
• AODM
• Metabolic Syndrome
• Obesity (core)
• Major depression/ deaths of despair (suicide)
• Peripheral vascular disease
• Osteoporosis
• Bipolar disorder
• Addiction
• Obsessive compulsive disorder (OCD)
• Schizophrenia
• Cancer – except colon cancer and melnoma

You may be wondering how so many different symptoms and disease states can be linked by a common cause. It is because under sustained heightened threat physiology, each cell and organ system responds in its own unique way and will eventually breakdown.

Each of us is unique

Chronic disease is a complex problem affected and defined by many individual variables. It is not going to be solved by information gained by prospective clinical trials on ill-defined groups of patient. There are several reasons for this problem.

• • Trauma of any sort is connected to a higher chance of experiencing chronic disease.² It is worse when it happens in childhood as it alters the structure of the brain as well as causing long-term elevations of inflammatory markers. However, chronic adult trauma, bullying, or living under societal threats also keeps one in an activated threat state.³

There are at least four patient scenarios that affect one’s capacity to heal.

• Willing to engage – Since the greatest factor predicting a successful outcome is willingness to engage and take responsibility, any clinical study has to begin here. If people can or will engage, will they heal? This seems to consistently play out and we have seen hundreds of patients heal as evidenced by many powerful testimonials. This group must be clearly defined, and then various clinical interventions can be evaluated and refined with ongoing research. The “stages of change” questionnaire is one validated tool to sort this out.⁴
• Emotional inability to engage – This group is one who has suffered so much trauma that they have incurred a significant mental illness and/ or have no capacity to face incredibly unpleasant emotions. They are in a mental survival state. 86% of people in chronic pain referred as an outpatient to a psychiatrist are so frail, they cannot engage.⁵ It is a major reason why traditional psychotherapy is not very effective for treating chronic pain. There are ways to bring this group into a better state.
  • Skilled somatic trauma therapy – training one to feel safe
  • ISTDP – Intermediate Short Term Dynamic Psychotherapy.⁶ This is a specific approach designed to teach people to tolerate unpleasant emotions and also feel safe.
  • Specifically stabilizing their mental health situation.
• Don’t want to engage – Angry/ frustrated – This group is maybe the most challenging in that they are so angry that they will not engage in anything. Anger is a hyper-inflammatory/ metabolic state that causes the neocortex (thinking centers) to be less active and the survival midbrain to become more active. In other words, they cannot think clearly and process new information. They also don’t want to in that anger is destructive, including self-destructive. So, the activated physiology also blocks willingness to engage.
  • There are many approaches to bring them back “online”, but it is unclear what is the best approach for a given person.
• Lack resources – There are other obstacles to learning new skills. They include illiteracy, low educational level, no access to computers or lack skills, low IQ, poor access to care, poverty, chaotic family situation, and anything that causes unrelenting threat (stress).

Treating the individual

• We are not going to be healed from data gleaned from randomized clinical trials on general populations. Each person is “programmed” by their entire past up to this moment and are infinitely unique. It is a little unclear how modern medicine has veered so far away from treating each person individually.
• The complexity of chronic disease, uniqueness of each person and circumstances, and the need to address multiple factors simultaneously makes it impossible to do randomized prospective studies on large ill-defined groups and obtain meaningful data. It simply cannot and will never be done. How can you compare a college professor with someone who is illiterate? The core basis for our “data” is deeply flawed.
• We must think differently, as current approaches are not only ineffective, but they are also making the problem of chronic disease much worse. “Data” has not helped us heal. In fact, physicians, by being more focused on the data (which they may not realize is so flawed) have become more detached from their patients as they continue to administer ineffective care. Many caregivers and patients alike are frustrated by the lack of success and have somewhat given up.
  • Research has shown us solutions for specific symptoms, but it has not helped us deal with the complexity of a person and his or her disease state.
• This quote from Dr. Francis Peabody in 1927⁷ is at the core of the problem.

Disease in man is never exactly the same as disease in an experimental animal, for in man the disease at once affects and is affected by what we call the emotional life. Thus, the physician who attempts to take care of a patient while he neglects this factor is as unscientific as the investigator who neglects to control all the conditions that may affect his experiment.

What we now know is that emotions reflect one’s physiological state and he was well ahead of this time. In 1927, he was concerned with the intrusion of technology into the patient/ physician relationship.

Summary

Big data is harming all of us because it is not granular enough. Not only is the burden of chronic disease continuing to rise, but it is also crippling our society both financially and emotionally. “Mainstream medicine” is not only actively promoting ineffective risky, expensive, and ineffective treatments, we are hurting people that trust us.

Chronic disease is solvable by applying a systematic approach that creates a healing alliance where both the patient and provider can heal. Humans are not data points. The “data-based” foundation of care is deeply flawed. Is it any wonder that the burden of chronic disease continues to crush us financially and emotionally?

It is more important to know what sort of person has a disease than to know what sort of disease a person has. 

              Hippocrates

References

1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
2. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.

3. Takizawa, R, et al. Bullying victimization in childhood predicts inflammation and obesity at mid-life: a five-decade birth cohort study. Psychological Medicine (2015); 45: 2705- 2715.
4. Carr JL, et al. Is the pain stages of change questionnaire (PSOCQ) a useful tool for predicting participation in a self-management programme? BMC Musculoskeletal Disorders (2006); 7:101-108. doi:10.1186/1471-2474-7-101.

5. Abbass Allan. ISTDP in the treatment of chronic pain. Lecture to the Dynamic Healing Discussion Group (4/6/22); from the Halifax ISDTP database. https://drive.google.com/drive/folders/1k9AXx1webG69mKlCGoCU8XeUtNwTTM3q?usp=sharing
6. Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
7. Peabody FW. The care of the patient. JAMA (1927); 88:877-882.

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I am somewhat beside myself regarding several aspects of her story.

• Mainstream medicine is overlooking the basic physiology that we all learned in high school. When you feel threatened, your body goes into flight or fight and you experience physical symptoms. When this state is sustained, your body will break down, and you’ll develop serious illnesses. (1)
• The medical profession took away her hope. It has been documented in the neuroimmunology literature that hope/optimism directly lowers inflammatory markers. Taking it away does the opposite.(2)
• You may consider her story unusual or a “miracle.’ What is a miracle is life and the body’s capacity to heal. What if broken bones couldn’t mend as strong as they were before? What about cuts and deep wounds? What if your body couldn’t fight off infection? What kills patients in cancer treatment is often infection because strong drugs that kill cancer cells often compromise the immune system.
• Every day, I take a moment to consider how my heart can beat 60-80 times a minute with the only rest being between beats. It doesn’t make any rational sense.
• But what I find especially upsetting is the story of her early family life, of which variations occur on over 35% of American families.(3) How can this continue to be? We know better and it all keeps happening. The effects of an abusive childhood have been documented to last the rest of your life.

Here is her story of hope and what keeps me moving forward.

I am an unwanted child who was abused by her family. I do not remember ever being healthy. At 13, I started getting migraines.

5 years ago, at age 52, I broke my ankle and had horrible pain after surgery. Even though the most prominent pain doctor in our country diagnosed me with CRPS (chronic regional pain syndrome), physical therapists and the physiatrist didn’t believe it. I tried my luck at another great centre for PT, but it was the same. After each session I could not live for days because the pain was so bad even though I was on opiates.

I reluctantly decided I would re-learn to walk by myself. I had to go excruciatingly slowly, but in a few months I was able to walk with almost no pain. I got off opiates without a problem. Getting in touch with anger that I repressed all my life was extremely beneficial. Even though both my surgeon and the pain doctor were mad at me for giving up on PT, they each wrote that the PT was “a bit too harsh” after they saw me walk again.

Everything was going quite well until I got herpes zoster. When I recovered I was very keen to go walking. I pushed myself to walk for the next few years, but each step I took was painful. In the midst of it, I convinced the surgeon to remove the hardware, which did not help. In the last few months I finally gave up on walking longer distances even though I love to walk.

I have been writing JournalSpeak/expressive writing for 2+ years. It has been a great way to get the anger and other repressed feelings out. In the first 4 months, I got rid of my lifelong insomnia, and my chronic depression was way less. I was able to slowly lower the dose of antidepressants. I am able get rid of my migraines with writing the anger out, and I also need to validate my feelings. While writing down my feelingsI discovered I was scapegoated and gaslit by my family. I see others and myself in a completely new way, and do not feel so helpless anymore.

I was incredibly lucky to discover Dr. Hanscom on the Trauma Superconference. No matter how much anger I got out in writing, I could not get any relief from ankle/hip/back pain. I was eager to try his advice: no listening to the news, no criticising, no talking about pain, and using another virtual desktop on my computer without pain being discussed. He also gave me “permission” to focus on happier things like planning for things I would love to do and am able to do instead of trying to make sense of the past.

I realize that I have pushed myself too hard all my life. I can walk the same distance, but if I push myself, every single step is painful. If I say to myself, “I am going out and will walk as much as I can,” I can walk the same 1.5 km with little to no pain at all. If the pain returns, my nervous system is calm enough now that I can believe myself when I say, “I am safe. My ankles/hip/back are OK” – and the pain goes away!

The fact that the pain doctor said in an interview only a couple of years ago that nothing much can be done for chronic pain, incredibly saddens me. Two of Dr. Sarno’s books(4) were translated to our language years ago. A psychologist that works with people with chronic pain has a 3+ years waiting  list for her groups. She recently said in a lecture for rheumatoid patients that they need to talk about their pain. Even though one patient insisted that people ignore or do not believe her, the psychologist insisted they continue to talk about pain. I know firsthand this does not work. A couple of years ago I joined an online support group for chronic pain, and just reading about pain made my pain so much worse that I had to leave.

I am so incredibly grateful to Dr. Hanscom for saving my life. All the advice and information he shares, allows us to help ourselves even if we live on another continent.

This is not about me

I would like to emphasize that the healing journey is based on deeply-documented interventions. The DOC (Direct Your Own Care) Journey is simply a framework that presents them in organized and accessible manner. There are a growing number of practitioners that understand the human need to feel heard, validated, and safe. Each of them has their own style of educating their patients, implementing effective treatments, and helping patients access their own capacity to heal. Some of the main principles are that chronic disease is complicated, multiple aspects of it must be simultaneously addressed, and the patient must take responsibility for his or her own care.

One interesting aspect to her story is that belonging to a pain support group carries a poor prognosis in that most them are focused on discussing the pain, medical care, and how badly they have been treated.(5) Although they may be correct, these discussions place your brain on the problems and not moving into the two-part solution – letting go and moving forward.

Some other effective interventions include:

• PRT – Pain Reprocessing Therapy(6)
• EAET – Emotional Awareness and Expression Training(7)
• ISTDP – Intermediate Short-Term Dynamic Psychotherapy(8)
• ACT – Acceptance and Commitment Therapy(9)
• Mindfulness-base Stress reduction(10)

She found way out on her OWN 

Again, each of these must be framed in an overall treatment approach. As much (most) of it is self-directed, not a lot of resources are required. When needed, they can be plugged into the bigger picture. I liken it to doing a jigsaw puzzle that is not that difficult. They key is persistence.

Note, that although the framework provided by Back in Control helped her move forward in a powerful way, she had already done a lot of work. I have never seen or corresponded with her. She truly pulled herself out of the hole and entered into a new life! For many who heal, this is the way it often happens.

References

1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
2. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
3. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.
4. Sarno J. The Mind Body Prescription. Warner Books, New York, NY, 1998.
5. Friedberg F, et al. Do Support groups help people with chronic fatigue syndrome and fibromyalgia? A comparison of active and inactive members. J Rheumatol ((2005); 32:2416-20.
6. Asher YK, et al. Effect of pain reprocessing therapy vs. placebo and usual care for patients with chronic back pain. JAMA Psychiatry (2021).doi:10.1001/jamapsychiatry.2021.2669
7. LumleyMA, Cohen JL, Stout RL, Neely LC, Sander LM, Burger AJ. An emotional exposure-based treatment of traumatic stress for people with chronic pain: preliminary results for fibromyalgia syndrome. Psychotherapy (Chic) 2008;45:165–72.
8. Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
9. McCracken LM and Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. Am Psychol (2014); 69:178–87.14. Hann KEJ,
10. Cherkin DC, et al. Effect of mindfulness-based stress reduction vs. cognitive behavioural therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA (2016); 315:1240-1249. doi:10.1001/jama.2016.2323

The post “My Way Out” (of “The Abyss”) – One Patient’s Story first appeared on Back in Control.

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• Understanding the nature of chronic disease and the principles behind the solutions, allows you to fully engage in your care.
• Characteristics that keep us alive are what also create disease states.
• Chronic pain is a neurological diagnosis that has profound effects on your body’s physiological state. Existing in flight or fight breaks down your body.
• Survival depends on the protection of anxiety and anger. Letting go of trying to fight or change them releases energy to live your life.
• The essence of chronic illness is living in sustained threat and the solution lies in finding safety.

Here is a review of some characteristics of staying alive, which are the same ones that cause illness and disease.

Your health is dependent on the amount of time your body is in a physiological state of threat compared to feeling safe. Life is dependent on feeling safe in order to regenerate and also dealing with threats in order to survive. But, when you are exposed to sustained threat physiology, your body will break down.¹

Physical and mental symptoms are the result of each organ system in your body uniquely responding to your body’s chemical makeup.² In addition to the multiple physical symptoms, the sensations created by the flight or fight inflammatory state are called anxiety and anger. They are the result of threats, not the cause. They are also powerful, uncontrolable, amoral, destructive, and necessary to maintain life.

The starting point

Picture a complex circuit board that has trillions of etched-in circuits that represent your lifetime of programming. These circuits are not alterable for several reasons. First, they are memorized, similar to riding a bicycle.³ Second, any time you spend trying to analyze and figure them out is counterproductive. The more attention you pay to these patterns of activity, the more they are reinforced. Finally, as the powerful unconscious brain is estimated to process 20 million bits of information per second⁴ (compared to your conscious brain only processing 40 bits per second), rational interventions alone, such as talk therapy, cannot hope to make a dent in these circuits. It is like trying to move a high mountain peak with a shovel. It is not going to happen and much of your life’s energy is consumed in the process of trying.

It sounds discouraging. You have these permanently embedded pain circuits in your brain and the harder to try to fix them, the more they are reinforced. They are also necessary and much more powerful than your conscious brain. So, what do you do?

Solving the unsolvable

Understanding that you cannot solve or improve these unpleasant circuits is the first and necessary principle behind the solution. You must put down your shovel and move on. Instead of trying to “fix yourself,” new strategies are needed to create fresh circuits in your brain. Most of these approaches utilize methods that connect with the unconscious part of your brain with repetition. It’s similar to diverting a river into a different channel. You begin with small steps to create these new channels, but eventually the water’s flow will aid the process.

So why would we ever take anxiety or anger personally? They are inherent for survival but have little, if anything, to do with who we are. By letting go of trying to solve an unchangeable situation, you’ll experience a huge energy surge that allows you to move forward.

The second principle is that since it is impossible to fix your pain circuits, you must develop or shift onto a new set of circuits that aren’t painful. There are many ways of stimulating these changes, and the process is called, “neuroplasticity.” It is similar to installing a new virtual computer on your desktop. With repetition, it is remarkable how quickly these changes happen. Since your brain will develop wherever you place your attention, you must move towards your vision instead of continually trying to fix yourself. As you embrace wellness, you’ll crowd out pain.

Third, you cannot move forward until you have let go of the past. This is difficult because when you are trapped by a chronic disease, you are legitimately angry. However, you are also stuck. There are ways to effectively process anger and there are tremendous benefits to learning these tools.

Fourth, The DOC Journey is simply a framework that organizes your thinking and presents tools in a way that you can apply them in a focused manner. The steps in healing are:

• Awareness – you have to understand a problem before you can solve it.
• Treating all aspects of pain simultaneously – it is similar to fighting a forest fire. Every treatment can contribute to a good outcome, but nothing will work in isolation.
• You take control of your care. Since chronic pain is complex and you are a unique individual, each person’s situation is incredibly complicated. You are the only person that can possibly solve it with guidance. If you are not in charge, nothing can happen.

Fifth, a core concept of The Journey is awareness. It includes awareness of:

• Your emotions
  • Suppressed emotions are especially problematic
• The impact of your actions on others and theirs on you
• The nature of chronic pain
• The principles behind the solutions to chronic disease
• Your specific diagnosis
• Your vision of what you want your life to look like

Finally, since your sense of well-being and health is dependent on the composition of your body’s physiological state, all of your efforts are intended to stimulate it directly or indirectly into a safety state. There are three areas of focus:

• Input – how you process your stresses
• The state of your nervous system – calm or hypervigilant
• Output – it is desirable to remain in balance or safety and minimize the amount of time you are in a threat state.

The desired safety state allows you to feel content and secure, have a slower metabolic rate (rate you burn fuel), less inflammation, and lower levels of stress hormones. Optimizing your body’s physiological state from threat to safety has a profound effect on your health and quality of life.

Recap

The solutions to solving and preventing chronic disease lie in understanding the principles behind them. Embedding these of concepts allows you to continually practice them. This is in contrast to randomly learning techniques to fix yourself. The process gives you control of regulating your body’s physiology from one of threat state to safety.

Questions and considerations

1. Consider that it is your whole body that responds to your immediate set of circumstances in order to optimize your chances of survival. Your nervous system is the processing center for sensory input and an integral part of the reaction. There is absolutely no separation of the mind and body and why even the use of the term, “Mind Body” is inaccurate.
2. Why would you take your powerful survival reaction personally? It is intended to feel so unpleasant so as to force you to act. It is what you possess and not who you are.
3. You’ll be taken on a journey that will allow you to depersonalize this flight or flight reaction. It is just a part of your daily life.
4. Take some time to review the above principles of solving chronic disease. They will eventually enter every aspect of your life and become automatic. As you spend a lesser amount of time in a threat state, you will be able to move forward into a new life and thrive.
5. You can’t fix chronic disease. You must let go and move into wellness.

References:

1. Torrance N, et al. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain (2010);14:380-386.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Hashmi, JA et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751 – 2768.

4. Trincker, Dietrich. 1965 lecture at the University of Kiel. German physiologist

The post Common Links to Chronic Disease – RUTs are Relentless first appeared on Back in Control.

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Roadmap to a solution

What are the clues? Over 90% of people who have died of COVID-19 have some other chronic medical condition(s) (1). The common perception is that in this scenario, the body simply gets overwhelmed. The pre-existing situation is unsolvable and the outcome is inevitable. This idea could not be farther from the truth.

All these chronic conditions are associated with elevated inflammatory markers from the body responding to threats. A major aspect of this response is the immune system. Mental threats are more problematic than physical threats in that you cannot escape disturbing thoughts and emotions and repressing them is even worse. Therefore, every human being is exposed to some level of elevated stress hormones and inflammation. Many people have learned to process threat in way that causes little damage. However, many, if not most of us, have not been taught these skills and therefore are  exposed to elevated levels of inflammatory cells. It is the essence of chronic disease.

The following chronic diseases are all connected to sustained inflammatory and metabolic destruction of tissues: cardiovascular disease, peripheral vascular disease, Parkinson’s disease, autoimmune disorders, obesity, adult-onset diabetes, anxiety, depression, obsessive compulsive disorder, and bipolar disorder. It is all the same process with different clinical manifestations and many people suffer from multiple different ones.

Plan A–Lowering Inflammation Lengthens Life

This document, Plan A, presents 12 categories of interventions that will lower your levels of inflammation. If most severe cases of COVID are connected with chronic medical conditions, then address them. By starting with lower levels of inflammation, there is a better chance of staying below the critical threshold where the inflammatory process spins out of control, there is diffuse damage to many different organs, and your lungs fill up with fluid. There are now multiple professionals advocating a similar approach. One group looked at it from using preventative medications, but it can be achieved with these other means.

Getting and being happy is a learned skill and it is well-documented that those who learn it live longer with a better quality of life. Dealing with COVID-19 requires the same approach as dealing with chronic disease–lower threat and inflammation and create safety. Obviously, it all occurs at a much faster rate with COVID.

Join us in this grass roots movement

Please circulate Plan A to as many of your friends, family, and colleagues as possible and also encourage them to pass it along to their circles. This plan was assembled by a group of physicians and scientists who feel strongly that this approach will have an impact in lowering the severity of this deadly disease. It also represents a template for the future of healthcare moving from an illness to a wellness model. It boils down to means of creating safety instead of being at the mercy of threats. Most chronic mental and physical disease is preventable and some if it even reversible. This booklet represents a major effort to change both the trajectory of COVID–19 pandemic and also the manner in which we approach health care and chronic disease.

There is another aspect of all of this to consider. Inherent in this approach is each person taking full responsibility for his or her role in their health. It is easy to look at others or society for solutions when they truly exist only in each one of us. It is possible with a collective effort of taking personal responsibility for every aspect of our lives, we can change the course of this relentless pandemic, the nature of health care, and create societal changes that will enhance the quality of our lives and those of future generations. We each have to take action, as the burden of chronic disease is crushing us. (2)

Seeing such clear relationship between chronic stress and disease, both in my clinics and in the literature is what finally persuaded me to quit my practice. The DOC Journey is the most recent evolution of the healing process. It has been inspiring and energizing to continue to see people without hope consistently connect to their own capacity to heal.

Plan A – Lowering Inflammation, Lengthening Life

References:

1.   Williamson EL, et al. OpenSafely: factors associated with COVID-19 death in 17 million patients. Nature (2020); https://doi.org/10.1038/s41586-020-2521-4.
2. O’Neill Hayes, Tara and Serena Gillian. Chronic disease in the United States: A worsening health and economic crisis. Americanactionforum.org; September 10th, 2020.

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