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

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

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

Overview

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

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

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

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

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

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

Books to read

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

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

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

On the slopes

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

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

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

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

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

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

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

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

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

Feeling unsafe

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

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

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

So how do we behave?

ADDICTIONS

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

POWER

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

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

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

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

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

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

SELF-ESTEEM

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

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

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

What can you do?

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

DYNAMIC HEALING

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

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

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

RUTs (repetitive unpleasant thoughts)

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

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

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

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

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

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

References

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

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

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

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

Here is a famous quote from Gabriel Garcia Marquez.¹

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

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

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

People grow old because their dreams are crushed by anxiety.

Stress

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

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

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

Safety

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

Threats

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

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

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

Dynamic Healing

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

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

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

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

Why not become a “professional” at living life?

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

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

Modern stresses

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

A healing sequence

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

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

Homework

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

 References

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

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

My perspective

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

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

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

What’s currently being done?

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

1. Not addressing the root cause

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

2. Inadequate training

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

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

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

3. Known data is ignored

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

4. No one is listening

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

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

5. It’s the mental pain

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

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

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

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

6. Simplistic thinking

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

Finding relief any way that he can

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

The viable solution

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

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

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

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

References

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

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

The added dimension of language

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

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

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

Your options

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

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

Why let go of anger?

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

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

Train your brain

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

.

References

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

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• AI and the human brain both are blank slates whose functionality depends on what is loaded into them.
• Your capacity to navigate life depends on the quality of data and the “algorithm” loaded into your brain.
• Poor data or inept processing skills creates ongoing and progressive dysfunctional thoughts and behaviours.
• Your “trauma story” is not a “story”. It is a dynamic state, and you have a choice in directing it.

There is a striking similarity to computer-based learning called artificial intelligence (AI) and the human brain. AI has the capacity to process sensory input, analyze it, and arrive at conclusions as well as make decisions. There is also a marked difference in that AI cannot react to the internal sensations from the body’s physiology (body’s chemistry and function) because there are no neurochemical support systems for AI. Every living creature reacts to its environment through collecting sensory input, analyzing it by the millisecond, and the signals are sent out to regulate the physiology to that of “threat” or “safety.” These internal sensations are called “interoception,” and interpreting these signals is the basis for the evolution of human consciousness.¹

Co-regulate??

Thoughts are a major form of sensory input and emotions are what you feel; they reflect your physiological state (how the body functions). Much of human physiology is regulated through the vagus nerve, which is close proximity with your facial muscles. Through a complex set of interactions, we are able to “co-regulate” with others with the first step being that of determining if the other person is “safe” or not.

AI can only react to electronic signals and can process them without any sense of threat or safety. Even if facial recognition could determine safe or dangerous, there would just be an electronic response that mimicked this state, but there is no chemistry to feel.

AI vs. your brain

The cognitive capacity of AI to accurately analyze vast amounts of data, and arrive at new insights, far outstrips the human brain. It can create art that elicits emotions (physiology) in humans, but another AI machine will be unable to “feel” anything. It also cannot co-regulate with another machine or human, although it may appear that way on the surface. For example, when patients were evaluated by an AI machine compared to physician, the AI machine was much more effective in allowing a patient to feel heard and safe.²  Of course, if a clinician is stressed and feeling rushed, the co-regulation will be in the wrong direction.

But here is the real problem with the human condition that is being highlighted by AI. It is clear that the effectiveness of AI depends on two core factors. The first being the quality of the data being inputted and second that the “rules” of processing the data or the algorithm.

Jinho/AdobeStock

For example, if you simply download the rules of chess into AI without any strategies of how to use it, nothing of significance will happen. For AI to develop a mastery of chess, the data and the approaches need to be “taught” by a chess master. Then it can analyze the approaches, mistakes, good moves, and eventually become a better player than the master.

What if you inputted the wrong rules or if you trained it with someone like me who really only knows the rules and can only see one or two moves ahead. There is little or no chance of the computer gaining enough experience to compete at a high level, much less become a grand master. The computer can improve on good and also enhance incompetence. In the business world, inputting bad data into AI costs industry a lot of money. AI is developing tools and approached to understand when bad data is being gathered and the results are not going in the right direction. Could it salvage my chess game someday? Maybe.

The human database

Let’s get back to the human brain. I often refer to David Eagleman’s book, Livewired, where he clearly describes the incredible neuroplasticity of the human brain.³ It will adapt to almost any input to optimize your chance of survival. But what he describes so well is how dependent we are on our parents for physical survival compared to most mammals. Even more clear is that ALL of our consciousness is constantly programmed every second from birth by sensory input from inside and outside of us. We are who everyone thinks we should be and eventually those “voices” become our own. There are an infinite number of data points and most of it is around molding our “identity”, behaviors, accomplishments, and surviving. Additionally, most of us are not taught effective coping skills and even fewer are taught to nurture joy.

Consider the extreme form of poor input and coping skills of being raised in an abusive environment. All a child needs from his family is to feel safe, be safe, educated, taught relationship skills, and feel nurtured. That’s it. That is not what many of us get. So, the download in our brains from the beginning is “flawed data,” we are not taught to process it, we are too busy surviving to feel safe, and we don’t have the skills to nurture creativity. So, our processing system is full of bad data, analyzed by the wrong set of rules, and our life trajectory may spiral out of control.

OlegD/AdobeStock

The real trauma story

Trauma is stored in your body, but maybe in a different way than you might think. There is a trend to develop a “trauma” story. The real trauma story is reflection of the trend of your entire challenging life. Your “personal AI” will continue to add dimensions and depth to it. You may be rapidly evolving in the wrong direction depending on what “data” has been loaded into it. This is especially true if your “processing system” is also flawed. It is ongoing until you become aware of the nature of the data that is contained in your brain up to this second and you learn more effective methods to process it.

There is good news in that by changing the nature of your input and the way you process it, you can program in any reality you wish. What doesn’t work is trying to rearrange the old data and “fix” the flawed operating system. The first step is becoming aware of the nature (not the details) of the data that has been downloaded into your brain. Equally important is understanding the ways of processing your input to break into these swirling circuits and get your brain moving in the right direction.

To have a good life, you must live a good life. It requires skills and practice.

References

1. Damasio, Antonio. Feeling and Knowing: Making Minds Conscious. Vintage Press, 2022.
2. Ayers JW. 2023. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Internal Medicine.https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2804309
3. Eagleman, David. Livewired. Canongate Books, 2021.

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As a surgeon who has spent a lifetime dealing with patients with chronic pain, including me, have come to see that the MUS diagnosis is wholly inaccurate and should be immediately discarded. Every bodily symptom you experience results from an identifiable structural problem or from your body’s physiological response to  your surroundings. Symptoms don’t just happen. The correct diagnosis is MES (Medically Explained Symptoms).

Physiology

Physiology is the term that describes how the body functions. We stay alive because living creatures can maintain an incredibly delicate balance of the body’s acid/ base balance, electrolytes, blood pressure, temperature, heart rate, and the list is long. It is a dynamic process that changes by the second in response to input from your surroundings.

We require safety (rest and relaxation) to regenerate and build up our reserves. When we are under any stress (threat), the body responds with elevated activity in multiple different organ systems to increase the chances of survival. Fuel stores are depleted, and reserves are lowered as energy is shunted to muscles in the event of fast action is required.

Our bodies are intended to be mostly in “neutral” or what is called homeostasis. When you are going about your daily business without noticing how you are feeling, you are in homeostasis. It can be maintained for long periods of time because reserves are being replenished commensurate with your needs.

Any time your body is under any kind of mental or physical threat, your body’s physiology will react in a manner to bring you back into balance. There are three contributors of this scenario 1) your circumstances (input) 2) the state of your nervous system (coping capacity) 3) output (body’s total neurochemical response).

By definition, anytime your senses any level of danger from any source, you are under threat – even if it lasts for just a few seconds. When you are in homeostasis, your body responds so quickly, you won’t notice the changes. However, when the threats begin to overwhelm your nervous system’s coping capacity, you’ll experience unpleasant symptoms.

The threats can be mental or physical and there are almost always multiple physical and mental responses. The physiological manifestations include:

1. Changes in your immune system with increased inflammation.
2. Your body’s metabolism (the rate you burn fuel). You are either storing fuel (anabolic state) or consuming it (catabolic state).
3. Nervous system activity – you are designed to become more sensitized and alert when there is potential danger.

These are broad categories of the effects of threat. But, since there are so many organ systems required to keep you alive, numerous physical and mental symptoms are created. Every symptom that is not from an obvious anatomical problem is a result of this interaction of your body responding to sensory input from your surroundings that is interpreted as potentially dangerous. How else could you stay alive?

Defining threat

Examples of physical threats include viruses, bacteria, being attacked by a predator – human or animal, hunger, lack of shelter, poverty, lack of opportunity, being bullied at work or school, racism, authoritarianism, trapped in a difficult living or family situation, and physical maladies.

Mental threats are processed in a similar manner as physical ones with the same physiological response. (2). They are more problematic in that humans have consciousness and many of our thoughts and emotions are unpleasant, and unlike visible threats like tigers or a severe storm, we cannot escape our thoughts. Repressed thoughts and emotions are even more impactable on your body’s neurochemical state. Many of our unpleasant thoughts are based on cognitive distortions or “stories” about our lives. Unfortunately, whether the threat is real or perceived it has the same deleterious effect.

Physiologically explained symptoms

Unpleasant sensory input progressively impacts your body at three levels.

• Response
• Symptoms
• Illness/ Disease

When the threat is short-lived your response will be appropriate to the situation and quickly disappears when it has passed or resolved. Almost every internal and external action of your body is directing you in a manner, so you don’t feel unpleasant sensations. If you do sense danger, you are programmed to resolve it immediately. Examples are looking away from the sun, spitting out rancid food, pulling your bare foot back from hot pavement, frequently shifting in your chair to avoid skin breakdown, and avoiding an aggressive dog.

When threats are more prolonged, you will begin to suffer symptoms such as back pain, tension headaches, anxiety, poor appetite, nausea, urge to urinate, sexual dysfunction, burning sensations, skin rashes, dizziness, ringing in your ears, and insomnia. There are over 30 different physical symptoms that can occur. (3)

But when threats are sustained, you have a significant chance of becoming seriously ill or developing a disease. It is well-documented that stress kills people and unfortunately the symptoms of a chronic illness also add to the threat load. This is particularly true in chronic pain. (4)

The nature of your body’s physiology under threat

Environmental cues of threat set off a defensive response. Immediately, before you are even aware, your immune system girds for the possibility of injury by initiating inflammation (to protect cells against bacterial or other invasion), elevates metabolism to provide fuel for defense, increases the speed of nerve conduction–which increases your alertness but also your pain sensitivity, and elevates the levels stress hormones (cortisol, adrenaline, noradrenaline, histamines). Much of this defensive state is modulated by small signaling proteins called inflammatory cytokines.

So how do you think you feel when you are in this physiological state? Your heart is racing, you are sweaty, tired, anxious, overwhelmed, nervous, stomach feels tight, blood pressure is elevated, pain is worse, and your breathing is rapid. The bottom line is that you don’t feel great when your body is in this heightened neurochemical state. Are these symptoms imaginary? Not a chance. None of them.

The consequences

This is a list of some of the symptoms and illnesses that are connected with your body’s physiology being in a prolonged heightened state:

Symptoms

• Irritable Bowel syndrome
• Irritable Bladder syndrome (interstitial nephritis)
• Migratory skin rashes
• Tinnitus
• Burning sensations
• Migraine headaches
• Pelvic, neck, thoracic, and low back pain
• Insomnia
• Tendonitis

Illness

• Anxiety
  • Depression
  • OCD
  • Bipolar
  • Schizophrenia
• PTSD
• Fibromyalgia
• Chronic fatigue

Disease

• Autoimmune diseases
  • Colitis/ Crohn’s disease
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Multiple Sclerosis
• Cancer
• Coronary artery disease
• Alzheimer’s disease/ Dementia
• Early death
• Suicide
• Addictions
• Parkinson’s disease
• Obesity
• Liver disease
• Osteoporosis

There is a wide range of “Medically Unexplained Symptoms/ Illnesses/ Diseases” that are created by your body’s  survival response. Dr. Stephen Porges has eloquently explained how the autonomic nervous system through the vagus nerve, modulates these various physiological states. (5)

Why is MUS such a deadly diagnosis?

The worst aspect of the diagnosis of MUS is that it creates despair; it takes away hope. Research has shown that hope, optimism, and a sense of purpose are anti-inflammatory and allow your body to regenerate. (6)  So, the diagnosis itself is inflammatory and adds to threat. Do not accept it at any level. The correct diagnosis is MES.

Any major reason MUS is so damaging is that many physicians assume it is untreatable, there is nothing more that can be done, and refer you to a psychologist for any number of reasons that most of you are familiar with. “It is in your head.” You don’t have much of a pain tolerance.” “You are just looking for drugs.” You have “secondary gain issues and don’t really want to work.” The labels keep piling on and none of them are helpful to your healing and they are just wrong. But MUS has a certain finality to it, and it is crushing. It is tragic because physicians have not been taught the link between mental/ physical threats to the physiological changes that cause physical symptoms. I feel the ultimate tragedy is that with the correct understanding, MES is one of the most treatable diagnoses with minimal costs and risks.

Beware of IES (Incorrectly Explained Symptoms)

When there is an obvious anatomical abnormality and the symptoms exactly match the lesion, that would be considered a structural identifiable source of pain. An example would be a painful inflamed tooth. It is a straightforward process to diagnose it by testing with hot and cold or pressure. A root canal or pulling the tool will quickly solve the problem.

But this discussion is complicated by the fact that there is an emphasis in modern medicine to explain reasons for pain from a structural problem when the anatomical abnormality is not actually the cause of it. Many symptoms are attributed to normally aging anatomy and the cause and effect are not supported by medical research.

For example, pain is commonly attributed to scoliosis and there has never been a research paper documenting that it even contributes to back pain unless the deformity is severe and unbalanced (your head is not directly center over your pelvis).

Degenerative disc disease, bone spurs, arthritis, ruptured discs, bulging disc, and spinal arthritis have all been documented in multiple research papers that none of these “diagnoses” are the cause of chronic neck or back pain. (7)

There is marked debate about small tears of the structures around the hip and shoulder. Even severe hip, knee, and shoulder bone-on-bone arthritis has little correlation with pain. There is actually more of a relationsip to stress. (8)

How can you figure this out?

First, it is always important to undergo a medical workup to make sure there is not a structural issue such as vascular disease, pinched nerve, tumor, or an infection.

Second, regardless of the findings of the workup, maintaining your body’s metabolic, immune, and nervous system balance is important. If you require a procedure, your odds of a good outcome will be maximized.

There are many ways to accomplish this. The DOC Journey is one platform that presents proven medical treatments in a way that allows you learn and implement these strategies. All three aspects chronic illness must be addressed.

Output (stimulation of the body’s anti-inflammatory response)

• Breath work
• Mindfulness/ meditation
• Humming
• Vagal stimulation
• Certain pitches of music

State of the nervous system (decreasing sensitivity and stimulating neuroplastic changes in your brain)

• Exercise
• Sleep
• ACT (Acceptance Commitment Therapy)
• Processing prior trauma

Input (what are you uploading into it and what are you holding onto?)

• Forgiveness
• Cognitive Behavioral Therapy
• Expressive writing
• Never discussing your pain or medical care

What really does not work is just “coping”, which is what most of us have been taught to do. It requires specific approaches and tools to effectively create the desired changes. Regardless of what approach you use, the key is to learn how to utilize these tools to consistently process threat in way to keep you in homeostasis or a state of safety.

Finally, you must commit to taking charge of your own body and health. The first step is understanding the nature of chronic disease. The solutions lie in implementing strategies we already know are good for our health–healthy diet, sleep, regular exercise, taking time for yourself, process addictive behaviors, and nurturing close relationships. The common theme with all of these interventions is that they lower inflammation. Ongoing inflammation directly destroys tissues throughout your body.  It sounds daunting but it is more doable than you think. Not taking control may have more severe consequences than you can imagine.

Chronic pain is one of the MUS diagnoses. It is one that is particularly untrue. By understanding the nature of chronic mental/physical pain and the principles behind the solutions, it is a Medically Explained Symptom (MES) and a consistently solvable problem.

MUS must go!

References:

1. Edwards T M, Stern A, Clarke DD, Ivbijaro G, & Kasney LM. (2010). The treatment of patients with medically unexplained symptoms in primary care: A review of the literature. Mental Health and Family Medicine, 7, 209–221.
2. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006);126:132-138.
3. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
4. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013);7/4:217-227. 10.1111/spc3.12020
5. Porges Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
6. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
7. Jarvik JG, et al. Three-Year Incidence of Low Back in an Initially Asymptomatic Cohort. Spine (2005); 30:1541-1548.
8. Wise BL, et al. Psychological factors, and their relation to osteoarthritis pain. Osteoarthritis and Cartilage (2010);18:883-887.

The post The Myth of MUS (Medically Unexplained Symptoms) – It’s MES first appeared on Back in Control.

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Chronic mental and physical disease are connected by a common root cause – stress. How and why?

Stress (threat) creates chemical (physiological) changes in your body (fight or flight), which creates mental and physical symptoms. When you are subjected to chronic stress, the ongoing inflammation and increased fuel consumption (metabolism) breaks your body down. Hence, you’ll eventually develop illnesses and disease.

Stress kills

It is well-documented that stress kills. The Holmes-Rahe stress scale was developed in the early 1960’s with points assigned to life events – both positive and negative. If your score was 300 or more, there was an 80% chance of developing a major illness within two years.¹ I have a close friend that I took the test with recently. His score was 463. Guess what? He developed cancer in his spine.

Bruce Lipton is a developmental biologist who stepped out of academic medicine in 1993 because what he was observing in the lab did not conform to the standard thinking in mainstream medicine. He understood that all life is possible because living organisms were able to transform energy into functional forms. Atoms, the building blocks of life and substance consist mostly of space and are powerful energy fields. Biologists embraced the role of quantum physics in biology in 1927, but mainstream medicine has been slow to adapt. His views have not historically been well-received, but it turns out that he was not only right but was decades ahead of his time.

Beliefs and your body

He is the best-selling author of The Biology of Belief. His work is now well-documented regarding the effects that beliefs exert on your body’s physiology. Negative belief systems fire up the fight or flight response and keeps it there. The common link to chronic mental and physical disease is sustained threat physiology and healing happens when you are in safety. Here is a small sampling of some data that supports this perspective.

• Dantzer in 2018² published a review on resilience. He documented the effects of stress on inflammatory molecules called cytokines. There are four factors that lower inflammation.
  • Optimism/ Hope
  • Sense of control
  • Positive outlook/ vision
  • Sense of social connection and community

Notice that when suffering from chronic mental or physical pain that all these factors are compromised – badly.

• Cole in 2007³ documented that chronic stress and social isolation caused the production of aggressive monocytes that he called, “warrior monocytes.” These are white blood cells that attack foreign bodies such as viruses, bacteria, and cancer cells. But these monocytes also attack your own tissues.
• Lisa Feldman-Barrett runs a large neuroscience lab in New England. She has documented that thoughts and consciousness become embedded in our brains as concretely as any object.⁴ So, each person views the world completely differently regarding threats vs safety and body’s coping resources are also infinitely unique. It doesn’t matter if the threat is real or perceived. If your perception of a situation doesn’t match the reality, you’ll have a stress response and your beliefs have to adjust for similar scenarios in the future.
• Note on the Holmes-Rahe stress scale that most of the stresses are not physical. They are real because they are events for which your body has to mobilize resources to deal with them. Unfortunately, perceived stress also causes your body to be activated.
• Consider ACE (Adverse Childhood Events) scores. The score is a rough measure of childhood trauma and higher scores cause inflammatory markers to remain elevated for decades.⁵ When you are raised in an abusive environment, you are programmed to see much of the world as dangerous, and that doesn’t change unless you thoughtfully reprogram your responses.
• Systemic chronic inflammation (SCI) is a state of inflammation that cannot be measured by blood tests.⁶ The problem arises from the breakdown of small structures in each cell called mitochondria. They are the engines whose chemical reactions create the energy of life. The “fuel” leaks outside the cell and is highly inflammatory. Over 50% of all deaths and diseases are caused by SCI. Chronic stress is one of the drivers.
• Pain reprocessing therapy (PRT) is a process where patients’ fears and beliefs about their pain are acknowledged and connected to the actual experience. Patients are reassured that the nature of the pain or problem isn’t dangerous, and then gently taken through a process of reassurance while performing actions that would normally cause pain. By feeling safe while engaging in activities they considered risky, they are able to calm down, feel safe, and the pain decreases or resolves most of the time.⁷ Again, the structure of their body hasn’t changed, it is their beliefs about it.

Why did Bruce and David team up?

It is clear that anxiety and anger are hard-wired automatic reactions that we have not control over. Bruce has pointed out that you might as well have a conversation with the hard drive of your computer. But he has pointed out for a while that you can reprogram them.

I have been on this course of action for a while but have not stated it as clearly as Bruce. I have seen so many “hopeless” patients heal that I am convinced that you can reprogram your brain around almost anything. Our brains are incredibly adaptable.⁸

Getting there

The DOC Journey course and app take you through a sequence that first teaches tools to calm down your nervous system, helps understand the principles of healing chronic disease, presents the problem of anxiety being the pain, explores awareness, teaches anger processing strategies, emphasizes repetition, and then helps you visualize and act on building your future.

The final answer to chronic mental and physical pain is shifting into joy, and where Bruce presents a wonderful picture of what that looks like.⁸ A significant aspect is programming in this outlook. We both agree that positive thinking can’t and doesn’t work. The DOC Journey course and app present practical strategies to achieve the state of consciousness that allows us to not only heal but thrive. Once you flip your beliefs to the future you want, your brain and life will follow, and it will become your reality.

Bruce and I created this four-part video series along with a lesson plan that presents an overview of the healing journey as well as suggestions how to start. We are excited about them in that we did not realize how close we were in our thinking until we made these videos. We hope you enjoy them and welcome to your new life.

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, Behavior, and Immunity (2018); 74:2842. https://doi.orgl/10/1016/j.bbi.2018.08.010
3. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189

4. Feldman Barrett, Lisa. How Emotions are Made. Houghton Mifflin Harcourt, New York, NY, 2017.
5. Dube, SR, et al. Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine (2009); 7:243-250.
6. Furman D, et al. Chronic Inflammation in the etiology of diseases across the life span. Nature Medicine (2019); 25:1822-1832.
7. Ashar YK, et al. Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain. JAMA Psychiatry (2021); Published online 9/29/2021.
8. Lipton, Bruce. The Biology of Belief. Hay House, Los Angeles, CA, 2016.

The post Connecting the past and present to the future – Bruce Lipton and David Hanscom first appeared on Back in Control.

The post Connecting the past and present to the future – Bruce Lipton and David Hanscom appeared first on Back in Control.

Feeling safe

There are many benefits of feeling safe and secure, with the first one being your body’s chemical makeup consists of reward hormones and you feel great. The opposite occurs if you constantly feel on guard. It is in the first scenario that you feel free to create, explore, play and use your imagination. Your capacity to interact with the world in a meaningful and effective manner is increased.

When you are constantly on hyper-vigilant and trying to protect yourself from real or imagined threats, your short and long-term quality of life will be compromised. One of the effects is that more situations in the present will resemble what you learned was unsafe in your childhood. You will be over-reacting to scenarios that really aren’t dangerous, but your brain won’t know it. Your body will feel under threat and your chemical makeup will keep you on “high-alert”. It will be harder to relax and enjoy your life.

ACE score

This is documented by the ACE (adverse childhood experiences) study done in 1996. (1) A survey of challenging childhood circumstances was given to over 17,000 people and health surveys were administered. There were ten exposures.

Household dysfunction

• Substance Abuse
• Parental separation/ divorce
• Parent with mental illness
• Battered mother
• Criminal behavior

Abuse

• Physical
• Psychological
• Sexual

Neglect

• Emotional
• Physical

Only 30% of participants had a score of zero and 26% had a score of 3 or more. There were increased chances of severe health consequences with higher ACE scores.

• Depression/ anxiety
• Obesity/ eating Disorders
• Heart disease/ hypertension
• Suicide
• Teen high-risk behaviors/ pregnancy
• High risk of being a victim of domestic violence
• Substance abuse
• Smoking/ COPD
• Unstable home/ family life
• Poor workplace performance
• Early death

America, on the whole, is not doing a great job of parenting. We are modeling behaviors that we wouldn’t want to see in our children. My ACE score is five and I developed 17 of over 30 possible symptoms related to sustained exposure to high levels of stress hormones. My migraines began when I was five years-old. The list began to grow and reached 17 of them by the time I was 37. Yet no physician could provide an answer or a treatment approach. All of symptoms have resolved. But that is not the message of this article. It was your parent’s responsibility to both protect and nurture you. Mine did not. What about yours? What kind of home environment are you currently  creating for your family?

Oak tree vs army barrack

One of my favorite personal metaphors is that of a large Valley Oak tree, which were abundant in Napa Valley, CA before there were so many vineyards. I view the role of parents of being the trunk of the tree, providing stability. One responsibility is for each member to continue to evolve through awareness and self-exploration, which creates deeper roots and emotional support. The first responsibility of parents is to each other and continuing to create a lasting stable and loving relationship. The expansive branches are the opportunities for all the individuals in the family to be creative and also be protected from the elements.

The opposite scenario is that of a military barrack. There is rigid order and unwavering expectation that every command will be immediately responded to. Nothing you can or will do will be “good enough.” If you don’t comply as deemed adequate by one of your superiors, you will be disciplined and often harshly. You may be made into an example. You can never let your guard down, especially in the presence of your officers. The list of demands is endless with an equally long range of possible consequences. Does any of this feel familiar? I don’t what percent of families have this framework as the reference point, but based on the ACE data, I would daresay that it is high. Is it any wonder that so many of us have this voice in our heads of, “Not good enough.” It can be deeply embedded in your brain and you can’t outrun your mind.

There several factors that result in a home that more resembles an army barrack than a spreading oak tree.

• It was the way you were raised and the way parenting was modeled.
• Everyone has anxiety and it is intended create control behavior. The more control you exert, the less anxiety. Since your family is dependent on you, they cannot easily escape from your need for control.
• You have labeled yourself as the parent and somehow you have a responsibility to “raise your child” properly. I read a book, Parent Effectiveness Training when my son was young and thank goodness I read it so early. The book had a major impact on my life. One core principle is that the label of “child” disappears, and it becomes a human-to-human interaction. Prior to reading it, my obsession was discipline and control and I was highly critical of “permissive parents.”
• All of these family issues are dramatically magnified if one or both parents are suffering from chronic mental or physical pain. You are trapped, angry, and awareness of other’s needs is blocked. It is the essence of abuse.

Awareness

All of the healing process begins with awareness of what is happening in the current moment. What is your family environment like now? Each half of the couple needs to write it down and compare notes. If you can’t have a civil conversation, then you already have your answer. Anger that is often front and center will also block constructive dialogue.

Moving forward

What kind of family life would you like to create? What is your vision. This step should be done as a couple.

How do you want to accomplish it and what is the timeline? What doesn’t work is waiting your pain to first resolve. Every day your family is encompassed by anger, it is damaging them.

Any and every person has the capacity to thrive and move forward when starting from a strong foundation based on love, support, laughter, safety, and play. Eventual successes will be more sustained. One is also able to enjoy life.

It has been known for decades that employees thrive in this kind of work environment. Why not allow your family to thrive?

1. Anda RF, et al. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience (2006); 256: 174–186.

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