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

The Depth of Your Suffering – Darkness

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

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

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

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

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

 “The Abyss”

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

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

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

Life in The Abyss

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

The Abyss = Anxiety/Anger x Time

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

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

Losses include:

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

No Way Out

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

Recap

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

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

Questions and considerations

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

 References:

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

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

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One is that going back into The Abyss is inevitable and part of life. The key is to learn to use the tools more skillfully to come back out of it. The second point is that none of us really have the luxury of remaining angry without significant mental or physical consequences. Your body’s physiology is on overdrive and people get sick.

I was aware of this possibility when he first began to deal with the situation with his neighbor. I even warned him about it. Even though he intellectually knew anger was a problem, it is a powerful force that pulled him in. He not only became ill, but seriously so. None of us have the luxury of remaining angry without paying a price. Interestingly, effectively processing anger ALWAYS is the gateway to true healing and that is also part of this story.

Tom’s latest encounter with anger

I lived more than 22 years in debilitating chronic pain. I lost my business and seriously damaged many relationships. Having had 28 surgeries including 7 spinal operations, my medical history includes 3 heart attacks, opioid addiction, and a suicide attempt. I was trapped in the hell of the abyss for a third of my life. Since discovering Dr. Hanscom’s book “Back in Control” several years ago I have been free from chronic pain. Now at age 67, I have survived and am thriving.

This past winter I became very stressed and angry at my neighbor lasting a few months. He notified me  that he planned to cut down the cedar trees surrounding my front yard sanctuary, I was furious. My cobblestone courtyard, complete with a triple waterfall was ringed by towering evergreen cedars and my covered front porch. It was green, quiet, and very private. I loved it as my place for meditation and relaxation. My rocking chair was my perch as I watched the hummingbirds zip around my hanging baskets and frolic in my fountain. The sound of the waterfalls is music to my ears. My neighbor made me so upset for what he’d done to me, as I became a victim! I went indoors to the basement and literally screamed. I allowed myself to remain angry; incensed, for 3 months. It made me sick.

The symptoms begin

Soon after finding out that the demise of my sanctuary was imminent, my right eye started to constantly tear up resulting in tears streaming down my face. Being very upset, I’m sure my emotional state caused the tears to stream.  The tear duct clogged up which resulted in me needing surgery, which included the surgeon accidently burning the inside of my nose due to a surgical error. After the first surgery they “…went back in there…” a second time. The pain was indescribable, some of the worst I’ve ever experienced. I HATE the term “going back in there”. Twenty years ago, my neurosurgeon went “back in there” 3 times. It didn’t help.

The demolition date for the trees was set, and my sanctuary was decimated on the morning of my 67^th birthday. My green amphitheater was gone in a matter of hours along with my sanctuary and privacy. The neighbor’s house  towered over my courtyard with an unimpeded view of my yard and porch. I implored him to buy tall replacement plants to restore some of my privacy, but he said, “I don’t care…that’s your problem”. I talked him into allowing me to buy  the replacements. He chipped in all of $200 towards my $2,500 cost to plant his plants in his yard. My anger escalated. The sanctuary should by restored in about 10 years. Meanwhile I’m building a replacement sanctuary in the backyard.

More problems

Just as I was healing from the complications of my eye surgery, I woke one night in a lot of pain. As I sat up, I was overcome with pain in my right flank. I laid back down desperately trying to determine what was happening. I writhed in pain the rest of the night refusing to admit I was in trouble and telling my wife I was hurting. By the time I decided I needed to get to the hospital I could no longer sit up as the pain was too intense. My wife called 911.

My anxiety level skyrocketed. I was frightened by the duration and intensity of the pain.  A CT scan revealed a blockage in my right renal artery. The doctor said it was like the kidney had a heart attack (infarction). My right kidney was damaged, and its function was reduced by about 50%. They medicated and admitted me to the hospital.

Now COVID–and The Abyss

The nurse woke me at 2:30AM and said, “Sir, please wake up, you aren’t going to like what I have to tell you.” She was right, I didn’t like it when she told me my hospital roommate had Covid-19. He was an elderly man with serious respiratory distress. He had been coughing and hacking for the past 2 hours with no mask and the door closed. I bolted from the room and was quarantined for the remainder of my four-day hospital stay. No visitors allowed.

I was already on edge worried about producing another clot and having another stroke before the Covid-19 exposure. With the news that I’d been exposed, I went over the edge and quickly descended to the bottom of the abyss. I couldn’t talk or think straight. Everything around me went dark as I was in dire pain both emotionally and physically. With my comorbidities including COPD, congestive heart failure, and a prior stroke I was at high risk for succumbing to the virus. I thought I may die from the kidney blood clot and/or the virus exposure. My anxiety level was off the charts.

There was no social interaction for the next 4 days. Staff came in daily in “moon suits”. I couldn’t see anyone I knew during my 4 day stay. When discharged, I was quarantined at home until I tested negative; 10 long days after my exposure.

Clenched teeth–the descent continues

The day I was admitted to the hospital was the same day that I was set to have oral surgery. A week before the kidney problem appeared, I had broken and/or damaged my lower 4 lower front teeth. While chewing, I clamped down too hard and the front teeth landed behind the lower teeth breaking  them. I was crushing my food as my jaw was set and tense still manifesting the anger since I was not ready to let it go. It cost $10,000 for dental repairs because I was stubbornly holding onto my anger rather than processing it and letting it go. 

 It became  obvious to me that I was triggered by the neighbor and was profoundly angry and resentful of what he had done to ME (the victim). Whenever I thought about or saw my neighbor, I’d have a real bad reaction.

There were 3 major health events within 100 days of my neighbor announcing that he was going to remove the trees that guarded my sanctuary. #1) required one surgery and two intensely painful “procedures”. #2) I broke my teeth by biting down too hard. #3) I had the renal artery infarction of the right kidney.

Moving on

How did I go from lounging in the green circle in my sanctuary to being in the red circle back in the pit of darkness and despair? By failing to address and process my anger I caused myself  to be sick. I knew how to calm myself through meditation, processing anger and climb out of the pit. Finally, I flipped the switch on my anger toward the neighbor and subsequently let the whole problem go. I’m building a new refuge and I’m back to greeting my neighbor. The eye healed completely, the teeth were replaced, and the kidney suffered some damage but is now stable. The most important consequence from this incident was me having to consciously decide that I was not going to be the victim and that I need to maintain my “practice” of the DOC Journey’s main tenets. Meditate and relax your nervous system. Refuse to discuss your pain problem with others, and always process your anger expeditiously.

My new life

Having been on The DOC Journey for 7 years, I’ve NEVER felt better in my life. My chronic pain is gone; my anxiety is under control. Over the 20+ years while in the abyss my anxiety was so high the future terrified me.  The pain haunted and tormented me. Now I eagerly look forward to today with, awareness, renewed energy, and a pain free existence. My reaction to what was previously unending pain was living an angry, sedentary, reclusive, and psychologically paralyzed life. I’m now very active walking, swimming, and practicing yoga daily. I no longer perseverate about problems and issues over which I have no control. The physical activity promotes awareness, positive thoughts and the never ending “chatter” in our minds. I’m happier now than I’ve ever been in my lifetime. I’ve learned when and how to “flip the switch”.

The consequences of anger

I have learned a lot about anger from observing hundreds of patients navigate it or not and from my own journey out of chronic pain. There are no shortcuts. If you decide to remain angry, you are choosing to hold onto your pain. What makes this challenging is that anger is powerful, it protects you from feeling vulnerable. Additionally, the more legitimate your anger, the harder it is to let go. Tom certainly had a lot of legitimate reasons to remain angry.

Anger is so powerful, no one ever wants to really give it up. I have used a term, “flip the switch.” You just have to decide to move on. Life is never fair and other wrongs will continue to be done to you. If you continue to hold onto them, it becomes a heavy load. It also compromises your immune system and you’ll have a significant chance of becoming ill. Tom’s story is a classic example.

Processing anger is a learned skill set that will allow you to live the life you choose on your own terms. Tom continues to be a major inspiration for me.

Addendum

I’m trying to adjust to this feeling of well-being. I’m so relieved to not be in pain anymore that I could shout it from the rooftop. One thing we need to pay attention to is the “why”. Why me and not so many others?  But also, what traits, characteristics or beliefs do I and others share that have successfully made the transition from chronic pain to a pain free existence? That question hangs in my head daily.

Best. Tom

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Hi Dr. Hanscom,

My name is Tom and I am 67 years old.

I’ve had 28 surgeries including six spinal operations, three heart attacks, one stroke, an attempted suicide, opioid addiction and 20+ years of debilitating chronic pain. My body is a mass of scar tissue that requires extensive stretching every morning. I’ve done my time in the deep, dark Abyss and yet, I have overcome each of these experiences. I’m a survivor, not a victim.

Driving home from work one night, I was rear-ended by a young teenage driver, which exacerbated an already bulging disc in my back. This one, minor accident began a chain of events that would change my life into one of endless misery, pain, and despair.

I tried every therapy I could find from surgeries, injections, chiropractors, acupuncture, drug therapies, hypnosis, biofeedback, counseling from eight different psychologists and psychiatrists, and even a healer that worked with tuning forks. No one could figure out why I was in constant, debilitating pain. Nothing worked. The only common treatment I received was a prescription for narcotic painkillers.

Into The Abyss

My whole life deteriorated as I was overcome with debilitating, chronic pain. It wouldn’t go away and I talked about it obsessively. I was too ill to attend my son’s baseball games and my wife and I weren’t able to have any quality time together. Friends and family didn’t want to talk to me anymore because I was such a “downer.” I became self-isolated. I was obsessed and all I could focus on was my pain, suffering, and how I was victimized.

Things got worse. I had a stroke when I was 47 years old.

I woke up, got out of bed, and fell on my face. My left leg would not respond to commands and my thinking was clouded and unclear. For a few hours, I was temporarily blind. I also lost my short-term memory. I went from reading a book a week to not being able to comprehend two sentences in a newspaper article. By now, I was deep into the Abyss. I had lost everything, including my business and marriage. I spent my days wallowing in chronic pain and self-pity.

My neurologist kept assuring me that my brain could reprogram and I might regain my balance, the use of my leg, my reading comprehension, and some of my memory. I had my doubts, but I had nothing to lose by believing him. Over a period of eighteen months, I regained full control of my left leg. Most importantly, after a few years, I reprogrammed my brain so that I could function almost as well as I did pre-stroke.

Connection

In all of this crisis and personal implosion there was a glimmer of light. I reconnected with my high school sweetheart, Patty. We had broken up when we were 21 and had gone our separate ways. She found me on Facebook and we reconnected 10 years ago. We’ve been inseparable, ever since. Patty and I are a team. She is my soul mate to whom I owe my life. Patty was the one who called the medics when I attempted suicide. And it was Patty who never gave up on me, although I gave her plenty of reasons to.

I attempted suicide not because I wanted to die, but because I couldn’t stand the physical pain of living any more. When my suicide attempt failed, I was faced with the reality that I’d quit trying to get better. I started to listen when people said my life still had some meaning and that I meant something to others and those in my family. I decided that any life, even one full of pain and suffering, was worth living. I told myself I would never give up again.

“I’m done with this”

I made the decision to quit narcotics and find a solution for my chronic pain. I didn’t think there was a cure, but rather a better approach to cope with it. I started calling clinics and caregivers across the country looking for relief. I discovered your project and that of another doctor, the late Dr. Peter Przekop in Palm Springs, with whom I spent a month.

Under Dr. Przekop’s care, I learned how to meditate, and through that practice, I experienced a profound recovery while in an altered state of consciousness. However, I was still feeling pain and prior to reading your book, was convinced that I’d never be pain-free.

The tipping point occurred when I started reading the “Stories of Hope.” When I first picked up Back in Control, I was focused on other people’s stories of hope, pain, and suffering. I perused these types of stories because I wanted to confirm that my pain and suffering was worse than everybody else’s. However, as I read their stories of pain, suffering, and recovery I started to realize that the solution was within me. It was up to me to resolve myself. I started to ask, “What can I do for myself that the doctors couldn’t?”

Taking charge

Through The DOC Journey I finally figured out that I was going to heal myself. I was done waiting to see what “they” were going to do to help me, how were “they” going to fix my pain. Drugs, injections, surgeries, and therapy were not going to cure me – I was.

In the long run, my stroke was actually a blessing rather than a curse. I had first-hand success with neuroplasticity and knew that the process worked. While I had doubts about the power and influence anger was having on my chronic pain, I knew that I could reprogram my brain.

Expressive writing forced me to accept that regardless of my chronic pain and suffering, I was still accountable for my words and actions. I wrote about my wounds, demons, and downfalls. I wrote about all of the people who had caused me anger and earned my scorn. Expressive writing helps me manage my anger and frustrations as I “shred and shed them” each morning.

I learned to forgive and move on, which helped to cleanse me of the anger I had built up inside of myself. I forgave my dad, the teenager that crashed into me, and the neurosurgeon that erred. I came to understand that the anger inside me was preventing me from moving on with my life.

Choosing not to remain a victim

To this day I have resolved to deal with my anger head-on, without delay. Anger is inevitable, but allowing it to poison your life by hanging on to it is a choice. I have elected to take responsibility and control of my “pain circumstances.”

It was absolutely critical to my recovery that I learned to control and manage my anger, learn forgiveness, and be compassionate towards those I resented. Once I learned to forgive and forget, I become unstuck and was able to move on.

Physically, I haven’t felt this good since before I was hurt 30 years ago.

From reading Back in Control, I have learned to use the principles of active mediation, expressive writing, anger management, daily walks, yoga and swimming as daily endeavors. I got a second chance to live my life, to repair the relationships I’d damaged, and become a survivor – not a victim.

I did not elect to be in pain, but rather I elected to not be in pain.

Best, Tom

He is The DOC Journey

His story gives me a lot of hope. I always chose to give every patient that walked through into clinic my full attention and to work with them. However, down deep I would not have had much hope for improvement for him with this amount of trauma. I certainly would not have expected this kind of a turnaround. If you look at his story, he engaged with every concept presented in the DOC process. It is not a self-help program but rather a framework to break the parts of your pain into smaller components, and people find their own way out.

He and I have now met and connected and he is looking forward to giving back, which is also an important aspect of healing.

I could write a book about all the aspects of escaping pain that are illustrated by his experience (I guess I already did). I just want to highlight two of them. The greatest obstacle to solving pain is your unwillingness to engage in any part of a healing journey. The DOC process is just one possibility. One my successful patients made a comment that he had to, “Suspend disbelief” to embark on his journey.

The second point is that the tipping point of deep healing is always processing anger through forgiveness. This is not a philosophical issue. It a matter of deciding to take full responsibility for every aspect of your life. Anger is the last ditch effort to regain control to survive and your stress hormones are through the roof. The mental and physical toll of living with anger at your core is horrific. One of the clearest parts of his story is him deciding that he was done living like he was and he decided simply to take his life back regardless of where it took him.

His story is remarkable, but not unique.

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I am excited to be able to offer her services to you. She has been able to help people out of the Abyss that simply needed some extra support and guidance. Her level and type of expertise is not widely available and one of our projects is teaching other medical professionals these concepts and skills.

She shares an understanding of the depths of misery you can experience when trapped by mental and/or physical pain that has allowed us to help others find their own way out. Here is her story.

How Chronic Pain Saved My Life: From a Fishbowl to the Ocean 

Chronic pain patients usually end up in my office because they feel trapped and out of options. The same reasons are what finally brought me to the table with Dr. Hanscom. At the time I was so anxious I knew I wouldn’t last more than a year if something didn’t change. I had a successful practice as a Somatic Psychotherapist, studying neuroscience and was increasingly devastated that no matter what I did, no matter how much I learned—my anxiety was only getting worse.

What I was surprised to find on this journey with David, is that the pain of my anxiety turned out to be my greatest teacher and opportunity once I finally found the right frameworks, structure, and support.

Just last week, I received a glowing email from a woman who has suffered for two years with debilitating headaches that have taken her out of her life as a well-known surgeon. What lit up her message to me was the freedom in realizing that she had been basing everything off a problematic definition of success her whole life—a logical one rooted in everything she had experienced in a neglectful and cruel household, but not one that allowed for sustainable health, peace, or enjoyment. Although the pain of her headaches have not yet gone away fully, she wrote to me from a place free from suffering.

I am grateful to be able to say that although sometimes my pain flares back up for a few days, I have also been suffering-free for almost 2 years.

In working with clients, I share the belief that we are all born with the innate ability to thrive. However, our access to this innate ability can become blocked over time.

As we grow in the first few years of life, some of our developmental needs are met and others are missed. The blank slate of our nervous system uses the interactions in our early caregiving environment to build a sense of who we are, what we must do to get love (which is the equivalent of safety for us vulnerable baby monkeys), how to have emotions, what we can express, and what to expect from people and the world. These patterns and beliefs passed on to us by our family creates the foundation that determines how our brain unconsciously interprets everything we encounter. In an effort to keep us safe the brain wires primarily on fear and negativity, so privileges those lessons. Our internal worlds can quickly become small and uncomfortable.

It’s similar to being born into the ocean, and unknowingly put into a fishbowl…believing we are still in the ocean. The situation becomes more severe when some of these self-reinforcing fear patterns become like bacteria and algae overgrowing the tank, clouding the water with no good filtration system—things become toxic. We fish are trapped in an environment with no clue it’s the water we are swimming in that’s making us sick because it is all we have ever known. Until one day someone suddenly lifts us out for a moment, and we feel the ocean again.

Chronic pain is an indication of how the levels in our bowl are off—quite literally in terms of our bodies’ stress chemicals connected to the anxiety, anger, and sensitization at its root. Not only is the water “clouded”, every cell in our body is bathed in toxic chemicals. By coming to our pain with an understanding of the ocean and how to get there—the toxicity that forces us out can actually become our greatest hidden gift.

I would have perished in my fishbowl—as I see with clients in my practice every day. Helping others use these tools and strategies to find freedom is an honor and I am inspired by peoples’ capacity to thrive even under the most dire of circumstances.

For more information about my approach or working with me please check out www.KendraBloomTherapy.com. You are welcome to book a coaching session.

The post Back in Control Coaching first appeared on Back in Control.

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Good Times

It’s always a wonderful weekend and incredibly relaxing in that everything is right there. Good food, fireplace, hot tub, warm pool and a lot of bantering (that would be the mild term). We do revert back to middle school behavior (at best). My wife keeps asking me the question if guys ever grow up. I think the answer is obvious. It’s a great break for all of us.

We ski in smaller groups and we usually meet at a restaurant in the middle of the mountain called “Watsons” at 11:30, just before the lunch crowd arrives. I don’t ski quite as well as I used to and decided to come in a little early and relax. I purposely worked on enjoying the fantastic view of the valley and could not have been in a better state of mind. It was also one of the few times when I was well ahead of the curve with regards to saving enough seating for 18 people. The restaurant was almost empty.

I was sitting at the end of two tables that seated 12 and had placed my gear on a table for six just across the aisle. Four of my group appeared at 11:20 and sat down at the large table. My plan was working well, and I was having a great time. We were talking about the morning, which included skiing on fantastic snow. Suddenly I turned around and there were four boys between nine and eleven, who had pushed aside my gear on the other table and were sitting down.

Trouble

I pointed out to them that I had another six people arriving shortly and this table was saved. “Where are they? We’re here! You can’t save tables.” They were clearly veteran Alta skiers, but I had never heard of that rule at any ski resort in over my 50 years of skiing. I also didn’t see any signs that I couldn’t save a table. I was caught off guard and firmly restated my case. At that point four more of my “ buddies” sat down at the large table. There were also two older women immediately behind the boys and they started hissing, “Just give them the table.” As I continued my protest, one of the boys looked at me said, “We’ll give you five minutes.” I was getting more confused and flustered. I don’t remember that I would have talked to an adult in this manner when I was 10 years old. Usually skiers just walk on by, since saving a table for your group is the norm (so I thought).

Thrown under the bus

Then I asked my friend, Bill, to come over and sit down at the embattled table with me, since the larger table was continuing to fill up with members of my group. Instead of coming over and helping me out, he said, “Come on, why don’t you let them have it?” while looking directly at them. I was now well into looking like a “grouchy old man” and the women continued to hiss at me. I caved in, but I wasn’t happy. My tranquil meditative state had been severely compromised, and I was being thrown under the bus. My “friend” fist-bumped them and they said, “Thanks!”

Three minutes later, another seven people showed up and had no place to sit. This wasn’t going well, and my group thought all of this was hilarious. I wasn’t happy with them, the kids, the women or me. I really was upset, and it was just over a table. My friends know how much stress I deal with every week and were surprised how triggered I was over such a non-issue. Of course, the more frustrated I became, the harder they laughed – even though I was holding the space for them. I haven’t been that angry in a while. What the heck happened?

Gulliver

The image that jumped into my head was that of Gulliver being tied to the ground after being captured by Lilliputians. Gulliver’s Travels was written in 1726 by Jonathan Swift, and was a disguised commentary on world affairs, as well as on human nature. The book is divided into four sections. The first is about being captured by the Lilliputians, who were one twelfth his size. He was tied to the ground by hordes of them while he was sleeping. They wanted to seal the deal by blinding him. He had to navigate some tricky situations to eventually escape.

I was trapped by people a fraction of my size and age. My “adult” friends finished me off. The similarities to being pulled into the Abyss of chronic pain weren’t subtle. It’s always a combination of factors that pull you into the hole. They add up quickly and escape becomes essentially impossible. When I was pulled into the Abyss in 1990, I didn’t see it coming and it took me 13 years to come out of my tailspin. And it was by pure luck that I did. It took me years to figure out what had happened to me, and longer to learn how to share the concepts with my patients. A few of the variables that can trap you are:

• The source of pain is usually not able to be identified, so no one really believes you’re in pain.
• Although modern neuroscience research has revealed the answers to solving your chronic pain, mainstream medicine continues to ignore the data. Essentially every treatment in spine care that is covered by insurance has been shown to be ineffective. Proven effective treatments are usually not covered. We are pretending to practice medicine.
• Repeatedly having your hopes dashed is a reliable way of inducing a major depression, as demonstrated in animal studies.
• You are labeled and judged.

This list is only a hint of the multiple ways  you are trapped by mental or physical pain. You can’t see them coming and the adversities keep pummeling you from multiple directions. The worst aspect of it is that since there doesn’t appear to be any viable solutions offered to you, where is the endpoint? You eventually lose hope and retreat into an angry survival mode.

I felt trapped and any one of the variables alone would not have stopped me from holding onto my treasured table. I didn’t anticipate all the angles of the situation that took me down. A major one was my own sense of not looking good to the other parties or to me. I was a “grouchy old man.” I am still not sure, as I am writing this piece a couple of weeks later, that I’ve completely let it go…………

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What I did not understand until the last few years of my practice was the impact of chronic pain on the family and the effect that the family had on pain. It turns out that the family is the strongest force that will keep you in chronic pain and also can be the most powerful one in pulling you out–with the correct understanding and approach. The bottom line is that the anger created by pain usually destroys much of the family structure, yet at the same time, the family becomes used to the situation and resists change.

But the most perverse aspect of this picture is that humans evolved through language and social connection. It is a basic need and the deeper the connection, the better. However, the stronger the connection the more powerful the triggers and irrational behavior. We crave connection, yet it sets us off. Why else would there be a 30% lifetime incidence of physical domestic violence in the US? (1)That doesn’t even include verbal abuse. (2) Why do we treat our family members who we care about worse than a stranger?

The conversation

I am going to present the overall structure of the solution first and the present the problem and solutions in more depth later. This is the conversation I would have on the second or third visit with both surgical and non-surgical patients.

“Chronic pain is a complex problem that is solved addressing all the factors affecting your perception of it.  The impact of chronic pain on your family is usually negative and often devastating. Pain in the household dampens the sense of closeness and play. Patients tend to vent their frustrations on their immediate family since they are the source of the deepest and most powerful triggers for anxiety and frustration. Since pain and anger are linked neurological circuits, it’s difficult to free yourself from the grip of pain unless you can become aware of and learn to process these family triggers. Conversely, the family may be the most powerful and fastest way out of The Abyss. I am asking you to consider four aspects of addressing the family dynamics around pain.”

The first thing I asked is that every adult member of the family, living at home to immerse themselves in The DOC Journey. I want everyone not only reading Back in Control but to fully engage in their version of an action plan outlined in this website. The DOC Journey quickly has you engage in calming exercises that include expressive writing, which is combined with the active meditation. I wanted them to just begin and learn the reasons why later.

Second, I asked them to never discuss their pain – ever; except with their medical team. It just reinforces pain circuits and is frustrating to those who care about you but can’t help. I repeat it several times, “You’ll never discuss your pain or medical care with anyone ever again, especially your family. But that also includes friends, colleagues and co-workers. Never!!” The patient usually widens their eyes while the rest of the room often breathed a sigh of relief. “I mean it. You aren’t going to share your pain with anyone. That also includes acting out your pain with grimaces and groans.” Then I said to the rest of the family, “I don’t want you to ask about the pain. And if any of you are having a bad day, don’t complain. Each person takes ownership of their pain – whether it’s mental or physical.”

It’s a little harder than you might think for everyone. People in pain usually talk about it to anyone who’ll listen and we all feel we have a right to complain. It’s a behavioral pattern that’s extremely hard to break. I was adamant in saying “When you walk out the door of the office today, I want you to visualize a 10-foot wide concrete wall between you and the rest of the world with regards to your pain. It’s off the table forever.”

Third, I ask them to spend the car ride home reminiscing about the most enjoyable time of their relationship. What were the fun times? Discuss them in detail and stick with the conversation. Try to feel it. Anxiety, anger and pain have a way of taking the joy out of a relationship, not to mention how your children might feel.

Interestingly, this was a big hurdle for most people and I would still try to have them engage in this conversation within a few weeks. Resentments build up and block this conversation.

The final fourth and most challenging step was bringing it home. I told them, “When you walk out of my office door, you’ll make a commitment to never bring pain back into the house. The intention was to create a safe haven in their living space. I wanted them to take the positive energy generated by the conversation about the best times of their relationship into the home and keep it there.

There are many layers to this step but the essence of it is that any time you are anxious or upset, you are in an automatic irrational survival mode. Something in the present triggered a response conditioned by the past. It’s not solvable by rational means.

When was the last time you really were able to solve anything by arguing? You might as well put on boxing gloves. Anger is only destructive. So stop it. Each person must give each other permission to walk away from an argument and hold each other accountable to do it. It is best if both can walk away from a given unpleasant situation, but usually one person is more fired up than the other. If you get upset, take it outside. Don’t allow your physical living space to become a battlefield. You have to have some place on this planet to feel safe. This stage has many other “rules of engagement” that many have found helpful.

The response

Our team observed a surprisingly powerful and consistent response to these initial steps if engaged at some level. The tools of expressive writing, active meditation, and not discussing their pain often had a significant early impact and I wanted have people engage as quickly as they could.

I remember one young couple in their 20’s struggling with pain, anxiety and issues around a bipolar disorder. Although it was apparent that they really cared for each other, they were struggling mightily. He had been in pain for about 10 years.  I had this conversation with them and showed them the basic starting steps that are now part of The DOC Journey. When they returned for their one month visit, they were so excited that they could hardly contain themselves. He was free of pain for the first time since he was 15. They were seeking counseling and she was more directly addressing her bipolar issues. They were smiling, laughing and felt they had the tools and approach to create bright future.

Practice, practice, practice

I saw variations of this story every week. Having the whole family engage in The DOC Journey created a structure from which to work from. It isn’t perfect but neither is life. My wife and I also still get to practice these approaches daily. One day, I was talking to her and began to complain about five different things at once. She called me right out and reminded me about the “no complaining” rule. It was challenging for me because the issues were intense and important to me. However, she was right that they weren’t her problems. I needed to get out of my victim mode and deal with them. Another humbling experience……..

The DOC Journey will be adding a whole section on “Healing Your Family’s Pain.” Your family can be your safest and most enjoyable refuge or your deepest hell. You have a choice of what you want to create and nurture. Connecting and enjoying those closest to you is possibly the most powerful way out of “The Abyss” for you and your whole family.

References:

1. Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization—National Intimate Partner and Sexual Violence Survey, United States, (2011).Morbidity and mortality weekly report. Surveillance summaries. (2014).
2. Evans, Patricia. The Verbally Abusive Relationship, Expanded 3^rd edition: How to Recognize it and How to Respond. Simon and Schuster, Avon, MA, 2010.

The post Healing Begins at Home – The DOC Journey Starting Point first appeared on Back in Control.

The post Healing Begins at Home – The DOC Journey Starting Point appeared first on Back in Control.

 Escaping your thoughts

The essence of this post is that there is nothing any person can do to escape their thoughts. Unfortunately, unpleasant thoughts create the same chemical reaction in your body as threatening physical input. Any sustained threat is eventually going to make you sick in a number of different ways.

The Florida Project portrays the life of a six-year-old girl who lives with her mentally unstable mother in a low-class motel just outside Disney World in Orlando. There is a stark contrast between the amusement park and her reality. Initially, it seems that her mother is able to somewhat hold it together but then she begins to rapidly buckle. She goes from erotic dancing and begging to prostitution. Finally, social workers have to step in to protect the daughter and get her into school. She and her mother had a tight bond but the problem was that it was based more on her mother being a playmate than an adult. Like most people in her situation, there was no escape. She lived in abject poverty without structure or role modeling. Her solution for her situation was for her and her best friend to run from the authorities and “escape” into the Magic Kingdom.

Ain’t Too Proud is a remarkable musical that is headed to Broadway. The Motown business model for the group was that the singers were replaceable. This clearly wasn’t first choice, but often the performers were difficult or encountered severe personal problems. The group was formed in the early 60’s and is still performing today. Otis Williams was the pillar of the group and the only one who is still a part of it. There have been over 20 different members since its inception.

What’s sobering was that the original groups came from difficult family and environmental circumstances. Each of them had big ideas and dreams of overcoming their beginnings. It was inspiring to hear and feel their energy. Unlike the girl in The Florida Project, they did it. They became incredibly successful. They possessed wealth, talent and fame. Yet one by one they self-destructed. They couldn’t get along or even be happy. David Ruffin was one of the more dramatic stories. He was the lead singer that originally put them over the top. But he was violent towards his family, became addicted to drugs and tried to have the group named after him. Even after he was released, he would jump up onto the stage and perform with them like he was still part of it all.

We all know the tale of Cinderella. What I didn’t know was that there have been many versions of it, written over centuries. It seems to have originated around 7 BC. The recent Disney rendition is incredibly well done. I was watching it to help keep my infant granddaughter entertained. She didn’t care much and fell asleep. I began to get pulled into it and realized that the story contained many layers of metaphors. Cinderella was trapped by her stepmother and two stepsisters. However, she had loving parents who imbedded a deep value system based on truth and love. Nonetheless, she was essentially imprisoned in her own house and treated as a slave. She didn’t have much hope of escape.

Her hope appeared as her fairy godmother and you know the rest of the story. You must be thinking that I am out of my mind. Why would a fairy tale have the most relevant answer to being imprisoned by pain? Whether she was in the woods or at the royal ball, her value system shone through in her appearance and demeanor. She wasn’t trying to be someone that she wasn’t. When her stepmother tried to bribe and then threaten her, she wouldn’t back down. She chose to remain in her current state rather than betray the prince. She asked the question, “Why are you treating me this way?” There was not a good answer. The last thing she said to her stepmother on the way out with the prince was, “I forgive you.” She went on to live happily ever after.

What’s my point?

You can’t outrun your mind. All of us know this at some level. In the first scenario of The Florida Project escape seemed possible by running into Disneyland and the land of happiness. That is a fantasy that most of us pursue incessantly. We work hard at creating a reality that will quell our fears. Since the unconscious brain is so much more powerful than the conscious brain, it can’t and doesn’t work.

The Temptations’ story is compelling in that each of them obviously needed to escape from difficult environments and they accomplished it in a big way. But they only become more miserable in the midst of having every possible physical need met. You might wonder how can this be? I think it is the norm. When you achieved everything you thought you needed to become happy and still feel trapped by anxiety and frustration, where do you go next? It is desperate feeling and the situation becomes worse.

This is what happened to me, as I descended into my own Abyss. I remember skiing in Utah on a clear day with 18 inches of new powder. I was with friends and family. My practice was going well. I owned a nice house near town. I was traveling and lecturing and my anxiety was continuing to escalate. I embarked on even a more intense phase of working to quell the noise in my head. I outran it for a while but then I really crashed. I had nowhere to go. Many of The Temptations self-destructed having much more than I did. Who doesn’t want to become a rock star?

How can the answer lie in the tale of Cinderella? She was able to attain peace of mind in the midst of dire circumstances. She didn’t succumb to viewing herself as a victim although she was actually being victimized. She was able to stay grounded and eventually thrived. You are still saying to me that “I am being unrealistic. How can you have peace in the midst of chronic pain or terrible circumstances?”

Connecting to your healing capacity

I am not dishonoring anyone’s suffering, including my own. Peace of mind is achievable although it is admittedly more difficult when your basic needs aren’t being met. I witness it weekly. The key is connecting to your own value system and thereby to your own capacity to heal. You can’t accomplish this with positive thinking or mind over matter. You will lose. The paradox is that the calmer you are, the higher the chances you will be able to come up with constructive solutions to improve your physical situation. From reactive to creative

There are many high-profile examples of this scenario. The one I am most familiar with is that of Viktor Frankl, who was an Austrian psychiatrist imprisoned in a concentration camp. His immediate family was executed. He was subjected to extreme physical pain, yet he was somehow able to ask the question, “What is life asking of me now?” He was able to find meaning in the midst of suffering. He wrote his story in nine days. Man’s Search for Meaning sold more than 30 million copies. Not only did he survive, he thrived after his release. He was able to forgive and move on. I’m pretty sure that I wouldn’t have been able to pull this off at his level, but I was finally able to let go and move forward. I have watched many others do the same. Moving forward with your pain

It is critical to understand the link between pain and anger and as long as you want to hold on to your anger, you will hold on to your pain. The answer to pain is in the “fairy tale.” It’s not a fantasy to become aware of your thoughts and life outlook and then engage in the processes that will allow you to become free. It is a remarkably energizing way to live. Although there may seem to be some early success in trying to outrun your mind, people commonly eventually wear out and descend into The Abyss.

Which Abyss are you trying to escape from? Is it the difficult circumstances you are living in or is it the one where you are being pinned down with repetitive unpleasant thoughts? There is a lot of anxiety in both of these holes. Could it be that your anxiety is crippling your capacity to create a better environment or get the training for a higher paying job? Am I operating on your pain or anxiety?

There are two types of hell – the physical one and the mental one. By escaping from your mental one you will have a higher chance of separating from your physical pain and attaining your dreams.

Mental or physical health – which is more critical?

The ring of fire

The post Escaping the Abyss – Which One?? first appeared on Back in Control.

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