The post Compassion first appeared on Back in Control.

The post Compassion appeared first on Back in Control.

Then someone told Sarah she was losing her mental capacities. I explained that several studies had revealed that brains shrink in the presence of chronic pain, but re-expand when the pain abates. (1) I encouraged her not only to continue using the DOC tools, but also to re-connect with prior interests. Over the next six months, her depression lifted and she became more energized and interactive. She also regained much, if not all, of her alertness and reasoning abilities. Instead of focusing on dementia, she had re-set her sights on moving forward.

At one point Sarah brought in some dolls that she had created over the years as a therapeutic tool in her recovery. I asked her to write a letter telling the fascinating story of her dolls, so that I could share it with you.

Sarah’s Letter

To my mentor, Dr. Hanscom:

Some time ago you took pictures of my “emotional dolls.” I had shut down physically and emotionally, lost in pain and fear. I had forgotten all the biofeedback training that had helped me years before, and could not escape my desperation. I had no purpose, no reason to live. It was then my physical therapist referred me to you. Your program set me on the right track.

We all have our hurts, some more tragic than others. By telling my story I can be proud of turning suffering into achievement.

The Big Doll

When I was in my late 20’s I began to have severe headaches on the left side of my head. My family doctor diagnosed migraines, taught me about food triggers and exercise, and prescribed Imitrex. But the pain became so bad that when I wasn’t hoping that God would take me, I considered getting a lobotomy or going anywhere in the world that could rid me of this.

When the number of debilitating migraines reached 4 – 5 per week—sometimes landing me in the hospital for days at a time—my family doctor sent me to the Diamond Headache Clinic in Chicago. Dr. Seymour Diamond used a multidisciplinary approach that included biofeedback therapy, cranio-sacral work, and yoga. Through nutritional counseling I learned more about food triggers. Whenever I sensed a migraine coming on, I retreated to a dark room.

But no matter how much I tried, I could not ignore the terrifying, head-eating monster behind the left side of my head, ready to stick its fangs into my left eye. While I was visualizing the monster, I remembered a visit to the Milwaukee County Museum. At a Far East exhibit was a frightening, human-sized doll with huge teeth, a dangling tongue, bulging eyes, hanging breasts, and skulls in its hands. That was my monster, I thought. That is what my migraine looks like.

Then I had an idea. What if I sculpted a doll that looked like the hideous monster that sits behind my left ear? I began to create a doll out of cloth. When I was done, I hung it in my sewing room where I could see it every day. Now this doll, not I, contained all the migraine pain I ever experienced. It could not hurt me—it was only a doll. If I got a mild migraine, which I did about once or twice a year, I remembered it was not my migraine, but the doll’s. I was free and immensely grateful to Dr. Diamond for giving me tools to live a pain-free life.

The Bike Accident

When I was in my 30’s, The Boeing Company hired my husband as an engineer and me as a draftsperson. Life was remarkable with no pain. I stopped using Dr. Diamond’s biofeedback techniques but embraced a rigorous physical fitness regimen. I became a serious triathlete. Every day I biked to work, ran during my lunch hour, biked to a gym and lifted weights or went swimming for an hour or two in the lake across the street from my house.

By my 49th year, I had a good job with a promising future and won most of the races I entered. I was elated to have been accepted to the Ironman Kona Hawaii Triathlon Championships, a 140.6-mile race. I had all summer to train, and I trained hard.

One day I rode my bike to Bellevue, Washington, to join some other bikers on a 100-mile training ride. When I got to the meeting place, a hotel parking lot, my wheel caught a hole in the driveway. I cantilevered over my handlebars, hitting my head on the concrete, and passed out. When I woke up, emergency personnel were all around me, cutting my brand new $65 biking sweater off me. Badly injured, I was put in an ambulance and taken to the hospital, where I had a neck surgical fusion and a wrist reconstruction. The pain never went away. Eventually I had two-level fusion through the front of my neck.

The Small Doll

I lost all that identified me—my job and the ability to run, swim, and bike. I found it difficult to do most tasks. All my friends were athletes, so we no longer had anything in common. After a while I stopped seeing them. The only people I saw were doctors and physical therapists.

I saw no sense to life, no purpose, and felt nothing but the prospect of one surgery after another. My suffering had no limit; If one day was bad, then I knew the next would be worse. I had fallen into a dark pit, an uncharted underworld of loneliness and despair. It was time to sew another doll. I visualized a two-sided face with features on both sides. On one side was the person I wanted others to judge me by.

The opposite side showed who I thought I really was. On this side I jabbed a pair of scissors in my heart and put a mirror in my hand that reflected the word “Fear.” I pierced “my body” all over with copious amounts of needles and other sewing notions, to represent the pain that I had endured for the last 20 years.

Today I am doing well. Dr. Hanscom, thank you for all the training. On the few days I start to slide back into the darkness, I can find my way back to loving myself. Life is potentially meaningful under any conditions. What matters is the capacity to turn life’s negative aspects into something positive and constructive; to make “the best” of any situation. Just focus on all the beauty that surrounds us.

Dolls, as objects of our creative imagination, will, if we invite them, take us to play again in the house of our childhood past and perhaps bestow upon us a future we hadn’t imagined.

—Cassandra Light, The Way of the Doll: The Art and Craft of Personal Transformation

Self-healing

Sarah’s story illustrates several aspects of successfully treating chronic pain, which include: 1) de-adrenalizing your nervous system 2) creating new neurological circuits 3) shifting back on to enjoyable ones.

One of the more important exercises I recommend in my book is to consider one of happiest times of your life and spending an hour recalling as many details as you can. Then experience the feelings. Your brain will begin to wake up as you reconnect. Her dolls pulled her back into a better place. Making the dolls is also an enjoyable activity that shifts your brain onto more relaxing circuits and your adrenaline levels will decrease. Play

It’s Anxiety, Not Dementia

Why is mental function compromised in the presence of chronic pain? First of all, the stress hormone, adrenaline, decreases the blood supply to your brain’s frontal lobe. Second, obsessive thoughts cause the brain to get stuck on a few repetitive circuits, making them more embedded, blocking your creativity, and causing portions of your brain to be under-used. The most tragic part of this sequence is that, with this diminished brain function, you are less willing and less able to learn new ways to heal. In other words, the pain blocks its own treatment.

I, too, experienced a cognitive decline during the worst part of my burnout; but eventually I regained all my faculties plus an added creative bonus–an interest in writing poetry. I predict that research will eventually show much of dementia to be anxiety-induced. It is not necessary—or recommended—to “combat” your illness or try to “fix” yourself. Instead, you can employ the DOC tools and watch the miraculous process of self-healing. Solving the unsolvable

Not only is Sarah doing well, she emanates joy. She is mentally sharp and moving forward quickly with her life. It has been a remarkable experience for me to witness this transformation.

1. 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.

The post Out of the Valley, with Dolls first appeared on Back in Control.

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Florence is an insane place to drive with people and motorcycles darting in front of your car every few seconds. It is part of the experience. From the moment we left the station he began to curse at everyone in his way. “They should be using the tunnel under the street. Get out of my way. Don’t you know cars to have use the road?” He did not stop his tirade until we reached our piazza. He clearly was more than burned out and had no interest in any conversation. The stress in his car was palpable.

I don’t know him or anything about his life. What I do know is that being chronically angry is a strong factor in creating burnout and depression. How could it not?

Physician Burnout

The burnout rate in every state survey shows that 50 – 55% of physicians are burned out. My spine fellow recently put an article on my desk showing that 65% of neurosurgeons are burned out. It’s both disturbing and predictable. There is a tremendous amount of stress in medicine and we are not trained how to process it. Additionally, the medical culture often engages in behavior similar to the cab driver in that we frequently become upset about things that we have no control over.

Dr. Fred Luskin, in his book, Forgive for Good, describes this phenomenon as the “unenforceable rules.” When you’re frustrated about any situation or relationship that you have no control over you are wasting your time and destroying your quality of life. An example might be that you wish your spouse would watch less TV or treat you better. It is fine to wish it but when that wish becomes a demand in your mind it has now become an “unenforceable rule”. If you write down a list of upsetting situations or people, you might be surprised at how long it is and how unsolvable they – at least by you.

The Emergency Room

One classic example in the medical field is in the emergency room. I worked in the ER throughout my residency when I had a few gaps in my schedule. The vast majority of ER visits are not emergencies. Examples include sore throats, back pain, neck pain, a low-grade fever, stomachache, etc. All of which could wait to the next day to be seen in a doctor’s office. These patients frequently show up around two to three o’clock in the morning. It is about time when the on-call physician is trying to grab some sleep. Many ER doctors become upset about a patient showing up with a minor problem at that hour. It’s understandable and frustrating. However, he or she might  tee off on the patient, letting them know that they shouldn’t be coming to the ER with a non-emergent situation especially in the middle of the night.

First of all, the on-duty physician is expected to work a full shift and be available the whole time. Second, is educating that one patient going to stop the other thousands of those who will be following? Why spend one second being upset about a runny nose at two o’ clock in the morning? Why not just take care of it and move on? Talk about an unenforceable rule. It is fine to wish that patients were more aware of what constituted an emergency but when you become upset that all of them don’t, then you have turned this wish into a demand. Indeed the burnout rate in ER physicians is as high as any medical specialty.

What are your unenforceable rules?

What are some of your unenforceable rules? “My claims examiner is not responding to my needs. I wish my spouse would lose some weight. I hate bicyclists in my way to work. My boss isn’t that nice to me. I want to be free of pain now. My son needs to be more serious about school. I just want my life back.” Take a few minutes to write them down. It will be long list in that there are many things wrong with this world and life is imperfect for everyone.

With age and repetition, many of these legitimate wishes will turn into “demands”. Unfortunately, becoming upset about them not only drains you, but worsens the problem. For example, people suffering from chronic pain commonly become socially isolated. One reason is that anger is not attractive, which pushes others away. One wish, of course, is to have more friends and become frustrated when they don’t seem to want to spend as much time with you. There is also a tendency to complain others about your pain and situation, which becomes old quickly. Are you sabotaging your wish?

Remaining upset about situations you have no control over will drive you into the ground and bury you. The first step is to become aware of your own unenforceable rules and how they play out in your life. Develop your own tools to process these “wishes” and truly move on.

Listen to the Back in Control Radio podcast The Unenforceable Rules

Your book is bullshit

The post “The Unenforceable Rules” first appeared on Back in Control.

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Self esteem involves endless judgment of comparing yourself to others around you. I discuss the negative impact that this concept has on us.

For more, see The Myth of Self Esteem.

The post Video: The Myth of Self Esteem first appeared on Back in Control.

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“Happy”

We all want to become better, happier people, and we work pretty hard at it. The marketing world keeps reminding us that we are not even close to our potential and holds up endless images of perfection that reinforce that idea. The solution advertising offers is a better appearance, more friends, accomplishments, public recognition, power, etc. We are programmed into being defined by external factors.

Additionally, self-help resources are everywhere. There are seminars, healers, books, lectures, and retreats, much of which can be helpful. The message is “if I had more of  ‘___________’ I would be a happier person.”  This includes wisdom, the tools on this web site, less pain, etc.

What we really mean when we say that we want to be happy is that we would like to experience less anxiety.

The “Abyss”

Many, if not most, of my patients would test out just fine on a psychological test. But chronic pain will still take you down anyway. It creates extreme anxiety and frustration. I define “The Abyss” as:

Anxiety x Anger x Time

The Abyss represents an unspeakably dark area of your brain. My patients can’t express it with words. I spent over seven years in a severe burnout. My experience also included chronic pain in several areas of my body. I experienced an intense burning sensation in both of my feet, tinnitus, multiple areas of tendonitis, migraine headaches and crushing right-sided chest pain.I didn’t know why I was having all of these symptoms and all the testing was normal. I eventually lost all hope. I “pre-tested” every millimeter of the pathway outlined on this website, mostly by trying multiple approaches that didn’t work. Suffering from chronic pain is far removed from happiness.

 Paradoxes

• The DOC process is paradoxical. The harder you try to get enough of the tools to “fix” yourself the less likely you are to be successful in becoming pain free (or happy). It is critical to understand that you have to enjoy your day with the idea that your pain or your life circumstances may never improve. In other words you must learn to enjoy life with what you have—NOW!
• If you are waiting for more wisdom, more re-programming tools, more money, a nicer spouse, better-behaved kids, or less pain before you can fully engage in your life, it’s never going to happen. It is life’s ultimate paradox. The harder you try to “fix” your life and yourself, the less likely you are to enjoy it.
• We also forget how illogical it is to think that all of the variables in our lives are going to align so well that we are going to finally be fulfilled. And if it could happen, how long do you think it would last?  Think how much energy we spend trying to control so much. Yet, we don’t give up trying.

The Reverse Paradox

Then there is the other side of the paradox. The more you can enjoy your day in light of your current life circumstances; you will then possess more energy and creativity to create a life that you desire. The Eye of the Storm

An Exercise

I often do an exercise with my patients. I look at my watch and point out that the time is X and you have Y number of hours left in the day. I ask them to make a decision to enjoy the next number of hours regardless of their circumstances, including the pain. A major key to solving your pain is to step fully into the life you want, with or without the pain.

When I was in the middle of my own intense burnout about 10 years ago, I had to make ongoing decisions to just enjoy the next 15 minutes. I’m serious. I had to make a conscious effort every 15 to 30 minutes.

My ongoing challenge to myself and to my patients is, “Enjoy your day—today.”

Listen to the Back in Control Radio podcast Enjoy Your Day – Today

The post Enjoy Your Day-Today first appeared on Back in Control.

The post Enjoy Your Day-Today appeared first on Back in Control.

80 Hours a Week???

I have witnessed the downside of thought suppression firsthand in the medical profession. In medicine, suppression is a way of life — it is the way we “succeed.”  We have extreme training conditions, infamously long hours, and harsh demands. A law was passed a while ago limiting residents’ hours to 80 hours per week.  Those hours are still too many for a given workweek. Think what it was like before those laws were passed. Complaining is not an option, though. What can we do?  Nothing. So we just put our heads down and go to work.  We learn to be “tough.” However, the price in terms of mental health is high. Various variations of this problem are present in all high-level/ performance professions.

Physician Burnout

The rate of physician burnout is over 60% and climbing. It is considered a major crisis affecting every aspect of health care. (1), and there is a higher prevalence of psychiatric disorders, drug abuse, and alcoholism among physicians compared to the general population. (2) The suicide rate for male physicians is 40% higher than men, in general, and 130% higher in women doctors.(3) I personally have four out of 80 medical school classmates and two close spine surgical colleagues who committed suicide. The most recent one occurred with a close friend of mine who was assisting me in two surgery cases.  Each case had gone extremely well. Afterward, he shook my hand, said “nice case,” and shot himself three hours later.

Over the years, I had watched my friend slowly fold under the stresses of being a spine surgeon. He suffered the deadly combination of suppressed anxiety and extreme perfectionism. At the time of his death, however, he appeared to have finally gotten a handle on it and seemed like he was pulling out of it. None of us saw it coming.

Patients tend to think of their doctors as somehow stronger than they are, and many physicians take on that projection. They don’t admit to themselves how much personal damage that poorly processed stress is doing to them.

Effects of Suppression

Trying to suppress or not think about negative thoughts is a disaster – in my opinion, it may even be more damaging than suffering. When you try to not think a negative thought, the thought is stronger when it reoccurs. It also takes a significant amount of additional mental and emotional energy to keep thoughts under wraps. For example, you might be upset at your spouse, partner, or child because they routinely don’t pick up after themselves. The first approach is usually to quietly ask them, which often progresses to nagging, and so on. You also might respond fairly aggressively to effect a change. As you know it usually doesn’t work.

As you are closely connected to this person, you also don’t want to be frustrated. So you aren’t. You try to ignore the untidiness. Your rational brain kicks in and starts to “keep score.” You rationalize that this isn’t that big of a deal. There is now a lot of mental energy being expended. You know the rest of the story.  The longer you try to ignore the problem, the higher chance you will be irrational when you finally do decide to deal with it.

There are other adverse effects on the brain with thought suppression.

• It is a mediator between depression and opioid craving in patients suffering from chronic pain. (4)
• It causes amnesia through damage to the hippocampus of the brain (memory area). (5)

Positive Thinking

There has been a movement for decades encouraging people to think positively. In my opinion this philosophy represents a global form of thought suppression. If a situation is bad, it is bad. Pretending otherwise does not help. The energy spent suppressing the negative emotions could be better spent solving the problem. Positive thinking was the one biggest factor in precipitating my burnout. My approach was that of being fearless and “bring it on.” It worked until it didn’t.

A simple but elegant experiment conducted in regard to suppressing negative thoughts published in 1987 showed that suppressing thoughts is not only ineffective but there is a trampoline effect and you experience them a lot more. I think it may be one of the most key concepts relevant to human’s mental health. Allow yourself to feel and embrace what is right in front of you.

1. Jha, AK, et al. A Crisis in Healthcare: A Call to Action on Physician Burnout. Massachusetts Medical Society, Waltham, MA.
2. Rath K, Huffman LB, Phillips GS, Carpenter KM, Fowler JM. Burnout and associated factors among members of the Society of Gynecologic Oncology. Am J Obstet Gynecol. 2015;213(6):824.e821-829. 
3. Shanafelt TD, et al “Suicidal ideation among American surgeons” Arch Surg 2011; 146(1): 54-62.
4. 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.
5. Hulbert, JC, et al. Inducing amnesia through systemic suppression. NATURE COMMUNICATIONS | 7:11003 | DOI: 10.1038/ncomms11003.
6. Wegener, D.M., et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.

The post Suppressing first appeared on Back in Control.

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