Self-esteem

Every human is judgmental. It is an inherent aspect of survival.  However, it is not a trait that engenders close enjoyable relationships or peace of mind. It is made worse by our cultural programming that having self-esteem is essential for happiness. Nothing could be further from the truth. To attain and maintain high self-esteem requires endless comparison to those around you and also to norms that society, your family, friends, and you have set for yourself. You will eventually wear down and crash. There is not an endpoint to this process.

The pursuit of self-esteem can’t and doesn’t work. At some level, we all know this. Whenever your peace of mind and/ or identity is at the mercy of external circumstances, including other’s opinions, you’re at the mercy of them. Also, it gives others power to shut you down, which is one of their efforts to improve their self-esteem. You are riding on a universal merry-go-round that will never let you get off. The eye of the storm

Envy

As these attempts at “improving self-esteem” eventually and miserably fail, the next level of emotion is envy. It isn’t pretty and interferes with almost every aspect of life from work to your personal life. Although you may be on the same pursuit of happiness like the rest of us, it can’t happen if you are perpetually envious. Happiness and envy are not compatible emotions. What is even more ironic is that when you are judging someone else, you are just projecting your view of yourself onto someone else and broadcasting your insecurities to the world.

I have an exercise you may want to consider. Think of someone that you dislike. He or she usually isn’t too difficult to identify. Then in one column, write down as many things about them that you dislike. The to the right of each pronouncement, write down what you dislike about you in a similar area. You may not like his or her work ethic. Maybe you think they are lazy?  Do you procrastinate? Or are you in a reactive pattern where you are a workaholic? “He’s fat!” Are you happy with your weight? Maybe people think you are too thin. You don’t like her political views. Who is to say yours are more correct.

What is fascinating and disturbing is that many people are often unhappy about other’s success, even if they are a close friend.

Schadenfreude

There are two basic types of envy. One is being unhappy with another’s success, whether it is a friend or competitor. The other is silently rejoicing when someone you are envious of suffers a loss. The term for this second scenario is “schadenfreude”. Both elicit feelings of guilt because we know we shouldn’t feel this way. But when you try not to feel a certain way, it becomes worse. It’s even more problematic if you feel the person you have envied didn’t originally deserve his or her success.

In light of the current neuroscience research, we now understand the impact of sustained frustration on your body’s chemistry and the resulting physical symptoms. This unknown writer succinctly points out that good health is the essence of living a good life. Yet, when we spend our energies comparing ourselves to others, we are frequently frustrated. This chronic anger with the attendant elevated levels of stress hormones wreaks havoc with every organ in your body and you’ll eventually get sick.

Envy and pain

I’ve had as much of a challenge with self-esteem and envy as anyone. I came from a tough household and it seemed if everyone had a life that I wanted. I was envious of friends, accomplishments, adventures, families, and the list went on. What is now obvious in retrospect was that my mother was insanely envious and our family’s situation was never good enough. She would become unhappy to the point that our whole family would move to another town to start over. The cycle would begin again and she would complain about any and everything. By the time I was 18 years old, we had lived in 11 different houses. After I refused to move from my high school area in Napa Valley, they kept on moving. It’s clear where I learned this pattern of behavior.

When I ended up in chronic pain, it all become much more intense. It seemed everyone had something I wanted. The first thing I was envious of was not being in pain. Then it seemed that everyone had a better family life than I did. I become more and more socially isolated and I withdrew even more. Although, I wanted to re-engage with friends, my fear of rejection became almost a phobia. Holidays were particularly unpleasant. It seemed like every person in the world was having a better time than I was. Of all the terrible experiences I endured, the loneliness was crushing. It is one of the reasons I have described the world of chronic pain as, “The Abyss”.

Self-destruction

Additionally, anger is destructive, including self-destructive. One of the ways this plays out is disregarding your own health. All of us have a choice of how we choose to treat our bodies. Chronic frustration is possibly the main reason why you wouldn’t choose to feel physically great. It’s hard to really enjoy life if you don’t feel vigorous and energized. Ongoing self-neglect is a form of slow suicide. You’re angry and take it out on yourself. We all have some degree of self-destructive behavior and many of us have a lot. So, the emotions that you might be feeling from another’s success are sucking you dry. You now have less of a chance of “being successful” whatever that might mean. Jealousy and frustration aren’t solving much.

Moving forward

I have undergone many phases of healing. However, I have never forgotten the intensity of the loneliness and envy. It was the accidental discovery of the expressive writing exercises that halted the downward descent and it is still the one necessary starting point of the healing process.

One exercise I frequently discuss with my patients is similar to the one I presented above. I ask them in the room to visualize someone they dislike. They have read enough of the DOC process to quickly understand where I am going. I point out that they know the being judgmental is problematic and then I ask them what happens when they try to not be judgmental. Of course, you will become more judgmental. So, whether you are judgmental or not judgmental, your nervous system remains fired up. What can you do? Write down your specific thoughts and immediately destroy them. This allows you simply to separate from your thoughts, not to solve or change them. You may not become friends with this person or even like them. But in that “space” you’ve created, possibilities arise. Once you can see your judgements as a projection of you, you may be able see this person in a different light. At a minimum, it certainly makes life more interesting.

The Way to Love

So, the solution doesn’t lie in “not being envious.” Another key to dealing with it is to become more aware of it and the impact on your quality of life. I have now incorporated Anthony DeMello’s book, The Way to Love, into the DOC process. He defines love as awareness.  I frequently re-read a few pages. He’s clear on the consequences of being attached to your external circumstances for your peace of mind. Becoming aware is a critical step and a significant part of the solution.

Although, it’s a daily, minute to minute exercise in awareness, not being caught in the quicksand of envy has been a remarkably freeing experience. Try it. At least become aware of your resistance to living a different life.

1. I was going through some old files and happened to find this paragraph that I had clipped out over 30 years ago when I began my spine practice. It initially had a big influence on me and I would read it intermittently to remind myself to keep both feet on the ground regardless of major successes or failures. Life began to cave in on me and I lost touch with these concepts amongst many other losses. I don’t know the source but the wisdom of it struck a deep chord with me. A reader just let me know the writer was Aleksandr Solzhenitsyn.
2. Schadenfreude: Understanding Pleasure at the Misfortune of Others. Wilco W. van Dijk, Jaap W. Ouwerkerk; Cambridge University Press, Jul 24, 2014.

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• 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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Your Hand Over the Heat

If you were to put your hand close to a hot burner on a stove, what would happen to your level of anxiety?

• It would quickly escalate.
• You would withdraw your hand.
• You would protect yourself.
• Anxiety would be alleviated.

What would happen to your anxiety if you were forced to leave your hand over the burner?

• It would go through the roof.
• You would feel trapped and extremely angry.

I don’t believe you’re OK.

Anxiety is a Programming Problem

The changes to the central nervous system during chronic pain represent a programming problem rather than a psychological problem.

• Anxiety gains strength with time and repetition.
• Anger is a powerful force that covers up the feeling of anxiety
• Anger spins anxiety-inducing neurological circuits more quickly.
• We deal with anxiety by exerting some form of control.
• If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
• Without control, you become frustrated or angry. Anger = loss control

With chronic pain, you have, metaphorically, lost your ability to “withdraw your hand from the red hot burner.” How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain alone would be enough to destroy the quality of your life.

There are several other stress factors to consider with chronic pain.

• People in chronic pain don’t see an end to their suffering. They lose hope in returning to a pain-free life.
• Chronic pain patients are truly victims of pain. So it’s more difficult to let go and not have anger run your life.
• When chronic pain patients suppress anxiety and anger, these negative feelings become much stronger. (2)  White Bears and ANTS.

Being Pain-Free is a Basic Need

We all deserve to live free of constant pain. Being pain-free is a basic need. It has been shown that the impact of chronic pain on a person’s quality of life is equivalent to having terminal cancer. (1) We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies. I discuss this in “Maslow’s Miss”  and in the video: “Your Hand Over the Stove.”

“The Link Between Pain and Anxiety”. Inspire, January 21st, 2013

1. Fredheim OM et al. “Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients.” Acta Anaesthesiologica Scandinavica (2008); 52: 143 – 148.
2. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.

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In 2003, a neurosurgeon performed a laminectomy of his neck. That’s an operation where the lamina or the bone over the back of the spinal cord is removed to relieve pressure. He seemed to improve for a little while. In 2005, his symptoms worsened, and in 2009, he underwent a fusion through the front of his neck between his 5^th and 6^th vertebrae. Again there was a slight improvement but two years later he was in my office with crippling pain throughout his whole body.

Normal studies

As I talked to him, I could see how desperate he was for relief. He also wasn’t sleeping and his anxiety and frustration were a 10/10 on my spine intake questionnaire. I couldn’t find any neurological problems on my physical exam. When I looked at his neck MRI, I could see where the two prior surgeries had been performed, but there were no pinched nerves. The alignment and stability of the vertebrae were also fine. He also had undergone several workups of his brain and the rest of his nervous system. Everything was normal.

When I explained to him that I did not see a structural problem that was amenable to surgery he became understandably upset.  He was stuck on the idea that the prior surgeries had helped and that I was missing something. It didn’t matter what I said or how I explained the situation to him. He wasn’t buying it.

What I didn’t tell him was that I had also looked at his scans he had prior to undergoing each surgery. Telling a patient that they did not really need a prior surgery is a very unproductive, unpleasant interaction; I didn’t see why this patient’s prior surgeries were performed. On the first MRI of his neck, there were no bone spurs and the spinal cord was completely free. There wasn’t a structural problem that could have been corrected by surgery. On the scan before the second operation, there also wasn’t a hint of anything that could be causing any symptoms of any type.

The power of placebo

What’s difficult for patients (and physicians) to realize is that the placebo rate for any medical or surgical treatment is between 25-30% or even higher. The response and improvement is not only real but is powerful. It is the result of your body’s own healing capacity. It is a desired response, and you feel less pain.

The pain-killing effects of a placebo are reversed with Narcan, which is the drug used to reverse the effect of narcotics. There is a part of the frontal lobe of your brain that shuts off pain pathways for short periods of time. Another example is the placebo effect of cardiac medications causes the heart rhythms to actually change. Just because a prior surgery or procedure on normal age-appropriate anatomy might have been temporarily effective is irrelevant. It should have nothing to do with current decision-making. I tell my patients “If I can see it, I can fix it” and  “If I can’t see it, I can’t surgically correct it.” It’s critical to have a specific structural problem with matching symptoms before surgery becomes an option. Surgery: The Ultimate Placebo

I suggested that he take a look at the DOC website and I would be happy to explain the whole program to him in as much detail as needed. He was so angry that I didn’t think I’d hear from him again.

Early engagement

Over the next couple of months, I received a couple of emails and had a telephone conversation that seemed to go pretty well.  He was willing to engage in the DOC protocol and began some of the writing exercises. I had a second phone conversation with him a couple of weeks later that seemed to go even better. He was able to recognize that his thought of me “missing something that needed to be fixed” was an obsessive thinking pattern. I was encouraged and thought that maybe I had been able to break through his “story.”

Time went by and our third and final conversation was dismal. He couldn’t let go of the thought that “something was being missed” and that his seventh cervical vertebra was “out of alignment.” I assured him it was OK. As a surgeon, I am also quite obsessive about not missing problems that I can fix. At this point, it didn’t matter. He’d found a surgeon who was going to fuse his neck.

Injury conviction

Physicians use the term “injury conviction” to describe this phenomenon. It is the relentless pursuit of a cause for your symptoms that is well beyond reason. My concept has changed in that I feel this pattern of thinking becomes its own irrational set of neurological circuits. It is similar to phantom limb pain and my term is “phantom brain pain.” Regardless of whether the original source of pain is there, the symptoms are the same. Rational arguments have absolutely no effect.

Hell

I wrote a post Anxiety and Anger: The Highway to Hell. Unfortunately, if you’re in this pattern, you’re in Hell, and the only way out is through you. The deep tragedy is that if you don’t realize you’re in Hell, you’ll remain there. I never give up, but I have learned to let go when I can’t penetrate that firewall of obsessive thinking. For those of you that have let yourself out this hole, I am open to suggestions as to what gave you the insight to move forward. Awareness is the basis of the entire DOC process and is always the first step.

I don’t know how many more tests and surgeries he’ll undergo over the next 30 years. The personal cost to him and society will be enormous.

What’s puzzling is that if any of the surgeons who’d chosen to operate on this man’s essentially normal anatomy were examined by a board examiner about their indications for his surgeries, they’d be failed immediately for giving a “dangerous answer.” It’s our medical responsibility to you to not offer risky procedures that have been documented to be ineffective.

Video: “Get it Right the First Time”

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She was a healthy physically active rancher. Her low back pain started in the summer of 2005 after a lifting injury. The pain had become constant and was located throughout most of her back. She was still functioning at a fairly high level, in spite of the pain.

Her prior care

Jean’s care so far had consisted of six visits to physical therapy, and two sets of cortisone injections in her back, none of which had been helpful. She had not been prescribed a ongoing organized treatment plan. On her second visit to a spine surgeon, it was recommended that she undergo a eight-level fusion of her lower back from her 10^ththoracic vertebra to the pelvis. It is a six to eight-hour operation that carries significant risks.

Jean’s x-rays showed that she had a mild curvature of her lower back. Other imaging tests did not reveal any identifiable, structural source of pain. From my perspective as a scoliosis surgeon, I felt her spine was essentially normal for her age.

Instead, I felt that her pain was probably from the muscles and ligaments around the spine. The medical term that we use is myofascial. When an operation geared towards the bones, such a fusion, is done in the presence of mostly soft tissue pain, it rarely works. In addition to the risks, the entire lower back becomes a solid piece of metal and bone. This surgery should only be done if there are no other options. The procedure comes with long-term lifestyle limitations and she was still so active.

At this point, I was perplexed as to why surgery had been recommended when she had done so little rehabilitation. I also didn’t understand why she was continuing to experience such severe ongoing back pain without any obvious cause.

What was missing?

I consulted her spine intake questionnaire to look for clues.

It revealed that she’d had some marital difficulties and had just reconciled with her husband six months earlier. That immediately caught my attention because marital troubles usually indicate significant stress. She then said her job had become much more difficult. Although she worked for the same employer, they had forced her to switch duties without adequate training. She was worried about not only her performance, but also her ability to keep her job – another major problem.

I turned the page. A month before her pain began, her twenty-six-year old son had drowned. I knew that outside stressors played a role in chronic pain, but this factor had never been so powerfully demonstrated. Her case really brought home for me how crucial it was to take a full view of the patient’s life and circumstances, instead of just looking at surgical solutions.

As I sat there stunned, I realized that I needed to do something different. In fact, the whole medical profession needed to do something different. How could a surgeon have recommended a fusion without taking the time to get to know Jean and to hear her circumstances? I have always wondered if she went through with the surgery, but I never heard from her again.

From that moment, some form of structured rehabilitation became my focus with every patient, without exception. I have not taken my eyes off of that vision since that day.

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Disneyland

While in medical school, I was at Disneyland with several of my friends. I had been there many times and one of my favorite rides was “Pirates of the Caribbean”. I enjoyed the music, art, and the general excitement of it all. The sensation of quickly sliding down to the next level in a boat was also a lot of fun. For some reason, I suddenly looked at the pirate scenes more closely.

“Pirates of the Caribbean”

As we entered the large room with a captured ship, there was a terrified bound woman getting ready to walk the gangplank. Behind her, several pirates were gleefully observing while getting the next victim ready. The scene of the captured town in flames showed a group of young frightened women on a platform being auctioned off to the highest bidder. Three or four women were being chased around the burning buildings attempting to escape their pirate pursuers. Several pirates were lying on the ground drunk, disinterestedly watching the whole scene. Another prisoner was trapped in a burning jail cell trying to persuade a dog to come closer, as the dog had the keys to the cell in his mouth.

We entered the main pirate’s lotto, which had piles of loot scattered everywhere. There lay the drunken captain, lounging in the midst of it. Many personal items were depicted in the middle of the mass of treasures.

“Pirate’s Cove”

Many years ago, I was in New England on a family vacation. We were playing miniature golf at a “Pirate’s Cove”. I looked up and there was a cage that housed prisoners until they starved to death. On each hole there was a continuing story about Captain Blackbeard. Part of the tale involved his marriage to his 12^th wife who was 16 years old. The governor of the state attended the wedding, as it was a major societal event.

Why?

What is it about pirates that we admire and romanticize so much? What characteristics should we embrace? The aspect I find particularly disturbing is that their terror is guised under the cloak of light fun and entertainment. This exposure begins in childhood for essentially all of us.

They rob at will. They not only just kill their victims, they often use perverse methods of torturing them to death. What is admirable about raping and selling women and children? The prisoner potentially being burned alive did not seem much of a concern to them. Why did the governor of a Southern State attend the marriage of a brutal older man to an underage girl? Why did I need to learn about that story while enjoying an evening of miniature golf with my family? Society has frowned on divorce for centuries. What about 12 marriages?

Do we admire what the Nazis did to their prisoners? Are their unspeakable deeds minimized in children’s rides or miniature golf courses?

My relative as a pirate prisoner

In the late 1700’s, I had a distant relative who was captured by pirates. My genealogist brother researched the story. He was one of 30 prisoners that were allowed to live, but they were enslaved. The conditions were so harsh that after three years only three were left alive. Thomas Jefferson finally paid his ransom. He was so brutally treated that he was disabled for the rest of his life. He passed away a few years after his ordeal. Another entire Hanscom family was murdered in a different pirate raid.

Packaging evil deeds in fun – normalizing abuse

It’s my feeling that when horrible deeds are packaged and presented in a way that minimizes the severity of their effect, it has a corrosive effect on who we are as humans. It becomes easier to ignore things around us that are unacceptable. Verbal abuse would be one of those amongst an infinite list.

Might this be confusing for children? They are taught to treat those around them with respect, yet simultaneously are being presented with the idea that being a pirate would be somewhat of the ultimate dream – freedom to do whatever you want to whomever you want without consequences.

I have worked with a medical system in Alaska that provides high quality medical care to a population of Native American Indians. They have recognized that abuse of any kind is detrimental to one’s health and the data is clear that an abusive upbringing is associated with poor mental and physical health. They have committed to eliminating abuse within this generation and have developed a remarkable infrastructure to address the problem. Several of the programs are focused on victims telling their stories. What I had not realized was the severity of the abuse and it is so common that in many villages it is the norm. The population had become de-sensitized to the problem although they weren’t de-sensitized to the suffering. It’s a terrible cycle. Bringing the abuse into awareness through telling their stories has been a major step in defining the problem and solutions are being implemented. Awareness is always the first step in solving a problem in any domain.

Aced out

Awareness of suffering

I have become acutely aware of my own suffering and those around me. It was a rough experience that brought me to this awareness. It is now clear to me how violence mixed with entertainment contributed to my inability to really appreciate the depth of others’ pain. Do you find pirate tales and violent movies entertaining? I did for much of my life.

Chronic pain is misery that is endless. Put yourself in the shoes of those poor pirate prisoners and imagine how they must have felt. Consider the suffering of other people around you who are in chronic pain. There are plenty. In the U.S. alone there are over 100 million people in chronic pain.

Awareness

The first step of reprogramming your nervous system is awareness. There’s nothing noble about pirates or the suffering they inflict. Become aware of how becoming desensitized affects your connection to the pain of those around you. If we are to evolve, issues such as these must be addressed both individually and as a society. Calling out the damage inflicted by packaging bad behavior under the guise of entertainment would be a significant concrete step.

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Three of the couples have been married about 40 years. Most of us didn’t make it that long. Since the family issues have become one of the main focuses of the healing process from pain, I asked both halves of each couple what was working for them. Here are their comments.

Bernie and Carolyn

Bernie worked night shifts for many years and they were forced to have a lot of space in their marriage. Although there were some negatives, they felt that it was helpful in making them develop their own styles and interests. They also had a shared value system and were active in the church. They enjoyed a strong sense of community and giving back. Social isolation

Finally, they often “ignored the problem” and eventually it disappeared or “just wasn’t worth fighting about.”

Ken and Merrilee

Merrilee:

“Love them even though they change.”

She felt the honeymoon ended when her focus shifted from making her husband happy back to her happiness. “Life keeps coming at you and you just don’t have the same energy to keep giving.” She has been reconnecting to being more emotionally supportive going forward and enjoying her family more.

She shared that her daughter had a wonderful perspective in that she quit worrying about herself and concentrated on being “the wife that her husband deserves.” Without expectations, his behavior and their relationship improved. She also performed “deliberate acts of service.”

Ken:

He felt that respect for each other’s views was important. There is rarely one answer and it doesn’t have to be repeated scenarios of “win or lose.” This perspective evolved about five years into his marriage and involved better awareness and willingness to listen.

He also realized that under stress that he would remain aloof and withdraw and that sharing everything, enjoyable or unpleasant, was critical. A turning point occurred when their daughter incurred severe life-threatening injuries in a boating accident and everyone pitched in and pulled together. Shared adversity became a strong bond.

Jennifer and Gary

They both shared that maintaining a sense of humor was the cornerstone of why they had thrived for so long. They just “laugh a lot.” Consequently, they don’t seem to trigger each other that much. Their main advice to their children is, “Find someone with a sense of humor.”

Shared values were also important. They cared about similar issues. Appearances and material things aren’t that important to them. They really enjoy traveling together.

Respect was also in the forefront of their relationship. They espoused being kind and treating each other and others well. “Being tired” wasn’t an excuse to behave poorly. They consciously don’t speak badly about each other to others.

Chronic pain and your family

There are many books giving marriage advice, but I was impressed how these observations reflected a lot of wisdom. Chronic pain introduces an intense angry energy into the home and the effects are consistently devastating. Every time I ask a patient’s partner about the impact, the response is strong. It’s a disaster.

Chronic pain is a legitimate reason to be angry. You’re trapped – from every direction. Why would you not be angry? The problem is that anger is destructive and the family you treasure now becomes one of the targets of your anger, even if it isn’t directly focused on them. As they react back, then it triggers your pain and there is not an end to this vicious cycle.

We are seeing tremendous success in guiding families to create structures to break up these unconscious survival patterns. They are powerful reactive survival responses that aren’t subject to rational interventions. These strategies are outlined in multiple posts in the family section of this website.

One of the most effective approaches, after the chaos has settled a bit, is to proactively recreate a life that you want beginning at home. The wisdom of these couples encapsulates this concept. It also happens to be the foundation for our three-day workshops, which are based on awareness, hope, forgiveness and play. Omega 17

Awareness

All the couples felt respect was essential, but to have it you must to be able to listen and become aware of the other person’s needs. When you’re angry, you’ve completely lost awareness. It’s crucial to be aware that you are upset and not take action while you are reacting. This one is tough and an ongoing challenge for me personally. However, anger is about your own needs and is destructive to others and relationships. You have to disengage until you can calm down and then discuss the possible solutions to the problem.

Committing to the other person’s needs or well-being also requires a keen awareness of what those might be. Awareness is the foundation of any relationship in all arenas of your life.

Hope

What were your dreams for your life and family on the day of your wedding? Why did you want to be with this person? That energy seems to be commonly crushed by life stresses for many families. One of the suggestions we make to couples is to spend an hour remembering the most enjoyable and happy times of their relationship. Most couples with pain in the family haven’t done that for a while and often find it difficult to get back to that spot. If you can’t re-connect with why you are together in the first place, then you have to really dig in and figure a few things out. You’re in a pressure cooker.

Forgiveness

This is a self-evident truth that most of us forget in the midst of relationship issues. It is easy to be judgmental of your partner’s “faults.” However, when you are judgmental you are just projecting your view of you onto someone else. When you have labeled anyone, either positively or negatively you have lost awareness and you have little or no idea who this person is, and you cannot see the world or situation through his or her eyes. All the couples had their own style of letting go and moving on. Fighting is the antithesis of love, compassion and respect. Would you talk to a stranger or fellow worker the way you talk to your partner?

My wife and I have a little saying, “Anger isn’t attractive.” It’s true. However, although it’s easy to see how unattractive the other person is in that state, it’s challenging to see how you appear to others when you are in that mode. Do you want to remain that way? Is that the way you want people to consistently perceive you? Isn’t it great to be around someone who laughs a lot? Wouldn’t you want to be that person? You can’t get there without deep forgiveness.

Play

One of the more definitive solutions to solving chronic pain is play. There is a surge of wonderful chemicals such as serotonin, GABA chemicals (Valium-like chemicals), oxytocin (the love drug) and dopamine (the pleasure hormone). As the body chemistry switches into this mode, there is a profound effect on all of your body’s organ systems and many physical symptoms resolve. Why wouldn’t you want to spend most of your time in this state? What was a common theme with all of the three couples? Actively cultivating pleasure is a learned skill and needs to be nurtured. Taking things in stride with a sense of humor is the essence of this aspect of relationships. We have been amazed at how frequently we have observed how much controversy is generated around how to load the dishwasher. That might be good starting place to step back and just laugh about how deeply we get pulled into situations of little consequence. We can do better than that.

Life is full of adversity and you can either support each other or bring each other down. I have never advocated positive thinking or enjoying adversity. However, sharing challenges together is an intense bond and it’s helpful to bring a sense of adventure and play to all of this. Challenges will always be coming at us. Without making a conscious effort, play will be pushed aside. It’s critical to be able to regenerate your energy daily.

Chronic pain infiltrates every aspect of your life – especially into your family. It appears to be one of the most powerful forces keeping you in pain. However, with relatively simple strategies, the energy can be switched to your close relationships being a wonderful connection to healing – for both you and your family.

Healing begins at home

The post Married 40 years – What Worked? first appeared on Back in Control.

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A functional pain system is critical to your health and even survival. He presented several stories of children born without a pain system. Their body quickly becomes deformed from over-stressing their joints and skin breakdown. The average lifespan of these children was only 15 years. I knew him when he moved to Seattle to be close to his family. He was over 90 years-old and still writing and lecturing all over the world. He was one of my true inspirations.

My Gift

I have slowly realized that I have been granted a similar gift that I did not want, nor would I accept it again if it were offered to me. It is the gift of prolonged severe suffering in the form of both physical and mental pain. I slipped into an anxiety-driven depression/ burnout in 1988, and developed symptom after symptom of the Neurophysiologic Disorder (NPD). At one point I was experiencing 16 of the over 30 symptoms outlined by Dr. Schubiner in his book, Unlearn Your Pain.

OCD

The worst part of the descent into oblivion began in 1995 when I developed a full-blown Obsessive Compulsive Disorder (OCD). I had always thought it was a loose term for some compulsive habits and felt it was some type of TV joke. It is the ultimate anxiety disorder manifested by intense, repetitive intrusive thoughts. They never stopped and became increasingly intense. By 2002 I was done and ready to check out. I will never completely understand why I survived. I have 18 medical colleagues that have committed suicide. Most recently it was one of my best friends in the spine surgery world and the other was an orthopedic surgeon acquaintance that I did some business with. Both had everything life that one could ask for.

While I was living in Sun Valley, six men between the ages of 45 – 60 committed suicide over a span of 18 months. All were extremely successful and prominent in the community. Why?

Anxiety

Raw anxiety is intolerable. It mental pain that I couldn’t escape. I cannot describe my suffering in words. My best metaphor is a “branding iron on my brain.”

I got extremely lucky in pulling out of it. In 2002 I began to heal and by 2004 began to thrive. The last five years have been the richest I could ever imagine. All of my NPD symptoms resolved, and flare only if I quit practicing the principles I have outlined in my book. So what are my gifts? This does not sound that convincing yet. They are many:

My Gifts

• Every day I am alive I can appreciate it at a depth I could not have imagined. It is a marked contrast to extreme suffering.

• I can look any patient in the eye and let them know that I understand your suffering. “You may be suffering as much as I suffered but not more.” I know where they might be going and where they are at as the come out of “The Abyss.”

• I understand the endless quest to find the one answer to the pain.
• I know loneliness.
• I did not have a shred of hope. NONE. Having the physical surroundings of success made it even worse in that I had worked so hard to attain them and I was still miserable. My efforts to find happiness had not worked. That included friends, family, and incredible experiences. I could not run from my mind. If none of that worked I developed a deep feeling of desperation of,  “What do I do next?”

• As I have learned to accept myself (the medical world is not an accepting culture), I can accept my patients wherever they are at. I know them better and it is one of the most enjoyable aspects of my practice.
• I have learned when I can help and when I cannot.

• I no longer let patients make surgical decisions when they are under extreme personal stress. In the past I never really was aware of the degree of their personal suffering in addition to the pain. The lines between mental and physical pain overlap.

• I saw patient a few months ago who came to me for a second opinion. She had seen a surgeon for correction of a spinal deformity. She did have the deformity and surgery would have been helpful. The problem was that she was scheduled for a 10-hour procedure just a week after meeting the surgeon for the first time. A month earlier her 34 year-old daughter had died of cancer.

Gratitude

The greatest gift has been gratitude. That was not a familiar word for me until a few years ago. I was charging full steam ahead just doing the best job I could. I am grateful that I am able to share the tools I learned coming out of my burnout and witnessing so many patients experiencing the same success.

I am a surgeon and do not understand all of the reasons why the dramatic turnarounds occur with such regularity. I am not a neuroscientist. But it is a completely unexpected phase of my career and is incredibly rewarding.

The post The Gift of Pain – Thanksgiving 2013 first appeared on Back in Control.

The post The Gift of Pain – Thanksgiving 2013 appeared first on Back in Control.

Crystal could not walk for more than half of a block without having to sit down. As she had been this way for several years, she was becoming increasingly weaker. She was very unhappy at the prospect of losing her independence, in addition to experiencing a lot of discomfort. Understandably, her anxiety was through the roof.

The Surgery

I performed a three-level laminectomy on her at L2-3, L3-4, and L4-5. This procedure removes the narrowing around the nerves, and about 70% of the time, patients are able to walk without pain. It takes a while for the strength and endurance to return. Unfortunately, most patients don’t engage in the rehab enough to experience the full benefit of their surgery. As she was so frail, my optimism for Crystal was tempered. I knew her leg pain would improve, but probably not her strength.  She also just did not seem like the person who would engage in a full rehab program.  I never give up though, so I talked to her about the DOC project and told her about my website.

Post-Op

The surgery went well and Crystal’s legs felt better. During our first phone appointment, she began to ask a lot of questions about the website and had begun the writing exercises.  She was slightly encouraged, and I was pleasantly surprised. The talk evolved into a somewhat extended conversation about the central nervous system and conditioning. It is difficult to make the effort to exercise when a person has a lot of anxiety.  To see a full recovery, I ask all of my patients to workout with weights three to five hours per week.  She was interested in getting completely involved in the process.

One month after the surgery, she was sleeping better, and felt her anxiety dissipating. She would go out for small walks every now and then. I encouraged her to join a gym. I really did not expect her to go.

Her Outcome

When I talked to her a few months ago, she was a different person. Her voice was energized. She had joined a gym and was working out four or five times a week. She felt a dramatic increase in her strength and endurance. Her anxiety was down by 80-90%.  She was going out with her friends and socializing. She was ecstatic.

I asked her to write a follow up letter about her experience, which is about a year from her surgery.

Crystal’s Letter

Dear Dr. Hanscom,

How nice it is to feel better!

It’s great to be able to do some of the things again that I used to do. I am doing everything that I have been asked to do. I am working out in the gym every week. I am also working through all of the stages of the web site. All of the books have been interesting and helpful.

My friends tell me how good I look. They say that they no longer see the look of pain in my face.

I feel like I have my life back.

Sincerely,

Crystal

Move Forward

I have kept in touch with Crystal and we talk every three months. Seven years later, she is still working out in the gym, and her strength and endurance have continued to improve. She is active in the community with a nice circle of friends. This in sharp contrast to when I first met her and she was lying around her house, at the mercy of her pain.

The tools on this website are self-directed. My observation is that there is no question of “if” you’ll better, but only a question of “when.” The decisive factor is a patient’s willingness to engage. It is stories like Crystal’s that keep me moving forward with this project.

“Better Not Look Down”

The post A New Life at 72 first appeared on Back in Control.

The post A New Life at 72 appeared first on Back in Control.

Abraham Maslow

Abraham Maslow (1908-1970) was a brilliant professor of psychology. He founded a branch of psychology known as “Humanistic Psychology,” which focuses more on psychological virtues or excellences rather than on psychological disorders. Maslow is best known for his conceptualization of “man’s hierarchy of needs.” This hierarchy is usually represented as a pyramid, which is depicted above. Maslow thought that meeting one’s basic needs in the lower part of the hierarchy was necessary before progressing to the needs at the top. He also recognized that getting to the very top of the pyramid, what he called self-actualizing–flourishing as a human being, was not commonly attained.

Basic Human Needs

The most basic needs are physiological:

• Air
• Food
• Water
• Sleep
• Sex

According to Maslow, it is impossible to progress up the pyramid if you cannot obtain air, food, water, sleep, and sex.

Where is Pain?

A thought struck me as I looked at his hierarchy: where is the need to be free from pain? I believe this need belongs on the bottom row. Any time a basic human need is not met, anxiety quickly results. If the basic need remains unmet, then the anxiety will progress to anger, disrupting your quality of life and compromising your ability to function. When you are in pain, your body will flood you with anxiety in an attempt to protect itself from harm. (I talk more about the relationship between pain and anxiety in “Your Hand Stuck Over the Stove.”)

Will you have the wherewithal to progress up the hierarchy of needs when you are consumed by pain? You won’t. I believe it is impossible to flourish as a human being without first absolving yourself of your pain. Maslow simply missed including this basic need in his paradigm.

A.H. Maslow, A Theory of Human Motivation, Psychological Review 50(4) (1943):370-96.

The post Maslow’s Miss first appeared on Back in Control.

The post Maslow’s Miss appeared first on Back in Control.