I received this message from a person I have never met or communicated with. She had engaged in learning the tools to heal.

The key to healing mental and physical pain happen from learning two separate sets of skills. The first is separating identity from your necessary survival circuits, developing a “working relationship with them. The second is shifting your brain onto more enjoyable and functional circuits. You cannot experience play and joy will simultaneously fighting pain.

You also cannot heal your body, including your brain. It already knows how to heal, and the healing stories are nothing short of miraculous. But life itself is a miracle. Our conscious brain gets in the way and blocks healing. You only must believe your body can heal, let go, and allow it to occur. Her email is typical of what happens, and the healing is deep and transformative.

Not fixing yourself

One of the most difficult challenges is letting go of trying to fix yourself to rid yourself of the mental and physical pain. Why wouldn’t you? You are trapped in miserable place without an apparent way out. It is bad enough enduring the pain, but when you get angry about it, you have now doubled down, and your brain is really on fire. Dr. John Sarno, a famous physiatrist and author used the term “rage”.¹

Good Studio/AdobeStock

However, trying to solve the pain places your attention on it and reinforces it. But when you try not to think about your pain or distract yourself, the thought suppression inflames your brain even more. Either way, you are trapped. Specifically considering self-esteem, which is an endless set of judgments, trying not to be judgmental is impossible. Positive thinking is another form of suppression. Even reading self-help books is another way of staying focused on the problem. Even with my books, there is a tipping point where I recommend people stop reading them and focus on practicing and implementing the tools they have learned.

“Phantom Brain Pain”

There is the additional problem of thinking that something is being missed, and these thoughts become independent sets of circuits. They really are not responsive to reason, and the ongoing pursuit of reassurance only reinforces them. Along with all RUTs (repetitive unpleasant thoughts), I call this phenomenon, “phantom brain pain.” In my mind, the same issues are in play as phantom limb pain, where the suffering is intense, and you cannot even touch the absent limb to calm yourself. How can this happen. The known “source” of pain is completely gone, and the patient still feels the limb and the pain. So, where does this pain exist?

The key to healing lies in separating from your racing necessary survival circuits, developing a “working relationship with them, and dynamically shifting your brain into more enjoyable and functional circuits – and letting go. You cannot experience play and joy while simultaneously fighting pain.

“I give up”

I vividly recall feeling like I was in the midst of a major battle with unpleasant thoughts. The mental pain was a much bigger problem than my physical symptoms. I was never bothered during surgery with them in that I was so focused on what I was doing. For a long time, I was also fine in clinic while I was connecting with my patients. Towards the end of my ordeal, even being at work did not help, and I was pummelled every two or three minutes with ever-increasing intense, intrusive, and vivid thoughts. Meanwhile, I was trying everything possible to deal with them, including working with a psychiatrist. Nothing helped and in fact, it all seemed make things worse. It was around this period where I came close to committing suicide.

One evening, I had read yet another self-help book and I had a flash of a vision that I was standing in front of a repeating circus mirror. I can still see it. It was about six feet high, and it was in a tent. I was looking at endless images of myself. At that time, I was doing what felt like hand-to-hand combat with my thoughts. I would have a disturbing thought, and then counter it with a “good” thought. I was wearing down quickly. I could see that there was no rational solution to these RUTs. I said to myself, “I can’t do this anymore and I quit.” I felt my identity was stripped down to nothing and felt there was little left of what I thought was me.

I honestly gave up and was not sure what I was going to do next. Instead of feeling despondent, I felt a strange sense of freedom, and it turned out that “giving up” the fight was the right answer. It was after that moment, things began to change for the better. I had much to learn, but at least I had inadvertently created some “space” in my brain to allow healing to begin.

Hope

This is a link to a collection of patients’ success stories that I call, “Stories of Hope.” Essentially everyone who is trapped in the Abyss of chronic pain is in a very dark place. Knowing you are not alone is important.

ipopba.AdobeStock

It is impossible to let go of “fixing” without the tools to accomplish it and also learning how to feel safe. You can’t force it and as per her email, you just have to keep moving forward, and it will happen when you are ready. I also wish for you that it happens sooner than later, but persistence is the key. You will learn to regulate your stress physiology and become much better at nurturing joy and creativity. Your behaviors become automatic, your skills will increase and improve, and you can let go and live your life.

References

1. Sarno, John. Mind Over Back Pain. Warner Books, New York, NY.

The post How healing happens 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.

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People of the Lie

I read a book during my late teens that shed some light on my mother’s behavior. It is a brilliant book by Scott Peck called People of the Lie. The book begins with the story of a 12 year-old boy who has a near-psychotic break after being given a 22-caliber rifle for Christmas. His parents were confused because they felt that they were making a positive statement to him. Their son was entering his teen years and they wanted to send him the message that they trusted him enough to give him as big a responsibility as owning a gun. The problem was that it was the same gun his 15 year-old brother used to commit suicide the prior Christmas.

The Essence of Abuse

The essence of abuse is being unaware of another person’s needs. If you are consumed by anxiety and just trying to keep your head above water, there is a high chance you are unable to view a given situation through another person’s eyes.

This is taken a step further with regards to anger. When you are angry, you cannot see anything clearly. It is truly all about you. Anger is temporary insanity, and it is dangerous to interact with people or make decisions in that state of mind. When you are experiencing chronic pain, you are frustrated and angry much of the time. You have a legitimate gripe in that your basic need to be pain-free is not being met. Maslow’s miss You feel the world, including your family, owes you something. You feel justified when you vent your anger whether it is directed at someone or just expressed.

Your Family’s Perspective

It is becoming increasingly clear that chronic pain is a major family issue. Its effect on a family is usually devastating and I frequently bring the topic up in clinic. Rarely, do I have people disagree with my statement, “Chronic pain is disruptive and is rough on your family. Family members in the room invariably begin to nod their heads. It is like a dark cloud over the household. I ask them if they love their family and the answer is always, “Of course.” Then I ask them if they snap at their family when they are upset. You can guess the answer. I point out to them that everyone has a choice of creating a safe haven for themselves at home. If you are upset, why would your family be a target. They are the least logical choice.

How do you think your children or partner perceives your mood and actions?  You are frustrated because you have lost control of the pain and your life. How much control do you think a five-year old has when you are angry or in a rage after yet again being disappointed by the medical world or beat up by the worker’s comp system? Pain Rules the Roost

You may not perceive your actions as abusive. I guarantee you, it is abuse.

Rules of Engagement

I ask my patients as part of their healing process to ask their family what it is like to be around them when they are upset?  I ask them to visualize scenarios from the receiving parties eyes. The answers are not pretty.

I also ask my patients to never talk to their family when they are upset. They have to go to another room or leave the house. They cannot re-engage until they have calmed down. You cannot suppress or control anger. But you don’t have to become a living weapon. Anger must be dealt with using one of the strategies that have been presented in other parts of this web site. Protect Your Family from Your Pain

One homework assignment I ask a family to do on their way home from my visit is to recall a time in their relationship that was full of happiness and joy. Their eyes widen when they realize that they have not connected with that energy for a long time. They are to recall as much detail as they can about that era and then I ask them to work immediately on creating that environment. Their pain is not the family’s problem.

Then I point out one of the basic rules of healing from pain to never share their pain with anyone – ever. The moment they walk out the door they will never complain about pain. You can just feel the relief in the partner, spouse or child within seconds. Your family member cannot help you and they will become frustrated. Besides, your pain is not that interesting of a subject. Do you really enjoy discussing your pain compared to discussing an interesting topic or learning new ideas? How interesting are you to your friends and family when you not only continue to talk about your pain but do it over and over again. Just stop it – now. You are only reinforcing the pain pathways. The chronic pain marriage-go-round

Many people, including me, are addicted to the power of pain and simply do not want to give it up. You are probably not the one reading this post but it is important to understand how powerful pain is. No one, at the end of the day, really wants to give it up. It is only solved by remaining aware of its effect on you and how if affects others. The clearest delineation of this tendency is outlined by Anthony DeMello in his book, The Way to Love. He defines love as awareness and anger blocks it – completely. My victim/ anger pathways run deep and I read a few pages of this book every week. It has taken me a while to accept that these are permanent pathways and the only logical answer is to commit to remaining aware of when they are triggered. I have learned to come out of the Abyss more quickly.

Wake up! There are 116 million of you in the US suffering from chronic pain. That is one in three. If you consider the effect your pain is having on your family, the numbers of people affected have to be well over half of the population.

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You’re never going to get rid of anxiety or anger. They are a necessary part of life. It has been demonstrated that avoiding these emotions will just increase their frequency. In the famous White Bears study, Dr. Wegner demonstrated that when you to try not to think about something, you will inevitably think about it more. Ignoring your anxiety and frustration will not get rid of those feelings, and the concept of self-esteem won’t help for a variety of reasons.

First, self-esteem involves endless judgments of you versus those around you. You are either “better than” or “worse than” the people around you. This line of reasoning creates labels; you cannot really see who other people are, what their needs might be, and how you might help. You have lost awareness. This is the antithesis of what is necessary for the world to become a better place – the acceptance and celebration of differences.

Second, attempting to build self-esteem involves using rational methods to deal with irrational neurological circuits. The emotional unconscious brain is much more powerful than the intellect; it’s a huge mismatch.

Third, what happens after you’ve achieved the things that should have alleviated your frustrations and anxiety, and it doesn’t work? (and it won’t) You will become more frustrated because there’s nowhere left to go. The list of high-profile people who have self-destructed is long. They usually had every imaginable comfort life has to offer. It’s impossible to outrun your mind.

Achievement Doesn’t Work

In the medical profession, it expected that you encounter death frequently. What is not as talked about is how often those deaths are of fellow medical caregivers taking their own lives. I know of 19 medical colleagues who are dead from suicide. Two close friends, and also four out of my eighty medical school classmates are dead from suicide.

These aren’t just numbers to me. I had a friend who was an excellent spine surgeon and one of those guys you could count on for anything. He had spent the day in surgery with me, assisting with a difficult operation. At two o’clock he shook my hand and said, “Nice case, I have an appointment I can’t miss.” He walked out, and three hours later shot himself.

All of them were “living the dream.” They were highly educated, wealthy, with big reputations, beautiful families – the list is endless. They possessed more than enough to have self-esteem. Yet the anxious, perfectionistic drive that pushed them to the top destroyed them.

Perfectionism

Perfectionism is rampant in the medical culture. Although “perfect” sounds reasonable when applied to surgery, it is actually deadly. What it does it creates an intense, chronic anxiety of “never being good enough,” and then frustration of never being able to achieve these unattainable goals. Perfectionism fosters anxiety-driven anger. Over time, the anxiety becomes intolerable. People don’t kill themselves because they are depressed. It is an angry act. Anger is destructive and the ultimate act of destruction is to destroy yourself.

I know this first-hand because I went through a similar experience that came to a head in 2002. I was actively suicidal with extreme anxiety for 18 months and crossed the line to put my plan into action. I was lucky. I made it through this gauntlet. I eventually published my story in 2011, in our national spine publication, SpineLine.

Nick and Holt

In my book, Back in Control, I talk about my son, Nick, and his friend Holt, who are both world-class mogul skiers. I learned many of the performance concepts presented in my book from watching them deal with the adversities of competing under intense pressure, while being at the mercy of judges. They were also obsessed with winning as the ultimate goal. Through working with an athletic performance coach, David Elaimy and also myself, they were able to learn to enjoy the journey regardless of the outcome.

In 2007, Holt won the national championship in mogul skiing. He felt that significant contributing factors to his victory were the awareness and visualization techniques presented in my book. One principle was letting go and performing with freedom. By connecting with his best effort instead of the outcome, his performance soared. The day after his victory, he turned to me and said, “You were right. Winning changed my life for about twelve hours. Life moves on.”

No matter your profession – a surgeon or an athlete – if you are connected with who you are, then you can create the life you want. If you are creating a life to fill a hole inside you, it becomes a major problem. It’s important and rewarding to strive for excellence; it just has nothing to do with decreasing anxiety and frustration.

“Better Not Look Down”

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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.

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