• When your nervous system is inflamed and hyper-reactive, lesser levels of stress cause your body to go into flight or fight.
• In contrast, you are able to more easily deal with challenges if you feel safe and calm.
• Four categories of factors influence your baseline physiological state of safety versus threat: 1) sleep 2) diet 3) exercise/activity level 4) childhood programming/ patterns.
• All of these factors are addressed throughout the course, but the initial focus is on getting adequate sleep.

Your nervous system gathers about 20-40 million bits of information per second, and interprets the sum total as safe or threatening. Signals are continuously sent out to adjust the body’s physiology (output) and actions to optimize your function. The reactivity of your nervous system ranges from calm to hypervigilant. These four categories of factors influence the sensitivity of the nervous system.

• Consistently restful sleep is necessary for your brain to refuel and empty waste products.
• Lack of exercise affects your physiology and also your capacity to cope with both mental and physical stress.
• A poor diet is inflammatory.
• Your baseline physiology is also affected by your past. Survival depends on learning what is dangerous and then avoiding it in the future. If you were raised in a chaotic abusive environment, many situations were dangerous or perceived as such. That doesn’t change as you age even when you intellectually know you are safe. So, more scenarios in the present seem threatening with less stress than you might expect.

Although all these variables affecting your nervous system are presented throughout the course, successfully addressing sleep is a high priority. The DOC Journey approaches will be marginally effective if you aren’t getting 7 or 8 hours of restful sleep. Not sleeping is NOT an option. No major decisions regarding your medical care should be made until you feel rested during the day. This is particularly true regarding surgical procedures.

Systematic Approach to Sleep

Insomnia is consistently solvable with a stepwise approach regardless of the level of your pain. The key is focus and persistence. It is a myth that you need less sleep as an adult and at least seven hours of sleep is desirable. Few patients suffering from chronic pain are getting adequate sleep.

Incorporating sleep into the treatment was my first step in conceiving the DOC protocol. I had a new resource that was effective and measurable. My patients’ sense of well-being improved and often other symptoms diminished.

Sleep and pain

I originally thought that people suffering from chronic pain couldn’t sleep because of their pain. But a large study out of Israel demonstrated that lack of sleep induces chronic low back pain, and that the reverse was not true – that pain caused insomnia.¹

Another study documented that consistently poor sleep was a greater predictor of disability than the severity of back pain. Even more interesting was that this was also true for leg pain (sciatica), which surgeons generally feel is an incredibly disabling symptom.²

I treated one businessman who had experienced chronic neck pain for almost two years. There was no specific injury. He continued working as an owner of a small accounting firm, but he was miserable. He had been through multiple courses of physical therapy. I started him on a strong sleep medication, which immediately allowed him to experience restful sleep. I saw him back at two weeks and noted the medication was working well. I was planning on starting aggressive physical therapy on the next visit. When he returned six weeks later, I was surprised that he was pain-free without any other interventions.

Start sleeping – NOW

Most people find a way to sleep using a combination of the suggestions listed below. If you are still struggling after a few weeks, Discuss sleep with your primary care physician. The details of each of these suggestions are outlined in chapter 14 of my book, Back in Control. Please use this as a resource.

Approaches to Insomnia

Self-directed

1. Sleep hygiene – well-known set of principles to optimize sleep.
2. Stress management at bedtime – i.e., don’t read business emails for at least an hour before going to bed.
3. Exercise – Physical conditioning improves sleep, but don’t exercise late in the evening.
4. Expressive writing –  shortens the time it takes to fall asleep.
5. CBT-I –  Cognitive Behavioral Therapy Insomnia is documented to improve sleep. Online resources are readily available.
6. Over-the-counter sleep aids – I do not have specific recommendations. They may be helpful, but should not be used long-term. Alert your physicians if you are using them.

Under the guidance of a physician

1. Prescription Medications – Many stronger medications are effective for treating insomnia. I have observed that if you are suffering from chronic mental and/or physcial pain that you often need a kick-start with strong sleep meds. Once your nervous system quiets down you can and should come from them relatively soon. Using narcotics for sleep is not recommended and creates many additional problems.
2. Diagnosing a sleep disorder – there are over 100 sleep disorders with the most common one being sleep apnea. Sleep apnea is caused from your airway intermittently becoming partially occluded. Oxygen levels drop as you gasp for air. Sleep quality is poor, and daytime sleepness is one of the hallmarks of this disorder. More importantly, your heart is stressed and its function is progressively compromised. It is important to diagnose and treat it if there is any suspicion. Restless Leg Syndrome is another common sleep disorder that is treatable with the correct medications.

Recap

The other factors affect the reactivity of your nervous system, buy a consistently restful night’s sleep is necessary for healing. It must be not only be addressed, but at least partially solved as an early step. Most people improve their sleep with simple self-directed interventions, but you should not hesitate to seek help from your physician.

Questions and considerations

1. Assess your sleep.
   1. How many hours do you sleep per night?
   2. How often do you wake up?
   3. How long does it take for you to fall asleep?
   4. Do you feel rested in the morning?
   5. Do you fall asleep easily during waking hours?
2. Do you notice a difference in your physical and mental symptoms after several nights of restful sleep? What symptoms are worse with poor sleep?
3. From a practical perspective, how can you really enjoy your life if you are tired? Why pursue so many other treatments without covering this base?
4. Temporarily push away the other aspects of your situation and focus on sleep. It is a clear and measurable variable.
5. “I can’t sleep because of my pain.” You have to flip that idea around. Remember, it is lack of sleep that is causing so many problems.

References

1. Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.
2. Zarrabian MM, et al. “Relationship between sleep, pain, and disability in patients with spinal pathology.” Archives of Physical Medicine and Rehabilitation (2014); 95:1504-1509.

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• When you are suffering for any reason, you mind races, which makes it harder to think clearly.
• Doing battle with your thoughts or suppressing them makes it all worse.
• Simply placing your attention on a specific sensation for a short time separates you from your racing thoughts.
• Your body also calms down, your thinking brain functions better, you can better engage in learning, and live your life with more clarity.

 Dr. Daniel Wegner out of Harvard, wrote a paper in 1987 called, Paradoxical Effects of Thought Suppression.¹  He demonstratedthat the more you try not to think about something the more you will think about it. The paper has been nicknamed, “White Bears.” This not news to any of us. But he also demonstrated that there was a trampoline effect, in that you think about it a lot more. When you frame this discussion in terms neurological circuits and programming this phenomenon becomes a huge problem. Disruptive thoughts progress with age.

A basic tenet of many Eastern philosophies is that worrying about the future and thinking about the past causes internal unrest. There is anxiety around the future and many regrets and frustrations about the past. Staying in the present moment is key, but how do you accomplish it?

You cannot control your mind with your mind. When your mind is racing your body will be tense and tight. The harder you try to calm down your thoughts, the faster your brain will spin. Neurological circuits are deeply embedded, especially the unpleasant ones you instinctively fight.

Active meditation

As you cannot fix, repair, or outrun them, one option is shifting from them to more functional and enjoyable circuits. This is quickly accomplished by focusing your attention on a specific sensation from your immediate surroundings. Any sense works – sound, smell, taste, feel, pressure, and sight. My term for this tool is “active mediation.” It is an abbreviated version of mindfulness, and you focus on any sensation for a few seconds up to a minute. You have connected your consciousness to the present moment. The intention is incorporating this practice frequently into your daily routine until it becomes habitual.

Three steps from Eastern philosophy.

• Relaxation
• Stabilization
• Focusing on a sensation

I learned them in a workshop given by Alan Wallace, a prominent researcher in integrating Buddhist contemplative practices with Western science.

Active meditation in practice

I practiced this daily during my hectic days at work. I often did it with my patients in clinic, especially if I was running behind. We sat back in our chairs, let our shoulders sag, jaws relax, took a long deep breath, and slowly let it go. (Relaxation). We stayed relaxed for 5-10 seconds (stabilization), while I had them listen to the ventilation system. Then our attention shifted to voices outside the door, our feet on the floor, and back to the vent. It took about a minute.

Invariably, everyone felt more relaxed and I heard my voice change to a softer pitch. Our attention had shiftedoff of racing thoughts to the current moment through sensory awareness. I encouraged them to do this often until became automatic.

You can also do this much faster for just three to five seconds. Simply engage with any sensation for short periods as often as possible throughout the day. During surgery, I would engage with active meditation with essentially every move I made.  My “go to” sensation was grip pressure on my surgical instruments. There is more feel and control with light touch. Eventually, the sensation and moves I made become so automatic that I developed a “safe zone”, and it would have required a conscious choice to be unsafe. The consistency of my performance improved my enjoyment of the day as well.

Listening

Another rendition of this tool is listening; I mean really listening in a way that you can visualize the other person’s perspective and realizing that the words they are saying mean something different to them than they do to you. It is remarkably more interesting to hear other’s perspectives rather than replaying your own.

The past is the past

You cannot change the past or control the future, and neurological circuits are permanently embedded. Tryingharder to analyze and fix them stimulates and reinforces these patterns (neuroplasticity). Going to battle with them is deadly. Simply shift your attention to any immediate sensory input. That is it and it is that simple.

Homework

1. Begin using this strategy right now. Sit back in your chair and let yourself relax from your head to toe. As you do this, focus on different sensations.
2. Then do this for 5-10 seconds through the day. Just let your attention land on a sensation while you continue your activities.
3. Keep doing this daily and indefinitely. With repetition, you’ll do this automatically. It is an important foundational tool on which to rebuild your nervous system.
4. Small calming steps add up, body chemistry shifts from threat to safety, and your neocortex (thinking centers) function better.
5. You cannot control your thoughts, but you can separate from them and redirect your focus.

References

1. Wegener, D.M., et al. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5-13.

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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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• Anti-depressants
• Sound generators
• Hearing aids
• Cochlear implants
• Behavioral therapy
• Transcranial magnetic stimulation (2)

Much to my surprise (and shock), my tinnitus of over 25 years resolved as I went through my own healing process. It has been gone for over 20 years.

My Experience

The old saying, “Youth is wasted on the young,” is true—especially in my case. Many of the physical issues of my adulthood resulted from a perceived invincibility during my teenage years, combined with my refusal to heed adult advice. Protecting my ears was one of those cautions that I cavalierly ignored.

The Destruction of My Hearing

I worked as a carpenter and hod carrier from the time I was 14 years old and into medical school. Every summer and most college vacations, you could find me building houses. The summer before medical school began, I built my parents’ home. Although I was involved in many aspects of construction, my most frequent task was framing and pouring concrete slabs, which entailed using a Skilsaw much of the day. I never gave a thought to decibel levels, even when I was using the tools close to my ears.

Fellow workers mentioned ear protection, but I just did not see the need. To further punish my ears, I used a nail gun to shoot nails through two-by-four floor plates into concrete. I would load a 16-penny nail (3.5 inches long) into the gun, position it over the 2 by 4, and pull the trigger. To make matters worse, the sound was magnified when I performed this work in basements. Still, the suggestion of using ear protection didn’t seem important.

The Ringing Begins

When I was about 32, I began to notice a strange sound in my ears, like a bell ringing, all the time. It started during a time when I was recovering from low back surgery that had gotten infected. I wasn’t sleeping well, and my stress levels were extremely high.

At first, I didn’t think much about the ringing—until I realized that it wasn’t going to stop. First, I tried to ignore the ringing, which didn’t work. Every time I heard it, I became increasingly frustrated. My attempts to cope with it began to drive me slightly crazy. The problem grew larger and larger. One day I read about a former TV star who had committed suicide because of his tinnitus. This was not reassuring.

No Answers

I saw several ear-nose-and-throat (ENT) physicians, whose exams revealed that I had suffered some high-frequency hearing loss. When I asked about the ringing, they shrugged their shoulders and said it was nerve damage, and nothing could be done. Loud environments aggravated the condition, so I avoided them. Even eating in restaurants would exacerbate it. Earplugs were somewhat helpful.

The Ringing Stops

The tinnitus ceased along with 16 other chronic symptoms around 2003. I could not understand why I could have been so miserable and then have so many divergent symptoms resolve. I heard a lecture by Dr. Howard Schubiner, author of Unlearn Your Pain, where he listed over 30 symptoms that are caused by your body being under sustained stress.(3) Essentially, all chronic mental and physical symptoms, illnesses, and diseases are caused by sustained flight or fight physiology. The effects occur at the mitochondrial (energy producers in each cell) level, and your DNA directs the production of inflammatory cells. The solution lies in calming your stress response to safety (rest and digest) where your body can refuel and regenerate.

Hearing loss is common as we age and permanent. It includes a diminished capacity to discriminate. For example, I could not hear you well if you talked to me in a noisy restaurant. Today I regret the folly of my youth, knowing that much of my hearing disability was self-inflicted. The exact link between hearing loss and tinnitus is unclear.

Calming Down Your Body’s Chemistry

The process of lowering your stress chemistry is called “Dynamic Healing.” You can regulate your body’s stress physiology by:

1. Processing the input in a manner that is less impactful to your nervous system.
2. Increasing the resiliency of the nervous system.
3. Using tools to directly lower your stress physiology. The speed of nerve conduction slows down, and your inflamed brain calms down.

I don’t know the numbers, but numerous people who have learned and used these concepts have reported that their tinnitus diminished or disappeared. I talked to a radio show host who inadvertently used these principles and noted his tinnitus resolved.

The tinnitus still returns when I am in noisy environments, if I am sleep deprived, or if my stress-coping skills are especially challenged. But if I am careful, the ringing is minimal to non-existent. It has been an incredible relief to escape that endless, irritating sound.

Conclusion

There are various types and causes of tinnitus. Not all of them will respond to these concepts, but there is no way of knowing without learning to calm yourself and see what happens. There is no downside, and you may be pleasantly surprised. no longer have to endure tinnitus.

References

1. National Institute of Health. Tinnitus. Available online: https://www.nidcd.nih.gov/health/tinnitus (accessed on 17 September 2021).
2. Denton, AJ, et al. Implications of transcranial magnetic stimulation as a treatment modality for tinnitus. J. Clin. Med (2021); 10:5422. https://doi.org/10.3390/jcm10225422
3. Schubiner H and M Betzold. Unlearn Your Pain, third edition, Mind Body Publishing, Pleasant Ridge, MI, 2016.

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

My perspective

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

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

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

What’s currently being done?

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

1. Not addressing the root cause

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

2. Inadequate training

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

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

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

3. Known data is ignored

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

4. No one is listening

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

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

5. It’s the mental pain

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

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

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

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

6. Simplistic thinking

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

Finding relief any way that he can

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

The viable solution

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

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

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

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

References

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

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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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Begin writing now

I ask my patients to begin the expressive writing quickly before they read my book. From the beginning it creates some level of a shift and seems to open the door to change. Many people resist this simple exercise. That includes me. I am not sure why so many people resist this foundational step, since there is no risk or cost. Over 2200 research papers have demonstrated its effectiveness. But I hear and endless number of reasons why he or she can’t write. One of them is, “My hands hurt or are unsteady.” “I don’t have the time.” “My life is unusually stressful.” There is another alternative – the verbal route.

The mirror

Dr. Wegner, author of the famous “White Bears” article (1) on suppressing thoughts pointed out that the verbal route of expressing thoughts is also effective. I recall in the midst of my misery that one exercise that helped create a shift was one suggested by David Burns in his book, Feeling Good. He said to stand in front of a mirror and talk to that person using the self-critical voices in your head. You would never talk to another person in that manner. Of course, you can speak with freedom and there is nothing to destroy. I have to say that it was disconcerting I and I quickly realized how toxic these thoughts were. So I suggest to my patients that they can express themselves verbally in private with or without a mirror.

One research paper (2) looked at switching the self-talk voice from the first to the third person. Of course, most of our self-talk is negative, which is an unfortunate part of the human experience. They were able to document on functional MRI (fMRI) scans, which document area of brain activity that this process calmed down the region of the amygdala (considered the danger signal area) without engaging the higher thinking areas of the brain. In other words, it cut through the need for using your cognitive function to do battle with anxiety.

Using words

I want to share an email I received from one of my colleagues.

While expressive writing is great, I find that at home, I rarely can find a solid uninterrupted 20-30 minutes to dedicate to it, with professional obligations, my wife, and daily life/planning/activities/chores. I’ve tried doing it at work, but distractions and tasks are ever-present.

So, what I have been doing is during my drive home (which can be up to 45 minutes or more), or during my 15-20-minute walk to the gym, I simply visualize writing, or narrate to myself what I would write. It flows even faster than writing, and once I get going, the words flow, the images flurry, and I get it all out in the open. Then, if in the car, my personal favorite is to laugh at how ridiculous it sounds or, if particularly angry, swear it all away. When at the gym, with every repetition I imagine squashing it.

I do this about 4 times a week and all the negatives of the day, personal challenges, or doubts about the future turn from massive, insurmountable problems to very solvable obstacles; it’s incredibly energizing.

I have found that even with the writing exercises, it wasn’t the act of writing, but the act of ripping it up and throwing it away that felt so liberating. If it was a great week and my writing was all positive, I’d read it a few times and be proud, and throw it away. It is that physical act of squashing, tearing, destroying negativity that is what makes all the difference.

A few months ago I read a book called The Charisma Myth, and one part was about managing stress with public speaking. The technique the author described was closing your eyes, identifying all doubts, negative thinking, worry, stress, and visualizing all this negative energy being expelled to either a benevolent god, the universe, or something that the individual personally identifies with. When I had to have some difficult conversations and meetings over the last few months, before every meeting I closed my eyes, identified my stress, nervousness, doubts, etc. and visualized myself breathing out these thoughts to a collective universal being, where I identified that billions before me and billions after me have had these same exact feelings, and I could expel it to a pre-existing unity. I walked into the meeting calm, cool, and collected, and though it was tough, I was able to think clearly, not shy away from making my case, and stand my ground confidently.

I think this illustrates that feelings, especially negative ones, like anxiety, stress, uncertainty, self-doubt, pain, etc. are all intangible ideas.  The act of making it tangible, whether it be through the written word, a visualized entity, or an audible sound (like when I dictate to myself) makes it something tangible and something people are comfortable dealing with. Squashing that tangible thing, whether by tearing it up, pounding it away in the weight room, swearing it away in my car, or breathing it out to a universal entity, are all physical, tangible methods of dealing with a now tangible foe that was before just an illusory concept. And that’s what makes these tools so powerful.

Neuroplasticity

The concepts of rewiring your brain (neuroplasticity) are based on awareness, separation and reprogramming. The writing creates an awareness of what is racing around in your brain and now there is a space between you and your thoughts. The verbal route also creates a separation, and you are now able to re-direct your attention to whatever you choose. The data is convincing.

Here is a link to a detailed overview I created to explain the details of expressive writing. You don’t have to write for 15-20 minutes day. As little as a minute can change the nature of your day. I also feel it is important to write at least several times a week indefinitely. It is a way of “maintaining” your brain.

We asked Dr. Pennebaker, the originator of the research, why he thought it was so effective. It was his impression that it was a simple way to release secrets, not solve or get rid of them. Everyone has some parts of themselves they are not particularly proud of. It is just the way human consciousness works. It is not a solution for your mental or physical pain in isolation, but it is a necessary starting point. I have seen few, if any, people deeply heal without this exercise.

References

1. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Moser, JS et al. Third-person self-talk facilitates emotion regulation without engaging cognitive control: Converging evidence from ERP and fMRI. Scientific Reports (2016); 7: 4519 | DOI:10.1038/s41598-017-04047-3

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Artificial disc disaster

In 2005, Marsha had an MRI scan done that showed some mild degeneration of the discs in her lower back. These were normal for her age. A surgeon recommended she undergo two artificial discs at L3-4 and L4-5. They did not help her pain; in fact, she got worse. The discs buckled, and a year later they were removed at another hospital on the west coast. During this operation, surgeons went back in through her abdomen to remove these artificial discs. In this operation, the major blood vessels are attached to the discs. It is a very difficult procedure, and during the operation, her major vein, the vena cava, was torn. Her ureter (the tube from the kidneys to the bladder) was also torn. Both were repaired, but she was left with residual swelling of her feet due to the partial disruption of the vena cava. A year later, she had L5-S1 fused for ongoing low back pain. When she saw me, she still had ongoing low back pain, thoracic pain, and neck pain. Two other spine surgeons had recommended that she undergo a two-level fusion in her neck. The MRI of her neck was normal for her age, showing just some mild degeneration.

She desperately wanted to go back to work. Her husband was threatening to leave her. She was on drugs to wean her off narcotics but was having a difficult time. She was extremely motivated to get better, but she was also completely trapped by her pain and lacked a plan to solve her pain problem.

Why Surgery?

None of her surgeries were helpful or necessary. Yet the spine world was offering her only more surgery. I do not know the end of this story. I spent a couple of extra hours with her explaining the DOC protocol in detail. She did not want to engage in any of the concepts and continued to spiral downward, as I learned from a phone call a few weeks later.

It is upsetting to me that she has the three-level fusion in her lower back and residual swelling in her feet. If she had been able to engage in the structured rehab before any surgery, her potential would have allowed her to completely come back to normal. Now, she will have some permanent structural limitations and a high chance of permanently suffering from chronic pain. BTW, if she had chosen to pursue a healing journey, she could still have done well in spite of her multiple surgeries.

Two Years Later

I am writing this about two years after our visit.  I never heard another word from her.  There is a high probability that she went on to another operation.  The mindset that “surgery is the only solution” becomes its own irrational circuit.  I have found out that the longer I try to talk someone like this out of surgery, the less productive it becomes for both of us.  Often, the patient becomes extremely agitated and sometimes will progress rapidly into a rage. You cannot solve irrational anxieties by rational means.

I am a surgeon trying to talk you out of surgery

I am a spine surgeon who was paid extremely well to do surgery. I am not against performing spine surgery but I am strongly against operating on normally aging spines that have been documented to not be a source of pain. So, I’m trying my best to talk you out of surgery that has not only a low chance of helping you but that actually worsen your situation. If that isn’t even the slightest bit persuasive, you need to look very closely at your decision-making process. Right now, trying to break through this barrier is my biggest challenge.

Before you make the final decision to proceed with spine surgery, get to know your surgeon. If he or she doesn’t want to engage in a detailed conversation about it, then you need to look elsewhere. There is no turning back and a failed spine surgery can destroy your life. Also, I wrote a book, Do You Really Need Spine Surgery? that breaks down the decision-making into two factors – the anatomy and the state of your nervous system. The decision will become clear for you. Video: Get it right the first time.

BF

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• Connect mainstream medicine with existing science – most symptoms, illness and disease  are created by the body’s physiology (how it functions), and not structures.
• Establish the necessity of a trusting dynamic relationship with your clinician. Feeling heard and safe is not a luxury. They are healing modalities in that they shift physiology from threat to safety. Also, if we don’t know you and understand the details of your situation, how can we make accurate decisions.

Most chronic mental and physical disease is caused by the body being in a sustained state of flight or fight (threat physiology). The fallout of treating most diseases from a structural paradigm isn’t effective and causes harm. It is particularly damaging in spine surgery, and the rates of spine surgery for chronic low back pain continue to skyrocket. It eventually became clear that we were performing low back fusions for anxiety (sensation created by threat physiology) with a success rate of less than 30%.¹

Understanding chronic symptoms, illness, and disease

My efforts evolved out of my own 15-year struggle with chronic mental and physical pain. Most of my approaches failed and then some began to help. As I pursued treatments that worked and abandoned the ones that didn’t, I inadvertantly escaped out of this Abyss in 2003. All 17 of my symptoms resolved and continued to improve. However, I still had no idea why I become ill and why I healed. I was shocked, as many of my fellow clinicians, that the answers have been in literature of over 60 years.

In 1962, two researchers clearly documented that stress causes illness, disease, and early death.² I was aware of this data, but I did not connect the dots. I treated my patients from the paradigm that it was my responsibility was to find a structural cause of pain, and I felt badly if I could not find a reason to perform surgery. I aggressively performed fusions for low back pain for the first 8 years of my practice. When a paper out of Washington State³ showed a success rate of less than 25% for low back fusions for pain, I stopped doing them, but did not know what to do.

The healing journey

My current approach represents what I learned from my struggles, witnessing what helped hundreds of my patients heal, and now understanding the science behind these concepts. The DOC Journey course and app and my other efforts are simply a framework that presents documented science in amanner and sequence that is accessible by patients and clinicians. My vision is to connect medicine with known science of chronic stress causing illness, with the fundamental idea being that the doctor patient relationship is at the core of healing. If a patient can’t feel safe with their health care provider, the rest of the treatments are of limited value.

Many people heal with just these self-directed concepts, but outcomes are always better and more consistent with added resources. This framework is intended to allows patients to take charge their care, the clinician can leverage his or her efforts, and provides a long-term template for ongoing learning and healing. It evolved out of my busy practice with increased efficiency, effectiveness, and enjoyment. It is inspiring and energizing to witness patients emerge from hopelessness to thriving.

An important aspect of these concepts is the clinician learning and implementing these approaches in their personal and professional life. A dynamic working partnership can  then be created when both parties understand these healing principles. These resources are an adjunct and/or foundation for other clinical practices, and not an alternative.

Anxiety is a physiological state

It took me many years to realize that anxiety is not primarily a psychological issue. It is the intentionally unpleasant feeling generated by your body when in flight or fight. Avoiding this powerful sensation is the driving force behind human behavior, and much of it is dysfunctional. We are not taught how to regulate our body’s danger response. Our conscious brain is no match and our efforts to control it create a lot of misery for us and those around us.

It is actually a gift that keeps us alive. This survival warning signal is necessary, and the key is developing a “working relationship” with it. It is what you have and not who you are.

This is an article I wrote for Psychology Today regarding the mental health crises.

Obsessive thought patterns and OCD

Crippling anxiety is what almost took me out. It initially manifested with panic attacks and progressed to severe OCD (Obsessive Compulsive Disorder) for over 15 years. The hallmark of OCD is repetitive intrusive thoughts that for me became quite intense. I had “internal OCD” which consists of a disturbing thought following by a compensatory counterthought. There were no external behaviors. So, I had no idea of what was going on, and there seemed to be no endpoint.

OCD is relatively common,⁴ and variations include nail biting, hoarding, body image disorder, skin picking, hair pulling, and eating disorders. Additionally, many if not most people are bothered by disruptive thought patterns or ruminations, which detract from quality of life. One could also consider addictive behaviors in light of efforts to escape these repetitive unpleasant thoughts. Much of the mental health world views OCD and ruminating thoughts as unsolvable and the approach is to manage them. The missing link is that threat physiology is not being adequately addressed. Half the brain consists of glial cells, which have cytokine receptors and are part of the immune response.  A fired-up brain fires off a lot of thoughts.

My hypothesis is that RUTs (repetitive unpleasant thoughts) are a major driver of chronic mental and physical disease by stimulating sustained threat physiology. Humans are trapped by unpleasant thoughts with the main variables being frequency and intensity. They are a universal function of human consciousness. They may be a significant factor in driving teens to commit suicide, “deaths of despair.” However, I am seeing RUTs create misery in every age group, and as young as 6 years old. RUTs were the main source of my misery followed closely by social isolation.

I no longer suffer from OCD, and I escaped from this Abyss over 20 years ago. I don’t even have the disruptive thoughts I had before I became ill. It has taken many years to figure out how and why I escaped from these obsessive thought patterns. High level achievers are particularly prone to them. This is a link to the section I created on my website that presents my concepts of a solution.

This RUTS section is a rough outline of my upcoming book. Solutions are discussed first and the background of the problem later. There is a large body of research of the mental mechanics of the brain, physiology, consciousness, and effects of stress. I learned a sequence of healing while helping many other people out of this hole and it continues to evolve.

Action needed soon

The burden of chronic disease continues to rise in the US and lifespans are dropping compared to other developing countries. We spend almost four times as much per capita as any other nation.⁵ The business of medicine has essentially kidnapped all of us – clinicians and patients. How can thoughtful decisions be made without patients feeling heard and clinicians not understanding all of the dimensions of their lives generatingthreat physiology (anxiety)?

Performing risky and expensive interventions that are not data-based are causing a lot of harm. “First do no harm.” Individually and as a society, do we embrace this core manifesto or is this just rhetoric? I feel there is some urgency for change as the fabric of our society is coming apart.

Clinicians allied with patients are the only possibility of taking back our medical care. It will require ongoing collaboration from all parties. Whether my resources or another similar set are utilized, we have to treat people in a manner that honors the body’s physiology and capacity to heal. We have the data. Let’s implement what we already know!

References

1. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Franklin GM, et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine (1994); 19:1897–903.
4. Carmi, L., Brakoulias, V., Arush, O.B.et al. A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC Psychiatry22, 190
5. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.

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• Avoiding danger is what keeps us alive. Humans call this signal anxiety.
• Avoiding this sensation drives much of dysfunctional human behaviour. We know how to stay alive but not necessary thrive.
• Anxiety is a physiological reaction that is about a million times stronger than the conscious brain. It cannot be controlled.
• We can auto-regulate and redirect it. Addressing anxiety at the root physiological cause will solve many mental health problems.

Why is Anxiety Considered a Psychological Diagnosis?

Anxiety is simply a warning signal. Every form of life has a withdrawal/ avoidance response to real or perceived danger. All life forms, from one-celled organisms to humans respond with complex changes to optimize the odds of survival. This unconscious automatic reaction is powerful and has evolved to feel extremely unpleasant in higher life forms. It compels action to lessen the sensations. The species who did not pay attention to these danger signals, simply did not survive.

 Staying alive

When you sense danger, how do you feel – anxious? Although this a basic survival feeling, humans have the capacity to name it. It is the result of stress, threats, and life challenges, not the cause. Avoiding this sensation is the driving force behind much of human behavior, and seeking safety is necessary to store up reserves to fight another day.

What happens in your body that creates this sense of dread? The term is, “threat physiology.”

Threat physiology

Physiology is the term that refers to how your body functions. Your survival reactions are mostly unconscious, and about 40 million bits of information are processed per second. Our conscious brain deals with only about 40 bits per second. Your unconscious brain is a million times stronger than your conscious brain; the responses are hardwired and automatic, and the reason it is not subject to being controlled. However, it can be regulated and reprogrammed.

Examples of physiological actions are heart rate, blood pressure, blinking your eyes, acid-base balance, sweating, breathing, bowel and bladder function, hunger, and the list is almost endless.

These are some of drivers activating threat physiology.

• Stress hormones – adrenaline, noradrenaline, histamines – ready the body for fight and flee
• Cortisol – mobilize fuel (glucose) from tissues throughout your body.
• Glutamate – Neurotransmitters change from calming to excitatory to increase alertness and sensitivity to danger signals.
• Inflammatory cytokines (small molecules that transmit signals between cells) – the many aspects of the immune system kick into action.

Anxiety is a physiological state

This is a small fraction of actually what occurs in fight or flight physiology. Consider how you feel when your body is in this state. Here is a suggested word progression.

• Alert
• Nervous
• Afraid
• Angry
• Paranoid
• Terrorized

They fall under the umbrella of “anxiety” or “fear.” We will do almost anything to avoid this sensation resulting in many bad behaviors. Psychological diagnoses are ALL anxiety driven. The exceptions are in the positive psychology domain.

A paradigm shift

The way we view mental health must change. Here are some suggestions.

• Eliminate the word anxiety from the DSM coding system. It is the driving force and cause of poor mental and physical health.
• Most psychological diagnoses are descriptions of behaviors driven by the sensations created by threat physiology. Descriptions are less pejorative than labels (diagnoses).
• Substitute the word anxiety with the phrase, “activated threat physiology.”
• Anger is “hyperactived threat physiology.”

“Dynamic Healing”

The root cause of our mental health crisis is sustained threat physiology. There are many ways of lowering it and creating “cues of safety.” The model is called “Dynamic Healing” and is at the core of how medicine should be delivered. The portals are:

• The input – you can process your stresses so as to have less impact on your nervous system.
• The nervous system – the resiliency can be increased so it takes more stress to set off the flight or fight response.
• The output – your nervous systems takes in sensory input, summates them, and sends out signals of threat or safety. There are ways to directly dampen the threat response.

None of the approaches are difficult and require few resources. There are many clinicians in all medical fields that understand and are applying these approaches. It is just not happening on a wide enough scale.

There is no question that symptoms and behaviors must also be addressed while people heal. But if the root cause is not dealt with, their suffering will continue. Hence, the nationwide burden and fallout of poor chronic mental health continues to skyrocket.

Let’s do this!!

Our mental health crise reflects a lot of needless suffering as deep science has pointed the way to effective treatments for over 40 years. Most of clinical medicine is not connected to the data or is categorically ignoring it. It is certainly not being widely taught in medical school.

Where will the energy come from to wake us all up? It has to emanate from the public demanding better care because the business of medicine seems to have little interest in true change. It is the responsibility of the medical profession to honor the known data and implement what is already known.

The answers for our mental health crises are right in front of us if we just pay attention. Take your medical care and life back. It is your right.

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