A chaotic, even abusive upbringing predicts a long and harsh life. There are many chronic mental and physical health issues that occur that shorten lifespan and also markedly compromise quality of life. Raised in this environment, a child cannot reach his or her full potential when so much energy is consumed by trying to survive. Consider a young plant in rich soil with plenty of sunlight and water. Compare it to the same plant in poor soil, limited sunlight, little water. It may even look a different species.

Feeling unsafe

When we don’t feel safe, we’ll do whatever we can to achieve it. Feeling unsafe drives many, if not most destructive behaviors. Feel trapped causes us to react aggressively to solve the situation. The physiological response is called anger, which represents the body’s powerful last-ditch effort to regain control.

Since the most stressful problems are ones we can’t solve, sustained anger (threat physiology) turns into rage, destructive behaviors, and chronic illnesses as the body breaks down. Consider how many life situations are unsolvable. One of the deadliest and universal problems is feeling trapped by our thoughts.

We cannot escape our thoughts. Suppressing unpleasant thoughts fires up the threat response even more than experiencing them. Suppression causes the hippocampus (memory center) of the brain to shrink¹ and increases craving for opioids.²  Distracting ourselves with experiences, pursuing pleasure, adventures, and achievements also fires up the immune system.³

So how do we behave?

ADDICTIONS

Addictions create a sense of safety while engaged in the activity, but obviously are not long-term solutions. The reason addictions are so destructive is they temporarily mask mental and physical pain, and pursuing relief is compelling.

POWER

A deadly outcome of feeling chronically unsafe is the relentless pursuit of power in order to gain more control. It can’t and doesn’t work, but few of us are taught alternatives. The manifestations are almost infinite and infiltrate every domain of our lives and relationships with others. People closest to us are the most affected. No one wants to be controlled, yet trying to control others is almost universal. Anger is generated in those being controlled and also in those exerting control. There is never enough to assuage the unconscious brain. Unfortunately, anger is intentionally destructive, as it is your body’s last-ditch effort to survive emotionally or physically.

The data is deep, beginning in the schoolyard. We try to avoid anxiety, or – if we already have it – we try to get rid of it. Nothing enhances our feeling of control more than by gaining power in some way. This need is expressed in our interactions with each other; in fact, it dictates much of human relations.

Every child has significantly increased anxiety when they leave home to begin school, regardless of their family situation. They want to be accepted but there is also the greater need to diminish their fear. The need to get rid of fear and gain power is played out in forming cliques, excluding others, and overt bullying.

Researchers did a study of students who have been bullied versus the bullies to see if there was any difference in their physiological makeup. ⁴ They looked at the levels of a substance called C-reactive protein (CRP), which is elevated in the presence of inflammation; it’s often drawn to determine the presence of a hidden infection. Chronically elevated levels also indicate a stressed and overactive immune system. It is not desirable to have an elevated CRP.

The study revealed that children who had been bullied had significantly elevated levels of CRP compared to those who had not been bullied. Being bullied as your introduction to the real world is not a great start. What I find even more disturbing is that the levels of CRP in bullies was lower than the norm. As it turns out, there is both a social and physiological reward for possessing more power. How all of this plays out in adulthood is not subtle. Why would you want to give up power and control? Especially when feeling the pain of anxiety is the other option.

Every child has a strong need to be accepted, yet what should we make of the fact that it gives him or her more power (and self-esteem) to reject someone else? This is an endless loop, the root cause of which is the solvable problem of anxiety.

SELF-ESTEEM

The other as futile effort to counteract these deeply upleasant survival sensations is to pursue more self-esteem. This is problematic for seversal reasons. First, it is a gross mismatch of your unconsious brain overpowering your conscious brain by about a million to one. Anxiety and anger are hardwired automatic survival reactions over which we have absolutely no control.

Second, the unconscious brain never stops for a millisecond and is always on the lookout for danger. It is why we evolved and stay alive. The conscious brain’s attention is not sustainable and we quickly develop cognitive fatigue trying to stay happy. We also become physically tired as 20 to 25% of your entire body’s energy is used to run your brain.

Third, we are programmed by everyone around us about who we should be or not be. These voices in our heads become as concrete as any object and we act on them. Unfortunately, the “stories” in our heads are essentially all cognitive distortions. Self-esteem represents a huge distortion of labeling. We expend a tremendous amount of energy building up our ego, and then spend endless efforts defending it. The relentless pursuit of self-esteem disconnects us from the reality immediately in front of us. In other words, you lose awareness of other’s needs and relationships are compromised. Look at the human experience of how terribly we treat each other as individuals and societies. We have the resources to create a planet that could thrive yet we are at the mercy of our personal and societal “stories.”

What can you do?

Learn vulnerability. Being vulnerable is at the core of meaningful human relationships, but there is no reward in nature for being physically vulnerable.  Since emotional pain is processed in similar regions of the brain as physical pain, there are penalties for being emotionally vulnerable. Language creates a massive problem causing emotional pain that is much more complex than in other mammals. Anger, as unpleasant as it is, is powerful, addicting, and masks being vulnerable. Anger creates a sense of emotional safety, but no one around you feels safe. How do you learn to be vulnerable when you are used to dealing with a lot of anger?

DYNAMIC HEALING

Needing to pursue the above-mentioned destructive behaviors drops as you address the root cause of sustained threat physiology. You cannot control the survival reactions but there are numerous ways to regulate your physiology. When your body is bathed in safety physiology, you feel safe, connected, and incredibly relaxed. We use the term, “dynamic healing”, which addresses factors affecting your physiology.

• Input – dealing with life’s challenges in a manner that less impact on your nervous system.
• State of the nervous system – calm or hyperactive
• Output or the physiology – can be directly regulated from threat to safety.

The details of the Dynamic Healing model are beyond the scope of this discussion. The focus is on you and learning skills in each category to create “cues of safety”, and not on fixing or solving your pain. It is a healing process, and not “self-help”.

RUTs (repetitive unpleasant thoughts)

Regarding the onslaught of unpleasant thoughts, consider the metaphor of a hornet’s nest, with the nest being your brain, and the hornets your thoughts. At rest, the hornets are busy collecting food, building the nest, cleaning house, and reproducing. If the nest is shaken, the hornets will become aggressive and defend themselves. When your nervous system is inflamed and hyperactive, your thought patterns become intense, since your conscious brain interprets your internal physiology.

The usual approach is to use cognitive rational techniques to counter bad thoughts with good thoughts, which is an impossible task. Then we put up our “shield” (self-esteem, self-affirmations) to protect us. It also overwhelming and wears us down. Exerting increased control (suppression) is also futile. Then the more attention you pay to the thoughts your brain is fired up even more. It is a bi-directional process.

The answer lies in “quit shaking the nest.” The hornets will calm down and return to their usual activities. As your nervous system calms down, your unpleasant thought patterns will lessen, which in turn helps calm your brain. Although cognitive approaches lower the input into the nervous system, calming it down is a separate skill. There are endless other ways besides unpleasant thoughts that fire it up.

There are four aspects of creating a safe relationhip with your thoughts.

• Thought separation
• Calming the nervous system (processing anger)
• Creativity – stimulating new neurological circuits away from the unpleasant ones.
• Dissolution of the ego – once you learn to feel safe, there is less need for it.

Calming your nervous system allows you to feel safe. It allows you to break free of ruminating thought patterns frees you up to create and live life on your terms.

References

1. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003
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. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
4. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.

The post Our Need to Feel Safe first appeared on Back in Control.

The post Our Need to Feel Safe appeared first on Back in Control.

The First Day of School

Every child entering school has a baseline anxiety that is heightened by leaving the familiar surroundings of home even if the home environment is dysfunctional. We are not taught how to process anxiety at any age, especially early on. It has been disturbing to me, as I talk to my patients in pain, that many report having significant anxiety since age five or six. I realize that I have a self-selected group but the vast majority of them report crippling anxiety during their teens.

One of the main antidotes for anxiety is control. The more power you have the more control you can exert. Since every child has this need for affirmation, he or she is launched into a power struggle without an endpoint. What makes it even more problematic is you are now placing your sense of well-being into the hands of another person, who’s self-worth is reinforced by putting you down. It is a deadly cycle.

Power

There is also a physiological reward for possessing power. Every human being depends on anxiety for survival. Your nervous system, through all of the senses is constantly scanning the environment for danger. This is an unconscious function that you will become aware of only when a certain threshold is reached. You are constantly controlling your environment or your behavior to minimize anxiety. The corollary of this scenario is that the more power you possess the more control you can exert. Indeed, the benefits of power have been demonstrated in a study looking at inflammatory markers in students who have been bullied versus the bullies.

C-reactive protein is a blood test that is elevated in the presence of inflammation. It is often drawn to determine the presence of a hidden infection. Chronically elevated levels also indicate a stressed and overactive immune system. One consequence can be occlusion of the blood vessels to the heart. It isn’t great to have an elevated C-reactive protein.

Researchers drew samples of this marker on children who had been bullied and found significantly elevated levels of C-reactive protein compared to those who had not been bullied. (1) Being bullied, as your introduction to the real world is a tough start. School or Prison: What is the Difference? What I find even more disturbing is that the levels of C-reactive protein in bullies were lower than the norm. There is both a social and physiological reward for possessing more power. How all of this plays out in adulthood is not subtle. Why would you want to give up the power of anger?

Bullied at work

I had another patient who I had worked with for several months to avoid yet another spine surgery. It looked like he had re-ruptured a disc but I wasn’t sure how new it was. Over six weeks his symptoms abated. Several month later he returned with the pain being the worst it had been in a while. I have learned that stress can cause pain flareups because stress chemicals cause an increase in nerve conduction. I asked him if there was anything going on that might be causing more stress than normal. He was being severely bullied at work by almost all of his co-workers. It had been going on for a while. After some discussion, he made a decision to go to Human Resources as well as directly dealing with the bullies. His pain quickly abated.

First of all, to those of you reading this who are one of the people intimidating others around you, “Stop it.” What are you thinking? Are you continuing your playground behavior? Is your behavior something your children would be proud of? Do you want your children to behave in a similar manner?

Second, the name for this trend is, “mobbing.” If you can’t go to work and enjoy what you are doing, where do you escape to? We spend most of our waking hours at work? With your body under a sustained stress chemical assault, why would you not eventually become ill or disabled? Destroyed by bullies

Finally, it has taken me many years to figure out the major block to healing pain is that people become addicted to pain and won’t/ can’t let it go. They would have to learn to live with more anxiety for a while and they don’t want to. Then become honest with yourself and admit that you don’t want to give it up and then becoming angry at the medical profession who is trying to heal you, which also adds fuel to your fire.

“I can’t let go”

I have patient who I have seen over several years. He is middle-aged and has experienced low back pain for over 10 years. He has disc degeneration that is not amenable to surgery. He never bought off on the idea of addressing his pain using the DOC concepts and did not want to let go of his anger. When he showed up in my office a couple of years later I vividly recalled our prior conversation, as the emphasis had not changed. He said, “I can’t let go of my anger.” I pointed out that no one was forcing him to hold on to it. I didn’t know any of the details of why he was so upset. I reminded him that he was the only one who was continuing to suffer. Dr. Luskin in his book, Forgive for Good uses the term, “renting too much space in your mind.”  I asked him again, “What could be so hard to forgive compared to this level of ongoing pain?” He didn’t answer me and walked out the door.

Compassion??

Although we can pay lip service to the concept of living a compassionate life, the unconscious survival patterns will always win out when we are exposed to stressful situations. The Angry Meditator The problem is further magnified by society’s emphasis on accomplishments and winning rather than play. The quest for power is endless since anxiety progresses with age.

Although power is necessary to deal with bullies who are terrorizing the world, fighting violence with violence is not a viable long-term solution. Anxiety-driven anger is the root problem. Understanding that anxiety is powerful automatic neurological response that is not amenable to rational interventions is the first step in solving it. Then presenting the solutions based on de-adrenalizing and re-routing the nervous system must be approached from public health perspective. If we began in pre-school we could  create a massive shift in human behavior and relationships. Why are we continuing to nurture a school environment where being a bully is your best chance of surviving? What has happened to the concept of play?

The First and Last Day of School

1. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.

The post The Power of Pain first appeared on Back in Control.

The post The Power of Pain appeared first on Back in Control.

I will never forget a 40 year-old woman I met in the office a few years ago. She had suffered from chronic pain that enveloped almost her entire body since her late teenage years. She was anxious, depressed, and would barely lift her head to talk to me. The depth of her sadness struck me. She did not have a structural spine problem, and I began to discuss some of the ways she could approach solving her chronic pain. Shortly into the conversation she related to me that she had been severely bullied in high school and in spite of her best efforts she did not seem to be able to get past it. I never saw her back.

Dreams shattered

I was pretty shaken by the encounter in that she seemed so broken. I was talking to my assistant about the encounter and she told me a story about her daughter that happened in high school. She loved animals and had a cat that she adored. Her dream was to become a veterinarian. She was asked to the prom by a boy she did not care for and turned him down. He became very aggressive. He and a friend began to taunt her and threatened to kill her cat. They did. They killed her cat and then proceeded to make cat sounds every time they saw her at school. Her life was never the same and she did not pursue her dream. As a cat lover this story was quite upsetting to me.

Bullying affects the body’s chemistry

A study was reported in the New York Times last week about the effects on the body’s chemistry from being bullied. C-reactive protein (CRP) is a blood test that measures the level of inflammation in the body. It is sensitive and I order it frequently if I am suspicious of an infection. High levels have been correlated with heart disease.

The study was out of the department of psychiatry from Duke University. Researchers followed 1420 boys and girls between the ages of 9 to 21 with extensive interviews of close family and friends. (1) The CRP was elevated in direct proportion to the amount of bullying they had experienced. In contrast, bullies had lower levels of CRP – even lower than individuals who were not exposed to bullying. It was postulated that the increased social status of the bully might have “biological advantages.” Anger = loss of control

Stress causes changes in the body’s chemistry and every organ system is affected creating a multitude of physical responses. There are over 30 symptoms of the Neurophysiological Disorder (NPD). Prolonged stress is even worse. It is similar to trying to run a marathon at sprint speed. You will collapse and often quickly. The symptoms are not subtle.

Letting go – NOT

I have long observed that many patients have no interest in engaging in the DOC program. They don’t seem to want to let go of their anger. I think the reasons for a given person are complex but I do think that the need to remain angry is deep. If you are the bully there is a feeling (and bodily response) of power that is difficult to let go of. If you are the victim then feeling powerless is stressful. But it is also a familiar pattern and the only haven of power you have left. In the victim mode you are angry and you do feel powerful. You can then exert that power over your employer, the medical system, and your family. If down deep you feel powerless, what other choices do you have? Advantages of victimhood

Power

I suspect that the bully’s bodily response is mediated through the pleasure centers and the victim’s through the fight or flight system. There is power in being a bully and there is power in remaining a victim. I don’t know what the chances are of a bully developing chronic pain but I do think the odds are much higher in the bullied group. Being bullied does cause an increase in inflammatory markers and there is an established link with chronic stress and  autoimmune disorders such as systemic lupus, ulcerative colitis, Crohn’s disease, and rheumatoid arthritis? (2)

Pain pathways and anger pathways are inextricably linked. You will not solve your chronic pain until you can let go of the past at a deep emotional level. Do you really want to heal?

1. Copeland W, et al. Childhood bullying involvement predicts low-grade systemic inflammation into adulthood. PNAS (2014); 111: 7570-7575.
2. Song, H, et al. Association of stress-related disorder with subsequent autoimmune disease. JAMA (2018); 319: 2388-2400.

The post Destroyed by Bullies first appeared on Back in Control.

The post Destroyed by Bullies appeared first on Back in Control.