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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Health care professionals want to provide healing. When we don’t have the tools to help you, all parties become incredibly frustrated. Additionally, the most basic healing modality is feeling safe with your provider because it creates a shift in your physiology to one of safety or “rest and digest. This is where healing occurs, and we are limited by the business of medicine that won’t let us spend time with our patients. How can we know you? What is your life like? Are you feeling stressed? How can we methodically understand your care up to this point, and make thoughtful decisions about what to do next? What has been done to optimize your chances of a good outcome of surgery?

Modern medicine is evolving in a dangerous direction with regards to your care. The major factor in deciding to offer a procedure or treatment is often whether it’s covered by insurance and how well it is reimbursed. The effectiveness of the intervention is a lesser consideration. In fact, we are sometimes encouraged to perform surgeries that have been documented to be ineffective. Additionally, there is little accountability for the outcomes unless there is severe negligence.

Profits over quality

The business of medicine, like any other business, is focused on making a profit. There are computer programs that monitor physicians’ contribution to the profit margin. The most revenue comes from performing procedures, many of which have been documented to be ineffective.¹ The downside risks include unnecessary costs, significant risks and patients are often worse off than before the intervention.² It has also been documented that only about 10% of spine surgeons are addressing the known risk factors for poor surgical outcomes.³

Dr. Ian Harris, who is an orthopedic spine surgeon from Australia, has done extensive research on the utilization of ineffective procedures. He wrote a book, Surgery: The Ultimate Placebo, where he extensively documents the data behind many procedures for pain that have been proven to be of no benefit and it hasn’t stopped their use.⁴

We want to provide relief, it is what we are trained to do, but we are not aware of the alternatives. It is like trying to hit a major league baseball pitch with a golf club. I would have no insights either unless I hadn’t suffered with chronic pain for over 15 years.

What works?

There are many ways to cause your body to change from threat physiology to safety. A term for this is, “dynamic healing.” Input (your stresses) are processed in a manner that has less impact on your nervous system, the nervous system can be calmed down, and there are ways to directly stimulate the powerful anti-inflammatory effects of the vagus nerve.

Effective treatments are often not covered or don’t generate enough revenue. For example, expressive writing has be shown to been helpful in multiple medical conditions in over 1,000 research papers.(5) Yet, I had never heard of it until I accidentally ran across it in 2003. It costs nothing, has minimal risk, and is rarely presented as a treatment option. It has proven to decrease symptoms of asthma, depression, and rheumatoid arthritis, improve student’s athletic and academic performance, speed up wound healing, and diminish many other symptoms. I had dinner with one of the pioneers of the technique, James Pennebaker, who is a psychologist from Austin, TX. The methods may differ, but it has only been reinforced as an effective tool. There is a lot of debate of why it works, but not about whether it works.

Mindfulness-based stress reduction has also been demonstrated to decrease pain in many papers and is usually not covered by insurance. I watched several excellent pain programs in the Puget Sound shut down because they could not afford to keep them open.

Listening is a proven healing modality in addition to being a basic requirement to understand a given patient’s whole situation. Dr. Francis Peabody, a famous Boston physician, was concerned about the intrusion of technology into the patient-physician relationship. One of his more notable quotes was, “The secret of care is caring for the patient.” He wrote this in 1927 when he was concerned about the intrusion of technology into the patient doctor relationship.(6)

What about the patient?

A person suffering from chronic pain is trapped beyond words. My term for it is, “The Abyss.” These are just a few of the ways.

• You have told that there is nothing wrong and you have to live with your pain the best you can. The reality is that there is a physiological explanation for all of it.
• There does not seem to be way out. Most people lose hope. The solutions are there but not being offered. The patients who break out of it feel the healing process is “disturbingly simple.”
• You are labeled by almost everyone, including the medical profession. They include, drug seeker, malingerer, lazy, not motivated, making things up, not tough enough, and the list is endless.

When you are trapped by pain, your frustration and anger is deep and powerful. This scenario creates a more intense flight or fight response, the blood supply to your brain shifts from the thinking center to the survival midbrain, and your behaviors are not rational.

Another problem that is not often acknowledged is that of inducing a depression from repeatedly dashing people’s hopes. This was powerfully demonstrated by Harry Harlow.⁶

Inducing depression–“The Pit of Despair”

Harry Harlow was an internationally renowned psychologist who pioneered research in human maternal-infant bonding using primates. During the first half of the 20^thcentury, it was felt that mothers should touch their children as little as possible. Leading mental health professionals aggressively discouraged mother-child interaction in research papers, lectures, books, and the media. Interestingly, or tragically enough, their recommendations were based on rodent research.  Dr. Harlow was the leading force in changing the tide of opinion using various species of monkeys. His story is well-presented in an entertaining book, Love at Goon Park by Deborah Blum. (

In the 1960s, he turned his attention, also based on primate research, to some of the smaller details of human interaction.  He wanted to understand how to induce depression. He used isolation methods and ways of simulating parental neglect or even abuse. He was able to create seriously disturbed monkeys, but not depressed ones.

He finally found a consistent methodology by devising an apparatus that resembled an upside-down pyramid. The sides were steep, but still allowed the monkey to climb to the top to peek outside the mesh-covered top. For the first couple of days, the monkeys would repeatedly climb up to look out and quickly slide back down. Within a couple of days, they would give up, sit in the middle of the device, and not move. They became almost unresponsive, and when they returned to their families, they wouldn’t revert back to normal social behavior. It didn’t matter what problems the monkey had prior to the experiment. The abnormal monkeys became worse and normal monkeys suffered the same fate. Even the “best” monkeys from stimulating and interactive families would succumb. The researchers were upset and called the apparatus, “The Pit of Despair”. It was felt that this “learned helplessness” was from a combination of feeling the loss of a good life reinforced by occasional glimpses of the outside world and feeling trapped. Within a half a week, every monkey spiraled down.

Tulsa

The surgeon was doing what he was trained to do with the best of intentions. I would feel badly during the first eight years of my career if I could not find a way to relieve my patients’ pain with surgery. The patient was trapped at a level that is indescribable and surgery is often viewed as the definitive answer. It also requires enduring more pain and a lot of anxiety about the whole process. So, the level of disappointment is even higher when it fails.

The literature also shows that pain is often worsened when surgery is performed in the presence of untreated chronic pain.² I was also not aware of that data until after I had quit my surgical practice. For him to act out the way he did is unacceptable but understandable. BTW, suicide is problematic in patients suffering from relentless pain. I was also at that point towards the end.

Recap

Physical therapy, chiropractic adjustments, injections, acupuncture, vocational retraining, medications, traction, inversion tables, and finally surgery. How many times can your expectations be dashed before you lose hope? You cannot blame a person for actions taken in this state of mind.

All the parties were victims of the business of medicine and I put the blame squarely on its shoulders. There are many variables, but the energy is all directed the same direction–money.

The business of medicine has trapped both the providers and patients and with computerized medical records, it is getting steadily worse. There are real solutions, but both the medical profession and patients are going to have to demand it.

References

1. Jonas, JB, et al. Are invasive procedures effective for chronic pain? A systematic review. Pain Medicine (2019); 20: 1281-1293.
2. Perkins, FM, and Henrik Kehlet. Chronic pain as an outcome of surgery. Anesthesiology (2000); 93: 1123-1133.
3. Young AK, et al. Assessment of presurgical psychological screening in patients undergoing spine surgery. Journal Spinal Disorders Tech (2014); 27: 76-79.
4. Harris, Ian. Surgery, The Ultimate Placebo. New South Publishing, Sydney, Australia, 2016.
5. Pennebaker JW and JM Smyth. Opening up by Writing it Down. 3^rd edition. Guilford Press, New York, NY, 2016.
6. Peabody, FW. The Care of the Patient. NEJM (1927); 88:877-882.
7. Blum, Deborah. Love at Goon Park. Perseus Publishing, New York, NY, 2002.

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• When stresses overwhelm the coping capacity of your nervous system, your body will go into flight or fight physiology.
• You have choices regarding what you input into your nervous system.
• If your attention dwells on disturbing topics, you’ll remain agitated, which fires up the physiology of your whole body.
• You may not be aware of the many ways you’re continually keeping your physiology fired up.

Anger and anxiety are words that describe agitated physiological states and are sensations generated by your body’s response to threats. When states of agitation are sustained, your body’s physiology causes physical damage to your tissues, sensitizes your perception of sensory input, and detracts from your capacity to enjoy life. Mental and physical pain will also increase. To some degree, you are in charge of the information going into your nervous system, and what you choose to input into your nervous system will affect your body’s chemistry (output).

What are you choosing to input?

Living creatures stay alive by scanning their environment and interpreting the resulting sensory input to determine whether a situation is safe or dangerous. Your nervous system coordinates your body’s internal and external responses to adapt and move on. Much of this process of adaptation involves your autonomic nervous system, which regulates your internal organs and the makeup of your body’s chemistry. When you feel threatened, your body reacts by upping its rate of energy consumption (preparing to fight or flee) and kindling inflammation (putting the immune system on guard against wounds). When this physiological state is sustained, you have a significant chance of becoming ill, as you are consuming resources to surivive.¹

Humans have the additional input of consciousness. Any threatening thoughts or concepts will cause your body to go into fight or flight. Consider the various ways we upset ourselves that we have conscious choices about. Simply recognizing the effects and choosing different calming input can significantly change your body’s physiology to a healing state of safety.

UNSOLVABLE PROBLEMS

A common means of becoming and remaining upset is focusing on situations that we have no control over. It is an effective way of maintaining an unpleasant physiological threat state. Dr. Fred Luskin, director of the Stanford Forgiveness Project and author of Forgive for Good,² has a term called, “the unenforceable rules.” His point is that it is fine to wish people would behave in a better manner, but you can’t control other’s behavior; especially at a societal level. It is easy to complain about politics, abuses in almost every arena of life, the unequal distribution of wealth, human trafficking, blatant misuse of power, the educational system, and bullying.  There are endless societal problems to be upset about, and it is a deeply justified reaction.

When these unpleasant thoughts rise to the level that you are reacting to them, you are consuming energy that you could otherwise use to actually make a difference in your own sphere of influence. Unfortunately, when you are agitated, your inflammatory markers are elevated,³ which increases the speed of nerve conduction;⁴ the brain is sensitized, and any pain will be magnified.

Here is a letter from a person who has been suffering from chronic pain for many years.

…… violence in nature is difficult for me, but human cruelty to others is incredibly upsetting. I have been this way since childhood. I am very sensitive, and I almost do not feel at home on this planet. I feel wired and tired at the same time.

Her outlook is understandable, and I think most people feel this way. However, she is “wired and tired” from being in a sustained flight or fight state.

Healing occurs only by stimulating your physiology to move into a state of safety. and It is almost impossible to accomplish while remaining agitated about situations you have no control over.

COMPLAINING

Another way we  remain agitated is by complaining, engaging in malicious gossiping, being judgmental, and giving unasked-for advice. How can this input bring your body’s physiology into that of feeling safe? When you are suffering from chronic pain, your overall life outlook may be clouded, and these behaviors may become more frequent. Although you have legitimate issues to be upset about, you are also reinforcing unpleasant neurological circuits in your brain. A better alternative is choosing to place your attention on more functional or more positive neurological circuits.

WHAT ARE YOU WATCHING?

What about what we choose to watch? Violent movies and video games fire up your nervous system and consequently your whole body. You have to ask yourself why would you choose to do this to yourself? It is a surefire way of being in a heightened state of flight or fight. Unfortunately, with repetition, it may become normalized, and you may not appreciate your body being in this state, although it has detrimental effects on your mental and physical health.

THE NEWS

Another behavior to consider is how much time do you spend watching the news? It goes without saying that most newsis upsetting. Although it is fine and important to have a feel for current events that affect our daily lives, watching the news for hours is counterproductive. You are sedentary (exercise is anti-inflammatory)⁵ and you are not viewing material that is creating a sense of relaxation and peace.

Moving forward

Understanding the effects of what you are inputting into your nervous system is important in calming it down. Initially, they may be so ingrained that you can’t see them or the effects they are having on the quality of your life. It takes practice to notice and is also challenging to change. How much of your life has been consumed by them. Are they productive?

You may notice that as you back away from these activities, you may feel more anxious, as you are less distracted. Anxiety is unpleasant and it takes practice to learn to tolerate it. Eventually, as you quit fighting this sensation, it will be less powerful and integrated into your daily life. It is a stepwise process and a learned skill.

Quit upsetting yourself

Here are some suggestions regarding changing your input in order to quiet down your threat physiology.

• Create a list of societal issues that are deeply upsetting to you. Feel how enormous and terrible these problems are. Express your feelings on paper – and tear it up. This can be done repeatedly. Paradoxically, you have more energy to take action in some domain you have a say in.
• Stop engaging in the following activities:
  • Watching violent movies or playing intense video games
  • Complaining about the states of various world affairs that are particularly upsetting to you.
  • Complaining about anything. If you can’t do something constructive, don’t spend time with it.
  • Giving unasked-for-advice or being verbally critical. Consider how you feel when someone does this to you. Both parties are on the defensive, social connection is compromised, and your nervous systems are fired up.
  • Malicious gossiping. Consider why are you engaging in it? You are in a small or big way, robbing a person of his or her reputation. You certainly are not creating a sense of peace and safety.
  •  Spending long periods of time watching the news. Limit yourself to maybe 30 minutes a day or just skim the daily headlines.

Become a light

Your individual contribution to the human experience lies in creating positive changes in yourself and being available to others you care about.  However, you can’t reach out if you are consumed by pain and frustration. You may be so deeply involved in dealing with the negatives of the human condition that it may not seem possible to be any other way. But you have a choice.

Not only is a constructive mindset —not to be confused with mindless positive thinking—attainable, it is possible in the worst of circumstances.

Exhibit A is Man’s Search for Meaning , written by Viktor Frankl,⁶ an Austrian psychiatrist who survived the WWII concentration camps. He bore witness to the worst horrors of the human experience, lost much of his family, and still found meaning and purpose in the midst of extreme suffering. The question he kept asking was, “What is life asking of me now?” Few of us could pull this off, but he demonstrated it could be done. Keeping perspective on a given day when the challenges seem unsurmountable is in sharp contrast to feeling like a victim.

The Swerve  by Stephen Greenblatt⁷ tells the story set in the mid-15^th century of the discovery of an ancient Greek manuscript. Greenblatt defined “The Swerve” as an event that is so significant that it altered the course of human history. The manuscript written in 60 BC contained the poem, The Nature of Things by Lucretius. Somehow, Lucretius figured out that matter was made up of particles called, “atoms.” The Church realized that if this was widely known, that there was a more powerful force than their authority, they would lose their hold on the population. Indeed, after this poem was discovered, it seemed to be a factor in ushering humanity out of the Dark Ages.

The most remarkable aspect of Lucretius’ poem is that he concluded, even while living in the midst of the misery and brutality of ancient times, that all each person can and should do is to live a full, rich, and meaningful life.

Both of these books drive home that the world—then and now—is full of extreme suffering. It is easy to become focused on what is wrong or we can step up and do what we can to alleviate it. Living life with sense of purpose improves your quality of life and contributes to happiness.⁸ It also pulls you out of threat physiology and allows you to refuel and regenerate.

Recap

Healing from chronic illness requires your body to be in a state of safety. You can’t heal while consuming your body’s resources while in threat. In a way, accomplishing this by carefully avoiding upsetting input is the easiest aspect of solving your chronic mental and physical pain.

Awareness of the effects of various inputs is the starting point. Then becoming more aware of the numerous ways you engage in these activities is important. As you use your brain’s survival circuits less and nurture more pleasurable ones, you will be able to experience a more gratifying life. To have a good life, you must live a good life.

 References

1. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013); 7/4217-227. 10.1111/spc3.12020
2. Luskin, Fred. Forgive for Good. Harper Collins, New York, NY, 2003.
3. Shields GS, et al. Psychosocial interventions, and immune system function. JAMA Psychiatry (2020); doi: 10.1001/jamapsychiatry.2020.0431
4. Chen X, et al. Stress enhances muscle nociceptor activity in the rat. Neuroscience (2011); 185: 166-173. Evans, Patricia. Verbal Abuse: Survivors Speak Out. Avon Media Corporation, Avon, MA, 1993.
5. Sallis R, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48440 adult patients. Br J Sports Med (2021); 0:1-8. doi: 10.1136/bjsports-2021-104080
6. Frankl, Viktor. Man’s Search for Meaning. Beacon Press, Boston, MA, 1959.
7. Greenblatt, Stephen. The Swerve. Norton and Co., New York, NY, 2011.
8. 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

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• Anxiety is at the core of how we evolved and continue to survive. It is a gift.
• It is universal, powerful, automatic, and intentionally unpleasant. There is no reason to take it personally.
• It is not subject to rational interventions and the way to lower it is simply lowering your stress reaction to threats.
• An important and critical step is to separate your “identity” from it and develop a “working relationship” with it.

Every living creature has a threat avoidance response that involves every cell in their bodies. Humans are unique in that we possess language and can name it. Anxiety is a word that describes this intentionally extremely unpleasant sensation that compels us to take action to alleviate it. There are levels of intensity. Here is a word progression that falls under the umbrella term of anxiety.

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

The neurochemical state that we have labeled as anxiety is an amoral powerful survival reaction in response to stress and is not the cause of it. It is how we evolved, and it also keeps us alive. You can’t and don’t want to get rid of it. It is so powerful you can’t control it by rational means. It is hardwired and automatic. You might as well try to have a conversation with the hard drive of your computer.

Relentless anxiety is the worst aspect of suffering for many people. So, if rational interventions can’t work, how can you lower your anxiety? Since it simply describes the feelings created by your body’s neurochemistry, the answer is to learn and use approaches that lower your stress hormones, metabolism, and inflammatory proteins. In other words, you can stimulate your body to switch from flight or fight physiology to safety.

Effectively dealing with anxiety

The goal is not to control or “manage” this reaction, but to develop a “working relationship” with it. As you quit fighting anxiety, it will be less disruptive to your quality of life. There are four aspects to consider.

• Separating your identity from it. Anxiety is a gift of survival and life, but not who you are as a conscious human being.
• Using tools to directly lower your stress chemicals (output) through stimulating the parasympathetic nervous system (vagus nerve).
• Increasing the resiliency of your nervous system.
• Becoming aware of the input into your nervous system that creates threat physiology.

Separating your identity from anxiety

These will be discussed further in the next few lessons in this rest stop. But the first step is to separate your conscious identity from this all-encompassing feeling and view it is simply your body’s mechanism of protecting you. It is a gift.

One helpful step is to eliminate the word, “anxiety” and substitute phrases such as, “heightened stress response”, “elevated stress hormones”, or “increased sympathetic tone.” Any words that describe your body’s heightened physiological activity will do. What happens with many people is that they feel badly about these disturbing feelings and impulses. However, they are universal and why would any of us take them personally? It has nothing to do with your identity or value system. In fact, the research shows that the more of a well-intentioned person you are, the more you will fight these deep impulses, which reinforces them. The result can be crippling anxiety.¹

Another separation strategy is to visualize a large thermometer on a wall. As you feel your physiology become more activated, describe the intensity of emotion with one of the above words. Then mentally assess your “temperature” in light of the “thermometer.” Again, the way to lower anxiety is to use tools to shift your physiology from a threat profile to that of safety. In other words, “lower the temperature.” You’ll be using approaches from all three areas:  input, nervous system, and output.

As our challenges keep coming at us, you’ll use these tools multiple times per day. The key is learning to process adversity effectively and efficiently so as to minimize your time in threat and maximize your time in safety. Healing can only occur when you are in safety and not consuming your body’s resources to survive. There will many times when stresses are overwhelming, or you are overtired when you will not do well. That is the norm.

Once you can consistently separate “you” from this physiological reaction, you’ll be free to “observe it” and get on with your day and life. You must break loose in order to move forward into the life you desire.

Recap

Thoughts are what you think, and unpleasant ones can be considered “mental pain.” They are processed in similar brain circuits as physical pain and is why they are so disruptive. They create a flight or fight response with a resultant surge of stress hormones, increased metabolism, and inflammation. Emotions are the feelings caused by these changes in your body’s neurochemical profile. The word that describes this heightened state is anxiety. It is not primarily psychological.

This is a critical concept in that you cannot control these automatic and powerful survival responses with rational means. It is huge mismatch. You cannot outrun your mind.

Anxiety is a universal survival reaction that is your protector. You cannot and don’t want to get rid of it nor do you want to take it personally. There are many ways to develop a “working relationship with it, use it to move forward with your life and heal. The critical first step is to separate your personal identity from it.

 Questions and considerations

1. Every cell in your body is bathed and affected by stress hormones and inflammation when you are in flight or fight. It is the reason people identity with this sensation, when it actually has nothing to do with who are as a person.
2. Carefully consider anxiety for what it is. It describes the feelings generated by your physiological state when your body is in a survival mode. It is critical to understand this situation, as the conscious brain is no match for your unconscious brain.
3. You cannot control the unconscious aspect of your nervous system, but you can reprogram it. It is a step wise process and why The DOC Journey is in the sequence it is.
4. View your unconscious brain as your guardian and learn to develop a “working relationship” with it. As you quite fighting the unwinnable battle with anxiety, you’ll much more energy to live an enjoyable life – and heal.
5. You cannot heal when you are in flight or fight and consuming your body’s resources to survive. Healing can only occur when your physiology is one of safety.

 References

1. Wegner DM. The Seed of Our Undoing. Psychological Science Agenda. Jan/Feb 1999, pp 10-11.

The post Eliminate the Word, “Anxiety” first appeared on Back in Control.

The post Eliminate the Word, “Anxiety” appeared first on Back in Control.