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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I talk about how anxiety and stress can lead to certain obsessive tendencies. Some of the tools from the DOCC project are laid out, specifically those that can help break down the circuits that fuel anxious and stressful thoughts and behaviors.

For more, see Your Demons are Robots.

BF

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I talk about how the suppression of negative thoughts associated with chronic pain can really fire up the nervous system.  Dr. Daniel Wegner from Harvard published an elegant paper in 1987 demonstratng the impossibity of trying to suppress thoughts. I’ve talked about it before in White Bears and ANTS.

BF

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Gabriel Garcia Marquez

“It is not true that people stop pursuing dreams because they grow old. They stop pursing dreams when they are crushed by relentless anxiety…

Gabriel Garcia Marquez modified by David Hanscom

Life just beats us up—pain or no pain. Eventually many if not most of us gravitate towards a survival mode. Instead of living life with creativity and vigor, we’re just trying to get to Friday and recover over the weekend.

Chronic pain greatly magnifies this process. Instead of aiming for Friday, you are trying to just get through the day. As you become more anxious and frustrated, it becomes more difficult to engage in positive experiences with your family and friends. Good food, wine, and hobbies gradually disappear. In almost all cases, people suffering from chronic pain become increasingly isolated.

The major problem with this sequence is that an inordinate percent of your nervous system is focused on your pain, so you will feel it more. The reason that goal setting becomes such an important part of the DOC project is that it causes your thoughts to be somewhere else besides your pain. Goal setting is not positive thinking. Positive thinking is just another way of suppressing negative thinking and particularly in the context of chronic pain it is a disaster.

I was reminded about a poem I wrote in 2003 while attending a surgical training session sponsored by one of our instrumentation companies.  It was a remarkable weekend that altered my surgical approach to spinal deformity. Most of the three-day course was spent working on cadavers. I wrote this poem:

Whoever you were
You were generous
Giving yourself
To be my teacher
On your last day of
School

Remember the time of your life where your dreams were running free. Spend some time with it and re-connect with that energy. Reminisce with your partner. You have only one shot at this life. Give it your best shot!!

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People of the Lie

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

The Essence of Abuse

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

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

Your Family’s Perspective

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

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

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

Rules of Engagement

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

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

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

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

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

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

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The problem is that even an ideal system will never be able to respond to the needs of a given patient quickly enough to really make a large-scale difference.  Not only are there problems navigating through all of the various parts of the worker’s comp system, these patients’ personal lives are often a disaster.  I don’t know if many of them are still even on their feet.

The more effective strategy is to give patients the tools to deal with stress.  They can often navigate their way relatively quickly through the process.  The tools also make a difference in their personal life and their families will become their support system instead of targets for their frustrations.  Conversely, without any personal support, their anger will cause them to disengage from reason and the opposite effect occurs.

It’s true that, where I practice, 80% of injured workers do well with minimal intervention.  But we don’t know which injured workers will become one of the 5% that consumes 84% of the medical resources in the state of Washington. Even the simplest injury creates additional stress on a given worker.  It is the luck of the draw whether they end up with a physician and employer that can create a smooth process.  It is unpredictable what provider or circumstance will set off the cascade of extreme disability. The idea of being pro-active in a claim is 20 years ahead of its time. It has been incredibly frustrating watching employers, in the face of overwhelming data, still not want to engage in any type of innovative process.

The category of mental health strategies described are the one’s we have been routinely using.  My concept is to “calm down” the nervous system, which has consistently decreased my patient’s perception of pain.  However, I always start with sleep.  None of the tools are effective without sleep.

I think the roundtable could develop a laundry list of strategies that could be ferreted out and implemented.  This is a group that has the power to change some things and I would challenge us to get focused.

I did become incredibly discouraged last night thinking about national politics.  Regardless of your political leanings, jobs are disappearing.  No matter how skilled you are with these stress management tools, none of them are going to negate not being able to put food on the table for yourself or your family.

BF

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Thanksgiving weekend of 2008, I was playing golf with three close friends. All were significantly better golfers than I. The one thing I have accomplished in golf is the ability to have a great time on the course, regardless of the score. This group was one I had played a lot of golf with, and we were having a wonderful day in the bay area of California at my brother-in-law’s club.

Tough first four holes

The first three holes engendered optimism. I had two pars and a bogey. I stepped up to the fourth tee and promptly hooked my ball left out-of-bounds. My second shot off the tee was fairly long but off to the right. I was laying three. My next shot didn’t need to be so ambitious.  Nevertheless, I decided to go beyond my comfort zone and hit a low shot that would fade to the right under a branch that was about 60 feet off of the ground. I hit the shot of my life. It sailed off of my club and began a slow descent to the right heading towards the pin. The tree branch was one inch too low. Not only did my ball hit the branch, but it bounced 40 feet to the left out of bounds. I ended up with a nine.

At this point, I was debating the merits of continuing to keep score but decided to record the nine and move on. The next couple of holes were a struggle, but finally woke up and had a good run in the middle. The 16th hole took me down a bit with some remarkably bad shots.

I stepped up to the par three 17th hole having to work a little harder at enjoying myself. It was a beautiful day and the course has a panoramic view of the whole bay area, including the Golden Gate Bridge. I pulled myself into that reality after a couple of deep breaths.

The perfect bounce

The hole was 165 yards away, downhill, and to the right. My three friends, of course, had hit three nice shots. I stepped up with an eight-iron feeling that I did not have much to lose. I hit the sweet spot and killed it. But it was clearly going to be too long. The ball was drifting to the right and headed off the back of the green. It was one of those bittersweet moments of feeling like I had hit the perfect shot but still needed some luck just to salvage the hole. The ball landed, took one bounce, directly hit the flag and dropped into the hole.

I will never forget that moment. Everyone started to cheer. I was not sure that it had really happened. We could not stop yelling. The rest of my life seemed somewhat small. The best part was that I was able share it with my friends. Even as I am writing this story, the memory of that event still gives me chills. There are not words to describe the depth of enjoyment and pleasure I felt that day. One my playing partners gave me a beautiful plaque with a picture, the ball, and the scorecard commemorating the experience.

Even though I am not a good golfer, after taking so many lessons, I have a reasonable understanding of the golf swing. I have taught over a dozen people to play, most of whom have long surpassed me. One of those people is my best friend, who is my golfing buddy most weekends. We have a great time relaxing and coaching each other. My only solace as I routinely watch him beat me is that he must have had a great teacher.

Golfing on a busy Sunday afternoon 

One weekend, my wife and I joined my friend and his wife for a Sunday afternoon of golf at a course in Alameda by the bay. It is an executive course that is nicely laid out and fairly challenging. We arrived early and spent a couple of hours at the driving range. My friend worked with my wife and I worked with his wife. (It is a lot safer that way).  His wife had not played much golf, and I was hesitant to give her too many things to work on. Every concept I gave her she mastered in about five swings. An hour later she was hitting her driver over 160 yards. My wife was also enjoying her time working on her swing. I was getting very relaxed, which is not my normal state.

As we headed over to the course, I had some anxiety about the situation. I have learned over the years that no one cares about your golf score except you. But most experienced golfers care about the pace of play. I have difficulty enjoying a round when the group in front of us is holding up play. However, my frustration level can become extreme if I am in a group that is holding up the rest of the course. His wife had never been on a golf course and my wife had only been on one a couple of times. Somehow, we decided to have a friendly competition and keep score between the families. Golfers know that any competition slows the game down and I did not think that this was a great idea. As I was only one out of four, with one of the others being my wife, I lost that discussion.

Delaying play

The course started out empty, and we were having a wonderful afternoon. Our wives had some great shots. I was playing with my usual inconsistency and my golfing buddy was playing with his usual consistency. At the fourth hole, another group began to have to wait for us. Between the fourth and fifth hole we had to walk past the starter’s booth. She walked out and yelled at me, “You have taken 80 minutes to play four holes. You have to step it up.” My relaxed state of mind began to wane. We let that group play through the fifth hole but by the seventh hole we had three other groups stacked up behind us. My suggestions to my group to help speed up our pace of play were going unheeded. I was losing my mind, and my frustration level was a 12 out of 10. I was additionally frustrated in that I was with some of the closest people in my life, and I particularly wanted my wife and I to have a great experience on the course. I wasn’t saying much, but my wife was not fooled and became upset at me being upset. You all know how that works. Now my frustration factor was at a 20 out of 10.

I stepped up to the ball. The hole was a flat par three that was 208 yards. I took my five-wood and hit a low shot that started out to the right and began to drift left. The ball landed about 20 yards in front of the green, continued to roll left towards the hole, hit the flag and dropped into the hole.

The power of anger

There was not a flicker of response inside of me. Nothing. I was so frustrated about holding up the rest of the course that I just turned around and walked away. Everyone else was excited. I felt nothing. Even when I walked up to the hole and physically pulled my ball out of the cup, there was a slight sensation that this was sort of cool that I had hit another hole in one. But that was it.

The contrast between the two experiences was dramatic. As much pleasure that I had etched into my mind from my first hole-in-one, I have only frustration burned into my head with the second hole-in-one. Even as I am sitting here writing this story and thinking about that moment, it causes me to feel a pit in my stomach.

Anger has the power to destroy every part of your life that is meaningful and good. I am unsure how to commemorate this second hole-in-one.

The post A Tale of Two Golf Holes first appeared on Back in Control.

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