Chronic pain takes a terrible toll on families. People in pain often have forgotten what it’s like to have fun. They tend to become socially isolated and withdrawn, even within their own home. Much of the conversation centers around pain and medical care. It becomes tedious and frustrating because there is little that can be done to solve the problem. Additionally, it’s common for patients to lash out with their family being the closest target. A term used to describe the anger associated being trapped by pain is “rage”. (1)

Trapped

But now the whole family is also trapped. The scenarios become apparent quickly within the first couple of visits. So, I ask them a simple question, “Do you like your family?” The answer is always, “Of course!” The essence of the problem is that anger has become so normalized within the household that they can’t see effects of their pain on those around them. The core of human relationships is being aware of other’s needs from their perspective. The essence of abuse is lack of awareness and anger obliterates it.

Then I ask, “If your family is so important to you, why would you allow yourself to get so upset with them? Would you yell at a stranger the way you talk to your family?” Of course not. “Then why would you treat your family, who you deeply care about, better than someone you have no connection to?” Protect your family from your pain

Homework

After a brief conversation, I assign some homework. I want them to individually ask each family member what it’s like for him or her when they are exposed to their anger. Then I ask them to consider, “How do you look when you’re angry?”  Why would you want them to see you in that state?” Anger isn’t attractive and you’re no exception.

How do you want your family to feel when they hear your footsteps approaching the front door? Are they excited or are they dreading it? Are they on hold until they see what mood you’re in? What do you want them to feel? Do you enjoy playing with your family? How often to you do it? Can you really play if you aren’t in a good mood? Is your family a haven of safety and joy?

Who’s the adult?

I was taken aback a few years ago while talking to a large muscular patient. It was slightly intimidating just being in the room with him. He was a high-level businessman who had suffered from chronic neck pain for years. I asked him if he ever got upset? He initially said he didn’t and then admitted he did occasionally. That turned out to be a daily occurrence and happened multiple times a day. I asked him, “Who’s the target of your anger?” He replied, “My daughter.” I asked him how old she was, and he said, “Ten.”

I was startled because the focus of anger tends to be the partner. I asked him who was the adult in this scenario, and how do you think she might feel being the focus of his rage. He hadn’t considered that angle, but he couldn’t let go of how much she was upsetting him.

Awareness

The second part of the homework is that I want him or her to practice awareness beginning when they walk out my office door. The assignment is that they are not to give any advice to their partner or children until the next visit. None, unless specifically asked. I also ask them to consider some of following.  “How often do you give unasked-for-advice? Do you realize that you’re actually telling them that they aren’t good enough the way they are? Are you overtly critical? Do you enjoy or appreciate being criticized? How would you react? How do you expect them to react?”

Triggers

It appears that the family is one of the greatest factors in propagating pain and anxiety. One of the most perverse parts of the human condition is that the species that survived did so because they learned to cooperate with other humans. The need for human connection is deep and the deeper the better – except that the triggers that set you off are stronger. So potentially the most safe and secure place in your home is often the most dangerous.

You don’t feel safe because your body has betrayed you and you’re being constantly assaulted by pain. Then it plays out in your home and no one feels safe. Is this what you had in mind when you got together with your partner and were excited about building a future together? What happened? What can you do? You have choices and the first step is becoming aware of the depth of the problem. Healing begins at home

Even if you think your family environment isn’t a problem, I would challenge you to still ask your family the above-mentioned questions. These issues are universal, and you’ll be surprised and sobered at the answers. The good news is that with becoming more aware, the family environment can quickly improve. We were excited by speed and depth of the changes. The whole family feels hope.

This is an essay sent to me by one of my patients on Mother’s Day

Here are a couple of books that I have frequented recommended regarding parenting and improving your relationship with your partner. They have both had a significant and humbling impact on my interactions with my family. Looking back on my experience with pain, it is incredibly frustrating to see how my endless quest to find a cure for my pain interfered with my relationships both in and out of the home.

• Gordon, Thomas. Parent Effectiveness Training. Three Rivers Press, NY, NY, 1970, 1975, 2000.
• Burns, David. Feeling Good Together. Broadway Books, NY, NY, 2008.

“The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention…. A loving silence often has far more power to heal and to connect than the most well-intentioned words.”

~Rachel Naomi Remen

References

1. Sarno, John. Healing Back Pain: The Mind-Body Connection. Warner Books, NY, NY, 1991.

Listen to the Back in Control Radio podcast Do You Like Your Family – Listen

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Learning to enjoy life

We have been evolving for millions of years and human consciousness began with the cognitive revolution about 70,000 years ago. (1) Additionally, the unconscious brain is a million times stronger than the conscious brain and although we often know our behavior is less than ideal the behavioral patterns always win. We are not designed to have a good time. That is a learned skill.

Dr. Luskin, a friend of mine and author of Forgive for Good has taught me a lot about anger, forgiveness and the body’s need to protect itself. One of his points has been that the human organism has only one function – and that is to survive. So, your brain is constantly scanning the environment for danger, analyzing every sensory input.

There are few times and places where you can feel safe. Life is competitive and it’s challenging to get a break. School has many layers of stress. Bullying is rampant. Close friends often turn on each other. Social media has intruded on privacy and quiet time. Research has shown that only about a third of families are relatively free of chaos. Other stressful arenas include sports, music, the arts, employment, and social status. Where’s there a place to rest?

Additionally, when you are suffering from chronic pain you are really trapped. You’re being attacked by your own nervous system. As your body is subjected to sustained levels of stress chemicals, such as adrenaline, cortisol, histamines and endorphins you will experience a myriad of other physical symptoms. It has been shown that the impact of chronic pain on your life is equivalent to suffering from terminal cancer. (2) The problem with chronic pain is that there usually isn’t an endpoint. It is a terrible state of being.

Connection

The Omega weekend is focused on re-connecting people with each other, which helps a person in pain connect to themselves. It is tightly structured with a lot of sharing of enjoyable experiences. Many of the activities are held in small groups of four or five. Participants can feel safe and it’s remarkable how quickly healing occurs. Much of the weekend is spent in play, which is a great venue to feel safe. We quickly realized after the first seminar in 2013 that we didn’t have to do much after we set up the weekend. Participants healed each other. It is also a remarkable experience for us being in the presence of those who are so supportive of each other.

Here is an overview of the workshop and the link to the course registration.

The seminar is based on:

• Awareness – You have to understand a problem before you can solve it.
• Hope – most people in pain have lost hope of a solution. We’ll share many success stories.
• Forgiveness – You have to let go before you can move forward.
• Play – We all have the capacity to play but it often gets buried in the morass of life and pain. It is the most powerful way to move forward.

Many of the participants experienced significant shifts in their pain and mood during the weekend. The hope is that you’ll reconnect to the part of your brain that already knows how to enjoy life. The solution to pain is not trying to fix it but to first learn to be comfortable with it, separate and then move away from it. As you quit fighting the pain, it will lose its energy and diminish. This process is the main focus of Saturday morning –  “The ring of fire”.

Family dynamics and pain

Human connection is a basic need and how consciousness evolved. People who are socially isolated have a similar area of the brain light up as in being in pain. It’s common, if not the rule, to become progressively isolated when in pain. You just don’t have the energy to interact with others. Then the loneliness becomes crushing. People will often endure terrible domestic abuse just to avoid being alone. One of the most perverse aspects of the human experience is that we turn to our family for meaningful connection and the deeper the relationships the better – except the closer the relationship the more powerful the triggers that set off anxiety and anger. At the same time the family can provide the deepest sense of safety, it is also the most vulnerable and most unpredictable area of life. Saturday afternoon will be focused on the role of the family in both healing and exacerbating pain. I warn the group that once you’re home and back amongst your triggers, the pain will return. But you have tasted freedom and will continue to evolve the tools return to it more and more quickly.

We request that the participants become familiar with the DOC concepts and be actively engaged in using the basic tools. The intention is to deepen your healing journey and support each other. Commonly, the process provides the needed push to propel you onto your new life. The group will be limited to 30 people to keep it interactive.

Some of the stories

We have dozens of great stories emerging from the weekend. One remarkable story is about a young man who flew in from Toronto to the Seattle workshop. He had been struggling with substance abuse problems for over 10 years and had been clean for about 8 months prior to the workshop. He had been through three stints of comprehensive rehab and desperately wanted to get on with a productive life. He was quiet but interactive and asked great questions. I wasn’t sure how much of an impact all of this was making on him. I talked to him a few months later and he had returned to a difficult situation where his “friend” and roommate had stolen money from him. He said that historically he would have remained angry and probably would have gone back to the drugs. He was able to use the DOC strategies to calm down and come out of his reactive mode quickly. I had a great conversation with him. He said the crux of his success was that, “I let the pain in. I’m no longer on the run.”

A middle-aged businesswoman had been experiencing pain in her right tailbone for over seven years and had difficulty sitting. She also was experiencing over 20 other symptoms of a fired up nervous system. I looked over her intake questionnaire and wasn’t sure she would benefit from the course. Over the last two days of workshop she experienced a marked decrease in her pain and it disappeared over the following weekend. She is continuing to thrive, got married and returned to part-time work. We have stayed in touch with her triumphs and struggles.

One woman had been experiencing chronic headaches for over 10 years. She had also developed abdominal pain and right leg pain that was persistent for a couple of years. She shared with us that she had been walking in the Omega garden on Tuesday, when her whole body seemed to have a deep reaction. She was passing by some rocks that others had written on. They were short tributes. She stopped and wrote a short poem honoring a stillborn baby that died two years earlier. She had never gotten to see her before she was buried. She woke up Wednesday morning without a headache for the first time in 10 years, her leg pain disappeared, as well as her abdominal pain. Needless to say, the whole group was stunned. She had no pain the rest of the week and has continued to enjoy life for the last four years.

We are looking forward to meeting this new group and have enjoyed remaining in touch with many of the alumni.

1. Harari, Yuval Noah. Sapiens. Harper Collins, NY, 2015.
2. O’Connor AB. Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009;27(2):95- 112.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143-148

Listen to the Back in Control Radio podcast “Connecting with Your Capacity to Heal.”

The post A Safe Haven – Omega 2018 first appeared on Back in Control.

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ACE’s

It is clear from data produced from the ACE (Adverse Childhood Experiences) study that we, as a culture are not parenting very well. The list of ACE’s is the following:

Household dysfunction

• Substance abuse
• Parental separation/ divorce
• Criminal behavior
• Mental illness
• Battered mother

Abuse

• Psychological
• Sexual
• Physical

Neglect

• Emotional
• Physical

The higher the ACE score, the greater the chances of the children experiencing depression addiction, extreme obesity, anxiety, suicide, partner violence, etc. The list is long. (1)

What is striking is that only 30% of children had an ACE score of zero. Over 35% had an ACE score of 3 or higher. It is ironic and unfortunate that the people you care for the most are also the ignition for strong unpleasant reactions. Why is this the case?

Our programming

We are programmed from birth by our environment. It matters little what you “teach” your child. It is how you behave. So each of us have patterns of behavior that are imbedded in our nervous systems that are a result of witnessing the actions of our parents. Whether you adopt or reject the patterns, the patterns are still running your life. The behaviors play out the most strongly in our new families regardless of the makeup. They originate in the unconscious part of your brain and are not solvable – especially when you are not aware of their magnitude or existence. Hoffman process

So as you begin to engage in the DOC principles with some success, it is difficult to move forward when you are continually being triggered at home. We do know that pain and anger are linked pathways. Additionally, these reactions are so powerful, none of us want to give them up, even though we know better. The family unit may be the most critical aspect of keeping you stuck in the Abyss of pain. The crab bucket  It may also be the most influential in pulling you out of it. A promising sequence involving the whole family is beginning to emerge. Here is how I finish a typical office visit after I have done my evaluation and explained the relevant issues.

Beginning the family healing

I hand them a copy of my book and show them this website, www.backincontrol.com. I ask all members of the household to go “all in”, whether or not they have pain. Everyone has anxiety, which is the pain. After I have suggested that they begin the expressive writing combined with active meditation, I jump to the final step of Stage 1 – Do not share your pain.

Here are the guidelines:

• When you walk out the door of this office you are never to discuss your pain with anyone – especially your family. BTW, no complaining about anything – period.
• On the way home you are to spend the time reminiscing about era of your relationship when you had the most fun. Remember your dreams, friends, adventures, conversations and shared suffering in detail.
• When you walk through the door of your house that same energy will be brought into the home and nurtured – without exception and indefinitely. If you must argue – take it outside. My nurse pointed out to me that you cannot have a bar fight in a bar. Why do you want your home to be a no-holds-barred fighting arena?
• They must make a commitment to honor this part on not engaging with each other when they are upset and I ask them both to verbally affirm it.
• I show them the link to “Protect Your Family from Your Pain.” Each of them has permission to withdraw from any unpleasant interaction – without reprisal. Each party also has permission to ask the other to person stop discussing his or her pain.

It has been eye-opening for me to see how much time people spend talking about their pain or what is wrong with their lives. It is not that interesting. It is incredibly frustrating for family and friends to constantly hear about it. There is nothing they can do to help. It is also interesting how responsible family members feel to help the other person solve the pain and also how the person in pain can hold the family’s feet to the fire to help. It is a deadly cycle. Your pain is yours and yours alone. It’s your responsibility to own and solve it.

I’ve had patients blurt out, “Well what can I talk about?” Almost anything is more interesting than pain. The alternatives are infinite. You have to first unhook from your pain before you can re-experience these wonders.

Not sharing the pain

I have been heading towards this conversation for a while and have taken it up several notches over this last year. It has been encouraging and change can occur quickly. I had a woman who had been in pain for over 30 years, in addition to some other significant neurological problems. She had a strong right to complain and be upset. The problem was that her husband was simply worn out. The tension in the room was high and uncomfortable. When I introduced the rule of not talking about pain, he immediately had a smile emerge and both of them relaxed a bit. I said, “I want you both to fully engage but separately. Imagine a 10-foot steel-reinforced concrete wall between the two of you regarding the topic of pain.” I then went on to explain the above-mentioned rules.

I was shocked when they returned a month later. They were animated and laughing. Her pain was down by about 60% and both of their moods were dramatically improved. They had re-discovered how to have a good time. Remember that although pain pathways are permanent, so are play pathways. You just have to re-connect with them. It is a powerful way to move forward. Interestingly, some of her neurological symptoms had improved. They could hardly contain their excitement about the possibilities. The only negative of the day was that I was so interested in what had transpired that I got hopelessly behind in clinic.

Safe

It has also struck me that one of the core concepts of healing is feeling safe, which is hard to do in this world amongst fellow workers, classmates, bosses, and most importantly from yourself. We endure an endless barrage of negative self-talk. However, you do have a choice about what you want to create at home. I think that by constructing a “safe house” that you are more able to do the same in other areas of life.

I have decided that the focus of my next book will be on both protecting the family from chronic pain and using that same energy to connect to the body’s capacity to heal. I am looking forward to seeing where this might go.

Happy Mother’s Day!!

Listen to the Back in Control Radio podcast Parenting – Creating Your Own Triggers

1. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci 2006;256:174–86.

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