The worst part of my ordeal was the mental pain and being bombarded with unpleasant and intrusive thoughts. It was the most disturbing aspect of it all and the more I did battle with them, the more intense they became. I had already slipped into an “internal OCD” (obsessive compulsive disorder) five years earlier. It  manifested with repetitive disturbing thoughts that I countered with positive thoughts. Internal OCD does not have external characteristics such as hand washing and counting.

I had begun the expressive writing about six months earlier with a lot of success. My anxiety and other physical symptoms had diminished but I was still struggling on many fronts.

“I am a victim”

On Mother’s Day of 2002, I suddenly realized what being a victim entailed and saw that I was deeply enmeshed inthat role. Up to that point, I had no idea that I was even angry. I was just “right” and “frustrated.” But since I had so many legitimate reasons for feeling this way, I never considered myself as angry. In fact, my concept was that I had dealt with anger and had moved on. Nothing could have been further from the truth.

I felt a deep shift and over the next six weeks, more of my physical symptoms began to resolve, with the most unexpected one being that the ringing in my ears (tinnitus) decreased dramatically. After 25 years of dealing with it, I had assumed that it was a permanent symptom. However, many of the disturbing thoughts persisted and were interfering with my capacity to enjoy my life. I felt stuck.

The circus mirrors

One day, I suddenly had an image of myself standing in front of the kind of reflecting mirrors that you see in the circus. I was staring at repeating versions of  myself, going into infinity. I could see the battle playing out in my brain – a disruptive thought followed by a  counterthought – without an end. This had been playing out in me for years. I realized that there was nothing I could do and I “gave up.” I had reached a point where I had to let go. I truly became deeply discouraged yet at the same time, this realization was accompanied by a deep physical feeling of release. I was perplexed.

I continued to use all the tools of writing, mindfulness, forgiveness, etc. But with my new outlook, I began to move forward with my life and within six months most of my physical and mental symptoms (Including the obsessive thoughts) had dramatically abated. I didn’t realize it at the time, but it turned out that letting go and moving on was the definitive answer. This was well before I understood the concepts of neuroplasticity. Your brain develops whereveryou place your attention and I had been reinforcing the problem by trying to fix it.

Take a break

My patients and I frequently discuss the idea of taking a break from The DOC Journey. They have been diligent in reading, writing, not discussing their pain or medical care, meditating, processing anger, and even working hard at play. But they continued to be frustrated because, even though their pain had diminished, their anxiety levels remained too high, upsetting thoughts continued to bombard them, and they still didn’t have the quality of life that would allow them to thrive.

Perfectionism came into play in that he or she wanted to be the best student and really do it right. But the harder they worked at it, their neurologic energy was still directed at themselves. Inadvertently, by stimulating neuroplastic changes towards the problem, they were reinforcing these unpleasant neurological circuits.

Remember that the victim role (including perfectionism) is so powerful, you will never want to give it up – even afteryou have felt how free you can be. It is too strong of a survival need. The  decision to let go of the victim role is a day-by-day decision, sometimes a minute-by-minute one. Being triggered is inherent to being alive, and you have to decide if and when you want to let go, and when you are ready, just do it. I have not found an alternative and logic doesn’t work. I call it, “flipping the switch.”

Bill

Occasionally, at the end of an office visit, I asked my patient to sit in the exam room and not leave until they committed to “letting go” of the victim role. They may have sat for 10-20 minutes before they left. Walking out the door was symbolic of them stepping into their new life. It was surprising how effective that simple action could be.

Bill was a middle-aged, small-business owner who had been in chronic pain for over twenty years. He had done quite well with the DOC principles, along with the help of one my colleagues. One day Bill was triggered by one of his business partners and fell deeply back into the Abyss of pain and despair, to a depth he had not experienced before. He was becoming suicidal. Unfortunately for me—but fortunately for others— through my own experience, I gained extensive insights into suicide and realized that anger is what pounds your soul into the ground. Bill was in an extreme victim mode. I called him out on it during an extremely intense conversation. Although it was nerve wracking for both of us,  it clicked. He sat in the exam room for about half an hour.  When I saw him back a few months later, he was achanged man and re-entering the workforce.

A friend sent me this poem:

“She Just Let Go”

She let go. Without a thought or a word, she let go.

She let go of the fear. She let go of the judgments.

She let go of the confluence of opinions swarming around her head

She let go of the committee of indecision within her.

She let go of all the “right” reasons. Wholly and completely, without hesitation or worry,

She just let go.

She didn’t ask anyone for advice.

She didn’t read a book on how to let go….

She didn’t search the scriptures.

She just let go.

She let go of all of the memories that held her back.

She let go of all the anxiety that kept her from moving forward.

She let go of the planning and all of the calculations about how to do it just right.

She didn’t promise to let go.

She didn’t journal about it.

She didn’t write the projected date in her day timer.

She made no public announcement and put no ad in the paper.

She didn’t check the weather report or read her daily horoscope.

She just let go.

She didn’t analyze whether she should let go.

She didn’t call her friends to discuss the matter.

She didn’t do a five-step Spiritual Mind Treatment.

She didn’t call the prayer line.

She didn’t utter one word.

She just let go.

No one was around when it happened.

There was no applause or congratulations.

No one thanked her or praised her.

No one noticed a thing.

Like a leaf falling from a tree,

She just let go.

There was no effort. There was no struggle.

It wasn’tgood, and it wasn’t bad.

It was what it was, and it is just that.

In the space of letting go, she let it all be.

A small smile came over her face.

A light breeze blew through her.

And the sun and the moon shone forevermore.

–Rev. Safire Rose

This poem “She Just Let Go” by Reverend Safire Rose beautifully conveys the essence of The DOC Journey. Letting go is the simplest and simultaneously the most difficult aspect of the healing process. Our anger is powerful and often legitimate. We are accustomed to fixing others and ourselves, but our attention is still on our flaws and those of others. Too much attention to shortcomings inadvertently strengthens our unpleasant neurological circuits.

The DOC Journey provides guidance and tools to get to a place where you are able to let go. The freedom you will experience is remarkable. For me, it was unlike anything I had ever experienced in my life. Watching people enter this realm is inspiring and is a major factor in motivating me to keep me moving forward with this project.

Reconnecting with Your True Self

On Saturday, November 6th, Dr. Les Aria, a friend of mine, and I are holding a workshop that is being hosted through The Open Center in New York. We will be discussing both the process of letting go using specific strategies to connect to the best part of who you are. The intention is for you to leave with a clear concept of the power of the unconscious survival mind, how to develop a “working relationship” with it, and move forward into the life you desire. Click this link to take a look at the course and register.

The post “She Just Let Go” first appeared on Back in Control.

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• Perfectionism is felt by many of us to be a virtue. It is reflected in terms of,
  “high standards,” “excellent quality,” and “strong work ethic.”
• It is actually a disguised version of anger directed at yourself. These ideas actually become translated our minds as, “not good enough,” “imposter syndrome,” and “why do I always do this?”
• Holding yourself up to impossible standards is a way of remaining in a victim role indefinitely.
• These “standards” also translate into judgments of others as you project your views of yourself onto them.
• The most disturbing aspect of this issue is that all of this arises from the unconscious brain, are hardwired circuits beginning from birth, you have no control over them, and are unresponsive to the conscious brain.
• They have to dealt with by reprogramming the unconscious brain.

Perfectionism may be the most common, almost universal disguise of anger. I had been raised with the idea that it was a virtue, and this perception was dramatically reinforced during my medical training. It was at the core of my burnout and journey into The Abyss of pain and I had no idea it was problem until well after I had crashed and burned.

Perfectionism fits into the anger cascade in the following manner.

• A given situation, person, or you, are less than your concept of ideal.
• You blame one of the above for being “less than perfect.”
• You are now a victim of “less than perfect”
• You will perpetually exist in some state of conscious or unconscious agitation.

David Burns in his book, Ten Days to Self Esteem,¹ points out that the gap between your concept of perfect and your reality is the degree of your unhappiness. Perfection does not exist in the human experience. Since perfection is unattainable, why do so many of us continue to embrace it? I will offer a couple of observations from the perspective of an extreme perfectionist.

Why do we keep holding on to “perfect?

First of all, we are programmed to “be all that we can be.” We are also taught that “pushing yourself” is the best way to accomplish this goal – except that pushing often evolves into punishing in the form of self-criticism without limits. Since this strategy often achieves impressive short and medium-term results, it seems like a reasonable pathway. It’s not. Using the medical profession as an example, the burnout rate amongst physicians is over 50% in every state in the US and has risen between 5-10% in the last five years. The burnout rate in neurosurgeons, in one study, demonstrated that it was over 65%.² The same driving energy that pushes you up the hill takes you down the other side. Striving for perfection becomes a deeply-established programmed pattern of thinking and behavior.

A second reason is that the victim role is so powerful that humans will do almost anything to create and hang onto it. Since perfect is unattainable, you are able to remain a victim of imperfection indefinitely. It is self-flagellation. The DOC Journey is about letting go, allowing yourself to repeatedly “fail,” and continuing to move on. Perfect does not allow for failure. BTW, much of your capacity to create a wonderful life is dependent on your ability to deal with adversity successfully and efficiently. Your body will spend less time being exposed to threat physiology. Also consider, “what is failure?”

Third, your self-critical voice is part of the powerful unconscious brain that is not subject to conscious interventions. There is a phenomenon called “the ironic effect” that sabotages your best intentions. When you try to focus on noble ideals and concepts, your brain focuses on ways that you might not attain them. In other words, the more you try to think about something positive, the less you will think about it. You’ll develop anxiety from the futility your efforts. We tend to take these voices personally and we should not. They are your brains automatic programmed patterns. We can “talk” to them as much as we want but there is no one there. It is tragic that we try to quiet these voices that are just repetitive circuits. The more of well-intentioned person you are, the louder they are.

Perfectionism is rampant

85% of people in chronic pain have not forgiven the person, employer, other driver, etc. who caused their pain. Interestingly, the person they are the most upset at is themselves.³ If your intention is to live a life filled with peace and joy, how can you accomplish it by holding onto resentment, especially if it is directed at yourself.

Starting a new life

I was talking to a friend of mine who had recently lost his wife. He was a high-level professional and trying to meet someone to start a new life. Invariably, his internal dialogue was “inadequate,” “boring conversationalist, narrow interests, unattractive, and the list went on. Then it came out that he placed these same labels on his dates. What he wasn’t aware of is that your mind projects onto other people and situations the way we feel about ourselves. The term for this behavior is projection. So, when you are in a judgmental mode and expressing it to others, you are revealing to the world the way you feel about yourself. This is particularly true when you are upset (in pain).

Hard on his family

I was talking to one my colleagues who had experienced a lot of success using the approaches in The DOC Journey with a marked decrease in his anxiety and stomach pains. He found the expressive writing and relaxation tools the most helpful. He had also read Dr. Luskin’s book, Forgive for Good.⁴

He had returned from vacation and stopped the expressive writing since he felt so good and relaxed. The day he walked back on the job his symptoms returned. It came out in further conversation that he is extremely hard on himself. He was an ex-baseball player who almost went pro. I asked him if he was critical of his kids. He admitted that he was. I pointed out that he was not going to be any easier on them that he was on himself and that in the big picture he was not being that nice to either. What he held up as “high standards” was really intense perfectionism. Was this really the world he wanted to create for himself and his family? It is antithesis of creating a haven of safety. Dr. Luskin is clear that forgiveness has to begin with forgiving and accepting yourself? We all sort of know this, but down deep we don’t pull it off very well.

Letting go

So what is the solution? These are not pathways that you can intellectually solve. They are mindless endless loops. Your body is also chemically reacting to these thoughts and creating n. Suppressing them makes the situation even worse. The key is to become aware of the depth and nature of your critical self-talk and create some “space” between you and these circuits. Writing down your thoughts down an awareness of them and also creates this needed space. Then you can use your conscious mind to redirect your attention to more pleasant choices. Just understanding the magnitude of the impact that perfectionism is having on the quality of your life also helps.

Finally, decide to be happy. You have to use repetition to reprogram the unconscious. This is different than positive thinking, which is a form of suppressing. It entails creating a positive vision. You cannot get to happy while remaining perpetually judgmental. Then choose to program your brain with positive alternatives and solutions. Paradoxically, you will possess an endless amount more energy to achieve your goals.

I hold a Q&A session a couple of times per week. Perhaps the most common topic that keeps coming up is “not feeling good enough” and self-criticism. I joke that we could call our roundtable, “The perfectionist’s club,” except it is not funny and actually is tragic. The accomplishments of this group are remarkable, yet there is a limited capacity to enjoy their successes. Perfectionism is what was the essence of my personal demise.

Recap

Creating a vision of excellence is much different than having “high standards.” You understand and accept where you are along with your resources. Then you create a plan to pursue your vision of what you want your life to look like. This involves filling your brain with positive solutions as well as accepting and processing  the inevitable failures. This is a different journey from wasting your energy flagellating yourself for your inadequacies and failures. If you are not willing to fail, then don’t attempt the journey. Paradoxically, you will have an endless amount of additional energy to achieve your goals. Happiness is only possible while pursuing a vision of excellence.

References

1. Burns, David. Ten Days to Self Esteem. Harper Collins, New York, NY, 1993.
2. Kurapati, Rajeev. Burnout in Healthcare. Sajjana Publishing, 2019.
3. Carson JW, et al. Conflict about expressing emotions and chronic low back pain: Associations with pain and anger. The Journal of Pain (2007); 8:405-411.
4. Luskin, Fred. Forgive for Good. Harper Collins, New York, NY, 2003.

The post The Ultimate Victim Role – Perfectionism first appeared on Back in Control.

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You’re never going to get rid of anxiety or anger. They are a necessary part of life. It has been demonstrated that avoiding these emotions will just increase their frequency. In the famous White Bears study, Dr. Wegner demonstrated that when you to try not to think about something, you will inevitably think about it more. Ignoring your anxiety and frustration will not get rid of those feelings, and the concept of self-esteem won’t help for a variety of reasons.

First, self-esteem involves endless judgments of you versus those around you. You are either “better than” or “worse than” the people around you. This line of reasoning creates labels; you cannot really see who other people are, what their needs might be, and how you might help. You have lost awareness. This is the antithesis of what is necessary for the world to become a better place – the acceptance and celebration of differences.

Second, attempting to build self-esteem involves using rational methods to deal with irrational neurological circuits. The emotional unconscious brain is much more powerful than the intellect; it’s a huge mismatch.

Third, what happens after you’ve achieved the things that should have alleviated your frustrations and anxiety, and it doesn’t work? (and it won’t) You will become more frustrated because there’s nowhere left to go. The list of high-profile people who have self-destructed is long. They usually had every imaginable comfort life has to offer. It’s impossible to outrun your mind.

Achievement Doesn’t Work

In the medical profession, it expected that you encounter death frequently. What is not as talked about is how often those deaths are of fellow medical caregivers taking their own lives. I know of 19 medical colleagues who are dead from suicide. Two close friends, and also four out of my eighty medical school classmates are dead from suicide.

These aren’t just numbers to me. I had a friend who was an excellent spine surgeon and one of those guys you could count on for anything. He had spent the day in surgery with me, assisting with a difficult operation. At two o’clock he shook my hand and said, “Nice case, I have an appointment I can’t miss.” He walked out, and three hours later shot himself.

All of them were “living the dream.” They were highly educated, wealthy, with big reputations, beautiful families – the list is endless. They possessed more than enough to have self-esteem. Yet the anxious, perfectionistic drive that pushed them to the top destroyed them.

Perfectionism

Perfectionism is rampant in the medical culture. Although “perfect” sounds reasonable when applied to surgery, it is actually deadly. What it does it creates an intense, chronic anxiety of “never being good enough,” and then frustration of never being able to achieve these unattainable goals. Perfectionism fosters anxiety-driven anger. Over time, the anxiety becomes intolerable. People don’t kill themselves because they are depressed. It is an angry act. Anger is destructive and the ultimate act of destruction is to destroy yourself.

I know this first-hand because I went through a similar experience that came to a head in 2002. I was actively suicidal with extreme anxiety for 18 months and crossed the line to put my plan into action. I was lucky. I made it through this gauntlet. I eventually published my story in 2011, in our national spine publication, SpineLine.

Nick and Holt

In my book, Back in Control, I talk about my son, Nick, and his friend Holt, who are both world-class mogul skiers. I learned many of the performance concepts presented in my book from watching them deal with the adversities of competing under intense pressure, while being at the mercy of judges. They were also obsessed with winning as the ultimate goal. Through working with an athletic performance coach, David Elaimy and also myself, they were able to learn to enjoy the journey regardless of the outcome.

In 2007, Holt won the national championship in mogul skiing. He felt that significant contributing factors to his victory were the awareness and visualization techniques presented in my book. One principle was letting go and performing with freedom. By connecting with his best effort instead of the outcome, his performance soared. The day after his victory, he turned to me and said, “You were right. Winning changed my life for about twelve hours. Life moves on.”

No matter your profession – a surgeon or an athlete – if you are connected with who you are, then you can create the life you want. If you are creating a life to fill a hole inside you, it becomes a major problem. It’s important and rewarding to strive for excellence; it just has nothing to do with decreasing anxiety and frustration.

“Better Not Look Down”

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