• Social isolation is both a contributing factor to anxiety and also a result of it.
• When you are suffering, it is challenging to reach out to others in a meaningful way.
• The physiological effects are devastating, with significant mental and physical consequences.
• It even affects the expression of your genome (DNA) in forming aggressive inflammatory cells that destroy your own tissues.
• The loneliness and isolation that many people experience is one of the worst aspects of the whole experience of dealing with chronic illness.
• Conversely, reconnecting with your family, friends, and colleagues is a powerful force for healing.
• The catch-22 is feeling good enough to begin reaching out. It is one of the reasons that there is a sequence to the healing journey. Each person is ready at a different point along the way.

Loneliness and social isolation may some of the worst aspects of suffering from any chronic illness. Over 50% of Americans are socially isolated regardless of where they live or the size of the town or city. It is ironic in that social isolation is such a significant contributing factor to poor health in this modern era. It is also dangerous. It is estimated that the effects on one’s health is equivalent to smoking about 15 cigarettes/ day.¹ Sadly, the age group that is the most affected are those in college and in their 20’s. This stage of your life has the potential to be the best of times.

 Consumed by suffering

When suffering from crippling anxiety and other physical symptoms, you spend a lot of your conscious hours looking on the Internet, seeking medical care, trying different treatments, and discussing your problems with anyone who will listen. Why wouldn’t you? Your life has been consumed and you want it back. Unfortunately, in spite of your best efforts to move forward, from a brain development and physiological perspective, you are moving the wrong direction. Here are some of the effects:

• Unpleasant circuits in your brain are reinforced.
• Pleasant one become less active with disuse.
• You drive people away that you used to have fun with and bond with others who are in a similar condition.
• Eventually, many people are so drained from the endless battle with their suffering, they become isolated, even in the midst of their own family.
• Oxytocin is a hormone that causes social bonding and is also powerfully anti-inflammatory. Lack of connection drops it down and your inflammatory state becomes even higher.

Some data

The effects of social isolation are deep. They go right down to the expression of your DNA directing the production of proteins that are the essence of life. There are about 20-30 genes that effect the production of certain white blood cells called monocytes. White blood cells are at the core of fighting foreign material in your body, including cancer cells, viruses, and bacteria. There is an over-active form of them called, “warrior monocytes” that are too aggressive and also attack your body’s own tissues creating many diseases states and symptoms. Anxiety is one of these inflammatory states. The most powerful factor causing the creation of these cells is social isolation. The second factor was chronic stress (anxiety).²

Dr Dantzer wrote an extensive review paper³ looking at the social influences on inflammation. There are many factors that affect inflammatory markers, and he presented the top four factors that lowered inflammation.

• A sense of control
• Hope/ optimism
• Positive affect/ attitude
• Social connection

Humans evolved by having language and being able to cooperate through social connection. It is the reason we are so tribal, and unfortunately, we haven’t evolved enough as a species to view every person as part of the human tribe. There is an evolutionary basis for excluding groups of people, as we compete for resources. That being said, social connection is a deep need, and it is expressed in your physiological state.

Another paper out of UCLA reported on a study where a volunteer was placed in a special MRI scanner called a functional MRI (fMRI). It highlights area of increased brain activity. The volunteer then played a computer-based video game where he or she was in a game of three-way catch. The computer was programmed at a certain point to exclude the volunteer and the ball was “tossed” between the remaining two players. The volunteer did not know the other two players were just the computer. Guess what? Even though it was just a computer game, and the volunteer could not physically see the other players, the centers of the brain that are active in chronic physical pain lit up. In other words, emotional pain is processed in a similar manner. ⁴

The catch-22 of social isolation

I will only say that becoming socially isolated and feeling lonely was one of the worst aspects of my 15 years of suffering. The only word that slightly described the feeling was, “crushing.” I began to experience deep self-deprecating thoughts that revolved around, “why would anyone want to hang around with me?”, and “I don’t have anything interesting to say.” These thought patterns were endless. This occurred despite me generally being very social person. Just the feeling of being lonely felt like an Abyss and was paralyzing with regards to re-engaging. I really could not see an end to it.

Healing

I noticed very early on that my patients would check off, “re-engaging with family and friends” as part of their healing. Social interactions are tricky in that you be rejected sometimes and hence one of the reasons people have social anxiety. It is greatly magnified when you are already experiencing chronic mental and/or physical pain. So not only do you not have the energy to reach out to others, feeling inadequate may also contribute. Here are some suggestions.

• Be kind to yourself. You are doing the best you can.
• People who you used to be friends with may not have as much in common with you and you may be rejected.
• Others you have bonded with through your pain may also reject you as you heal. You are no longer validating their suffering, and as you heal, they are confronted with their own inability or unwillingness to pursue the same journey.
• So, the first step in returning to a normal life, is to be prepared for these kinds of interactions.

Then just move forward in any way that you can.

• Call old friends or family members. Many of them are in the same condition you are. It is remarkable how common it is to be trapped by anxiety and pain. However, as mentioned many times, conversations around these topics are counterproductive for all parties.
• Re-engage with old skills such as art, music, and hobbies.
• Read interesting books or watch inspiring movies. They are great topics for conversation.
• Join a club. You don’t need to be an expert. There are numerous choices such as birdwatching, Scrabble, ping pong, book, movie, and history clubs, walking with friends, and music.
• Find ways to give back and there are endless options. One of my successful patients was “trapped” in a nursing home and spiraling back down into the Abyss. She decided to become an advocate for other patients who had dementia. Within a few weeks, her whole mood and outlook dramatically improved.

Recap

Loneliness is crushing and both a contributing factor to chronic illness and also a result of it. A significant aspect of healing is reengaging with those around you. What makes this all the more difficult is that while you are suffering, you may not have the interest or energy to reach out to others. Then if you are still in the mode of discussing your troubles, you will push people away who can nurture you, or attract others who are also frustrated with their suffering, and they will pull you deeper into The Abyss. This cycle is deadly.

That is why you must empirically make decisions to keep reaching out and connecting regardless of how you feel. You will feel awkward, especially when you have taken medical conversations and complaining off of the table as topics. The connections can be as simple as a phone call, reaching out to old friends, or joining a book club. The key is doing something – anything to reach out and break out of your patterns.

Humans and language evolved through language and social connection. It is one of the most basic of needs. Actively reaching out and giving back is a powerful move to stimulate your brain to rewire and heal. To have a good life, you must live a good life. It requires practice.

 Questions and considerations

1. You might be sitting here and feeling overwhelmed by the thought of even trying to reach out. That is OK and understandable. You can’t just flip this one around on a dime.
2. Just do something. Anything. You have heard the term, “baby steps” many times.
3. The problem is that when your brain has been barraged with negative thought patterns, you may feel people may not want to be around you. That is a classic common cognitive distortion of, “mind reading.” Maybe they don’t and you also have to be OK with that. Maybe they are in the same situation as you are and don’t have the energy to engage.
4. I can personally vouch for how distorted thinking patterns become from my own experience. For a long time, even after I was much better, I was still quite self-conscious.
5. Humans evolved by interacting with other humans. Somehow, re-engaging with life has to be part of your healing journey.

References

1. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
2. 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

3. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42. https://doi.orgl/10/1016/j.bbi.2018.08.010
4. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.

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The First Day of School

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

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

Power

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

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

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

Bullied at work

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

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

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

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

“I can’t let go”

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

Compassion??

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

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

The First and Last Day of School

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

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

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

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

Dreams shattered

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

Bullying affects the body’s chemistry

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

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

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

Letting go – NOT

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

Power

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

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

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

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

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