My first year in training

I will never forget my first holiday season as an internal medicine resident in Spokane, WA. I learned that the holidays are a nightmare for the medicine service, especially the GI service. Diabetics don’t take their insulin and their sugars go out of control. Cardiac patients don’t take their meds and are admitted for chest pain and abnormal rhythms. The GI service is the worst in that patients with liver disease drink more and develop major bleeding in their gut. People are depressed and the stress of the holidays puts them over the edge.

He died?

We had a resident’s clinic once a week. One of my favorite patients was an 80 year-old gentleman, who was as nice of a person as you could meet. He had some moderate lung disease but otherwise was fairly healthy. He was admitted to the hospital on Christmas Eve with respiratory failure. It didn’t make sense to any of us, as his lung disease wasn’t that severe. We had a whole team working intensely to solve the puzzle. It didn’t matter. He died two days later. During the course of the hospitalization I found out that his son who lived in Seattle had not invited him over for Christmas and he had become despondent. I have since learned that the will to die is as strong as the will to live.

My descent into loneliness

I could not figure  this increase in illness and depression over the holidays for many years – until I descended into my own anxiety-driven depression and chronic pain. There were many unpleasant (terrible) aspects of being in the abyss, but maybe the worst one was feeling alone. I am an extremely social person. As I became progressively more anxious and reactive I began to feel isolated. In retrospect I realize that a lot of this was occurring in my own head. My friends were not avoiding me. I was not interacting with them. While I was trying to survive the terror of raw anxiety I was not able to reach out to others. I became more withdrawn and felt uncomfortable even talking to people. Discovering I had NPD

Obsessive thought patterns

What began to happen is that I developed what I now recognize as an obsessive thought pattern (classic symptom of the Neurophysiologic Disorder) that everyone else had a better life than I did. It did not matter what the evidence was to the contrary. I could not shake that thought. The holiday season made it much worse. First, it reminded me of times that were much better and I felt even more sorry for myself. Secondly, people really seemed like they were having a better time than I was. (jealous/angry). Finally it seemed like the merriment around me was almost mocking my plight. For over 10 years I would become dark around the holidays.

I became socially isolated. I imagined that people just didn’t want to be around me and the story in my head became strong and convincing. Fortunately, I had a few people that I connected with that could see through the storm of my thoughts. It was that human connection that kept me going. But the feeling of loneliness was one of the worst aspects of my descent into chronic pain.

Social exclusion and the ACC

A study published in 2003 (1) looked at the brains of volunteers who were hooked up to a functional MRI scanner (fMRI) which highlights metabolic activity of the brain in response to different stimuli. The volunteers were visually involved in a computer game of “three way catch”. They were not told that the other two “players” were just the computer. At a certain point they were suddenly excluded from the game while the other two “players” threw the ball back and forth another 45 times. The volunteer would consistently feel excluded and experience emotional distress. Interestingly, a part of the frontal lobe, the ACC, would light up. This part of the brain is “the neural alarm system.” It lights up when something in the environment is not right or threatening. Not surprisingly pain is a basic signal that also lights up this area. This study documented that emotional pain lights up the same area.

So chronic pain creates yet another vicious loop. Pain lights up the ACC (anterior cingulate cortex). While in pain you feel much less inclined to be social, which then reinforces the stimulation of the ACC. You now have added emotional pain to the physical pain.

Where does chronic pain begin?

People need people. People need to connect first with themselves and then with others. There are many societal factors, in addition to chronic pain, that create social isolation. It is unclear whether the social isolation that stimulates this “neuro warning center” could be the starting point of chronic pain.

Omega

My wife, Dr. Fred Luskin, and I put on a five-day seminar at the Omega Institute last summer. There were 11 participants who experienced a significant shift in their mood and pain during the week. As they went back to their home environment some had their pain return and many remained relatively pain free. The essence of the week was that we were able to relax and connect with one another. My impression was that the environment allowed us to open up and share. The capacity of people to heal each other was powerful. (The workshop was July 19-24, 2015.) “The Cup Song??”

The holiday season during my burnout was the equivalent of being excluded from the computer game. I’m sure that if I was placed into a fMRI during that period my ACC would have lit up like a small nuclear reactor. The sense of social exclusion was crushing. My Battle With NPD

I was very fortunate to not only escape from the abyss, but thrive. I wish the same for you in 2016.

1. Eisenberger, Naomi, et al. “Does Rejection Hurt? An fMRI Study of Social Exclusion”. Science, 2003, pp. 290 – 292.

The post Happy Holidays – Not first appeared on Back in Control.

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 This blog is written in conjunction with Dr. Les Aria, who is an experienced pain psychologist working in Northern California. He brings a wide range of approaches into successfully treating and solving chronic mental and physical pain.

Being triggered and stressed is so common during the holidays that it is somewhat normalized. Yet hope springs eternal and we keep gravitating back to the same historically chaotic situations. Why do some levels of crises keep happening at Holiday family gatherings? This article is written with all due respect to those of you who are socially isolated, which is devastating and magnified during the Holiday season.

There are many ways to enjoy your family and close friends during this time of year regardless of their behaviors and your stresses. It is supposed to be a season of peace and joy. Understanding the nature of the problem allows solutions.

We acknowledge the many additional stresses around the holidays that have been discussed in many venues and numerous excellent suggestions have been made. However, once you have navigated the obstacles to actually being with your friends or family, it would be reasonable to expect to relax and enjoy them.

Defining a trigger

The basic problem arises from people in close relationships triggering each other. What does being “triggered” mean? We survive by learning from prior experiences what is safe or threatening. This includes your emotional states and consciousness, which are processed in a similar manner as physical threats. Many, if not most, of these mental threats are perceived and are based on cognitive distortions. It is the reason many of us have a baseline state of being “fired up.”

So, anytime you feel anxious or angry, something in the present has been connected to a situation in the past that was perceived as threatening or was dangerous. Your adult brain will still process it in the same manner. You have been triggered. The problem arises from the fact that you are now in the past and not the present. You have lost awareness of the present moment, which is at the core of functional human relationships.

As your earliest and most powerful programming happens with your immediate family, they are the strongest and most consistent triggers. Close relationships are not far behind. The deeper problem is that when you are in this state of threat physiology, the activity of your brain shifts from the neocortex (thinking centers) of your brain to the lower regions (survival) of your brain and you cannot think clearly. It is not possible. So, then your behaviors or those of others may be less than ideal. What can you do? Here are some suggestions.

Dealing with triggers

The first and necessary step is to understand the problem and there are many resources that will help you understand the nature of chronic mental and physical pain. The essence of chronic disease is sustained exposure to your body’s threat chemistry or in other words, being constantly triggered. Here are a few practical suggestions.

Triggers are a whole-body response to a real or perceived threat. Here are 3 behavioral/ physical cues to help you identify that you are being triggered before becoming fully activated by past family triggers.

1. Mood Shifts: Notice when you experience a mood shift. Do not suppress those emotions. Burying emotions alive will lead you to step on them at some point during the holidays–KABOOM!
2. Tension Shifts: Notice when you experience sudden muscle tension in your body. Check your shoulders right now! Left = Anxiety and Right = Anger/suppression of emotions/complaining all day long!
3. Breath Shifts: Notice how often you hold your breath when around certain family members. You know who they are! Are you holding your breath? Are you breathing shallowly? Are you breathing rapidly?

What are the triggers when you are around your family?

1. Criticism is one of the most common triggers.
2. Financial worries from food to travel plans.
3. Feeling pressured to be happy or positive

These are just a few of many triggers–know yours.

*Note: Your physiological states determine your psychological states; vice-versa.

 If you are already feeling stressed or wired, be careful. Your nervous system is “trigger happy” and you’ll not only ruin your experience but create chaos for others.

Practical tips to process triggers

1. Manage expectations. Holidays have a way of making wanting to feel like what Hollywood puts out – this amazing, beautiful scene where we all get along. Not everyone experiences such stuff. Dashed hopes make things worse. Once you understand how to remain calm during any level of chaos, no one can take away your capacity to enjoy yourself.
2. Utilize your Mindbody practices. They are learned skills and include breathwork, meditation, exercising, expressive writing, restful sleep, humming, relaxing music, and mindfulness. Each person has their own set of tools that works best for them. If you haven’t learned to regulate your stress response, please make the effort to do so. They eventually become automatic with practice, and the Holidays are a great opportunity to practice.
3. Avoid all negative conversation–period. No complaining, gossiping, criticism, giving unasked for advice, or discussing your pain or medical care. This is something that is basic to healing and you’ll do the rest of your life. Consider how much time you are spending in this type of activity.
4. “5–3–2” is a strategy to create some “space” in your brain before you take any actions. The numbers represent the words describing each step.
   1. No action in a reaction
   2. Flip the switch
   3. Move on

The details are discussed in this article.

 5. Take time for yourself. This is something we practice and preach about. Set time aside from everyone. Go for a walk before the hoopla starts if you are staying over with your family. Break away from the family during the day or when you need some space to “come back online.”

Summary

Keep your perspective! Remember that you always have choices–once your brain is back “online.” Keep focused on who or what is important to you. How do you wish to show up for the holidays?  Practicing the skills we discussed, especially noticing when you are triggered and doing something about it will help you keep your love, peace, and joy during the holidays.

As always –be kind to yourself. Let the Holidays begin!

The post No One Can Take Away Your Holiday Joy – But You first appeared on Back in Control.

The post No One Can Take Away Your Holiday Joy – But You appeared first on Back in Control.

The initial download to your brain

There are many theories about how an infant and child acquire knowledge.  My thoughts are that your brain is an empty slate that is downloaded from the environment. During your first couple of years of life, you have no say in what is put into your nervous system. Around the time your consciousness emerges around three years of age, you have little awareness or skills to deal with the automatic responses to your environment. The term I learned from the Hoffman Process was “patterns.”  Anytime you are anxious or upset you are in a pattern because something in the present connected to something upsetting from the past. Until you become aware of your patterns programmed in by your family, you are at the mercy of them

These patterns play out as you move out into the world. You either adopt a given pattern or you reject it. The problem is that either way you are a reflection of your parent’s patterns and they are not you. You are not living connected to who you are – “your authentic self.”

Passing on of patterns

If one or both of your parents are disabled you might rebel and become a super-achiever or become disabled yourself. Either way you are not running the show. Your family patterns are. Of course your parents had similar experiences with their parents and so on. Until you become aware of the impact of your family’s programming on your nervous system you cannot live your life on your terms.

Did you graduate from high school with your dream to become disabled??

I am aware that the vast majority of people on disability hate being on it. You are under the control of a person (claims examiner) or system that is depersonalized and unresponsive. In addition to the frustration of being in pain you have also lost control of your life. However, the deep, familiar family patterning of being disabled may be an even stronger force.

Breaking Loose?

Additionally, if you decide to break loose (and it is doable), often some or all of your family will not let you. I used to think that family members would be ecstatic to watch a sibling or offspring become pain free. Many of them are, but many are not. First of all, you are challenging their paradigm of who you are. This is particularly true if you are dependent on that sibling or parent. You are challenging their role as a “caretaker”.  Second, as you get better it calls them out. You are doing and have done it – getting better. What about them? Why are they not pursuing the same path?

Triggers

Another huge problem is that your family is the deepest source of your “negative “triggers”. It was in this environment that your negative patterns were created and it is not possible to be around your family without these being set off on a regular basis. The eventual goal of the somatic work with the DOC project is to “de-engergize” them, but initially you often need to put distance between you and your family. Eventually you will be able to enjoy your family at a much deeper level.

The holidays

I was reminded of this problem in a very profound manner a couple of years ago. I had worked with a severely disabled gentleman who had a marked decrease in pain and improvement in his quality of life as he worked with the DOC project. Every holiday was a disaster as his family overtly reminded him that he was “not normal” nor ever would be. Finally about a year ago he caved in and descended back into his familiar anger patterns. His life is now more miserable than ever.

The crab bucket

I ran across a metaphor I am sharing with you from Wikipedia. Crab fishermen never need to put a lid on the bucket of crabs they have trapped. As soon as one tries to escape several other crabs will grab onto it and pull it back into the bucket.

Why be successful?

There have been multiple surveys showing that if a given person is successful that few others are truly happy for their victories. They become jealous and backbiting. How often are you excited by another person’s success, especially if they are a close friend? Why do we instinctively jump to the thought, “Why not me?” From elementary school on, being different or unique, either in a positive or negative way, is grounds for being bullied. Wouldn’t it be much more enjoyable and interesting to celebrate differences?

Breaking loose from your family and its patterns is one of the biggest obstacles on your road to a fulfilling and pain free life. What is your role in preventing others close to you from being successful?

The post Escaping Your Family – The Crab Bucket first appeared on Back in Control.

The post Escaping Your Family – The Crab Bucket appeared first on Back in Control.