• Understanding the nature of chronic disease and the principles behind the solutions, allows you to fully engage in your care.
• Characteristics that keep us alive are what also create disease states.
• Chronic pain is a neurological diagnosis that has profound effects on your body’s physiological state. Existing in flight or fight breaks down your body.
• Survival depends on the protection of anxiety and anger. Letting go of trying to fight or change them releases energy to live your life.
• The essence of chronic illness is living in sustained threat and the solution lies in finding safety.

Here is a review of some characteristics of staying alive, which are the same ones that cause illness and disease.

Your health is dependent on the amount of time your body is in a physiological state of threat compared to feeling safe. Life is dependent on feeling safe in order to regenerate and also dealing with threats in order to survive. But, when you are exposed to sustained threat physiology, your body will break down.¹

Physical and mental symptoms are the result of each organ system in your body uniquely responding to your body’s chemical makeup.² In addition to the multiple physical symptoms, the sensations created by the flight or fight inflammatory state are called anxiety and anger. They are the result of threats, not the cause. They are also powerful, uncontrolable, amoral, destructive, and necessary to maintain life.

The starting point

Picture a complex circuit board that has trillions of etched-in circuits that represent your lifetime of programming. These circuits are not alterable for several reasons. First, they are memorized, similar to riding a bicycle.³ Second, any time you spend trying to analyze and figure them out is counterproductive. The more attention you pay to these patterns of activity, the more they are reinforced. Finally, as the powerful unconscious brain is estimated to process 20 million bits of information per second⁴ (compared to your conscious brain only processing 40 bits per second), rational interventions alone, such as talk therapy, cannot hope to make a dent in these circuits. It is like trying to move a high mountain peak with a shovel. It is not going to happen and much of your life’s energy is consumed in the process of trying.

It sounds discouraging. You have these permanently embedded pain circuits in your brain and the harder to try to fix them, the more they are reinforced. They are also necessary and much more powerful than your conscious brain. So, what do you do?

Solving the unsolvable

Understanding that you cannot solve or improve these unpleasant circuits is the first and necessary principle behind the solution. You must put down your shovel and move on. Instead of trying to “fix yourself,” new strategies are needed to create fresh circuits in your brain. Most of these approaches utilize methods that connect with the unconscious part of your brain with repetition. It’s similar to diverting a river into a different channel. You begin with small steps to create these new channels, but eventually the water’s flow will aid the process.

So why would we ever take anxiety or anger personally? They are inherent for survival but have little, if anything, to do with who we are. By letting go of trying to solve an unchangeable situation, you’ll experience a huge energy surge that allows you to move forward.

The second principle is that since it is impossible to fix your pain circuits, you must develop or shift onto a new set of circuits that aren’t painful. There are many ways of stimulating these changes, and the process is called, “neuroplasticity.” It is similar to installing a new virtual computer on your desktop. With repetition, it is remarkable how quickly these changes happen. Since your brain will develop wherever you place your attention, you must move towards your vision instead of continually trying to fix yourself. As you embrace wellness, you’ll crowd out pain.

Third, you cannot move forward until you have let go of the past. This is difficult because when you are trapped by a chronic disease, you are legitimately angry. However, you are also stuck. There are ways to effectively process anger and there are tremendous benefits to learning these tools.

Fourth, The DOC Journey is simply a framework that organizes your thinking and presents tools in a way that you can apply them in a focused manner. The steps in healing are:

• Awareness – you have to understand a problem before you can solve it.
• Treating all aspects of pain simultaneously – it is similar to fighting a forest fire. Every treatment can contribute to a good outcome, but nothing will work in isolation.
• You take control of your care. Since chronic pain is complex and you are a unique individual, each person’s situation is incredibly complicated. You are the only person that can possibly solve it with guidance. If you are not in charge, nothing can happen.

Fifth, a core concept of The Journey is awareness. It includes awareness of:

• Your emotions
  • Suppressed emotions are especially problematic
• The impact of your actions on others and theirs on you
• The nature of chronic pain
• The principles behind the solutions to chronic disease
• Your specific diagnosis
• Your vision of what you want your life to look like

Finally, since your sense of well-being and health is dependent on the composition of your body’s physiological state, all of your efforts are intended to stimulate it directly or indirectly into a safety state. There are three areas of focus:

• Input – how you process your stresses
• The state of your nervous system – calm or hypervigilant
• Output – it is desirable to remain in balance or safety and minimize the amount of time you are in a threat state.

The desired safety state allows you to feel content and secure, have a slower metabolic rate (rate you burn fuel), less inflammation, and lower levels of stress hormones. Optimizing your body’s physiological state from threat to safety has a profound effect on your health and quality of life.

Recap

The solutions to solving and preventing chronic disease lie in understanding the principles behind them. Embedding these of concepts allows you to continually practice them. This is in contrast to randomly learning techniques to fix yourself. The process gives you control of regulating your body’s physiology from one of threat state to safety.

Questions and considerations

1. Consider that it is your whole body that responds to your immediate set of circumstances in order to optimize your chances of survival. Your nervous system is the processing center for sensory input and an integral part of the reaction. There is absolutely no separation of the mind and body and why even the use of the term, “Mind Body” is inaccurate.
2. Why would you take your powerful survival reaction personally? It is intended to feel so unpleasant so as to force you to act. It is what you possess and not who you are.
3. You’ll be taken on a journey that will allow you to depersonalize this flight or flight reaction. It is just a part of your daily life.
4. Take some time to review the above principles of solving chronic disease. They will eventually enter every aspect of your life and become automatic. As you spend a lesser amount of time in a threat state, you will be able to move forward into a new life and thrive.
5. You can’t fix chronic disease. You must let go and move into wellness.

References:

1. Torrance N, et al. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain (2010);14:380-386.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Hashmi, JA et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751 – 2768.

4. Trincker, Dietrich. 1965 lecture at the University of Kiel. German physiologist

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• Consider ongoing environmental input separately from your body’s responses.
• Understand the essence of illness/ disease is sustained exposure to real or perceived threats.
  • It creates an adverse chemical profile that increases metabolism (your rate of fuel consumption) and causes inflammation. Your tissues will be physically damaged over time.
• The core of the solution is discovering and learning methods to shift your physiology (body’s function) from threat (fight and flight) to safety (rest and digest).

All living creatures survive by mobilizing resources in their bodies to deal with threats and replenishing them when feeling safe. Both are necessary for life. However, sustained exposure to threats causes a shift in the chemical profile that breaks down your body causing mental and physical diseases. (1)

It is important to understand the nature of threats, the various ways they present, and the makeup of your body’s neurochemistry in a survival flight or fight mode. In other words, your body is collecting massive amount of data from multiple sensors in your body that is transmitted to the nervous system, which is translating it into action. The reaction causes changes in your physiology, stimulates physical actions, and creates behaviors that are appropriate to the situation.

Physiology

Physiology is the term that describes how the body functions. We stay alive because living creatures maintain an incredibly delicate balance of the body’s acid/ base balance, electrolytes, blood pressure, temperature, heart rate, and the list is long. It is a dynamic process that changes by the second in response to input from your surroundings.

The physiological changes cause sensations that we call emotions. But emotions are just words that describe what you are feeling when your body is in action. Your physiological state affects every organ system and translates into symptoms  Every physical and mental symptom you experience is explained by an inherited problem, an identifiable structural abnormality, or changes in your body’s physiology. There no such entity as unexplained symptoms.

Nature of threats

Any mental or physical threat, perceived or real, is going to be met with a defensive response from your body. Much of this mediated through the autonomic nervous system (ANS). It is called “autonomic” because all the effects are automatic in response to input. The stimulation/ survival aspect is a function of  the sympathetic nervous system (SNS), and the calming part is mediated through the parasympathetic nervous system (PNS). The vagus nerve is the main nerve that transmits these signals. It is the 10^th cranial nerve that originates in the midbrain just below the brain.

Physical threats include allergens, parasites, bacteria, viruses, lions, tigers, bears, and people we perceive as or are dangerous. Less obvious, but even more inflammatory, are mental threats, because we can’t physically escape our thoughts and emotions. Repressed ones are even  more problematic.

Mental threats are processed in a similar manner in the brain as physical ones and cause an inflammatory response that forms the basis for chronic mental and physical disease when sustained. Examples of mental threats are memories, negative thoughts, suppressions, repressions, insecurities (social, financial, health, etc.), cognitive distortions, and loss of life perspective and purpose.

Your body’s chemical makeup under threat

The survival response is the well-known flight, fight, freeze, and faint reaction. (2) We are all familiar with the physical manifestations of threat that includes an increased heart rate, sweating, muscle tension, and elevated blood pressure. But what you may not know is that the immune system also gets fired up and mobilizes many types of cells that fend off predators such as bacteria, viruses, and cancer cells. Cytokines are the signaling mechanism to mobilize or calm this response.

Cytokines are small proteins that serve as messengers throughout the body, transmitting higher-level signals and coordinating activities at the cellular level. They are central to modulating the immune system and inflammatory response. There are two kinds of cytokines: pro-inflammatory (Pro-I) and anti-inflammatory (Anti-I). While Pro-I cytokines protect us by warding off acute perils, Anti-I cytokines keep us safe by allowing us to regenerate, thrive, and prepare us for battle with environmental/ internal enemies.

When threats activate pro-inflammatory (Pro-I) cytokines, the resulting inflammation allows “warrior cells” to exit the blood stream through widened openings in the vessels to destroy the invaders (antigens). However, when they are chronically activated, inflammatory cells will destroy normal tissues. They are elevated in almost every chronic disease state. For example, researchers discovered that some types of depression are inflammatory responses of the central nervous system to chronic stress. (3)  Anxiety, bipolar, obsessive compulsive disorder (OCD), and schizophrenia also have elevated inflammatory markers. (4) Chronic stress also causes early mortality. (5)

Your body’s chemical profile when feeling Safe

 Anti-inflammatory (Anti-I) safety cytokines are the underpinnings of health and wellness. With the elevations of the Anti-I’s, we see the states of “breed and feed” and “digest and rest.” We are restorative, connected, bonded, sexual, reproductive, cognitive and creative. We also have high immunity.

There is a dramatic difference in your body’s neurochemical makeup when you feel safe compared to sensing danger. There is a deep sense of relaxation, contentment, sense of well-being. So, why do we not exist in this state most of the time? Generating a sense of safety is complicated for humans in that we have language and consciousness that is not present in any other species of life. You cannot outrun your mind.

The essence of healing

The essence of disease is sustained threat and the solution lies in connecting to your sense of safety using specific strategies.

Discovery and acknowledgement of all our threats–whether real, imagined, anticipated, or repressed–is the first step towards addressing them. The second is choosing an adaptive rather than maladaptive escapes to safety, whether the threat be physical or spiritual. We are better at physical escapes to safety than we are at spiritual ones.

If you have a choice of solving an unpleasant situation, that is clearly the first choice. But the stresses that have the greatest impact on your health are the ones that are not solvable. Being trapped by anything or anyone really fires up your defenses. But since you can’t escape your consciousness, what can you do?

There are multiple ways of dealing with threat while creating safety.

It is the reason that The DOC Journey is a specific sequence. The anger from being trapped by pain is intense and unpleasant but also powerful and protective. The antithesis of anger is being vulnerable, which living creatures are not naturally programmed to allow. You must build a foundation and learn safety at a doable level. Then it is important to proceed at your own pace to tolerate being vulnerable and still feel safe. If you dive in too quickly without a solid base, you will react in a way that makes your defenses stronger. As you deliberately progress through the healing journey, you will learn to trust your skills and discover ways to find safety regardless of the circumstances. You have regained control of your life.

Recap

The cause of chronic disease is sustained exposure to threats. The solution lies in learning ways to find safety. Although you cannot control your thoughts and most of your external stresses, you do have control of shifting your body’s physiology. They are simple tools that become automatic with repetition. Acquiring these skills will allow you to live your life on your own terms – and feel safe.

What about the need to tolerate vulnerability? There are no rewards in nature for being vulnerable. You won’t survive and that includes humans. Yet being vulnerable is the core of human relationships. But what if you were abused and don’t inherently trust people – and why would you?

We have a dilemma

• The essence of chronic disease is sustained exposure to threat (feeling vulnerable).
• Yet allowing yourself to be vulnerable is at the core of human relationships.
  • You must be able to trust someone before that can happen.
  • If you had a chaotic, even abusive upbringing, how do you know who to trust?
• What happens if you don’t have the tools to deal with rejection or being hurt?
• How can you feel safe while allowing vulnerability?
  • Every relationship requires taking risks.

This is one of the reasons you must learn in a sequence, steps, and at a comfortable level. It is not a straight-line path, nor will it ever be. You do have to care for yourself and learn to “fail.” Every person has their own way of learning to feel safe and live life on his or her own terms.

References:

1. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013);7/4:217-227. 10.1111/spc3.12020
2. Porges Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
3. deHeer, EW, et al. The association of depression and anxiety with pain: A study from NESDA. PLOSone (2014); 9:1-11. e106907.
4. Shields SS, et al. Psychosocial interventions and immune system function. JAMA Psychiatry(2020); doi:1001/jamapsychiatry.2020.0431
5. Torrance N, et al. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain (2010);14:380-386.

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Trying not to think about something will cause you to think about it more. All of us know this phenomenon but we don’t know how to deal with it. The deadliest emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by it. Prolonged exposure to raw anxiety is the worst part of the human existence. It is a universal problem that few people want to admit to much less discuss.

Nate

A few weeks ago, I was discussing the problem with one of my best friends, George. He has an 11-year-old son, Nate, who is personable, athletic, good-looking, and has many friends. He has a wonderful family life. George has engaged his family with many of the principles of dealing with Neurophysiologic Disorder. (NPD) One of the exercises is the writing down of his  thoughts and throwing them away. Recently he suggested that Nate draw a picture of himself with these thoughts.

He showed me the drawing. It was brutal. “I am ugly. I have no friends. No one likes me. I am stupid.” The list went on for 15 thoughts that were equally as negative. How could this be? He is living a childhood that remarkably rich and supportive. It reinforced to me that every human being struggles with disruptive thoughts.

Harvard study – white bears

In 1987 Dr. Daniel Wegner, a Harvard psychologist published a paper, The Paradoxical Effects of Thought Suppression. (1) The experiment is commonly referred to as “White Bears”. He asked a group of students not to think about white bears. He designed it in a way that demonstrated that when you try not to think about something, not only do you think about it more; you think about it a lot more. He used the term, “trampoline effect.” He pointed out in an essay; The Seed of our Own Undoing, that simply writing down or saying the thoughts you are suppressing interrupts the phenomenon.

“ANTS”

David Burns in his book, Feeling Good (2) uses a term he calls “ANTS”, which stands for “automatic negative thoughts”.  These ANTS are a universal part of the human experience. Since I picked up his book in 1990, I have always wondered why we don’t have “APTS” or “automatic positive thoughts.”  WE DON’T SUPPRESS POSITVE THOUGHTS.

Pain, ANTS, and white bears

People suffering from chronic pain lose their sense of humor. Pain causes anxiety and when you are it, extreme frustration and anger will run your life. Anger results from loss of control. What causes the need for control is anxiety. Anger is just anxiety on steroids. One step worse than suppressing anxiety is suppressing anger. The eventual outcome is rage. My term for the darkness that consumes my patients in pain (and historically me) is the “Abyss.”

There is a solution

I have learned that pain, anxiety, and anger are classic symptoms of the Neurophysiologic Disorder (NPD). Dr. John Sarno first described it in the 1980’s under the term, “Tension Myositis Syndrome” (TMS).  (3) There are least 30 other MBS symptoms connected to and caused by the nervous system. (4) The nervous system component is NOT psychological it is a programming issue. Like any learned skill such as riding a bicycle these pathways are permanent.

Anxiety is a physiological reaction to sensory input of any kind including thoughts. It results in behavior that causes you to react in a way to protect yourself. You can talk about it all day long, but you cannot get rid of anxiety whether it is from a  mental or physical source. It is a symptom of NPD.

Fortunately your conscious brain focuses on one thing at a time. That is why we are not safe texting and driving. When your mind is here it is not there. By creating alternate pathways around your fixed circuits, you can shift your nervous system into a new set of pathways. Additionally, we now know your brain can grow new nerve cells at any age. The term is “neuroplasticity.” At a certain tipping point your pain pathways will become dormant. The switches are turned off. Anxiety and anger also will dramatically drop.

I experienced 17 of the 33 symptoms of NPD disappear. I not only have my life back, but I also have a new life.

Connecting thoughts with physical sensations is one way of creating new pathways. One foundation of treating NPD is the simple the act of writing down your thoughts and immediately throwing them away.

Patients won’t write

But I often cannot persuade my patients to begin this exercise. It’s the necessary foundational step of the reprogramming process, which is to create an awareness of these ANTS. The thoughts can be positive or negative. I have my tear them up both to write with freedom and not to spend any time analyzing them. This exercise is only a separation process from your conscious thoughts.

Regarding the negative thoughts that arise, my patient’s first response is, “This is not who I am.” That is correct. These thoughts are not who you are. They are JUST neurological connections and the opposite of you who are. Otherwise, you would not be suppressing them. You are only giving them life by blocking them. Your brain will develop wherever you place your attention.

We all know that being reassured that our hidden thoughts aren’t valid does not make them disappear. I could collect dozens of signatures and testimonials from Nate’s peers and give them to him. He could win a “greatest human being contest” along with a big trophy. How would that work? I predict, based on my personal experience with NPD, the next set of thoughts would be centered on, “They don’t really know me.”

Possibilities

What if we could teach these simple writing exercises to our children in pre-school? We would have a shot at solving chronic pain at a societal level.

References

1. Wegener, D.M., et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Burns, David. Feeling Good. Avon Books, Harper Collins, New York, NY, 1999.
3. Sarno, John.Mind Over Back Pain. Berkley, 1999
4. Schubiner, Howard.Unlearn Your Pain. Mind Body Publishing, 2010.

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