Feeling safe

There are many benefits of feeling safe and secure, with the first one being your body’s chemical makeup consists of reward hormones and you feel great. The opposite occurs if you constantly feel on guard. It is in the first scenario that you feel free to create, explore, play and use your imagination. Your capacity to interact with the world in a meaningful and effective manner is increased.

When you are constantly on hyper-vigilant and trying to protect yourself from real or imagined threats, your short and long-term quality of life will be compromised. One of the effects is that more situations in the present will resemble what you learned was unsafe in your childhood. You will be over-reacting to scenarios that really aren’t dangerous, but your brain won’t know it. Your body will feel under threat and your chemical makeup will keep you on “high-alert”. It will be harder to relax and enjoy your life.

ACE score

This is documented by the ACE (adverse childhood experiences) study done in 1996. (1) A survey of challenging childhood circumstances was given to over 17,000 people and health surveys were administered. There were ten exposures.

Household dysfunction

• Substance Abuse
• Parental separation/ divorce
• Parent with mental illness
• Battered mother
• Criminal behavior

Abuse

• Physical
• Psychological
• Sexual

Neglect

• Emotional
• Physical

Only 30% of participants had a score of zero and 26% had a score of 3 or more. There were increased chances of severe health consequences with higher ACE scores.

• Depression/ anxiety
• Obesity/ eating Disorders
• Heart disease/ hypertension
• Suicide
• Teen high-risk behaviors/ pregnancy
• High risk of being a victim of domestic violence
• Substance abuse
• Smoking/ COPD
• Unstable home/ family life
• Poor workplace performance
• Early death

America, on the whole, is not doing a great job of parenting. We are modeling behaviors that we wouldn’t want to see in our children. My ACE score is five and I developed 17 of over 30 possible symptoms related to sustained exposure to high levels of stress hormones. My migraines began when I was five years-old. The list began to grow and reached 17 of them by the time I was 37. Yet no physician could provide an answer or a treatment approach. All of symptoms have resolved. But that is not the message of this article. It was your parent’s responsibility to both protect and nurture you. Mine did not. What about yours? What kind of home environment are you currently  creating for your family?

Oak tree vs army barrack

One of my favorite personal metaphors is that of a large Valley Oak tree, which were abundant in Napa Valley, CA before there were so many vineyards. I view the role of parents of being the trunk of the tree, providing stability. One responsibility is for each member to continue to evolve through awareness and self-exploration, which creates deeper roots and emotional support. The first responsibility of parents is to each other and continuing to create a lasting stable and loving relationship. The expansive branches are the opportunities for all the individuals in the family to be creative and also be protected from the elements.

The opposite scenario is that of a military barrack. There is rigid order and unwavering expectation that every command will be immediately responded to. Nothing you can or will do will be “good enough.” If you don’t comply as deemed adequate by one of your superiors, you will be disciplined and often harshly. You may be made into an example. You can never let your guard down, especially in the presence of your officers. The list of demands is endless with an equally long range of possible consequences. Does any of this feel familiar? I don’t what percent of families have this framework as the reference point, but based on the ACE data, I would daresay that it is high. Is it any wonder that so many of us have this voice in our heads of, “Not good enough.” It can be deeply embedded in your brain and you can’t outrun your mind.

There several factors that result in a home that more resembles an army barrack than a spreading oak tree.

• It was the way you were raised and the way parenting was modeled.
• Everyone has anxiety and it is intended create control behavior. The more control you exert, the less anxiety. Since your family is dependent on you, they cannot easily escape from your need for control.
• You have labeled yourself as the parent and somehow you have a responsibility to “raise your child” properly. I read a book, Parent Effectiveness Training when my son was young and thank goodness I read it so early. The book had a major impact on my life. One core principle is that the label of “child” disappears, and it becomes a human-to-human interaction. Prior to reading it, my obsession was discipline and control and I was highly critical of “permissive parents.”
• All of these family issues are dramatically magnified if one or both parents are suffering from chronic mental or physical pain. You are trapped, angry, and awareness of other’s needs is blocked. It is the essence of abuse.

Awareness

All of the healing process begins with awareness of what is happening in the current moment. What is your family environment like now? Each half of the couple needs to write it down and compare notes. If you can’t have a civil conversation, then you already have your answer. Anger that is often front and center will also block constructive dialogue.

Moving forward

What kind of family life would you like to create? What is your vision. This step should be done as a couple.

How do you want to accomplish it and what is the timeline? What doesn’t work is waiting your pain to first resolve. Every day your family is encompassed by anger, it is damaging them.

Any and every person has the capacity to thrive and move forward when starting from a strong foundation based on love, support, laughter, safety, and play. Eventual successes will be more sustained. One is also able to enjoy life.

It has been known for decades that employees thrive in this kind of work environment. Why not allow your family to thrive?

1. Anda RF, et al. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience (2006); 256: 174–186.

The post Do You Feel Safe in Your Own Home? first appeared on Back in Control.

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Then you add partners (your children) who have a much deeper relationship with the business of being a family. They are completely dependent on the family unit as a base of operations, for patterning for their emotional makeup, developing coping strategies, and learning most of their life relationship skills. They need a safe and nurturing environment to develop a strong identity and thrive.

Your family as a business

A successful enterprise generally has an idea of its purpose and it is often elucidated in a business plan. It begins with a vision and mission statement. It starts with assessing where you are, where do you want to go, and how are you going to get there? Without a least a simple description of these steps, you will remain in a reactive mode and focusing more on surviving day to day. You can do it, but is the life you have the life that you want?

There has to be some structure and delineation responsibilities and tasks. One can’t happen that well without the other. So, learning organizational and execution skills is important.

Then there are the finances, which is well-known to be the most common reason for family conflict. The battles will be more intense without clear data and a sense of how to manage money as a family unit. Who can spend what with what constraints?

Finally, why are you a family and what is your vision of enjoying life? Has your family been under so much stress that you have forgotten the reason you are together in the first place?

Some starting suggestions

There are an endless number of ways this can all play out but the most important step is just doing it. Here are a few suggestions.

• Create a mission statement
  • Make it as detailed as you are comfortable with.
  • Create protected time in a retreat atmosphere without any digital devices or outside interferences.
  • Write down and create your document quickly.
  • Put it in a spot that is easily seen and refer to it frequently.
• Hold regular family meetings with guidelines and an agenda.
  • Have a defined start and stop time.
  • No fighting (Different than a direct discussion).
  • Frequency
    • Weekly short ones at a regular time
    • Quarterly evening meetings to stay connected with the mission statement
    • Annual retreat to update the vision and mission statement.
  • Look up resources to create a more detailed family planning process.
    • Here is one great set of suggestions from a businessman written in the Wall Street Journal.

How can I do this when I am in pain?

I am extremely aware of the obstacles that are present when a family member is in chronic pain. As we worked with many families over the years, it became apparent how destructive chronic pain was to the whole family. Often, it bordered on complete chaos, just trying to get through the day. You may think that these suggestions are ridiculous in light of your suffering. And BTW, they are. That is why the rest of the healing process must be learned well enough to begin to calm down your nervous system. The essence of healing chronic pain is feeling safe, which means you are able to optimize your body’s chemical profile from stress hormones to relaxation ones. You will be able to think more clearly and begin to consider creating a functional family unit.

However, structure is also a powerful antidote for anxiety. There is a strong bi-directional effect, in that a stable family unit aids in aiding your healing. Even a discussion about how this might look in the midst of the disruption caused by your pain can begin to break up the cycle. Just the one rule of NEVER discussing your pain with anyone, especially your family members causes a shift in the energy of the home. Holding family meetings, even if they are disorganized will add to the process. Making a family decision to, “Be nice” is a major step, even if you frequently fail.

You may still be thinking that none this makes any sense and I must not have any idea of what chronic pain does to a family. Let me give you a couple of insights that represent the tip of the iceberg.

I do know family chaos

My father was a physician who simply was never home. My mother was emotionally unstable and had four children in five years, which put her right over the edge. She suffered from chronic pain and would find ways to get a hold of opioids and benzos. She was a hoarder and would sit in her room most of the day trying to clean it. My father would frequently come home at nine o’clock at night and have to wash piles of dirty dishes. Whenever they sat down to pay bills, there was at least a two-hour screaming match. There was no sense of direction and there was also no way to make my mother happy. We kept moving from city to city and I lived in 12 different houses by the time I was 16 years old. My mother would focus on the negatives of a given situation and her endless complaining was a significant factor in causing us to move so often.

This lack of structure and stability did have a severe impact on me and most of my life efforts were focused on running from all of this chaos. I did escape with one of the strategies being that of an overachiever. It worked until it didn’t. I ran out of fuel and crashed at age 37. I was on the same pathway as my family; reacting and surviving instead of pursuing a vision. I spent the next 15 years in severe chronic pain.

If you don’t make a decision to take control of your life and be in charge of your family, who will? Where is the endpoint? Creating and executing a plan for you and then for your family will be part of being able to calm down your turbo-charged nervous system. Continuing to wander without direction will not. You may not feel like you can or want to take this step of creating structure for your family. Just do it. It will have a remarkable healing effect on everyone.

You started out like this.

What does it all look like now?

The post Develop a “Family Business” Business Plan first appeared on Back in Control.

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 Polishing Rocks

 “Now, as for stability, check out the way stones are polished in a tumbler. It all starts with these rather nondescript, encrusted rocks that only a trained eye could see had something precious about them. Add a bit of water, a good amount of sand or other annoying grit, and the rocks tumble and tumble until they come out shiny gems. All their rough edges, the hardened muck and mire of ages – it vanishes! The process is so simple, the results seem almost unbelievable.

Well, maybe, maybe not… Ask one of those rocks! While the rock and all of its companions are being polished into jewel-like luster, they (and all that grit) are continually scraping and jostling each other. And let’s not forget all the water that facilitates things!

The gritty water essential to both enclosure and stability is sometimes annoying to the tumbling community. But that doesn’t remove its usefulness. The spinning employed, at times intense, is the harsh reality of objectivity and outside-referenced truth. Like any rock tumbler or community, everybody gets polished, one way or the other. How very like Benedictine stability in community and the enclosure of the monastery! Community is any connected group, workplace, or home. Enclosure is your home, as well as your heart.

Without being obsessive, or making the people who live with you crazy, guard what comes into your enclosure –  both heart and home. There is a switch on your TV. There is a less visible, but equally effective one on your mouth. There is a useful one on your heart and thoughts, too.

Guard the people who tumble about getting polished with you, too, especially the annoying ones. While they are tough to be around, they are the ones doing you the most good! Without the abrasions they share with you, the process would take much longer.”

My colleague’s final comment was, “Well, it sure looks like I am being called to pay close attention to the tumblers in my life!”

Rock crusher

What about when the tumbling becomes too extreme? When the force of contact goes beyond abrasion and leaves scars? After talking to hundreds of couples dealing with chronic pain, I became aware of people caught in a rock-crushing relationship.

A rock crusher takes large rocks and breaks them down into smaller and smaller pieces. The end result is usually gravel, but can be as fine as sand. There is no resemblance to the original rock, and it certainly isn’t polished.

When people are angry, they are reactive and often aggressive to those close to them, whether it is at home or work. When you are consumed and trapped by pain, anger is an understandable response. However, the support system that you need to move forward is destroyed and pushed away.

The bigger problem with acting out when you are angry is that you lose awareness of the impact of your behavior on those around you. Anger completely blocks awareness, which is the essence of any successful relationship. Lack of awareness is the essence of abuse, which can range from mild to extreme. It isn’t logical that you would treat people you love so poorly, yet in my clinic, we heard about it on a daily basis. The partner or spouse was usually the target, but often children were in the line of fire. Anger is only about survival and is destructive. Protect your family from your pain

The essence of  a relationship

While mulling over the differences between a rock tumbler and a rock crusher, I came across this piece written by one of my medical school classmates. He has also been married for over 40 years.

“For couples so eager to call it quits and throw in the towel on your relationship because everything isn’t ‘perfect’…here is some food for thought:

Lifelong commitment is not what most people think it is. It’s not waking up every morning to make breakfast and eat together. It’s not cuddling in bed until both of you fall asleep. It’s not a clean home filled with laughter and love making every day.

It’s someone who steals all the covers, and snores. It’s slammed doors, and a few harsh words at times.

It’s stubbornly disagreeing and giving each other the silent treatment until your hearts heal, and then you find forgiveness.

It’s coming home to the same person every day that loves and cares about you in spite of (and because of), who you are.

It’s laughing about the one time you accidentally did something stupid.

It’s about dirty laundry and unmade beds.

It’s about helping each other with the hard work of life.

It’s about swallowing the nagging words instead of saying them out loud.

It’s about eating the easiest meal you can make and sitting down together at a late hour because you both had a crazy day.

It’s when you have an emotional breakdown and your love lays down with you and holds you and tells you everything is going to be okay. And you believe them.

It’s about still loving someone even though sometimes they make you absolutely insane.

Loving someone isn’t always easy – sometimes it’s hard. But it is amazing and comforting and one of the best things you will ever experience.”

Who are you?

Committing to staying in the tumbler with your partner is a humbling and rewarding experience, although it would be nice if there was an easier way. And we all need to acknowledge the different roles that we play in one another’s lives. Are you tumbling or crushing?

This idea extends to all relationships.

What about work? If you are the supervisor, are you listening and supporting your staff, or are you overly focused on enforcing the rules?

What about your children? Do you remain flexible and adaptive, or do you take advantage of your power over them?

Are you sticking with toxic relationships out of fear?

Are you willing to continue to work on a friendship when he or she has behaved badly, but expresses a sincere desire to change?

No one can answer these questions but you.

So again, I ask – are you in the tumbler or have you jumped out?  Are you being crushed or crushing? Becoming aware is the first step in moving forward.

.

The post Relationships and Rock Tumblers first appeared on Back in Control.

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For some, the holidays are synonymous with a strong sense of familial closeness and love. However, this is not the case with many family gatherings, where relatives trigger each other, and chaos quickly ensues. If this describes your experience with the holidays, then this article is for you.

I’ll never forget one Christmas break during my second year in medical school. I hadn’t been home for two years because of study and work demands. I was excited to see my family. Within five minutes, my mother launched into a fight that had started two years earlier. She picked it up almost to the sentence. I was both dumbfounded and upset. This wasn’t part of my vacation plans.

This isn’t an uncommon occurrence.  You’ve waited all year to be with those who you love, and people aren’t getting along. It goes both ways in that loneliness is also magnified. The medical wards are usually full because many patients have increased problems around drugs and alcohol. It doesn’t make sense, except it does if you understand the mismatch between the conscious and unconscious brain and the nature of triggers. So what happens?  Happy holidays – not

Triggers

Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.

The reason why family dynamics can be so volatile, is that most of your reactions are programmed by your parents during the first 12 years of life, especially the first two. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from an abusive family, your reactions to the present will be intense, although the present “danger” might be minimal. It is well-documented in the ACE (adverse childhood experiences) studies that the incidence of chronic pain, anxiety, depression, obesity, heart disease and suicide are higher than the norm. You needed to be hypervigilant as a child and it doesn’t change as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.

During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder they can be problematic. Landmines are everywhere.

How did this happen? I watch parents with babies and young children laugh, hold and play with them. It’s a precious time and they would do anything for them. Yet by five or six years-old, there is often a lot of arguing and fighting between parents and children. Suffering from chronic pain doesn’t help. I don’t have to detail what frequently happens during the teen years. The household can be a battlefield — a war without any hope of an end. I don’t how common this scenario is, but I am seeing it frequently in my practice. I only need to ask a few questions and be observant. Many family situations are intolerable.

Learned behaviors

The problem is that we program our own triggers into our offspring. They watch their parents become upset with them or each other and they learn their own behaviors in response to similar stressors. Then they become the cause of deep reactions in their parents. Why else would you yell at this person who used to be this incredibly wonderful child you brought into this world? But you are the adult and you are now in the same boxing ring as your 12-year-old. It’s your role and responsibility to provide a safe environment where your family can feel safe and nurtured. Only then can your child connect with his or her creativity and thrive.

You also may be critical of them. Really?? Anytime you are critical of someone, you have projected your view of you onto them. Remember that you are the one who taught them these behaviors that are now upsetting to you. It is remarkable the number of friends we have whose parents continue to be incredibly critical of them well into adulthood. The negativity is often intense and occurs in the face of the son or daughter doing the best they can to help and be supportive. The intensity of the verbal barrage is unbelievable to me and seems to worsen with age.

So, you have planted your own landmines. Would you yell at a stranger with the same intensity that you talk to your child or spouse? How do you think you appear to them when you are upset? Is that what you want your children to see?

Now it’s the Christmas season, and these deep triggers are coming back into your world. You have missed your family and want to be with them. What are you going to do? How are you going to handle being triggered, because it is inevitable you will be set off at some level. The two faces of Christmas

Here are a few suggestions, most of which I have learned the hard way.

• Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
• Don’t give any unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent’s criticism at any age?
• Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
• Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
• If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
• Be curious and genuinely interested in what your family is up to.
• Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.
• Read Parent Effectiveness Training by Dr. Thomas Gordon. It is a classic and the most influential book that I have ever read on any topic.

I want to re-emphasize the powerful irrational nature of being triggered. It is only you and not them that is responsible for your anger. (I well-know that it still feels like it is him or her that upset you). Own it. It is yours.

You’re the one who created the behavior in your child that is now upsetting you. Own that too! Remember how excited you were when they came into the world. Remember the good times and don’t spend time on past differences. Why? It’s done.

A Cigna insurance study in 2018 demonstrated about 40% of Americans feel socially isolated.(1) During my pain experience, loneliness might have been the one most crushing aspect of my ordeal. It was brutal. Connect with gratitude and remember how lucky you are to have friends and family. If you are someone reading this who is socially isolated, work on finding a way to re-connect with someone or give back. I am aware how terrible a feeling this is, and I’m really sorry. The Holidays do make it worse. But by being aware of the impact, you have a higher chance of dealing with it.

Make a commitment to enjoy your holiday season and if you detonate a landmine, use the situation as an opportunity to practice your own tools of staying connected and centered. Become the source of Holiday cheer!

1. Cigna U.S Loneliness Index (2018).

The post Holiday Landmines – Your Family first appeared on Back in Control.

The post Holiday Landmines – Your Family appeared first on Back in Control.

I have also witnessed several families re-uniting. Here is one of these stories.

Needed Surgery

Bill was a middle-aged executive who has experienced many stress-related physical symptoms. He had a structural low back problem that required a multiple-level decompression. He had severe pain in both of his legs that completely resolved with the operation.

He initially was not open to any of the ideas of the DOC project, but his pathology was so severe that I proceeded relatively quickly instead of having him go through the rehab prior to surgery (prehab). About a year later all of his pre-op symptoms recurred. I offered him a three level fusion to relieve his leg pain, but I was also suspicious he had triggered his old pain circuits. Although he was initially resistant to the rehab concepts, the magnitude of the recommended operation cause him to reconsider and he felt he had nothing to lose. Surgery was still on the table because his bone spurs were quite impressive.

WHEN A PRIOR PAIN CIRCUITS ARE TRIGGERED YOU CANNOT TELL THEM APART FROM THEM BEING CREATED BY A STRUCTURAL PROBLEM. THE PAIN IS IN EXACTLY THE SAME LOCATION AND HAS THE SAME INTENSITY – OR WORSE.

Within two weeks his pain abated and by six weeks it disappeared. What had fired up his nervous system and pain were problems at work, as well as serious issues with his marriage. A few months later his wife left him. Although he accepted his responsibility for her needing to leave he had a difficult time dealing with it. However, his pain didn’t return and he was becoming more proficient at using his tools to keep his nervous system calmed down. For me, this was all surprising because I had assumed that we would still be performing a surgical procedure.

Waking Up – his wife returned

Over the next couple of years he worked with a pain psychologist, psychiatrist, and with the DOC concepts. I saw him about every 4-6 weeks. Not only did his pain continue to remain minimal, his entire personality transformed from being obsessive and controlling to extremely warm and engaging. (Of course, it was always there) He came off all of his psych meds. One day he came to the office and he was beaming. His wife was coming back. This was the second couple I had seen re-united over a short period of time.

His letter

Dear Dr. Hanscom,

Fantastic to see you. During our meeting today, Sarah e-mailed me her travel plans. She leaves Wisconsin Monday, driving the car I bought her before we wed. Nevertheless, my outlook is “open hands”. (David Burn’s concept) I can be and am happy (enough) on my own with or without Sarah. Or with or without any romantic partner, I stand on my own.

I checked the DOC site for the printed version of Back In Control and I just bought it. As a DOC project participant, I want to share some of my experience.

I’ve nearly eliminated my physical pain and my residual “background” pain from psoriatic arthritis NO LONGER HURTS. This pain no longer gets to my emotions, UNLIKE the princess in The Princess and the Pea. But I still feel exquisitely vulnerable to emotional pain. To me, emotional pain really hurts badly. There’s just no other way to describe it.

But I have made progress. And just as in life my progress is NOT a straight line. I’ve had setbacks followed by advances then a stumble – just like real life. Here is what I credit, first and foremost.

First, without a doubt: Writing and throwing away the paper IMMEDIATELY afterwards. I regard throwing away the paper as equally important as purging the bladder & bowel. Writing and throwing away the paper MUST BE done to avoid systemic toxicity (My analogy is that it is similar to brushing your teeth).

Second: Physical exercise. Three times a week minimum of vigorous “break-a-heavy-sweat” exercise. It also MUST BE done to avoid systemic toxicity.

Third: I read. (For the record, the very first book that I read was: Back in Control.  Were it not for Back In Control by David Hanscom I wouldn’t have been nearly as motivated to read all these other books:

• The Pain Chronicles – Melanie Thernstrom
• Forgive for Good – Fred Luskin, PhD
• The Talent Code – Dan Coyle
• The Traveler’s Gift – Andy Andrews
• Epictetus and The Art of Living – Sharon LeBell
• Full Catastrophic Living – John Kabat-Zinn
• Journey into Love – Kani Comstock
• Demystifying Love – Stephen Levine
• Man’s Search for Meaning – Viktor Frankl
• Awareness – Anthony De Mello
• Thanks – Robert Emmons
• Feeling Good Together – David Burns, MD

Needless to say, I hadn’t read a single one of these books before embarking on the concepts presented in The DOC Journey.

Lastly I’ve got a personal recommendation –  cry. Not like an actor on TV, I mean really cry. And cry hard. You will feel better. It might take 3 hours or 3 days, but you WILL feel better. Show me a man with no cry in him and I’ll show you a severe case of deadly fired up nervous system and denial!

Best Regards,

Bill

P.S.

One item:  The “think positive” myth:

I know it’s just bull but I can clearly describe why…it’s about phonyness… or trying to pretend something bad is actually good? I mean this section on DOC delves into the fallacy of positive thinking:

• “Positive thinking is another way of suppressing negative thinking. This is a tricky concept in that by committing to a process of true forgiveness the results are very positive. You first have to go through the steps (allowing yourself to feel pain) to achieve the positive result.”

Can I convince my dad to stop saying, “think positive son!?” Maybe I’ll let him say his thing and ignore it. I once tried to articulate this point to my dad, but I couldn’t clearly describe the fallacy of the “power of positive thinking”.

My perspective on Bill’s journey

There are numerous points I could emphasize about his transformation, as it has completely enveloped him. I would like to touch on a few.

1 – Do you need your pain?

The first point is that he clearly expressed what I have observed for a long time: Humans consciously and unconsciously will do whatever it takes to avoid emotional pain. That includes experiencing physical pain, even if it is self-inflicted. I feel this is one of major reasons that patients won’t engage in that you have to learn to feel pain in order to move through it.

2 – Anyone can get better

The second is that with persistent engagement in the healing principles most people improve. It’s a matter of time and commitment. He was in as bad a mental and physical state as anyone I have worked with. Now he is pain free and thriving.

3 – The absolute block – Obsessive thought patterns

The third is that one of the core symptoms of NPD is obsessive thought patterns. This is a huge problem in that it also the symptom that blocks treatment. The one variable that predicts success is openness to engagement. In chronic pain, you’re legitimately angry and your mind is going a thousand miles an hour. It interferes with rational thinking. Some of the more common thoughts I hear are:

• “I’m feeling the pain right here. It’s not imaginary.”
• “The doctor is missing something. There has to be a reason for my pain.”
• “I’ve tried everything you’ve suggested, and it hasn’t worked. Why should I try this?”
• “I’m not angry!”

“You don’t believe me”

Then when I tell them that their spine has degeneration that is normal for their age and surgery isn’t indicated, they will often explode with anger. As I am not offering them an operation or a procedure I must not really believe that they are experiencing severe pain. I do believe them, but there doesn’t seem to be anything I can do to convince them to at least learn about the nature of chronic pain. I feel badly, but I have to let go quickly and hope they’ll circle back around again.

It took Bill over a year to be open and a few months to really immerse himself in NPD principles. I don’t know why he decided to engage, and I don’t think he does either. I do know that he is one of many examples that keeps me fired up about moving forward with this project.

The post A Couple Re-united first appeared on Back in Control.

The post A Couple Re-united appeared first on Back in Control.

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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What was also inspiring was the hope and optimism about the future and the endless dreams of adventure and accomplishment. I am always energized by this age group. I have noticed for years that this feeling is not as apparent in a gathering of adults. I am not sure what age is the tipping point where people seem to become more worn down. What is puzzling is that many adults have the means to actually do what the younger generation is dying to experience.

I always wonder in light of this initial celebration why so many marriages fail and why does the enthusiasm wane? It is a neurological trick. I realize that this is a simplistic statement and relationships are complicated. For example, many unseen problematic mental health and substance abuse issues can’t be concealed from a life partner. However, even in the best of situations, marriage is often more of a struggle than it seems it should be and why wouldn’t the excitement about your life together build as you continue to lay down the foundation.

Neurological tricks

The first neurological “trick” is the well-known effect of thought suppression. When you try not to think about something you not only think about it more, you think about it a lot more. There is a documented trampoline effect. So in a relationship, there are many things you like and admire about your spouse and a few traits that are less than ideal. Since they are minor in the big picture, you ignore (suppress) them. They are not that big of a deal; except you are exposed to them over and over and over again. They are still minor except that the suppression over time creates a monster in your brain. Five years later this simple irritation becomes intolerable and often irrational. The good traits are still there and maybe even better. Yet the irrational response begins to become overwhelming and “talking” it out can’t work with the unconscious brain. In spite of an overwhelming number of positive aspects of your commonly shared life, it frequently is blown up because this unconscious survival response is so much stronger than your rational brain.

The kitchen cabinet doors

Early on in our relationship, it frustrated my wife that I regularly didn’t close the kitchen cabinet doors. Initially, it wasn’t a big deal and not worth seriously addressing (at least for me). A couple of years into our marriage, it became a bigger issue.” I was doing it to irritate her and wasn’t respecting her needs.” The problem was that my mind was in a different place and I never knew and still don’t know if I close them or not. I have tried many times to figure out a way to consistently close them and I think that I accomplish it most of the time. However, I wouldn’t know since I never could see if I did or didn’t in the first place.

We don’t talk about it much anymore. Maybe I do close the cupboards or it is more likely that she just gave up trying to deal with it. I am not that bad of a person because I don’t (can’t) close the kitchen cupboards. It is just one of many examples of issues that are not that important but can slowly erode your capacity to have a great time together.

So the same concepts that apply to chronic pain are applicable to relationships. It is repetition of negative sensory input. Even if your chronic pain is relatively mild, it often becomes a major distraction over a period of time. The same is true of aspects of your relationship with your partner.

More tricks

There are other neurological tricks that wreak havoc with your home and your relationships:

• Mirror neurons
• Your reactive patterns are learned from your own family of origin. They play out in your new family. Your deepest and strongest triggers are in your household.
• Anger destroys awareness, which is the foundation of any relationship.
• Humans are extremely social creatures and the need to belong and connect with others is almost as strong as your need for food and water. This can manifest in being willing put up with more negative energy than you should and why people stay in abusive situations.

If you step back a take a look at this somewhat incomplete list, you might realize that they are all part of your survival unconscious brain. Rational strategies can’t and don’t work. All of us know that a lot of our behaviors are less the stellar at times, yet we continue to engage in them. The behavioral patterns too powerful.

Linked Circuits 

What does all of this have to do with your chronic pain? The basic problem is that your pain pathways are linked to anger and frustration circuits. Whenever you are triggered for any reason, especially by your family, your pain pathways will fire up. It is more difficult to heal when you are being frequently set off. It is one of the reasons why I ask all members of the family to engage in the DOC concepts and the family structure can be an important source of healing.

The solution lies in understanding the problem. Once you understand that the automatic neurological aspects of your aggravations are not solvable, you can quit wasting your efforts. You can then direct your energy in a new direction and re-connect with your youthful perspective and sense of adventure. You can’t do it with positive thinking or good intentions. You cannot have more commitment to treating your partner well than you observe at a wedding.

The DOC process is one of the ways to de-energize and re-direct your reactions. Whatever approach you work with, you must learn tools to become aware and calm down. Additionally, you have to learn when to let go and move on. My wife and I have SLOWLY learned how impossible and irrational we can become over minuscule issues and we are working on simply disengaging with each other when we are upset.

Don’t let these neurologic tricks take away your capacity and energy to create and live your vision. The strategies to address them aren’t difficult and will allow you to thrive. Enjoying your journey with others is an important aspect of living a full life.

The post Happily Ever After first appeared on Back in Control.

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Mirror neurons

Then I ask the spouse/ partner/ son/ daughter of my patient, “What is it like when he or she is having a bad day?” Invariably, a look of resignation or frustration comes over their face and they drop their shoulders and groan. They try to make light of it but it is not a joke. Chronic pain often puts you in a bad mood in addition to experiencing other unpleasant sensations. It stimulates a similar part of the brain in those around you so everyone is affected. You have also seen the same phenomena occur with yawning and laughter. “Laughter is contagious.” All this is occurring through mirror neurons in the brain. It’s how we learn.

Mirror neurons were accidently discovered in a primate lab where the researchers were looking at different areas of brain activity in monkeys in relation to grasping objects. They noticed that similar brain activity occurred when the monkey was observing another monkey performing the same task. There is ongoing debate whether there are specific cells that are mirror neurons or there is mirroring of brain activity from neurons in general. Regardless of how or why the mirroring activity takes place, there is little question that similar areas of the brain can be simulated whether you are performing or observing an activity. (1, 2)

My non-functioning mirror neurons

I will never forget a day I spent taking ski lessons with my son while living in Sun Valley. The instructor was a friend of ours and an extraordinary teacher. He was able to break down new concepts into doable steps. My son was ten. As the instructor was giving us the detailed instructions, my son wasn’t paying much attention. The lesson was focused on a technique called “railing” which puts your skis only on the edges and creates a precise controlled turn. It is a powerful turn and the skis don’t slide sideways at all. However, to get your skis on edge like that requires specific positioning of your shoulders, hips and knees. I was working through the steps in detail and was excited about learning. Nick was bored and I kept urging (nagging) him to pay more attention. The bottom line was at the end of the lesson, he could rail and I couldn’t. He simply imitated the instructor demonstrate the turn and in about five repetitions, he nailed it.

Mirror neurons in action

I ran across this video that illustrates the effect of mirror neurons. Watch the reaction of the baby, especially in the middle of the video. It is also a reminder how quickly babies learn and they are going to absorb what they see, not what they are told. It is one of the reasons it is so important to live the values you are trying to teach.

1. Di Pellegrino, G.; Fadiga, L.; Fogassi, L.; Gallese, V.; Rizzolatti, G (1992). “Understanding motor events: a neurophysiological study”. Experimental Brain Research. 91: 176–180. PMID1301372. doi:1007/bf00230027.
2. Rizzolatti, Giacomo; Fadiga, Luciano; Gallese, Vittorio; Fogassi, Leonardo (1996). “Premotor cortex and the recognition of motor actions”. Cognitive Brain Research. 3(2): 131–141. PMID8713554. doi:1016/0926-6410(95)00038-0.

References obtained from Wikipedia/ Mirror neuron: https://en.wikipedia.org/wiki/Mirror_neuron

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So, when the patient’s partner is snippy, critical, or hostile, the patient tends to feel worse, too. The region of the brain that elicits a bad mood simply is stimulated. Conversely, if one partner is in a great mood, the other tends to be happier.

That is why—indirectly for my patients’ sake and directly for that of their partners—I believe it is vital that both partners learn tools such as expressive writing and adding more play into their lives, that enable them to live a joyful life.

Where is the support?

However, there may be an additional issue beneath the surface because it is remarkably difficult to convince other members of the household to engage in these tools. If you care for your family member, why would you not try to do as much as possible to help him or her heal? I ran across this article that partially explains why. Family members may not believe that a patient really is experiencing that much pain. It may be more common than I believed. Therefore, their compassion may understandably be limited.

Couple’s study

A multi-center published in 2013 (1) measured the following variables in 105 couples over two weeks:

• Patient’s pain
• Spouse’s observations of patient’s pain behaviors such as complaining, grimacing or grabbling.
• The patient’s perceived criticism or hostility from his or her partner

The following observations were made:

• Patient’s pain increased for over three hours when they felt hostility or were criticized.
• Patient’s observed pain behavior consistently created a negative reaction from their partner.
• These interactions were consistent. The assumption was that long-term low level negative interactions will erode relationships and quality of life.

This interaction is similar to what has been found in depression research. Depressed patients act in ways that cause rejection from others, which in turn exacerbates the depression.

There is no question that chronic pain is a family issue. The couples study does not even take into account the damage an angry person in chronic pain can inflict on his close relationships. The family unit can become a living hell and it can seem like a hopeless situation. But, like the patient’s condition, the family dynamic can get better, with the right tools. It did with me.

Pain = anger= abuse

Feeling Good Together

David Burns, MD is a Stanford psychiatrist and the author of Feeling Good. I attended his five-day seminar a few years ago where advanced Cognitive Behavioral Therapy (CBT) techniques were presented. One afternoon was devoted to relationships. He had been given a large advance to write a similar book applying (CBT) to relationships. He then used these techniques on 50 couples without any success. He returned the advance and went on a five-year quest to find out what was really going on. Subsequently, he wrote a second remarkable book called Feeling Good Together. One stunning insight from this book that hit me hard was that, when your partner acts in a way that upsets you, of course you want to blame him or her; but you are the one who set it up. It was your actions that caused your partner to react in a way that made you angry.

That insight had a major impact on my awareness of my own behavior—not just toward my wife, but in my relationships with everyone. However, I found it to be by far the hardest part of my journey. Whenever I feel upset as a result of something my spouse says or does, it still feels like it is she, not I, who caused the upset. It has taken me years to consider the effect my words and behavior have on others’ feelings. I still have a long way to go. It is unbelievably humbling.

Protect your family from your pain

The Marriage-go-round

How do you break the cycle of pain behavior, criticism from your partner, and more pain? Let’s face it: You have the choice whether to engage in pain behavior or not. At some level you must know that your partner is going to react negatively to it, but you do it anyway. When you feel the hostility and criticism from your partner, your pain increases. This is expected, since we know that stress chemicals increase the speed of nerve conduction, resulting in more pain. (2) Since there is seemingly no end to the pain, the cycle can continue for a long time. You’re already mad at your partner; why not continue to be irritating?

If endless conflict is damaging your whole family, consider it an opportunity to work through the solution together and come out stronger than ever before. The solution for chronic pain is not difficult once you understand the nature of the problem. It turns out—and I say this from experience—that anxiety and anger are the pain. Use the DOC tools to help you, your partner, and other family members to live a life you all cherish.

Listen to the Back in Control Radio podcast The Chronic Pain Marriage Go Round

1. Burns, JW, et al. Temporal associations between spouse criticism/ hostility and pain among patients with chronic pain: A within-couple daily diary study. Pain (2103); 154: 2715-2721.
2. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173

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Our Christmas

Whatever holiday you celebrate, this time of year seems to revolve mostly around family, friends and re-connecting. There are lights, a sense of giving, and celebration. It was the one time of the year when my mother would calm down and we could relax for a few days. We had a quirky Christmas by any measure but it also added to the charm of it. We never put up our tree until Christmas Eve. After dark we would go to several Christmas tree lots and find a forlorn tree. They were always pretty bad. But we had some ornaments and bubble lights that seemed to make up for it. We covered almost every inch of the tree in tinsel. It worked and I loved sitting in the room with the tree and gifts. My father would take time out of his 100-hour work week as a small town doctor to spin the car on the empty, icy streets in downtown Newport, New Hampshire. We caroled with our church group for a couple of weeks, which was both fun and frightening, asking people for donations. A few times my father had the owner of the Western Auto store open it up on Christmas Eve to do our Christmas shopping. Over the years our family somehow seemed to rally together and enjoy Christmas. In the midst of a chaotic childhood it was magical.

Christmas 1964

Christmas lost

Then it wasn’t. Anxiety began to creep in without me recognizing it and when I tried to relax I would experience it even more strongly. As I dove deeper into depression in the midst of my chronic pain ordeal, Christmas became increasingly miserable. One of the hallmarks of anxiety and depression is that you feel that everyone else has it made except you. I was obsessed by what I did not have and became emotionally and socially isolated. Much of it was in my head as my friends were still around. I had no way of reaching out to them. As I interacted less with people my anxiety increased. I was convinced that no one wanted to hang out with me. My world was dark and the magic of Christmas made it worse.

The nightmare of Christmas

Christmas can be a nightmare for people suffering from chronic pain. One of the major causes of pain flare-ups is personal loss, and I see it in my patients every week. It takes only a few minutes to figure out which loss is driving the flare-up. The losses are significant and often catastrophic, such as losing a spouse, child, job, physical function, or reputation. Christmas magnifies this problem in that you are now reminded of a lifetime of losses. There are many friends and family who are no longer with you. There is also the loss of small children running around the house, jumping up and down to open their presents, and the knowledge that those days will never return. For myself, there were many holidays where I skied steep and deep powder and now my knees are not working so well.

What could have been

A friend of mine sent me this piece from Wikipedia:

Sehnsucht is a German noun translated as “longing”, “pining”, “yearning”, or “craving”, or in a wider sense a type of “intensely missing”. Sehnsucht represents thoughts and feelings about all facets of life that are unfinished or imperfect, paired with a yearning for ideal alternative experiences. It has been referred to as “life’s longings”; or an individual’s search for happiness while coping with the reality of unattainable wishes. Such feelings are usually profound, and tend to be accompanied by both positive and negative feelings.

Loss is permanent

As I discussed loss with my patients I have slowly realized that it is not possible to fully get over a deep loss; and the harder you try, the worse the pain. You are still thinking about it. The better alternative is to realize that you don’t have to get over your loss and understand it is now part of the fabric of your life. It is healthier to continue to acknowledge it, live with the unsettling emotions and continue to embrace your life. Remaining stuck in your pain is just another creative way of holding onto the victim role.

Then it hit me that living a successful life involves navigating loss. The list of losses you will experience over your lifetime is limitless. Memory, strength, endurance, friends, family, prestige, jobs, reputation–you can choose to dwell on them or understand that loss is at the core of living, with the final loss being your own existence.

Can you honor your life by enjoying the magic and connection of the holidays? Or will you get mired in the quicksand of frustration, consumed by what was or what might have been?

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