• Anytime you are anxious or frustrated, something from the past has invaded the present.
• By definition, you cannot be completely connected to what is right in front of you.
• To change these automatic hardwired reactions, you must first create some “space” between you and your reaction.
• Learning and mastering specific skills allows this to happen.
• You must “C” first in order to come out of the reactive mode.

Hard work and creativity are equally important to successfully developing and implementing new ideas, both personally and in the business world. It can be argued that insanity is the antithesis of creativity. Consider Albert Einstein’s thoughts on what constitutes insane behavior.

Insanity is

Doing the same thing

Over and over

And expecting a different result.

Looking at this quote more carefully, you might ask why a person would continue to engage in obviously self-destructive behavior, especially if it is destructive in business and in one’s personal life. One reason is that we become conditioned throughout our lifetime to react automatically to certain stimuli based our unique programmed patterns. To create meaningful change, it is critical to break up these automatic links. You can then reprogram your responses to unpleasant stimuli. There are three steps in reprogramming your nervous system.

1) Awareness

2) Separation

3) Creating new circuits

Kinds of awareness

Awareness is the link to every aspect of The DOC Journey, which is a metaphor for your life. We have presented four types of awareness:

• Environmental
• Emotional
• Judgement/ Storytelling
• Ingrained patterns

It is clear that the first step in cultivating deeper awareness is recognizing when you are unaware. Awareness is the opposite of projecting your perception of the world onto others and situations. Understanding the different types of awareness allows you to expand your consciousness quickly. You are continuing to reinforce your life outlook in that if your life “data input” confirms your view, it strengthens it. What is more problematic is that if you receive conflicting input, you’ll reject it. This is an even more powerful force in strengthening your outlook and “filter.” How can you really learn and change? Continually projecting your views eventually becomes tedious and you’ll become more “set in your ways.” It is the way your brain works. The marketing world calls this phenomenon, “reactance”, and they use it to their advantage.¹

Make some “space”

Consider how much more interesting life could be if you learned the skill of creating some “space” before your brain instantly kicks into a reactive or projection mode. Then you would be better able to see others’ views, meet their needs, and it is incredibly more interesting. Words like curiosity, awe, gratitude, compassion, and empathy will re-enter your consciousness. Your body chemistry shifts into safety physiology resulting in a deep sense of connection and contentment.

Anger is the antithesis of awareness. Yet in chronic pain you are trapped and understandably angry. Anger completely blocks awareness by definition. Yet you need to become aware to break through the anger barrier. It is a terribly vicious cycle and that is why it requires tools and persistence to move through anger.

Awareness – “C’ing”

The first step in problem solving is seeing ALL aspects of a given problem AND having a choice in how to respond. To be creative, the “C/see” needs to be first. All of us know that certain phrases, behaviors, situations, people, etc. will elicit a fairly predictable and rapid reaction. You are reacting before you have even absorbed or comprehended the full scope of the problem. Consequently, you may make a flawed decision. Unfortunately, these programmed reactions become stronger with age and repetition. The phrase, “you can’t teach an old dog new tricks” is an accurate phrase. It is not that the dog cannot be taught. He or she must be open to being taught.

It is helpful to be aware of these two words throughout the day. You can quickly see when you are in a reaction and can quickly switch into a creative mode. Experiencing creativity is not only effective, but also more enjoyable.

Reactive

Creative

Recap

The difference between these two words – and these two concepts – is that in the word “creative,” the “C”  is at the beginning. You must understand and see a problem first before you can solve it. In “reactive” the “C” is buried in the middle of the word. The location of the letter “C/see” can be thought of as reflecting the concepts this article is conveying. It’s a good way to remember why you cannot be creative in problem solving if you are in a reactive mode.

There are many methods of accomplishing this. Instead of having a “stimulus-automatic response” situation, you now have a “stimulus-choice of response” scenario. With repetition, the more functional responses will become the automatic default mode. That is the beauty of neuroplasticity.

Questions and considerations

1. Have you noticed that when you are upset, it seems like your thinking is clear, sharp, and focused? It is except that it is all about you.
2. Do you really feel you are able to see the situation through the other person’s eyes? Are you able to see and evaluate all possible solutions in this state?
3. It is humbling and sobering that when you are calm, many answers become obvious in retrospect. Anger really is temporary insanity.
4. Consider the possibility that you have been in a baseline state of being upset for so long, that it feels “normal “to you. It is one of the core ingrained patterns that is almost impossible to see without outside help.

References

1. Berger, Jonah. The Catalyst: How to Change Anyone’s Mind. Simon and Schuster. New York, NY, 2020.

The post From Reactive to Creative first appeared on Back in Control.

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Good Times

It’s always a wonderful weekend and incredibly relaxing in that everything is right there. Good food, fireplace, hot tub, warm pool and a lot of bantering (that would be the mild term). We do revert back to middle school behavior (at best). My wife keeps asking me the question if guys ever grow up. I think the answer is obvious. It’s a great break for all of us.

We ski in smaller groups and we usually meet at a restaurant in the middle of the mountain called “Watsons” at 11:30, just before the lunch crowd arrives. I don’t ski quite as well as I used to and decided to come in a little early and relax. I purposely worked on enjoying the fantastic view of the valley and could not have been in a better state of mind. It was also one of the few times when I was well ahead of the curve with regards to saving enough seating for 18 people. The restaurant was almost empty.

I was sitting at the end of two tables that seated 12 and had placed my gear on a table for six just across the aisle. Four of my group appeared at 11:20 and sat down at the large table. My plan was working well, and I was having a great time. We were talking about the morning, which included skiing on fantastic snow. Suddenly I turned around and there were four boys between nine and eleven, who had pushed aside my gear on the other table and were sitting down.

Trouble

I pointed out to them that I had another six people arriving shortly and this table was saved. “Where are they? We’re here! You can’t save tables.” They were clearly veteran Alta skiers, but I had never heard of that rule at any ski resort in over my 50 years of skiing. I also didn’t see any signs that I couldn’t save a table. I was caught off guard and firmly restated my case. At that point four more of my “ buddies” sat down at the large table. There were also two older women immediately behind the boys and they started hissing, “Just give them the table.” As I continued my protest, one of the boys looked at me said, “We’ll give you five minutes.” I was getting more confused and flustered. I don’t remember that I would have talked to an adult in this manner when I was 10 years old. Usually skiers just walk on by, since saving a table for your group is the norm (so I thought).

Thrown under the bus

Then I asked my friend, Bill, to come over and sit down at the embattled table with me, since the larger table was continuing to fill up with members of my group. Instead of coming over and helping me out, he said, “Come on, why don’t you let them have it?” while looking directly at them. I was now well into looking like a “grouchy old man” and the women continued to hiss at me. I caved in, but I wasn’t happy. My tranquil meditative state had been severely compromised, and I was being thrown under the bus. My “friend” fist-bumped them and they said, “Thanks!”

Three minutes later, another seven people showed up and had no place to sit. This wasn’t going well, and my group thought all of this was hilarious. I wasn’t happy with them, the kids, the women or me. I really was upset, and it was just over a table. My friends know how much stress I deal with every week and were surprised how triggered I was over such a non-issue. Of course, the more frustrated I became, the harder they laughed – even though I was holding the space for them. I haven’t been that angry in a while. What the heck happened?

Gulliver

The image that jumped into my head was that of Gulliver being tied to the ground after being captured by Lilliputians. Gulliver’s Travels was written in 1726 by Jonathan Swift, and was a disguised commentary on world affairs, as well as on human nature. The book is divided into four sections. The first is about being captured by the Lilliputians, who were one twelfth his size. He was tied to the ground by hordes of them while he was sleeping. They wanted to seal the deal by blinding him. He had to navigate some tricky situations to eventually escape.

I was trapped by people a fraction of my size and age. My “adult” friends finished me off. The similarities to being pulled into the Abyss of chronic pain weren’t subtle. It’s always a combination of factors that pull you into the hole. They add up quickly and escape becomes essentially impossible. When I was pulled into the Abyss in 1990, I didn’t see it coming and it took me 13 years to come out of my tailspin. And it was by pure luck that I did. It took me years to figure out what had happened to me, and longer to learn how to share the concepts with my patients. A few of the variables that can trap you are:

• The source of pain is usually not able to be identified, so no one really believes you’re in pain.
• Although modern neuroscience research has revealed the answers to solving your chronic pain, mainstream medicine continues to ignore the data. Essentially every treatment in spine care that is covered by insurance has been shown to be ineffective. Proven effective treatments are usually not covered. We are pretending to practice medicine.
• Repeatedly having your hopes dashed is a reliable way of inducing a major depression, as demonstrated in animal studies.
• You are labeled and judged.

This list is only a hint of the multiple ways  you are trapped by mental or physical pain. You can’t see them coming and the adversities keep pummeling you from multiple directions. The worst aspect of it is that since there doesn’t appear to be any viable solutions offered to you, where is the endpoint? You eventually lose hope and retreat into an angry survival mode.

I felt trapped and any one of the variables alone would not have stopped me from holding onto my treasured table. I didn’t anticipate all the angles of the situation that took me down. A major one was my own sense of not looking good to the other parties or to me. I was a “grouchy old man.” I am still not sure, as I am writing this piece a couple of weeks later, that I’ve completely let it go…………

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I also remember that there was usually a lag between the end of school and the beginning of my summer job. I was fine for a couple of days but then I would quickly get cabin fever. I could not stand laying around the house and not being productive. I enjoyed getting outside and being with my co-workers.

Abusing my back

Unfortunately, I had little regard for my body with regards to lifting properly. I was continually reminded to use my legs and not my back and arms. I did not have great upper body strength so, of course, I used my back. I had no concept of the consequences and had a perverse sense of pride about how much I could lift and for how long.

The perils of parenting

In March of 1985 I was holding my sleeping one-year old son and placed him over the top of the side rail of the crib. It would have made much more sense to lay him down, lower the side rail and then place him in the crib with a relatively straight spine. I was still bulletproof and why would I change my lifting habits now? Just as I was fully leaned over the top of the rail I felt a snap in my back and a searing pain in my left big toe. That was the beginning of a six-week descent into abject misery of constant severe pain. I had thought (incorrectly) that if pain was very localized, that it would be more tolerable. I could not and did not sleep more than two to four hours a night for over six weeks. I still do not know how that is possible and I never had even one full night’s sleep.

My suffering worsened in that I could not eat,  lost 25 pounds, developed kidney failure from taking too many aspirin, experienced ringing in my ears, and I became increasingly irrational. (at least that is what I am told)

I was only able to work half time as the second partner in a private orthopedic practice. I had only debt after just finishing my residency. I was about to begin my spine fellowship training in Minneapolis in 4 months. I finally elected to do the one thing I swore I would never do and that was to have spine surgery. The simple decompression surgery at L5-S1 went well and my great toe pain was gone. I quickly returned to work and was excited about getting on with my training I was ecstatic – until my wounds began to drain about 10 days later. I developed a deep wound infection from being malnourished after losing so much weight. A second operation and six weeks of antibiotics finally resolved it. My spine surgery – and infection

“You’re fired”

I had been through a lot and fortunately I had a remarkably benevolent partner who continued to pay my salary, although I was only about a third functional. I was dealing with it pretty well until my future fellowship directors found out about my infection and promptly informed me that I had been replaced. They did not think I could do the job and I was also not offered a later position.

Somehow that was it. It was the one part of the situation I could not handle – losing my job. I was devastated. That night I sat alone in my car and completely broke down. I cannot verbalize the depth of despair and helplessness that I experienced. I could not care for my family or even myself. I clearly saw how vulnerable you were not being able to fend for yourself in a capitalistic society. I felt like a medieval warrior going to battle without any weapons or armor. It was one of the most painful and enlightening moments of my life.

The “benefits” of being disabled

Physicians are often given the impression that people are generally looking to get off of work. The answer to disability is to tighten the rules and get tougher. They feel that many injured workers just don’t want to work. They also do not realize the implications of taking people off of work. Once a person loses their job the whole nature of the claim changes. It becomes more difficult to get hired by anyone since you now have a track record of missing work. Here are some of of the other “benefits” of being off of work:

• Your income is at least 25% less and is fixed.
• A claims examiner is in charge of your life instead of you.
• You cannot get through to them to get an update on your progress or status and he or she is in charge of your entire life.
• Your disability check can be taken away from you without notice.
• No one believes you are in pain. My battle with NPD
• Life becomes one of surviving rather than thriving.
• Worker’s comp will not cover stress management treatments or provide resources to help you.
• How do you get out of this situation?
• Your providers are not filling out the paperwork and not getting back to your employer.
• There are endless contradictions regarding your care and diagnosis and you often are given bad news.
• Even without the conflicting medical advice, anxiety and frustration usually continue to rise.
• Pain invades every part of your life including many conversations. It is not that interesting after a while.
• What happened to your dreams?
• Research has shown that being off of work is detrimental to your mental and physical health.
• Many people lose their assets, including their home

I remember a moment about five years into my practice when I realized that my Worker’s Comp patients were not doing well because of lack of motivation. It was because  were justifiably angry. The Worker’s Comp system that they expected to help them and allay their anxiety was mostly harassing them. I didn’t blame them for being upset.

Disabled

Life is not better being disabled. Maybe you have been that way for so long that you can no longer understand or appreciate the alternatives. You are so used to being trapped that anger seems normal. Many people don’t even think they are angry. That included me. No one, and I mean no one, is going to help you out of this hole. It is deep and will keep getting deeper. Many Italians choose suicide – People need to work

The only patients I see succeed are those who have made a decision to live a different life and they are not going to live this way anymore. I have watched hundreds of patients become pain free. It is just much more difficult if it involves Worker’s Comp. How do you want to live your life? I had the smallest taste of what it is like to not be able to work and take care of myself. Not only did I not like it, it was the worst part of my ordeal.

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A surgeon’s perspective

David, Your early experience in training really struck home, as I heard this old classic song on the radio about the same day as I received your email.

Skip a Rope, the time and location; 1968, around time of MLK’s death, Nashville TN, 1st year Vanderbilt med school; this song was released years before its time. Psych courses meant little to me at the time as a budding surgeon who considered orthopedics to be simply mechanics ….fix what’s physically wrong and all will be OK. Move on to next broken bone.

Now, almost 50 years later, retired as an orthopedist, currently practicing addiction medicine, the impact of that song is more profound to me than the first year psych courses presented to a misdirected med student.

Most of my female (and a lot of males) addiction patients are also chronic pain patients. A review of the pain diagram and word descriptors frequently reveals vague, somewhat neuropathic, generalized pain. Often without any preceding injury or solid medical explanation. Next question is “do you have nightmares?” Response is typically a puzzled “yes”, as that is usually the only time any physician has ever asked that in connection with the pain. This then leads to the ACE questionnaire and the connection then is usually obvious. Frequently, they can be considered a chronic form of PTSD, which has led, at least in part, to inappropriate self-medication. As with the VA-recognized concept of PTSD treatment, sleep is the first consideration. and the use of specific medications usually improves or eliminates nightmares. This is how the healing process often now proceeds in my practice as a physician whose medical training focused on curing the physical ailment without sufficient understanding of mind body healing process.

Should have paid attention to the lyrics of Skip a Rope 50 years ago, but what do young medical students know anyway?

Best regards,  Gene Saiter

ACE

ACE stands for “Adverse Childhood Experiences”. Drs. Andra, Felliti and others published a landmark study in 1998 (1) looking at the long-term effect of these experiences in over 17,000 people. There were 10 ACE’s defined in three categories.

Household Dysfunction

• Substance abuse
• Parental separation/ divorce
• Mental illness
• Battered mother
• Criminal behavior

Abuse

• Psychological
• Physical
• Sexual

Neglect

• Emotional
• Physical

They clearly demonstrated a link between the ACE score and difficulties functioning later in life – the higher the score, the worse the adult problems. There is an endless amount of data that can be discussed but the most disturbing aspect of the study for me was that only about a third of people have an ACE score of zero. 26% had three or more. Our country overall  isn’t doing a competent job of parenting and all of us are paying the price.

What is your children’s ACE score?

I would also dare say that the incidence of ACE events is higher in a family where at least one of the members is suffering from chronic pain. If you have to ask why I would think that, then please read or re-read my book. Being trapped by pain is frustrating and often results in what Dr. Sarno called “rage”. It is completely understandable, but your family doesn’t deserve to be the target. Healing begins at home

You also have a legitimate gripe in that the medical profession isn’t meeting your need to become free of pain. We have no comprehensive training addressing it. We’re focused on “disease” and methods to “fix” you. We aren’t taught the concept that the mind and body are simply a unit. There is no separation. I asked Dr. Saiter if I could use his letter and here is his reply.

The knowledge gap

Thank you, David for your kind thoughts. I am more than willing to share my name and these treatment experiences, as it took me many years to discover the techniques I now employ with addiction and pain. I owe much of this to Jennifer who directed me to Vincent Felitti’s articles pertaining to long-term effects of ACE scores. Unfortunately, this medical knowledge is not taught in usual medical curriculum, nor is proper use of opioids for that matter, but it should be. Gene

Dr. Luskin’s perspective

I am not writing this post to let you off of the hook. The past is done and there is nothing you can do about it. Dr. Luskin, a friend of mine and author of Forgive for Good summed it up nicely at one of the workshops my wife and I put on with him at the Omega Institute. Here is a rough version of his thoughts.

“It is a tragedy to have your life ruined by your parents. However, to hold on to it 50 years later does not make any sense. It is fine to be upset that they harmed you until you were 18 years old. Then you must acknowledge that you took over and continued to ruin your own life.”

The bigger tragedy

Take responsibility for every aspect of your own life. Write down a list of everyone and everything you can blame for screwing up your life. It will become ridiculous quickly. What is a bigger tragedy is that you are continuing to blame the past and now adding to the world’s misery instead of being a source of joy.

I am not saying that this is an easy task and it does take specific tools, which are different for everyone. My ACE score was greater than 4. I first had no awareness, as I thought that this was the way everyone was raised. I did spend my life blaming the world for my unhappiness. I also thought that this was reasonable. My familial programming runs deep and I still find an endless number of ways to remain in a victim role. I was fortunate to have discovered methods to let me out of my mental trap. But I’m also aware and I have lost any of my excuses. So have you. Choose to not be a victim

There are numerous solutions proposed to solve this problem of poor parenting. I have heard variations of these thoughts for over 40 years. They generally are focused on somehow improving parenting in the home. It is not possible to get into enough families’ lives to make a major societal impact. However you can make a make a difference by taking full responsibility for your own life and break up the cycle of abuse within your own family. If you are in pain, frustrated, and do not think you are abusive, think again. Anger is self-centered, destroys awareness and is abusive. The first step is to become aware of the effect of pain and anger on your family and your life. Pain = Anger = Abuse

An excellent resource on awareness is Anthony Demello’s book, The Way to Love. 

Maybe you were ACE’d out but don’t ACE out your family.

1. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.

The post Aced Out first appeared on Back in Control.

The post Aced Out appeared first on Back in Control.

Anger changes your body chemistry

Anger is the “Continental Divide” of chronic pain. Anger pathways are tightly connected to pain pathways and as long as the anger switch is on the pain switches will also be on. That does not even take into account the fact that your body chemistry is out of balance when you are agitated. Levels of cortisol and adrenaline are elevated that has a direct effect on every organ system in your body. That is one reason that there over 30 physical symptoms of the Neurophysiologic Disorder (NPD). It is similar to driving your car down the freeway in third gear or trying to sprint a marathon. It is not sustainable without physical consequences. Until you can truly let go of your legitimate anger you cannot heal. I have yet to see that happen. Conversely, it is predictable that you will heal if you do move on. However the following are examples of how anger also blocks rational thinking and engagement. Anger is part of the disease process that also blocks effective treatment.

“I have already tried all of these things”

A common defense I hear is, “I have already tried everything you are recommending and I am no better.” I explain to them that there are three parts to the process:

• You must learn everything you can about chronic pain
• Every variable that pertains to your situation must be addressed – simultaneously.
• You have to take charge of your own care and situation – this is a catch-22 in that to take on that responsibility, you have to let go of your anger, which is also the solution.

“But you’re still angry”

This point has been illustrated to me a couple of times in the recent past. I was talking to a successful businesswoman who had been experiencing severe neck and low back pain for over five years. She really had tried everything and kept interrupting me. She was essentially reminding me that I had nothing to offer her.  Finally I stopped and looked at her and said, “But you are still angry, aren’t you.” It was more than obvious and she replied, “Yes”. There was nowhere else to go with the visit and she left angry.

“I don’t know why I am here”

About 18 months ago I was caring for a woman who initially seemed to be quite engaged in the DOC project and I thought she might do well. I lost track of her and she recently returned.  “I have read your book and the nine others you have recommended.” She was spitting the words at me while rolling her eyes at her friend. “I don’t know why I am here. My pain doctor made me come.” Her whole body was shaking. There was nothing I could say, as I had become another medical provider she could blame for not solving her problem.

The book is not the problem

It does not matter how you can find forgiveness and peace. My book is just one possibility. I am grateful that my story has been helpful to so many people in pain. It may not be the book you connect to but don’t blame the book. There is an answer out there for everyone and you do have a choice. The question is, “How serious are you about searching it out?”

Neuroscientists have a saying, “Neurons that fire together wire together.” As long as you remain angry you will be in pain.

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The consequences of endlessly striving for self-esteem aren’t just dire for the individual, but for the society as a whole, as those in charge – of families, companies, countries, anything — judge others harshly, driving them into the ground on their path to power. At its worst, the quest for greater self-esteem leads to despotism, war, and mass murder, blocking world peace. What can be done about this dangerous scenario? The real key to harmony for us as individuals and as a society is not self-esteem but compassion. Only by practicing compassion – for ourselves and others — can we make our world a more peaceful one. The road to compassion starts at the point where you become aware of your own efforts to inflate your self-esteem, which can be traced back to anxiety.

Compassion

Let’s look at compassion first. Compassion is now recognized as vital force in our society: in fact, there is a group (in which I am a partner) called “A Charter for Compassion” founded by Karen Armstrong, a prominent theologian. The group’s mission is to promote compassion on an international level. It’s a great and important cause but we have one major challenge: while the idea of using compassion to bring about peace (in our world and in ourselves) has been around for a long time, there has been no lasting change.

In her book, Twelve Steps to a Compassionate Life, Armstrong points out that 2,500 years ago, Confucius had remarkable insight about the importance of compassion and worked to spread the word about it. In spite of his significant efforts, though, he felt that he’d failed to convince any world leaders to act in a compassionate way. The challenge continues today.

Self-Esteem, Anxiety, and Judgment

Now let’s consider the origins of our inability to achieve world peace: the pursuit of self-esteem, which is rooted in the universal feelings of anxiety and anger. Here’s how the sequence unfolds: we don’t like to feel anxious, so when the feeling starts, we struggle to gain control of the situation that’s causing it. If we can’t gain (or retain) control, we become angry. Anger covers up the anxiety, making us feel more in control and more powerful. It’s a vicious cycle in which those in power see no logical reason to give it up.

In trying to gain more self-esteem, we inevitably compare ourselves to others, which results in harsh judgments. This is problematic for several reasons: first, these negative feelings don’t help you enjoy your day. Second, although you might intellectually believe that “all men are created equal,” actively judging anyone – whether it’s a friend or a homeless person on the street — means you haven’t internalized this belief. Third, negative judgment leads to ill treatment of others (even if we display a veneer of civility). Lastly, self-esteem has odd blinders; whatever defines us most is what we most often judge in others. Think about this for a while.

Do you often make negative judgments? Ask yourself the following questions:

• If you are intellectual do you view people who are less educated or less intelligent as your equal?
• If you are in incredible physical shape, how do you judge the other 95% of the population that is not fit?
• What if you are poor? Do you identify with your “simple” life so much that you judge those who have more than you?
• If you aren’t poor, how do view those who have less than you? Do you treat them the same way you would treat your boss or your family?
• If you are attractive and are defined by your looks, how do you feel about those who are physically challenged?

We really all are equal

In answering these questions, remember that every human being is flawed. The beauty of this realization is that it allows us to see that not only were we are all created equal; we truly are equal. Being judgmental interferes with our ability to enjoy the human experience at the deepest level, which is tragic for you and everyone you come in contact with. When you judge someone as being “less than” you, it enables you to rationalize some pretty bad behavior. In labeling that person, you’ve lost the capacity to view the world through that person’s eyes. It’s the antithesis of compassion. The essence of compassion is awareness.

What is really odd about this process is that you may focus so hard on the few traits you define yourself by that you become detached from the feelings of worthlessness you possess in multiple other areas. This disconnection can and will lead to aberrant behaviors. Here’s a recap of the sequence:

• Anxiety is a universal trait
• Anxiety drives the need for self-esteem
• The pursuit of self-esteem leads to a pattern of judgment
  • Of others
  • Of self
•  Working on your self-esteem is an attempt to gain more power and there is no endpoint.

Remember that in the end, no matter how hard you work on your self-esteem, there will always be people in your “target” zone who are more competent, skilled, wealthy, etc. So at the same time you feel superior to many, you also feel inferior to many. By the way, how are you keeping score?

Guaranteed to Fail

Also keep in mind that instead of making you happy, self-esteem pretty much guarantees that happiness will always elude you. For example, suppose you are brilliant in your field of work but are physically out of shape and cannot get on top of it. Does your brilliance overcome your negative feelings about your body? The answer is: probably not. There are a million traits to feel good or bad about, which is one of the reasons that self-esteem is so ineffective in allaying anxiety. It eventually becomes destructive.

I recently had a conversation with a young professional about self-esteem. He told me that in any social situation that he is in he feels like he is the most intelligent person in the room. It does not matter who is in the group or if it is in his area of expertise. He then went into a somewhat complicated explanation why he thought this was the case. I could only feel sorry for him as I realized how much of his life energies were being consumed by this process.

Solutions

We’ve established that anxiety and the resulting negative judgment lead to the pursuit of self-esteem, which, in turn, results in power struggles. The resulting judgment blocks awareness, which is the foundation of compassion. As self-esteem is so widely promoted how is world peace even a concept? What is the solution to this problem? First, we have to start at the individual level and deal with our anxiety/judgments. The most effective technique is a strategy called reprogramming, which essentially “resets” your nervous system via the following tactics: 1) awareness, 2) detachment, and 3) reprogramming.

The first step is to become aware of your anxiety/judgments. One effective method is to either write down or speak your judgmental thoughts, which allows you to separate from the, which accomplishes the second step.

The detachment process doesn’t get rid of your judgments; they will still be there the next time you interact with the same person. However, in separating from your thoughts, your negativity is no long running the show. You don’t have to like this person but you’ve created a situation where the possibility of liking him or her one-day exists. At a minimum you can do business or interact with them without it disrupting your peace of mind. This third step is the reprogramming part of the process.

Note that it may be tempting to try and suppress your anxiety-driven judgments, but this won’t work; the anxiety that lies beneath our judgments is a mental reflex, and impossible to deal with in any way that might seem rational.

“Not being judgmental”

I have an ongoing discussion with my patients about why suppressing their judgments doesn’t work. For instance, suppose they’ve decided to turn over a new leaf and not be judgmental of a person they don’t like, such as a coworker or relative. The next time they interact with this person, what happens? In trying not to think negative thoughts about the other person, they focus on these thoughts even more, literally “firing up” their neurological circuits of judgment. It’s a problematic way to run one’s life, since lack of awareness results in detached and even bizarre behavior.

There are other, effective methods for breaking the negative cycle of self-esteem:

• Treat anxiety/anger as a Neurophysiological Disorder (NPD) symptom.
  • Become aware of your own self-esteem needs and resulting judgmental nature.
  • If you are working on your self-esteem, realize that you are using rational means to deal with the powerful unconscious brain. It is a mismatch.t
  • Become aware of the impact of your judgmental behavior on yourself and others.
    • Stop it – now.
      • Every person, every time. No exceptions.
  • This work is done via small, multiple daily interactions.
    • Example: avoid taking part in gossiping.
    • Connect with who you are. It does not matter how you compare with others.

Once you become aware of the destructive nature of pursuing self-esteem, you can implement tools to change, creating the possibility for peace within you and around you.

World Peace – Act Now or Quit Talking

The concept of world peace has been in my thoughts my entire life. Though I have at times been hopeful, it currently seems like we are headed the wrong direction. In fact, sometimes I feel that much of the free world is heading back into the Dark Ages. Many parts of the world still live in the same conditions as the Dark Ages, subject to absolute control by a few leaders, with severe consequences for breaking the arbitrary rules. Can the human condition ever overcome its own nature? What would it take for us to achieve world peace? This is the question that needs to be answered; otherwise let’s quit talking about it and deal with the reality that it’s never going to happen.

Consider this breakdown:

• World Peace is a result of having….
• Compassion, which only occurs if we…
• Remove what’s blocking compassion: our need for power/pursuit of self-esteem
• The drive for power/self-esteem can only be stopped if we address…
  • Anxiety/ anger, which has to happen at the…
  • Individual level, because…
    • The institutions that can create world peace are a result of the collective consciousness

Compassion is contagious. The more compassionate you are with your partner, children, friends, coworkers, or a stranger on the street, the more likely they will be compassionate to those around them.

Change Your Behavior, Change Your World

Most everyone would agree that world peace is a good idea, so how do we go about achieving it? Besides being compassionate to your fellow man, it helps to let others know about the destructive nature of self-esteem.

This is the idea put forth in the book Influencer: The Power to Change Anything written by people who are highly skilled in creating change. The book is about pinpointing which behaviors need to be modified in order to create the desired result. For example, if you wanted to improve people’s dental hygiene habits, you might think you should display this message on every billboard in the country: “Practicing good dental hygiene results in healthier teeth and gums.” This tactic wouldn’t change a thing, however. But if you systematically educated the population about regular and correct methods of brushing and flossing your teeth, you’d achieve your goal.

Let’s consider this idea in the context of world peace. You can promote the concept that world peace is a good idea, but you won’t get anywhere unless you specify to others what behaviors need to change. One might be to stop working on their self-esteem and instead, practicing awareness and compassion. True lasting change can only occur one person at a time and everyone is important.

Video:

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Anger

It is my observation that the whole system of care ignores the most significant factor that contributes to the development of chronic pain—anger. Anger is universal and part of the human experience. Some argue for the necessity of anger. In any case, it is not going away any time soon. Anger provides a useful survival mechanism. When you are threatened and feel anxiety, you will take evasive or avoidance action. When that ability to escape is lost, you will become angry, which increases your body’s physical reaction and mental focus to solve the problem.

Control

The antidote to anxiety is control.

Loss of control = anger.

The current disability system strips the worker of control. Additionally, at least in Washington State, the injured worker is at the mercy of a medically unsophisticated claims examiner. That examiner has final say in everything. As “enlightened” as I am, I cannot discuss a case with an examiner for more than a few minutes before I feel like I am losing my mind. I cannot imagine having my well being, as well as my livelihood, at the mercy of this system.

Dealing with the Anger

It will not matter what systems are designed to “incentivize” workers to return to work, unless this core issue of anger is addressed. You don’t have to incentivize any living creature to jump out of a cage. You just have to the door. Anger not only traps workers so they cannot fully engage in their care, but it also robs them of the ability or motivation to become engaged.

Although anger can be a useful survival mechanism, it is usually destructive to you and everyone around you.  Your anger imposes its own will on the immediate surroundings, and you lose all ability to rationally interact with your environment. The consequences are often disastrous. The most well designed programs are not going to be effective unless the wall of anger can be penetrated.

Anger and Frustration with Workers Compensation 

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It is also a block to awareness. Once you have labeled someone, you have projected your view of the world onto that person. Anthony de Mello in his book, The Way to Love, teaches that it doesn’t matter whether the label is a positive or negative one. You can no longer see the person for who they are or a situation from their perspective. You are no longer able to really hear them or meet their needs.

When suffering from chronic pain, you are often labeled by almost everyone and anyone, including your doctors and other health care providers. “You are a difficult patient.” Isn’t everyone challenging when basic needs aren’t being met. “You don’t really have anything wrong with you. The pain is in your head.” Really?? Neuroscience research has revealed chronic pain is memorized by the brain (1) and can’t be erased. Unfortunately, mainstream medicine hasn’t assimilated this knowledge and continues to offer ineffective treatments. “You are just looking for drugs to get high or to relax.” First of all, the vast majority of patients on chronic opioids don’t get high and they barely get pain relief. The side effects are often unpleasant. I have seen few people who like being dependent on any medications. People just want some pain relief.

Labeled

Here is an excerpt from an email I received from a reader. She has been working hard with the DOC process and is moving forward.

“My pain doctor told me it’s people like me who caused all this opioid crisis.”

It’s the physician’s responsibility to treat each patient with compassion regardless of the situation. Nurturing a supportive patient-physician relationship is the essence of being a physician. For many reasons, beyond the scope of this discussion, this interaction is often less than ideal. So, not only do many patients in pain not feel safe, they feel like they are under attack from many directions. This creates more anxiety and physically exacerbates the pain. (2) Another risk is that your physician may not see your whole picture and an important diagnosis may be missed. This letter is one patient’s story.

Mary’s Letter

Hi Dr. Hanscom,

I know that you had asked me to send you an email telling you how it made me feel when L&I (WA Dept. of Labor and Industries) “stereotyped/categorized/labeled” me.

The First Surgery

I know that you had asked for another story, but I felt compelled to tell you about the first time I was stereotyped after my injury. It happened in an emergency room in Everett and was about one week after my first back fusion. I had only been home from the hospital for two days when I started getting back spasms. Initially the spasms were very bad but they had progressed to the point where I couldn’t even stand.  I ended up falling to the floor because my legs would not hold me up. It felt as though the muscles in my back where trying to bend me in half backwards. On the third day I couldn’t stand it anymore as the spasms were happening very frequently and I felt almost delirious.

Emergency Room

My oldest daughter called for an ambulance that transported me to the hospital emergency room. I spoke briefly with a nurse about what was going on and then to the doctor. I overheard them talking and saying that they felt there was NOTHING wrong with me, but rather I was there looking for pain medication. Meanwhile I became upset and was telling my oldest daughter about what I had heard. She reached up and put her hand on my forehead and said, “Oh my God Mom you are burning up!” She proceeded to grab a thermometer and stick it in my mouth. After seconds she was freaking out and yelling for a nurse to get in there because I was burning up. The nurse didn’t even believe her so she herself took it again and my temperature was 103 degrees. About this time my younger of the adult daughters arrived.  My two daughters talked about the situation. The younger one grabbed my purse, which had ALL my medications in it, dumped it on the bed, and told the nurse to look at it! She told her that she too had witnessed me falling and that I had NO NEED for any more pain medication. I had more than enough and that they had better do something!

Sent Home with a 103 degree fever

After that they did some blood work, an X-ray, and wrote me a prescription for muscle relaxers. I was basically patted on the head, told me they found nothing, and sent me home. That was on a Wednesday. On Friday morning my phone rang and it was the hospital telling me that I needed to come in and be checked. I had a very serious infection, which was in my spine and my blood and I needed IV antibiotics!

Labeled

I won’t take up more of your time telling you the rest of the nightmare, but I felt like you should know this, BECAUSE they decided what kind of a person I was BEFORE gathering all the facts. It almost cost me my life. If my two adult daughters had not been there to advocate for me, I would be dead. I honestly believe they would have not done or checked anything. They probably would have just sent me home saying it was nothing!

I will guess that by now you can understand why when we first met I was so “angry.” Part of my anger stemmed from my nightmare experience that almost cost me my life. There is also about a six-week window during that time that I don’t remember a lot without help from my kids!

I am SO GRATEFUL that I was sent to you and that you decided to help me! I know that I am probably not as far a long with my entire recovery process as you had hoped. But I know that I wouldn’t even be this far if it wasn’t for YOU!

Sincerely,

Mary

My Perspective

Mary is a patient on whom I have performed two low back surgeries. The second was a fusion that went very well. However, the amount of family stress she has been under is beyond description. When I first met her over two years ago, she was one of the most angry patients I had ever met. I did not think she would return. She has made remarkable progress and is now just on minimal pain meds. I thoroughly enjoy my visits with her.

Her stresses continue, but she’s now trying to find a job, which in this economy is no small task. She has been consistently treated poorly by her claims examiner, and we have had to fight for every bit of her treatment. The subject of labeling came up, and I asked her to share part of her story.

You aren’t going to stop labeling

It isn’t possible or necessary to stop labeling. The key is to be aware when you are doing it, and name the labels to yourself. Once you recognize the label, then you have the capacity to know the person behind it. Recognizing your language makes a difference is also helpful. Epictetus, was a Greek Stoic philosopher, who pointed out that it is one thing to call a person a drunk as opposed to saying that this is a person who drinks a lot. It’s similar to being labeled a “chronic pain patient” versus being described as a person who is suffering from chronic pain. None of us like being labeled. How do you react? What are the labels that you place on others? How are they interfering with your relationships? Are they helping you heal from your pain?

Becoming aware of your inherent need to label, what the labels are, and your reactions to being labeled is an important aspect of your healing journey.

The Cry of Chronic Pain: No one is Listening. WSMA Preceptor, August 2011.

1. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014); 32: 129-139.
2. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience(2011); 185: 166-173.

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Abraham Maslow

Abraham Maslow (1908-1970) was a brilliant professor of psychology. He founded a branch of psychology known as “Humanistic Psychology,” which focuses more on psychological virtues or excellences rather than on psychological disorders. Maslow is best known for his conceptualization of “man’s hierarchy of needs.” This hierarchy is usually represented as a pyramid, which is depicted above. Maslow thought that meeting one’s basic needs in the lower part of the hierarchy was necessary before progressing to the needs at the top. He also recognized that getting to the very top of the pyramid, what he called self-actualizing–flourishing as a human being, was not commonly attained.

Basic Human Needs

The most basic needs are physiological:

• Air
• Food
• Water
• Sleep
• Sex

According to Maslow, it is impossible to progress up the pyramid if you cannot obtain air, food, water, sleep, and sex.

Where is Pain?

A thought struck me as I looked at his hierarchy: where is the need to be free from pain? I believe this need belongs on the bottom row. Any time a basic human need is not met, anxiety quickly results. If the basic need remains unmet, then the anxiety will progress to anger, disrupting your quality of life and compromising your ability to function. When you are in pain, your body will flood you with anxiety in an attempt to protect itself from harm. (I talk more about the relationship between pain and anxiety in “Your Hand Stuck Over the Stove.”)

Will you have the wherewithal to progress up the hierarchy of needs when you are consumed by pain? You won’t. I believe it is impossible to flourish as a human being without first absolving yourself of your pain. Maslow simply missed including this basic need in his paradigm.

A.H. Maslow, A Theory of Human Motivation, Psychological Review 50(4) (1943):370-96.

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Self esteem involves endless judgment of comparing yourself to others around you. I discuss the negative impact that this concept has on us.

For more, see The Myth of Self Esteem.

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