• There are many different physical and mental symptoms that are possible when you are in sustained flight or fight physiology.
• At my lowest point, I was experiencing 17 of them. No one could tell me what was happening despite seeing many physicians. I suffered for over 15 years.
• The mental pain was the worst part of my ordeal.
• One reason this process has been effective for so many people was that I learned many important details from my own harsh experience.
• My symptoms resolved and I am grateful I can pass along the healing principles.

I was driving across a bridge late one night, when my heart began to suddenly pound at a furious pace. I couldn’t breathe. I was sweaty, light-headed, and I thought I was dying from a heart attack. I was only 37 years old. This was the first of many panic attacks I would have over the next two years. In one minute, I went from being a fearless spine surgeon to experiencing relentless, progressive anxiety. I wouldn’t emerge from this slow spiral into hell for 13 years. What happened and why so suddenly?

The beginning

My first migraine happened on the 4^th of July. I was five and excited because the local fireworks were being set off in the town commons, directly across the street from our house. But as the sun set, my head began to throb and by 10 o’clock I felt like I was being hit with a sledgehammer. The fireworks less than 100 yards away weren’t helpful.

This was the first of 17 symptoms of a stressed nervous system I developed over the next 50 years. My suffering included tinnitus, burning feet, prolonged tendonitis, insomnia, anxiety, Obsessive Compulsive Disorder (OCD), major depression, migratory skin rashes, crushing chest pain, sweats, PTSD, back and neck pain, heart palpitations, light-headedness, and tension headaches. At my lowest point, I was experiencing all of them simultaneously.

The “perfect” family

My father was a family doctor in a small, New England town. He was highly respected and appreciated. My mother was active in many local activities. I was the oldest of four children, with two brothers and a sister. People would often comment on our  “beautiful family.” We were – from the outside.

Inside our house, my mother was in an intense rage most of the time. She was physically and verbally abusive to me and my three younger siblings. My father wasn’t around much, and he didn’t comprehend the full extent of the situation.Since this was all, we knew, we thought this was what life was supposed to be like.

Interestingly, one of the few things that would cut her anger short was one of my migraines. She would instantly become a loving and nurturing mother, placing cold compresses on my forehead, and keeping everyone quiet.

My new identity

When I entered high school, I felt a deep shift. I was increasingly aware that my family life was not ideal, and I decided that I had had enough. I “shut the door” on my past

Although I still lived at home, I mentally separated from the chaos. I embarked on a quest to create a new identity. I became an excellent student, trumpet player, hard worker, leader, and athlete. During my junior year in college, I took 18 to 21 hours of credit every quarter, worked construction 10-20 hours a week, played sports, had an active social life, ran for student body president, and pulled off a 4.0 GPA. I was having the time of my life. I wasn’t sleeping much.

I continued to graduate from medical school with honors and was accepted in a competitive orthopedic residency in Hawaii. With a great wife, a home in Hawaii, and a promising career, I thought I had it made. I was unaware that I was keeping busy to outrun my past and I had also become a master at suppressing unpleasant emotions.

I completed two years of internal medicine residency before I entered surgical training in Hawaii. Most orthopedic residents undergo a couple of years of general surgery residency before specializing and are comfortable in the operating room. I had never made a skin incision or even knew how to tie a knot. However, handling stress was such a core part my existence, I did not feel it. I was wrapped up in my identity of being “cool under pressure.”

I noticed that my feet burned while I was jogging, which I thought was due to the warm, Hawaiian pavement. My migraines were more frequent, and I had a reoccurrence of warts over both of my hands. One afternoon, while in a weekly orthopedic conference, I noticed some vivid, intrusive thoughts entering my mind. I didn’t think too much about it, but I felt a bit unsettled. Still, I was on top of the world, enjoying my family, learning, and living in a paradise.

Stress

The wheels started to come off when during my post-residency spine fellowship at one of the top programs in the world. It was not as physically demanding as the rest of my residency, but the expectations were extremely high. My migraines were occurring every other week, my ears started to ring, while my feet continued to burn. I pushed through it all.

My “iron man identity” continued to evolve. It seemed that I could handle an unlimited amount of stress. It was my badge of honor. The obstacles I encountered in private practice dwarfed any prior challenges in my training. I recall sitting at my desk one night after working yet another 14-hour day. A patient had developed a serious postoperative wound infection. Another one had gotten into a fight with a security guard. I discovered I wasn’t getting a paycheck that month because of the high office overhead. My mindset was, “ Bring it on.”

A few weeks later, I crashed with the panic attack.

It was only the beginning

Little did I know how severe these symptoms would become and how many more would occur. Skin rashes popped up and disappeared all over my body, my scalp itched, my nightmares became more intense, I had deep aching pains in my upper back, and intermittent crushing chest pain.

There were other terrible aspects of my ordeal. I am a social person and since I didn’t feel great, I quit spending as much time with my friends. The loneliness was crushing. No marriage could have survived all these untreated symptoms because I was often not in a great mood. I worked at hiding it from almost everyone.

As my family disintegrated, I descended into a full-blown obsessive-compulsive disorder (OCD). I had the internal version, which is experiencing vivid intrusive thoughts, that I would then try to counter with “good” thoughts. I was in an endless, unwinnable battle and my thoughts progressed to disturbing impulses. Along with my many other symptoms, I was in bad shape. I then made the mistake of reviewing some articles on OCD and discovered that the prognosis was (and still is) poor. The best outcome would be to somehow manage or diminish the symptoms with medications or behavioral therapy. I became totally despondent. There was no escape and I sunk into a major suicidal depression. Still, no one could explain to me what was going on or how to solve it

Penetrating the facade

I now understand that major life changes, especially around family dynamics, create more stress and symptoms. The stresses can be positive or negative. The problem with major family events is that they penetrate the façade, and I had been working on mine for decades. A major shift in my symptoms occurred with the birth of my son. My divorce was disastrous. The burning in my feet increased to the point where they felt like they were in a toaster oven. The ringing in my ears was intolerable, I couldn’t sleep, all my other symptoms worsened, and the unrelenting anxiety was the worst part of my ordeal.

I pursued many self-help books, took medications, saw other physicians, underwent multiple diagnostic tests, and aggressively pursued psychotherapy and counseling. I was both open to anything and desperate.

I would’ve thought that meeting my current wife would have been the answer to my suffering. We had an instant connection and I fell in love – except it felt like I was falling off a cliff. I lost more control. When I mustered up the courage to tell her that I was in love with her, she thought I was going to tell her that I had terminal cancer. My suffering dramatically worsened, and I was beginning to seriously give up. No avenue of treatment was working. I had no hope.Slowly, things changed. I escaped the grip of chronic pain in 2003 and continued to gain a deeper understanding of the problem, as well as the principles behind the solutions.

Recap

One reason that the concepts presented in Back in Control  have been helpful for so many people is that they evolved from my prolonged suffering. Almost everything I tried failed, and when I experienced the faintest glimpse of a way out, I kept building on it, step-by-step. Not only I am I doing well, but I am thriving. It is my  privilege to share these strategies with you and be a witness to your healing journey.

Chronic pain has multiple manifestations. Each person has a different experience and must find their own way out. But contrary to common perception, chronic pain is a solvable problem. I am one of the success stories.

The post My Descent Into The Abyss first appeared on Back in Control.

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• Unpleasant thoughts are impossible to avoid and can significantly impact your quality of life.
• They are a “neurological trick” created by your unconscious brain. They are not subject to rational interventions.
• The root cause of the problem is the human need for mental control. It sets off two different reactions.
  • One is that suppressing unpleasant thoughts causes them to become more frequent and stronger.
  • The other one is that when you try to think about something, you’ll think about it less.
• The final outcome is obsessive thought patterns that fire up your nervous system, which causes you to be in a sustained flight or fight response. This state compromises your mental and physical health.
• The DOC Journey teaches you recognize the nature of these thoughts, and you can move past them into the life that you want.

The inability to escape from unpleasant thoughts has a major impact on many people’s quality of life. Much energy is spent in attempting to control or suppress them. It turns out that they arise from the unconscious brain as a reflex, and they are much more powerful than your conscious brain. Rational interventions cannot and do not work.

The problem arises because these disruptive thoughts become stronger with time and repetition, are memorized, and evolve into obsessive patterns. A historical research term for them is, “URT’s” (Unpleasant Repetitive Thoughts). (1) My description is “RUTs” (Repetitive Unpleasant Thoughts). I refer to this phenomenon as “Phantom Brain Pain.”

Then there even a bigger issue in that they are processed in a similar manner as physical threats and stimulate your body into a flight or fight response (threat physiology). It is important to have this survival response, but it is deadly when it is prolonged. Your body is in high gear and your inflammatory cells are attacking your own body’s tissues. However, thought suppression is only part of this story.

The Ironic Effect

A significant obstacle to health and well-being is the “ironic effect.” We all know that when you suppress thoughts and emotions that they become more powerful and disruptive. (2) But a lesser known, and even more deadly problem is that when you try to think of something, you’ll think about it less. (3) Your conscious intention is overwhelmed by your unconscious brain focusing on ways you may not achieve this goal. Since the unconscious brain is so powerful, it is a huge mismatch.

The problem is that the more well-intentioned you are, the more likely this universal process will kick in. If your intention is to be out of pain, inadvertently, you’ll think about the pain more and reinforce it. The research shows that if you seek happiness, you’ll end up sad. If you try to be sad, you’ll end up buoyantly happy. If you try not to stereotype people, you’ll end up being more prejudiced. It is a major human existence problem in that many people who want to contribute to the world’s well-being, end up being crippled by overwhelming unpleasant thoughts and crippling anxiety. People with few scruples are not as bothered by this ironic effect and perhaps why many people in power run over people that are more conscientious.

The “seed” of this ironic process is the need for mental control – any control. (3)  The effect varies considerably from individual to individual, but it is consistently present. As bad as it sounds, and it is problematic, the solution is incredibly simple. Just write down your thoughts on a piece of paper and destroy it. The act is that of giving up mental control and it is without risk. It is the reason The DOC Journey has you begin this exercise before you get into the substance of the course. Every human being should do this daily like brushing your teeth. Look at it as cleaning out the lint trap of your dryer. Even a few minutes a day interrupts this reactive process. It is also the reason why expressing writing is the one “mandatory” step without an alternative.

Moving past these obsessive thought patterns

Understanding the powerful irrational nature of these inner critical voices will change your life in several ways. First, they are a neurological mechanism intended to protect you. You cannot take them personally. This realization allows you to learn to separate your identity from this reflex and access who you are and want to be. Your “demons” are actually suppressed thoughts and who you are NOT. Again, the more of a well-intentioned person you are, the more intense the thoughts. It really isn’t fair.

The other mechanism of trying to think noble and positive thoughts creates the opposite effect in that you think about them less. It creates disruptive thought patterns such as, “not good enough”, “just work harder,” “I’m a loser,” and “why does this always happen to me?” It is also problematic in that they push you to become “successful”, but you may not be able to feel it. A common scenario is the “imposter syndrome.” It seems many highly successful people feel like frauds even though there is abundant evidence to the contrary.

Where is your attention?

Whatever the reason, the end result is the same. You spend a significant amount of your life energy trying to squelch these voices and they won’t respond because they can’t. In fact, they will become stronger in that you are paying attention to them and stimulating neuroplastic changes in brain. It is similar to spinning a basketball ball on the tip of your finger. It will keep spinning as you put more energy into it. Also consider these thoughts as “dust devils” that are mini-tornadoes that occur in the prairie. They spin extremely fast, they cannot be stopped, or even penetrated.

So, the second way your life will be impacted is that once you understand the problem and realize you are wasting your energy trying to assuage this noise, you can move past them. The energy is now available to turn towards the future and construct the life you desire. Going back to the basketball comparison, as you stop paying attention to these circuits, they will slow down and may stop spinning almost completely. You cannot “fix” these thought patterns. The key is to first separate from them (expressive writing), and then create circuits in your brain that are much more enjoyable. You can also shift onto the part of your brain that already knows how to play. All of this can happen quickly with practice. The energy now available to go this direction will amaze you. You’ll quit trying to solve the unsolvable.

Begin with your disbelief

Your success with this course is not about generating belief in David Hanscom, The DOC Journey, or any other set of resources. That would be a form of thought suppression. Positive thinking generates the same thought pattens through the ironic effect. Your journey must begin and continue by connecting with what is happening at the moment. As you begin this course, that would be acknowledging your disbelief and downright cynicism. You have tried almost everything presented in this course at least once. Why should this experience be any different? Like trying to be happy ends up being sad, wanting to be free of pain causes you to be in more pain. If you can’t seem to get past positive thinking, keep trying. We all want to believe and experience happiness but living in chronic pain is tough.

The DOC Journey presents deeply researched tools that will allow you to calm and down re-route your nervous system as well as ways to regulate your body’s chemical state. It begins where you are and sequentially teaches you tools to accomplish this one step at a time. The way out of pain is truly paradoxical and why The DOC Journey is presented in a planned sequence. It also reflects the journey taken by many successful patients.

Recap:

Unpleasant repetitive thoughts are the “curse of consciousness.” They are unique to being human in that we possess language and can create abstract thoughts and concepts. They become our version of reality and identity. (4) We may spend a lot of time trying to fix or escape from them, but it isn’t possible. They are relentless and irrational.

Understanding the neurological mechanism of how they occur allows you to recognize them for what they are, connect to your own value system, and move past them into a much more enjoyable life experience.

References

1. Makovac E, et al. Can’t get it off my brain: Meta-analysis of neuroimaging studies on perseverative cognition. Psychiatry Research: Neuroimaging (2020); 295:111020. doi.org/10.1016/j/psychresns.2019.111020
2. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
3. Wegener DM. The Seed of Our Undoing. Psychological Science Agenda (1999)/ 10-11.
4. Feldman-Barrett. How Emotions are Made. Mariner Books; Main Market Ed. 2018.

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Neil Hilborn – “OCD”

Obsessive Compulsive Disorder (OCD) is an extreme of form of anxiety. It is characterized by a relentless assault of unwelcome intrusive thoughts. I suffered from OCD for several decades well before I knew what OCD meant.

The beginning

My anxiety became disruptive one night in 1990 when I experienced a panic attack while crossing the 520 bridge over Lake Washington. I had no idea what had hit me and I tried to simply tough it out. It was the wrong decision. By 1997, my anxiety became extreme and I was desperate. I picked up the Seattle Times, which had a front page article reviewing a book, Tormenting Thoughts and Secret Rituals by Ian Osborne. He was a psychologist who had experienced OCD. It was a relief to know that I was not alone in experiencing these vivid, crazy thoughts. It turned out that I was experiencing “internal OCD”, which does not have any outward behaviors, such as counting and hand washing. I was experiencing endless disturbing thoughts and then countering them with “good” thoughts.

Fighting a losing battle

The harder I tried to fight these thoughts the more vivid they were becoming. I only realized later that your brain develops where you place your attention and I was inadvertently reinforcing them. I read several medical review articles on the problem and learned that the prognosis is poor, although there was some success with behavioral therapies and meds. I would even snap a rubber band on my wrist when one of these thoughts occurred. I tried everything imaginable and nothing worked. Not only was I desperate, I was actively suicidal. If you told me that I had to live the rest of my life in that state, I would still choose to check out. Physician Suicide: My Journey

Raw unrelenting anxiety is intolerable. It is possibly one of the worst experiences of the human existence. I now understand that anxiety is not primarily a psychological issue. It is a neurochemical response to the environment. All living organisms have an avoidance response to danger. Humans have the additional problem that unpleasant thoughts are processed in the same region of the brain as adverse physical input and the chemical response is the same. Emotional pain and physical pain are equivalent entities.

OCD is intriguing

There is a certain fascination with observing people with this problem and is often referred to in a jocular manner. I recall a TV show where a man was interviewed who counted out a thousand pennies every day. Many of you are familiar with the TV show, Hoarders. I could never watch it because I was raised in a house where my mother was a hoarder. She saved everything including plastic milk and butter cartons, magazines and newspapers. The bedrooms and hallways had two to three feet of junk and the only reason it was not to the ceiling is because the four of us children would clean out the house every three to four months. It was confusing in that we always thought we were helping and she would become incredibly angry at us. It is easy to look at the Hoarder show and be judgmental. They only deserve compassion. Their suffering is extreme and their lives are being consumed by anxiety. This is not the way that life was supposed to be. Additionally, consider the other manifestations of OCD that can be almost as problematic:

• Eating disorders – over or under-eating
• Body Dysmorphic Disorder (focus on minor physical flaws)
• Trichotillomania (hair pulling)
• Health anxiety (hypochondriasis)
• Tourette’s Disorder (involuntary vocal and motor tics)

Although the incidence of classic OCD is reported to be only about 2-3% of the population, everyone has anxiety. It is difficult to define at what point it becomes disruptive to one’s quality of life. Here is my word play on the progression:

• Alert
• Nervous
• Anxious
• Afraid/ fearful
• Paranoid
• Terror

Your unconscious brain

Since anxiety is body’s automatic response to a real or perceived threat, it is part of the unconscious brain; which is approximately one million times stronger than the conscious brain. You cannot control it. Any attempt to do so simply places neurologic energy in that direction and reinforces it. The essence of creating disruptive anxiety is trying to control it. We all know and it has been documented that trying not to think about something causes you to think about it more. (1)

Thought suppression

There is now research emerging showing that thought suppression causes damage to the hippocampus of your brain, which is the area of your brain that process short and long-term memory. (2) Indeed, in chronic pain your brain physically shrinks and you lose some ability to process information. (3) Fortunately, it returns as you heal. Thought suppression has also been shown to be linked to opioid addiction. (4)

You cannot control your thoughts or emotions without paying a significant price. I was a master of suppression to the point that I did not know what the word anxiety meant. Even if you feel you are largely successful in suppressing it, you will experience some or many of the other physical symptoms connected to a fired up nervous system. I had 16 of the over 30 possible manifestations during the worst part of my ordeal. It all sounds dismal and the general feeling about anxiety disorders, especially OCD, is that you can manage the symptoms but not generally solve OCD. I am not only fine but am thriving.

Once you understand that anxiety is the pain you are able to move past and through it. That is how the DOC process was born and has continued to evolve. You will discover which approaches work and don’t work for you and use them indefinitely.

As you learn to live with uncomfortable feelings they will lose their power over you. Here is a poem that came across my desk that is at the core of solving disruptive mental pain.

Unconditional

“Willing to experience aloneness,

I discover connection everywhere;

Turning to face my fear,

I meet the warrior who lives within;

Opening to my loss,

I gain the embrace of the universe;

Surrendering into emptiness,

I find fullness without end.

Each condition I flee from pursues me,

Each condition I welcome transforms me

And becomes itself transformed

Into its radiant jewel-like essence.

I bow to the one who has made it so,

Who has crafted this Master Game.

To play it is purest delight;

To honor its form–true devotion.”

– Jennifer Welwood

Anxiety is at the core of the human existence. You cannot survive without it or thrive living under its threat. Live with it, experience it and become comfortable with it. Then you will become free in a way you never imagined was possible.

Listen to the Back in Control Radio podcast OCD Is No Fun

1. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.

2. Hulbert J, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); DOI: 10:1038/ ncomms 11003.
3. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.

4. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39: 128-138.

The post Extreme Mental Pain – OCD first appeared on Back in Control.

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In the first edition of my book, Back in Control, my advice was that if you had a surgical problem, get the surgery done quickly and engage in the rehab process after you recovered from the operation. I had felt that people in pain could not tolerated the extra burden created from a structural problem. I also thought that surgically correcting severe pathology would relieve the pain to the point that people would be compelled to move forward with their lives. However, I had many patients continue to do poorly in spite of a well-performed indicated operation. I was perplexed and could not predict when this would happen.

Inducing more pain

But I wasn’t aware of the research that shows there is a 40–60% chance of inducing chronic pain as a complication of any surgery if you operate in the presence of untreated chronic pain in any part of the body. It can become a permanent problem 5-10% of the time. (1) Chronic pain as a complication of surgery is not a well-known concept. If I had a neurological complication rate of 5%, I would not have remained in practice for long. This occurs even if the procedure goes well.

My staff pointed out that our patients that had gone through a structured rehab program prior to a procedure were doing much better, and we made a team decision to not perform surgery unless a given patient was sleeping, working on stabilizing medications, experiencing improvement in his or her anxiety/ depression and willing to deal with anger issues. We called the program, “prehab”, and asked our patients to fully engage for at least 8-12 weeks. When we considered major deformity surgery, the prehab might take up to a year.

Many patients did choose to go elsewhere, but the ones who stuck with it, consistently did better and frequently patients with significant structural anatomic problems cancelled surgery because their symptoms had improved or resolved. This turn of events was completely unexpected. It appears that as the nervous system calmed down that the pain threshold was elevated.

Four patients

I saw four patients within a two-week span that I had an almost the same conversation with regards to their decision to undergo surgery. All were professional men between the ages of 45-65. They had leg pain originating from an identifiable problem in their spine. The pain was severe enough that each wanted to have surgery, but they were all at least an 8 out of 10 on the anxiety scale and were sleeping poorly. Their stresses included seriously ill children, loss of jobs, marital problems, etc. and none of them were coping that well.

Can you live with your anxiety?

They were familiar with the DOC project but had not engaged with the concepts at a meaningful level. They were coming back for their second and third visits. Finally, I asked each of them the same question, “What would it be like if I could surgically solve the pain in your leg, but the anxiety you are experiencing would continue to progress over the next 30 to 40 years?” Their eyes widened with a panicked look and every one replied, “That would not be OK. I couldn’t live like this.” Each of them also grabbed his leg and asked, “Won’t getting rid of this pain alleviate my anxiety?” My answer was “No.”

Anxiety is a sensation generated by the body’s chemical response to a mental or physical threat. It is a deeply unpleasant sensation, and the intent is for you to take evasive action and survive. Although surgically removing the spur and pain will relieve the pain and some anxiety, it doesn’t come close to solving it. The essence of lowering anxiety is training your body to secrete less stress hormones.

The quest

I told them that although I would love to get rid of their leg pain with surgery, my bigger concern was their severe anxiety and possibly chronic pain. I recalled my 15-year battle with pain and anxiety. I was on an endless quest to find the one answer that would give me relief; especially for the anxiety. I also remembered the intensity of that need. At that moment I realized that each of these patients felt that by getting rid of the pain they could lessen or solve their anxiety.

It is actually the opposite scenario. As your anxiety resolves, it is common for pain to abate. Crippling anxiety is a solvable problem with the correct approach. That usually doesn’t include surgery. Also, after a failed surgery, another level of hope has been taken away.

Can you live with your leg pain?

Then I asked each of them that if I could resolve their anxiety but they would have to live with their leg pain, what would that be like? Although not completely happy about the scenario, they thought they could deal with it. It was more palatable than experiencing no improvement in their fear.

“No” to surgery

These patients didn’t want to jump to surgery and wanted to give the DOC program a try. Within six to twelve weeks their pain disappeared or subsided to the level where they weren’t even considering surgery. Although I know pain and anxiety are linked circuits, I had never realized that for many patients the pain relief they were asking for was really for peace of mind.

Conversely, I’ve had many patients over the years undergo a successful surgery for a severe structural problem with no improvement or worsening of their pain. Now I understand. “Neurons that fire together wire together.” Pain, anxiety, and anger are tightly intertwined. As long as the anxiety/anger pathways are fired up, they will keep the pain circuits firing.

Surgery may or may not help your arm or leg pain. It rarely solves neck or back pain. It really doesn’t work for anxiety. What relief are you asking your surgeon for?

Listen to the Back in Control Radio podcast Am I Operating on Your Pain or Anxiety?

1. Ballantyne J, et. al . Chronic Pain after Surgery or Injury. IASP (2011); 1-5.

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