An interview with Dr. David Hanscom, author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain, on WFXT-TV in Boston on May 9, 2013. His book …

Photovoltaic cells

The photovoltaic cell is a solar technology that converts sunlight directly into electrical current.

Your nervous system “on the prowl”

Your nervous system is designed to process external stimuli and direct various organ systems to respond in specific ways to maximize your ability to survive and thrive. While this sequence is also a direct conversion of energy into a physical response, the obvious difference is the complexity. Sunlight to electricity is a passive, fixed process depending just on the amount of sunlight stimulating one fixed reaction whereas the brain is conducting an orchestra of billions of cells.

Your body in balance

All organ systems are in delicate balance. There is always a feedback loop that inhibits or shuts down a process when the job is done. For example, when you reach your arm out there are essentially as many nerves stimulating the opposing muscle groups as there are driving the movement. When this balance is disrupted, such as in head trauma, spasticity is the result.  All hormone systems have chemicals that provide feedback to the gland to halt secretion when a certain level is reached. It takes little to disrupt this delicate balance. The pain system is indescribably complicated regarding the feedback loops in the spinal cord and brain in addition to the multiple varieties of pain receptors.

Your body out of balance

Acute disruption of this balance is clear, for example, if you were driving down a mountain road and an oncoming car narrowly missed hitting you head-on while passing. What would happen to your heart rate, stomach, skin, and muscles? But you were not hit or injured. Why did that intense response occur? It was the thought of being in a major accident that caused the bodily reaction. What about waking up from a nightmare with your heart wildly racing? Really, nothing physically happened to you.

Thoughts = sunlight

Your body gathers data from your surroundings in the forms of vision, sound, feel, pain, smell, taste, etc. and converts that data into thoughts that direct your body to respond appropriately. Your thoughts are similar to the sunlight aspect of the photovoltaic cell. The more sunlight – the more electrical current. The more intense and frequent your thoughts – the more intense your body’s response.

What is neutral?

Even in a seeming “neutral” state you brain and body are engaged in an endless dance to maintain balance in all of your systems.

What about chronic stress with its attendant racing, catastrophizing thoughts? Whether your thoughts arise from real or “perceived” stress your body will respond in exactly the same way. That means your “neutral” state is really an agitated state with your body constantly being overworked.

On a white sand beach

Imagine that you are sunbathing on a white sand beach and having a great time.  The reason you feel relaxed is that your body is secreting chemicals that are similar to Valium. Or rather Valium was designed to work on the same receptors that cause you feel calm. But what if you are lying on the beach and are thinking about the promotion you just missed or your boss yelling at you? Your environment is the same but your body’s chemistry is completely different. Any time you are anxious or frustrated, your thoughts will stimulate the secretion of chemicals that will cause muscle tension, decreased blood flow to your intestines, dilation of the airways in your lungs, sweating, mobilization of stored energy from your liver, and an increased heart rate to prepare you to defend yourself.

Stuck in third gear

What if you don’t know how to relax or can’t? This is a common scenario and maybe the rule. Do you think it is your body causing that? No! It is your irrational uncontrollable thoughts. It is similar to driving your car 75 mph stuck in third gear. The engine will be racing at 7000 rpm’s instead of 2500 rpm’s. How long do you think your engine is going to last before it needs major repairs or blows up? That is why cars have transmissions. They are intended to match the power required from the engine to the terrain.

Brain =  car transmission

How do you think your body is responding to your constantly racing thoughts, “I am not good enough. What will people think? How am I going to pay my bills? Why is my stomach upset?” Every person has these disruptive thoughts and for the vast majority of us they rarely stop? Do you think your body is producing the Valium type substances?  Your brain cannot physiologically differentiate a perceived stress from a real threat. Remember in the examples above it was the thoughts that kicked off the body’s response – not physical harm. If you are in a state of constant worry your brain (transmission) is going to be stuck in third gear resulting in a heavy toll on every organ system in your body.

Do you know relaxed?

Why is it so hard for people (including physicians) to understand that EVERY thought you have is connected to a specific change in your body’s chemistry? Of course most variations are imperceptible but many are not. Under chronic stress your body is going respond by being in a non-relaxed state. You might be so chronically stressed that you do not even know that your body is in the wrong gear for relaxation. You need to regenerate every aspect of you and constant worrying (or frustration) does not accomplish that basic need.

Mind Body Syndrome

Your body can and will produce a physical response to both acute and chronic stress. There have been several names given to this phenomenon as it applies to chronic stress: Mind Body Syndrome, Tension Myositis Syndrome, Central Sensitization Syndrome, and Stress Illness Syndrome. It is NOT a psychological problem. It is simply your body’s response to stress.

Are thoughts “imaginary”?

You do not have to have an identifiable source of pain to have pain. Pain can be generated spontaneously by the chemical imbalance generated by your thoughts. Just your thoughts can be a source of pain. There are also at least 30 additional symptoms that are caused by this chronic imbalance. The racing thoughts are not imaginary, nor are the physical responses. What is delusional is the world’s obsession to find a physical “source” for every bodily symptom.

What is wrong with the medical profession?

I understand the patient’s problem understanding how all of this might work. But what is perplexing to me is why the medical profession does not comprehend and embrace it. All of us learned about every aspect of the human anatomy and function in more detail than you can imagine. We know how connected every part of the body is. Yet we continue to be so fixated on finding a structural source for every symptom that we will perform endless procedures for vague indications. Many are high risk.

Will someone please wake up?

I don’t know who is going to wake up first – the medical profession or the consumers. The first step of treating a patient is to make the correct diagnosis. We continue to miss the diagnosis of the Mind Body Syndrome resulting in tremendous cost both financially and in human misery. Hundreds of billions of dollars are spent treating just symptoms. The irony is that addressing the root cause is incredibly effective and costs almost nothing.

Pain pathways are permanent

The foundation of the DOCC project is understanding that pain pathways are laid down in your brain quickly and they are permanent. It is unclear in a given person when acute pain becomes chronic. Once that line is crossed the “pain switch” in your nervous system is stuck “on”. Although many treatments can temporarily decrease the symptoms, you are trapped in “managing” your pain. You eventually become worn down. It is like a mental cancer that consumes your life.

One Choice

Your only choice is to retrain your brain to create new pathways around the old ones. You “move through” the pain pathways and at a certain threshold the pain can and will disappear. There are three steps in creating these new circuits:

• Awareness
• Detachment
• Reprogramming

Mastery

The harder you try to “fix” or suppress the old pain pathways the more active they will become.  This “rewiring” is not a major life philosophy. It is simply a learned skill that can be mastered. These are universal steps in reaching mastery.

Shuhari

A friend of mine pointed out to me that in the Japanese martial arts there is the concept of “Shuhari” that describes the sequence to mastery. These concepts are from Wikipedia.

The word is really three words.

• “Shu” is “to learn”
• “Ha” is “to detach or digress”
• “Ri” implies “moving on” or “transcendence”

Mastery of your pain

“To learn” – awareness

This sequence is critical to dealing with chronic pain. You must first become aware of what “programs” in your head are running your life. You must understand and embrace them before you can be effective in creating the “detours”. Otherwise you will be just running into a solid wall.

Separate – detach

You then have to separate from yourself to see what the options are to move forward. It might be similar to a football running back who has to see the hole in the line before he can progress up the field. I have one friend who visualizes himself sitting in a large theater. He “watches” himself on the big screen dealing with the situation in front of him. He feels like he can make better decisions. His ability to handle stress is unbelievable.  Chronic pain may be life’s biggest stress.

Reprogram – Transcend

I have used the word reprogramming for the final step of creating new pathways. However, I like the word transcendence. It implies that not only have you moved through the obstacles you are far above them. Regaining your perspective on life is a critical step. I have often described the final phase of the DOCC project as the spiritual journey.  It can be manifested in an infinite number of ways.

A Bunch of Balloons

Play

The gift of mastery

Shuhari – the steps to mastery are universal. View your journey through chronic pain as a learned skill. What you probably cannot see at the moment is that when you have transcended your pain you will have been given the greatest gift that life has to offer – deep gratitude. Your appreciation of every second of life becomes profound.

I am a partner in the Charter for Compassion. They are doing some wonderful things regarding creating an awareness of the need for compassion as well as supporting some great projects. However I think all of us need to dig much deeper.

Sartatoga Teen Hangs Herself

I am upset. It is a terrible thing that three 16 y/o boys raped a young girl few weeks ago. What is much more disturbing is that instead of rallying to support her in a time of extreme distress, her classmates turned on her. She was verbally abused both directly and over cyberspace. “Slut”. “Will you have sex with me?” She is now dead from hanging herself. A photo went viral.

I recently wrote a website post, School or Prison – What’s the difference? Bullying. Children are being required to attend school with people who they not only dislike, but also are being treated badly by them – very badly. We come up all types of solutions; such as talk circles, zero tolerance, etc. None of it is going to work until we address root causes.

Norway’s prison system

Ari Cowan, a very active member of the Charter sent a link to the Charter Partners regarding the prison system in Norway. It is a short video clip describing their approach to treating prisoners. It is striking that spending time in their prison system would probably be a more pleasant experience for many children than spending time in our school system. I am doubtful whether there is much difference between our private and public schools.

Seven issues

I would like to list some of the issues around bullying and then look at more creative ways of solving the problem.

First, most bullying occurs at a level well below the teachers’ radar. Just being excluded from a group can be devastating. It is not going to be possible to put the responsibility solely on the their shoulders.

Second, our children are at an age where they are discovering and creating their identity. Most of it depends on some type of approval from their peers. For some reason the approval usually needs to come from the person or group who is the least likely to give it. When someone else defines your identity the person has power over you.

Third, people wring their hands and point out that all of this should be done in the family. There are several significant problems with this thinking. I resent the term “dysfunctional family”. That implies that there are functional families. I have yet to see one. Every human has significant behavioral patterns that are problematic. This is always played out in the home setting.

Even if a child comes from a less dysfunctional family they then become targets for the bullies. They are similar to a domestic animal turned loose into the wild. They either fold or become tough. Neither is great.

Fourth, the argument goes that school is an important socialization process. Really?? Going into an environment where peace, love and joy are hammered into the ground does not create a person who is loving and compassionate. They are just learning dysfunctional survival skills. Behavioral patterns set before age 12 are permanent. Bullies as children have a high chance of exhibiting aggressive behavior as adults. Many children with their egos destroyed will live the rest of their lives in fear.

Fifth, home-schooled children have been shown to do well later in life. My observation of several families that have taken it on is the their children are more creative and thrive without the hierarchy of the schoolroom. Here is an example of the work of some close friends of mine. They have been home-schooled and creativity oozes out of them. Beautifull

Sixth, look at what is happening to our society. We have a life that any generation prior to a hundred years ago could not imagine. Are we happier and more loving? We are not passing along peace and love to our kids – especially in school. External possessions and accomplishments do not change human nature.

Finally, there is a high correlation between the ACE score (Adverse Childhood Events) and disability. As pain drives anxiety and frustration and vice versa this should not be a surprise. These pathways are linked. We are not going to solve the chronic pain problem, which is crippling our society, unless we tackle it in kindergarten.

Bullies are not going to willingly engage

The Charter For Compassion is increasing the awareness of the need for compassion and engaging in many commendable projects. But the people that need to learn compassion the most are the bullies. The people, who are having the most negative impact on our children, are not going to engage or be engaged in a compassion project unless we figure out specific strategies to include them.

Influencers

An important book for each one of us to read is Influencer: The Power to Change Anything. It is a brilliant book and dramatically changed my approach to challenging projects. The main question they ask is “What behavior do I want to change to result in the desired result?”

The result that the Charter wants is for the world to become a more compassionate place. But everyone already knows this. I think most of us were taught about the Golden Rule since we could speak. Compassion is great and desirable. Yet when people are angry and reactive, it quickly disappears. We are not going to have a meaningful impact if we just work on increasing awareness of the need for compassion and engage in compassionate activities.

The question is what can we create and implement in our school system that will teach our children to act and react in a compassionate manner when they are under stress? I have to say it again. Right now we have the opposite scenario. Bullying a girl to death is not compassionate. What about passing the photo along to your classmates? She may have survived the rape.

Solutions

This is a solvable problem with an accurate assessment and implementable action plan. Here are my thoughts as a starting point. .

There are a few givens:

• As all families have various levels of dysfunction this is not going to be the arena to implement solutions.
  • This also means that everyone is somewhat on the same footing. Life is stressful including your immediate family.
  • Stress in life is not the problem – it is your reaction to it. Stress never stops and your ability to engage and thrive on it will determine your ability to be successful.
  • Stress, including your family, becomes the opportunity to practice your tools.
  • Although stress management is a critical part of life it is not taught in the school system – anywhere. I went through medical school, internal medicine and orthopedic residency, a trauma fellowship, and spine fellowship and there was not a word whispered about how to manage stress. I made it through because I was tough – really tough. Tough does not equal compassionate. Although I thought I was trying to be compassionate I was really just trying to survive. Ten years into my practice I broke – badly. Tough always gets worn down.
  • What does a second grader do when under pretty extreme stress? He or she is trapped in very anxiety-provoking situation. What does the world look like from that perspective – especially when you are defining yourself by these experiences? Without any resources he or she is going to be forced to act out and keep the cycle going.

What is the desired result?

Children that will support each other. That requires several things.

• The capacity to care for him or herself – and then for others
  • You cannot reach out unless you have an internal compass.
  • It also takes courage.
  • Watch out for their friends – a culture of support.
  • The only people that can watch out for each other are the students.
  • Within the student environment unkind words and acts must become unacceptable.
  • Accepting and celebrating differences – both positive and negative.
  • Compassion for the bullies.

What behaviors can be changed?

Here are some suggestions:

1. Every child must learn functional stress management skills. Curriculum can be developed from many sources. It must be taught at least two hours a week.
   1. When a child is anxious and frustrated they have minimal awareness of other’s needs.
   2. Reward systems can be implemented for being nice to each other
   3. Set up a buddy system with the specific task of supporting your buddy regardless of the circumstances.
   4. Educate students regarding the devastating effects of bullying – both on the bully and the victim.
      1. A bully also needs compassion. Serious focus needs to be put on the most troublesome students. Bullying arises from abuse and anxiety. They also don’t have the tools to deal with stress. Their acting out is just more extreme.
         1. The antidote to anxiety is control. The more power you have the more control you have. The ultimate cowards are the bullies.
         2. But they are that way for a reason.
            1. Zero tolerance is important
            2. It is more important to find the reason.
2. By the way, how are you going to define a bully? Overt behavior is easy to recognize. But what about subtle acts such as excluding others from your group, snide comments, texts, etc. Unless you are taught to actively care for others a lot of seemingly innocent behavior will be damaging.
   1. The only alternative is to actively engage in compassionate behavior.
3. What about the teachers? It is easy to be endlessly critical of a student’s work or behavior. A book, “Verbal Abuse: Survivors Speak Out” by Patricia Evans is a very sobering book that clearly redefines abuse. Endless criticism in any relationship is abusive.

1. 1. Do they understand their role on possibly engendering bullying?
   2. Are they inadvertently bullies themselves?
   3. Were they bullied or bullies while in school?
   4. They have a high chance of being part of the problem.

I am challenging the Charter to teach our children the tools that will enable them to be aware of each other’s needs and create a compassionate environment. Arming the whole student body is the only solution. They are the only solution to this growing problem.

White Bears

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

Nate

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

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

Harvard Study

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

“ANTS”

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

Pain, ANTS, and White Bears

People suffering from chronic pain lose their sense of humor. Pain causes anxiety and when you are trapped by it, extreme frustration and anger will run your life.

Anger results from loss of control. What causes the need for control is anxiety. Anger is just anxiety on steroids. One step worse than suppressing anxiety is suppressing anger. The eventual outcome is rage. My term for the darkness that consumes my patients in pain (and historically me) is the “abyss.”

There is a Solution

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

Anxiety is not an emotion – it is a mental reflex. It is a link to behavior that causes you to react in a way to protect yourself. You can talk about it all day long but you cannot get rid of anxiety pathways nor can you eliminate pain pathways. It is a symptom of MBS and is not a psychological issue.

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

I have had 16 of the 33 symptoms of MBS disappear. I not only have my life back, I have a new life.

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

Patients Won’t Write

But I often cannot persuade my patients to begin this exercise. It’s a necessary first step of the reprogramming process, which is to create an awareness of these ANTS. The thoughts that come out are often unspeakable.  My patient’s first response is, “This is not who I am.” That is correct. These thoughts are not who you are. They are JUST neurological connections and actually the opposite of you who are. Otherwise you would not be suppressing them. You are only giving them life by blocking them.

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

Possibilities

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

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

2.  Burns, David. Feeling Good. Avon Books, 1999

3.  Sarno, John. Mind Over Back Pain. Berkley, 1999

4.  Schubiner, Howard. Unlearn Your Pain. Mind Body Publishing, 2010.

Charter for Compassion

I am an active member in the Charter for Compassion. There is a sub-group forming looking at compassion in medicine. I realized a while ago that my relationship with my patients was an important part of the healing process. What I did not realize for a long time is that you cannot really understand and hear your patients until you have a deep relationship with yourself.

In March of 2011 I put together a seminar for medical professionals. It was called, “A Course on Compassion: Empathy in the Face of Chronic pain.” It was a remarkable learning experience for me and I would encourage you to watch the videos, which reflect the entire course.

MD Burnout

One concept I learned that day was about  a research study showing that the compassion inherent in most medical school applicants takes a deep dive during the third year of medical school. This is well before the rigors of residency, which makes medical school look like a vacation. Many training programs are downright abusive. Indeed the burnout rate in every survey is between 50-60%.

No Awareness – Wrong Treatment

The driving force behind burnout is anxiety. It is a word that is seldom mentioned amongst physicians. We are supposed to be above it all. Our medical culture does not admit to it or discuss it.  Additionally, the treatment paradigm for anxiety is flawed. Traditional psychology is ineffective as anxiety is a core symptom of the Mind Body Syndrome (MBS).

This is essence of the problem:

It is hard to reach out when you’re burned out.

Burnout is both a preventable and solvable problem. The medical world needs to figure this out quickly – for all of our sakes.

A radio interview

Tinnitus is an annoying symptom that I had experienced since 1985. In another website post, The Ringing in My Ears, I tell my story about how it has all but disappeared. I recently was interviewed on a radio program and the host shared his experience with tinnitus.

A Surgery gone wrong

He had required a surgical procedure on his ear when he was 19 years-old. The surgeon slipped and perforated his eardrum. He initially had a lot of pain that resolved over several months but he ended up with significant ringing in his ear.

He spent years being frustrated at the endless ringing and also at the surgeon who had caused him so much suffering. His quality of life was not close to where he wanted it, particularly at such a young age.

Tinnitus gone

As I was being interviewed it was clear that he knew much more about the Mind Body Syndrome principles than most people I had talked to. Yet he had not been exposed to the concept. I began to ask him a couple of questions as he indicated that the tinnitus was no longer a problem.

Letting go

At some point he realized that the energy he was expending being angry was a waste  of time. There was nothing he could do about it. He made a decision to accept his ringing and in an odd way “made friends” with it. Although it was not his intention to get rid of the symptom, over the next few years the ringing stopped. He only occasionally experiences it.

You cannot “fix” yourself

The intent of the DOCC project is to create a nervous system shift into a more enjoyable and functional place. The more you fight and try to “fix” your symptoms the stronger they will become. You will become worn out. It is similar to an insect being trapped in a spider web. As he quit reacting to the signal from his hears his nervous system shifted into different place. Eventually the pathways became less functional and he really did have relief of his symptoms.

Embracing Adversity

He went a step further and somehow embraced his tinnitus. Viktor Frankl tells a similar, more intense story. His book is titled Man’s Search for Meaning. He was a Jewish psychiatrist who survived the concentration camps but lost several immediate family members. Somehow in the midst of indescribable suffering he felt it was important not only to find one’s purpose in life, but also to find meaning in suffering.

What is your choice?

Remember that in the big picture of life stress is not the problem. It is how you choose to react to it. It is only by letting go, and possibly embracing your adversities, will you be able to move past your pain into a full and rich life. What is your choice?

In our society today, it’s commonly believed that the higher you think of yourself, the more confident, happy, and successful you’ll be; high self-esteem is held up as the ultimate goal. In actuality, however, this couldn’t be further from the truth: the pursuit of self-esteem is a destructive concept that is merely the manifestation of man’s thirst for power, driven by anxiety and the need for control.

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
  • 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 very effective method is to either write down or speak your thoughts, which allows you not to change them but to detach from them, thus accomplishing Step #2.

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 Mind Body Syndrome (MBS) symptom (for more information on MBS, see back-in-control.com)
  • The most effective way to treat anxiety
  • Will minimize the need for self-esteem
  • Become aware of your own self-esteem needs and resulting judgmental nature.
  • If you are working on your self-esteem, realize that your actions are driven by a need for power, and accept that we are all powerless.
  • Understand 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

Think about it: compassion catches on. 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: Kerry Patterson, Joseph Grenny, David Maxfield, Ron McMillan, and Al Switzler. 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: they must stop working on their self-esteem and instead, practice compassion.

Summary

Let’s review how to bring about world peace: the problem starts with individual anxiety, which can be successfully processed by letting go of anger and the need for power. This can only happen by using the treatment principles of the Mind Body Syndrome. The pursuit of self-esteem fosters anxiety instead of allaying it. By dropping judgments and labels of those around us we can have a deeper awareness of their needs and act in a compassionate manner. Becoming aware of the destructive nature of self-esteem and how it blocks empathy is the first step. Individually taking responsibility for our judgmental nature can create a collective consciousness that would be a significant step towards world peace.

Structuring the Own Management of Your Pain (STOMP) is a program that was developed by Dr. Gordon Irving and his staff at the Swedish Medical Center Pain and Headache Center. They have a wonderful set of resources that has greatly enhanced my patient’s capacity to become pain free. They also work on the principles the Mind Body Syndrome. Dr. Irving asked me to help edit this latest version. You will find many additional tools to assist you on your journey back to full health.

STOMP

Swedish Pain and Headache Center

My Friend’s Back

A friend of mine asked me for an opinion a couple of years ago about his back. I was giving him advice as a friend, not as a surgeon. He was having some pain and numbness down the side of his leg. It was down the distribution of his 5^th lumbar nerve root.

His MRI scan showed that there was a bone spur between the 5^th lumbar and 1^st sacral vertebra as it exited out of the side of the spine. It was surrounding the 5^th lumbar nerve root. It was my feeling that surgery might help but I also thought he might avoid surgery with certain exercises that flexed his spine and also working on some the Mind Body Syndrome principles.

The Surgery Didn’t Help

He elected to go ahead with surgery. He improved for a couple of months and the pain returned except that it was worse. He then underwent a second operation about six months later that did not help and in fact worsened his pain. He asked me again what I thought he should do next.

He Took Charge

About six weeks before I talked to him he had fired everyone and stopped everything. No more doctors, medications, or surgery. Within a week of making that decision his pain disappeared. He had taken complete charge of his care.

The Bone Spur is Still There

What makes his story more interesting was that when I looked at the MRI scan done after his second operation the bone spur was still there. The surgeon had missed it. He had worked on the middle part of his spine freeing up the 1^st sacral nerve root, not the L5 nerve root. He had needed to remove the bone spur out to the side of the spinal canal, not the middle.

Another Patient

I had another woman a couple of years ago who had pain down both of her legs in the pattern of the L5 nerve root. She had resisted the DOCC project for a long time. She decided to undergo surgery to free up both of the L5 nerve roots. She did have significant spurring touching both of the nerves. When she made the decision to have the operation she also engaged in the DOCC project. When she came in for her pre-operative visit her leg symptoms disappeared. I cancelled her surgery.

They Both Had Structural Problems

In both of these cases there were structural problems with matching symptoms. In the first case, if the L5 nerve root had been correctly freed up his pain would have disappeared after the first operation or the second operation. As the bone spur was never removed it now was clear that he could have gotten the same improvement without any surgery. With the second case she would have also done well with surgery. Both of them solved their own problem with engagement and taking charge. That is why my book is titled, “Back in Control.” Every patient I have seen get better has taken full responsibility for their pain and care.

Raising the Pain Threshold

When your nervous system calms down utilizing Mind Body Syndrome principles the threshold for sensing pain is raised. I am sure that the structural lesions in their spines are still firing pain impulses to the brain. It is just that they are now below the elevated pain threshold and are not interpreted as pain.

What did they do? They both took charge of their problem. They took control, which instantly decreases anxiety. That, in and of itself, is a major step in calming down the nervous system. Their pain did not just decrease; it disappeared.

Surgery is Still an Option

In the future there is a high chance that the symptoms will re-appear under a certain level of outside stress. I am now used to having my patients go through the steps that originally calmed them down and the symptoms will reliably disappear. Remember that pain pathways are permanent. I also reassured them that if the symptoms don’t diminish I could always perform an operation with good success.

Why Not Just Do the Surgery?

You might be asking, “Why not do the operation and then they would not have to worry about it in the future?” There are a several reasons. First, even with a successful operation it is common for pain pathways to get fired up under stress, even if there is not a recurrence of the structural problem. Second, even the simplest operation has risks. I could write a book of simple operations going bad. Third, with spine surgery you always cause the formation of scar tissue that can be permanently irritating. You are just better off avoiding surgery if at all possible.

The Change in My Thinking

I now have over a dozen cases similar to these two. It has caused me to change my thinking about the timing and role of surgery. I use to think that surgery was always required in the presence of a structural problem. My conversation with my patients would be, “Let’s get the surgery done and we’ll work through the rehab later. You cannot rehab a structural problem.”

My discussion now is, “I am happy to perform your surgery but I have seen patients go to pain free even in the presence of a structural problem. If we can calm down your nervous system your post-operative pain will be less and easier to control. Maybe we don’t even need to undergo surgery.”

The DOCC project is a Process in Evolution

I am a surgeon. My thinking around the DOCC project is continually evolving. The idea that a person could raise their pain threshold enough to avoid surgery simply by taking complete charge of their decision-making has been surprising to me.