Episode #135- Treating Neuroplastic Symptoms with Dr David Clarke

Today I have a special guest, a leader in the field of Mindbody medicine and President of the ATNS (Association for Treatment of Neuroplastic Symptoms, formerly PPDA), Dr David Clarke.

Dr Clarke practiced Gastroenterology in Portland from 1984 to 2009, treating over 7000 patients whose symptoms were not explained by diagnostic testing. 

 

In this episode, Dr Clarke summarizes Pain relief Psychology.  With research based methods teaching patients to take their focus off the symptom, shift attention to brain, and feel the emotions or deal with life stressors.

 

Responding to chronic pain or symptoms this way rewires the brain, so that symptoms can be eliminated instead of just managed.

Listen to hear more!

 

Find Dr Clarke and the 12 question quiz on the ATNS website-  https://www.symptomatic.me/

 

Dr Clarke's challenging patients course https://ppdassociation.org/online-course

 

For fresh content on healing chronic pain or disease, follow Betsy

on Instagram https://www.instagram.com/bodyandmindlifecoach/

 

Youtube https://www.youtube.com/channel/UCvXZSYYGL2cfJl-oEOzqspA

 

Website https://bodyandmindlifecoach.com

 

Transcript- Automatically Generated:

This is Betsy Jensen, and you are listening to Unstoppable Body and Mind, Episode 135, Treating Neuroplastic Symptoms with Dr. David Clarke.
In this podcast, we learn to upgrade our brain and understand the power of our thoughts, to heal and to create the results we want in our life. Become the person in control of your healing and make peace with your life. Become Unstoppable Body and Mind.
All right. Hi, everyone.
Welcome.
We have a special, special guest today. This is Dr. David Clarke. Welcome.
Great to be with you, Betsy.
Well, we are so glad to have you here. So Dr. Clarke is one of the pioneers and leaders in this field. The head of the PPDA, which is now the ATNS, we can talk about what all of these initials mean and acronyms.
But why don't we start with a little bit about your story, coming from being a Western physician to what you do now?
Yeah, I didn't know anything about this. The first seven years of my formal training and education, you know, it's kind of embarrassing to admit as a physician that nobody ever mentioned the idea that your brain could cause serious pain or illness in your body, in the complete absence of anything wrong structurally or with your organs. But then I encountered a patient, I didn't know the first thing about diagnosing or treating.
In year eight of my formal training, she was referred to us at UCLA where I was in training by another university because they couldn't find anything wrong to explain her symptoms. She was actually averaging one bowel movement per month, despite taking four different laxatives at double the usual doses. We did some specialized testing on her that also was normal.
I was doing her exit interview and basically telling her she was just going to have to live with this because there wasn't anything more we could do. But just so the conversation wouldn't be over in two minutes, I started asking her about stress. She didn't really have any.
You know, her current day life was really going just fine. But when I asked her about stress earlier, she started talking about having been molested as a girl by her father. Unfortunately, not just once or twice, which would have been bad enough, but hundreds of times.
And I had never heard anybody say that before. I didn't know what to do with that information. I had no formal training in how to respond to that.
But I fell back on basic instincts as a doctor, which is to try to get the story. When did it start? How often did it happen?
When did it stop? Those kinds of things. And she was telling me the story in a perfectly calm tone of voice.
It didn't look like she was distressed by this at all. If you didn't know better, you would think that, and I didn't know better at the time, you would think that she had completely processed this information and had moved on. And yet she has this terrible physical symptom with no explanation for it.
So I didn't think the two things could possibly be connected, but they were both very striking. So I had vaguely heard of a psychiatrist at UCLA that was interested in conditions like this. And I thought maybe it'll help her to live with this a little better.
So I connected her up with Harriet Kaplan, who was a psychiatrist and forgot all about her. Until I ran into Harriet in an elevator three months later, and I've told this story many times before, but this was the elevator ride that changed my career. Because in making conversation with Harriet, it turned out she had cured this patient with less than three months of counseling.
And the idea that you could alleviate a serious, real physical symptom just by talking to somebody, that was nowhere in my medical education or training. And I thought, you know, if I'm going to be a complete doctor, I should know a little bit about this. So I got Harriet to teach me how she thought about these things.
And I thought, you know, maybe I'll see a couple of patients a year that have this concern or this issue, and I'll be able to use this information, and get the patient over to whoever the Harriet is in my medical community. And I was, you know, started practice in Portland, Oregon a few years later. And I was wrong on multiple counts.
First of all, there weren't any Harriots in Portland. I would send patients to mental health, they would get cognitive behavioral therapy, it wouldn't help them, and they would come back and they say, you know, now what do we do? And so I did, you know, I tried to help them by trial and error.
And I'm confident I wasn't very good at it in the beginning, but even as a bumbling beginner, I was helping people. They were having improvement that they weren't getting from the rest of the healthcare system. So, you know, that was back in the 1980s.
Today, it's been 7,000 patients I've treated like this. It was 250 or 300 every year, which was another shock for me, one out of three of my patients. And I just got better and better at it as time went on.
My first book, which is called They Can't Find Anything Wrong, came out in 2007. And then I started getting invitations to speak. And then I met other people who were doing this work, which I'd never met before.
And we founded a nonprofit in 2011, which is now the Association for Treatment of Neuroplastic Symptoms. And you came to our conference in Boulder just six weeks ago.
Yeah. That's where we met officially. And I realized how tall you are in real life.
I look a lot shorter on Zoom.
Yeah. You said it's your superpower to look short on Zoom. And yeah, that I have to say was such a cool conference.
It was really, really amazing just being around all of these people who we've read their books, we've followed podcasts and done research and read a lot of works and studies that people have put out. And a lot of those big name people were there. It was kind of the everyone who's anyone of this world, the mind body world.
It's really true. Yeah. The speakers we had were tremendous.
I mean, I've been doing this all these years and I learned a lot from them. And the research is something we haven't had before. Just in the last mainly three years, there has been gold standard randomized controlled trials of the treatment methods that we recommend at the ATNS.
And they've been getting stunningly good results at universities across North America, everywhere from Halifax to Los Angeles is showing the power of first of all, focusing on relieving people's symptoms like that first patient, not just helping them live with it, but actually relieving it and focusing on stress in people's lives, trauma, the long-term impact of adversity in childhood, other life challenges. When you do that, people actually get better.
Yeah, yeah. And it's not just digestive issues, as we know. Like that can be a main one.
That's what brought me to the work was ulcerative colitis and irritable bowel.
Yeah, absolutely. That's how I started. But when people found out that I was doing this kind of work, they started sending me mysterious cases with symptoms from head to toe.
You know, I didn't, I have to say, I didn't see that many with migraines, but all kinds of things, dizziness, itching of the skin was one, back pain was a big one, fibromyalgia, pelvic pain, pelvic pain was very common in my practice. I had a whole slew of gynecologists that would send me patients that they couldn't find anything wrong with the pelvis, and yet it was very painful for people. Some of them had genital or bladder pain as well.
So, you know, joints, skin issues.
Genital urinary problems, like incontinence could have a mind-body component, right?
It should be checked for, that's the thing. What we emphasize is, you know, we're not going to have this mind-to-body connection in every single case, obviously, but there are a lot of people it should be checked for to get a complete evaluation.
Yeah, I personally know that because I had incontinence issues during a super stressful time, and I also just had four kids. So I thought, well, this is just my life. I'm just going to have this now.
But turns out I don't have that anymore. So, but I read Dr. Sarno's book when I first, because I found out about this stuff kind of like 2019, I think, 2018-19, a little before, I think, Cureable came out. I didn't really know about the PPDA.
I kind of found Sarno first, and he did say genitourinary issues. So I just got curious, and I started noticing some patterns with incontinence that I was like, oh, it's only certain times. It's right at the end of a conversation, right when I get home in the driveway.
Not the whole ride home, just right when I get home.
No, it's good that you had the insight to figure that out. That's what a lot of practitioners call gathering evidence, that it's not an organ-based or structure-based condition. For example, if the symptom moves from place to place, or if it's not always triggered by the same thing, if you can sit at home for a long period of time and your back is okay, but you sit at the office for the same period of time and your back is not okay, you know, your back doesn't know the difference, but your brain definitely does.
One of my early patients, he had daily low back pain except two weeks out of the year. And you know, no prize for guessing what he was doing in the two weeks out of the year, he was on vacation and he was not resting carefully on a warm beach, you know, taking good care of his back. He was fly fishing in British Columbia, which involves a lot of motion of the spine.
And at the end of the day, he would help the lodge owner clear brush from behind the lodge. Did any of this cause problems for his back? Not a bit.
As long as he was on vacation, he was fine. But when he was back from vacation, he was a workaholic and it manifested in back pain.
The thing is too, I've seen where people on vacation they don't have the pain, they do all these things, maybe on the plane ride back or once they get back, they do have pain, but they don't attribute it to coming back to work or the stressors they're putting on themselves. They think, oh, I must have overdone it three days ago when I did that ATV riding. And they attribute it to something they did several days before, or even I've heard of people up to two weeks before.
Oh, my, my chiropractor said it was probably what I did on vacation two weeks before. And that's why I had the pain two weeks later.
Yeah, no, I hear that too. When you believe that all pain and illness is connected only to organ disease or injury, as a clinician, you will bend over backwards trying to make it fit into that box. If you don't have the training or the capability to assess somebody for a brain-to-body condition or what we today call a neuroplastic condition, you're not going to be thinking of it.
And so you have to try to make the patient's condition fit into something else. And what we see a lot is people trying to make it fit into things like long COVID or Ehlers-Danlos syndrome, which is stretchy connective tissue, or mast cell activation syndrome, or chronic Lyme disease. I mean, there's a whole long list.
Chronic fatigue is another one, a whole long list of conditions that are being blamed for this. Systemic candidiasis, another one, being blamed for this without any real reason to blame it. And what we encourage people to do at the ATNS is to become aware of how you assess somebody.
Look at the stress in their life right now. One of my patients only got his pain when he was driving to work. When he was driving home from work, he was fine.
But none of the doctors who had seen him before me thought to ask him about that, to get that detailed story of when and where his symptoms were happening. But a really big one is, if you went through experiences as a child, that you would never want for a child of your own. And that can be just about anything.
You know, anything from, you know, the sexual abuse that I mentioned in the first patient. But it can also be just lack of support, lack of being made to feel good about yourself, being made to feel like a second rate or a worthless person. That can have profound long-term impacts on people.
And we can't change the past, but those long-term impacts can make you physically ill. And we can change those long-term impacts. We can successfully treat those.
And when we do, the symptoms start to alleviate.
Yes, yes. That's one thing I'll always remember about you is that question to ask yourself is, if I had my own child and was going through the exact same things that I went through as a child, are there any things that I wouldn't want them to have to go through? And maybe it's even a bully in third grade or something, right?
Even those kinds of things can have an impact on that fear base, your nervous system, and then later in life, something similar comes up and you develop that. So it could be not a direct correlation of the symptoms don't just start at the time necessarily.
That's right.
Right? And then the other thing I find is that a lot of times people may not acknowledge the stressors that they are under currently, a lot of times people tell me they don't have a lot of stressors. That's not always the case.
But sometimes pain has become its own stressor or illness, or the lack of a diagnosis has become its own stressor, but they minimize or don't realize how stressful that is. Could you speak to that?
Yeah. My patients are very strong people, and they are capable of carrying levels of stress that most people cannot. And so when they look at their life, they're going like, no, it's really not that huge an amount of stress.
Or they'll say the same thing about when they were kids, that it wasn't that bad. Other people have been through worse. You know, I think I'm over it now.
But they are like Olympic weightlifters who are carrying 50 pounds more than the world record for their weight class. And they just don't know it. So their bodies are breaking down.
And you know, they're feeling that physical impact of this weight of stress that they're carrying without recognizing just how much is going on. Until, you know, as you point out, asking them to think about what it would be like to watch their own kid and try to cope with the same childhood issues that puts a completely different spin on it, helps people to recognize much more accurately. Or to, you know, imagine if a friend was carrying all the stress that they are.
One of my patients was, let's see, she was working full time. Her husband was working full time. She had been an athlete as a girl, and she was coaching her two daughters in her sport.
She was coaching other people's kids in the sport. She was on the Athletic Club Board of Directors. She was driving kids to out-of-state competitions on a regular basis.
And you ask her, when do you put yourself on the list of people you are taking care of? And she was like, not really sure. She had to think about it, and maybe she got to go to the movies with her husband every other month.
But the rest of the time, she was on a treadmill. She never stepped off and hadn't really recognized it until I made her go through the list of everything that was going on in her life, and began to see that it was adding up. But even in her case, it connected back to her childhood.
She didn't suffer any abuse. But as an athlete, she was doing her sport before school, after school, and on weekends, starting at age four. She never really got to be a kid.
She never really got to just play. I'm sure your kid's growing up, they got plenty of time to play. And when kids play, they are learning self-care skills.
They are learning that they need to take a break. If you don't learn that, then you fall into this always on the treadmill kind of lifestyle, and the body is going to protest after a while. And that's what it did with her.
She wound up in the emergency room with a sudden abdominal pain just out of the blue.
And don't you recommend something like purposeful play? Is that something?
Yes.
Yeah. Let's talk about that.
It's an essential human skill. And if you don't do it, it's sooner or later going to catch up with you. But the good news is that you can learn it as an adult, even if you never learned it as a kid.
And I ask people to set aside a block of time every week if they possibly can. And some people, it's a challenge that you have to admit. If you're a single mom, for example, and trying to hold down a job or two at the same time, it can be hard to find space for yourself.
But find as much as you can, and use that time for trial and error. Refuse to feel guilty about this because all you're doing is putting yourself on the list of people you take care of, and try to find something that has no purpose, but your own joy. And the moral equivalent of finger paints for a four-year-old, as I put it, just something that's so much fun, you can't wait to do it again next week.
And it can take months of trial and error to figure out what that's going to be. My champion athlete patient with the very busy lifestyle, all she could think of to do at first was go for walks in a park. But that was better than what she had been doing.
And while she was walking, she was thinking. And eventually she hit on the idea of taking piano lessons. And she had never done anything musical before, but she absolutely loved it.
And that was when her pain finally went away.
Oh, that's so cool. And I love that you said it because my experience when I first learned about like self-care and putting myself first, and I still had that mindset of like getting things done and achieving. So if I did a craft, it was like scrapbooking because then I had a scrapbook.
Or when I thought of just relaxing, I thought I should learn an instrument. And it wasn't out of like pure joy and relaxation. It was kind of like then that could be ticking off the box of relaxation while also doing something productive.
So for me, I'm actually proud of the fact that I can watch TV now without judging myself. Like I can watch a reality show and just get into it and waste some time that way. And I've noticed I like to go to thrift stores and just like meander around.
Or there's some things that I might like doing that other people might not like. But like you said, I love that idea of trial and error. Don't think you have to be perfect at it.
Do not think you have to be perfect. Do not think you have to be even productive.
You don't have to be productive.
That's a trap.
Exactly. That's what I used to think though, is like how could I like sneak some kind of like productivity into it and have a nice talent to show off later or like a package I could give something. You know, I did a craft and I made that for someone, you know.
Yeah, the four-year-old with the finger paints, they're not sitting there thinking, gosh, you know, I need to do more pictures per hour here.
Exactly.
They're not worried about being productive.
Right. Yeah. I mean, that's the biggest thing for me is that I really just was so hard on myself.
I was never letting myself relax. And I really noticed because I started learning about all this stuff and COVID hit. And at that time, I was a physical therapist working with babies and my job went remote because we weren't working with babies in the clinic or in the homes anymore.
And so I thought, oh great, I can just relax, right? I'll have so much free time. But then I started noticing all the baseboards that needed cleaning on all the closets that needed cleaning out.
And so I noticed it didn't really have anything to do with time. I just had that urgency inside of me that was like, I need to be doing something all the time to feel good about myself.
Yeah, it happens with so many of my patients. Many of them, not necessarily like the athlete who had to practice her sport, but the kids who become focused on solving problems in their home when they're children, they observe that things are not ideal in some way. And as kids, they have an exaggerated sense of their ability to fix things.
And so, they get focused on what they can do to make whatever is happening in their home better. But that's distracting them from focusing on their own needs, which is really what kids need to be. Kids are selfish for a reason.
They just take a lot of time for themselves and their own enjoyment. And that's when they learn those self-care skills. If there's something in the home that pulls the attention away from themselves and on to solving problems in that household, then they are taking the first steps on that treadmill of quote unquote productivity.
And if the problems continue in the household for a long enough period of time, that's how they learn to be in the world, is productive people who solve problems.
Yeah. And then if they're not taking care of themselves, it does take its toll. It does.
The body eventually breaks down. The body says no, or you just start developing pains.
Yeah. It's part of that Olympic weight that you're carrying around and that you never get a chance to put it down. That's a big part of the treatment process is people learning, first of all, that the weight is there.
And second of all, how to put it down. And when they do, they realize how strong they've been all along and the symptoms finally start to lift.
Yes. Okay. So if someone thinks that they might have some kind of stressors in their life, but they're not sure, and they're not really sure if their pain might be neuroplastic or not, where do you suggest they start?
Yeah. Well, the website Symptomatic.me has just been launched in the last couple of weeks, and we have worked very hard on a 12-question quiz, which is for self-assessment. It takes less than three minutes, and it covers the major issues that people with neuroplastic symptoms have.
It's set up in a way that the more questions to which you answer yes, the more likely it is that there's a brain-to-body connection going on as the source of your symptoms. And each question comes with a line or two of information to explain what a yes answer means and where you might explore it further. And it can start you with a big step in the right direction toward figuring out where the symptoms are coming from and what to do to alleviate them, because there's tremendous hope for this.
You know, once you get an understanding of what the stresses and challenges are that have produced the symptoms, we can almost always find a good treatment plan.
Yes. Okay. So we'll definitely have a link to that.
And when people come to you, I'm curious when, in my experience, I'll start it this way. I've started to notice that a lot of people tend to hear this information and think that they're probably the exception that has something structural and something neuroplastic. And I'm just curious how often you tend to see that versus how often we know that that really occurs.
Well, it can be a challenge, but definitely people can have both. You can have, for example, rheumatoid arthritis and neuroplastic pain exacerbating the pain of the rheumatoid arthritis. You can have ulcerative colitis, as you did with irritable bowel syndrome, making the symptoms of that worse.
And it's only when you treat both conditions that you have success in alleviating the symptoms. So it's possible, but there's no contradiction in my mind for people working with their medical doctors on whatever physical symptom might be going on, or whatever organ disease or structural damage might be happening. And see if you have some success with taking a medical approach to those.
But at the same time, get an assessment, whether it's from the 12 question quiz, or from one of our practitioners in the directory on our website, get an assessment for whether there could be some stresses, some challenges, some adversity in childhood, some emotions going on that can be producing a neuroplastic symptom at the same time. And if you find those issues, get started on using the now well-validated scientific treatment measures that are out there. Pain relief psychology is the sort of umbrella term for it.
And use that right in parallel with what the doctors are doing. And it's going to become fairly clear fairly quickly which approach is working the best for you.
I'm curious what you advise people who, there is this symptom imperative is what Sarno called it, or Alan Gordon calls it the extinction burst time. So there is this real time that most people go through as they start to learn about this work, and heal, and decrease their stresses, and buy into this mind body approach, and test things out, and start maybe moving more, that they do have some other symptoms.
Yeah, I don't like those terms a lot. I have to be honest, especially the imperative one, it makes it sound like you're screwed for life, that you're always gonna be getting these things coming back. I like a more positive take on it, which is that honestly, your body is your friend, even when it is flattening you on your bed with fatigue or with a migraine or is doubling you over in pain, it's still your friend.
It is trying to tell you something. Your brain is using your body to communicate with you, that there is a stress, an emotion, a challenge, an adversity from childhood that is going on in your life that hasn't been addressed, that hasn't potentially even been discovered yet. And that signal you can use to try to figure out, okay, what is my brain trying to tell me?
That signal from your body, when it's having a severe symptom or collection of symptoms, what is it trying to tell me? My body is actually my friend. It's trying to help me out here.
When I discover the underlying stress that's responsible for this, not only are my symptoms gonna get better, but my life is gonna get better. My ability to set boundaries with toxic people is gonna be better. The relationships that I have in my life are gonna be better.
My ability to assert myself is going to be better. So not only do you get symptom relief from this, you also get a better life from this. But you have to go through the process of shifting your attention from your body where your attention naturally gravitates to when there's a big symptom going on, shifting it to the brain and trying to figure out, my brain wants to tell me something.
And if you have a flare up after you've gotten better, naturally you're gonna be a little disappointed. But I would say it just means that I'm ready to take the next step in my healing, that there's another thing that I need to discover about myself that's gonna take me to the next level. And so that even when you're having one of these disappointing flare ups after a period of improvement, you can take that as a positive.
Yeah. Yeah, you can take it as a positive. Okay, here's a question that I am just really curious what your thoughts are about this.
A lot of people ask me about, don't you just get stiff and sore when you get older, right? Like, I know Dr. Schubiner is 72 and he says he's not sore every day and he does Zumba classes. So what's your take on?
Is there just going to be just pain with aging that people should expect?
Usually not, but it can certainly happen. I mean, all of us do age and that can make us more vulnerable to injuries, for example. So it's certainly possible that you're going to be more prone to developing soreness from time to time.
But for the most part, those are going to be acute, meaning short-term, meaning that if I go over to the gym and I haven't been there for a while and I try to do exactly my previous workout, I may be sore the next day or two. But it's not going to be months. Chronic pain is defined as being at least three months.
And that is not going to happen just from aging. There's going to be something else going on. And it absolutely could be a neuroplastic process, which deserves to be evaluated as carefully as anything else.
I don't know what it is, if it's the programming that we get from the commercials or the drug companies or what, but so many people have told me, well, isn't it just normal that we're just going to feel really stiff every morning and just really sore as we get older? And I don't know.
Well, yeah, there are billions of dollars being spent to market products to all of us that are trying to persuade us that if there's anything going on in our bodies, that it must be our bodies that are at fault. And hey, we're selling you a product that is gonna fix your body. But it turns out that when it comes to chronic pain, a majority of the time, it's not your body.
And so when people rush out to buy spine decompression belts or, you know, infrared laser joint pain reducers, or there's a Procter & Gamble product that I won't even say the name of, that's supposed to alleviate nerve pain. You know, there are 30 billion dollars worth of marketing for dozens and dozens of these products, all focused on making you believe that if something is uncomfortable in your body, that it's your body that's responsible. But there was a study this year or late last year that looked at pain in the spine and did a very careful assessment to see, okay, how much of the, you know, they had 200 and plus patients coming to a clinic for spine pain.
How many of them was it actually the spine? And how many of them was it a brain-generated neuroplastic condition? And the answer was 88% it was brain-generated.
Wow.
And of the remaining 12%, half of them, it was a mixture of brain-generated and spine pain. So only 6% was the pain actually coming from the spine. Now, that's probably a little higher than pain in other locations in the body, but it just shows you how much of chronic pain is neuroplastic.
And is not going to benefit from these, you know, billions of dollars of marketing for these products.
Yeah. And I heard you mention some numbers about treatment, because if you think of only 6% are truly structural, but we're treating everyone as if they're structural. We're treating about 100% of them in this system, that they're structural.
What were those numbers you were saying about as far as the amount of people getting treatment for a neuroplastic condition?
Yeah. Well, it's about 20% of the adult population that have a neuroplastic condition. So 50 million people in the United States alone.
It's about 40% of people that come to a primary care doctor's office, so it's almost double the number of people that have diabetes, for example. Then almost all of them are getting treated with the assumption that their body is responsible. The value of those treatments is typically a little better than placebo.
Those treatments have been used for people with this condition for 4,000 years, and we're not doing any better for those patients today than we were in ancient Egypt when it was first written about. There's almost no other disease where that is the case, that we haven't made any beneficial progress in 4,000 years. And it's completely a social justice issue now, because we've got half a dozen gold standard research studies now that show that pain relief psychology is dramatically effective for this condition.
But maybe 1 in 5,000 people are getting the care that they deserve. So if you've got pain in your spine, for example, that's from a pinched nerve, that's from an actual damage of your spine, you're going to get good care in this country. If you've got exactly the same pain coming from a neuroplastic brain generated process, you are going to get effectively a placebo.
You've got this huge gap in the quality of care. You've got millions of people not getting the care they deserve. It is truly a social injustice.
Yeah, it's amazing to think of it that way. 1 in 5,000, that was the reference. Yeah, yeah, and about 20% of Americans of...
Yeah, 50 million people. And there at the moment is nowhere near the number of practitioners that can meet that need. But the Association for Treatment of Neuroplastic Symptoms is growing every year.
The number of people that we're teaching about this is growing every year. The resources on our website that are scientifically based growing every year. So we are on the threshold of a change in medical history and that people are finally going to get the same quality of care as everybody else.
Yes. And like you said, it's not even just saying there's some kind of mind-body connection or CBT therapy, which is cognitive behavior therapy. It's not just, oh, you have this and there's a mind component to it.
So let's tell you how to cope with it. Do you call it pain reprocessing? I know there's so many different names.
Yeah, I lump them all together under pain relief psychology. There are three major types of pain relief psychology, and they've all got their individual research evidence behind them. But they share so many principles that it makes sense to me to just call them all by that one term.
You know, they're all about taking your focus off of the part of your body that has the symptom, shifting your attention to the brain, and then figuring out what is going on in the brain. What is the stress? What is the long-term impact of childhood adversity?
What is the life challenge? What are some of the buried emotions? Anger, fear, shame, grief, guilt, that people can have in volcanic levels without knowing it.
One of my patients was hospitalized at a prestigious university 60 times in 15 years. She was the first person I wrote about in my first book, They Can't Find Anything Wrong. 60 admissions, a dozen specialists, including a psychiatrist, very prestigious hospital, no diagnosis at all.
She was so discouraged. She ended up getting hospitalized at my hospital because she happened to have an attack here in Portland, Oregon. And she tried to kick me out of the room.
She said, Doctor, don't waste your time with me. I've already had all the tests. Nobody can figure out what's wrong.
You'd be better off seeing your other patients. Well, you know, I couldn't resist a challenge like that. So I said, you know, give me 30, 40 minutes.
Tell me your story one more time and we'll see if we can figure out what's happening. And, you know, to make a long story short, it turned out that all of her attacks of dizziness and vomiting were connected to encounters either direct or indirect with her abusive mother. And she had tremendous emotions with respect to this woman who was still mistreating her.
The patient was age 50, mom was in her 70s. Mom was still mistreating her in a terrible way after, you know, 47 years of this. So the emotions were all there, but she was completely unaware of what they were doing to her body.
That's amazing that you could put it together with the dizziness and vomiting.
All of her episodes we found were linked to encounters with her mom. And I should, you know, close the story by saying that in her case, just bringing that into conscious awareness cured her on the spot. She never had another attack.
I wish I could cure everybody with a one hour conversation, but she called me a year later, said, I've gone the entire year. She used to get between six and 10 of these terrible episodes every year. Half of them, she would be hospitalized for.
Didn't have a single one. Once she could understand where they were coming from, set some boundaries so that her mom wasn't going to have the same impact anymore. You know, that was a big part of what I did in our conversation was to empower her to, that she really needed to set those boundaries to the point where she wouldn't get symptoms ever again.
Amazing. I bet you have so many amazing stories. Are there any others that jump to mind that are just your favorites to share?
Well, actually, I put a bunch of them in a new course that we released early this year called Challenging Cases. I wanted to give people the feeling of actually encountering these patients in real life, and so we hired five actors to play roles of the key people in the stories of these patients. In one case, it was the patient's mother that was playing the role, but in the others, it was the actual patient that we were trying to recreate.
And those are some of my favorite stories, some of my most challenging cases. The first one, actually, it was early in my career, and as I tried to treat him, he got up and walked out of the room. He was not having any of my treatment.
But I learned from that case, and it taught me a lot about the depth of feeling that some people can have. And so I try to convey that in this challenging cases course. But yeah, there have been so many over the years that have had these incredible levels of symptoms.
One of them, she was a record for me in terms of the duration of her condition, 79 years of abdominal pain. And she was a nurse, so she had plenty of access to health care. She got all the diagnostic tests.
She had plenty of doctors look at her over the years. But not one of them, she was 87 years old, so she had the symptoms for 79 years. You do the math, and she's eight years old when it started.
And so, immediately I jumped to the question, did anything happen to you when you were eight?
Yeah.
And sure enough, she went through a terrible trauma when she was eight, and she was carrying a huge burden of guilt around that for all these decades. And nobody had ever made the connection to the beginning of her illness. And her treatment, which was very successful, was simply to write kind of an essay about what had happened when she was eight, and with the goal of alleviating the guilt she felt around that episode.
And that was enough, just putting, you know, putting emotions into words. First, feeling the emotions, recognizing the emotions, then putting them into words. The more they go into words, the less they need to be expressed into your body in the form of symptoms.
And worked very well for her, even after so many decades.
So it's like those repressed emotions were like that Olympic weight that she was just carrying and carrying around. And then once she could express that, her body didn't need to suffer the hit. And suffer that, yeah.
I know it gets so weird sometimes explaining the repressed emotions and how the body... But really, I think we can all see examples of that. When we kind of tell someone something and we don't really mean it, and it catches in our throat or our stomach kind of turns.
Or our bodies are sensitive. It happens more than we realize that our bodies are these barometers for us.
Yeah, I mean, we've all had the experience of feeling a knot in our abdomen when we're in a tense situation. You know, that's a brain to body reaction. Usually, you know that the situation is tense and you know why it's tense.
And you get this, you know, the body has always been part of our emotional reactions. You know, we can get, you know, blushing with embarrassment is another one. Pounding heart when you're afraid or excited is another one.
The body is always involved in emotions. Where the problem comes is if you've got an emotion and you're not aware of it. And then you get the body reaction without the brain knowing why.
And when the brain doesn't know why, it can't do anything about it. It's just going like, why is my body doing this? And it's a mystery.
So, but sometimes people can figure this out for themselves. Sometimes they need an app like Cureable to help them, or a book to help them get insights, or a therapist. Something to help them see the connection to where that emotion might be coming from.
But once they do, solution is on its way.
Yes, yes. And like you said, sometimes it's just even that realization. You don't have to cut off ties with that person, or you don't have to completely cut them out of your life necessarily, but just the realization.
I'm curious. Yeah, if you have any-
I just wanted to say that that was that, you bring up the hardest situation, which is when you are really angry at somebody that you also care about. And what do you do with that? That's very challenging.
And it takes people a long time to work it out. A big part of the issue too, is that people don't like to be angry at somebody they care about. And that's why they repress it.
But it's very, very common to be just volcanically angry at people that you still care about. And we have to find a way to balance those and give, you know, each of them their due. They both have a reason to be there.
And we have to acknowledge that. And sometimes it means setting boundaries. Sometimes it means limiting contact.
One of my patients had to have, you know, just for a period of six months, zero contact with the toxic parent in her life. And that's what she needed to get well. After that, she could begin to gradually reintroduce contact with this person.
But she had a lot of processing to do, and she needed six months to do it.
Yeah. Yeah. Well, do you have, would you say that you have, I mean, everyone is different.
In your experience, do you have a technique that you really like and recommend? I mean, there's so many different things from journaling to breathing to, you know, all the different things. But if you were to give some advice of your favorite or maybe top three things.
You know, most of my patients who have the most severe levels of illness, it's from the long-term impact of adverse childhood experiences or ACEs. And the long-term impact tends to fall into three major categories. And so I focus on helping people with all three.
The most difficult are the emotions, and we just talked about those. The second one is personality traits, that children develop when they're in a dysfunctional or toxic or adverse environment. They try to cope with it by being very good little kids, by being perfectionist, by being very self-critical, by not asserting themselves, by not learning how to play, we talked about earlier, by their self-esteem suffers.
So I try to help them with all those things by seeing, what did they learn about themselves as kids that isn't true? Did they learn that it's their job to help everybody else in the world and neglect their own needs? Did they learn that they're a second-rate person?
I try to help them see that when you're born into an environment like that, it's like parachuting into a dangerous jungle when you're a toddler. And through no fault of your own, you find yourself in this difficult environment. But you need to give yourself tremendous credit for having somehow found your way out of there.
And by giving yourself that credit, you are starting to flip yourself image from the negative one that you learned as a kid that's false into a positive one that you deserve for having made it through those difficult experiences. And then the third, and a lot of the toxic or stressful personality traits will begin to move and to shift into a more positive frame once you've made that shift about your own self-image. And then the third major area are the triggers, which are people, situations or events in your present day life, that are especially stressful for you because they are linked to the past in some way.
And often the most common is, like my patient who was hospitalized 60 times at the prestigious university, it was a person who mistreated her as a kid who was still in her life in the present day. That's probably the single most common kind of trigger. But there can be others, even some ironic ones.
Many of my patients who have just met the love of their life, somebody who is totally for them, that's when they get sick. And they get sick for two reasons. One is they've never had a person like this in their life before, so they're not sure they can trust it.
And they're worried that this wonderful person they have in their life is going to wake up one day and say, no, you're not who I really wanted. Even though there's no evidence for that whatsoever, it doesn't stop people worrying when they've never had this in their life before. And then the second reason is that if you decide that this person who thinks you're wonderful is actually right about you, then it means that you were actually quite a bit mistreated as a kid, that all those negative beliefs about yourself that you absorbed as basic assumptions when you were growing up, they're not true and you didn't deserve to have them inflicted on you.
And that's going to stir up a certain amount of justifiable anger that you had to go through that. And so that's, you know, obviously on balance extremely positive that you have this wonderful person in your life. But in the short run, it can stir some things up and can serve as a trigger.
Yeah. Yeah, it makes so much sense. And yeah, with that anger, you know, it's like we don't have to express anger to that person.
Sometimes that person isn't in our life anymore. They're not even in this world. And in this world, that's true, you know.
So, you know, there are ways, if people are looking for ways to express anger, it doesn't have to be, you know, that you go and get mad and yell at that person.
Yeah, that's right. You can, what I have a lot of my patients do is write them a letter that they don't mail. So you can do that even with somebody who's deceased.
Yes.
One of my patients took the letter to his father's grave and read it to him. And he told me that it took him four or five hours to read the whole thing and that by the end he was shouting, you know, he's there in the cemetery shouting at this gravestone. But when he was done, his symptoms were 90 percent better.
Wow.
Yeah. So very powerful technique. And when you write the letter, it doesn't have to be all bad.
You can put the good stuff in it too. Just try to put everything in it that you're feeling.
Yeah.
Yeah.
I love that. Yeah. And even if the symptoms are better with this work, you look at all that other stuff that you develop, you know, the sense of self and compassion for yourself, and learning to stand up for yourself and take care of yourself.
And those are things that people might even do some therapy or coaching for, even if they didn't have pain, right? So it's like, these are good things to learn just as a general human, as an adult, as a parent. And then also, it takes away your chronic pain.
Yeah. It's a great thing about this work is that in parallel with alleviating the physical symptoms, it makes for changes in people's characters that lead to a better life for them. Many of my patients, you know, I'm always remember one who, we don't have to go into a lot of detail about who she was, but she was known to the public.
And the, she had had one rotten boyfriend after another, her entire adult life, as you know, part of the outgrowth of growing up in a dysfunctional home. But when she went through this work, she suddenly had a much higher level of respect for herself and how much, you know, even though she'd been quite successful in her career, she kind of felt like an imposter, that she was, you know, just fooling people, because she'd had it, you know, drilled into her that she was a failure as a kid. And when she finally realized that she wasn't a failure, she had just been one of these people who's parachuted into the Amazon and found her way out, and that she could take a huge amount of pride in having done that, and that she was no longer going to tolerate being in a relationship with anybody who didn't recognize the quality person that she was.
And as soon as she recognized this about herself and accepted, you know, how strong a person she was, dumped her boyfriend the next day, went without a boyfriend for a year and a half, which was about 12 or 15 times longer than she'd ever gone without a boyfriend before. And then the guy comes along because she wasn't going to put up with anybody who didn't fully respect her. And a guy came along who fully respected her and they've been together for a decade or more now.
So it was not just a relief of physical symptoms for her, it was a major life change.
Yes. And I've seen that with parents where, you know, when they start showing up differently and they're not in pain and they're thinking differently, like their kids even show up differently or their partner does. Not that that's why we want to do it either, but sometimes there are those side benefits of like, you know, we're not as ornery and irritated with our kids.
And then the kids kind of show up a little happier too sometimes.
And so, all in all. Yeah, absolutely. Yeah, it makes the families definitely improve from that.
And what you're doing there is you're breaking the cycle. If you came from a family that was toxic or dysfunctional, you don't have to do the same thing to your own family.
Yeah, even just realizing you can have different emotions, kids can express their emotions. So many times I see parents saying, don't cry, don't cry, you know, and just, I think this is shifting a lot of people's ways of being and so it is, it's breaking those generational cycles and there's anything, I guess, good from all of this physical pain, it's that this awareness is coming out of it and all this change.
Yeah, I think it's going to, once it's spread throughout the healthcare profession, once the general public becomes aware that your brain can create any level of pain or illness in the body and that there's a solution for it, the impact on healthcare is going to be tremendous and the impact on the next generation is going to be tremendous too.
Yeah, they'll look back at this podcast episode and might be like, man, they knew what they were talking about.
That's right, that's right. We should have listened to Betsy right from the start. Yeah.
Man, she was right after all. She knew Dr. Clarke was awesome. Well, so good.
I think you're right. I feel like even just in the last five years that I've been studying this work, it's just skyrocketed and maybe that's just my reticular activating system seeing more of what I want to see. But it really does seem like people are becoming more aware.
Yeah. 15 years ago, most of us who do this work had no idea there was anybody else out there that was doing it. Now, six weeks ago, we had 270 people in a scientific lovefest in Boulder, Colorado and we're just going to have to do it again next year.
I can't wait. I made a few reels and social media posts about it and people were like, I've got to come next year. That looks so fun.
I was like, it was so fun. I mean, we learned stuff too, but you guys really made it such a great warm, welcoming atmosphere and it was just electrifying. It was so exciting.
There was just energetic there.
Yeah. I would just finish reading the comments in our post-conference survey. It's not like I attended some nice presentations, kind of thing.
It's like this was life-changing. This was the best conference I ever went to in my life. You know, those kinds of things that you just don't normally see from a scientific conference.
Yeah, absolutely. You're on to something good and I'm glad to be a part of it.
So very much appreciated, Betsy. Really, anybody who's helping us get the word out about this is one of our people and we love talking to you.
Well, I am so glad and I'm sure many people will enjoy hearing this. So thank you so much for your time. I know you really spend a lot of time promoting and talking to people and getting the word out.
I really just can't thank you enough because even if it just helps one more person, that's a whole life that was changed.
So yeah, incredibly rewarding work to do this for the clinicians out there that are listening. If you learn how to do this, there's nothing that's more rewarding as a professional.
Yes. So I will be sure to put your contact info and the website there. Thanks again for all the work you do and for being here today.
Thank you very much. It's been a pleasure.
Thank you so much for listening. I hope you learned a little bit about your brain today that helps you in your life like it helped me. Please be sure and subscribe and leave a review.
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