Episode 25: Waking Up

Episode 25: Waking Up

Dr. Zev Nevo explores awareness and alertness as the key to “waking up” in the context of pain and healing, arguing that awareness is the most important thing because nothing has experiential value without it. He explains that pain requires alertness and can diminish with distraction, and that suffering reflects both sensation and our interpretation of threat, shaped by limbic sensitivity, past experiences, and cumulative stress/trauma. The nervous system’s survival responses (fight, flight, cry for help, freeze, shut down) are framed as protective rather than adversarial, and a flashlight metaphor illustrates how attention can narrow reality to pain. Nevo emphasizes reconnecting to self-worth and values—what one is fighting for—so alertness has meaning, warning against identity becoming centered on pain, and offering the formula: aware plus alert equals awake.

00:00 The Big Question

01:32 Why Awareness Matters

03:05 Pain Needs Alertness

04:36 Meaning Makes Suffering

10:02 Flashlight Metaphor

11:49 What Are You Fighting For

12:59 Self Worth And Belonging

14:44 Stuck In Survival Mode

17:41 Aware Plus Alert Awake

20:22 Practice And Hope

24:44 Reflection Questions

26:12 Closing Encouragement

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 25 | Waking Up

[00:00:00] If someone were to ask you what is the most important thing in your life, what would you respond? Hey everyone. Welcome back to Mind Your Body. I'm Dr. Zev Nevo, your source for pain and trauma-informed psychoeducation and the exploration of Mind-Body Rehabilitation. Today we're going to explore something that I think might fundamentally shift how you understand not just your pain, but really your entire experience of being human.

[00:00:30] We are going to talk about awareness, alertness, and what it means to truly wake up. So let me ask you again. If someone were to ask you what is the most important thing in your life, what would you respond? Take a moment. What comes to mind first? Maybe it's a material possession. Something you've worked really hard for.

[00:00:57] something that represents security or comfort or [00:01:00] achievement. Maybe it's an accomplishment, a degree, a career milestone, something you built from the ground up. Perhaps it's a relationship. Your partner, your children, your closest friends, or maybe it's your health, your ability to move through the world.

[00:01:22] To do the things you love, to feel good in your body. And all of those answers, they're valid, they're real. They matter deeply. But I want to propose something to you that might sound a little strange at first. An argument can be made that the most important thing to have is awareness. Now, stay with me here. Without awareness of something's value, does it have value? At least not to us, not in any way that we can actually experience or connect with or benefit from. [00:02:00] So awareness is our most priceless gift. In fact, what would anything be worth if we aren't aware of its presence? Think about this. What good is an ancient antique if we don't know what it's worth?

[00:02:16] You could have a priceless artifact sitting in your attic right now. Something worth thousands, maybe tens of thousands of dollars. But if you don't know what it is, if you're not aware of its value, you might use it as a doorstop. You might donate it to a thrift store. You might throw it away. when you're cleaning out the attic. The value exists. The worth is real, but not to you. Not until you become aware of it. What makes something precious to us is our awareness of its value, and this principle, this fundamental truth about awareness, it applies to everything in our lives, including our selves, [00:03:00] including our pain, including our healing journey.

[00:03:05] So let's connect this concept to pain, to suffering. To the experience that so many of you are navigating right now in this moment. When we feel pain, we are alert. And I want you to understand what I mean by alert here. Alertness in this capacity is rooted in a drive to survive and recognize threat while formulating a solution to relieve us of the threat and find safety.

[00:03:35] It is primal. It's automatic. It's your nervous system doing exactly what it was designed to do. Pain is experienced when we are alert to it, and here's something fascinating. In fact, with sufficient distraction, we may not even notice we are in pain. You've probably experienced this yourself. You're completely absorbed in a conversation or you're [00:04:00] watching something that has your full attention.

[00:04:02] Or you're in flow state working on a project and you don't even notice that your back hurts. You don't notice that you've been sitting in an uncomfortable position for an hour. You don't notice the headache that was bothering you earlier. The sensation is still there. The signals are still firing, but without your attention, without that state of alertness, the pain doesn't fully register in your conscious experience. Therefore, pain requires a state of alertness. Now, here's where it gets really interesting. Our pain experience is a combination of what we feel and how we feel about what we feel. Let me say that again because this is crucial. Our pain experience is a combination of what we feel and how we feel about what we feel. It's not just the sensation [00:05:00] itself, it's our relationship to that sensation. It's the story we tell about it. It's the meaning we assign to it. It's the fear or frustration or anger or sadness that comes along with it. The degree of suffering we have in relation to the sensations of pain that we experience depend on many factors.

[00:05:26] In particular, the sensitivity of our limbic system, our past memories and experiences of pain and collective allostatic load, which includes cumulative stress and trauma burdens. If you've had chronic pain for years, if you've been through multiple traumas. If you're carrying a heavy load of stress, your system is going to interpret pain signals differently than someone who hasn't had those experiences.

[00:05:56] Your threshold is different. Your nervous system [00:06:00] sensitivity is different, and that's not your fault. That's just the reality of how our systems adapt to what we've been through. 

[00:06:08] Our mind in turn plays an integral role in our pain experience by appraising the severity of pain based on its interpretation of actual and or perceived threat and danger that are associated with the felt sensation we are labeling as pain.

[00:06:28] Your mind is constantly asking questions. How bad is this? How dangerous is this? What does this mean? Is this something I need to worry about? Is this getting worse? Will this be permanent? Am I safe? And based on those appraisals, based on your mind's interpretation, this translates into the intensity and level of unpleasantness of the pain sensation, and the degree of suffering that we subsequently experience.[00:07:00] 

[00:07:00] Two people can have the exact same injury, the exact same tissue damage and experience completely different levels of pain and suffering. Because pain isn't just about what's happening in your body. It's about what's happening in your mind. It's about the meaning you're making of it. However, and I need you to hear this clearly, our mind is not our enemy.

[00:07:26] I know it can feel that way sometimes. I know when you're lying awake at three in the morning and your mind is catastrophizing, telling you stories about how this pain means you'll never get better. How your life is over, how you're broken beyond repair. It can feel like your mind is working against you, but the intent is towards survival and to establish safety as soon as is feasible.

[00:07:49] Your mind is trying to protect you. It's trying to keep you safe. It's doing the job it was designed to do. Without the awareness of our minds, we would not be able to [00:08:00] experience or connect with our own processes. We'd be completely disconnected from ourselves. We wouldn't be able to make sense of anything.

[00:08:10] So when we feel an emotion as a result of our pain. Be it foreboding, fear, frustration, anger, or sadness. This is representative that we are alert to the fact that something is wrong. These emotions aren't the problem. They're information, they're signals. Our ability to interocept, to sense internally, picks up a signal that implies threat to ourselves or the imminence of threat.

[00:08:38] And the suffering that we then feel is related to and dependent on the degree of threat that we perceive. In other words, how unsafe do we feel? Not how unsafe we actually are, but how unsafe we feel we are. And there's a big difference between those two things. A nervous system that perceives threat can go through a [00:09:00] finite list of domains that aim to protect and preserve life: fight, flight, cry for help, freeze or shut down.

[00:09:08] These are the options your nervous system has. These are the tools in the toolkit and your system will cycle through them trying to find the one that will get you back to safety. The thoughts and feelings may fluctuate. It may manifest differently in our bodies or vary in intensity from person to person, but generally can be attributed to one of the survival domains that we all have as mammals. You might feel the urge to fight to push through to force your way past the pain, or you might feel the urge to flee, to avoid, to distract yourself, or you might cry out for help seeking support and validation, or you might freeze feeling stuck and unable to move forward. Or you might shut down completely numbing out and disconnecting.

[00:09:56] All of these are normal. All of these are your [00:10:00] system trying to survive. However, and this is key, to be alert is dependent on our state of awareness. If we are not aware, we cannot become alert. Let me give you an image to hold onto a metaphor that I think really captures this. In a pitch black environment with a single flashlight, we can only see what the beam of the flashlight is pointed at.

[00:10:30] Everything else is darkness. Everything else is unknown. We intrinsically know that there exists a reality outside of the beam because of object permanence. We understand that just because we can't see something doesn't mean it's not there. But sometimes we forget this fact if we believe reality exists only within what we can see in that moment. If all you can see is your pain, if that's where your flashlight is [00:11:00] pointed, then that becomes your entire reality. You forget that there's a whole world outside of that being. You forget that there are parts of you that aren't in pain.

[00:11:11] You forget that there are possibilities beyond suffering. The beam of your flashlight is your awareness, and where you point it matters tremendously. If you're only pointing it at the pain, at the threat, at what's wrong, then that's all you're going to see. That's all you're going to experience. But if you can learn to move that beam, to widen it, to point it at other things, at what's still working, at what brings you joy at what you're fighting for, your self-worth, then your reality expands. So here's the relevant question. The question that I think changes everything. What are we fighting for? Obviously we don't enjoy the feeling of [00:12:00] pain, threat, or danger, and we want to protect our bodies at all costs.

[00:12:04] But why? Why does it matter? Why are we fighting so hard? What makes your life meaningful, and what are the values that make it so worth fighting for? Clearly, this question will have different answers for each individual. For some, it's a foolish question because it's so obvious and simple. Of course, life is worth living.

[00:12:27] Of course, I matter. Of course, there are things worth fighting for. But for others, and maybe this is you, this may cause a pause to actually ponder the implications of the question. Because if you've been in pain for a long time, if you've been suffering for years, if you've lost touch with the things that used to bring you joy, you might not have a ready answer, and that's okay.

[00:12:56] You might have to really think about it. You see, for [00:13:00] those that don't have sufficient awareness of the value of themselves, self-care, loving kindness towards self, self-compassion, self-esteem, and a sense of self-worth. They're not truly aware of the intrinsic value of their lives. And this is so common, especially for people who have been conditioned to put everyone else first, to earn their worth through achievement or caregiving or being useful to others.

[00:13:28] Their intuition recalls, and that's why the pain hurts so much because it's fighting for something worth fighting for. Your body knows, your nervous system knows. At some deep, primal level you know that you matter, that your life has value, that you're worth protecting, and that's why pain hurts.

[00:13:51] But they aren't fully consciously aware or give the proper attention or respect to their own value as an individual. Their strengths [00:14:00] and characteristics that make them unique. Consciously, you might not believe it, you might not feel it. You might not be able to articulate why you matter.

[00:14:11] Each person inherently belongs as a basic human right. There's no need to prove one's worth. You don't have to earn it. You don't have to achieve it. You don't have to be perfect or productive or pain-free to deserve care and compassion and a good life. You belong simply because you exist. This can be especially hard to land for the people pleasers out there, for those of you who have spent your whole lives making sure everyone else is okay, often at the expense of your own wellbeing.

[00:14:44] So what happens when there's this disconnect? There becomes a disconnect between the intensity of how hard we are activated for protection, to combat threat, to find our way back to safety and the recollection or [00:15:00] realization of what we are even fighting so hard for. Your nervous system is in overdrive.

[00:15:05] Your pain is screaming, your body is mobilizing every defense mechanism it has, but you can't remember why. You can't connect to what you're protecting. You cannot see what's on the other side of this fight. This makes us feel that we are suffering unnecessarily. It feels pointless. It feels like too much.

[00:15:30] It feels like your body is broken, like the alarm system is malfunctioning, like you're being tortured for no reason. However, when we realize that so often the intensity of a dysregulated nervous system is tied to the drive to survive, we can learn to appreciate that our armor is aiming to protect us because we are worth protecting.

[00:15:55] The intensity is not a mistake. It's not your body failing you. [00:16:00] It's your body fighting for you because at some level, your system knows that you matter. For those who do not take the time or opportunity to recognize their self-worth, who are not aware, they can get stuck in just remaining alert. They get stuck in survival mode, stuck in the fight, stuck in the pain.

[00:16:22] That is their entire purpose becomes the fight itself, becoming the pain, and what we encounter while in a state of defense, their identity becomes wrapped up in being the person in pain, the patient. The one who's struggling, the one who needs help, the appointments to go to, the nurturing, the empathy and support and attention we receive when we're in pain. We forget this is just a means to an end, which is to return to our lives without pain.

[00:16:52] All of these things, the doctor visits, the treatments, the support from loved ones. These are supposed to be tools to [00:17:00] help you get back to your life. But, t hey can become the life itself. We get used to a new normal of pain and sometimes forget to think about, what would my life look like again, without pain?

[00:17:15] What would you be doing? Where would you be going? Who would you be spending time with? What dreams would you be pursuing? What would bring you joy? If you can't answer those questions, if you've lost touch with that vision, then you've lost touch with what you're fighting for, and that makes the fight so much harder and so much more painful.

[00:17:41] So we must be aware and alert. Both, not one or the other, but both. We must become aware so we know the value and importance of being alert. Awareness gives alertness, meaning. It gives it [00:18:00] context, it gives it purpose, it makes being alert have meaning, a point, serving a purpose, and we end up honoring the system of pain as opposed to despising it, running from it, fearing it or feeling it's our body failing us.

[00:18:16] When you understand that your pain is your body trying to protect something valuable, you, then you can work with it instead of against it. You can listen to it. You can respond to it with compassion instead of fear. As above, so below; as below, so above. The mind-body connection. What happens in your mind affects your body, and what happens in your body affects your mind.

[00:18:43] They're not separate. They're one integrated system. While the body has innate wisdom, it's heavily influenced and directed by our state of mind, our attitude and awareness and level of alertness. Your body is wise , it knows things. [00:19:00] It's picking up on signals and patterns that your conscious mind might miss.

[00:19:05] But it's also being shaped by your thoughts, your beliefs, and your interpretations. When we are awake, we are both aware and alert. Aware plus alert equals awake. Let me say that again because this is the formula I want you to take home with you today. Aware plus alert equals awake.

[00:19:31] Awareness alone isn't enough. If you're aware of your value, but not alert to the threats, you won't protect yourself. You won't set boundaries. You won't take care of yourself. On the flip side, alertness alone isn't enough. If you're alert to every threat, but not aware of what you're protecting, you'll be in constant survival mode.

[00:19:52] You'll be fighting battles without knowing why. We need a healthy balance of both to be awake, which is to [00:20:00] accurately interpret our sensations, to not just be aware without alertness nor to be alert without awareness. When you're awake, you can see clearly, you can respond appropriately. You can distinguish between real threats and perceived threats.

[00:20:17] You can honor your body signals while also guiding it towards safety. If we find ourselves running from pain or denying our condition, we need to raise the energy of alertness. We need to turn toward it. We need to listen. We need to ask, what is this pain trying to tell me? What does my body need?

[00:20:36] What threat is my system perceiving? And if we find ourselves identifying as our pain and cannot see a life without it, we need to elevate awareness of our life's value beyond pain. We need to reconnect with what matters. We need to remember who we are outside of this struggle. We need to envision what life could look like on the other side.

[00:20:59] [00:21:00] We aren't our radar system. There is a means to an end. You are not your pain. You are not your nervous system's threat detection mechanism. You are not the alarm. You are the person the alarm is trying to protect. Battles are fought for an end goal, a purpose, a return to an equilibrium, a sense of tapping into the value that we have, the ideals and goals that have been stunted by an injury or illness, which we can no longer temporarily do.

[00:21:31] And I want to emphasize that word temporarily because even when it doesn't feel like it, even when the pain has been there for months or years, the limitations are temporary, things can change. Healing is possible. Not always in the way we expect, not always on the timeline that we want, but possible. This makes it worth the fight. When you know what you're fighting for, when you can connect to the value [00:22:00] of your life beyond pain, when you can see the possibility of returning to the things that truly matter to you.

[00:22:07] Then the fight has meaning, then the struggle has purpose. Don't lose sight of what we are fighting for. Your relationships, the people you love and who love you, your passions, the things that light you up, that make you feel alive, your contributions, the way you make the world better just by being in it.

[00:22:28] Your capacity for joy, for connection, for growth, for meaning, all of that is worth protecting. All of that is worth fighting for. Remain both aware and alert to stay awake. This is the practice. This is the work. Not to eliminate pain, though that may happen, not to never feel threatened, though, that would be nice, but to stay awake, to maintain that balance of awareness and alertness, to keep your flashlight pointed at both the threats and the [00:23:00] treasures to remember what you're protecting while you're in the fight.

[00:23:04] Let me bring this full circle. We started with the question, what is the most important thing in your life? And I proposed that it's awareness because without awareness, nothing else has value. Without awareness of the threat, you can't become alert. Without awareness of your worth, you can't understand why the alertness matters. But awareness alone isn't enough.

[00:23:29] You also need alertness. You need that capacity to recognize threats, to mobilize protection, to fight for what matters. Aware plus alert equals awake. When you're awake, you can hold both realities at once. You can acknowledge the pain while also remembering your worth. 

[00:23:48] You can honor the threat signals while also staying connected to what you're protecting. You can be in the fight while also knowing why the fight matters. This is not easy work. [00:24:00] I'm not going to pretend it is. Staying awake when you're in pain, when you're exhausted, when you've been fighting for so long, that takes tremendous courage and effort.

[00:24:11] But it's the pathway to healing, not because it makes the pain go away, though sometimes it does, but rather because it reconnects you to yourself. To your values, to your life beyond pain. And that reconnection, that remembering, that's where the shift happens. That's where you stop being at war with your body and start working with it.

[00:24:35] That's where you stop identifying as your pain and start reclaiming your identity as a whole person who happens to be experiencing pain. So I wanna leave you with some questions to sit with. Not to answer right now necessarily, but to carry with you, to ponder, to return to. What am I fighting for? Not in the abstract, but specifically. What people, what [00:25:00] activities, what experiences, what values make my life worth protecting?

[00:25:04] Where is my flashlight pointed right now? Am I only seeing the pain, the threat, the problem, or can I widen the beam to include what's still working? What still brings me joy, what I'm grateful for? Am I more aware or more alert right now? Am I disconnected from the signals my body is sending, running from the pain, denying the reality of my condition?

[00:25:30] Or am I so hypervigilant, so consumed by the threat that I've lost touch with what I'm protecting? How can I cultivate both awareness and alertness? How can I stay awake? These aren't questions with easy answers. They're questions you'll probably need to ask yourself again and again. Questions that will have different answers on different days, but they're still worth asking because they point you toward waking up, [00:26:00] toward that balance of awareness and alertness, toward honoring both your body's wisdom and your mind's capacity to guide and interpret.

[00:26:12] I know many of you listening are in pain right now. I know many of you are exhausted from the fight. I know many of you have forgotten what you're fighting for, and I want you to know that I see you. I understand. I've been there myself, and I've worked with thousands of people who are there right now, and what I've learned both from my own experience and from witnessing so many healing journeys, is that the turning point often comes, not when the pain goes away, but when we remember and recall why it matters that we're fighting in the first place. When we reconnect to our worth, when we reclaim our awareness of our value, when we understand that the intensity of our nervous [00:27:00] system's response isn't a malfunction, it's a measure of how much we matter.

[00:27:05] You are worth protecting. Your life has value. Your presence in this world makes such a difference. And your pain, as much as it hurts, as much as you wish it would go away, is your body's way of fighting for that value, of protecting what matters. So don't despise it. Don't run from it. Don't feel like your body is failing you.

[00:27:30] Honor it. Listen to it, work with it. Ask it what it needs to feel safe, and then gently, compassionately, remind it of what you're protecting, remind it of what you're worth. Remind it that you're on the same team. Aware plus alert equals awake. Stay aware of your value. Stay alert to the threats. And in that balance, stay [00:28:00] awake to the fullness of your life, pain and all.

[00:28:05] Thank you for being here with me today. Thank you for doing this hard work. Thank you for staying in the fight, even when it's exhausting. If this episode resonated with you, I encourage you to take a moment, maybe right after you finish listening, maybe later today, and ask yourself: What am I fighting for?

[00:28:24] Write it down, if that helps. Say it out loud. Share it with someone you trust. Make it real, make it concrete. 

[00:28:32] And remember, you don't need to prove your worth. You don't need to earn your value. You belong simply because you exist. You are worth protecting. Until next time, stay awake.