Your Brain Is Trying to Tell You Something: A Conversation with Dr. Clarke

Dr. David Clarke, Knowledge Becomes Healing

The Association for the Treatment of Neuroplastic Symptoms advances the awareness, diagnosis, and treatment of chronic pain and illness.

One in six adults suffers from chronic pain or illness that is either “medically unexplained” or unresponsive to virtually any treatment. These patients have neuroplastic symptoms (NS) — brain-generated conditions linked to past or present stress, trauma, or emotions. These chronic symptoms manifest themselves as fibromyalgia, migraines, irritable bowel syndrome, many cases of long COVID, and dozens more conditions. Their incompatibility with conventional diagnosis leaves most NS patients feeling neglected by the medical profession and hopeless about their future. The Association for the Treatment of Neuroplastic Symptoms (formerly the Psychophysiologic Disorders Association) is a 501(c)(3) nonprofit dedicated to ending the chronic pain epidemic by promoting awareness, diagnosis, and treatment of neuroplastic pain and illness. 

Dr. David Clarke, President of the Association for the Treatment of Neuroplastic Symptoms (ATNS), a 501(c)(3) nonprofit dedicated to ending the chronic pain epidemic. Dr. Clarke holds an MD from the University of Connecticut School of Medicine, and is Board-certified in Internal Medicine and Gastroenterology. His organization’s mission is to advance the awareness, diagnosis, and treatment of stress-related and brain-generated medical conditions. As host of the podcast “The Story Behind the Symptoms," Dr. Clarke delves into origins of patients’ unexplained symptoms. Learn more at Symptomatic.Me. Welcome, Dr. Clarke. What are neuroplastic symptoms and how do they differ from those caused by injury or disease?

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Transcript

SPEAKER_00 0:07

Dr. Clark Clark is um with the association for the treatment of neuroplastic symptoms of the answer is the awareness of notice in treatment of chronic pain and illness. Um what have you think about the suffering chronic pain or illness? And it's either medically unexplained or unresponsive to virtually any treatment. And there's a lot more underlying to all this. And so it's a pleasure to have you on.

SPEAKER_01 0:31

Great to be with you, Pamela. Thank you.

SPEAKER_00 0:33

So you're based in Portland, Oregon, I understand. Tell us a little bit about your research, your practice, what you have found, and how you can help guide others that might be dealing with unexplained pain.

SPEAKER_01 0:48

Yeah, absolutely. I was trained very traditionally that when you have pain or illness, there must be an injury or disease to explain it. But it turns out there's this whole other category that can also cause pain or illness in the body, real symptoms, not imaginary, not in your head, but real, based on uh nerve pathway changes in the brain. And these can be very severe. I've had patients in the hospital with it, I've had patients who've suffered from these things for decades. But the good news is that it's uh able to be diagnosed and treated every bit as successfully as any other form of illness. And the reason for this is that the changes in the brain that are responsible for this, and again, this can happen in people with no structural abnormalities, no organ disease. And the reason that these have happened is because somebody's been through a significant stress or a trauma, or they've got powerful negative emotions that they don't fully recognize, or they went through experiences as kids that were challenging or adverse for them that they would, for example, never want for a child of their own. And those all can have long-term impacts on people changing the structure of the nerve pathways of the brain, and resulting in symptoms like migraines or fibromyalgia, irritable bowel, uh, pain in the back or neck, uh, chronic fatigue, some cases of long COVID, pain in the pelvis or bladder or genitals, uh, joints, certain kinds of rashes, um, lots and lots of different uh symptoms. But again, by identifying the causes, they can be successfully treated. And um, the only difficulty now is educating people about this, especially healthcare professionals, so that they know what to look for.

SPEAKER_00 2:45

So, and it and you're you're describing a wide range of things from autoimmune to really, really serious diagnoses. What are some of the ways that you help someone understand what might actually be going on and get to the bottom of this so that you can understand how to better treat?

SPEAKER_01 3:01

Yeah, well, the first step is to make sure that they don't have an organ disease or structural abnormality. And we're very careful to make sure that we do all the proper tests to check people out for any kind of physical cause for their symptoms that might be responsible. Uh, a handful of cases over my career, the tests have not shown anything, and the person has not improved with the mind-body methods that we use. Uh, and then we go back and look. Um, look again for uh an organ disease that perhaps didn't show up on the tests initially. But that's you know, maybe been five or 10 patients uh in the 40 years that I've been doing this. It's it's quite rare with the quality of tests that we have available today. So my next step is to do what I call a stress evaluation, looking for stress in a person's life right now. Um very simple example of that was a patient who only got his pain when he was driving to work. When he was driving home from work, he was fine. Um, similarly on the weekends, uh, when he was not at work, uh, he was fine. Um, so the next obvious place to look was well, what's happening uh at work? And he had a huge stress going on there. And the duration of that stress corresponded exactly with the duration of his illness. So by going to his supervisor and making some significant changes, um, symptoms went away. But he hadn't connected it uh at first, and none of his other doctors before he came to see me had connected it either. So, stress in your life right now, um, stress going on from a trauma. Uh patient that was described to me by a colleague in Arizona was going from doctor to doctor to doctor looking for an explanation for numerous symptoms that she was suffering from. And nobody found out until my colleague who does this work asked her if she'd been through anything traumatic. And sure enough, she had been a hostage during the robbery of a store right before she developed this illness. And during that robbery, she had a handgun pointed at her neck for over half an hour. So very traumatic. And she had a number of uh symptoms of post-traumatic stress disorder. Um, I also look to make sure that nobody's missed a diagnosis of depression or anxiety, because those are not always obvious. People who've suffered from those for a long period of time, it just feels normal to them. And they they may say that they're not depressed or they're not anxious, but when you look into it in more detail, you find out that they have a lot of symptoms of those conditions. But probably the biggest single category, especially in people who've been ill for a long time or who have multiple symptoms, is that they went through some kind of adversity as children. And this can be fairly obvious adversity, like physical or sexual abuse or violence in the home, or somebody who's got an active alcohol or drug problem. But it also can be much more subtle. Um, people who were taught not to feel their emotions or not to express their negative emotions, for example, they uh lose an important signal uh about how the world is treating them and result in all kinds of problems, uh, or anything that would make you feel like you weren't measuring up somehow, or you were a second rate or even worthless human being. Um, or most broadly experience as a kid that would make you sad or angry uh to watch it happen to a child of your own. Um, those things can have long-term impacts on people. Uh, it can create uh personality traits, for example. Children in those environments will try really hard to be the best kids they can be. They'll try to be perfect, they'll be extremely self-critical, they will be so focused on taking care of the needs of everybody else in that household that they may fail to put themselves on the list of people they take care of. And that can carry on. When you learn it as a kid, it can carry on into the adult years and become progressively stressful. So, all of those areas we can look into, uh, uncover issues that people may have been struggling with without really recognizing the magnitude of it. Um, but when we can bring all of that into conscious awareness, we can help people make changes, bring the stress level down, the patient's symptoms then begin to improve, and everybody becomes confident that we're on the right track.

SPEAKER_00 7:52

So, what kind of diagnostics do you like to run first to explain away anything physically wrong with any organs? And then what sort of things do you move into to work through some of this neuroplacity?

SPEAKER_01 8:06

Yeah, it's all depending on what the initial symptoms are. You know, we're gonna focus on what is the range of possibilities for a particular symptom. For example, if I'm evaluating somebody who's got pain in the upper abdomen, I was a gastroenterologist uh for decades, and that was a common symptom that I would see people for. Uh, and I would be talking to them about the possibility of gallstone attacks, for example, or peptic ulcer, or an inflamed pancreas. Um, but I would also mention at the same time that brain-to-body uh stress-related neuroplastic symptoms are also on the list of possibilities and that we should consider all of them if we want to do a complete evaluation. So I might order an ultrasound or a CAT scan or do an upper endoscopy on the patient looking for the ulcer, blood test to look for the pancreas problem. But at the same time, I'm asking them to think about stresses in their life past and present. If we don't have time at the first visit to get through the full list of stresses, I'll ask them to make a list and to bring that with them when they come back after they've had their diagnostic evaluation. And then we can look at that and we can see, you know, is there enough stress here to explain what's going on? A patient of mine, and you know, a lot of doctors, you know, fail to do this and they miss the diagnosis in uh 40% of the patients that come to see them because that's that's what's going on. It's a neuroplastic condition. Uh, and it's 20% of the adult population now, according to the latest surveys. So we're looking at 60 million adults in the American population alone. So once we've uh got all of the diagnostic tests done and we've looked for the stress evaluation, um, usually I can find uh a connection uh to a stress in the person's life and the physical symptoms they're having. Um the uh the first story uh in my first book, uh, which was called They Can't Find Anything Wrong, was a patient who'd been hospitalized at a major university 60 times in 15 years for severe attacks of dizziness and vomiting that would last for days. Um, and they had a dozen specialists see her with no diagnosis. They got really frustrated. They had a psychiatrist evaluate her, he completely missed the diagnosis. And it turned out that to make a long story short, um, her attacks of illness were all linked to interactions, direct or indirect, with her abusive mother. Um, and as soon as I was able to show her that this was a very strong connection, she had one of those light bulb moments. I can still remember her looking up at the ceiling and going, oh my God, I can't believe it. Uh and as soon as we brought that into conscious awareness, she was able to set strong boundaries with her mother, and the attacks uh stopped happening. And she'd been having these for 15 years.

SPEAKER_00 11:18

Yeah, no, it's fascinating. And it took me years to understand why I had a stomachache, just meant I was stressed out and worried about something, and then I was able to control the stomachache.

SPEAKER_01 11:27

Um exactly. That's a perfect example. Uh and for your uh viewers who are interested in whether their own symptoms might be connected to this, on the website, symptomatic.me, we have a 12 question self-assessment quiz that people can do in less than three minutes, and we'll give them a lot of information about their personal situation.

SPEAKER_00 11:50

So talk to us a little bit about your method or your way of working someone through. Almost like a I I I envision this is kind of like a counseling meets a workshop type of uh activity that you're bringing people through. You know, not only you have the ability to run all the tests because you are a doctor, but now you've got the ability to understand there's something potentially more in this. And so it seems like you're kind of um doing a combination of like a talk therapy and a medical diagnosis. Is that a fair way to kind of think about this?

SPEAKER_01 12:22

And yeah, absolutely. I mean, it wasn't how I was trained. I went through the first seven years of my training strictly focused on organs and structures. But then I met a patient in my eighth year. Um, you know, by the eighth year, you know a lot. I mean, you're qualified to go out and practice independently. I was taking some extra training to become a gastroenterologist. And I met this patient. I didn't know the first thing about diagnosing or treating. Uh, she had a severe condition, she had completely baffled another university. They didn't know what was wrong with her. They sent her over to us at UCLA for some specialized testing. This woman was averaging one bowel movement per month, uh, despite taking double the recommended doses of four different laxatives every single day. Um, but our specialized test was also normal. Uh, and I was just having a conversation with her about stress, and eventually she trusted me enough to say that she'd been abused by her father as a girl. Um, and I didn't know what to do with that. In fact, I'd never been trained that I should even be looking for information like that. Uh, but I got the story. Uh, she was happy to share it, um, explained it in a very calm tone of voice, uh, didn't seem upset at all. I didn't think it could possibly be related to her illness, but um, at least I could refer her to a psychiatrist to get some counseling about it. Well, I forgot all about this patient until three months later, I ran into the psychiatrist whose name was Harriet Kaplan in an elevator. And this turned out to be the elevator ride that changed my career because between the ground floor and the fifth floor, she told me she had cured this patient uh with less than three months of weekly counseling sessions. And I just thought that was astounding. Uh, and I thought, you know, if I want to be a complete doctor, I need to learn something about this approach. Uh when I got into practice in Portland, Oregon, I started using it. Uh, I never thought I'd use it for more than a handful of patients a year, but it turned out to be five or six every week that had these mind-to-body issues causing very real symptoms. There wasn't a Harriet Kaplan here in Portland, so I ended up treating these patients myself, um 250 or 300 of them a year. Uh, it took me four or five years to get you know reasonably good at it, uh, but I found it tremendously rewarding because people who were not getting better uh elsewhere in the healthcare system were finally getting good outcomes, good results. And I just really love doing it. And, you know, sitting here today, I've successfully treated over 7,000 people with this.

SPEAKER_00 15:12

Yeah, it's fabulous. So is there a certain type of age range or um malady that you see more often than not?

SPEAKER_01 15:21

You know, the age range, it's interesting. I did look at that, uh, studied my own practice, and it spans the entire range. Uh, you know, I would see patients down to age 13 years of age. Uh, and my oldest patient uh was 87, uh, and she had been having unexplained abdominal pain uh since she was eight years old, so for a total of 79 years. Um, I did have one uh very nice uh nine-year-old uh that they sent to me. I I became kind of a go-to doctor for mystery cases, and this young boy had already been seen by all of the pediatric uh doctors that did gastrointestinal work, and nobody was finding an explanation for his abdominal pains. Uh, and it turned out to be very simple because he only got his pain uh on days when he was scheduled to pitch for his little league team. Um, on days when he was in the outfield, he was fine. Um, and so that was the you know the clear connection. He just had a whole lot of stress when it was his turn to pitch. Um, but yeah, full full-on age range. And the symptoms, uh, you know, as I mentioned earlier, they can be from head to toe. Um, the only common denominator is that there often is more than one at a time. Um, my nonprofit, uh, the Association for the Treatment of Neuroplastic Symptoms just did a national survey, and we found that 71% of people who are likely to have this condition had more than one symptom. Um, so that's that's a tip-off. When I have somebody in my office that has got symptoms in, especially if they're in more than one location or if they are uh moving from place to place. Um one patient that was referred to me by I used to do a lot of second opinions from other doctors in my department. In fact, I did 90% of the second opinions. And one patient I remember very well, her her belly pains would move from place to place in her abdomen. Um, tumors don't do that. Um infections and inflammation doesn't do that. Um, but neuroplastic, you know, brain to body does that all the time, or it it moves around the body depending on where those nerve signals are being sent from the brain.

SPEAKER_00 17:45

Is there anything um in particular that you like to teach people when it comes to something like this, whether it's through meditation or some sort of practice, or I mean, is there anything that's kind of your go-to when you're first starting to help people work through some of this nerve pain?

SPEAKER_01 18:00

Yeah, it's great to have um a way to self-regulate your nervous system. Um people can look up online how to do mindfulness meditation, for example. It's a very simple technique that can bring people's stress level down when it's getting too high. Um, but beyond that, I like people to recognize that the diagnostic tests have shown that their bodies are okay, and they can stop being afraid that there's gonna be some serious underlying diagnosis in there. Uh, they can stop being afraid that they're gonna be, you know, have lifelong disability, um, and they can start shifting their attention to their brain where this is going on. And these physical symptoms are kind of a language or a form of communication from the mind, that the mind is in a state of distress over something. And if we can shift attention from the body where the symptoms are to the mind and start thinking about well, what might that distress be coming from? Uh and when people start thinking about that, they very often can figure it out. Sometimes they need, you know, the help of a therapist, or you know, we have self-help books. Uh, I do a podcast of my own called The Story Behind the Symptoms, where I interview patients, much as I used to do in my office, and all of these things, and and we've got courses and self-help books that can give people insight into what the mind's distress might be about. Uh another important aspect of treatment is that if you are not taking regular time for your own joy, if you don't have an activity that you can do on a regular basis that has no purpose but your own enjoyment, you know, putting yourself on the list of people you take care of, um, that turns out to be an essential human skill. And if you don't do that on a regular basis and your your life is on a treadmill of constantly taking care of everybody else in your world, sooner or later your body is going to protest. So I like I like people to learn those uh self-care skills, to do some trial and error, to find an activity that, you know, it's the moral equivalent of finger paints for a four-year-old. Just something you're doing because you love it.

SPEAKER_00 20:26

That's a great idea. What a great reminder. Anything else you want to touch on that we haven't talked about today?

SPEAKER_01 20:34

Well, I'll just say that these symptoms can be uh very severe. Um, but even the ones that are severe or long-lasting uh can be turned around with the new forms of treatment. And we've got very solid gold standard randomized trial research published in top-notch journals coming from leading scientific centers across North America that are showing just dramatic outcomes with this. Uh, the Boulder Back Pain Study, they had people with back pain for 10 years with four weeks of this new form of treatment, the pain scores dropped by 75%. At UCLA, they had a goal of getting at least 30% pain relief in a very tough group of older male veterans. Uh, and with the new form of treatment, they got 63% of their patients uh to achieve that goal. Using the older uh cognitive behavioral therapy, only 17% achieved the goal. And we've got, again, studies from Harvard, from Halifax, Nova Scotia, from Detroit that are all showing the same thing, all published in the last five, 10 years showing these dramatic benefits. So it's not just me and the the stories I like to tell. It's it's very solid research showing this as well.

SPEAKER_00 21:58

Well, and it's it's a holistic Way of taking a look at the person. If someone is trying to find a practitioner like you or someone that is open to taking a look at the entire body, where should they go?

SPEAKER_01 22:11

Well, our website is symptomatic.me, and we have a practitioner directory there of people who've taken extra training to learn these techniques. Quite a number of them have overcome these symptoms themselves. So they've got their own personal experience to draw upon as well. And many of them, even if they're not local to you, will see patients via telehealth so that they can reach people around the country and around the world. And also on that website, again, we've got lots and lots of resources. People who support us by becoming members, there's a monthly QA that they can join and ask their questions of experts. We have an annual conference. We had one in September of 2025 with 350 people from around the world and 40 expert presenters. Our next conference is in October of 26 in Dallas, Texas.

SPEAKER_00 23:14

That's fabulous. Thank you so much, Doctor, for being on today.

SPEAKER_01 23:17

Thank you. I appreciate it very much.