Heal with Grace

40. "When they can't find anything wrong!" with Dr. David Clarke

• Grace Secker / Dr David Clark • Episode 40

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In this empowering episode of the Heal with Grace podcast, Grace is joined by Dr. David D. Clarke, MD, president of the Psychophysiological Disorders Association and Clinical Assistant Professor Emeritus of Gastroenterology at Oregon Health and Science University. Dr. Clarke brings his extensive experience in treating over 7,000 patients with symptoms from stress or trauma, not explained by disease or injury. He discusses his holistic approach to treating patients, integrating physical treatments with emotional expression and understanding brain-based origins of conditions. The conversation offers valuable insights into the reality of these disorders and how to heal from them effectively.

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[00:00:00] Grace Secker: Okay. Welcome back to the heal with grace podcast. Today we have a special guest, David Clark, who's an MD goes by Dave and he is here to talk to us all about stress related illnesses that are brain generated. And we'll obviously jump into what that means. but I'm really excited to have him on. thank you so much for being here, Dave.

Great to be with you. Grace. Thank you so much. 

[00:00:24] Grace Secker: Let's go ahead and just help people get to understand who you are. So tell us a little bit about you and how did you become an MD who now specializes in stress related illnesses? 

Yeah, that wasn't supposed to happen. Actually. I got through the first seven years of my training and I was heading toward being an ordinary gastroenterologist who, you know, put tubes inside people and looked around and fix things and snip things out.

But in that Eighth year of my training, the last thing I expected was to encounter a patient. I didn't know the first thing about diagnosing or treating. but I did, she had been sent to us by another university because they couldn't figure out what was going wrong. she was, averaging one bowel movement per month and nobody knew why.

we did some specialized testing. We were convinced my department chair and I that this would show the problem. but that test was normal as well. And I was. Left to do her exit interview and tell her she was just kind of have to live with this, but I asked a few more questions. I looked into, you know, whether she might be experiencing any stress.

And we eventually stumbled onto the fact that she'd been severely abused as a girl. And I had no idea if that could be connected to illness 25 years later. but I had heard about a psychiatrist named Harriet Kaplan, who was interested in these mind to body connections. I sent the patient to see Harriet, never thinking for a second that anything good would come of it.

But then I ran into Harriet, several months later in the elevator ride that changed my career and Harriet told me she had cured this patient with counseling alone. I mean, this was a woman who was 37. She was taking four different laxatives at double the recommended doses, and it wasn't doing a thing and Harriet cured her with basically a dozen counseling sessions.

So that kind of blew my mind. And I had Harriet. Explain to me how she did this thinking it might come in handy for a few patients a year. And, but when I got into private practice, I was seeing five or six patients a week like this, without even trying, not usually as severe as that first one, but with the same underlying, mind to body type of illness and.

The approach that Harriet had taught me, even though I was a beginner, was very effective. So even though I wasn't nearly as experienced in the early days, I was still getting good results. And people who'd been ill for years, were improving with this. And I just, I just got hooked and I started treating patients myself with this, because there really wasn't another Harriet Kaplan in Portland, Oregon, where I'm based.

And You know, it was just so rewarding professionally to have people who had been lost in the health care system. And now all of a sudden you can turn those situations around. 

[00:03:16] Grace Secker: Wow. Sounds really powerful, especially for a first patient. I mean, and also you have to be curious and open. Right. To see different things.

I don't think every MD would do that as well to be curious and open to understanding, okay, what, what could this be, right? And open to different treatments other than maybe what you understand or what you know. 

That's right. And Harriet had shown me what was possible. So I knew that these outcomes could be achieved if you had enough empathy to understand what was happening to patients.

The biggest difficulty was that. Many of my patients, when they looked back, they didn't see their early years as being all that bad. I would hear from a lot of them that, you know, things, you know, were no worse than many other people have been through, or I think I'm over it, or it really wasn't that bad.

But I learned to ask people how they would feel. If they're a child of their own was going through the same experience that they did. And all of a sudden, when you start thinking about an innocent child going through the same adversity, it puts a completely different perspective on it. And you would see people's facial expressions change, and they would get a, a much deeper realization of what they had overcome in their early years, and that would start a conversation that, would lead to a lot of fundamental change.

[00:04:40] Grace Secker: Okay, I have multiple questions and I'm trying to figure out which one is best. Let's first just start with what, what constitute a stress related, I mean, I'm sorry. Yes. Stress related brain generated symptom. What does that mean exactly? 

Yeah. Also called neuroplastic symptoms or psychophysiologic disorders.

There are a lot of synonyms for this, but. Essentially it's pain or illness and it's real. You know, the, the expression it's all in your head needs to be banned forever. I never want to hear it again, even though I probably will. but it's, it's absolutely real brain generated neuroplastic symptoms anywhere in the body in the absence of organ disease or structural damage.

That's the key is that if you do find. Organ disease or structural damage. It's not causing the symptoms, the, but most people when they have the diagnostic tests, nothing shows up. That's why the title of my first book is they can't find anything wrong. just as with that very first patient, all the tests were normal.

So it's generated in the brain rather than by organ disease or structural abnormality. and so we go after. What's doing this to the brain? And it's stress in a person's life, either past or present, because a majority of my patients, the stress could be traced back to when they were children, what we call adverse childhood experiences.

[00:06:02] Grace Secker: And so what are some of the most common, stress related PPG symptoms? 

Migraines, you know, starting from the top and working down migraines, dizziness, ringing in the ears, visual disturbances, fibromyalgia, irritable bowel syndrome, bladder spasms or interstitial cystitis, it's called sometimes pelvic pain, spine pain.

I should have mentioned that close to the top, either in the neck or the low back is huge for this. Many cases of long COVID, many cases of chronic fatigue, functional neurologic disorders, the list is virtually endless. Yeah, 

[00:06:44] Grace Secker: I'm really glad that you mentioned, you know, it's not just all in your head, that phrase.

I've, I've talked about it on here too, if we have, we have listeners that have been listening for a while and I've said the same thing, I promise you, it's not just in your head. It is real, you know, to really validate because it can be so confusing and people get dismissed all the time when they're having real symptoms.

and also when someone first hears about this understanding, okay. It's my mind, but it's real, you know, they feel dismissed already. So I'm glad that you kind of talked through that because it can be, it can be difficult to understand at first. It's a whole 180 of understanding health. 

Yeah. And my patients, a number of them have been hospitalized for this.

I mean, it got to that level. one of them was a 17 year old that I was asked to see on hospital day, number 70. And this person was getting Morphine intravenously around the clock, and had already seen six other gastroenterologists over the previous 18 months for unexplained abdominal pain. And this was a hundred percent stress because once we identified the stress and began to treat it, patients steadily improved, was out of the hospital in a week and off of all opioids in 30 days.

You know, when they first started, I mean, this was as severe as it gets. They were getting doses of morphine. You'd normally associate with people who had advanced cancer. 

[00:08:06] Grace Secker: Wow. So I want to talk about what the treatment is you're saying you're talking about, right? What is it that you're doing, but let's back up to the, at least one of cause.

Right. So you mentioned adverse childhood experiences and a lot of these you can track back within people that have difficult experiences and their childhood. Can you tell us a little bit more about that and what you look for? 

Yeah, it's sometimes, you know, the really obvious kinds of child abuse, for example, that very first patient, her father's sexually assaulted her, an average of once a week for eight years.

you know, once still to this day, one of the worst stories I've ever heard. But in other people, it's a lot more subtle, people who are continually made to feel like nothing they ever do is good enough. and that kind of beats your self esteem down on a long term basis, makes you feel like, you know, a second rate person or a failure or worthless.

and that just adds up, over time. So that's the kind of thing that I'm looking for. Anything that, you know, Lowers your self self esteem below where it needs to be. Now, we obviously can't go back as much as we'd like to and change what the person went through as a child, but we can absolutely change the long term consequences and the three major areas for those are in.

Personality traits, which are stressful for people, low self esteem we've mentioned, but a limited ability to put yourself on the list of people you take care of. and the flip side of that is excessive devotion to the needs of other people in your life. A lack of assertiveness, perfectionism, Constantly focused on pleasing others rather than taking care of yourself.

excessive self criticism, a whole long list of personality traits that can grow out of trying to survive those early aces. Second major area are triggers, people, events, or situations in the present day that are highly stressful for you because they are in some way. Link to what you went through in the past, and the most common there is typically a parent who mistreated you as a kid, and they're still in your life, even though you're an adult today.

1 of my patients with that issue was hospitalized at a prestigious university 60 times in 15 years, and they had absolutely no idea. What was causing her attacks of dizziness and vomiting, but it was all connected to ongoing contact with an informally abusive and still abusive parent. And then the final area, which is the most subtle and difficult and took me the longest to appreciate, is repressed emotions, anger, fear, shame, grief, guilt, that.

The individual typically doesn't recognize her there. Sometimes they can burst out for little or no reason, but a majority of the time they're they're locked away somewhere. There's they're in there. The emotions are getting expressed physically in the body in the form of symptoms. But the patient themselves, has no idea that very first patient with the severe constipation, that was her issue.

There was a part of her that was just like a smoldering volcano inside. When she talked about her childhood sexual abuse, the tone of voice was the same as if she'd been reading a grocery list. You just didn't see any indication, about those emotions being there. 

[00:11:38] Grace Secker: Yeah, that I'm curious to do you notice with G.

I. issues that there is there are more often that issue with repressed emotion or is that across the board? 

Yeah, it can be across the board. I mean, this is obviously how I got into it. 35 percent of my patients had these brain to body symptoms going on. But it's still a bit of a mystery why one individual will get migraines and somebody else gets bladder spasm from seemingly similar levels of stress.

and we still don't have a great answer for that, but we do have a great answer in terms of treatment. The research based on this has just exploded in the last couple of years. And, people who are studying these techniques with. Gold standard randomized controlled trials are finding astounding results compared to the older forms of treatment.

[00:12:31] Grace Secker: So you're saying that those are the 3 areas that we can actually help someone work on that, you know, we can, we can work on this present day when we can't obviously change what happened in life that has led us here. 

That's exactly right. And. There are also people where the stress is simply in the present day.

It's not especially connected to the past. one of my patients was, and no other doctor found this out, but he was getting his symptoms when he was driving to work. He was perfectly fine when he was driving home from work, and on the weekends when he was not at work. So, you know, led to the obvious question, what's going on at work?

And, you know, Stress level was through the roof and the, time when that had begun corresponded very closely to the time when his symptoms had begun. So sometimes it's, it doesn't have all these layers of complexity. 

[00:13:25] Grace Secker: I was going to follow that up with what about the people who who say, you know, I don't have.

high levels of abuse in my childhood and I don't identify with that, but obviously still experiencing some of these mind, body symptoms. 

Then I'm following up again with that same question. Well, did anything happen to you that you would never want for a child of your own?and they start thinking about it and they start talking about this, that, or the other thing that, that went on.

and. I just sit there and listen, and usually one idea leads to another, and you begin to put the pieces together and see that there was a lot more pressure on that child than they have ever recognized before, you know, without any more prompting from me than that, just to get them talking about what it was like, and both the patient and I start to recognize that there was more pressure than they thought.

[00:14:22] Grace Secker: Yeah, which then I'm guessing can lead us to recognize, okay, how we've held those experiences, not only in our minds, our bodies, how we treat ourselves based on what has happened, how we, you know, engage with the world around us. And I'm coming from, obviously, psychotherapy perspective, but that's kind of what you're talking about, too, is just listening, asking questions, helping them understand themselves.

Is that right? 

That's exactly right. And I'm using my experience with having heard over 7, 000 of these stories over the decades to try to put what I'm hearing into context and help people put their own jigsaw puzzle pieces together into a complete picture because, as I say, the early experiences Can lead a child to try to be perfect to try to please everybody in the environment to, to focus on the needs of others to pay attention to details, far beyond what a child would normally do.

And then when people hear this, they're able to make the connection between what their personality is doing today and what it learned to do years ago. 

[00:15:35] Grace Secker: Okay, so we're kind of getting into it already. What, what is your approach to working with people and mind body? 

Well, I'm first wanting to shift people's attention from their body to their brain, because the brain is where the symptoms are being generated.

And then from the brain, we want to go to, okay, Where are the stresses in a person's life past or present? And we should add that there are people who have depression, anxiety or post traumatic stress that are manifesting in their bodies primarily rather than as mental health symptoms. So they're going to a medical clinician about their bodies rather than going to a mental health professional about depression, anxiety or PTSD because the main manifestation is in their bodies, but for the people who.

Survived aces adverse childhood experiences. I'm first wanting to find out what those experiences were. What was the impact in terms of personality, emotions and triggers? and then I'm wanting to help people recognize just how much they overcame because one of the fundamental shifts that happens to people is in their self esteem, just what they believe about themselves.

People who have been through these experiences, for me, they're like Olympic weightlifters who are trying to carry 50 pounds more than the world record on their shoulders and, they don't realize it. So their bodies are breaking down. They're feeling all of that weight, but they have no idea how much they're carrying.

So I want to help people realize Just how much they had to overcome. and again, when I go back to that exercise, imagine a child of your own, trying to cope with everything you had to cope with and what would it be like for you to watch a child like that? Try to cope with everything. And didn't that child have a tremendous amount of heroic perseverance to come through that experience?

And can't you take some credit for yourself for having come through all that? And. By thinking in these terms, people are steadily re engineering their self image into a much more positive frame. And when they do that, lots of other things change for the better. 

[00:18:04] Grace Secker: So you're helping them see how essentially, mentally, emotionally, probably physically too strong they are, right?

To help them understand, okay, maybe they're not thisweek, and I put that in quotes, right person who has failed X, Y, and Z or their bodies failing them or something like that. Yeah, we can get really self critical about ourselves, but any kind of conditions, 

yeah, self critical and perfectionist and, not asserting yourself and.

Devoting yourself to the needs of others, to the point where you're not putting yourself on the list of people you take care of, being in unbalanced relationships, where you're giving a lot more to the other person than you're getting back, in return, lots and lots of these long term consequences, that can be changed, you know, when people realize just How remarkable it was that they overcame what they did.

they're going to be less tolerant of being mistreated. 

[00:19:05] Grace Secker: I'm guessing that's, I mean, that's because people will be able to see themselves in a higher perspective, right? A more positive perspective, like you see. 

And I think of it as a more accurate perspective and the, Ability to do that also supports setting boundaries.

You know, if there is somebody who's in your life at the moment, who's toxic for you, whether it's a parent or somebody else, when you start thinking, you deserve better, you can set some hard boundaries with this person that you're. much less willing to let them cross and that's going to bring your stress level down, which is going to bring your symptoms down.

And when the symptoms come down, you're going to see that all of this is working and be encouraged to do more. 

[00:19:49] Grace Secker: Yeah. It's that confidence feedback loop. See things working. You're going to want to keep doing it. 

Yeah. A lot of my patients start out, they're really not a hundred percent convinced that this approach is going to work for them because many of them, nothing has worked for them for years or sometimes even decades.

but I'm perfectly happy to let them carry on with whatever medical approach they're interested in. as long as they give the concepts that I'm sharing with them a good try. Yeah. And it will become clear, fairly quickly, which approach is effective. 

[00:20:24] Grace Secker: So you're talking with them, however, so often about some of this stuff, is that right?

Are they coming in? 

Yeah. And because of the nature of my practice as a, you know, two thirds of my work was as a, still a garden variety gastrointestinal specialist. So I didn't have the luxury of, You know, weekly, biweekly visits, indefinitely. I had to help people put those jigsaw puzzle pieces together, very quickly.

you know, I would average less than two visits per client. and if I could give people insight. then I could refer them on to a mental health professional, but they would carry the insights into that visit. A lot of mental health professionals still today, they're not comfortable with assessing a patient who is physically ill as opposed to having a mental health issue.

So a lot of the issues that you and I have been talking about just now are not part of the traditional mental health approach. But if the patient could absorb some of these ideas themselves and be encouraged to delve into them with a mental health professional, the outcomes were much better. 

[00:21:37] Grace Secker: I see. And yes, you are correct.

There's a, there's a disconnect for sure. I didn't learn about anything in school, anything related to this at all until I sought it out on my own. And, yeah, there's a gap there for sure. There's a gap 

that's that's why the psychophysiologic disorders association exists is, you know, it was created. to provide this educational resource, because it isn't a huge new thing.

You know, somebody who's already trained as a mental health professional can graph these ideas onto what they do, very readily. And we've got textbooks and Video courses and, conferences. we have one at the end of September in Boulder, Colorado in 2024. lots of opportunities to, for somebody who's already skilled as a healthcare professional to add these ideas to what they're already doing.

And it absolutely transforms your work. I, I recall one family doctor who took our video courses that are on our website, and chronic pain. org. And it just. worked a miracle in her practice for the 40 percent of people who come through the door that have these issues. And she took me aside at a conference and said, this has put the joy back into my work.

[00:22:56] Grace Secker: Yeah. It's really empowering as a therapist to, to, to, To know that you can help in a different way, even more than what we know how to do is to hold space and help understand someone and help them understand themselves. But this takes doesn't take a whole lot. Actually, just takes learning about it, right?

And helping shift that perspective and then going into those areas of the client needs to go into with the emotions with perspective. I'm sorry. Perfectionism, probably aces, things like that. So, yeah, you're right. I mean, it's. it's very much so needed and, exciting that, that it's the mental health professional world.

I think is going this way. Sometimes I question because it's the world that I'm in this little bubble. I'm in how much is this norm and how much is this just where I am. But, yeah, it's going that way. 

Yeah, I think you're right, Grace, and it's tremendous to see, it also gives a mental health professional a new window into what's going on with the patient, because a lot of the issues that a patient is struggling with, they can't put into words.

So the, the normal interaction you have with that client in your office is not necessarily revealing the complete picture, but if you're able to interpret. what a person's physical symptoms are trying to communicate. It adds a whole nother level to your understanding of what's going on. 

[00:24:27] Grace Secker: Yeah. Even me as the client, when I did a lot of work healing, chronic pain through these types of methodologies.

And then I went through training as a professional and pain reprocessing therapy. Once I learned about the personality characteristics, it was one of those aha moments for me. It was. Oh, yes, those I definitely resonate with those and they completely affect me on a physical level. yeah, 

you're right.

You're absolutely right. And it gets into, even clients that you wouldn't necessarily. I think these would apply to, but there are a lot of people with eating disorders, cutting behavior, a whole range of addictions and not just the substances, but behavioral addictions, whether it's, I don't know, the internet or exercise or work or sex or, pornography or gambling, you know, all of those oftentimes can be traced back to the same kinds of ACEs that produce the physical symptoms and a lot of patients.

You know, have those physical symptoms as well. The people that are coming in to see you for seemingly an unrelated, mental health concern, they turn out if you ask them to be struggling with these physical symptoms as well, but they won't necessarily tell the therapist about them unless you ask.

[00:25:44] Grace Secker: Oh, that's very true. I've had that experience many times as a professional. I'm realizing later. Oh, you later on as I've realized, gone through training to ask, but recognizing. Oh, yeah, this client had this whole other set of issues going on that I had no idea about. We never talked about. Right. But when you put together the puzzle pieces together, it all makes sense.

And, you know, you're right. I actually wasn't a disorder therapist before I started specializing in mind and body. Even though it's all connected, obviously, but I see so many similarities between eating disorder and stress related illnesses and. 

Yeah, my, I had many patients with eating disorders, either in the present or even more often in the past, and they were all connected, at least in my population, which may be a selected subset, but they were all connected to the patient being in a state of emotional chaos and what they were doing with their eating disorder, at least in, in the past, was The patients that I saw it was they were trying to, you know, hang on to some form of control, when everything else in their life, was, chaotic.

And it was their body that, and their food intake, that was the thing they could control. And if you didn't pay attention to the chaos, and just focused on the food, You weren't going to get anywhere. 

[00:27:10] Grace Secker: Would you also say that for, other stress related symptoms that it's our body trying to take control, those physical symptoms or a sense of control in a way?

I would say that it's the brain trying to tell us something, the, you know, I, I never had these symptoms myself, fortunately, but having interviewed Thousands of people. I've come to the conclusion that, our bodies are our friends, even when they're, they're hurting. even when they have terrible symptoms, they are trying to communicate.

And if we can listen to that, if we can try to figure out, okay, what is trying to be communicated here? What is our body trying to tell us? Because it's, it's trying to help. In the only way that it knows how by a demanding attention, it's just that it's demanding attention on on your low back or your pelvis or your chest or wherever it is.

and that's not where we need to direct our attention. We need to direct it to. Okay, what's the stress that our body is trying to tell us about? And. You know, once we start asking about that, once we start on the, the hunt for clues about what that stress might be, that's when we start getting the answers that make a difference.

[00:28:24] Grace Secker: Yeah. Okay. So less about the body controlling, but more about, it's just sending us messages of well, danger, really, really, right. It's saying it's, there's something going on here that we need to pay attention to. 

Yeah, and and the eating disorders, you know, at least again, in my patients, they were just a way to have control over at least one thing in your life.

and the reason they needed that control, so badly, you know, to the point of physically endangering themselves in some cases, is because of the level of chaos that was surrounding them. So, the identifying the, where the chaos was coming from, and doing something about that, the eating disorder would no longer be necessary.

Similarly, with, with cutting behavior, most often in my patients who, had a lot of negative emotions and they needed to repress them so powerfully that they ended up repressing pretty much all of them. Every feeling that they could have. And so they were in a state of not being able to feel anything.

Again, this is my subset of patients. It may not apply to people who cut in general, but once once. They, had fully repressed these emotions. They reached a state of what's called alexithymia. and the cutting enabled them to feel something. and so it actually provided relief for them. but by helping them understand what the feelings were, usually anger or fear, that they were.

Thoroughly repressing and why they were repressing it and where the anger and fear came from. we could make progress 

[00:30:13] Grace Secker: and that's where that awareness is such a huge 1st step to understand actually, what's going on. What are the emotions? Why are they happening? And then to learn how to express and to feel and to set boundaries, like you're saying, is that next part of the process.

Yeah, makes, makes such a difference. I remember one eating disorder patient in particular who, because she worried me the most, let's put it that way. She had dropped from 227 pounds to 114, over 18 months and I had treated her five years before for irritable bowel syndrome and that had been successful.

And so she came back to me and said, I've got an eating disorder. Can you help me? And I said, that's not a good idea. you know, I don't have a professional background in this. You should go see an expert. And she said, I've already been to an expert and I had a terrible experience and I'm not going back either.

You treat me or nobody's going to treat me. And I thought, well, if I. If we go to the nobody, the next thing is she's going to be in the hospital because she was already down to 114. So I said, okay, I will make a deal with you if, if your weight drops below a hundred or if you stop having periods, you are going to see an expert and you're going to stop seeing me.

And she said, okay, I'll agree to the deal. And, I just use the same methods we've been talking about for the last half hour or so, and she got better. Her weight actually did go down initially to 106 was where it bottomed out, but then it started going back up and I was breathing a sigh of relief.

And when she hit 120, she said, okay, thank you very much and didn't need any further treatment. 

[00:31:53] Grace Secker: Wow. 

But it's exactly the same concepts that we've been talking about. 

[00:32:00] Grace Secker: I mean, really there's Yes, we're talking about these concepts for eating disorders, like you said, kind of control, addiction and then stress related physical disorders, but really, I mean, understanding our personality characteristics, understanding our history and our past and adverse experiences, understanding lack of emotional regulation, our environment.

These are topics that we're talking about that can be helpful for everyone, right? Any, anyone.but it is helpful to understand how specifically they go along with, especially chronic physical disorders. So that just dawned on me as we're talking about this. I'm like, well, actually these are all really great concepts to understand and learn, right?

no matter what it is. 

Yeah. It's just, you know, I had to learn them step by step through trial and error. I didn't have any formal psychological training. and when I. Diagnose these patients as having a stress related condition and sent them to mental health in my early years. They got cognitive behavioral therapy, which doesn't work very well.

And the research recently confirms this. And a lot of these patients came back to see me and said, I went to mental health. I got the cognitive behavioral therapy and I still have my symptom. Now what? And there was nobody, you know, Dr. Kaplan was in Los Angeles. I was in Portland, Oregon. I said, I will do my best.

And it turned out that Dr. Kaplan's concepts were powerful enough that, you know, even as a bumbling beginner, I was getting decent results. I just learned by doing trial and error over thousands of patients. 

[00:33:42] Grace Secker: How does this approach differ, or maybe it doesn't as much, but how would it differ from Dr.

John Sarno's approach and pain reprocessing therapy? 

You know, I think the, the biggest difference is. In pursuing the emotions, pain reprocessing therapy is great. It's straightforward to learn. the patients can apply it quite readily. it doesn't require a lot of,empathetic insight into, you know, Unrecognized emotions, for example, but, and it alleviates symptoms in a very large number of patients, but the ones that need more, the next level is emotional awareness and expression therapy, which is what I consider that I've practiced for 40 years, and it involves all the things we've been talking about, looking at the personality traits that are stressful and helping the patient understand better.

Where they came from, what was their origin? Because if you can see where they came from, it's a lot easier to make changes. you know, you can't just tell somebody, your self esteem is terrible. fix that. you know, you have to find out, you know, how did it get there? And to, Look at those early experiences and, and see how heroic you had to have been to endure that, that's what begins to flip somebody's self esteem to a more realistic and honest level.

so, the personality traits. Identifying the triggers and setting boundaries around those, and identifying the emotions, that same experiment of imagining yourself watching a child of your own growing up exactly as you did and letting the emotions, that you start to feel when you're. Doing that thought experiment, letting those emotions bubble up to the surface, start writing about them, write an unmailed letter to the parent or parents who mistreated you, the more you can put those emotions onto a piece of paper or onto a computer screen, the less they need to be expressed by your body.

[00:35:44] Grace Secker: Okay. So yeah, the combination of working with the brain and understanding, how it's affecting your body, but really using the emotional expression and awareness. I see how that all goes together. 

Yeah, there's a lot of that in our, psychophysiologic disorders, a textbook, the 1st, 1 and then the 2nd textbook, which was called a diagnostic guide to psychophysiologic disorders has a, a list psychophysiologic disorders.

500, medical diagnoses, and describes what they are in plain English and describes the, degree of a psychophysiologic component to them. 

[00:36:24] Grace Secker: Okay. That's super helpful. Is this also, would that textbook also be appropriate for someone who's not a professional? 

The diagnostic guide, not so much, but the first one, physiologic, psychophysiologic disorders,Interprofessional guide to a diagnosis and treatment.

that one is written without jargon. So people who are interested in the science, that's a good one. people who just like to read really good stories, they can't find anything wrong. My first book is great for that. 

[00:36:54] Grace Secker: Awesome. Yeah. And that will be linked below too. Okay. Another question is, what do you think that modern healthcare is failing to effectively serve patients with psychophysiological disorders?

Well, it's neglecting the idea that your brain can produce pain or illness in your body. In the absence of organ disease or structural damage, there's that whole third category of disease. You've got the organ disease, you've got the structural damage, and you have brain generated neuroplastic symptoms.

And healthcare professionals are taught, that if there's no organ disease or structural damage, then, you know, there's a terrible phrase, it's all in your head, we can't diagnose you. The best you can hope for is just to live with this. We haven't got any successful treatment for you. You're probably neurotic.

there aren't all that many of you. It's not really part of our job description to deal with you. and it turns out that. Every single one of those assumptions is not only wrong, but in most cases, the exact opposite is true. If you know what to look for, you can diagnose this condition as successfully as any other.

the best possible outcome is complete relief of the symptoms. Even after decades of suffering, this is possible. the patients are not Typically neurotic, they are typically mentally stronger than average. They're just coping with levels of stress that are, off the charts, and that you'll completely miss if you don't ask about it.

so the Psychophysiologic Disorders Association is trying to do, is educate people about this so that it becomes a routine part of health care. It shouldn't matter if your low back pain is due to a pinched nerve. Or if it's due to chronic stress, you should get top notch, excellent diagnostic and therapeutic care, no matter what's causing your back pain 

[00:38:52] Grace Secker: where what's missed there.

Why is the brain related, reason causation missing from medical treatment or actually, I guess, medical training, right? How's that? Why was that missed? 

Well, there are people who have advocated that it be included for 100 years or more, but I think the main reason is that it's a completely different way of thinking.

most of medical training is about organs and structures. this is frankly, it is about psychology and it's about stories and it's about. Empathy for what's happening to a patient that they can't necessarily fully express in words themselves. So it's, it's very much a different way of thinking, but we're talking about 40 percent of the people who come to a primary care physician.

We're talking about double the number of people that have diabetes. so it absolutely needs to be a routine part. Of professional training. 

[00:39:51] Grace Secker: Yeah, definitely. I think you, when you put it in those terms that, you know, structural organ and brain based, I mean, it's just, you said it in a way of it's matter of fact, right, because it is, but that's what got me thinking, well.

Okay. But yeah, so, so why, why does it have to be missing? And, yeah, I hope that the advocacy continues that we keep pushing for there to be more awareness. 

[00:40:16] David (2): Especially now that there's solid research. I mean, gold standard randomized controlled trials that are showing remarkable outcomes just in June of this year, 2024, a study from the West Los Angeles VA with a very difficult.

Patient population of older, mostly male veterans, average age in the early seventies, with chronic pain and they used cognitive behavioral therapy and only 17 percent of them reached the goal for pain relief that they had set. But with the new, emotional awareness and expression therapy that I use.

They got 63 percent of them, almost four times as many, reach the goal for pain relief. And that's just one of the studies. There's another one from Boulder and other couple of them from Harvard. Another one from, Ann Arbor, a couple from, Dalhousie and Halifax, that are all mutually confirming the incredible value of this approach.

[00:41:11] Grace Secker: That's amazing. It's happy to hear it. yeah, it's, it's exciting when you talk about it that way, you know, obviously this is my specialty and this is what I'm in, but then to hear more about how it's really making strides and this community and medical community and professional community, because that's how we can help people, 

right.

[00:41:28] Grace Secker: Teach more teachers. We're getting, we're 

getting to a tipping point. we've already, we've seen articles in the LA times, the Washington post,several television programs have now picked this up. So. We're steadily coming to a tipping point of public awareness. 

[00:41:45] Grace Secker: Is there anything else that you feel like, was missed along on conversation or that you feel like is important for our listeners to know around all of this?

Gosh, Grace, you really did a good job here. 

[00:41:59] Grace Secker: That's a big question. It doesn't have to be, but I like to ask people. 

Yeah, no, it's, it's really hard to shut me up once I get started on this topic, but I think we've covered it really well. I'll just say that,the level of illness you can get from this, is, Astounding.

One of my patients had this for 79 years and yet she was successfully treated once, you know, she got to my office and I started asking her this, this line of questions. Another patient, 27 different symptoms that he personally was suffering from simultaneously. Another patient had a completely paralyzed stomach.

we, you know, we did a special test on it and It was not emptying at all, and there was no biological reason for this. So, you know, the degree of severity you can get with this is every bit as much as you get from organ diseases or structural damage, and it's absolutely real. And yet, all of those patients I just mentioned, plus the one who was at the university hospital 60 times in 15 years, they were all successfully treated.

as was the one with the morphine around the clock. if you know what to look for, you can heal people. 

[00:43:20] Grace Secker: Powerful. Okay. Thank you so much. It was really wonderful to have you on here. This is an amazing episode. And I know that, I know it will go far with our listeners. So 

thank you, Grace. And I appreciate your being one of us doing this work.

Happy to. 

[00:43:36] Grace Secker: All right. I will see y'all next time.