Thursday, April 15, 2010

“Back Pain”

“Back Pain”

This is pretty dangerous territory.  Back pain is a big problem for many people including doctors.  The good news is the nine out of ten people do get over back pain!  Besides doing psychotherapy I do, do general medicine and there is a lot of back pain in general medicine.  There is just a lot of pain in medicine. One reason I do psychotherapy and general medicine is that I do not believe that there is not a great  difference between the mind and the body. Some people say “oh the pain is in your head” meaning it is not “real.” Well where is your head? Where is your brain? Is it not part of your body? 

Well, we now know that our emotional pain and what we call physical pain or “ouch” pain comes from very much the same places in the brain.  Back pain has to do with a lot, yes, with the spinal column. Where does the spine start? It starts in the brain!  Back pain also has to do a lot with muscle pain.

We have known, for a very long time, that if we take 200 people and take all their x-rays, cat-scans, and MRI’s we find that we cannot tell who has pain and who does not have pain on the basis of their studies. We find 100 of e people that  do not have back pain and 100 that do have back pain but all of them have things out of place on their studies that look like they should have pain and mix all their studies together and give them to radiologists to read. The experts cannot tell who has pain and who does not have pain.

Now this is very interesting.  One hundred have pain and one hundred do not but their studies are the same.

This is where people will get upset and I do not want people to get upset. I believe people have pain. They do have pain. Maybe their pain is NOT caused by what we see on the studies. Maybe the pain is much more complex. Maybe we should think differently?

When people go to surgery for these conditions only about one in three get better but often not completely better, what is going on? 

In this short space I want to offer a suggestion of Dr. John Sarno of Columbia University. After studying many patients he has discovered that the patterns of pain of many people just do not fit what is seen on their MRI’s and x rays. He, again, is not saying they do not have pain. He is suggesting that since our emotional and other nervous systems are so intertwined, so connected that we channel our negative emotions into, mostly our muscles, and this usually is in our upper back and upper hips.  I think it is a bit more complex than Sarno is suggesting but he is on the right track.  He talks mostly of our problems with anger. I think our problems are with a more broad range of feelings such as distress, fear, shame and disgust but it is a start. I would suggest any of his books such as the “The Mindbody Prescription.”

http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090


Tuesday, April 13, 2010

"Accept the things I cannot change and change the things I can."

"Accept the things I cannot change and change the things I can."

This is a short version of Reinhold  Niebuhr’s prayer that is used in the “AA” or alcoholics anonymous movement.

The other day the meaning of the prayer became much clearer to me in terms of how I try and help people go about clarifying their daily lives.

It seems that many of the serious problems people have are precisely because of issues in their life that cannot be solved. We all have them. We all, for example know we are going to die. We all know we have to pay taxes. We all know others will die. What we are not fully aware of is how we handle this knowledge. We do not realize that we might be wasting our lives trying to avoid death and not living. We might not realize that because we lost, for example a parent when we were eight years old that we are still trying to “solve” that problem and that is  taking up almost every moment of our life even though we are fifty.  Since the problems are unsolvable it is “beating ones head against the wall” and yet we just do not realize what we are doing and since it is unsolvable we do something else: we  get angry at the world, destroy our business, family, take drugs, just “give up.”

So the point is the “prayer” points out a very important truth. What can we do? I think it begs us to work very hard to see our lives in a new light; that which is possible and that which is not.

Sometimes something can be done. A toxic relationship with a parent or sibling just might be able to be healed. If things have gone on for years and they have consumed your life take steps to test the waters. If, however, the other party is unable to respond, continues to hurt you, revaluate. There are two ways to go. You can now go back to old habits which will continue to magnify. Things will get worse as things feed on themselves or through a window of opportunity, that you are now creating, one might realize that we can change albeit the other might not be ready to. Is all hope lost for the other? No. Why? Because often, when we really change others often change but this takes time and commitment. This becomes a new life of sorts, not the “old life” not the old dynamic.

Brian Lynch

http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090

“Testing Those We Love”

“Testing Those We Love”

“We read the world wrong and say it deceives us.” Togare


Have you ever told your child to do something and they have not done it? Likewise have you ever told a loved one, an adult that you could not do something for them and yet they somehow do not hear you? They come back to you in someway asking you do the very same thing? Is there any difference? In the end I think not. I think they are both quite obviously “tests” of our commitment and love. Or to put it in very personal terms, and from another perspective, it is a need to be taken care of.  That is either way you put it, it is not a healthy love or need as the emphasis is all on “my need.” I immediately say that that said we all have times of great need. We all need to be needed and comforted and we all will test others at some time or other and that is all right.

So a few examples: You ask your child to please brush their teeth and ten minutes later they are still playing around. Asking three more times still does not get results. What is going on and what is your response? It is a test is it not? First off the child is not “evil” or bad. The child is in some great confusion. They do need order and consistency in their life but how to do it? They my say I am doing it “because I can” meaning “I know you love me.” Meaning I need you now to figure out how to really show me to love me and figure out this problem. “How do you get me to brush my teeth without hurting me!” Of course they don’t realize this on this level but it must be this.

This is not the only reason. Very much of what we do is a type of “play” as we “feel” at a subconscious level  many  “feelings” as children and indeed as adults “out of the blue” that “surprise” us. We feel fear and anger in an instant towards someone and act on these feelings. Indeed we have to “play” with the feeling to manage them in the moment to figure and figure them out. But our point is that much of the time we are “testing” others.

So you tell your 28 year old son you cannot help him out when he gets out of the army or when he returns from overseas or in whatever situation.  You name the situation but he seems to not hear you. You state emphatically your situation, your budget. You do not have the money. And comes the refrain “dad you don’t understand what am I supposed to do! I need 800 dollars.” Yet, it seems to you that six eight weeks prior there were some steps that could have been taken and on the other hand maybe nothing could have been done. The point is that there is an unconscious engine of need just like the child’s   “How do you get me to brush my teeth without hurting me!”  Those things were not done or he is just not hearing you and being empathetic with you because the he your son needs you the father to take care of him.

Brian Lynch, M.D.








http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com

Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.




Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)






W.W. Norton & Company; ISBN: 0393311090




Monday, April 12, 2010

"Cognition"

 "Cognition"

The other day I was explaining to someone about how we could now see emotional expressions on baby’s faces before they were born. Some might think this is not news but it is. We have been able to see the fetus for years but not clear facial images until only a few years ago. So now we can see that a fetus can clearly smile (I then note that after birth it is several months before the baby then has a full smile again. I think a testament to how rough life is. ) . I off handily said that we are feeling and not “thinking” and the person said “How do you know we are not thinking?” My heart sunk and I paused.

The cognitive monster raises its head. Why on earth would we presume that we are thinking before we are born?  It is because as humans cognition is what makes us human. Without cognition humans are nothing more than another mammal. But without that thought simply within our own psyche it, cognition, gives us control. We intuitively know when anyone says anything along the lines that is going to remove “thinking” from the equation we panic and put it back in. We are unable to learn a new system of thought.

In short this summarizes the entire problem I and all my colleagues have in explaining what we think is the most important psychology information available. Simply put that in our essence “thinking” is not the most important part of being human. What is “feeling’ or “emotion” or whatever you want to call it is the most important. In the end we come to a conclusion that reason and emotion have to be handmaidens but it seems almost no one can put down the gun of reason even long enough so that they do not stop shooting themselves in their foot and listen not to us necessarily but to their own emotions!

So back to the fetus, if anyone is going to make the statement “How do you know we are not thinking before we are born?” My retort is, my default position is, it is a moot question until someone proves to me that they remember thinking before they were born or it is a meaningful statement for the average person. The default or meaningful statement is that we all can agree that none of us remember anything until our first memory and that, on average, is somewhere about two years of age. What we do have is proof of feeling and that is plentiful and it is demonstrated in the face!

I am not saying we do not think before we remember. This is clearly not so as we clearly behave in a logical manner very early on and talk long before we have memory.

The point is thinking takes learning. We have to build on concepts and relationships. We feel the very basic building blocks are the biological “feeling” building blocks. We are stimulated and our feeling centers are stimulated. This is how we feel alive. This is how we begin to “know” the world first. 

Brian Lynch

http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090



"Brian chemistry"

"Brian chemistry"

It is certainly not uncommon for me to run across people who will express a desire to understand the “chemical” nature of their mental problems or likewise see the problem as being fixable purely or solely on the basis of mediations.

This is a tragic situation.

Even as a doctor knowing what goes on inside the brain in terms of the chemical workings rarely helps me help you. We have to understand that we are nowhere near the sophistication in brain science that we are in other areas of medicine. We can, for example, test for a specific infection and give specific drug for that infection. We are not so lucky to do much of any kind of test on your brain.

For sure we know when someone has a seizure to give anti seizure medication. But that is a “physical problem” that has to do with the physical brain.  That it has to do with the “physical” electrical network of the brain. And we have learned that anti seizure medication often helps in more “mental” problems to calm people down yet exactly how and when to give them is not exact and certainly it is very individual how they effect an individual life.

My point is more with many a patient and doctor’s fascination with the thinking that knowing about serotonin, and dopamine and norepinephrine will somehow help them feel much better. I ask you do you experience these chemicals directly? No you don’t. Can you have any idea that you are affecting the levels of these chemicals? I say not by much.  And I as a doctor cannot measure them. Again I can give you medication that we believe alter these chemical levels and that we believe logically end in affecting certain pathways that end in making you feel different. There is the important point. You feel differently. 

If both doctor and patient would focus more on specific feelings I think we would make much more progress. And note I say feelings and not acting or behavior. Specific feelings like anger, fear, shame, disgust, interest and joy and forgo the more diffuse and imprecise words such as “depression” and “anxiety” or “panic.” These are being called into question by more and more professionals. Just tell yourself how you are feeling today. Then if you are taking a medication which of these specific bottoms did it push? Is the medication making you less angry? Less afraid or is it making things worse?

We live in a world of “feeling”, we do not live inside our brain. We will never be able to experience our brain. We experience what those chemicals in our brain produce. They produce in some miraculous way our feelings. If we want to have an effect on those chemicals the road is a direct one but one that shifts focus to something right under our noses, something palpable and real, our feelings. Work on our feelings and there will be a feedback to our chemicals that will then, in turn, feedback to our feelings and help us out.

Now a final thought. Focusing on the “chimerical” seems to presume, most of the time, that  the reason we feel bad is due to an ad hoc imbalance in the chemicals. Something is wrong in my head. Fix it doc! Give me some medicine. I have a cold in my head. Well we believe that the chemicals are being stimulated by something by what? By the world.  Anger, fear, distress, disgust and shame have their chemical equivalents in the brain. We “get our buttons pushed!”  We live in a world that can push our buttons. We need to work. We need to work with the environment and do also what we can to remove the button pushers and thus the stimulus that is causing the pain and causing, yes, that neuro-electrochemical imbalance. Not easy I know.  

Brian Lynch

http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090


Sunday, April 11, 2010

“’The Negative’ Is Interesting.”


“’The Negative’ Is Interesting.”

”Sometimes it hurts so badly I must cry out loud.”  Crosby, Stills, Nash and Young

One of my main messages to people in person or in writing is the idea that we live in a world of confusion and hurt and even though this is true we mange to deny this fact to a very great extent. 

The exact nature of what I want to explore took me about six months to really comprehend so now ten years later I am reevaluating my approach. I am stepping back and trying to empathize with my reader and understand that if it took me six months what can I expect of others?

It is that and the fact that it is one thing to understand a concept and it is another to make it part of your life.

It is well known, for example, that it takes physicians about a year, on average, to fully implement some new innovation in their practice! What are we to expect of patients when they learn something new from us? Many might be put off by that statement feeling I am patronizing the reader and my patients. At the end of it all I am saying that we are all slow learns and that is not to say that many, very many are smarter and faster learners than I am.

But and so I come along and I suggest something that sounds a bit crazy and that is that we need to pay very close attention to the moment when we get “hurt.” I have said that “interest in the negative brings joy.” This will bring looks of puzzlement at times, probably more often then not. Why would anyone want to look at the negative? Don’t we want to “runaway” from the negative?

Well, why would anyone look at the negative?  First it is inevitable that the negative is going to happen. It is going to happen many times during the day. We say that it happens when I don’t get what I want. So I must want something first. Well, we are always wanting something. I want my coffee and there is none. I am late for work and the train is stopped. I want to eat dinner and I get a call that my child is in the ER.  I want my child to be well, thousands of wants that are stopped.  I want to move forward but I also do not want to betray conflicting family values?

For me these are small and large “hurts” that cause at least a modicum of temporary “confusion.” “Now what do I do?” Often times it is confusion that leads to terrible wrenching tragedy.

The ideal thing to do, and what is so hard to comprehend at first, is in the school days phrase “stop, look and listen.” What is the hurt and confusion telling me?  It is getting my attention. It is telling me something is wrong and that I should do something about it. But that is not so easy is it? How do I know what I do not know?  It is really what I feel. I feel I want to move forward to connection in mutual positive interest with other. What is stopping me and how do I overcome it?  If you are stuck with these questions and feel the pain of answering them please do not given up. Keep at it no matter how often you fall back.

So often what we do is avoid the hurt and the confusion because who likes hurt and confusion? It is very old knowledge that we go towards pleasure and away from pain.

So a very simple truth and it can take a long, long time for it to sink in and if you read this you may think I am either just dumb or useless. I hope that you will at least get a glimmer of the thought that our  reaction too often is indeed is to avoid instead of looking to the confusion and seeing it as a problem to be solved. That is  getting interested in the negative.

Now, again, this writing has been triggered by the fact that I realize how some people that I know are in fact brilliant in their understanding of many concepts but have not, what we say, “internalized” them. That is they do not practice them very fully in their lives. And then I say do I after more than ten years? I certainly do more and more. But it all takes time. And the more confusion, shame and abuse you have suffered in your life it does not matter how well you “understand” the concepts it is going to take time for them to enter your nervous system and become “you.”  In fact we know that to become good at anything it takes about ten years.  Any journey starts with the first step. Good luck and never be afraid to ask for help.

Brian Lynch




http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090