The Revolutionary Science Of Recovering From Chronic Pain, Fatigue, Anxiety & Depression with Dr Howard Schubiner #662

31:19All you have to do is go to dohealth.co forward slash live more and use the code live more to gain access to the waitlist right now.

31:36This is part of being human. It turns out human beings need to be connected to each other and need to feel safe. And the brain has this danger signal. And everyone has experienced these kinds of neuroplastic, or sometimes we call it mind-body type symptoms. And if you look at people's lives and you look at your own life, most people will see times when they had that. and the neuroscience is showing this is real. This is exactly what's going on. We have fMRI studies of the brain showing that emotions and stress and emotions are intimately related to pain. When I was three, I was almost three, I had a sister come home, baby sister come home from the hospital and I started to stutter.

32:32I mean, what was going on? All of a sudden, you know, I just developed some stuttering problem. Well, I didn't want a baby sister. I was the king. I was the firstborn. I was the king of the household. And my mother is so smart. She recognized that when I sang, I didn't stutter. And so instead of taking me to speech therapy and medicalizing this problem and making me more aware and more focused on the stutter and making me fearful of it and feeling embarrassed about it, we just sang and it went away. And so, you know, children, everybody has these reactions. You know, when a child is having a tummy ache before going to school, you know, it's not, there's nothing, chances are there's nothing wrong with them.

33:28And chances are there's something in their life that they just feel unsafe about. And that's this understanding and compassion that we can have for people in these situations. Yeah, I would say the medical profession has a really good awareness in children that stress can cause pain. Because, you know, even when I was at medical school, I think when you learn about chronic abdominal pain in children, stress and emotions are a huge part of that. Because it doesn't mean you don't look for a physical cause or what you might call a structural cause. but a lot of the time it is emotional not wanting to go to school stress about something a repressed emotion parents arguing or not feeling smart enough or being bullied so that awareness is there within the profession already another way we can look at this if we don't believe that our thoughts can start affecting our physiology is, you know, many people know the feeling of feeling nervous or before an exam, they might feel the need to urinate or use a bathroom, right?

34:36Well, it's a similar thing, right? It's stressing the mind. Oh my God, I'm not prepared enough. What might happen? Or I've got to give a public presentation. You know, will I do it? Will I make a fool of myself? And people feel the need to go to the toilet. Exactly. And it's subconscious. It's not that you're thinking, not necessarily thinking that, it just happens. So I was giving a lecture a few years ago, getting ready to give a lecture. I was standing on the podium watching all the people in the audience and I felt cool and I felt fine and collected. I've given lots of lectures. I love lecturing.

35:08And I looked down at my hand and my hand was shaking. I didn't even realize my hand was shaking, but my subconscious brain was worried at some level about this because it's human to feel worried about being criticized, worried about being rejected, worried about not being accepted. These are very deep, deep parts of our souls, of who we are. And we think, you know, we have this idea that why would the brain cause pain when there's stress or worry. It doesn't make sense. You could see, well, it would cause anxiety or fear. That kind of makes more sense. But we think that Homo sapiens were on the earth at the same time as Neanderthal.

36:00Long, long time ago, right? Neanderthal were bigger, smarter, faster, had bigger brains even, but they died out. Homo sapiens lived because they worked in clans. They worked together, fought together, defended themselves, raised children, got food getting kicked out of the clan is like a death sentence and we all can recognize that being ostracized is very very painful and emotional pain can cause physical pain the brain has learned over time to cause physical pain as an alarm signal it's like a smoke alarm it's just so powerful when you think about it and in many ways it's quite obvious when you think about it, right?

36:46But the prevailing norm is so far away from that. It's almost, you know, the book title is Unlearn Your Pain. I would go further than that. It's unlearn many myths about your body because you don't just stick to pain, actually. If we have time later, we'll come to this, but you sort of expand this out to anxiety, depression, osteoarthritis, symptoms like tinnitus, right? Many, many other symptoms. There's a whole page of, there's I think three pages where you list symptoms that could be neuroplastic or have a neuroplastic component. Yes. And I was thinking, I was reading that, these are literally the bulk of the conditions that cause the bulk of the problems in modern medicine, particularly general practice, and the conditions that we don't generally have really good treatments for.

37:41They're the patients who would come in and you didn't quite know what was going on. So you'd end up giving a prescription and say, if it's not better in four weeks, come back. And again, I'm not criticizing anyone doing that. It's an attempt to try and help. But it's very clear that there just isn't a clear understanding of neuroplastic conditions. Yeah, exactly. And it's not common sense. Once you see this, you can't see it. You can't. And most of the people who do this work have had their own life experiences so they could see it in themselves or their family members. Yeah. I want to go into this treatment paradigm that you lay out, this five-part model to treat neuroplastic pain.

38:30And you're saying the bulk of pain that people struggle with is neuroplastic. Maybe even 90%, maybe more, maybe a bit less. It's in that category. But a lot, right? And there's five components to this. Assessment, education, reappraising symptoms, emotional processing therapies, and finally, number five, making changes in one's life. I wonder if we could just go through them all sequentially, because I think a lot of things will come out as we go through that model. Yes, yes. I mean, the first step is, as you said, it's what doctors need to do. Rule out a structural problem. Look for some disease.

39:07You know, the last thing any doctor wants to do, last thing I ever want to do is miss a structural condition, miss somebody who has a cancer, who has an infection, who has a fracture, who has an autoimmune disease, etc. So that's step one. But is it also worth looking at it the other way, which is if we're trying to rule out something serious, that mentality often will lead to a scan. Yes, of course, many scans. Many scans, right? But we're also saying that scans in and of themselves can be problematic in many cases. Right. So if you're not getting any of those red flag symptoms, do you think it's reasonable for a doctor to not go down the route of scanning?

40:01At least, say, look, there's nothing in your history that indicates that. Why don't we try some other things first? It's not only trying other things first, but it's a second level of assessment. Okay. So the second level of assessment is, first level is ruling out a structural problem. Second level is ruling in a neuroplastic condition. Okay. So how do we do that? Well, that's what I was saying a bit earlier about how if the pain is in the right side, right shoulder, and then it's in the left. Why is that? If it goes away when you're on vacation, then comes back when you come back to work. If it rises up when you go to visit your relatives who you have trouble with.

40:43if it goes away when you're on a boat there's all these and or it's triggered by the wind or the weather or heat or cold or stress so all these clues like with gary walking into the pharmacy that was his click moment but we have all these things and doctors it's very easy to actually do this kind of assessment to rule in a neuroplastic and then once you see it then you say well gee we you probably don't need the scan in that case, in this case. One of the examples you gave there, I think it was either back pain or neck pain. Oh, it's not there when I'm on vacation, but it is when I'm at work. Of course, some people would say that could be to do with sitting posture, right?

41:27They might think, oh, on holiday, you know, I'm out walking every day. I'm not sat in front of a laptop. I'm in the pool. Yes. Oh, but so they may not think neuroplastic. They may think this is a posture thing to do with my work environments. And I know you do tackle this in the book, right? So that's a possibility. Or would you look at it slightly differently? Just look, ask the question, you know, look carefully and take your time and don't jump to conclusions. And so in the book, there's several stories that talk about how over time people kind of figure it out. You begin to see what's going on.

42:08One of the amazing things that we've learned to do is if someone says, well, I'm worried, I really think it's probably the computer screen, you know, just looking at it, that visual. And so I, you could have someone just sit, close your eyes. Imagine you're looking at the computer screen. Sometimes that will cause pain. And I go, hmm, I just, I didn't, it wasn't the computer screen. It was my brain. We do this all the time. And it's another clue. So you're just taking your time, you're doing detailed histories and assessments, and looking carefully. Once you ask the question, usually the answer is pretty obvious over time.

42:55Is this where the FIT criteria comes in, FIT? Exactly. Yeah, and can you just quickly go through what are the FITs criteria? Yeah, functional, inconsistent, and triggered by innocuous stimuli. So this is those three things that help us determine, could this pain be neuroplastic? Exactly, exactly. So functional means that it's in a broad area. It didn't occur with the physical precipitation. It has characteristics that don't fit a structural problem because it's in a whole leg or a whole arm. and then inconsistent means it's turning on and off or moving around or shifting yeah and triggered means it's triggered by innocuous stimuli like imagining the the situation or um heat cold light sound etc okay so that's a useful mnemonic to help any clinician or or frankly a sufferer to start figuring out could my pain be neuroplastic yeah okay so so step one is assessment right step two is education yes what's education all about explaining how the brain works it's explaining predictive processing that our brain literally creates what we see what we hear and what we feel so it's it's validating people to understand again that their pain or other symptoms are real they're not imaginary they're not fake they shouldn't be shamed or blamed at all and because the brain can produce this level, even very severe symptoms that last a long time.

44:32It can be because the brain gets stuck in a loop, a conditioned loop, a horrible habit of continuing to turn on pain every morning, every evening, all the time. And so it's really understanding that neuroplasticity means the brain can organize itself and change. So it gives validation. It gives compassion because we're linking the stressful situations in their life to the onset of these conditions. So we're understanding them as a whole person. We're seeing them as a whole person, not just seeing their disease, not just validating their disease but validating them as a whole person and then offering hope because of because neuroplastic implies neuroplasticity which implies change reversal you know how for many years i've been coming to the conclusion that the most important thing in our bodies when it comes to health and well-being is the state of our nervous systems we literally see the world with the state of our nervous system.

45:45The nervous system that's wound up and tight, you're going to see threat and stress everywhere. A nicely relaxed, uncoiled nervous system, you're more compassionate, joyful, you will see the other side of the argument when someone says something and not react, right? And as I was reading Unlearn Your Pain over the last few days, it really reinforced that belief for me that the state of your nervous system is everything when your nervous system feels as though it's under threat in any way even mild threats there are all kinds of symptoms that you will experience that could well be related to that and too often in medicine we look at the symptom and try and treat the symptom the question for me over the last few days was if someone had a truly calm relaxed nervous system which of course is very rare now in the modern world because of the way in which we live i imagine many many seemingly unrelated symptoms would just go yeah because they're there for a reason yes because we're really understanding the whole person and understanding the causes of these things, you know, in reality, seeing the truth of what's going on.

47:09And so it's on one hand, the symptoms themselves create more and more fear. The symptoms themselves create more and more, more and more upsetness and just, you know, just ease, so to speak, which makes things worse in and of themselves. But at the same time, when we look at people's lives to really understand the connection between their lives, between what's going on in their relationships, what's going on in their work, what happened in their childhood in terms of traumatizing types of experiences that have sensitized the brain to be more sensitive, sensitized this subconscious danger signal to be more likely to react later in life.

47:53And we know for certain that traumatic experiences in childhood, and they don't always have to be the biggest ones, but the hurts of not feeling seen or not feeling heard or being criticized, etc., have impact or can have impact later in life when other stresses occur. Yeah. I always remember my very first conversation with Gabor Mate, I think back in 2018. And Gabor said something to me about childhood trauma. He said, it's not only when bad things happen to you, it's also when not enough good things happen. Yes. And what he's really great about is saying, it's not only that the bad thing has happened, but then you weren't attended to, cared for.

48:43and so you know many of the stories in my book have to do with that where people and especially women who have who have higher levels of emotional abuse higher levels of sexual abuse higher levels of online bullying higher levels of uh interpersonal interpersonal violence harassment in the workplace and and higher rates of neuroplastic conditions exactly yeah and again just to stay on the Gabor Maté theme, Gabor in his last book talks about women as being society's stress absorbers. Yeah. And they're conditioned to be there for everybody, to be people pleasing, to take care of others first, to make sure they're the ones who are taking care of the children.

49:32They're the ones who are taking care of their parents. They may be in a stable relationship, They're still doing most of the work. And these are real. This isn't blaming women. This isn't saying that women are weak or that they're deficient in some way. It's just the facts that I'm not the spokesperson for women. But the facts show that they have higher rates of neuroplastic conditions and higher rates of traumatic experiences in their lives. one of the most eye-opening sections in the book for me is when you list out conditions that you say are likely to be neuroplastic okay not 100 you're saying likely everyone needs an evaluation but i think it's worth reading this list out okay because i cannot imagine that there are many people listening to this podcast who haven't experienced at least some of these at some point in their life.

50:35Migraine headaches, tension headaches, trigeminal neuralgia, occipital neuralgia. I mean, I can't go through them all, right? Benign positional vertigo, restless leg syndrome, brain fog, memory difficulties, Raynaud's phenomenon, non-cardiac chest pain, POTS, postural orthostatic tachycardia syndrome, something that affects loads of people and they struggle to get good treatment for it. Tinnitus, chronic cuff, chronic back pain, chronic neck pain, sciatic pain, whiplash, fibromyalgia, piriformis syndrome, chronic tendonitis, plantar fasciitis. I mean, I could keep going on. The point is that it's kind of what I was saying to you before about the nervous system.

51:21If the nervous system feels under threat, in danger, the body can express that in a variety of different ways. And some people that's expressed as pain and other people it's expressed as something else. Yeah, it's an alarm system. And we realize that smoke alarms are there for a reason and they have to be loud to get our attention. And the symptoms that the dangerous alarm mechanism in the brain produces are vast and varied. And some people have many of them all in the same person, which is so hard to see. But it makes it more obvious that it is neuroplastic when people have so many of these. That's a really key point, Howard, right?

52:05So a lot of people I found over my career who have situations and conditions like these and are struggling to get help, they often end up picking up lots of labels and lots of diagnoses. and I always used to have this principle which was if ever I see someone with four five six different or seemingly different things just at the back of my head I was thinking are you sure these are all separate or do they all is there something at the roots that's causing all of them and again that is not really how we're trained as doctors because we're trained to look at things differently that oh you know that's a skin condition that's a heart condition that's a lung condition, which again has value some of the time.

52:53But you see this all the time when people have got 10 diagnoses. I'm like, has this person been really unlucky and they've got 10 different things going on with them? Or are we missing the root cause? And there's a story. We all have our stories that we tell ourselves and their stories define us. And so if the story is, I had difficult time in my childhood, there was a lot of stress. And on top of this, I was unlucky in that sense. And then on top of that, I've had other stresses in my life. And on top of that, I got all these different diseases that are all separate. That's really unlucky. And on top of that, I went to the doctors to try to help me and they really couldn't figure it out.

53:34And they tried lots of different things. Nothing works. I'm broken. It's a different story than to say, hmm, I did have these stresses in my childhood. I did have these other stresses in my life, but it turns out those stresses actually were the cause of these neuroplastic conditions that are real. And I've been suffering and the doctors couldn't help me because they didn't understand it. They didn't understand neuroplastic conditions. But the hero of the story is me, that I can have agency. I can take these things and look at them in a different way and look at my life and put it together so that it makes sense and heal emotional hurts and change my view of myself as not being broken and crippled and damaged, but able to move forward.

54:26That is an amazing process for people to go through. We've done number one, which is assessment. Number two, education. And then we move to step three in the five-part model, which is reappraising symptoms. And when you describe this in your book, you say something really important. Step three is a pivotal change. We're no longer discussing and identifying the problem, but we're now moving on to working on the solution. Because you make the case in the book that we're not just trying to manage pain, right, which a lot of treatments are trying to do, but you're trying to manage your pain. No, no.

55:05It's like, well, we want to reduce the pain and if we can eliminate it, Exactly. Which is very different. And we have high quality research showing that that can be done and that it's more effective than the standard models. And that people's pain can actually, if it's neuroplastic, can actually be reversed. And so pain reprocessing therapy, reappraising pain, is understanding that the pain or the fatigue, anxiety, depression, whatever symptoms, tinnitus, et cetera, is not actually damaged or broken. It's not actually dangerous. And it's calming and soothing yourself and your brain. And as you said, your nervous system to reduce the threat.

55:49And as the threat is reduced, the brain will often turn off or start turning down the symptoms or they'll go up and down. And then you'll see, oh my God, it just went up. I'm watching these symptoms. I'm curious about them. And I see that all of a sudden they went up. Now they went down. Now they move. Just like, oh my God, this is it. I got it. Now I can expand and do more as I calm and soothe my brain's danger signal. That is a model for reversing neuroplastic conditions. Is this stage really about self-awareness and reframing things? Yes, absolutely. Yeah, absolutely.

56:32It's kind of like the Bible says, you shall know the truth and the truth shall set you free. And it's really knowing this as truth, really feeling it and understanding it. Because what I tell people is like, when your brain gives you a pain or a fatigue or an anxiety sensation, it's also asking you a question. Are you okay? It's a protector. It's concerned about you. It's fearful. It's worried for you. It's reacting to some potential threat or harm, either emotional threat or harm or potential physical harm. It's asking you the question, are you okay? And most people in chronic symptoms are saying, no, I'm not okay.

57:11I've got all these things wrong. I can't do this. I can't do that. My life is a shambles. I'm not okay. And this is changing that paradigm to say, I actually am okay, which is sometimes hard to do, right? It's hard to take that step. Yeah, the symptom is not there just as an annoyance to suppress. It's a signal that we need to understand. Exactly. Right? So that's the key difference. Exactly. On page 262 of Unlearn Your Pain was just a beautiful paragraph that you wrote when you're referring to this stage three process of reappraising symptoms. you say here is a description of step three of our treatment pain reprocessing therapy which can be thought of as a form of symptom reappraisal recovery therapy and then you write this your brain is not your enemy it is your protector if your work is a torrent of incessant deadlines and toxic relationships wouldn't your brain want to create back pain anxiety or fatigue so you have to stay home?

58:23If you have a close family member who is making unreasonable demands or threatening you, wouldn't your brain generate headaches, depression, or insomnia so you'll have to avoid them? If you are constantly berating yourself, pushing yourself to do more than is possible, or feeling guilty or ashamed, wouldn't your brain turn on tinnitus, dizziness, or burning sensations to alert you to a problem of course it would that's that makes me like tear up you know because this is the situation of so many people in their lives and this is the human part of the human condition and thinking about it this way completely different understanding right compassion for people in these situations compassion for ourselves in these situations and understanding that there's a reason for it.

59:19And if there's a reason, and then there's hope. This work is so satisfying. I mean, it's incredible to see people change their lives and understand themselves in new ways. I'm going to bet, Howard, that at least 50 % of people who are listening to this podcast, when I just read out that paragraph, saw themselves somewhere in those lines. And it's probably more like 80, 90%. As you say, right in the conclusion, actually, of your book, which I found really, really remarkable. I wasn't expecting this. Page 347, right at the end, you write, most people will develop some form of neuroplastic condition at some point in their lives.

1:00:07It is simply a byproduct of being human. Beautiful. Yeah. I mean, it's a fact. and making that common sense, making that common knowledge is what we're talking about. That's how, you know, the last chapter is called transforming medicine one person at a time. Yeah. Because it's just this knowledge that's coming forward by people who are suffering, by the people who need it. Because one of the beauties of the internet is you can search endlessly. And eventually, and you can find a lot of misinformation, You can find a lot of all sorts of stuff. But you can also find this work online. And you can find the stories of other people who have what you have who've recovered.

1:00:55And when you kind of get to that and you start to look, one of the stories in the book is about a woman, British woman, a young woman who had horrible pain on and on and on. Then horrible fatigue on and on and on. And she was told by the doctors and by the support groups, you will never recover. You will never get better. You will never be able to walk or move or dance or run or travel. You'll never be able to go to school. This is your fate. And she got a pop-up ad for an app called Curable. Curable is one of the apps that promotes this work and has a program, online program. And she kept getting ads for it.

1:01:37And she got angrier and angrier at them for giving false hope, for giving false hope to people because she knew she could never recover. And so she joined the program to prove that it wouldn't work for her. But as she read it, as she read about it, and she learned this material that we're talking about here today, it started to make sense to her. She saw herself in these stories. She saw herself in this paradigm and it turned out she had had trauma in her life, all sorts of stuff that she hadn't ever processed or dealt with or understood that this could be related to her pain and her fatigue. And she started getting better.

1:02:19And now she's fine. You know, but the paradigm shift was just vast, vast. Tell me about your sister who had an episode of neck pain back in 2016. Oh, yeah. I mean, this is part of being human, you know. It occurred in the time when my mom died, our mom died. She was very close to our mom and she started getting neck pain. And so maybe not surprising, you know. Why wouldn't that happen? Yeah. Why wouldn't it? And so she goes to the doctor and then she goes to the chiropractor and everyone's looking at it structurally. But, you know, it's easy to look at the MRI and see that these are the normal findings that she had and then examine her and make sure that there's no neurologic damage and then talk about her life.

1:03:11And then just help her to say, give her brain a clear message. Our brains need certainty about what's happening in our lives. When you walk down the street, your brain is constantly there to protect you. And so every person we see, it's friend or foe, friend or foe. That's how our brain works. And so giving herself the messages of my neck is damaged and broken is going to lead down one path. But the other path, she started literally telling herself, I'm safe, I'm healthy, I'm strong. There's actually nothing wrong with my neck. And I'm going to keep moving it and telling myself I'm fine. And I'm going to move toward joy.

1:03:48and I'm going to, yes, I'm going to mourn our mom, but it's okay. I'll be okay. And you know, a few weeks, she's fine because she understood it in a completely different way. You talk about her story in quite a lot of detail in the book and as part of her recovery, you gave her a set of affirmations and you acknowledged her that I know affirmations can sound ridiculous, but they have been shown in functional MRI studies of the brain to change the brain by reducing threats. Again, these are concepts which a lot of people are going to be skeptical about. Well, Howard, I've got pain. I'm just going to tell myself, you know.

1:04:33I know, it sounds crazy. I'm happy. I'm calm. The thing is, I know this stuff works, right? But I'm trying to address the skeptic who's going, come on, man, you know, to that skeptic again. But because I think this work is life-changing and because millions around the world are suffering, I want to make sure that we bring people on board who might be going, wait a minute, how does an affirmation help you with your pain? What would you say to them? It gives the brain certainty. It directly affects the cause of the pain. Because when the pain is neuroplastic, the cause is danger and threat. and by giving our, and we're always giving ourselves messages.

1:05:13We're always giving ourselves messages. A lot of times people's messages they give to themselves are, I'm damaged, I'm broken, I'll never get better. Why is this happening? Why is this happening to me? You know, I'm a loser. All these messages we give to ourselves. And when you purposely change the messages, you're giving your brain certainty, you're putting it into a mode of safety, and neurons that fire together, wire together. So Gary, when he started walking, it was painful, but he started walking, telling himself, I'm okay, I'll be fine. There's nothing wrong. He was changing the neural circuits in his brain.

1:05:51And if you have a neuroplastic condition, all you need to do is change the neural circuits in your brain to recover. Yeah. Let's go on to step four. Just to make sure everyone's keeping up, number one assessment, number two education number three reappraising symptoms and there are many techniques within reappraising symptoms that we didn't get to but they're all there in the book step four emotional processing therapies i loved this section this is so interesting to me how our emotions can affect our health how anger guilt shame can potentially cause pain right it's incredible So, you know, let's go through it.

1:06:39What's the deal with stage four emotional processing therapies?

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1:10:28let's go through it what's the deal with stage four emotional processing therapies yeah like you said rangan it's recognizing that emotions are important they're real they have major effect on us and if you're living with guilt you're living with shame you're you're you're living with this toxicity of beating yourself up. Most of the people living with shame and guilt is undeserved. They haven't really done anything wrong. And it's very clear, and fMRI studies show that emotions are related to pain signals or depression signals or fatigue signals, etc. If you're living with anger, upset, carrying the grudges that we do, how's that helping us?

1:11:19It's creating this toxicity in our lives and it's creating the neural circuits that can fuel these sensations and neuroplastic symptoms. So, and as I said, traumatic experiences early in life and later in life activate the danger signal and make the danger signal more sensitized as people go through life. So one of the first people I saw was a woman who had headaches for 17 years. And that's a long time. She'd been to three top headache referral centers, injections, medication, everything they tried, nothing worked. And when she asked, what's the cause of my headache? They would go, I don't know.

1:12:06You know, we don't know. But what could I do? Well, I can listen to her and I can talk to her. and her life was pretty straightforward. She didn't have horrible traumatizing experiences in childhood except that her father was unpredictable. He came home some days from work. He was fine, happy, and good. Other days he was mean and ugly and angry and upset and he would grab her and yell at her and scream at her. So fearful. But she was fine. She would describe her childhood as being fine. And so when she got the headaches when she was in her 30s, I asked what was going on in your life then well let's see I had a new boss well what was he like unpredictable he was unpredictable just like her father he would be fine and happy and good and then sometimes he would go into rages and yell at people demean them debase them it was scary and her brain like we were saying earlier her brain was like well wait a minute this is not good and the headaches started.

1:13:09And now she understood them in a completely different light. And she could change her appraisal of them as we just spoke about, but she could also change her emotions about them. And she could allow herself to feel the emotions of the fear of the anger that she had toward her father, toward her boss. loss. And the method we've used called emotional awareness and expression therapy is to help people express their feelings in safe and healthy ways so that they can resolve them. And then they're not hanging on to underlying grudges and anger. They're not hanging on to underlying shame and guilt. And it turns out you can purposely change your emotions, change how safe you feel in your life in relation not only to current events that are scary or feeling trapped or hurt or betrayed, but also past events.

1:14:10So it's actually a treatment for trauma. I'm just wondering how people actually do this. So there may be people listening who have realized throughout this last section that, yeah, you know, I'm carrying a bit of resentment or anger or shame or whatever it might be. Howard's saying, I need to feel it. But, you know, what are people meant to do with that? I mean, are they meant to shout, cry, hit the wall, journal, you know, or can all of these things work potentially depending on the individual? Yeah, yeah. There's a lot of ways to do emotional processing. There's a lot of different therapies involved that people have developed over the years.

1:14:52Journaling is certainly one of them. And to be very useful. I lost my job four years ago. I was a senior doctor at my hospital for 20 years, but the hospital had budget crises and they let me go. What doctor loses their job? I mean, it seems like inconceivable. It's the last thing I ever thought would have happened to me and my back started to hurt. And I told people, the hospital let me go. That's kind of funny, right? And everyone said, oh, I lose jobs. Everyone loses jobs. It's no big deal. So my back is hurting and I'm kind of hobbling around and I do pain reappraisal. I do an assessment. I'm not damaged.

1:15:43Nothing happened to me. I had no injury. I do pain reappraisal. I'm telling myself I'm safe. I'm okay. Keep moving. Everything's fine. Didn't work. I'm in my car three weeks later and I realize it's not funny. I have feelings about this that I haven't expressed, that I haven't even recognized these feelings because I was just holding them down. And the first feeling was anger. So if you have anger, you can keep it in, which is toxic to yourself. You can let it out in the real world, which is damaging. Violence is not a helpful solution. Yelling at people in real life, yelling at the people you care about is not going to be beneficial to anybody.

1:16:27So, but I could let the anger out in a safe and healthy way. I just started screaming. I just started screaming and yelling. I was swearing in my car. I was in No one could hear me. And I started screaming and yelling all this stuff and swearing and cursing. And then I imagine, this is so silly and so crazy and funny, but I imagine blowing up the hospital with TNT like in a cartoon. And then I could relax. And then I just let that anger all out and I could just release it and not hold on to it. And it was safe and healthy. It only takes a relatively short time. Then I went to the other main feeling, which is hurt and sadness.

1:17:15They kicked me aside. They let me go. My God. And all the hurts and sadnesses from my life started coming up. And what do you do when you're hurt or you're sad for somebody? You care about them. You hug them. You give them compassion. So I started turning that hurt into compassion for myself. A friend of mine called me who was compassionate toward me right at that time. And so I could alleviate some of the hurt. And then I realized, you know what, the hospital, they put up with me for 20 years. I never made any money for them. I wasn't a high producer. I wasn't doing injections or anything. And I forgave them.

1:17:55And I thanked them. And I had gratitude for the 20 years I was there. and as I forgave them, as I processed the anger and the hurt and the forgiveness, the pain just disappeared on the spot. It's amazing how powerful that can be. Thank you for sharing that story, Howard. It is incredible to hear that there were so many things that happened there, but your ability or willingness to not pretend that you weren't feeling anger and hurt, right? Because that's what we do, don't we? We're very good at kidding ourselves. All of us, myself included, you know, we can pretend things, oh yeah, that didn't bother me.

1:18:44You know, everything's fine. Do you know what I mean? It's uncomfortable. It's uncomfortable to feel our feelings. We want to kind of push them down or push them away. Yeah, but for you to even acknowledge it in your car, shout, and even in this cartoon sort of way, imagine the hospital being blown up, right? You would never say that to anyone, right? You would never, A, you would never do it. B, you would never actually probably say that to anyone because it's like, well, what will they think of me? but this is real radical honesty to yourself about what you were actually feeling so you expressed it, you processed it it sounds as though what you're saying by processing the anger first you then were able to experience the hurt that sat underneath the anger you acknowledged that yeah I am feeling hurt I was there for over two decades you might have been pissed off, frustrated but whatever it was you were honest, expressed it, released it then you move on to forgiveness right and you use gratitude to help you do that which I think is very very powerful but the key point which fits with the entire conversation is that that was your story that was your story for this instance of back pain it may not be someone else's right each of us will have our own story about our life we create our own narratives around these situations that happen right so someone else may have lost their job after 20 years and had a different narrative in their head different emotions right so it's not so we can say oh that's the formula to deal with um losing your job in your 60s no that was unique to you because we're all unique individuals we all have our own way of dealing with things but the key point i'm taking from that is you have to be honest with yourself you have to start expressing how you're actually feeling and processing it and if you don't if you stuff those emotions down they will express themselves in some way or other in some part of your life it's it's hard to imagine how powerful this could be one of the stories in the book is about a woman who had severe back pain lower back and she even had surgery and it didn't help and she was in a meditative process and she had this memory of being and this is horrible to say but sexually assaulted when she was young with her back up against a ping pong table where the pain was and as part of that memory is creating a tremendous amount of hurt and fear and feeling trapped.

1:21:31But what she did as part of that memory was to start to change it, to take agency in her mind and imagination to throw this person off, to stop them, to kick them or step on them, to call the police, to get them arrested, to get her younger self to safety and giving compassion and caring to her younger self, all in this imagination to change the traumatic memory. And it turns out memories are always changing and we can change memories. And when she did that whole process, which didn't take that long, the pain went away. And it seems like, again, you're thinking of the skeptic, how could that possibly be the cause?

1:22:18How could that possibly make such a difference? But it does. It does. And if you look at it through a different lens, I think most of us understand if you've had a busy week at work and you've not taken lunch breaks, you've been working through, you've been staying late at the office, people recognize on a Friday evening, they may have a bit of a headache, right? or they may feel tense and be reactive with their family. They kind of get that, that, oh, the stress has given me a symptom or changed how I behave. So what you're asking people to do is not really much more of a leap from there. It's not just that stress gives you a bit of a headache.

1:23:02If your brain feels under threat, it can actually generate pain as a protective mechanism. Yeah, and you multiply this danger signal and people who are pushing themselves or being hard on themselves or not feeling good enough, people-pleasing, perfectionistic, all the pressure they put on themselves to succeed. And that can multiply. And at some point, the brain takes over and says, time out, you know, time out. And so sometimes it's people who are very successful, you know, that we see this in, who don't recognize that there may be some changes in their life, which is the fifth step, making changes in your life, that your brain is alerting you to.

1:23:47It's a message or a guide. It's saying, wait a minute, you are doing way too much. Yeah. One of the stories in the book is about a woman who was always people-pleasing, always doing what everybody said and never said no. And she was in an interaction with somebody. Somebody asked her to do something she didn't want to do. She said yes, and her stomach started to hurt. And then on reflection, she's like, wait a minute, what's going on here? Oh, my brain is giving me a message. It's a signal. I wasn't true to myself. So she went back, and she had a difficult conversation. And she was honest and authentic, saying, I can't do that.

1:24:26It's not good for me. It's not something I can do. I'm sorry. And the stomach pain went away, but she honored herself. Yeah. And that was a change for her that was so powerful because now it's making her a better person. It's making her a better version of herself. If you don't say no, the body will say no for you. Exactly. And there's multiple ways in which it can do that. Exactly. You're moving on now, as you've mentioned, to the final stage, stage five of this Vipop model to treat neuroplastic pain, making changes in one's life, addressing personality traits and life circumstances. And you just hinted with that example there of someone who's doing that.

1:25:15Again, a very powerful couple of paragraphs in the section of the book where you write about stage five, which I'd like to read to you, Howard, if that's okay. People who grow up with conditional love, high expectations, family secrets, social rejection or not fitting in, anxious or depressed parents, family members who have chronic illnesses or early life medical conditions are also prone to develop the personality traits that are associated with neuroplastic conditions later on in life. Our brains will recognize danger not only from the outside world of life stresses, but they will react also to the pressures that we put on ourselves.

1:26:05Personality traits that have been associated with neuroplastic conditions include people pleasing, perfectionism, self-criticism, guilt, and avoiding anger. it's important to recognize that everyone will have some of these traits and that they can be useful and desirable in moderation. But when they are excessive and tend to rule us, they lay the groundwork for the development and persistence of chronic pain, anxiety, depression, fatigue, and other neuroplastic conditions. I think I should have got you to read my book instead of me doing it. however that says it all so beautifully i mean again as i read that i think there's not going to be many people who are listening who don't identify with one of those things right it is as you say the process of being human but again i feel sort of stage five and stage four are linked in some way stage four is about processing your emotions i guess you're saying stage five is like with that example you just gave is yes understanding yourself understanding the emotion but then importantly taking the step to actually make changes in how you live your life some people need a different job some people need to set boundaries for what they will do and won't do some people need to set boundaries for how much they see certain people in their lives some people need a new spouse.

1:27:38And some of these stories are very poignant and very powerful. One of the stories is Cynthia in the book where she just, you know, really make it abbreviated, she grew up in a time and a place where she was not seen, not heard. She was hurt in many ways. And I was all put under the table. She had an abusive first husband, abusive second husband, had more and more and more and more and more symptoms. When she realized that she needs to make a change in her life, which took quite a while, and through some therapy, as she left the second abusive husband, as she realized she had neuroplastic symptoms, as she started a new life, as she gained agency, everything changed.

1:28:25But it couldn't have happened in the current environment in which she was in. do people need to address all five parts of this model in order to get better great question uh sometimes just the first two steps are enough a proper assessment and education that it's the brain that's creating pain yes sometimes that is enough because people may not have some severely traumatic things in their life or difficult situations and they have the freedom. If you get a test result saying, oh, we just did your biopsy and it's cancer, I'm so sorry. And then the next day they say, oh, sorry, wrong slide. We mixed the slides up.

1:29:12You're fine. You're fine. There's a liberation there. It's like, oh my God, I was so worried, but now I'm fine. That liberation can change the neural circuits in their brain by understanding, having the felt sense of I'm actually okay. So that can be enough for some people. And some people need more of the therapy, more of the emotional work, et cetera. Yeah. It's a very complete model. I can see how not everyone needs all five stages, but some people are going to need to go all the way from one all the way through to five. Irrespective of that, though, the message I get from that model, and frankly, all of your work and your book is one of hope.

1:29:54It's that even if you've struggled for years with chronic pain in whatever form that shows up for you, even if you've been to multiple doctors and taken multiple painkillers and you have not got better yet, you're basically saying that there is hope. There may be things that you've not tried yet. You may have a belief that only a problem with structure can cause pain. and what happens if you live your life with a different belief that actually wait a minute my body's not broken it's my brain that is choosing to create pain why is my brain choosing to create pain it's very empowering and I basically love the idea that you can apply this thinking model beyond pain you can apply it to depression and anxiety and fatigue right?

1:30:52And I write about these in detail in detail looking at the science behind it looking at some of the myths that are there that are out there I think the section of long COVID is going to be very insightful for people who are struggling because that is something that a lot of people struggle with but there are common principles right? And you know I think there's a beautiful story about an infectious diseases doctor senior doctor here in the UK who might have been skeptical but through his own suffering of long COVID turned things around. Because it's the science. It's really talking about the science here.

1:31:29It's not woo-woo. It's not just wanting false hope or whatever. It's really looking at the science of these conditions. And that's why I tried to put, there's over 800 medical references in this book. Yeah, it's incredible. I mean, what I think makes this book unique is that you have literally got a ton of modern scientific references to prove that what you're saying is repeatable and reproducible. And science is a spiral. It's good science and the truth will win out over time. Over time. And over time, this work, I believe, will become standard, will become common sense, will become common knowledge.

1:32:12Some of it may not turn out to be true. There's some parts that may change. and as a scientist, you have to be humble. If I'm not humble about my work, I'm not a scientist. But we've seen in our research studies that this model does work for many, if not most people. We've seen and we understand how the brain works now. We understand these conditions much better than we did before. And so, as you said earlier, you know, there is hope for people. and doing this work is saving resources, saving money. It's less invasive, less expensive, you know, than some of the current models. And so I'm not saying all medicine is bad.

1:32:58You know, medicine has had major advances in the last couple of decades in cancer treatment, heart disease, stroke treatment. however these disorders of chronic pain chronic fatigue chronic anxiety chronic depression so many of these others certainly appear to be neuroplastic for most people and if that's and when that's the case there's a chance for recovery and that is the basic message not only recovery but actually being better actually being a better version because we're not only getting rid of these symptoms but we're actually listening to a message that might guide us toward being more authentic yeah uh being you know being more real and and being more having more agency and compassion for ourselves.

1:33:55And that's the side effect that is just so moving, you know, when you see that it's so poignant. Howard, as I've said, I think one of the best things about your work is that it gives people hope for the future. I think the new book is stunning. Honestly, there's so much great stuff in there that are gonna help people, whether they have chronic pain or not. It goes far beyond chronic pain into fatigue, anxiety and depression and many other things. Thank you so much for writing it. I'd recommend people who are interested in this topic, I definitely recommend they get the book. If they want to stay in touch with you online or look at some other resources, depending on where they live in the world, are there some places that you can point them to?

1:34:40Yeah, we have a nonprofit in the US and there's other nonprofits around the world that are working together, peer-to-peer people who just want to help each other In the U.S., it's the Association for the Treatment of Neuroplastic Symptoms, neuroplastic.org. In the U.K., it's Living Proof, nonprofit here. It's amazing work. In the Netherlands, it's Schieckting Emovera, which I'm not exactly saying that, it's probably right. And all around the world, people are beginning to do this work. And they're doing it because they've recovered and they want to help other people. And that's their motivation.

1:35:29All these nonprofits aren't there to make money. They're there to help. Well, Howard, thank you for your work. Thank you for the hope you're giving so many people around the world. And thank you for coming back on the show. Thank you so much, Rangan. It's such a pleasure and an honor. Appreciate it.

1:35:49Really hope you enjoyed that conversation. Do have a think about one thing you can take away and apply in your own life and also one thing you could teach to someone else. Remember, when you teach someone else, it not only helps them, it also helps you learn and retain the information. Now, before you go, I just wanted to let you know about something I'm really excited about on July the 1st. I'm kicking off my first ever 21 day energy reset. It's a simple challenge built around the four pillars of how you feel each day, how you relax, eat, move and sleep. And if you're someone who's tired of feeling tired, then this challenge is for you.

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