#Which other chronic illness folks know intimately

[gon-and-killuas-mother]

i am attempting "light therapy" to help fix my sleep schedule and i'm cranky about it

my aunt, who's a neuropsychiatrist (one of the few women in her field and fairly well known at this point, don't know if anyone's heard of Dr. Jo Cara Pendergrass but damn she's cool) was in town this week to look after her mom post-cataract surgery

Cara is probably the smartest person in the family, all things considered

(my brother and I give her a run for her money but neither of us intend on getting a goddamn PhD lol) (also my dad wouldn't appreciate me saying that, he is also pretty smart. but like. he's got intelligence, he's just lacking in wisdom)

ANYWAY. of all the people in the family, Cara is the person i rarely have to explain my illnesses to. usually, i have to tack on a brief description of it anytime i say "yeah i have EDS and fibromyalgia and IBS and--"

but last time i saw her over Christmas, i told her the diagnosis and had my script prepared to explain, but she just went "Oh yeah Ehlers Danlos -- wait. Oh."

her face did the thing where she was processing new info at light speed by blinking and cycling through several expressions as the pieces of the mystery that is my chronic ailments settled themselves in place

unfortunately i wasn't at the point where i was comfortable enough to tell anyone how miserable and in pain i was, that was something i put off another couple of months before i confessed to Nana that i'd become a grocery thief and was on my way to being homeless. that's also around when my brother asked my permission to share my story with the family, because he knows how difficult it is for me to admit how much i'm struggling.

i'm rambling tbh but only to keep me awake and sitting outside long enough

ANYWAY

so Cara was here this week. i went to visit the other night. we always have really interesting conversations about our brains and genes and family shite, i don't think anyone other than my brother and i can actually hold a conversation with her about that kind of shit.

i did NOT go there just for advice, but when i told her how much trouble i've had getting out of bed before evening, she gave me a couple of tips that i'm now trying out

1). the 24-hour sleep deprivation strategy

it sounds like a nightmare to me, but apparently has supporting evidence that, at least in the short term, resets your circadian rhythm.

if you've ended up awake hours past your desired bedtime, then instead of simply going to bed late, it's advised* to keep yourself awake throughout the rest of the day until the next bedtime.

( * WITH CONSULTATION OR SUPERVISION OF A DOCTOR)

the reason this is supposedly effective is that the longer you stay awake, the higher the sleep pressure becomes (sleep pressure is just your body's signal to go the fuck to bed, which is something i'm intimately familiar with as it's a constant companion of mine regardless of sleep hygiene). the higher the sleep pressure the easier it is to fall asleep and, ideally, the better your sleep becomes.

Cara did emphasize that as far as we know, it's only a short term strategy. either we haven't done enough studies or we haven't figured out how to apply it to a longer term solution.

2). Light therapy

i was already somewhat aware of this but not to the extent that Cara explained.

the trick here is to force yourself out of bed (if you're able) and sit outside. preferably on sunny days. she said this even works if you end up falling asleep outside anyway, you're still absorbing sunlight.

there's no immediate change, as it does take a few days or more to notice any improvements (this checks out, as i am still drowsy as fuck) but doing this daily or semi-daily gradually convinces the body and brain to be awake earlier.

it's one of those things that a lot of disabled folk like me, especially those with fucked up sleep, would hear and get annoyed with, because we've tried so many different strategies that have each failed one way or another. and hearing "go outside" just reminds me of my mother and every yoga enthusiast insisting on all natural medicine, which understandably raises my metaphorical hackles.

but Cara, again, is the smartest person i know. i'm much more willing to take the advice of a neuropsychiatrist over a yoga mom, despite them actually agreeing on something.

and also? i do miss the Sun, quite terribly.

so if, by sometime next week, i'm magically able to wake up earlier with less struggle, i will let y'all know. i'm gonna be cranky about it, especially if it actually WORKS, but as the neighborhood mascot of Sleep Deprivation i think i'm a pretty good indicator if something like this is legit or not.

｡⁠:ﾟ⁠(⁠;⁠´⁠∩⁠`⁠;⁠)ﾟ⁠:⁠｡

[stardustedknuckles]

Me telling friends and family about my fibro diagnosis has just been like -

Folks without chronic illness/who haven't started their testing journey: I'm so sorry dude, you doing okay?

Literally every spoonie: OH MY GOD CONGRATS

[0w0]

Hey so more posting about my intimate mental health on Tumblr, because it is the void I scream into when I'm overwhelmed on deciding which interpersonal connection to dump this on

I've officically lost like 20 lbs in the past two months from just... Pretty much hardly eating. Officially relapsed 🤪 (the emoji is ironic and is an attempt to mask my true ditress)

I've largely come to the conclusion that it is because of depression. I do not eat because I simply feel like I, myself, am not worth maintaining. It's the same reason why hygene and chorws are hard. Everything just feels empty despite my best efforts, eating just is more work to keep doing something that ultimately, my mental illness makes me feel is pointless.

I've attempted suicide, yeah, but passive self harm has always been what lean on when I'm to lethargic to even hurt myself when I get the impulse.

The thing is, I'm scared. I'm super scared. I like that I'm losing weight. I want to be smaller. I want to take up less space and no feel so fucking fat and disgusting. (Being fat is not disgusting, and fat people are not bad. But my perception of self is really fucked up and thats how it comes out when I look at myself when combined with societal beauty standards).

Despite being scared-- I like how an empty stomach feels. Before it turns into pain, I mean. I like the hallow feeling, for the same reason I like sex. It's a physical sensation that puts me back in my body, especially when dissociating, which I do a majority of the time.

I used to purge, after binging. I won't state dates because depsite everything I'm spilling here, there's still some information I don't need out there. But I say that, because I never considered myself bulimic. Its not like it was chronic. There's a reason I gained like, 100 lbs through adulthood-- I stopped doing that shit.

One of my favorite memes online ever had this caption: "I had and eating disorder and all o have to show for it is this gross fetish". Emetophilia? Hello my old friend.

There's a certain part of me that has sexualized some of the pain I'm going through. That's what being hypersexual does, I guess, but it also feels like a way to dull the ache. Instead of calling it self harm, I call it needleplay, skin embroidery, make it an art. Make it palatable that way, for myself and others. I know it doesnt though, it's still worrying. And I'm not actively trying to transmute feelings associated with depression into something better, like sexuality. It just has .. kind of happened in my brain at some point.

I distinctly remember a time when I was in highschool. I was feeling incredibly sick, but I was on my bus ride home. I was nauseous, felt like I was going to puke, I was dizzy-- it aroused me. A few fucked up things were arousing as a teenager, and that's definitely impacted my long-term health and how I inherently respond to certain stimuli or situations: inappropriately.

As far back as I can remember, everything always circled back to sex for me. I don't remember and csa that my have happened, I don't think I was molested as a child. Bust started at 13, I had very unhealthy relationships until adulthood that hinged on sex. Whether I slept with boys or girls, it didn't matter, it was usually the same. I've had maybe 10 sexual partners in my life-- the fact I was in a relationship that was monogamous for 7 of it's 9 years was the only thing that kept that number from being much, much higher. I had many opportunities to sleep around and cheat. The impulsive desire was there, but I never did it. Was that self restraint? It feels charitable calling it that, but sure. I didn't want to hurt or betray my partner. Not in that way.

Suffice to say, everything is a pile of noodles and all my words are crossed.

Its like have synesthesia but instead of seeing sounds, everything is wirex directly to my dick. What a life, folks

Cheers to therapy making me think I guess. I'll follow this up with my therapist or a future psychiatrist.

🤷

[pleasureactivism]

Reflection: Bodyminds Reimagined

I loved this interview AMB conducts with Sami Schalk, the author of Bodyminds Reimagined: Disability, Race, and Gender in Black Women’s Speculative Fiction. In it, she explains what people with disabilities can teach us about pleasure. While I haven’t been thinking explicitly in the world of disability this year, I have been thinking about what folks who experience chronic pain can teach us about pleasure. I turned my thesis in this week titled, “Pain-full Worlds: Coming of Age with Chronic Pelvic Pain,” in which I explore the layered dimensions of pain women with chronic pelvic pain must navigate daily. One of the most important conclusions I arrived at after interviews with these women was the ways in which emphasizing penis-in-vagina penetration detracts from pleasure. It is SUCH a simple point, one I honestly felt embarrassed to even make because queer, disabled, and kink communities have been teaching us this for years. Yet, in my research I found that even folks who understand themselves to be within a capacious sex-positive theoretical mindset had a challenging time moving away from PIV penetration in practice. This was true for people who experienced immense pain from PIV penetration.  And my informants spend immense time, resources, and energy trying to achieve penetration, working with vaginal dilators and physical therapists. In naming this dilemma, it exposes the ways in which structural norms (i.e, the heteropatriarchy) augment pain for chronic illness sufferers, who must struggle to make their bodies able to perform a very specific kind of sex. I argue in the thesis that those of us without chronic pain must contend with the ways in which norms and practices we uplift cause undue pain for others. A close look at the lives of chronic pelvic pain sufferers necessitates a social shift to alleviate some of this layered pain, which will in turn alleviates pain for us all.

In the interview Schalk says:

Disabled people’s sexual and intimate lives teach use that sex and pleasure are not merely about penetrative, goal-oriented sex...sex for disabled people often means throwing out the norms and working with a partner to discover what their body can and cannot do, what they do and do not enjoy. Often for able-bodied people, there is an assumption that there are certain things everyone wants or enjoys, but when you have an atypical body or mind, it makes potential partners pause, ask more questions, take a little more time. We would all benefit from such an approach that takes each partner’s body, each sexual interaction, as new, figuring out what is best with this person in this moment, given how their body feels, what’s on their minds, etc. 

yes yes yes. All the yeses. This is it. That in adopting practices that make the world more caring, safe, and pleasurable for people that need it....our world is more caring, safe, and pleasurable. Can we implement a practice of universal design for sex? Can we take seriously that all bodies are unique and deserve partners that ask questions and cater experiences to their personal needs? I think the point Schalk is making is really easy for people to agree with, but challenging to implement in practice, much like my informants who know PIV sex isn’t theoretically more valuable than other types of sex acts, but still feel compelled to perform it. How do we learn to practice–without apology–pursuing pleasure over norms? Its something I’ve been struggling a lot with myself since I’ve been writing this year. How to I bring my work into my own life and body? For me, I think the easiest way to commit to a practice of pleasure is to model it with my sex partners first for their needs. I’ll ask what feels good for their bodies, what doesnt, what experience they are hoping to get out of our interactions. I date a lot of cis men, so unsurprisingly I’m met with a lot of nervous responses that they just like “normal stuff” or don’t have needs. And this may be true! (Though idk what normal stuff means to people). But it asking these questions it forces them and myself to consider what our actual answers are, even if we cant voice it in that moment. Maybe in the next moment of intimacy we will be able to ask for what we need, and more importantly, what we want. 

HRY

[illustratedbrum]

Large Letter A Mail Art Project: With Love From Birmingham, England

"Mail art has no history, only a present." —Ray Johnson

 Hey folks and greetings from my flat, which currently contains a measly 3 toilet rolls ¯\_(ツ)_/¯

I wish I was writing under better circumstances (more loo roll, less threat to humanity, etc) but watching the COVID-19 pandemic begin to sweep the UK and the global media with ever-increasing magnitude, we are all in the same boat wondering how we can best support our neighbours, our wider city, and those further afield without compromising the health of those most vulnerable by travelling or being around others unnecessarily, particularly given that the ramifications could well affect life as so many of us know it increasingly for many months to come.

As we watch on as upcoming festivals such as our pals at Glasgow Zine Festival, NW Zine Festival and more cancel / reschedule their forthcoming IRL activity, as well as smaller, local, more regular meet-ups, clubs and workshops being on hold, we know the effects of key places for marginalised makers to connect are going to be felt. We know that practitioners on the fringes of mainstream creative culture are going to experience interconnected, interlacing barriers to navigating this turbulent time, making West Midlands Artists Coronavirus Impact Fund by MAIA and equivalents across the country so significant and urgent, along with incredible people on the front lines doing the most to ensure the needs of everyone in our communities are met, no matter what their circumstance. If can absolutely feel like a fucking impossible time to be creative, to think and to process; to create anything new.

“So Because Abled People Might Get Sick Now...“ At present, the advice in the UK is around social distancing, and this is really important for keeping those most at risk as safe as possible. As Dave Grohl put it, “let's do this right and rain check shit.” But that absolutely does not mean we must be emotionally distant. Our thoughts are not only with those who are self-isolating due to the coronavirus pandemic, but those who feel this risk as part of their everyday lives due to longstanding conditions for whom this will be an additionally isolating and anxiety-inducing period, many of whom are zine makers we know and love.  Disabled, chronically ill, immunosuppressed, homebound, and neurodivergent people are, in the words of @kateandcrps, currently witnessing “ableds accommodating themselves with the accessibility that we disabled people fight for every day, all because of #COVIDー19″. How do we end up not going straight back to inaccessible practices in the creative sector? How do we position a whole range of creatives genuinely, meaningfully; nobly?

The effects of social isolation of any cause is mostly unappreciated, misunderstood and misrepresented by able-bodied, neurotypical dominances in society, and, for those for whom it is a part of their day-to-day reality, we hope the disruption to life for many of us can be a chance to experience increased empathy, awareness and action in connecting with others, particularly when we are well enough, and have the resources available to us. There’s also no reason why these folx would only be on the receiving end of projects, as long as they are designed inclusively, and we’re proud to exist deliberately to celebrate and centrally position badass makers of all walks, wheels, and movements of life, those that weirdly (systemically) much of the creative world renders completely invisible. With so much disruption and uncertainty, so much potential for offline isolation, inner turmoil and digital overwhelm, we wanted to orchestrate a simple but meaningful, low-cost, playful, experimental creative project that anyone can take part in from their homes, designed specifically to create connections. It absolutely embraces the relative leveler of all being stuck indoors as a result of COVID-19 yet will continue in its format indefinitely for the shared benefit of whoever wishes to take part over the long run. Everyone is able to participate in the same manner, at their own pace, for as long or short as they like, with no deadlines, and withdraw at any time with no consequence, or guilt.

Zines, Zines, Good For Your Heart Every single day, all across the world zinesters are making, sending and receiving zines, connecting with one another across great distances, around intimate moments, radical hacks and big ideas. We are lucky to feel meaningful, creative connections with complete strangers that go beyond digital interfaces from the comfort of our own letterboxes. Making and mailing is in our blood; our DNA. Holding something that someone has made in our hands can breathe a life into us that even instant messaging and Zoom calls cannot explain; something that may be missing in the daily lives of many people’s normal realities, and for even more of us during this socially distant paradigm. Mail art is a movement centered on sending small scale works through the postal service. It initially developed out of what eventually became Ray Johnson's New York Correspondence School in the 1950s and the Fluxus movement in the 1960s, though it has since developed into a global movement that continues to this day.

"The purpose of mail art, an activity shared by many artists throughout the world, is to establish an aesthetical communication between artists and common people in every corner of the globe, to divulge their work outside the structures of the art market and outside the traditional venues and institutions: a free communication in which words and signs, texts and colours act like instruments for a direct and immediate interaction." - Loredana Parmesani  Zines can be an example of mail art, but so can postcards, paper, a collage of found or recycled images and objects, rubber stamps, artist-created stamps (called artistamps), drawings, but also music, sound art, poetry, or anything that can be put in an envelope and sent via post. You can create one-off pieces, or make duplicates with a copier.

You’ve Got Mail Art! Mail art is considered art once it is dispatched. No money exchanges hands. Mail art is exchanged between people, not bought and sold. Mail art is given freely, without the expectation of something in return. No judgements are made about the artwork or its quality. We will prepare and share lots more resources, ideas and prompts around creating and sending mail art, but for now we mostly want to know if you’d like to participate, as a sender, a recipient, or both. You don’t have to consider yourself an artist, have any training or equipment, or have any money. We have a postage pot to distribute small funds to cover postage if needed, otherwise the only cost will be a stamp or possibly some rudimentary materials. Maximum size is a UK Large Letter, i.e. not exceeding: Length: 35.3cm Width: 25cm Thickness up to and including: 2.5cm Weight limit: 750g No minimum size.

If you are feeling well and able to do so, we would love to give you an excuse to make a little something with someone else in mind, or receive something, so here we are, just a zine festival sitting in front of a computer, encouraging you to make things; weird and wonderful things, scruffy things, beautiful things, any things.

SIGN UP HERE

Please note: On 17th March 2020 The New England Journal of Medicine published a study reporting that coronavirus can remain viable on paper and cardboard for up to 24 hours. If you have tested positive for COVID-19, have symptoms, or are living with someone who has symptoms, please opt to receive mail art only, and not send anything until you are feeling better or are beyond the quarantine period (7 or 14 days respectively). All personal details such as postal addresses and contact details will be stored securely / not used for any purposes beyond you receiving something charming, stimulating, or just plain confusing, in the mail. If you have any concerns or questions please contact us at: hello@illustratedbrum.co.uk

Image credits: [1] Leave Me Alone, I Am Sick via Dispatch From LA [2] Zine-Making for Kids by Diane Gilleland [3] John Held Jr. Please Add To and Return To: Mail Art Homage to Ray Johnson, 2015

[writtenbykaichu-a]

14, 16, 18

                          spoonie asks !! –&& not accepting                               🥄❛ @mercenaryrocket​ ❜ wants the inside scoop !

14. Hobbies you don’t spend much time on anymore?

bit of a sensitive subject, but without going too deep into things, they’d be uhh... composing, reading, writing poetry, and playing the (alto, soprano; learning tenor) saxophone.

16. Quote that brings you comfort/peace?

oh. uh. wow. i’m not sure that i really have one. i mean maybe i do but if so nothing comes straight to mind. with that said, i did recently see a tumblr post which expressed that “anything worth doing is worth doing poorly” and that’s had me shook for the past week or so. i’ll leave the link to the post here, because if anyone is intrigued by that idea and needs to hear those words, i don’t wanna botch it.

18. Advice to ableds on interacting with spoonies?

well ‘spoonies’ is a very broad term, so i’m going to narrow my advice down to ‘interacting with people who have chronic pain’. i’ll just bullet-point some advice in no particular order til i burn out i guess?

be in the business of trying to get to know our limitations. like, don’t just “understand them when they come up”. if you learn that something triggers that person’s symptoms, make a point to remember that for the future. if a person struggles with making plans, maybe see if spontaneous outings work better for them. (i find that some people i know with scd for example thrive on planning ahead to prepare their body for the upcoming storm while other people can’t rely on plans at all because of how often they get ill, so they rarely make plans and instead live in the moment.) the better you are at understanding your friend’s limitations, the fewer disappointments you accidentally set yourself up for with them; the better quality of time you can spend together, and plus... they’ll just really appreciate that you cared enough to get to know their illness so intimately.

try to continue to be there for them when they’re sick. for example, i’m in pain every day, and i certainly don’t expect people visiting me daily. but, i do have fairly frequent hospitalizations, and i can’t remember the last time one of my family members outside of my parents or brother came to visit. from my perspective, it feels like they have this view that “i’m just sick again” and because i should be used to it they don’t have to keep coming. and of course they don’t have to, but we never get used to pain and we never just adjust to events like that. obviously you can’t be there every time, but try to be there.

avoid saying things like: ‘i wish i could stay home as much as you do’ / ‘i wish i could have close parking’ / ‘it must be nice to lay around all day’. i think i actually do speak for most home-bound spoonies in general when i say that these things are NOT fun to us and we do NOT take this as a complement or endearing or whatever.

remember that invisible illness is real and it affects people of all ages. most people which chronic pain will also be invisibly ill, and that’s important to bear in mind when you see someone you don’t think should be in that handicap parking space even though they have a placard, or if you see someone use the cart at a store even if they look young. and i’ll admit i myself struggle with this one--particularly when people who “appear” able-bodied seem to be taking up what little space is designated for me. but i remind myself, every time, that someone could think the same of me, and i stay in my lane.

and not that it’s a contest, but try not to compare your pain to ours. even if you mean well, it comes off as either disingenuous, ignorant, patronizing, or some combination of the three when you compare your “really bad backache” to the debilitating pain we experience 24/7. because remember: most chronic patients never medicate down to “no pain”. we just get to medicate to a point of “able to make it through the day”. so trust us, we’re happy to just listen to you talk about your pain independent of your comparison to ours (we can still be sympathetic to common stuff like colds or heck--your broken bones). it’s just... they’re two totally different things, okay?

aaand i just looked up. wow i wrote a novel. we’re stopping here folks but honestly i could keep going lmao.

[satyrdaymornings]

I rarely post anything on this hellsite but I wrote an essay a while a back about why I write urban fantasy

This is not a critique of Tom’s essays but maybe an elaboration on what it means for a Fantasy to be True and it to explore the genre I tend to write and create. Urban Fantasy. I will be exploring my relationship with writing urban fantasy, the realness of characters, the places and the reasons why I choose to write in this genre.

Tom's books were a panacea for me as a young awkward autistic child. I started reading them in around sixth grade. I started with Heartlight, read The Ancient One then The Merlin Effect. By the time I started reading the Lost Years I was also invested in the Legend of Zelda series and even worldbuilding my own fictional world at fourteen and fifteen. It was the late 90s and early Oughts. The use of the internet to share stories and worlds was not available to me at such ready hands as my students have. I was pulled into these stories, lost in Finacyra and in Avalon. I wanted to be part of these worlds. I wanted to escape the bullies, the violent anxiety and chronic suicidal ideation and ride on the wings of Trouble the hawk and befriend Merlin. It was also the first moment I started to unfurl the first feelings of gender dysphoria. It was through the eyes of Merlin and then Tamwyn when I felt stirrings how I wanted to be them. Not join them but to be a boy on a big epic adventure. Sure girls can go on them, but it seems like the male characters had the better ones. At least in my fourteen year old head. But it was also when I started to notice other things too. I couldn't quite relate to the main characters as much as I wanted. I wasn’t like Kate from Barron’s early books and while I liked Merlin, his struggles were not mine. Yes there echoes, I see them now. How Merlin was disconnected by his father was a sympathy I had, as I was disconnected from my own. Barron’s stories were an adventure, an escape-and one that influenced me tremendously. Yet, they did not resonate in me deeply. While the characters were indeed real, none of them shared my problems, and I shared-really, none of theirs.

In 2001, I joined high school with some battlescars. I escaped Catholic school, wounded but determined to try again. I was in public school, my mother hoped here I would find friends and escape the violence of bullying. I did find the former but I did not escape the later. I was still reading Barron, but I also moved to David Clement-Davies for anthropomorphic fiction, I found Orson Scott-Card (before I knew how goddamn nuts he was) I also started discovered around the same time as Barron, Stephen Lawhead who’s rather preachy but deeply complex historical fantasy became a huge influence. I would even go so far as to say, that Lawhead was a huge reason why I am a practicing Druid and a member of a Druid church. It was also when I got my hands on my Terri Winding’s Bordertown and her anthologies. Suddenly I found characters whose eyes I could see through. Homelessness, drug use and addiction, running away, mental illness. These were all things I could wrap my hands on and go yes, that's what I deal with granted no in the same way as the folks in Bordertown can. It was my first taste of Urban Fantasy and I was hooked.

In Barron’s essay he talks about the realness of place. He draws massive influence from his experiences in Pasfic Northwest, Japan, and of course the Rockies. You can see that clearly in the Great Tree of Avalon. The protagonist Tamwyn explores Stoneroot and I can almost see him Stonewood looking just like Great Divide. However, I don’t live with the massive gaze of ancient mountains. Stoneroot, and Waterroot, and Woodroot, are far away to me. I can’t grasp them. But, I got Bordertown. It feels much closer. I could smell both asphalt of Bordertown, hear the police sirens and see both homeless men and elves alike. That seems more real to me. Because I know I’ve been to Bordertown.

I started working on Styx Water in 2013 as my Nanowrimo. It ballooned into this expansive massive story with struggle, love, sex, death, policial intrigue. It was here I crafted the lessons that I was taught from Barron and the myriad of other authors. Fantasy Must Be True-which I agree, yet there is another axis to this. Fantasy Must Be Real. What I mean is that there is a level of grounding I think that is needed at least for my genre. The grounding I found in Bordertown-and it's sister Neverwhere. Was at it's heart-what drove me to write in that genre. Because while I loved high fantasy and the exciting places I did travel. Sometimes I just needed to stay home rather than run from my problems.

Grounding is what gave my character’s substance. Hermes and Calix problems and stories while also fantastic were also rooted in a space that the reader has been in. Hermes’s struggle with mental illness is a road that many have been on. Indigo’s story of being non-binary is one we have heard before, often in different verses but one that is rarely told. While these are all my characters, I am not the only one that is doing neurodiverse and gender variant protagonists. There has been a dearth of stories in YA that have been taking advantage of the characters and stories that are more rooted in the reality of readers. We’re seeing more queer and disabled heroes and I am all here for it. Fantastic stories and grand adventures and powerful lessons were now available for people like me.

The meaning and messages of fantasy are to be true. Barron stated for a reader to be invested and to be deep within the narrative, the meaning must feel true. His messages are flavors of spiritual enlightenment, deep love for nature, and the triumph of light over dark. Powerful soup for a lonely and starve teen. Message of recovery from trauma, finding self-love, accepting loss and grief and the building the skill of asking for help. Themes that are dotted in my own fiction. Hermes' grand adventure of using the power of the River Styx and saving the world, is balanced with his need to take his medication, going to therapy, fighting with his sister and repairing his relationship with his step-dad. There is a sense of gravity urban fantasy has that high (or low for that matter) doesn’t have in my option. The Dresden Files by Jim Butcher is a crime noir with wizards than the elf kids slumming in Bordertown. It's gravity of relationships and real world problems are often eclipsed by the metaphysical and paranormal ones. Who cares about making rent when the Queen of Summer is after your butt? The flow of Big Problems (like saving the world and supernatural events) and Small Problems (Finishing homework, dealing with a new baby, finalizing a divorce) are a careful balance of realness and adventure. Big Problems show grand truths like ‘love can heal’ and ‘friendship is powerful’. Small Problems show smaller more intimate truths, “Compromise to succeed,” “It's okay to be mad,” and “you can be yourself.” Big Problems can certainly showcase those truths, but Small Problems do it in a more concentrated way. Loneliness on a small scale, small lense, feels more real. We can sit with the protagonist in his lonely moments. We can have this intimate space with them.

And perhaps that is why I write urban fantasy. The intimate Small Problems makes my writing True. It's easier to blend the slice-of-life Small Problems with the Big Problems of a massive epic in a place that we all know. The Small Problems make the story Real, in a way that larger massive narratives lack. I want to know the Small Problems. Does Merlin ever feel uncomfortable in his body while he goes through puberty? Tamwyn has to work with a splitting headache? Has Kate ever been in detention? Do any of the characters struggle with finding the difference between love and sexual lust, a common problem for many teens? Small Problems are not distractions, they are extra bits of garlic or chili flake in a dish. Knowing our grand heroes also have real human problems makes them grounded and tangible.

This is not a novel concept, many great authors have blended real issues that teens face with the hypercosmic problems of a greater narrative. Rick Riordan and Neil Schusterman both do a fantastic job in writing teenagers. Liba Bray and Nancy Farmer give us flesh out rounded characters with both Big and Small problems. I love writing the Small Problems. I love spending quality intimate time with my characters. I like over hearing lunchroom rumors and crude humor. I love the secret confessions made in the still mornings of a weekend. The passing of a bowl of weed or a bottle of beer behind the backs of the adults. I also love the intimate moments of my growns too. Kalliope (Hermes’ mom) paging through old photos of years gone by. Conversations spoke in Greek to her mother in law. Finishing a deadline and celebrating with wine. Love making on a warm Saturday morning. Those moments are sharp tang or the gush of sweet in a bite that makes the meal more rich and more enjoyable. And writing those moments adds a sense of Real to the big narrative of saving the world.

Barron’s statement about what makes fantasy True is the same as what makes fantasy Real. Readers need to believe in the places and feel the wholeness of the characters and the messages in the story, but also the characters need to feel the realness of the reader. They are not absent from the story. Readers should be more than passive voyeurs. They should be on their quest too and their problems, as Small as they are, should not less but the same as the Big ones and just as True and Real.

Kramer.

[robertjohnsonpatterson]

Best Wishes :

The Unsheltered Should Be a Protected Class

October 23, 2020

Dear Mr Joseph Robinette Biden, 47th Vice-President of the United States:

My name is Robert Patterson. I was born a Yankee (upstate), but raised in Richmond, Virginia, which makes us sorta neighbors, or it used to at least. We are both from the underwhelming but reliable Mid-Atlantic. It's a nice part of the country, as you well know. The autumns are as lovely as the winters are mild. I tried college in Austin in the 90s, but found only lifelong friends and the world's largest dormitory. I returned to Virginia only to leave again in 2008, to seek my special purpose, you might say. I traveled west and gigged seasonally at National Park lodges; I crossed the Great Basin in a friend's Chevrolet (a word that I think must mean 'chariot' in some future pidgin). I moved to San Francisco, but had not strong supports, which is a glaring deficiency in a city that wobbles. I left SF by the skin of my roommates' teeth and I wound my way up the coast and in to the evergreen and alwaysmist of the Pacific Northwest.

I became homeless in Portland in 2014, and that period, my time on the Street, has changed me more than any event of my adulthood. More than my two and a half years locked up, more than my marriage/divorce, and more than my semi-successful run for Eugene mayor this past year. My homelessness informs my unstudied brand of democratic socialism; it teaches me (in fits and starts) the meaning of respect, consent, and consensus; and it even reacquaints me with a pranking and peaceful God who smiles like Walter Matthau coaching the Bad News Bears.

My time on the Street also led me to Transition Projects in Portland's historic Old Town Chinatown. I used their very crowded, but very efficient mailroom services and that is where I first thought critically about the Census. I was lucky that winter to be placed by Transition Projects in the Walnut Park shelter where I had time to catch my breath and to save my life. I thank God for Transition Projects.

The memory of that mailroom is stuck to me as is the conclusion that I drew about the Census, that in order for the Constitution to work, there must be accessible, secure, and free mailboxes for the unsheltered. Let me repeat that: without such mailboxes, the pact that binds us to the idea of government of, by, and for the people is a faulty pact indeed.

You, sir, may know better than most of the increasing trend toward voting by mail. Perhaps you also know of the barriers that often stand between the unsheltered and a mailbox. In many American places, the unsheltered are even kept from registering to vote by workers poorly trained or just plain prejudiced.

The Census calibrates the American economy, just as some 1g button of pure platinum in a Swiss vault calibrates the world's scales and just as some nugget of plutonium buried beneath Greenwich decays steadily and sets our clocks. So does the Census tell us where to build the rural clinic for women, how many free lunches our schools will need, and where to pre-position the medicine we pray will keep off the next flu. Now the Census is in many ways the most remarkable thing our nation regularly accomplishes (outside of war), and the US Census Bureau is staffed by competent and creative thinkers. But every decade, every goshdarn time that the Census comes a-counting the unsheltered are among the most undercounted. It is true.

One need not be a fancy Harvard lawyer to see then that there are two classes of voters and two kinds of citizenry: those for whom voting is most convenient and those for whom voting is anything but.

There are those who are represented and those who are uncounted.

The unsheltered should be a protected class.

Unfairness in representation is just one example of the discrimination suffered by the unsheltered. We may also look at employment, or at that flirty first date of employment: the job application. There are movements around the country to ban the address box from job applications because studies have shown that by leaving that box blank (and thus indicating one's homelessness) an applicant significantly lowers their chances of being hired, all other things being equitable.

There is also widespread housing discrimination against the poor and unsheltered. Less than two years ago, Los Angeles' City Council chose unamimously to prohibit Section 8 rental discrimination, and other cities will hopefully follow, but doesn't it harken back to times we had wished were in the past. Hadn't we hoped that blockbusting, redlining, and the insidious other tools used by haters had been exorcized along with the ghost spirit of old Jim Crow.

The unsheltered damn well oughta be a protected class.

And at the hospital, more discrimination is found. We unsheltered suffer disproportionately from HIV/AIDS, mental illness, drug and alcohol abuse, and many more chronic and debilitating illnesses, not to mention the cold vulnerability to COVID - 19 faced by the unsheltered. We are also more likely to be malnourished and to lack access to basic health care. We die younger and are sick more often.

There is no bus stop for many of us, for even though access to transportation is a lifeline for the unsheltered, the high expense, poor reliability, and overall inadequacy of bus and train routes rob the unsheltered of many of the benefits of public transportation that others take for granted.

At the bank we're bounced before a check is even signed. Without an address, lines of credit are cut and service comes with a frown. Our schools too often fail the test of fairness. Homeless students face challenges that are often poorly understood by their teachers, their administrators, or their peers. Still though many succeed, future leaders no doubt.

And at our parks and on our sidewalks, there is little relief. A pernicious national trend toward the criminalization of homelessness exists. Police are frequently called in to 'sweep' areas where the unsheltered congregate and live. These sweeps inflict unnecessary trauma on innocent people and they result in confiscated property, detainment, and arrest. Some cities have enacted 'sit/lie' ordinances that restrict one's freedom of assembly and panhandling laws that restrict one's freedom of expression.

The unsheltered should please be a protected class.

This discrimination creates a permanent underclass, and where the unsheltered intersect with other marginalized groups, the prejudice grows more raw. The homeless are disproportionately female, disproportionately LGBTQ, and disproportionately physically and mentally disabled. We are more likely to be people of color, to be veterans, and to have been formerly convicted. We are more likely to be elderly and more likely to be young.

The unsheltered should now be a protected class.

You must orient your compass toward that goal from your first day in office, and your fast action will save lives. The difference in health outcomes, after all, is real and it is startling. Housing is understood by researchers to be one of the strongest social determinists of health. The housed live longer, happier, and healthier lives.

The thing I fear most, sir, is a car skidding on a patch of ice and careening through a sidewalk camp, crushing sleeping people under its wheels. Accidental death will take many homeless lives this winter. It is difficult to be exact as many police and public health departments fail to keep accurate records regarding homeless death, but we know that many will die. Crushed under cars, frozen in their camps, asphyxiated by their heat source, or poisoned by their inadequate and deadly rations.

Many more will be victims of violence. Domestic violence is far too common and much too unreported in homeless communities, and though the mind struggles to understand, there is a troubling trend of intentional violence against the poor. These acts are often not recognized for what they are: hate crimes.

Clearly, sir, the unsheltered must be a protected class if we are to climb out of this damn muck!

But you already know this, don't you, sir? You've known this for decades. You've known nearly all your life that comprehensive action by all levels of government is necessary in order to make our union safer for the poor to be, in order to level the field, in order to right society's path.

It is a truth sadly learned during winter holiday by children walking with their parents in the city.

It's a beggar surrounded by bitcoin billionaires.

It's an old matron sleeping on cold cobblestone.

It is a truth known to you in your youth, I bet, because of the values instilled deep in you by your folks, your God, and the good and great leaders that you grew up to revere.

We know certain truths to be self-evident. They are coded into our very DNA. Some truths call us to our special purpose: the inherit equality of all, the need for an active and compassionate government, and the dividend paid by hard work and mutual sacrifice.

Some truths are bittersweet, but still part of our national collective memory: the injustice of genocide, the horror of slavery, and the slow cook of our negligent stewardship of the earth.

We know deeply, intimately, and regrettably that life is unfair and that, though shelter is certainly a human right, we are far from achieving that goal.

I believe, however, that until that goal is reached, we can reduce the dangers of the Street, the deadly and beautiful Street, the Great American Street.

I know that you believe also. You believe because you have a mighty heart, because you have a soul of power.

I thank God for your heart, sir. I rejoice for your soul. There is a nation of proud, capable, but picked-on poor people. We are counting on your heart. We need with great desperation all the love your good soul can muster.

One can mark our national time by the expansion of liberty to those who clamor for it. Suffrage and emancipation. The many labor movements (and another one is coming soon). The civil rights movement that continues in Oregon squares and Minnesota mosques as I type and as you read! The proud movements that demand dignity for folks regardless of how their orientation or attraction. The movement to give greater agency and responsibility to our youth. The movement to decarcerate our jails and to restore our communities. The movement to end the suffering of other life forms and intelligences.The movement to save our planet.

I also champion a great movement: the movement to rebuild our cities, to pass the stone to a new generation, to win back some dignity for the poor. Join me in this movement, Mr Vice President, and see how we win!

If you ask around some corners in this great state of mine, they'll tell you that I can't fight worth a nickel or love worth a dime.

Like hell, I can't! I fight for the poor, and I love to fight for the poor! So do you, sir, and that's why I'm a Joseph Biden guy. That's why I'm a Kamala Harris guy. And a Jeff Merkley guy! And a Pete DeFazio guy! And an Ellen Rosenblum guy! And a Shemia Fagan guy! That's why I'm a fighter! That's why I'm a Democrat!

I'd rather sleep in a house built for dogs than party in a mansion made of stolen gold. I'd rather drink a warm Ranier in an emerald alley than sip cognac at some banker's beach. I'd rather be cursed by truth than sold a lie.

Thank God for the truth! Thank God for Joe Biden! May God bless Oregon! May God bless America! And may God bless the work we have cut out for us!

Best wishes,

Robert Johnson Patterson

©2020, Robert Patterson, All Rights Reserved

[boethiah]

(on the topic of dissociation and chronic pain by ymirjotunn, please ask before following syr if you’re so inclined.) 

hi! im friends w khoshekh and she pointed me towards yr post about dissociation and pain b/c she knows i’m dissociation and pain central… i do have some info so i thought id share, and since ur looking just for General Experiences it might be a bit of an infodump? i hope thats ok! (sorry in advance it turned out kinda long and idk how comprehensible it is)

from lots of personal experience, Yes its Very Very related. i have a genetic disorder (ehlers danlos syndrome) that causes frequent dislocation of joints, which means a lot of pain; i also have fibromyalgia which tumblr user namira mentioned in the notes! ive had problems with dissociation since i was very small, and had a period of uhhh…~14 yrs of dissociative amnesia, & i still have really severe dissociation issues now

this is Kind of a silly post but i think its got useful vocabulary when talking about dsc… “lawful neutral” is the kind i struggle with the most, and the kind that caused my dissociative amnesia. genuinely “being on autopilot” is the best way to describe it, and most chronically ill folks i know are at least Somewhat familiar with it, if not intimate - it’s a survival mechanism, it helps make sure we can keep doing what we need to do in order to live even if we can’t process things, or if we physically can’t do something that we need to do anyway. (that’s not always a good idea, but…you gotta do what you gotta do??)

“lawful negative” is pretty common with flares that aren���t earth-shattering / hospital-threatening (so when the pain is bad, but not that bad) - partly because when your entire body is in pain, it’s almost impossible to actually Do anything, so everything’s really boring and pointless, so…things get weird. this one’s my least favorite, b/c most dissociation is pretty “easy” (since you don’t really have to do much) but this one is just 100% shit and also very frustrating.

“neutral negative” is similar to the above, but typically comes when things are so shitty and so frustrating that everything feels hopeless and you wanna die but you can’t actually do anything b/c your body doesn’t work so you just kinda consider it, but it’s…detached

“chaotic negative” is definitely more associated with mental health, but for me, my chronic pain is Intimately tied with my brain garbage, including my schizophrenia, so it’s worth talking about in the context of pain&dsc, i think

specifically because after enough weird shit happens in your body, after you’ve lived long enough with pain that would be utterly devastating to other people (and is to you but also you’re still doing this somehow???) things get REALLY fuckin surreal… it’s just Weird and Scary and Unreal but it’s still happening and fucked up. it’s really hard to describe this lmao uh

there’s pain literally all the time, and after a while you get…somewhat tuned to it, but not used to it. you can’t adapt to it, you can’t not feel it. it’s just kind of There, and it’s…maybe i’d describe it as constantly surreal? i can’t imagine any part of me not being in constant pain, to the point that i can’t really comprehend that other people aren’t, but at the same time it’s a sense of feeling Not Quite Right, disjointed, almost like my body itself is glitching? pretty much all of those feelings are dissociation in some form…its fuck its weird

during really really bad flares of pain, i almost always slip into a dissociative episode, but its a particular kind - the best way i can think to describe it is pushing my consciousness away from my body, to try and distance myself from what feels like unbearable pain as much as possible. it’s kind of like acting, but you’re acting so hard that you can believe “oh yeah okay, it doesn’t hurt That much, i can ignore it” even if you’re at a medical 10 on the pain scale, yknow. usually this ends up as “true neutral” because i end up making more concrete efforts to stay positive through it.

but! im also a medical sociologist so i can give you some academic stuff as well! dissociation is, at its core, the body’s reaction to intense (and potentially otherwise unbearable) stress, which definitely includes pain, especially when prolonged.

(if you’re specifically talking about untreated pain, there’s also the frustration of not being taken seriously, not being given what you need, not knowing what’s going on, etc - that’s also really really severe stress. some of my worst dissociation happened in the 4 years i sought but could not receive an accurate diagnosis.)

this is a forum of chronic pain folx talking about dsc, just personal experience - it might be helpful to you.

this is like one of the only relevant studies that exists, maybe u already saw it?? given the combo of personal experiences & these tentative results it’s pretty much certain that there is a Definite Scientific Link b/w dsc and chronic pain, but they need to do a lot more experimentation to have decent data. theres also this one which is pretty good

this is a bunch of academic gobbledygook and i dont have the spoons to tear thru it but on the surface it looks like it has some decent info

this is a really really good description of “body maps” and how certain points on those maps can come undone thru stressful experience & cause dsc. it’s a good way to conceptualize the connection. relevant quote: “The pain experience gets divorced from what is happening in the tissues.” it becomes more of an emotional / psychological experience than a physical one, even if it really is rooted in physical issues.

(i personally always described my pain as “a sick feeling” - like severe and painful nausea, except instead of my stomach, it was inside my bones and muscles. nobody understood what i meant, and it was really frustrating to try and explain! overall it’s a really surreal and emotional and disjointed experience.)

i also want to point out that a ton of “dealing with chronic pain” techniques are straight up dissociation. many of us develop these strategies independently & naturally, just because dissociating is one of the only ways to deal with severe & constant & chronic pain

ANYWAY…sorry this was so long and kinda out of the blue!! i hope it gave you some insight, i wish i couldve described some experiences better lmao… feel free to ask me if you have any questions, id be happy to answer!

[accountabilityformargaretj-blog]

Testimony #1: “As long as Margaret Jacobson and their fiancé Noah is in a space, I do not feel safe.”

TW: for r*pe, sexual assault, non-consent

For more than a year, I’ve been quietly telling my local friends and chosen family about a person I do not feel safe around in our community since I found out some very disturbing and disconcerting information about them. I haven’t wanted to do a callout post because this person has A LOT of social capital, a lot of mutual friends and I didn’t want to start any trouble. But last week, after I had warned another friend about this unsafe person’s previous behaviour, this person sent me a text message that left me feeling like I was being intimidated. They told me I didn’t have my facts straight, that I was perpetuating gossip. But what was more troubling to me was that they gaslit me and called into question my own trauma that I’ve experienced at the hands of them and their partner. They made me feel invalidated. They made me feel crazy. They made me feel like I needed to keep my mouth shut.

I’ve been steering as clear as I can from this person for the last year, which has been extremely difficult—not just because they are literally *everywhere* but because we have a lot of mutual friends. But getting this text from them (after I’ve told them that I don’t want them to contact me) felt like a violation, and it’s in been on my spirit for the last few days to speak the truth of my experience.

The person that I do not feel safe around is Margaret Jacobsen and their fiance Noah.

Here is what I know:

I know that Noah (Margaret’s fiance) raped someone within the last couple years (I honestly don’t have an accurate date because I’ve heard multiple stories) and not a lot of people know this, despite Margaret insisting that they have been disclosing this to people. Margaret wasn’t even the one who told me about Noah raping someone. I found out through another person in the community who was told directly by Margaret and was very shaken up by it. After hearing this, I was deeply disturbed because I had shared intimate spaces with both Noah and Margaret recently. They had both seen me naked numerous times and I had even shared a bed with them at one point, so I felt extremely violated. I am also a sexual abuse survivor so I was very angry that I found this out this way and not from Margaret directly.

A couple days later, I confronted Margaret with what I knew at the time (they told me they had been meaning to reach out to me about this) and I told them that because of this I didn’t want to have anything to do with either of them because I did not feel safe around them. At the time of this conversation, Margaret had told me they were taking some space away from Noah for their own safety. A few days after this exchange, I saw both Margaret and Noah together at an event I was at and had the first panic attack I’ve had in years.

I found out a little later that Noah was/is going through an accountability process (which I admit that I know nothing about) but I do know that shortly after it was found out about Noah raping someone, he was still invited by Margaret into safe spaces amongst women and femmes, many of whom did not (and still do not) know his status. Noah is also still doing social justice work and organizing in the city without Margaret disclosing his past publicly.

Recently, I heard from a trusted source that Margaret was kicked out of a private callout Facebook community of sexual assault survivors this year after Margaret violated a major confidentiality rule by sharing information about the callout with Max Steele, the well-known rapist who was named. Margaret sharing this information undoubtedly harmed and put many other survivors at risk. Shortly after Margaret was kicked out, Margaret went on a podcast with Max critiquing callout culture. I know that Margaret is also a survivor, but they have upheld and protected a well-known rapist, which makes me feel like they cannot be trusted.

Other ways that I’ve been made uncomfortable by Margaret:

- Being sent explicit photos by Margaret of sexual acts they were engaged in with their partners without my consent

- Being sent explicit photos by Margaret of group sex they were participating in without my consent (or the consent of the parties involved in the group sex)

- Being given unsolicited information about private sexual experiences they’ve had with another friend that I’m certain this friend did not want to be disclosed

Margaret Jacobson has a lot of social capital and currency in our community which makes calling out their problematic behaviour tricky and terrifying for me. It also makes navigating the close-knit POC community here very challenging because I do not feel safe around Margaret or Noah, and since I’ve been blocked by Margaret on Facebook I have no way of knowing if one or both of them will be at an event that I am planning on going to, which causes me a lot of anxiety.

As long as Margaret Jacobson and their fiance Noah is in a space, I do not feel safe.

Margaret Jacobsen has a responsibility to the safety of their friends and community that they have been disregarding to the detriment of everyone around them. Margaret has contributed a lot to our communities and is a survivor themselves. I understand that Margaret has their own healing to do. Unfortunately, survivors too can perpetuate harm and abusive behaviour, and Margaret has done so for the last year. Just because someone is a victim doesn’t mean they’re exempt from critique and the consequences of their actions. Nobody deserves a pass on putting people at risk, including Margaret. This isn’t about Margaret, this is about unacceptable behaviour.

I am sharing all of this because I want to keep my own community safe. I’m sharing this because I don’t think most of you know all of this information because Margaret is not disclosing or being transparent with all of you. I’m sharing all of this so that you know that if you are a friend of Margaret Jacobson and you are not holding them accountable, you are being complicit in their problematic, unsafe behaviour.

Here’s what I need from you:

- I need your support and protection as I continue to navigate our very small POC community here in Portland as Margaret continues to organize and take up space (this can look like letting me know if/when Margaret will be at an event that I am RSVP’d to or interested in).

- If you are associated (or will continue to be associated after reading this) with Margaret and Noah in any way (professionally, personally)—no hard feelings. I just need to know so I can mute you on Facebook because seeing their faces and names is very triggering for me right now.

- I need you to believe me. I have been dealing with this in isolation and some of the folks I’ve told have made me feel dismissed. (And if you don’t believe me, that’s fine. Just please unfollow me.)

- If social justice and accountability processes are your thing, I need you to step up to the plate and make this happen with Margaret and Noah sooner rather than later.

As for the accountability process with Margaret, I don’t know what that is going to look like because I am not well-versed in this. But because of my current feelings about them and their fiance, I feel nervous about being a part of that process. I am however in full support of some kind of accountability process happening and I hope that with this testimony, it’ll help put some motion in action for proper healing. In time, I would be willing to join in the efforts in the accountability process with Margaret, but right now this feels too raw for me.

I do feel like I need to say this: I don’t think Margaret is a bad person, sincerely. I have no ill will toward Margaret and this is not meant to be an attack on them. I just want their problematic behaviour to be addressed and critiqued and for my friends and chosen family to be safe. (I should also note that because I am blocked by them on Facebook, Margaret cannot see this post but I have no illusions that this might be shared with them anyway.)

I totally understand that this is A LOT and get that you might have a hard time processing all of this information, and I apologize for putting this on you today. Again, I’ve been living with this for the last year and had been managing OK, but with the recent contact I’ve received from Margaret, I’ve had a hard time feeling safe and functioning on a high level. This is me trying to put the pieces back together and find some kind of closure on an issue that has been chronically inflamed for me for the last year.

Thank you for listening.

[brentrogers]

Podcast: Is There a Link Between Physical and Mental Health?

What does physical pain have to do with depression, and vice versa? On today’s Psych Central Podcast, our guest, Dr. Jack Stern, a board-certified neurosurgeon specializing in spinal surgery, explains the psychology of pain and how the two are inextricably linked. Dr. Stern describes how pain can lead to depression and how depression can intensify physical pain.

We also find out why opioids don’t work for chronic pain, and how past pain affects current pain. Join us for an in-depth discussion on physical pain and mental health.

SUBSCRIBE & REVIEW

Guest information for ‘Dr. Jack Stern- Chronic Pain’ Podcast Episode

Jack Stern, M.D., Ph.D., is the author of Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. He is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York. For more information, please visit https://drjackstern.com/

    About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Dr. Jack Stern- Chronic Pain’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Jack Stern, MD, PhD, who is the author of Ending Back Pain: Five Powerful Steps to Diagnose, Understand and Treat Your Ailing Back. He is a board certified neurosurgeon specializing in spinal surgery and co-founder of Spine Options, one of America’s first facilities committing to non-surgical care of back and neck pain. Dr. Stern, welcome to the show.

Dr. Jack Stern: Thank you.

Gabe Howard: Well, I’m really glad to have you, and I’m really excited. But before we get started, our longtime listeners are thinking, wait, you know, back pain, an expert in spinal surgery, spine options, neck. What does this have to do with mental health? Dr. Stern, what does this have to do with mental health?

Dr. Jack Stern: Probably a very appropriate question. All of us have been in pain at some point or another, stub your toe, hurt your back. Break a leg. And you know that it’s not just the pain that bothers you, but a variety of other emotions play a role, upset, sadness, depression. It runs the gamut. I get depressed when I have a cold and I can’t work. I just get so upset with myself that I got things to do and I can’t do them. And that’s just from having a cold. Could you imagine if I had something really the matter with me? Thank God. How I would feel. And that’s what I experience in my patients who come to me with rather significant issues related to their spine. And because without dealing with the emotional aspect, the psychological aspects of pain, you really cannot treat pain.

Gabe Howard: Dr. Stern, it sounds like you really think that mental health and physical health shouldn’t be separate. I’ve often said I don’t understand. Whose bright idea it was to decide that these were two separate things, since it’s all one person. Is that how you feel? Am I. Am I putting words in your mouth or have I nailed it?

Dr. Jack Stern: I think that’s absolutely right. Actually, I think that the concept of separating the two. I think that concept is really going away. I think most physicians and I mean probably even your internist. At least my internist, who is not a youngster, always asks me, well, Jack, how are things going? And he doesn’t mean, am I still on the treadmill and do I have intestinal problems? He’s asking me, how are things going? Emotionally. Are you feeling well emotionally? Are you sleeping well? How is your relationship with your children and with your job? And what kind of feelings does that bring up for you? So I think anyone who separates the physical and the emotional I think has missed the boat. And it’s clear, as someone who’s taught in medical schools for 30 years that we no longer make that distinction. Thank goodness. So I think that’s an old concept. And I feel that the two are intimately connected and can’t be separated, at least not easily.

Gabe Howard: That is wonderful news. Let’s move on to your book and your area of expertise. And my first question is, what is the anatomy of pain? Can you talk about that a little bit? I was trying to read about it and learn about it. And I have to admit, it was it was well over my head. But it was also fascinating because all of us have been in pain at some point. Like you said, whether it’s stubbing AHTO or, of course, something as serious as a spinal injury.

Dr. Jack Stern: So there are actually without and I don’t want to get too technical. There are actually two ways that the periphery. That means your body tells your brain that you’re having pain. And there are actually two separate pathways. If you think of the spinal cord as a big cable that connects to the central relay station, which is your brain, they’re actually separate cables for two types of pain. And once I describe it, you’ll probably recognize it. The first type of pain is what we call acute pain. That’s the pain where someone breaks their leg or stubs their toe. Where you go, oh, oh, wow. You really feel acute pain. But there’s also a separate pathway, a separate group of fibers that go up to a relay station. Your brain that are actually there in terms of evolution are actually there before the sharp pain. And those fibers, that pathway sends messages of what we call deep, gnawing pain. It’s like, oh, I got something in my belly. Just feels, you know, it’s, it’s just uncomfortable. It’s or my back just, it’s not killing me. It’s not like I can’t walk, but it hurts all the time. It’s that deep gnawing pain. So those two pathways exist in the body that has a lot of importance, both psychologically and physically, because the two pathways have a different what we call neurotransmitters, and those are the chemicals that send the messages to the brain.

Dr. Jack Stern: So, for example, if someone has that deep gnawing pain and you give them an opiate, they probably will not respond because those pathways don’t recognize opiates, whereas the pathways that transmit messages of acute pain do have what we call opiate receptors and they are effective. So if you break a leg and the doctor gives you one of the narcotic analgesics, it will be effective. But usually not if you have chronic low back pain. And fortunately, part of the and I’ll just digress here a minute. Part of the opiate epidemic is because opiates have been giving for conditions that deal with chronic pain, not the acute pain that responds. So the anatomical pathways are complex. But the important point here is that there are two separate pathways, one for acute pain and one for chronic pain. And certainly the greatest psychological issues arise when patients are in chronic pain. Someone who comes into my office and says I’ve had back pain for six weeks, eight weeks a year, and it doesn’t get any better. And those are the folks that really suffer psychologically.

Gabe Howard: It sounds like what you’re describing should work the same for everybody, but we all know that it doesn’t work the same for everybody. And part of that is, is our psychological response. I think of me and my brother when my brother gets hurt, he’s like supercharges. He’s like, yeah. Feel the burn. When I get hurt, I’m in a corner, almost traumatized. And I’m not really exaggerating. I just have a very low pain tolerance. What is the psychological response to pain on the human body and why does it differ from person to person?

Dr. Jack Stern: I think that to answer that, we could break it up into two parts. One, there are real reasons, intrinsic or innate to your anatomy, where you have more receptors that sense pain and send more pain messages to your brain, and therefore your brother will feel the pain less and you will feel the pain more because you have more receptors. And we see that all the time. You hurt your toe, stub your finger and the other person stubs theirs and they’ll feel it because you have more receptors than they do. But from a psychological point of view, there’s clearly an indication that I’m wondering whether you had an experience once where you were in pain and it could have been when you were very young. And that memory is embedded in your brain. And that memory of that pain, even when we were very young, now raises its awareness and subconsciously your body says, oh, I had that sense of pain so long ago. I don’t want to endure that pain again. I don’t want to experience that pain again. So subconsciously, reliving that experience is something that I think that we all do. And how that experience, previous experience impacted what we’re doing now reflects on how we’re going to relate to the pain psychologically. Does that answer your question?

Gabe Howard: It does. It makes perfect sense. As much as it makes perfect sense from my standpoint, and that kind of leads me to my next question. From your standpoint, you need actual data. So you need to measure pain. But the only thing that I’ve ever seen that measures pain is that, you know, smiley face all the way to a sad face chart that nurses have handed me. And that seems rather ridiculous because as you pointed out, pain is different for everybody. Pain is very personal and there’s a psychological point to pain. I guess my actual question then is, can pain actually be measured?

Dr. Jack Stern: It can be measured, but it’s much too difficult to measure it on a regular basis. So what we do in the hospital is use this device of the smiley face to the frowning face to give us some indication of where the patient’s pain is. But as I think you were alluding to, it doesn’t give us an indication of what the psychological parameters are that are involved in that patient’s pain. I’ll give you an example. A woman can have a very difficult delivery and it could be painful. And this has been shown. This is not me guessing. And then they, maybe a few hours later, and because she had this very healthy baby, they almost always have a smiley face. And the idea that they were in pain during the labor seems to be suppressed. So what I’m saying is that there’s a real complexity to how you experience pain. And some of it has to do with your previous experience with pain.

Gabe Howard: It’s interesting that you say that some of it has to do with your previous experience of pain, because it sounds to me like if you have something really traumatic, let’s go with the broken leg. So I break my leg. Now I’m all 100 percent fine. It’s now a couple of years later and something lesser happens.

Dr. Jack Stern: Yeah.

Gabe Howard: You bang into a table and of course, that hurts. You know, banging your shin into a table is a painful thing. Are you saying that because of the pain that I experienced with the broken leg, that that’s going to psychologically influence the pain I experience in the lesser banging my shin?

Dr. Jack Stern: Invariably. Invariably, because there’s gonna be a fear factor, there’s gonna be an avoidance factor. There’s gonna be a memory of the previous pain. There’s gonna be a wish that this second injury isn’t severe. All those things come into play. I’d also point out that where you are psychologically, when you have either the first or especially the second injury in this case will affect your reaction to the pain. It’s clear that individuals who are depressed will experience the pain or relate that the pain is more severe than someone who is not depressed. And that goes across pretty much across the board. And you’ve seen you’ve probably met someone who’s depressed and the slightest thing bothers them. And they say, oh, that hurts. Oh, that. Oh, my. Oh, there’s this hurts, oh, that hurts. It’s because depression really magnifies. And that’s a great example of how the psychological affects the physical. For example, there was a really good study that showed that a significant number of men and women who have chronic pain, that is pain that lasts longer than it normally should for the same type of accident. A significant percentage of those individuals at some point in their lives were abused physically or emotionally abused. And the pain then evokes that previous abuse. We also know that pain frequently provides the individual with secondary gain. Sweetheart, my back hurts, so could you take out the garbage? Whereas, you know, you probably take out the garbage, but the individual is using it for secondary gain, for not doing what what’s been asked of them. And I see that all the time when it comes to intimacy, where couples one member does you know, I really can’t participate in any intimate activity because my back hurts. So it has tremendous, tremendous psychological overlay in any type of pain we talk about, particularly if the pain lasts for any length of time.

Gabe Howard: Stick around. We’ll be right back after these messages from our sponsors.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing the psychological effects of pain with Dr. Jack Stern. One of the things that this is kind of reminding me of is I suffer from anxiety disorder and I’ve had panic attacks and panic attacks are they’re awful. And anyone who’s suffered from one can agree with it. But one of the things that I noticed is my fear of having another panic attack was very limiting to me. There were places that I wouldn’t go, things that I wouldn’t do. And I had to work all that in therapy. It sounds like pain sort of follows the same kind of thing. Right. I’m so afraid of it hurting or being hurt that I’m skipping out on things. In your example, you said, you know, intimate activity with your partner because you’re afraid that it might hurt your back. Is that analogous?

Dr. Jack Stern: I think so, I think. Absolutely. I mean, you’re not having a panic attack, but you’re concerned that you may have a panic attack. So there’s an aversion reaction that may or may not be real and it may not be real at all because you may be able to do that whatever it is, without getting a panic attack. So I may be a patient who has low back pain, and I don’t want to maybe intelligently don’t want to live that, even though I probably could, because I may injure myself and recreate my back pain. But as I said, there’s some folks who use that psychologically. They probably could lift it but don’t want to because they just want to be nice that day. So once again, the variability is significant.

Gabe Howard: Staying with a panic attack analogy, the way that I got over it is by going to therapy. I spoke with my therapist. I shared my fears about having a panic attack. We worked on coping skills. We talked about why I was afraid of it. Is that the same treatment for folks who concerned about re-injury or pain, who are avoiding pleasurable activities in life because they’re afraid of re-injury or experiencing pain?

Dr. Jack Stern: I think that is a near perfect analogy. Yes. And, of course, I’m not I’m not a therapist. So for me, when I see a patient who has that fear of pain, fear of surgery, first of all, I won’t operate on someone like that. And number two, I will almost always ask the individual to get therapy and refer them to a therapist who specializes. And we have several such in this community who specialize in pain issues. And they will use a variety of techniques to help the individual deal with the pain. And as in your case, it sounds like a find out what the original pain episode was or panic episode was so they can deal with that initial episode and then try to prevent it from stymieing their activities again. So, yes, I think your analogy is a very good one.

Gabe Howard: Dr. Stern, I really appreciate you connecting mental health and physical health, and I’m very glad to hear that things are changing in the way that medicine is practiced. Because I’m only 43 years old. In the grand scheme, I’m not that old. But I remember in the 80s being afraid of surgery and just being told, you know, buck up, it’s not going to be so bad. Don’t you trust the doctors? It’s going to be okay. And then after the surgery, even though, you know, it was scary, it was just scary. People were like, well, the worst is over. I would always hear that phrase, well, the worst is over. This is the worst it’s going to be. You’ll be fine. It wasn’t until I had a mental health problem and I started treating both that I realized that there’s just so much interplay between our emotions about, in this case, pain and the actual pain and treating. Both is our fastest way to wellness. So, kudos,

Dr. Jack Stern: Yeah,

Gabe Howard: I love

Dr. Jack Stern: Yeah.

Gabe Howard: What you’re talking about here.

Dr. Jack Stern: Yeah, absolutely. I don’t know how you can separate it out, and once again, I relate to my own experiences about the whole world seems dark to me if one of my kids isn’t doing well. And everything, every negative aspect of my life suddenly seems to be amplified. And that’s both physical and mental. There’s also a phenomenon that I think is overlooked many times, and that is individuals who have pain, particularly chronic pain. Let me say two things. One, they for whatever reason, whether it’s actually physical or emotional, can function at the level that they could function before the onset of the pain. And I believe that many such individuals and I think this is also part of regular aging, we mourn for lost body parts. So we’re still alive, but we realize that we are not who we were because part of us and I don’t mean to be too dramatic here, but part of us has died. We can’t do that anymore. And we mourn the fact that we can’t do that. And I think that has significant psychological overlay, depression, maybe anger, et cetera. And I see that all the time in individuals. And I see it in myself in terms of I just came from the gym and I realized every time I go to the gym that I can’t do things that I did 10 and 20 years ago. And it really upsets me. And I’m a little depressed about it. And I see these young folks and I wish I were could do that again. But so that’s one. And that’s the loss of body parts.

Dr. Jack Stern: Number two, the big elephant in the room with patients or individuals who have chronic pain is the psychological effect it has on everyone else in their lives, how it affects their spouses, how it affects their children. Oh, Daddy, can’t you play with me? No, my back hurts. You know, my daddy never plays ball with me because his back always hurts. Everybody else’s daddy was always out there playing with them. So imagine the impact that that has on the child, not even on the individual who had the back pain. So this can be in a familial sense and a family could have tremendous psychological impact, senses of rejection, senses of less worthiness, a sense of anger that my dad was never there for me when he when everybody else’s dad was there. So these are the things we don’t talk about. These are the things that get swept under the rug until someone decides, you know, I’m going to have to deal with my pain. And what the impact of my pain had psychologically on those around me and frequently how the others, spouses, children, fellow employees, but mostly family members eventually go into therapy and say, why am I so upset with my father? I understand why he was never there for me. He was always complaining of back pain or it’s the same as if my dad wasn’t there because he was always working. But this is a cloud that hangs over families when there’s an individual who has back pain. It’s what I call the psychological unspoken of psychological cloud of back pain.

Gabe Howard: And Dr. Stern, you have a whole chapter in your book dedicated to the psychology of pain and especially for our listeners. That’s very important to understand. And the book is called Ending Back Pain: Five Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Where can they find it and where can they find you?

Dr. Jack Stern: So the book is obviously on Amazon and most Barnes & Noble, most bookstores. But if you’re like me, you buy everything on Amazon. That’s why he became the world’s richest person.

Gabe Howard: Very true.

Dr. Jack Stern: My wife says, there’s another box for you from Jeff Bezos waiting at the door. So. And you can find me. Actually, my Web site is called very simply, DrJackStern.com. And I actually have a place on that Web site where people can actually consult with me if they’re having back pain. And we take their histories. We even have them send us their MRI or CAT scans. And I then communicate with them to see if I can share with them my years of experience. So that’s also a possibility. DrJackStern.com.

Gabe Howard: Wonderful. Thank you so much for being here. I really appreciate it. I can’t thank you enough.

Dr. Jack Stern: Thank you, it was really interesting speaking to you.

Gabe Howard: Wonderful. And listen up, listeners, here’s what I need you to do. Wherever you download this podcast, please rate us however you feel is appropriate. But take the extra step. I would consider it a personal favor if you would use your words and tell people what you like about the podcast. Obviously, subscribe to our show, share us on social media. Email a friend. Hey, it’s a good excuse to talk to your mom. And remember, we have a private Facebook group at PsychCentral.com/FBShow. And as always, support our sponsor. You can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we will see everybody next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at show@psychcentral.com. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share with your friends, family, and followers.

    Podcast: Is There a Link Between Physical and Mental Health? syndicated from

[erraticfairy]

Podcast: Is There a Link Between Physical and Mental Health?

What does physical pain have to do with depression, and vice versa? On today’s Psych Central Podcast, our guest, Dr. Jack Stern, a board-certified neurosurgeon specializing in spinal surgery, explains the psychology of pain and how the two are inextricably linked. Dr. Stern describes how pain can lead to depression and how depression can intensify physical pain.

We also find out why opioids don’t work for chronic pain, and how past pain affects current pain. Join us for an in-depth discussion on physical pain and mental health.

SUBSCRIBE & REVIEW

Guest information for ‘Dr. Jack Stern- Chronic Pain’ Podcast Episode

Jack Stern, M.D., Ph.D., is the author of Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. He is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York. For more information, please visit https://drjackstern.com/

    About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Dr. Jack Stern- Chronic Pain’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Jack Stern, MD, PhD, who is the author of Ending Back Pain: Five Powerful Steps to Diagnose, Understand and Treat Your Ailing Back. He is a board certified neurosurgeon specializing in spinal surgery and co-founder of Spine Options, one of America’s first facilities committing to non-surgical care of back and neck pain. Dr. Stern, welcome to the show.

Dr. Jack Stern: Thank you.

Gabe Howard: Well, I’m really glad to have you, and I’m really excited. But before we get started, our longtime listeners are thinking, wait, you know, back pain, an expert in spinal surgery, spine options, neck. What does this have to do with mental health? Dr. Stern, what does this have to do with mental health?

Dr. Jack Stern: Probably a very appropriate question. All of us have been in pain at some point or another, stub your toe, hurt your back. Break a leg. And you know that it’s not just the pain that bothers you, but a variety of other emotions play a role, upset, sadness, depression. It runs the gamut. I get depressed when I have a cold and I can’t work. I just get so upset with myself that I got things to do and I can’t do them. And that’s just from having a cold. Could you imagine if I had something really the matter with me? Thank God. How I would feel. And that’s what I experience in my patients who come to me with rather significant issues related to their spine. And because without dealing with the emotional aspect, the psychological aspects of pain, you really cannot treat pain.

Gabe Howard: Dr. Stern, it sounds like you really think that mental health and physical health shouldn’t be separate. I’ve often said I don’t understand. Whose bright idea it was to decide that these were two separate things, since it’s all one person. Is that how you feel? Am I. Am I putting words in your mouth or have I nailed it?

Dr. Jack Stern: I think that’s absolutely right. Actually, I think that the concept of separating the two. I think that concept is really going away. I think most physicians and I mean probably even your internist. At least my internist, who is not a youngster, always asks me, well, Jack, how are things going? And he doesn’t mean, am I still on the treadmill and do I have intestinal problems? He’s asking me, how are things going? Emotionally. Are you feeling well emotionally? Are you sleeping well? How is your relationship with your children and with your job? And what kind of feelings does that bring up for you? So I think anyone who separates the physical and the emotional I think has missed the boat. And it’s clear, as someone who’s taught in medical schools for 30 years that we no longer make that distinction. Thank goodness. So I think that’s an old concept. And I feel that the two are intimately connected and can’t be separated, at least not easily.

Gabe Howard: That is wonderful news. Let’s move on to your book and your area of expertise. And my first question is, what is the anatomy of pain? Can you talk about that a little bit? I was trying to read about it and learn about it. And I have to admit, it was it was well over my head. But it was also fascinating because all of us have been in pain at some point. Like you said, whether it’s stubbing AHTO or, of course, something as serious as a spinal injury.

Dr. Jack Stern: So there are actually without and I don’t want to get too technical. There are actually two ways that the periphery. That means your body tells your brain that you’re having pain. And there are actually two separate pathways. If you think of the spinal cord as a big cable that connects to the central relay station, which is your brain, they’re actually separate cables for two types of pain. And once I describe it, you’ll probably recognize it. The first type of pain is what we call acute pain. That’s the pain where someone breaks their leg or stubs their toe. Where you go, oh, oh, wow. You really feel acute pain. But there’s also a separate pathway, a separate group of fibers that go up to a relay station. Your brain that are actually there in terms of evolution are actually there before the sharp pain. And those fibers, that pathway sends messages of what we call deep, gnawing pain. It’s like, oh, I got something in my belly. Just feels, you know, it’s, it’s just uncomfortable. It’s or my back just, it’s not killing me. It’s not like I can’t walk, but it hurts all the time. It’s that deep gnawing pain. So those two pathways exist in the body that has a lot of importance, both psychologically and physically, because the two pathways have a different what we call neurotransmitters, and those are the chemicals that send the messages to the brain.

Dr. Jack Stern: So, for example, if someone has that deep gnawing pain and you give them an opiate, they probably will not respond because those pathways don’t recognize opiates, whereas the pathways that transmit messages of acute pain do have what we call opiate receptors and they are effective. So if you break a leg and the doctor gives you one of the narcotic analgesics, it will be effective. But usually not if you have chronic low back pain. And fortunately, part of the and I’ll just digress here a minute. Part of the opiate epidemic is because opiates have been giving for conditions that deal with chronic pain, not the acute pain that responds. So the anatomical pathways are complex. But the important point here is that there are two separate pathways, one for acute pain and one for chronic pain. And certainly the greatest psychological issues arise when patients are in chronic pain. Someone who comes into my office and says I’ve had back pain for six weeks, eight weeks a year, and it doesn’t get any better. And those are the folks that really suffer psychologically.

Gabe Howard: It sounds like what you’re describing should work the same for everybody, but we all know that it doesn’t work the same for everybody. And part of that is, is our psychological response. I think of me and my brother when my brother gets hurt, he’s like supercharges. He’s like, yeah. Feel the burn. When I get hurt, I’m in a corner, almost traumatized. And I’m not really exaggerating. I just have a very low pain tolerance. What is the psychological response to pain on the human body and why does it differ from person to person?

Dr. Jack Stern: I think that to answer that, we could break it up into two parts. One, there are real reasons, intrinsic or innate to your anatomy, where you have more receptors that sense pain and send more pain messages to your brain, and therefore your brother will feel the pain less and you will feel the pain more because you have more receptors. And we see that all the time. You hurt your toe, stub your finger and the other person stubs theirs and they’ll feel it because you have more receptors than they do. But from a psychological point of view, there’s clearly an indication that I’m wondering whether you had an experience once where you were in pain and it could have been when you were very young. And that memory is embedded in your brain. And that memory of that pain, even when we were very young, now raises its awareness and subconsciously your body says, oh, I had that sense of pain so long ago. I don’t want to endure that pain again. I don’t want to experience that pain again. So subconsciously, reliving that experience is something that I think that we all do. And how that experience, previous experience impacted what we’re doing now reflects on how we’re going to relate to the pain psychologically. Does that answer your question?

Gabe Howard: It does. It makes perfect sense. As much as it makes perfect sense from my standpoint, and that kind of leads me to my next question. From your standpoint, you need actual data. So you need to measure pain. But the only thing that I’ve ever seen that measures pain is that, you know, smiley face all the way to a sad face chart that nurses have handed me. And that seems rather ridiculous because as you pointed out, pain is different for everybody. Pain is very personal and there’s a psychological point to pain. I guess my actual question then is, can pain actually be measured?

Dr. Jack Stern: It can be measured, but it’s much too difficult to measure it on a regular basis. So what we do in the hospital is use this device of the smiley face to the frowning face to give us some indication of where the patient’s pain is. But as I think you were alluding to, it doesn’t give us an indication of what the psychological parameters are that are involved in that patient’s pain. I’ll give you an example. A woman can have a very difficult delivery and it could be painful. And this has been shown. This is not me guessing. And then they, maybe a few hours later, and because she had this very healthy baby, they almost always have a smiley face. And the idea that they were in pain during the labor seems to be suppressed. So what I’m saying is that there’s a real complexity to how you experience pain. And some of it has to do with your previous experience with pain.

Gabe Howard: It’s interesting that you say that some of it has to do with your previous experience of pain, because it sounds to me like if you have something really traumatic, let’s go with the broken leg. So I break my leg. Now I’m all 100 percent fine. It’s now a couple of years later and something lesser happens.

Dr. Jack Stern: Yeah.

Gabe Howard: You bang into a table and of course, that hurts. You know, banging your shin into a table is a painful thing. Are you saying that because of the pain that I experienced with the broken leg, that that’s going to psychologically influence the pain I experience in the lesser banging my shin?

Dr. Jack Stern: Invariably. Invariably, because there’s gonna be a fear factor, there’s gonna be an avoidance factor. There’s gonna be a memory of the previous pain. There’s gonna be a wish that this second injury isn’t severe. All those things come into play. I’d also point out that where you are psychologically, when you have either the first or especially the second injury in this case will affect your reaction to the pain. It’s clear that individuals who are depressed will experience the pain or relate that the pain is more severe than someone who is not depressed. And that goes across pretty much across the board. And you’ve seen you’ve probably met someone who’s depressed and the slightest thing bothers them. And they say, oh, that hurts. Oh, that. Oh, my. Oh, there’s this hurts, oh, that hurts. It’s because depression really magnifies. And that’s a great example of how the psychological affects the physical. For example, there was a really good study that showed that a significant number of men and women who have chronic pain, that is pain that lasts longer than it normally should for the same type of accident. A significant percentage of those individuals at some point in their lives were abused physically or emotionally abused. And the pain then evokes that previous abuse. We also know that pain frequently provides the individual with secondary gain. Sweetheart, my back hurts, so could you take out the garbage? Whereas, you know, you probably take out the garbage, but the individual is using it for secondary gain, for not doing what what’s been asked of them. And I see that all the time when it comes to intimacy, where couples one member does you know, I really can’t participate in any intimate activity because my back hurts. So it has tremendous, tremendous psychological overlay in any type of pain we talk about, particularly if the pain lasts for any length of time.

Gabe Howard: Stick around. We’ll be right back after these messages from our sponsors.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing the psychological effects of pain with Dr. Jack Stern. One of the things that this is kind of reminding me of is I suffer from anxiety disorder and I’ve had panic attacks and panic attacks are they’re awful. And anyone who’s suffered from one can agree with it. But one of the things that I noticed is my fear of having another panic attack was very limiting to me. There were places that I wouldn’t go, things that I wouldn’t do. And I had to work all that in therapy. It sounds like pain sort of follows the same kind of thing. Right. I’m so afraid of it hurting or being hurt that I’m skipping out on things. In your example, you said, you know, intimate activity with your partner because you’re afraid that it might hurt your back. Is that analogous?

Dr. Jack Stern: I think so, I think. Absolutely. I mean, you’re not having a panic attack, but you’re concerned that you may have a panic attack. So there’s an aversion reaction that may or may not be real and it may not be real at all because you may be able to do that whatever it is, without getting a panic attack. So I may be a patient who has low back pain, and I don’t want to maybe intelligently don’t want to live that, even though I probably could, because I may injure myself and recreate my back pain. But as I said, there’s some folks who use that psychologically. They probably could lift it but don’t want to because they just want to be nice that day. So once again, the variability is significant.

Gabe Howard: Staying with a panic attack analogy, the way that I got over it is by going to therapy. I spoke with my therapist. I shared my fears about having a panic attack. We worked on coping skills. We talked about why I was afraid of it. Is that the same treatment for folks who concerned about re-injury or pain, who are avoiding pleasurable activities in life because they’re afraid of re-injury or experiencing pain?

Dr. Jack Stern: I think that is a near perfect analogy. Yes. And, of course, I’m not I’m not a therapist. So for me, when I see a patient who has that fear of pain, fear of surgery, first of all, I won’t operate on someone like that. And number two, I will almost always ask the individual to get therapy and refer them to a therapist who specializes. And we have several such in this community who specialize in pain issues. And they will use a variety of techniques to help the individual deal with the pain. And as in your case, it sounds like a find out what the original pain episode was or panic episode was so they can deal with that initial episode and then try to prevent it from stymieing their activities again. So, yes, I think your analogy is a very good one.

Gabe Howard: Dr. Stern, I really appreciate you connecting mental health and physical health, and I’m very glad to hear that things are changing in the way that medicine is practiced. Because I’m only 43 years old. In the grand scheme, I’m not that old. But I remember in the 80s being afraid of surgery and just being told, you know, buck up, it’s not going to be so bad. Don’t you trust the doctors? It’s going to be okay. And then after the surgery, even though, you know, it was scary, it was just scary. People were like, well, the worst is over. I would always hear that phrase, well, the worst is over. This is the worst it’s going to be. You’ll be fine. It wasn’t until I had a mental health problem and I started treating both that I realized that there’s just so much interplay between our emotions about, in this case, pain and the actual pain and treating. Both is our fastest way to wellness. So, kudos,

Dr. Jack Stern: Yeah,

Gabe Howard: I love

Dr. Jack Stern: Yeah.

Gabe Howard: What you’re talking about here.

Dr. Jack Stern: Yeah, absolutely. I don’t know how you can separate it out, and once again, I relate to my own experiences about the whole world seems dark to me if one of my kids isn’t doing well. And everything, every negative aspect of my life suddenly seems to be amplified. And that’s both physical and mental. There’s also a phenomenon that I think is overlooked many times, and that is individuals who have pain, particularly chronic pain. Let me say two things. One, they for whatever reason, whether it’s actually physical or emotional, can function at the level that they could function before the onset of the pain. And I believe that many such individuals and I think this is also part of regular aging, we mourn for lost body parts. So we’re still alive, but we realize that we are not who we were because part of us and I don’t mean to be too dramatic here, but part of us has died. We can’t do that anymore. And we mourn the fact that we can’t do that. And I think that has significant psychological overlay, depression, maybe anger, et cetera. And I see that all the time in individuals. And I see it in myself in terms of I just came from the gym and I realized every time I go to the gym that I can’t do things that I did 10 and 20 years ago. And it really upsets me. And I’m a little depressed about it. And I see these young folks and I wish I were could do that again. But so that’s one. And that’s the loss of body parts.

Dr. Jack Stern: Number two, the big elephant in the room with patients or individuals who have chronic pain is the psychological effect it has on everyone else in their lives, how it affects their spouses, how it affects their children. Oh, Daddy, can’t you play with me? No, my back hurts. You know, my daddy never plays ball with me because his back always hurts. Everybody else’s daddy was always out there playing with them. So imagine the impact that that has on the child, not even on the individual who had the back pain. So this can be in a familial sense and a family could have tremendous psychological impact, senses of rejection, senses of less worthiness, a sense of anger that my dad was never there for me when he when everybody else’s dad was there. So these are the things we don’t talk about. These are the things that get swept under the rug until someone decides, you know, I’m going to have to deal with my pain. And what the impact of my pain had psychologically on those around me and frequently how the others, spouses, children, fellow employees, but mostly family members eventually go into therapy and say, why am I so upset with my father? I understand why he was never there for me. He was always complaining of back pain or it’s the same as if my dad wasn’t there because he was always working. But this is a cloud that hangs over families when there’s an individual who has back pain. It’s what I call the psychological unspoken of psychological cloud of back pain.

Gabe Howard: And Dr. Stern, you have a whole chapter in your book dedicated to the psychology of pain and especially for our listeners. That’s very important to understand. And the book is called Ending Back Pain: Five Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Where can they find it and where can they find you?

Dr. Jack Stern: So the book is obviously on Amazon and most Barnes & Noble, most bookstores. But if you’re like me, you buy everything on Amazon. That’s why he became the world’s richest person.

Gabe Howard: Very true.

Dr. Jack Stern: My wife says, there’s another box for you from Jeff Bezos waiting at the door. So. And you can find me. Actually, my Web site is called very simply, DrJackStern.com. And I actually have a place on that Web site where people can actually consult with me if they’re having back pain. And we take their histories. We even have them send us their MRI or CAT scans. And I then communicate with them to see if I can share with them my years of experience. So that’s also a possibility. DrJackStern.com.

Gabe Howard: Wonderful. Thank you so much for being here. I really appreciate it. I can’t thank you enough.

Dr. Jack Stern: Thank you, it was really interesting speaking to you.

Gabe Howard: Wonderful. And listen up, listeners, here’s what I need you to do. Wherever you download this podcast, please rate us however you feel is appropriate. But take the extra step. I would consider it a personal favor if you would use your words and tell people what you like about the podcast. Obviously, subscribe to our show, share us on social media. Email a friend. Hey, it’s a good excuse to talk to your mom. And remember, we have a private Facebook group at PsychCentral.com/FBShow. And as always, support our sponsor. You can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we will see everybody next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at show@psychcentral.com. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share with your friends, family, and followers.

    from World of Psychology https://ift.tt/2zF03N3 via theshiningmind.com

[positivepsychologyinterventions]

Podcast: Is There a Link Between Physical and Mental Health?

What does physical pain have to do with depression, and vice versa? On today’s Psych Central Podcast, our guest, Dr. Jack Stern, a board-certified neurosurgeon specializing in spinal surgery, explains the psychology of pain and how the two are inextricably linked. Dr. Stern describes how pain can lead to depression and how depression can intensify physical pain.

We also find out why opioids don’t work for chronic pain, and how past pain affects current pain. Join us for an in-depth discussion on physical pain and mental health.

SUBSCRIBE & REVIEW

Guest information for ‘Dr. Jack Stern- Chronic Pain’ Podcast Episode

Jack Stern, M.D., Ph.D., is the author of Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. He is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York. For more information, please visit https://drjackstern.com/

    About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Dr. Jack Stern- Chronic Pain’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Jack Stern, MD, PhD, who is the author of Ending Back Pain: Five Powerful Steps to Diagnose, Understand and Treat Your Ailing Back. He is a board certified neurosurgeon specializing in spinal surgery and co-founder of Spine Options, one of America’s first facilities committing to non-surgical care of back and neck pain. Dr. Stern, welcome to the show.

Dr. Jack Stern: Thank you.

Gabe Howard: Well, I’m really glad to have you, and I’m really excited. But before we get started, our longtime listeners are thinking, wait, you know, back pain, an expert in spinal surgery, spine options, neck. What does this have to do with mental health? Dr. Stern, what does this have to do with mental health?

Dr. Jack Stern: Probably a very appropriate question. All of us have been in pain at some point or another, stub your toe, hurt your back. Break a leg. And you know that it’s not just the pain that bothers you, but a variety of other emotions play a role, upset, sadness, depression. It runs the gamut. I get depressed when I have a cold and I can’t work. I just get so upset with myself that I got things to do and I can’t do them. And that’s just from having a cold. Could you imagine if I had something really the matter with me? Thank God. How I would feel. And that’s what I experience in my patients who come to me with rather significant issues related to their spine. And because without dealing with the emotional aspect, the psychological aspects of pain, you really cannot treat pain.

Gabe Howard: Dr. Stern, it sounds like you really think that mental health and physical health shouldn’t be separate. I’ve often said I don’t understand. Whose bright idea it was to decide that these were two separate things, since it’s all one person. Is that how you feel? Am I. Am I putting words in your mouth or have I nailed it?

Dr. Jack Stern: I think that’s absolutely right. Actually, I think that the concept of separating the two. I think that concept is really going away. I think most physicians and I mean probably even your internist. At least my internist, who is not a youngster, always asks me, well, Jack, how are things going? And he doesn’t mean, am I still on the treadmill and do I have intestinal problems? He’s asking me, how are things going? Emotionally. Are you feeling well emotionally? Are you sleeping well? How is your relationship with your children and with your job? And what kind of feelings does that bring up for you? So I think anyone who separates the physical and the emotional I think has missed the boat. And it’s clear, as someone who’s taught in medical schools for 30 years that we no longer make that distinction. Thank goodness. So I think that’s an old concept. And I feel that the two are intimately connected and can’t be separated, at least not easily.

Gabe Howard: That is wonderful news. Let’s move on to your book and your area of expertise. And my first question is, what is the anatomy of pain? Can you talk about that a little bit? I was trying to read about it and learn about it. And I have to admit, it was it was well over my head. But it was also fascinating because all of us have been in pain at some point. Like you said, whether it’s stubbing AHTO or, of course, something as serious as a spinal injury.

Dr. Jack Stern: So there are actually without and I don’t want to get too technical. There are actually two ways that the periphery. That means your body tells your brain that you’re having pain. And there are actually two separate pathways. If you think of the spinal cord as a big cable that connects to the central relay station, which is your brain, they’re actually separate cables for two types of pain. And once I describe it, you’ll probably recognize it. The first type of pain is what we call acute pain. That’s the pain where someone breaks their leg or stubs their toe. Where you go, oh, oh, wow. You really feel acute pain. But there’s also a separate pathway, a separate group of fibers that go up to a relay station. Your brain that are actually there in terms of evolution are actually there before the sharp pain. And those fibers, that pathway sends messages of what we call deep, gnawing pain. It’s like, oh, I got something in my belly. Just feels, you know, it’s, it’s just uncomfortable. It’s or my back just, it’s not killing me. It’s not like I can’t walk, but it hurts all the time. It’s that deep gnawing pain. So those two pathways exist in the body that has a lot of importance, both psychologically and physically, because the two pathways have a different what we call neurotransmitters, and those are the chemicals that send the messages to the brain.

Dr. Jack Stern: So, for example, if someone has that deep gnawing pain and you give them an opiate, they probably will not respond because those pathways don’t recognize opiates, whereas the pathways that transmit messages of acute pain do have what we call opiate receptors and they are effective. So if you break a leg and the doctor gives you one of the narcotic analgesics, it will be effective. But usually not if you have chronic low back pain. And fortunately, part of the and I’ll just digress here a minute. Part of the opiate epidemic is because opiates have been giving for conditions that deal with chronic pain, not the acute pain that responds. So the anatomical pathways are complex. But the important point here is that there are two separate pathways, one for acute pain and one for chronic pain. And certainly the greatest psychological issues arise when patients are in chronic pain. Someone who comes into my office and says I’ve had back pain for six weeks, eight weeks a year, and it doesn’t get any better. And those are the folks that really suffer psychologically.

Gabe Howard: It sounds like what you’re describing should work the same for everybody, but we all know that it doesn’t work the same for everybody. And part of that is, is our psychological response. I think of me and my brother when my brother gets hurt, he’s like supercharges. He’s like, yeah. Feel the burn. When I get hurt, I’m in a corner, almost traumatized. And I’m not really exaggerating. I just have a very low pain tolerance. What is the psychological response to pain on the human body and why does it differ from person to person?

Dr. Jack Stern: I think that to answer that, we could break it up into two parts. One, there are real reasons, intrinsic or innate to your anatomy, where you have more receptors that sense pain and send more pain messages to your brain, and therefore your brother will feel the pain less and you will feel the pain more because you have more receptors. And we see that all the time. You hurt your toe, stub your finger and the other person stubs theirs and they’ll feel it because you have more receptors than they do. But from a psychological point of view, there’s clearly an indication that I’m wondering whether you had an experience once where you were in pain and it could have been when you were very young. And that memory is embedded in your brain. And that memory of that pain, even when we were very young, now raises its awareness and subconsciously your body says, oh, I had that sense of pain so long ago. I don’t want to endure that pain again. I don’t want to experience that pain again. So subconsciously, reliving that experience is something that I think that we all do. And how that experience, previous experience impacted what we’re doing now reflects on how we’re going to relate to the pain psychologically. Does that answer your question?

Gabe Howard: It does. It makes perfect sense. As much as it makes perfect sense from my standpoint, and that kind of leads me to my next question. From your standpoint, you need actual data. So you need to measure pain. But the only thing that I’ve ever seen that measures pain is that, you know, smiley face all the way to a sad face chart that nurses have handed me. And that seems rather ridiculous because as you pointed out, pain is different for everybody. Pain is very personal and there’s a psychological point to pain. I guess my actual question then is, can pain actually be measured?

Dr. Jack Stern: It can be measured, but it’s much too difficult to measure it on a regular basis. So what we do in the hospital is use this device of the smiley face to the frowning face to give us some indication of where the patient’s pain is. But as I think you were alluding to, it doesn’t give us an indication of what the psychological parameters are that are involved in that patient’s pain. I’ll give you an example. A woman can have a very difficult delivery and it could be painful. And this has been shown. This is not me guessing. And then they, maybe a few hours later, and because she had this very healthy baby, they almost always have a smiley face. And the idea that they were in pain during the labor seems to be suppressed. So what I’m saying is that there’s a real complexity to how you experience pain. And some of it has to do with your previous experience with pain.

Gabe Howard: It’s interesting that you say that some of it has to do with your previous experience of pain, because it sounds to me like if you have something really traumatic, let’s go with the broken leg. So I break my leg. Now I’m all 100 percent fine. It’s now a couple of years later and something lesser happens.

Dr. Jack Stern: Yeah.

Gabe Howard: You bang into a table and of course, that hurts. You know, banging your shin into a table is a painful thing. Are you saying that because of the pain that I experienced with the broken leg, that that’s going to psychologically influence the pain I experience in the lesser banging my shin?

Dr. Jack Stern: Invariably. Invariably, because there’s gonna be a fear factor, there’s gonna be an avoidance factor. There’s gonna be a memory of the previous pain. There’s gonna be a wish that this second injury isn’t severe. All those things come into play. I’d also point out that where you are psychologically, when you have either the first or especially the second injury in this case will affect your reaction to the pain. It’s clear that individuals who are depressed will experience the pain or relate that the pain is more severe than someone who is not depressed. And that goes across pretty much across the board. And you’ve seen you’ve probably met someone who’s depressed and the slightest thing bothers them. And they say, oh, that hurts. Oh, that. Oh, my. Oh, there’s this hurts, oh, that hurts. It’s because depression really magnifies. And that’s a great example of how the psychological affects the physical. For example, there was a really good study that showed that a significant number of men and women who have chronic pain, that is pain that lasts longer than it normally should for the same type of accident. A significant percentage of those individuals at some point in their lives were abused physically or emotionally abused. And the pain then evokes that previous abuse. We also know that pain frequently provides the individual with secondary gain. Sweetheart, my back hurts, so could you take out the garbage? Whereas, you know, you probably take out the garbage, but the individual is using it for secondary gain, for not doing what what’s been asked of them. And I see that all the time when it comes to intimacy, where couples one member does you know, I really can’t participate in any intimate activity because my back hurts. So it has tremendous, tremendous psychological overlay in any type of pain we talk about, particularly if the pain lasts for any length of time.

Gabe Howard: Stick around. We’ll be right back after these messages from our sponsors.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing the psychological effects of pain with Dr. Jack Stern. One of the things that this is kind of reminding me of is I suffer from anxiety disorder and I’ve had panic attacks and panic attacks are they’re awful. And anyone who’s suffered from one can agree with it. But one of the things that I noticed is my fear of having another panic attack was very limiting to me. There were places that I wouldn’t go, things that I wouldn’t do. And I had to work all that in therapy. It sounds like pain sort of follows the same kind of thing. Right. I’m so afraid of it hurting or being hurt that I’m skipping out on things. In your example, you said, you know, intimate activity with your partner because you’re afraid that it might hurt your back. Is that analogous?

Dr. Jack Stern: I think so, I think. Absolutely. I mean, you’re not having a panic attack, but you’re concerned that you may have a panic attack. So there’s an aversion reaction that may or may not be real and it may not be real at all because you may be able to do that whatever it is, without getting a panic attack. So I may be a patient who has low back pain, and I don’t want to maybe intelligently don’t want to live that, even though I probably could, because I may injure myself and recreate my back pain. But as I said, there’s some folks who use that psychologically. They probably could lift it but don’t want to because they just want to be nice that day. So once again, the variability is significant.

Gabe Howard: Staying with a panic attack analogy, the way that I got over it is by going to therapy. I spoke with my therapist. I shared my fears about having a panic attack. We worked on coping skills. We talked about why I was afraid of it. Is that the same treatment for folks who concerned about re-injury or pain, who are avoiding pleasurable activities in life because they’re afraid of re-injury or experiencing pain?

Dr. Jack Stern: I think that is a near perfect analogy. Yes. And, of course, I’m not I’m not a therapist. So for me, when I see a patient who has that fear of pain, fear of surgery, first of all, I won’t operate on someone like that. And number two, I will almost always ask the individual to get therapy and refer them to a therapist who specializes. And we have several such in this community who specialize in pain issues. And they will use a variety of techniques to help the individual deal with the pain. And as in your case, it sounds like a find out what the original pain episode was or panic episode was so they can deal with that initial episode and then try to prevent it from stymieing their activities again. So, yes, I think your analogy is a very good one.

Gabe Howard: Dr. Stern, I really appreciate you connecting mental health and physical health, and I’m very glad to hear that things are changing in the way that medicine is practiced. Because I’m only 43 years old. In the grand scheme, I’m not that old. But I remember in the 80s being afraid of surgery and just being told, you know, buck up, it’s not going to be so bad. Don’t you trust the doctors? It’s going to be okay. And then after the surgery, even though, you know, it was scary, it was just scary. People were like, well, the worst is over. I would always hear that phrase, well, the worst is over. This is the worst it’s going to be. You’ll be fine. It wasn’t until I had a mental health problem and I started treating both that I realized that there’s just so much interplay between our emotions about, in this case, pain and the actual pain and treating. Both is our fastest way to wellness. So, kudos,

Dr. Jack Stern: Yeah,

Gabe Howard: I love

Dr. Jack Stern: Yeah.

Gabe Howard: What you’re talking about here.

Dr. Jack Stern: Yeah, absolutely. I don’t know how you can separate it out, and once again, I relate to my own experiences about the whole world seems dark to me if one of my kids isn’t doing well. And everything, every negative aspect of my life suddenly seems to be amplified. And that’s both physical and mental. There’s also a phenomenon that I think is overlooked many times, and that is individuals who have pain, particularly chronic pain. Let me say two things. One, they for whatever reason, whether it’s actually physical or emotional, can function at the level that they could function before the onset of the pain. And I believe that many such individuals and I think this is also part of regular aging, we mourn for lost body parts. So we’re still alive, but we realize that we are not who we were because part of us and I don’t mean to be too dramatic here, but part of us has died. We can’t do that anymore. And we mourn the fact that we can’t do that. And I think that has significant psychological overlay, depression, maybe anger, et cetera. And I see that all the time in individuals. And I see it in myself in terms of I just came from the gym and I realized every time I go to the gym that I can’t do things that I did 10 and 20 years ago. And it really upsets me. And I’m a little depressed about it. And I see these young folks and I wish I were could do that again. But so that’s one. And that’s the loss of body parts.

Dr. Jack Stern: Number two, the big elephant in the room with patients or individuals who have chronic pain is the psychological effect it has on everyone else in their lives, how it affects their spouses, how it affects their children. Oh, Daddy, can’t you play with me? No, my back hurts. You know, my daddy never plays ball with me because his back always hurts. Everybody else’s daddy was always out there playing with them. So imagine the impact that that has on the child, not even on the individual who had the back pain. So this can be in a familial sense and a family could have tremendous psychological impact, senses of rejection, senses of less worthiness, a sense of anger that my dad was never there for me when he when everybody else’s dad was there. So these are the things we don’t talk about. These are the things that get swept under the rug until someone decides, you know, I’m going to have to deal with my pain. And what the impact of my pain had psychologically on those around me and frequently how the others, spouses, children, fellow employees, but mostly family members eventually go into therapy and say, why am I so upset with my father? I understand why he was never there for me. He was always complaining of back pain or it’s the same as if my dad wasn’t there because he was always working. But this is a cloud that hangs over families when there’s an individual who has back pain. It’s what I call the psychological unspoken of psychological cloud of back pain.

Gabe Howard: And Dr. Stern, you have a whole chapter in your book dedicated to the psychology of pain and especially for our listeners. That’s very important to understand. And the book is called Ending Back Pain: Five Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Where can they find it and where can they find you?

Dr. Jack Stern: So the book is obviously on Amazon and most Barnes & Noble, most bookstores. But if you’re like me, you buy everything on Amazon. That’s why he became the world’s richest person.

Gabe Howard: Very true.

Dr. Jack Stern: My wife says, there’s another box for you from Jeff Bezos waiting at the door. So. And you can find me. Actually, my Web site is called very simply, DrJackStern.com. And I actually have a place on that Web site where people can actually consult with me if they’re having back pain. And we take their histories. We even have them send us their MRI or CAT scans. And I then communicate with them to see if I can share with them my years of experience. So that’s also a possibility. DrJackStern.com.

Gabe Howard: Wonderful. Thank you so much for being here. I really appreciate it. I can’t thank you enough.

Dr. Jack Stern: Thank you, it was really interesting speaking to you.

Gabe Howard: Wonderful. And listen up, listeners, here’s what I need you to do. Wherever you download this podcast, please rate us however you feel is appropriate. But take the extra step. I would consider it a personal favor if you would use your words and tell people what you like about the podcast. Obviously, subscribe to our show, share us on social media. Email a friend. Hey, it’s a good excuse to talk to your mom. And remember, we have a private Facebook group at PsychCentral.com/FBShow. And as always, support our sponsor. You can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we will see everybody next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at show@psychcentral.com. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share with your friends, family, and followers.

    from World of Psychology https://ift.tt/2zF03N3 via IFTTT

[whorchataaa]

Podcast: Is There a Link Between Physical and Mental Health?

What does physical pain have to do with depression, and vice versa? On today’s Psych Central Podcast, our guest, Dr. Jack Stern, a board-certified neurosurgeon specializing in spinal surgery, explains the psychology of pain and how the two are inextricably linked. Dr. Stern describes how pain can lead to depression and how depression can intensify physical pain.

We also find out why opioids don’t work for chronic pain, and how past pain affects current pain. Join us for an in-depth discussion on physical pain and mental health.

SUBSCRIBE & REVIEW

Guest information for ‘Dr. Jack Stern- Chronic Pain’ Podcast Episode

Jack Stern, M.D., Ph.D., is the author of Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. He is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York. For more information, please visit https://drjackstern.com/

    About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Dr. Jack Stern- Chronic Pain’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Jack Stern, MD, PhD, who is the author of Ending Back Pain: Five Powerful Steps to Diagnose, Understand and Treat Your Ailing Back. He is a board certified neurosurgeon specializing in spinal surgery and co-founder of Spine Options, one of America’s first facilities committing to non-surgical care of back and neck pain. Dr. Stern, welcome to the show.

Dr. Jack Stern: Thank you.

Gabe Howard: Well, I’m really glad to have you, and I’m really excited. But before we get started, our longtime listeners are thinking, wait, you know, back pain, an expert in spinal surgery, spine options, neck. What does this have to do with mental health? Dr. Stern, what does this have to do with mental health?

Dr. Jack Stern: Probably a very appropriate question. All of us have been in pain at some point or another, stub your toe, hurt your back. Break a leg. And you know that it’s not just the pain that bothers you, but a variety of other emotions play a role, upset, sadness, depression. It runs the gamut. I get depressed when I have a cold and I can’t work. I just get so upset with myself that I got things to do and I can’t do them. And that’s just from having a cold. Could you imagine if I had something really the matter with me? Thank God. How I would feel. And that’s what I experience in my patients who come to me with rather significant issues related to their spine. And because without dealing with the emotional aspect, the psychological aspects of pain, you really cannot treat pain.

Gabe Howard: Dr. Stern, it sounds like you really think that mental health and physical health shouldn’t be separate. I’ve often said I don’t understand. Whose bright idea it was to decide that these were two separate things, since it’s all one person. Is that how you feel? Am I. Am I putting words in your mouth or have I nailed it?

Dr. Jack Stern: I think that’s absolutely right. Actually, I think that the concept of separating the two. I think that concept is really going away. I think most physicians and I mean probably even your internist. At least my internist, who is not a youngster, always asks me, well, Jack, how are things going? And he doesn’t mean, am I still on the treadmill and do I have intestinal problems? He’s asking me, how are things going? Emotionally. Are you feeling well emotionally? Are you sleeping well? How is your relationship with your children and with your job? And what kind of feelings does that bring up for you? So I think anyone who separates the physical and the emotional I think has missed the boat. And it’s clear, as someone who’s taught in medical schools for 30 years that we no longer make that distinction. Thank goodness. So I think that’s an old concept. And I feel that the two are intimately connected and can’t be separated, at least not easily.

Gabe Howard: That is wonderful news. Let’s move on to your book and your area of expertise. And my first question is, what is the anatomy of pain? Can you talk about that a little bit? I was trying to read about it and learn about it. And I have to admit, it was it was well over my head. But it was also fascinating because all of us have been in pain at some point. Like you said, whether it’s stubbing AHTO or, of course, something as serious as a spinal injury.

Dr. Jack Stern: So there are actually without and I don’t want to get too technical. There are actually two ways that the periphery. That means your body tells your brain that you’re having pain. And there are actually two separate pathways. If you think of the spinal cord as a big cable that connects to the central relay station, which is your brain, they’re actually separate cables for two types of pain. And once I describe it, you’ll probably recognize it. The first type of pain is what we call acute pain. That’s the pain where someone breaks their leg or stubs their toe. Where you go, oh, oh, wow. You really feel acute pain. But there’s also a separate pathway, a separate group of fibers that go up to a relay station. Your brain that are actually there in terms of evolution are actually there before the sharp pain. And those fibers, that pathway sends messages of what we call deep, gnawing pain. It’s like, oh, I got something in my belly. Just feels, you know, it’s, it’s just uncomfortable. It’s or my back just, it’s not killing me. It’s not like I can’t walk, but it hurts all the time. It’s that deep gnawing pain. So those two pathways exist in the body that has a lot of importance, both psychologically and physically, because the two pathways have a different what we call neurotransmitters, and those are the chemicals that send the messages to the brain.

Dr. Jack Stern: So, for example, if someone has that deep gnawing pain and you give them an opiate, they probably will not respond because those pathways don’t recognize opiates, whereas the pathways that transmit messages of acute pain do have what we call opiate receptors and they are effective. So if you break a leg and the doctor gives you one of the narcotic analgesics, it will be effective. But usually not if you have chronic low back pain. And fortunately, part of the and I’ll just digress here a minute. Part of the opiate epidemic is because opiates have been giving for conditions that deal with chronic pain, not the acute pain that responds. So the anatomical pathways are complex. But the important point here is that there are two separate pathways, one for acute pain and one for chronic pain. And certainly the greatest psychological issues arise when patients are in chronic pain. Someone who comes into my office and says I’ve had back pain for six weeks, eight weeks a year, and it doesn’t get any better. And those are the folks that really suffer psychologically.

Gabe Howard: It sounds like what you’re describing should work the same for everybody, but we all know that it doesn’t work the same for everybody. And part of that is, is our psychological response. I think of me and my brother when my brother gets hurt, he’s like supercharges. He’s like, yeah. Feel the burn. When I get hurt, I’m in a corner, almost traumatized. And I’m not really exaggerating. I just have a very low pain tolerance. What is the psychological response to pain on the human body and why does it differ from person to person?

Dr. Jack Stern: I think that to answer that, we could break it up into two parts. One, there are real reasons, intrinsic or innate to your anatomy, where you have more receptors that sense pain and send more pain messages to your brain, and therefore your brother will feel the pain less and you will feel the pain more because you have more receptors. And we see that all the time. You hurt your toe, stub your finger and the other person stubs theirs and they’ll feel it because you have more receptors than they do. But from a psychological point of view, there’s clearly an indication that I’m wondering whether you had an experience once where you were in pain and it could have been when you were very young. And that memory is embedded in your brain. And that memory of that pain, even when we were very young, now raises its awareness and subconsciously your body says, oh, I had that sense of pain so long ago. I don’t want to endure that pain again. I don’t want to experience that pain again. So subconsciously, reliving that experience is something that I think that we all do. And how that experience, previous experience impacted what we’re doing now reflects on how we’re going to relate to the pain psychologically. Does that answer your question?

Gabe Howard: It does. It makes perfect sense. As much as it makes perfect sense from my standpoint, and that kind of leads me to my next question. From your standpoint, you need actual data. So you need to measure pain. But the only thing that I’ve ever seen that measures pain is that, you know, smiley face all the way to a sad face chart that nurses have handed me. And that seems rather ridiculous because as you pointed out, pain is different for everybody. Pain is very personal and there’s a psychological point to pain. I guess my actual question then is, can pain actually be measured?

Dr. Jack Stern: It can be measured, but it’s much too difficult to measure it on a regular basis. So what we do in the hospital is use this device of the smiley face to the frowning face to give us some indication of where the patient’s pain is. But as I think you were alluding to, it doesn’t give us an indication of what the psychological parameters are that are involved in that patient’s pain. I’ll give you an example. A woman can have a very difficult delivery and it could be painful. And this has been shown. This is not me guessing. And then they, maybe a few hours later, and because she had this very healthy baby, they almost always have a smiley face. And the idea that they were in pain during the labor seems to be suppressed. So what I’m saying is that there’s a real complexity to how you experience pain. And some of it has to do with your previous experience with pain.

Gabe Howard: It’s interesting that you say that some of it has to do with your previous experience of pain, because it sounds to me like if you have something really traumatic, let’s go with the broken leg. So I break my leg. Now I’m all 100 percent fine. It’s now a couple of years later and something lesser happens.

Dr. Jack Stern: Yeah.

Gabe Howard: You bang into a table and of course, that hurts. You know, banging your shin into a table is a painful thing. Are you saying that because of the pain that I experienced with the broken leg, that that’s going to psychologically influence the pain I experience in the lesser banging my shin?

Dr. Jack Stern: Invariably. Invariably, because there’s gonna be a fear factor, there’s gonna be an avoidance factor. There’s gonna be a memory of the previous pain. There’s gonna be a wish that this second injury isn’t severe. All those things come into play. I’d also point out that where you are psychologically, when you have either the first or especially the second injury in this case will affect your reaction to the pain. It’s clear that individuals who are depressed will experience the pain or relate that the pain is more severe than someone who is not depressed. And that goes across pretty much across the board. And you’ve seen you’ve probably met someone who’s depressed and the slightest thing bothers them. And they say, oh, that hurts. Oh, that. Oh, my. Oh, there’s this hurts, oh, that hurts. It’s because depression really magnifies. And that’s a great example of how the psychological affects the physical. For example, there was a really good study that showed that a significant number of men and women who have chronic pain, that is pain that lasts longer than it normally should for the same type of accident. A significant percentage of those individuals at some point in their lives were abused physically or emotionally abused. And the pain then evokes that previous abuse. We also know that pain frequently provides the individual with secondary gain. Sweetheart, my back hurts, so could you take out the garbage? Whereas, you know, you probably take out the garbage, but the individual is using it for secondary gain, for not doing what what’s been asked of them. And I see that all the time when it comes to intimacy, where couples one member does you know, I really can’t participate in any intimate activity because my back hurts. So it has tremendous, tremendous psychological overlay in any type of pain we talk about, particularly if the pain lasts for any length of time.

Gabe Howard: Stick around. We’ll be right back after these messages from our sponsors.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing the psychological effects of pain with Dr. Jack Stern. One of the things that this is kind of reminding me of is I suffer from anxiety disorder and I’ve had panic attacks and panic attacks are they’re awful. And anyone who’s suffered from one can agree with it. But one of the things that I noticed is my fear of having another panic attack was very limiting to me. There were places that I wouldn’t go, things that I wouldn’t do. And I had to work all that in therapy. It sounds like pain sort of follows the same kind of thing. Right. I’m so afraid of it hurting or being hurt that I’m skipping out on things. In your example, you said, you know, intimate activity with your partner because you’re afraid that it might hurt your back. Is that analogous?

Dr. Jack Stern: I think so, I think. Absolutely. I mean, you’re not having a panic attack, but you’re concerned that you may have a panic attack. So there’s an aversion reaction that may or may not be real and it may not be real at all because you may be able to do that whatever it is, without getting a panic attack. So I may be a patient who has low back pain, and I don’t want to maybe intelligently don’t want to live that, even though I probably could, because I may injure myself and recreate my back pain. But as I said, there’s some folks who use that psychologically. They probably could lift it but don’t want to because they just want to be nice that day. So once again, the variability is significant.

Gabe Howard: Staying with a panic attack analogy, the way that I got over it is by going to therapy. I spoke with my therapist. I shared my fears about having a panic attack. We worked on coping skills. We talked about why I was afraid of it. Is that the same treatment for folks who concerned about re-injury or pain, who are avoiding pleasurable activities in life because they’re afraid of re-injury or experiencing pain?

Dr. Jack Stern: I think that is a near perfect analogy. Yes. And, of course, I’m not I’m not a therapist. So for me, when I see a patient who has that fear of pain, fear of surgery, first of all, I won’t operate on someone like that. And number two, I will almost always ask the individual to get therapy and refer them to a therapist who specializes. And we have several such in this community who specialize in pain issues. And they will use a variety of techniques to help the individual deal with the pain. And as in your case, it sounds like a find out what the original pain episode was or panic episode was so they can deal with that initial episode and then try to prevent it from stymieing their activities again. So, yes, I think your analogy is a very good one.

Gabe Howard: Dr. Stern, I really appreciate you connecting mental health and physical health, and I’m very glad to hear that things are changing in the way that medicine is practiced. Because I’m only 43 years old. In the grand scheme, I’m not that old. But I remember in the 80s being afraid of surgery and just being told, you know, buck up, it’s not going to be so bad. Don’t you trust the doctors? It’s going to be okay. And then after the surgery, even though, you know, it was scary, it was just scary. People were like, well, the worst is over. I would always hear that phrase, well, the worst is over. This is the worst it’s going to be. You’ll be fine. It wasn’t until I had a mental health problem and I started treating both that I realized that there’s just so much interplay between our emotions about, in this case, pain and the actual pain and treating. Both is our fastest way to wellness. So, kudos,

Dr. Jack Stern: Yeah,

Gabe Howard: I love

Dr. Jack Stern: Yeah.

Gabe Howard: What you’re talking about here.

Dr. Jack Stern: Yeah, absolutely. I don’t know how you can separate it out, and once again, I relate to my own experiences about the whole world seems dark to me if one of my kids isn’t doing well. And everything, every negative aspect of my life suddenly seems to be amplified. And that’s both physical and mental. There’s also a phenomenon that I think is overlooked many times, and that is individuals who have pain, particularly chronic pain. Let me say two things. One, they for whatever reason, whether it’s actually physical or emotional, can function at the level that they could function before the onset of the pain. And I believe that many such individuals and I think this is also part of regular aging, we mourn for lost body parts. So we’re still alive, but we realize that we are not who we were because part of us and I don’t mean to be too dramatic here, but part of us has died. We can’t do that anymore. And we mourn the fact that we can’t do that. And I think that has significant psychological overlay, depression, maybe anger, et cetera. And I see that all the time in individuals. And I see it in myself in terms of I just came from the gym and I realized every time I go to the gym that I can’t do things that I did 10 and 20 years ago. And it really upsets me. And I’m a little depressed about it. And I see these young folks and I wish I were could do that again. But so that’s one. And that’s the loss of body parts.

Dr. Jack Stern: Number two, the big elephant in the room with patients or individuals who have chronic pain is the psychological effect it has on everyone else in their lives, how it affects their spouses, how it affects their children. Oh, Daddy, can’t you play with me? No, my back hurts. You know, my daddy never plays ball with me because his back always hurts. Everybody else’s daddy was always out there playing with them. So imagine the impact that that has on the child, not even on the individual who had the back pain. So this can be in a familial sense and a family could have tremendous psychological impact, senses of rejection, senses of less worthiness, a sense of anger that my dad was never there for me when he when everybody else’s dad was there. So these are the things we don’t talk about. These are the things that get swept under the rug until someone decides, you know, I’m going to have to deal with my pain. And what the impact of my pain had psychologically on those around me and frequently how the others, spouses, children, fellow employees, but mostly family members eventually go into therapy and say, why am I so upset with my father? I understand why he was never there for me. He was always complaining of back pain or it’s the same as if my dad wasn’t there because he was always working. But this is a cloud that hangs over families when there’s an individual who has back pain. It’s what I call the psychological unspoken of psychological cloud of back pain.

Gabe Howard: And Dr. Stern, you have a whole chapter in your book dedicated to the psychology of pain and especially for our listeners. That’s very important to understand. And the book is called Ending Back Pain: Five Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Where can they find it and where can they find you?

Dr. Jack Stern: So the book is obviously on Amazon and most Barnes & Noble, most bookstores. But if you’re like me, you buy everything on Amazon. That’s why he became the world’s richest person.

Gabe Howard: Very true.

Dr. Jack Stern: My wife says, there’s another box for you from Jeff Bezos waiting at the door. So. And you can find me. Actually, my Web site is called very simply, DrJackStern.com. And I actually have a place on that Web site where people can actually consult with me if they’re having back pain. And we take their histories. We even have them send us their MRI or CAT scans. And I then communicate with them to see if I can share with them my years of experience. So that’s also a possibility. DrJackStern.com.

Gabe Howard: Wonderful. Thank you so much for being here. I really appreciate it. I can’t thank you enough.

Dr. Jack Stern: Thank you, it was really interesting speaking to you.

Gabe Howard: Wonderful. And listen up, listeners, here’s what I need you to do. Wherever you download this podcast, please rate us however you feel is appropriate. But take the extra step. I would consider it a personal favor if you would use your words and tell people what you like about the podcast. Obviously, subscribe to our show, share us on social media. Email a friend. Hey, it’s a good excuse to talk to your mom. And remember, we have a private Facebook group at PsychCentral.com/FBShow. And as always, support our sponsor. You can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we will see everybody next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at show@psychcentral.com. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share with your friends, family, and followers.

    from https://ift.tt/2zF03N3 Check out https://peterlegyel.wordpress.com/

[ashley-unicorn]

Podcast: Is There a Link Between Physical and Mental Health?

What does physical pain have to do with depression, and vice versa? On today’s Psych Central Podcast, our guest, Dr. Jack Stern, a board-certified neurosurgeon specializing in spinal surgery, explains the psychology of pain and how the two are inextricably linked. Dr. Stern describes how pain can lead to depression and how depression can intensify physical pain.

We also find out why opioids don’t work for chronic pain, and how past pain affects current pain. Join us for an in-depth discussion on physical pain and mental health.

SUBSCRIBE & REVIEW

Guest information for ‘Dr. Jack Stern- Chronic Pain’ Podcast Episode

Jack Stern, M.D., Ph.D., is the author of Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. He is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York. For more information, please visit https://drjackstern.com/

    About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Dr. Jack Stern- Chronic Pain’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Jack Stern, MD, PhD, who is the author of Ending Back Pain: Five Powerful Steps to Diagnose, Understand and Treat Your Ailing Back. He is a board certified neurosurgeon specializing in spinal surgery and co-founder of Spine Options, one of America’s first facilities committing to non-surgical care of back and neck pain. Dr. Stern, welcome to the show.

Dr. Jack Stern: Thank you.

Gabe Howard: Well, I’m really glad to have you, and I’m really excited. But before we get started, our longtime listeners are thinking, wait, you know, back pain, an expert in spinal surgery, spine options, neck. What does this have to do with mental health? Dr. Stern, what does this have to do with mental health?

Dr. Jack Stern: Probably a very appropriate question. All of us have been in pain at some point or another, stub your toe, hurt your back. Break a leg. And you know that it’s not just the pain that bothers you, but a variety of other emotions play a role, upset, sadness, depression. It runs the gamut. I get depressed when I have a cold and I can’t work. I just get so upset with myself that I got things to do and I can’t do them. And that’s just from having a cold. Could you imagine if I had something really the matter with me? Thank God. How I would feel. And that’s what I experience in my patients who come to me with rather significant issues related to their spine. And because without dealing with the emotional aspect, the psychological aspects of pain, you really cannot treat pain.

Gabe Howard: Dr. Stern, it sounds like you really think that mental health and physical health shouldn’t be separate. I’ve often said I don’t understand. Whose bright idea it was to decide that these were two separate things, since it’s all one person. Is that how you feel? Am I. Am I putting words in your mouth or have I nailed it?

Dr. Jack Stern: I think that’s absolutely right. Actually, I think that the concept of separating the two. I think that concept is really going away. I think most physicians and I mean probably even your internist. At least my internist, who is not a youngster, always asks me, well, Jack, how are things going? And he doesn’t mean, am I still on the treadmill and do I have intestinal problems? He’s asking me, how are things going? Emotionally. Are you feeling well emotionally? Are you sleeping well? How is your relationship with your children and with your job? And what kind of feelings does that bring up for you? So I think anyone who separates the physical and the emotional I think has missed the boat. And it’s clear, as someone who’s taught in medical schools for 30 years that we no longer make that distinction. Thank goodness. So I think that’s an old concept. And I feel that the two are intimately connected and can’t be separated, at least not easily.

Gabe Howard: That is wonderful news. Let’s move on to your book and your area of expertise. And my first question is, what is the anatomy of pain? Can you talk about that a little bit? I was trying to read about it and learn about it. And I have to admit, it was it was well over my head. But it was also fascinating because all of us have been in pain at some point. Like you said, whether it’s stubbing AHTO or, of course, something as serious as a spinal injury.

Dr. Jack Stern: So there are actually without and I don’t want to get too technical. There are actually two ways that the periphery. That means your body tells your brain that you’re having pain. And there are actually two separate pathways. If you think of the spinal cord as a big cable that connects to the central relay station, which is your brain, they’re actually separate cables for two types of pain. And once I describe it, you’ll probably recognize it. The first type of pain is what we call acute pain. That’s the pain where someone breaks their leg or stubs their toe. Where you go, oh, oh, wow. You really feel acute pain. But there’s also a separate pathway, a separate group of fibers that go up to a relay station. Your brain that are actually there in terms of evolution are actually there before the sharp pain. And those fibers, that pathway sends messages of what we call deep, gnawing pain. It’s like, oh, I got something in my belly. Just feels, you know, it’s, it’s just uncomfortable. It’s or my back just, it’s not killing me. It’s not like I can’t walk, but it hurts all the time. It’s that deep gnawing pain. So those two pathways exist in the body that has a lot of importance, both psychologically and physically, because the two pathways have a different what we call neurotransmitters, and those are the chemicals that send the messages to the brain.

Dr. Jack Stern: So, for example, if someone has that deep gnawing pain and you give them an opiate, they probably will not respond because those pathways don’t recognize opiates, whereas the pathways that transmit messages of acute pain do have what we call opiate receptors and they are effective. So if you break a leg and the doctor gives you one of the narcotic analgesics, it will be effective. But usually not if you have chronic low back pain. And fortunately, part of the and I’ll just digress here a minute. Part of the opiate epidemic is because opiates have been giving for conditions that deal with chronic pain, not the acute pain that responds. So the anatomical pathways are complex. But the important point here is that there are two separate pathways, one for acute pain and one for chronic pain. And certainly the greatest psychological issues arise when patients are in chronic pain. Someone who comes into my office and says I’ve had back pain for six weeks, eight weeks a year, and it doesn’t get any better. And those are the folks that really suffer psychologically.

Gabe Howard: It sounds like what you’re describing should work the same for everybody, but we all know that it doesn’t work the same for everybody. And part of that is, is our psychological response. I think of me and my brother when my brother gets hurt, he’s like supercharges. He’s like, yeah. Feel the burn. When I get hurt, I’m in a corner, almost traumatized. And I’m not really exaggerating. I just have a very low pain tolerance. What is the psychological response to pain on the human body and why does it differ from person to person?

Dr. Jack Stern: I think that to answer that, we could break it up into two parts. One, there are real reasons, intrinsic or innate to your anatomy, where you have more receptors that sense pain and send more pain messages to your brain, and therefore your brother will feel the pain less and you will feel the pain more because you have more receptors. And we see that all the time. You hurt your toe, stub your finger and the other person stubs theirs and they’ll feel it because you have more receptors than they do. But from a psychological point of view, there’s clearly an indication that I’m wondering whether you had an experience once where you were in pain and it could have been when you were very young. And that memory is embedded in your brain. And that memory of that pain, even when we were very young, now raises its awareness and subconsciously your body says, oh, I had that sense of pain so long ago. I don’t want to endure that pain again. I don’t want to experience that pain again. So subconsciously, reliving that experience is something that I think that we all do. And how that experience, previous experience impacted what we’re doing now reflects on how we’re going to relate to the pain psychologically. Does that answer your question?

Gabe Howard: It does. It makes perfect sense. As much as it makes perfect sense from my standpoint, and that kind of leads me to my next question. From your standpoint, you need actual data. So you need to measure pain. But the only thing that I’ve ever seen that measures pain is that, you know, smiley face all the way to a sad face chart that nurses have handed me. And that seems rather ridiculous because as you pointed out, pain is different for everybody. Pain is very personal and there’s a psychological point to pain. I guess my actual question then is, can pain actually be measured?

Dr. Jack Stern: It can be measured, but it’s much too difficult to measure it on a regular basis. So what we do in the hospital is use this device of the smiley face to the frowning face to give us some indication of where the patient’s pain is. But as I think you were alluding to, it doesn’t give us an indication of what the psychological parameters are that are involved in that patient’s pain. I’ll give you an example. A woman can have a very difficult delivery and it could be painful. And this has been shown. This is not me guessing. And then they, maybe a few hours later, and because she had this very healthy baby, they almost always have a smiley face. And the idea that they were in pain during the labor seems to be suppressed. So what I’m saying is that there’s a real complexity to how you experience pain. And some of it has to do with your previous experience with pain.

Gabe Howard: It’s interesting that you say that some of it has to do with your previous experience of pain, because it sounds to me like if you have something really traumatic, let’s go with the broken leg. So I break my leg. Now I’m all 100 percent fine. It’s now a couple of years later and something lesser happens.

Dr. Jack Stern: Yeah.

Gabe Howard: You bang into a table and of course, that hurts. You know, banging your shin into a table is a painful thing. Are you saying that because of the pain that I experienced with the broken leg, that that’s going to psychologically influence the pain I experience in the lesser banging my shin?

Dr. Jack Stern: Invariably. Invariably, because there’s gonna be a fear factor, there’s gonna be an avoidance factor. There’s gonna be a memory of the previous pain. There’s gonna be a wish that this second injury isn’t severe. All those things come into play. I’d also point out that where you are psychologically, when you have either the first or especially the second injury in this case will affect your reaction to the pain. It’s clear that individuals who are depressed will experience the pain or relate that the pain is more severe than someone who is not depressed. And that goes across pretty much across the board. And you’ve seen you’ve probably met someone who’s depressed and the slightest thing bothers them. And they say, oh, that hurts. Oh, that. Oh, my. Oh, there’s this hurts, oh, that hurts. It’s because depression really magnifies. And that’s a great example of how the psychological affects the physical. For example, there was a really good study that showed that a significant number of men and women who have chronic pain, that is pain that lasts longer than it normally should for the same type of accident. A significant percentage of those individuals at some point in their lives were abused physically or emotionally abused. And the pain then evokes that previous abuse. We also know that pain frequently provides the individual with secondary gain. Sweetheart, my back hurts, so could you take out the garbage? Whereas, you know, you probably take out the garbage, but the individual is using it for secondary gain, for not doing what what’s been asked of them. And I see that all the time when it comes to intimacy, where couples one member does you know, I really can’t participate in any intimate activity because my back hurts. So it has tremendous, tremendous psychological overlay in any type of pain we talk about, particularly if the pain lasts for any length of time.

Gabe Howard: Stick around. We’ll be right back after these messages from our sponsors.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing the psychological effects of pain with Dr. Jack Stern. One of the things that this is kind of reminding me of is I suffer from anxiety disorder and I’ve had panic attacks and panic attacks are they’re awful. And anyone who’s suffered from one can agree with it. But one of the things that I noticed is my fear of having another panic attack was very limiting to me. There were places that I wouldn’t go, things that I wouldn’t do. And I had to work all that in therapy. It sounds like pain sort of follows the same kind of thing. Right. I’m so afraid of it hurting or being hurt that I’m skipping out on things. In your example, you said, you know, intimate activity with your partner because you’re afraid that it might hurt your back. Is that analogous?

Dr. Jack Stern: I think so, I think. Absolutely. I mean, you’re not having a panic attack, but you’re concerned that you may have a panic attack. So there’s an aversion reaction that may or may not be real and it may not be real at all because you may be able to do that whatever it is, without getting a panic attack. So I may be a patient who has low back pain, and I don’t want to maybe intelligently don’t want to live that, even though I probably could, because I may injure myself and recreate my back pain. But as I said, there’s some folks who use that psychologically. They probably could lift it but don’t want to because they just want to be nice that day. So once again, the variability is significant.

Gabe Howard: Staying with a panic attack analogy, the way that I got over it is by going to therapy. I spoke with my therapist. I shared my fears about having a panic attack. We worked on coping skills. We talked about why I was afraid of it. Is that the same treatment for folks who concerned about re-injury or pain, who are avoiding pleasurable activities in life because they’re afraid of re-injury or experiencing pain?

Dr. Jack Stern: I think that is a near perfect analogy. Yes. And, of course, I’m not I’m not a therapist. So for me, when I see a patient who has that fear of pain, fear of surgery, first of all, I won’t operate on someone like that. And number two, I will almost always ask the individual to get therapy and refer them to a therapist who specializes. And we have several such in this community who specialize in pain issues. And they will use a variety of techniques to help the individual deal with the pain. And as in your case, it sounds like a find out what the original pain episode was or panic episode was so they can deal with that initial episode and then try to prevent it from stymieing their activities again. So, yes, I think your analogy is a very good one.

Gabe Howard: Dr. Stern, I really appreciate you connecting mental health and physical health, and I’m very glad to hear that things are changing in the way that medicine is practiced. Because I’m only 43 years old. In the grand scheme, I’m not that old. But I remember in the 80s being afraid of surgery and just being told, you know, buck up, it’s not going to be so bad. Don’t you trust the doctors? It’s going to be okay. And then after the surgery, even though, you know, it was scary, it was just scary. People were like, well, the worst is over. I would always hear that phrase, well, the worst is over. This is the worst it’s going to be. You’ll be fine. It wasn’t until I had a mental health problem and I started treating both that I realized that there’s just so much interplay between our emotions about, in this case, pain and the actual pain and treating. Both is our fastest way to wellness. So, kudos,

Dr. Jack Stern: Yeah,

Gabe Howard: I love

Dr. Jack Stern: Yeah.

Gabe Howard: What you’re talking about here.

Dr. Jack Stern: Yeah, absolutely. I don’t know how you can separate it out, and once again, I relate to my own experiences about the whole world seems dark to me if one of my kids isn’t doing well. And everything, every negative aspect of my life suddenly seems to be amplified. And that’s both physical and mental. There’s also a phenomenon that I think is overlooked many times, and that is individuals who have pain, particularly chronic pain. Let me say two things. One, they for whatever reason, whether it’s actually physical or emotional, can function at the level that they could function before the onset of the pain. And I believe that many such individuals and I think this is also part of regular aging, we mourn for lost body parts. So we’re still alive, but we realize that we are not who we were because part of us and I don’t mean to be too dramatic here, but part of us has died. We can’t do that anymore. And we mourn the fact that we can’t do that. And I think that has significant psychological overlay, depression, maybe anger, et cetera. And I see that all the time in individuals. And I see it in myself in terms of I just came from the gym and I realized every time I go to the gym that I can’t do things that I did 10 and 20 years ago. And it really upsets me. And I’m a little depressed about it. And I see these young folks and I wish I were could do that again. But so that’s one. And that’s the loss of body parts.

Dr. Jack Stern: Number two, the big elephant in the room with patients or individuals who have chronic pain is the psychological effect it has on everyone else in their lives, how it affects their spouses, how it affects their children. Oh, Daddy, can’t you play with me? No, my back hurts. You know, my daddy never plays ball with me because his back always hurts. Everybody else’s daddy was always out there playing with them. So imagine the impact that that has on the child, not even on the individual who had the back pain. So this can be in a familial sense and a family could have tremendous psychological impact, senses of rejection, senses of less worthiness, a sense of anger that my dad was never there for me when he when everybody else’s dad was there. So these are the things we don’t talk about. These are the things that get swept under the rug until someone decides, you know, I’m going to have to deal with my pain. And what the impact of my pain had psychologically on those around me and frequently how the others, spouses, children, fellow employees, but mostly family members eventually go into therapy and say, why am I so upset with my father? I understand why he was never there for me. He was always complaining of back pain or it’s the same as if my dad wasn’t there because he was always working. But this is a cloud that hangs over families when there’s an individual who has back pain. It’s what I call the psychological unspoken of psychological cloud of back pain.

Gabe Howard: And Dr. Stern, you have a whole chapter in your book dedicated to the psychology of pain and especially for our listeners. That’s very important to understand. And the book is called Ending Back Pain: Five Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Where can they find it and where can they find you?

Dr. Jack Stern: So the book is obviously on Amazon and most Barnes & Noble, most bookstores. But if you’re like me, you buy everything on Amazon. That’s why he became the world’s richest person.

Gabe Howard: Very true.

Dr. Jack Stern: My wife says, there’s another box for you from Jeff Bezos waiting at the door. So. And you can find me. Actually, my Web site is called very simply, DrJackStern.com. And I actually have a place on that Web site where people can actually consult with me if they’re having back pain. And we take their histories. We even have them send us their MRI or CAT scans. And I then communicate with them to see if I can share with them my years of experience. So that’s also a possibility. DrJackStern.com.

Gabe Howard: Wonderful. Thank you so much for being here. I really appreciate it. I can’t thank you enough.

Dr. Jack Stern: Thank you, it was really interesting speaking to you.

Gabe Howard: Wonderful. And listen up, listeners, here’s what I need you to do. Wherever you download this podcast, please rate us however you feel is appropriate. But take the extra step. I would consider it a personal favor if you would use your words and tell people what you like about the podcast. Obviously, subscribe to our show, share us on social media. Email a friend. Hey, it’s a good excuse to talk to your mom. And remember, we have a private Facebook group at PsychCentral.com/FBShow. And as always, support our sponsor. You can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we will see everybody next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at show@psychcentral.com. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share with your friends, family, and followers.

    from https://ift.tt/2zF03N3 Check out https://daniejadkins.wordpress.com/

[twopintsandaprayer]

so everything’s been closed for like, a week and a half? i think it’s been a solid week of nothing going anywhere except for supplies

and like, my mother right, she’s definitely on the autism spectrum (not that she would ever, ever admit it because she has a very specific understanding of autism and what she has is not that). But she’s like, extremely low on empathy, or rather at expressing empathy. it’s like, hotbuttoned to wanting to fix whatever the problem is, and when she can’t fix it, she just gets frustrated. and she is frustrated with me all the time.

so I admit that I’m having a problem handling certain things about my chronic illnesses. (and it’s been getting worse, even though its something I have to deal with everyyear. and it’s a 100% just my own stupidity, rearing its ugly head. I’m fully capable of doing everything properly. I just forget. and then dealing with the fact I’ve screwed up, or lost somethiing, or forgotten, or don’t have something else done, or something has run out, just... i don’t deal with it. and I should be able to do it, there’s nothing stopping my ability to do it. and yet it is a struggle, every single time. I’m so sick of struggling. and my psychiatrist told me I was still lying to myself last time I talked to him. I still don’t know what he meant. and I’m lowkey terrified to go to my next appointment. he keeps cancelling them, because of conflicts. I got told off when I said I was running out of medication. honestly, I just...it takes so much effort to just stay alive.)

I admit a problem, or say I’m struggling and my mom yells at me, honest to goodness yells at me that everyone else has to do it, every single other person on this medication has to deal with the same process. did I think I was the exception. didn’t I realize that she is on the same medication, has to do all those steps too?

I am. intimately aware. that no one else struggles. over nothing. over nothing at all. quite like I do. I am fully and completely aware of the level of my own ineptitude and stupidity.

I am also fully aware that expressing too much negative emotion in this house is a sure fire way to start an argument. I know it. i just forget. I forget all the time.

asking for help in this family just gets you another argument. she gets mad that she can’t help, I know. but when I’m yelled at I just... shut down. I can’t handle it, it feels like knives inside. any attempt to explain myself, or refute what she’s saying gets immediately dismissed by as getting angry, or upset, or yelling. which I am obviously only doing to make her feel bad. or I’m overreacting. one of the two. I’m always overreacting.

like I can’t stop crying. the original issue is dealt with, and resolved peaceably. I’m not going to lose that $200. i just wish I hadn’t allowed myself to react at all. I really wish I hadn’t said I was struggling. I wish she hadn’t yelled at me.

I wish this wasn’t still something that I was dealing with at my age. And with the world’s economy just, completely going off the rails, like, we’re heading into a new dimension. I don’t see how I’ll ever be able to afford my own place.

i just need somebody to listen. I have to release these emotions like a pressure valve. I don’t know I can’t remember that she doesn’t understand me at all. If I tell her I accomplished something, or immediate reply is ‘is that all, what about this?’

like, does any of this matter? am I making this all up? is this what I’m lying about? am I reacting about nothing?

I feel like I’m suffocating all the time. like i’m trapped in tar, or pulled under water.

I told half of this to my friends. and they’re great. helped me make a plan to deal with the thing, listened to me complaining about my mother. but it’s a lot to put on their plates. I talk so much, I know it bugs them. I’m a burden on everyone.

i can’t figure out what i’m lying about. what did he mean? what did he mean? am I lying about being depressed? am i lying about feeling anxious? am I lying about wanting to be better?

I haven’t seen him in months. and I know he doesn’t like me. I know he thinks I’m overreacting. I probably am. Am I lying about needing help? am I too lazy to help myself? to do the work?

I told him the last time I was there that it’s getting harder to keep working towards my degree. that i don’t see the point in finishing, that its hard to see the point in anything. that’s when he said I was still lying to myself.

i

I don’t want to keep feeling this way. I can’t stand it, what a useless, pointless, pointless life

am I lying about that? am I faking it? what did he mean? what did he mean? what am I supposed to do?

does any of this matter, while this crisis is going on?

on the plus side, I’m like, significantly more likely to die is a catch the covid. strangely enough, it terrifies me. I’ve not done anything with my life worth doing, leaving nothing behind but debt and regrets and people better off

what a useless, useless, stupid life

what am I lying about, what is it, what is it, what is it, I can’t stand it. I can’t stand him not explaining. I can’t stand that every time I’m in there I feel like I’m faking it, like I’m two seconds away from a breakdown, like I’m bothering someone, like I’m taking up his time.

what did he mean? why wouldn’t he explain himself? what am I lying about? I didn’t think I was the habit of lying to myself, save about maybe what kind of work i’m going to put into my degree. but I can’t . . i don’t see the point, it’s all so pointless. I’ll get to the end of it and be right back where I started, except in more debt. I can’t get a good job unless I apply, without good relationships with people in the industry. if there are any jobs left at the end of this crisis. what the fuck what the fuck what the fuck .it’ll just be something else I can’t do, something else I’ll struggle with pointlessly. all I can see are the things I can’t do. it would be so easy to get good marks on everything.. I could get 100s on almost every subject, if I jsut did the fucking work.

but i don’t. and no amount of cajoling fixes that. who’d rely on me in a workplace? nobody in their right fucking mind. not the least of which I can barely replicate work other people do let alone add anything of use to what’s happening. everything is so confusing, all the time

i just...

i want to be done with fucking things up. I want to be competent and orderly and confident. I want to feel good about myself. I’m so tired of being so fuckin goddamn worthless. even when I do something well I gotta follow it with a massive fuck up

what the fuck is wrong with me. am I lying about the work I need to do to fix it? what the hell did he mean? what other goddamn way am I making something out of nothing??

it’s gonna be a rough goddamn year, folks