- So, you're in the same seat.
You're in the same seat.
You're in a different seat.
You're in the same seat.
They say if you're being mindful,
you should change the seat,
change the seat every day to get a new perspective.
But if you're being human,
you sit in the same spot every time,
'cause humans are creatures of habit.
'Cause our brains fall into these pathways very quickly.
Very quickly.
It's amazing how quickly your brain can fall into a circuit
that can just go.
And you don't even know that you're doing it.
You don't even know why you're doing it.
But you just automatically sit in the same seat.
You automatically walk in a certain path.
You automatically sit a certain way.
Walk a certain way.
And in Feldenkrais,
you probably work with that all the time, right?
With those habits, those brain somatic habits
of how you move and how you hold yourself,
and how you meet the world.
But it's amazing how quickly a habit can form
of having pain.
Or having worry or anxiety.
Or having fear of something.
Like if you have a fearful event
at a certain corner on a highway.
The next time you reach that corner of the highway,
what's gonna happen?
You're gonna tense up.
Your brain will automatically remember that,
even if you're not thinking of it.
Because subconsciously, your brain is always working.
It's always predicting.
It's always worried about you.
It's always protecting you.
And then those habits can become habitual,
I guess you would say. (laughs)
I guess that's why they're habits.
They become habitual.
And then you do it a little more and a little more,
and it becomes a habit.
And sometimes it's a little more.
That can happen with a simple itch.
You have a little bit of an itch,
and then you scratch.
And then you're scratch some more.
And pretty soon you're scratching all the time.
You're not even noticing that you're scratching.
And somebody points it out,
and you say, "Oh, I don't know.
I don't know why I'm doing what I'm doing."
One of the most influential books I read
when I started this work 20 years ago,
well there are two books.
One was called "Strangers to Ourselves" by Timothy Wilson.
And one was called "The Illusion of Conscious Will"
by Daniel Wegner.
And Wegner was a Harvard
and MIT psychologist who was very, very smart.
And he talked about how when you go to the store
and you choose a toothpaste.
You know, in America, there's way too many toothpastes.
It's very hard.
My father once went into a store
to buy some bandaids.
And 30 minutes later, my sister, who was waiting for him,
came in and said, "Did you get lost?
Are you okay?
Did you have.
What happened?"
He said, "I'm trying to find the best bandaids."
There was a hundred bandaids to choose from.
It's insane.
And he was very cheap.
So, he had to find the best cost and ratio.
Anyway, so you choose one,
and then someone will say,
"Why did you choose that one?"
And you'll say, "Oh, because of the, it's a nice box,"
or because of the, how many there were,
or what the value was, or what the cost was.
Or, I know this brand.
You have a reason why you chose that.
And research shows that chances are the reason you gave
is not the reason that you've chose that.
That's weird, right?
The reason you give
is a rationalisation you make to yourself
about why you chose it.
But the real reason, you don't even know why,
'cause it's subconscious.
And it's weird to think about that.
But this book is amazing.
One of the things that was influential to me
about the Daniel Wegner book is they studied people.
They said, "Okay."
They're measuring their brainwaves, right?
And they say, "Okay, you have a finger on a button,
whenever you want, press the button.
It's up to you.
You have agency.
You can choose at any point in the next,
take as long as you want.
At some point, press the button, okay?"
So, they're measuring the brainwaves.
And what they find
is that there's a brainwaves activity
that happens before you go to press the button.
Something happens in your brain,
and then you go, "Okay."
But you, when you ask them,
"When did you decide to press the button?"
You said here.
But something happened over here
that you're not aware of.
It's a subtle thing.
But it shows that we're doing things,
and we don't know exactly why.
The subconscious brain,
the brain that controls what we see,
what we hear, what we feel, what we experience,
what we like, what we don't like, is subconscious.
And it drives everything that we do.
And we're just trying to catch up to it.
And figure it out.
And it's amazing to think about it that way.
But when you understand the power of the brain,
then you can understand so many things
that have been unexplainable.
And in medicine,
we have these things called medically unexplained syndromes,
MUS.
And so you say, if someone comes in,
you say, "I've got this pain, I've got that pain.
I've got these other things."
And the doctor says, "Well, you have MUS."
What's MUS?
Medically unexplained syndrome.
That's helpful.
You're saying I'm unexplained.
You're saying it's inexplicable.
There's no reason for it.
That doesn't sound good.
So what we learned yesterday,
is that the brain controls what we experience.
So, here's a question for you.
When you talk to somebody about this work,
when you try to explain it.
There's lots of different ways of explaining it
that we talked about yesterday.
But what is the most important quality
that you can bring to the interaction
that you have with somebody,
when you're trying to explain something
that is sometimes hard to understand?
Sometimes counterintuitive.
Sometimes inexplicable.
Sometimes confusing.
What's the most important quality
that you can bring to that interaction?
Yes.
- Love. - Love, that's right.
Love, compassion, caring.
If someone doesn't know you care about them,
why would they even listen to you?
And I'm sure that's a cornerstone
of what Feldenkrais stands for.
I could be wrong.
But am I right?
Of course.
And what percentage of people
who have these medically unexplained symptoms,
what percentage of people who have chronic pain
that lasts for a long time?
What percentage of people who have chronic back pain,
chronic stomach pain, chronic pelvic pain?
What percentage of people
who have chronic headaches, or widespread pain,
or anxiety, or depression, or ringing in the ears,
or dizziness, or irritable bowel, or frequent urination.
What's the likely rough estimate
of percentage of those people
who have a mind-body condition, would you say?
It's about 90%.
85 to 90%, roughly.
For headaches, it's more like 95%.
For fibromyalgia, it's more like 99%.
I never say 100% because you never say never.
But it's really high,
is the point that I'm trying to make.
It's really high.
But it's not 100%.
There's a column in "The New York Times"
by a doctor named Dr. Lisa Sanders,
and she writes this column of,
you know, every month or so there's another case.
And the case always has a long history.
And the case always has the doctors.
Nobody can figure it out.
And then there's an answer.
Oh my goodness,
they had some rare condition that nobody could figure out.
Now they know what it is.
Great, everyone's happy.
It's kind of like that.
There's like any of the doctor TV shows.
"House" was a TV show where no one could figure out.
But Dr. House,
he could find the rare thing, that that was it.
And most people who have chronic conditions
that are elusive and hard to diagnose,
or hard to figure out, or they can't find answers,
that's what they're hoping for.
They're hoping that somebody can find
this rare condition.
This one thing that boom, ah, now we see it.
Here, take this medicine,
or do this treatment, you'll be fine.
The problem is rare conditions are rare.
They occur, but they're rare.
And common conditions are common.
I mean, I don't know,
I don't know how to make that anymore silly.
But it's true.
Common conditions are common, rare conditions are rare.
And the common conditions of back pain, headache,
widespread pain, irritable bowel, anxiety, depression,
fatigue, dizziness, tinnitus,
these are common conditions.
And most of the time,
the vast majority of the time,
they're going to be caused by a mind-body condition
and not a structural condition.
But not always.
So therefore, we wanna distinguish between the two.
We wanna see if we can do our best to figure out,
is it in this category, or this category, or some of each.
As I said yesterday,
many people in the fields of these medically unexplained,
or many people in the field of chronic pain,
will say it's always both, okay?
They say it's always both.
And to suggest
that it's either one or the other is ridiculous.
You're practising dualism.
The mind and the body are connected.
It always has to be both.
Well, of course, if you have a symptom, it's real.
A mind-body condition is real.
A conversion disorder is real.
It's not imaginary.
And if it's in the brain,
there's real things going on in the brain
that make it happen.
You know, as you're sitting here,
as you're looking, as you're listening,
as I'm talking, as I'm doing this.
Why am I doing that? I don't know.
But my brain is telling me
this is a good thing to do right now.
There's a tonne of neurochemical reactions, right?
Electrical signals and reactions that are going on
(imitates explosion) all the time in the brain.
And that's real.
It's not imaginary, it's physical.
But there's a difference in medicine
between something that's physiological and pathological.
This is a very important difference.
If you get scared, your heart rate may go up, right?
And if your heart rate goes up,
you go into a fight or flight reaction,
your heart rate goes rapid.
That is a physiological reaction.
It's not a disease of the heart.
A disease of the heart is a pathological reaction.
A disease of the heart is somebody who has a damage
to one part of the conducting system of the heart.
And the heart starts going into this rapid rate,
not because of the brain controlling the heart.
When you get fearful and frightened,
the brain is telling the heart to go faster,
and the heart goes faster, okay?
That rapid heart rate is under control of the brain.
It's physiologic, it's normal,
it's part of a normal reaction.
Heart rate would go up.
And then, when you realise that the thing that,
that eerie creaky sound was not an intruder,
it was the wind or something,
and you close the door, now you feel safe.
The heart rate goes down.
In the case of a rapid heart rate
due to an arrhythmia cardiac condition,
some damage to the heart that's not controlled by the brain,
the heart is doing it all by itself.
That's pathological, okay?
Is a very important difference.
And that difference determines this group or that group.
Can there be conditions where it's both?
Yes, certainly, there can be conditions where it's both.
In our back pain study we had 88% was non-structural,
6% was structural, 6% he thought was combined.
So combined is like some of each.
6% was purely structural, 88% was purely mind-body,
or purely neural circuit or neural plastic.
That's what you can expect when you see people.
But you don't want to assume that it's always neural plastic
'cause the last thing I would ever wanna do,
and I tell every patient of mine this,
the last thing I would ever, ever wanna do
is assume that something is a neural circuit
or a mind-body problem when in fact there's something wrong.
And in the United States,
you know what happens when you do that?
You get sued.
It's a very litigious society.
And you feel horrible.
I consider myself a very conservative physician
and trying to always, you know,
I mean, I was raised to be a good boy, you know?
I mean, clean your plate.
Yeah, I'll eat every bit of it.
That's why I look like... (laughs)
But I work really hard,
and I've spent a lot of time, my whole reputation,
you know, what do we have, you know,
in our profession is your reputation, your integrity.
And so my integrity, I take it very seriously.
It's based on doing the best job I can.
But why distinguish?
Why not just say it's always both?
That would be easy.
It would be so easy. It's always both.
I don't have to,
we can work with you, and we'll assume it's both.
We'll work on the body, we'll work on the brain, no problem.
But, as I said yesterday, that's the biopsychosocial motto.
When you say biopsychosocial, the people only hear bio.
So they're assuming there's something wrong.
And in our field,
I was attracted to this field in 2002
when someone said I should read a book by Dr. Sarno.
And I read the book,
and I was like, "Wow, that's really interesting."
And I learned more about it.
And I went to study with him, and I worked with him,
and I read, and I studied, and everything.
And I found when you,
and many of you know this,
when you get into this little field, this little niche,
there's a certain number of people
who have what's called the book cure.
Do you know what the book cure is?
You read a book, you get cured.
The book cure.
And it is not that rare.
It is amazingly common.
There's a documentary, "All the Rage," about Dr. Sarno.
And they interviewed David Stern,
all these, like, American celebrity,
David Stern, Larry David,
some other people.
There was a famous golfer they interviewed.
And these people, they would,
they'd read the book, or Dr. Sarno would say,
"There's nothing wrong with you.
You're fine."
Boom. Pain goes away.
After years of pain, boom,
it goes away within a day or a week.
The movie "This Might Hurt" that I was in
was made by Kent Bassett and Marion Cunningham.
Kent Bassett was in college his senior year of college
at Swarthmore University in Pennsylvania.
And he was lifting weights one day,
and he got a crick in his elbow.
And the next day, it didn't go away.
And then it got worse,
and then it spread to his arm and the other arm.
Pretty soon he couldn't type, he couldn't lift boxes,
he couldn't do anything, and there was no reason for it.
But he was in severe pain and disability.
He had to drop outta school, had to leave school,
went home, stayed with his mom.
He went to the best hand doctors
in New York City he could find.
And this doctor said, "I don't know what's wrong with you.
Don't let anybody operate on you."
That's good advice.
"And hopefully you'll get better."
"Well, what should I do?"
"We don't know.
You have medically unexplained symptoms."
So he went home and he tried acupuncture, physical therapy,
diets, variety of things.
And then, about nine months later,
he read a book by Dr. Sarno,
within a week, his pain was gone.
So how does that happen
that your pain goes away when you read a book?
It's amazing.
And it's not 90% of people read the book and it goes away,
but it's about, I don't know, we don't know a number.
Maybe 10%, maybe 20%, maybe even.
Some small percentage.
But it's that's, you know,
he sold a million of these books.
So 10% of a million is a lot of people
who've had their pain completely go away by reading a book.
And what happens there?
They shift the neural circuits.
It's education,
it's not therapy,
it's not emotional trauma work or whatever.
It was just shifting their understanding
of what the problem was.
And to me, this is a really important thing,
because that's why I feel it's really important
to try to distinguish between pathological problems
and physiologic problems.
So it's important to distinguish those two
from my point of view,
because a lot of people, just by that distinguishing,
just by that definition, by that recategorization,
can make all the difference in the world.
That's amazing.
And when you're in the middle,
you don't get that relief, that release.
When you're in the middle you say,
"Well, some of this, some of this.
Okay, well, now what?"
But if you're over here and you say,
"Yeah, actually, you're fine, you're gonna be fine."
Sometimes they go, their brain just clicks.
They go, "Yeah."
There's a release.
It turns off those neural circuits.
So that's, to me, a very important reason why,
why make the distinguishing,
why try to decide,
'cause it's the idea of recategorizing.
Remember I said yesterday about mindfulness?
How mindfulness is amazing?
Everyone should learn mindfulness.
I agree with that 100%.
And then, but why would mindfulness not work so well
for chronic pain?
Because the category of what the pain is
is a structural problem in the body.
And you're paying attention to it.
But it's not changing
because your categorization of it,
it's a structural, fixed, immutable,
unchangeable, irreversible problem.
And you can notice it, but it's not gonna change.
But when you change the category of the pain
from a structural problem in the body that won't change,
it won't get better.
You change that pain by reading a book
or by getting this new information,
you change it to,
basically, it's a neural circuit in the brain,
and basically, a neural circuit in the brain
is like a thought.
It's a thought.
Oh, just a thought.
Now, all of a sudden, it's not as dangerous,
it's not as scary.
It's more ephemeral, it's more changeable.
Thoughts come and thoughts go.
And then people are freer,
and 10%, 15%, whatever it is, of people just get better.
Sometimes people with those book cures,
a year later, or two years later, or five years later,
they get in a different stressful situation,
and now their pain comes back
or they get a new pain or a new symptom.
And then you know what they do?
They go back and read the book again.
(Howard laughs) (group laughs)
Makes sense.
Worked last time. It's really great.
I read the book again and guess what?
Didn't work.
Then they call me.
"Dr. Schubiner, I read the book again,
didn't work this time.
What do I do now?"
So that's why, to me,
it's really important to make distinguishing.
And that's what we're doing today.
Our job today is to learn how to make this distinguishing.
And now here's the other problem with distinguishing.
It seems like distinguishing is a word,
like, the word that we,
in medical term for that is diagnosing.
Well, diagnosing is a medical term.
You know, when you get a degree, you get, okay, you can be,
you can be a diagnostician.
But here on the screen,
I'm calling it assessment, not diagnosis.
But my point is, is that it is not hard.
Roughly 90% of people
with these situations have a mind-body disorder.
And 90% of the time,
it's very easy to distinguish
between these two categories.
Very easy, that anyone can do it.
And how do I know that?
Number one, I know it
because people read the book and they get better.
The reason they got better is they made an assessment
based on reading the book.
Oh, that's me, right?
They see themselves in the pages,
and then they know, "Oh, this is what I have."
And they're certain about it, and they get better.
And the techniques I'll show you are very simple
and easy to use.
And yes, it's not 100%.
I have trouble with assessment
or diagnosis of some people where I don't know,
I'm not sure.
I think maybe it is, maybe it's in this category,
maybe it's this, maybe it's in both.
Maybe we'll have to look harder, look longer.
Sometimes I don't know for sure,
and I'm just honest about that.
But when I know for sure, when I'm certain,
then I tell people, "Yes, I'm certain.
And I tell people,
I would never say that if I wasn't certain,
because that would be my integrity to say,
"Oh, I think it's this.
I'm sure it's this, but I really don't know."
I would never do that.
Does that make sense?
Okay.
So what we're gonna do is look at the assessment
or diagnosis of neural circuit disorders.
Let's take this hypothetical person,
a man with neck and back pain for 11 years.
Okay, first sentence.
He has neck and back pain for 11 years.
What's the chance this is a mind-body disorder at the start?
Very high, right? It's 11 years.
It's not that he's living in a cave
and never saw a doctor for 11 years.
He's been seeing doctors for 11 years,
and they haven't figured it out.
So what would you say then?
Oh, it must be medically unexplained.
Okay, well, now you're in our category.
Okay, he had a history of headaches beginning in his 20s.
What does that tell us?
Well, tells us he's human, basically.
In other words, he has a mind and a body.
And if something happened in his 20s,
he started getting headaches.
What's the chance those headaches
were a mind-body condition?
Pretty high.
He had an episode of depression in his 40s.
So now we have another time point when you look at his life
of seeing another condition,
depression is highly likely
to be a mind-body condition as well.
So you see him, this one person,
having likely episodes at different points in his life
that point back to this mind-body connection.
He got in an accident.
11 years ago, he fell when he was at a work.
He hit his head, he got a bruise on it.
He had a bruise on his head.
He did not lose consciousness.
He went to the hospital,
he did a CAT scan, CT scan of his brain.
It was normal. No bleed, no tumour, no infection.
He was observed overnight. He went home.
He had head pain for two days where the bruise was.
So he had an injury to his head,
he had a bruise, obvious injury.
It hurt for two days, and then that pain went away, okay?
That's what happens normally, right?
You have an injury, you have pain, heals,
the brain turns off the danger signal, it goes away.
Six days later, he developed neck pain.
What do you think about that?
Was the neck pain due to the fall?
Or was it due to something else?
It could be due to the fall, right?
He fell.
But how severe of a injury could you have
that doesn't show up until six days later?
I mean, it could be a twisting or turning, you know,
a malalignment, you know, something, I don't know.
But it's likely it wasn't a fracture or something severe.
And if it was a malalignment
or something that turned up six days later,
how long do you think it would last?
11 years?
I don't know.
In my estimation, probably not.
But anyway, and then six months later,
he develops low back pain,
and there's no precipitating cause for that.
So now, was the low back pain
due to the original injury six months ago?
I wouldn't think so.
You can make an argument that he turned something,
he twisted something, the fascia was off,
the bones were off.
It was a malalignment.
That malalignment caused malalignment down
and lower in the back,
and therefore he has pain that's spreading.
A lot of people would make that argument.
Okay, so he sought medical treatment, physical therapy,
his MRI shows degenerative disc disease,
degeneration at three levels.
A moderately large bulging disc,
facet arthropathy, spinal stenosis, foraminal narrowing.
These are all the things that you see normally in people
who are alive who have backs,
in this case, who are in their 50 years old people.
I used to have a lot of neck pain
when I was in my thirties and forties.
I would wake up sometimes, and my head would be like this,
and I'd go to work,
and I always said I slept on it wrong.
I'm sure it had nothing to do with the stress
of trying to build a career, being a father,
having small children, pressures.
Anyway.
And they told me I had arthritis in my neck,
and they had MRIs in my neck, and it shows exactly this.
My neck is exactly like this, only worse.
And now I'm way older than that. I'm almost double.
I'm more than double,
probably say double that what I was then.
I don't have any neck pain now.
My MRI is still very abnormal.
His lower back also has similar findings.
He had back injections.
There was some benefit, but it wasn't sustained.
He had surgery on his neck, but the pain got worse.
We talked about that yesterday.
His pain is now high.
He's on medication, including narcotics.
He's considering a stimulator.
He's been unable to work since the accident.
He's in a workman's compensation programme.
He has a lawsuit against his company after he was fired.
A lot of stress there, obviously, tonne of stress.
Lives with his wife, three children.
One of his children has a substance use disorder,
a lot of stress.
He himself used to have a drinking problem.
His father was abusive to him as a child.
Sensitization of the danger signal in the brain.
Dad passed away a while ago,
his mom is now elderly and needs help.
So there's a lot of clues here
that we're gonna talk about
that would suggest this is a mind-body disorder.
But the most important thing we're gonna talk about
is his neck pain is intermittent.
It comes and goes over the course of each day.
It's increased by head movements.
It's worse when it's cold or rainy.
The lower back pain is constant,
but the pain shifts from the right side
to the left side on certain days.
The pain also radiates up to his mid-back sometimes.
The pain is worse with bending over,
and it's worse with sitting in certain chairs
but not other chairs.
Herein on this slide tells us what the problem is.
And if you don't believe me, listen more. (laughs)
So how many of you would think, just based on what we,
what we have there,
that this is purely a structural problem?
How many would you think this is partly structural
and partly mind-body, kind of in the middle?
How many of you would think
this is a really all mind-body problem?
How many of you don't vote?
(Howard laughs) (group laughs)
Okay, so what we're doing here,
the process of the assessment, the way I think of it
is to validate their situation.
I hear you. I see you.
I know what you have is real.
I know it's not in your head.
I can't imagine what it's like,
and I'm sorry that this has happened to you.
I'm sorry for your struggles.
And tell me your story.
Let me listen.
I was saying last night,
I saw a woman who was a mom of a good friend of mine.
He is a psychologist that I've done research with.
This young psychologist, really brilliant, really great.
And I really wanted to help his mom.
You know, I was like, "I really wanna do a good job for you.
You're my friend.
You're a colleague, a research colleague of mine.
I'm gonna see your mom.
What an honour to see your mom."
So his mom has a long story,
and normally it takes me about 30 minutes
to get this part of the assessment.
But sometimes it takes an hour.
So it's roughly in that area.
And I usually book two hours,
so if it's an hour,
I have a whole nother hour to do all the treatment,
a lot of the treatment that we're gonna talk about tomorrow
and the next day.
So I start to, we start to talk,
and I'm listening to her story,
and I'm saying, "Oh yeah, oh wow, that happened.
That's weird, that's horrible,
that's amazing, and tell me more."
And so she's telling me,
and then it's becomes obvious
that she needs to tell the whole story.
And the whole story is very long.
And it doesn't go on for half an hour.
It doesn't go on for an hour.
It goes on for the whole hour and a half
to just hear the story.
But I listened, and the last half hour we wrapped it up,
and I explained what we're gonna do and how we're doing it
and gave her some of the initial tips.
And she was so happy.
No one had ever listened to her story.
No one had ever listened.
Who could take the time for that?
I could barely do it myself.
But I did it, and I found it was so helpful,
and she became one of my best patients.
She was so on board.
She was so ready to listen to what I was saying
because of that connection.
So listening,
explaining and listening with love basically, right?
So then we're explaining pain and predictive processing,
which we talked about yesterday, how to do that.
And now what we're gonna do today
is take the medical history,
looking for evidence of FIT,
functional, inconsistent, triggered.
We're gonna spend today talking about this.
We're gonna spend today talking about this,
looking at the life story,
looking for linkages.
Like the patient we just said.
In his 20s, he got headaches.
So, gee, what was going on in your 20s?
I'd like to know.
In your 40s, you got depression.
What was going on in your 40s?
I'd like to know.
Express empathy again, examine, look for evidence,
look at any medical testing that's been done.
Make sure that the person
has had some routine medical testing
that we don't wanna miss some horrible disease.
And then you can begin to personalise the information.
Explain again, hope, optimism, start treatment.
So what we're focusing on today is the FIT,
the linkages, and the evidence.
So if you go to the doctor and you have pain,
if you go to the doctor and you have fever,
your child has a fever,
and the doctor says, "Oh, your child has fever.
Paracetamol, Tylenol, cold packs."
Sound good?
No, you wanna know why does my child have a fever.
And the field of pain has thought
to treat all pain the same.
It doesn't matter what kind of pain you have,
we can treat it the same.
We can treat it with medications,
injections, physical therapy.
We can treat it with cognitive behavioural therapy
because we treat ACT, we treat all pain the same.
And the reason why what we're talking about
seems to work better than cognitive behavioural therapy
and acceptance and commitment therapy
is because we're not treating all pain the same.
We're making a categorization.
It's incredibly common
that these medically unexplained symptoms occur.
At least in this meta-analysis of studies,
40 to 50% of patients
had at least one medically unexplained symptom.
That's incredibly common.
This happens every day.
Doctors are seeing this every day.
Up to a third of people are diagnosed
with a somatoform disorder.
It's another way of saying pain of unknown origin.
Pain due to the brain, pain due to stress.
Most people with pain have pain in several places.
Most people with pain have several other symptoms going on.
It's not just one.
Like that patient, he had, if you look back in his life,
he had the headaches, he had the depression,
he had the neck pain, and the back pain.
Not just one thing.
So let's just go through a list
of some of the things that we see.
Irritable bowel,
or there's a term called functional dyspepsia.
Functional dyspepsia means you have upper stomach nausea
or upper stomach pain,
and the tests are normal.
So functional is a term doctors use
when it's saying it's not structural.
Dyspepsia just means uncomfortableness
or upset stomach.
Irritable bowel syndrome
is only diagnosed as irritable bowel
when the tests are normal,
colonoscopy is normal, ultrasound is normal,
upper GI is normal.
There's no evidence of gluten neuropathy or celiac disease.
No evidence of lactose intolerance, whatever.
All the tests are normal.
Okay, so with these, if you have this,
patient comes in saying, "Well, I've seen my doctors,
and they say it's irritable bowel syndrome."
Good. Now you know what it is.
You don't have to worry about figuring it out,
but I'll show you how to do that as well.
But you can be quite reassured
that this is a mind-body disorder.
Same with if the diagnosis is functional dyspepsia.
If the diagnosis is FM, or fibromyalgia,
chronic widespread pain.
If that's the diagnosis after testing
because the testing rules out lupus,
and rheumatoid arthritis,
and other inflammatory or arthritic conditions,
so that's a mind-body disorder.
MPS means myofascial pain syndrome,
which means there's pain in the muscles in the fascia,
which is just another word
for saying chronic widespread pain of unknown cause.
That's a mind-body disorder.
It turns out people have curved spines.
Curved spines don't actually cause pain.
But everyone thinks they do.
And the doctors now think they do.
But I'm old enough to know when I was young,
we never thought scoliosis caused pain.
It can cause deformity, it doesn't look good sometimes,
but it doesn't actually cause pain.
And we have cases,
we had one lady who had like this really 70 degree
and in one month her pain had gone away.
Weak core, tight hamstrings.
There's all these things.
And physical therapists,
I forgot if there's physical therapists here,
occupational therapists.
We teach a lot of physical therapists,
and what we're teaching them, and this is horrible,
but what we're teaching them
is to unlearn some of the things that they were told.
It's not that people don't have tight hamstrings,
or a weak core, or leg length discrepancy, or lateral shift.
There's a whole host of things
that are these minor deviations or abnormalities.
But we weren't,
we haven't been on this earth for tens of thousands of years
to have these minor deviations
cause such disability and suffering.
But we're seeing those, and then we're attributing,
it's a question of attribution.
What we're attributing the pain due to.
In the brain, chronic fatigue syndrome.
This is an area of hot and tremendous controversy.
And as I think we mentioned maybe yesterday,
people in the chronic fatigue community
are determined that they have,
that they can't possibly be a mind-body condition.
It has to be some structural disorder,
but nobody's found it yet.
We'll just wait until the medical science catches up to us
and finds us a cure.
But meanwhile, the suffering is tremendous and horrible.
Tension and migraine headaches, facial pain,
the one I talked about yesterday is called suicide disease.
These are mind-body conditions.
Even though in the facial pain syndrome,
you can have an MRI, which shows,
which can show, well, there's some pressure on the nerve,
or there's some pressure in the artery,
there's some pressure on the vein.
But it turns out,
people who have no pain also have similar MRIs.
Same as with the backs,
where MRIs are abnormal in normal people.
Small fibre neuropathy, have you heard of that?
Small fibre neuropathy is a new disease
which consists of tingling, and burning,
and numbness of the hands and the feet usually.
You can have that kind of problem if you have nerve damage.
People with diabetes can have nerve damage
and have tingling and burning of pain in the hands and feet.
It's not uncommon.
But in this case, people don't have diabetes.
They don't have a reason for nerve damage,
like toxins, or chemotherapy, or alcohol toxicity.
They just have the tingling and burning,
and all the tests are normal.
The hands move, and everything's fine neurologically.
But to have these symptoms,
so the doctors are assuming these symptoms are due
to a small fibre neuropathy,
that the small nerves are damaged.
There's a biopsy for it even.
You can have a biopsy which shows small fibre neuropathy.
So I had a patient come to me in a wheelchair
'cause she couldn't put any weight on her feet.
Her feet were so tender,
and she had been to the Mayo Clinic,
and she had a biopsy showing small fibre neuropathy,
and she's fine now.
Within two months, she was perfectly fine.
And it turns out if you do studies on people who are normal,
many people who are normal
and don't have any of these symptoms,
have the same biopsy findings.
So it's really so hard on patients
when you go to a big medical centre,
you even get a biopsy of your skin,
and they say, "Oh, you've got this disease,"
to think that somehow that could be due to the brain.
But this is a really common now disorder.
Postherpetic neuralgia, shingles, or herpes zoster.
Have you seen people who've had shingles
and they have the rash on their face or their,
or their trunk or somewhere.
And then it's very painful when you first get it,
there's a horrible rash,
and then, the rash heals, the virus goes dormant,
but then the pain keeps coming back.
And when I started this work,
I thought that pain was due to the virus
just coming out and coming out and coming out again.
But since then I've seen people,
and we've cured people with that.
I had this one guy who had this arm pain
due to this post-shingles,
and he could look at it and it would come,
and then he would say, "Yeah, it's fine."
And then it would go away.
And he'd look at it again, and it would come back again.
He could control it by his attention.
Remember the two women on the picture yesterday?
You see the one, you see the other based on your attention.
He could control his pain by paying attention to it or not.
So it's amazing.
TMJ, I think we talked about that yesterday.
A lot of times, and people, again,
if you look at the X-rays or the MRIs,
there's all these problems in the joint.
But if you look closely enough,
which we'll talk about how to do that today,
if you look closely enough,
you'll find that it's mind-body.
Interstitial cystitis, pelvic floor dysfunction,
pudendal neuralgia, vulvodynia.
These are all pelvic pain syndromes that are common,
that are mind-body disorders, just based on those words.
'cause those words don't mean anything
other than you have pain.
But they're scary to people when you hear those words.
They're scary.
And I think we talked
about endometriosis yesterday a little bit.
Endometriosis can certainly cause pain if it's severe.
But a lot of women have endometriosis with no pain at all.
And again, you can distinguish,
you can distinguish one camp versus the other
based on the listening to the story,
which we're gonna talk about in a minute.
In psychiatry, anxiety, depression, PTSD,
these are almost always mind-body disorders,
unless there's some hormonal problem.
When you go to bipolar, schizophrenia,
you know, we don't really tend to treat
those more kind of, quote, "serious disorders"
as mind-body disorders,
usually people get psychiatric treatment as well.
But there's a lot of people diagnosed nowadays
with bipolar disorder that it's just a mild,
like they're up, they're down.
Oh, you've got bipolar.
So there's been a creep, you know what I mean by creep?
It's like more and more people getting diagnosed
with getting labels of things.
There's a really, really important book
by a guy named Robert Whitaker
called "Anatomy of an Epidemic."
And Robert Whitaker is a journalist who started,
he was a science writer,
and he heard about this research study on bipolar disorder
where they were gonna give randomised people
to get a medication for a bipolar disorder versus a placebo.
And he's like, "How can you do that?
That's gotta be unethical.
Give a placebo to someone with bipolar disorder."
So he started to study, he went and looked at that.
It took him five years.
He went on this journey of five years or so or more
to look at the whole world of psychiatric literature
and psychiatric medications.
And it was incredible what he found.
Not making things up,
looking at the actual research that had been done,
showing that,
just like I showed you yesterday
about the depression medications,
that the placebo was as good
as the medication almost all the time.
And he found that for all these other disorders as well.
It's amazing.
So in my view, and I'm not Gabor Mate,
but in my view, cancer is not a mind-body disorder.
Can the mind affect cancer? Maybe.
Maybe sometimes, maybe in some people.
I have a good friend now who has cancer,
and she's on a very special diet,
and she feels it's helping her.
And I'm like, "Yes, go for it."
She's doing mind-body therapy as well.
Great, go for it.
But I'm not gonna stand up and take my medical credibility
and say, "Oh, we can cure all cancer by changing your mind."
I just don't think that's true.
And I would never say that.
HIV is a real disease, Lyme disease is a real disease.
Chronic Lyme disease is not.
There's a difference.
Lyme disease is curable. Antibiotics.
If you have Lyme disease in your brain,
severe Lyme disease in your brain,
and you take antibiotics for two weeks cured,
100% cured,.
100% cured. It's amazing.
So Lyme disease is curable.
Chronic Lyme disease is an invention of doctors
and folks who have a need,
not consciously, they're not bad or anyway,
but have a need to make the symptoms physical.
That there has to be a structural reason for 'em.
Parkinson's disease, dementia, ALS,
these are diseases that are brain diseases.
These are pathological conditions.
These are not due just to neural circuits.
On the other hand,
people with Parkinson's can have amazing changes
based on mind
because you can teach the brain to rewire.
After you have a stroke, you teach your brain to rewire.
And there's been some really interesting stuff
with Parkinson's disease where people can teach.
Like if they hold a cup like this, they're shaking.
But if they hold a cup like this, then they won't shake
'cause there's the habit.
The brain has this neural circuit
of the tremor in a certain way
and do it this way, and they won't shake.
So Parkinson's really interesting.
I'm not saying you can cure it by mind-body problems,
but there's ways of helping people rewire
from what I've seen.
And there's some people who have ruptured discs
that are pressing on the nerve that may need surgery.
But most people have actual huge ruptured discs
that's pressing on the nerve with pain down the leg.
90, 95% of those will get better with no treatment at all.
Now the ones that are really in the middle
are autoimmune disorders,
because there's a field of psycho-neuroimmunology.
The brain can control the immune system.
And that's been well documented.
But when you have lupus rheumatoid,
your joints can be certainly physically damaged, right?
And you can have inflammation, red hot,
what we would call macro inflammation.
Macro inflammation is inflammation you can see.
Red, hot, swollen, even with pus like a strep throat.
Red hot, swollen with pus, gout in the joint.
Red, hot, swollen.
Those are structural conditions.
But the brain can control the immune system,
at least to some degree.
And in these situations where you can have both,
you can treat both.
And it's a great opportunity to do both mind-body
and medical treatment as necessary.
Just because someone has a history of rheumatoid arthritis
doesn't mean that their pain is always rheumatoid arthritis.
In other words, you can,
if they had rheumatoid,
rheumatoid arthritis can go dormant and there'll be no pain.
But you can have continued pain due to mind-body pain
even though you had rheumatoid arthritis.
Why? Well, because of stress in your life.
But also, having rheumatoid arthritis
is stressful in and of itself,
and it makes you concerned about your joints,
and you're looking at your hands all the time
or you're looking at your knees all the time.
And when you're in a stressful situation,
maybe your brain will turn on that pain
because the brain has learned that pain
from having the actual disease of rheumatoid arthritis.
Does that make sense what I'm saying?
So that's why this investigation that I'm talking about,
the FIT criteria,
and as you'll see in a minute,
will help us to determine if it's in this category
or this category right now, today.
Not just based on the name.
MS is similar, it's an autoimmune disorder.
It can certainly cause severe damage in the nerves,
in the myelin sheaths of the body.
And so it's a neurologic disease,
it's not a mind-body condition.
But there may be some opportunity to work with it
in a mind-body way.
Vertigo and dizziness,
most of the time, are actually mind-body.
But you can certainly have ear damage or ear diseases.
Osteoarthritis.
So everyone has arthritis.
Osteoarthritis is the common wear-and-tear arthritis, right?
Everyone has some of it on X-ray
because when you take X-rays of people,
most people have some,
at least they define osteoarthritis in the knees
or the hips, or shoulders, mild, moderate, or severe.
And people with very severe,
I had a person email me about,
"I'm sure this is a mind-body problem."
And he showed me his X-ray of his hip.
His hip was, like, totally destroyed.
I said, "No, I think that's, you need a new hip."
Some people need new hips.
On the other hand, nowadays, doctors in the States,
I don't know about here,
but doctors in the States are very quick
to say you need a new knee or a new shoulder,
or you need a based on an X-ray
that shows mild to moderate arthritis and you have pain.
But what we're talking about today
is how to determine if the pain is in this category
or in this category,
not based on the X-ray,
but based on the characteristics of the pain.
Does it come? Does it go?
Does it turn off? Does it shift?
Does it move? What triggers it?
So this requires more investigation.
Crohn's disease and ulcerative colitis
are autoimmune disorders.
So they're in the same category as lupus
and rheumatoid arthritis.
Chronic fatigue syndrome,
SEID is severe exertional intolerance disease.
It's a name made up to really scare you.
Severe and exertional intolerance disease.
Chronic Lyme disease, chronic Epstein-Barr, chronic CMV,
these are mind-body disorders.
Another new one is Ehlers-Danlos syndrome.
So, are you familiar with that?
So Ehlers-Danlos syndrome
is the newest of these whole disorders.
And there is a genetic disease
called Ehlers-Danlos syndrome.
And these people are hyper-flexible.
Like they can take their thumb and touch here.
Can anyone do that?
Children are very flexible.
But as you get older, you get less flexible.
But there's tests for how flexible you are.
And people with the genetic condition
of Ehlers-Danlos can have,
their joints often easily dislocate like a shoulder.
It's easy for people with this genetic disease.
Their shoulder just go out of joint.
Needs to be put back.
Their kneecap, the patella,
go out of joint, needs to be put back.
Even the lens of the eye can be dislocated
'cause the tissues are more flexible,
more elastic, so to speak.
So you have very rare disease that's genetic disorder.
But now what people are saying is,
"Oh, you're somewhat flexible,
you're more flexible than normal,
and you're more flexibility than normal
is causing all of your pain."
And I believe that's wrong.
It's really dangerous thinking.
And just because you're more flexible,
you're gonna have more pain?
It doesn't make any sense to me.
You'll see it and hear it.
And people are being diagnosed
with different types of Ehlers-Danlos
that are mild conditions.
And all of their pain is being blamed on that.
And now they have a reason.
And now, the more you have a reason for what it is,
the more you think you have a structural problem,
the more you think you're gonna be crippled for life.
How does that affect the neural circuits in your brain?
It's gonna make you worse.
And that's what we're seeing with this disorder,
Ehlers-Danlos.
Chronic constipation, GERD.
SIBO is a bacterial overgrowth.
That's another new one
that's being diagnosed very frequently in people.
Which again, it's a rare disease
that can happen in some people,
but it generally only happens in people
who've had surgery on their bowel.
And there's what's called a blind loop.
A blind loop that goes nowhere and comes back.
The bacteria can overgrowth in that blind loop,
and that's a syndrome.
But people who've never had GI surgery
to have this bacterial overgrowth, no.
So there's just a lot of stuff that we're dealing with.
POTS is another new one.
P-O-T-S, postural orthostatic tachycardia syndrome.
It's being treated by cardiologists.
It's peoples who stand up and get dizzy,
and their heart rate goes up.
They stand up, their heart rate goes up, they get dizzy,
but their blood pressure doesn't go down.
If you stand up and your blood pressure goes down
and you're dizzy,
well, you're dizzy because your blood pressure went down.
That makes sense.
But in this case, the blood pressure hasn't gone down.
So the dizziness is not due to lower blood pressure.
It's not due to having a rapid,
a rapid heart rate doesn't cause dizziness.
It's due to a brain.
This is a mind-body syndrome that is now being treated
with all these different medications by cardiologists
who don't understand the mind-body condition.
And it's taking people down this path
of they have this horrible disease that's incurable.
I mean, do you see what's happening in our world today?
This medicalization of all these syndromes?
So mast cell activation is the newest,
really the brand newest one.
And what that means is that people have been told
that they have a histamine problem.
Histamine is a chemical that causes itching
and allergic reactions.
Like, that's why we take antihistamines
for hay fever, right?
So mast cell activation syndrome,
the idea is that you have your mast cells
are this type of cell that's for allergies.
When you get an allergy, and it releases histamine,
and you have a reaction.
Well, they say,
"Well, your mast cells are damaged and broken,
and you're releasing histamine all the time,
and you're releasing histamine in relation to foods."
Well, it's this food.
Well, it's not just dairy and not just wheat,
it's dairy, and wheat, and eggs.
And then it's more and more and more and more and more.
And remember I told you yesterday about the guy
who could eat only chicken and rice for three years?
That's what he supposedly had was this.
And then he was allergic to smells,
and perfumes, and even electromagnetic frequencies.
And there's all this stuff that people are telling you,
and it's getting worse and worse and worse.
And the more you're afraid of something, the worse it gets.
And the more you're afraid of one food,
then you get the other food and the other food,
and it spirals.
And people are almost dying from this
because if they're not eating any food,
they're unable to eat 'cause the foods are causing,
are actually causing the brain to activate severe itching,
or head migraine, or pain all over.
All these symptoms.
And there were a hundred thousand people
on the Mast Cell Activation website.
So there's support groups for all these things, right?
And online.
And what happens when you read about this disorder
that you have
and you read about other people who have it,
what's gonna happen?
You will get worse
because you're seeing I have this and this,
oh, but they have this, this, and this.
And then, guess what?
You start getting this, this, and this.
Just like the TikTok ticks and it gets worse and worse.
He said there were a hundred thousand people
on that website.
And finally, he had to leave the website
'cause it was hurting him.
It was causing him to get worse and worse.
So he stopped doing that.
He started doing mind-body work.
It took him two years to get better.
If you look up something
called Histamine Deception on YouTube, Histamine Deception,
that's him, this guy, my patient's name is Joe.
And he tells his story.
It's an amazing story to read.
So he went back on the website after he was recovered
and now he's not having symptoms.
He can eat any food he wants now.
And he went back on the website,
there's not a hundred thousand people on the website now.
There's 200,000 all suffering from this disorder
that doesn't really exist.
And so he went on the website, and what did he do?
He said, "Hey, I'm better, you know?
I did this mind-body therapy.
It's amazing. I'm better.
Some of you might wanna try it."
So what do you think they did to him on the website?
Kicked him off the website.
So almost any symptom can be caused by neural circuits.
The brain can cause a whole variety of symptoms.
Unbelievable variety.
Well, how it chooses, which ones, hard to know why.
And structural problems can also cause these disorders.
So now we're gonna take a break,
and we're gonna go into the next thing.
We're gonna talk about how we distinguish.