- I enjoyed watching your interaction,
and your discussion
and your dedication
and your diligence,
and I really enjoyed your laughing
and your joy and discovery.
And someone was saying, it's like being a detective.
That's what I feel.
And it's so much fun to be a detective,
to have an idea and a model,
an understanding of how this works,
and then see if it fits, see if you can apply it,
see where it works.
And the model is so robust,
it's a robust model of stress,
and emotions cause the brain
to produce sensations in the body, oftentimes.
And it's often so interesting
how eerie it can be
in terms of what kinds of situations occurred in young life,
and then the same situation can occur later.
As you saw in the video, with a young woman
who had a father who was critical, and get angry,
and then maybe a boyfriend,
and then another romantic partner,
and now she's getting married,
and there's these little things,
and it just takes a little bit of something
to trigger her brain when she's going to the wedding planner
because of how the brain was primed to be triggered
back earlier in life.
And you can see the confluence,
and you can see the connection,
and you can understand it and it makes sense.
And then you can know,
and she can help to be see that,
you know, on one level she's not in danger now,
the person she's marrying is great, is fine.
But, might there be some room for her
to speak, to have a voice,
to help to make sure that he understands
that there's some parts of the way he is
that may not work for her.
Is that possible? Would that be good for her?
Would that be good for their relationship?
Maybe. Right?
Does that make sense?
And so, the fact that she's having this pelvic pain
is an opportunity.
We're gonna talk a lot about that tomorrow,
what are the opportunities we have?
And I was saying, I think to Arnold, about,
one of my favourite detectives when I was young was Colombo,
Colombo was Richard Falk?
Peter Falk, Peter Falk.
And he had this shabby coat on,
and he was always dealing with these rich and famous people,
and he was very shabby.
And he would go, "Gee, I wonder why that happened,
can you explain that?"
And he would get the criminal or the murderer
to try to explain it, (chuckles)
and he got deeper and deeper.
But the questioning, just the simple question,
I wonder why, why did that happen?
Like Nicos was saying about his palms,
and we were wondering oh, gee, why does that happen?
Do you wanna say something about that?
- We were just talking about
how also it's a shift in mindset about a lot of things,
not just pain, but like you started questioning
a lot of other personal things
that you have in your life, no?
And one I had two at least that have come to mind
since being introduced to the work which,
one was that whenever I would eat oat,
I had belly pain.
But for me I was like, that's the only thing
that makes me feel pain in my belly,
so I was like, okay,
it must be something about oat that I can't digest, no?
And then years later now thinking about it, I said,
okay, but I was eating oat every morning
before going to school, and school was pretty stressful.
(Group chuckles)
And then it's like, okay,
maybe my brain just did a bug there and sort of,
okay, it's the oat provoking the stress, I don't know.
- And then,
maybe your brain connected the stress with the oats,
and then the brain was causing pain with the oats.
But then, when you're outta school, it might continue.
- [Nicos] Yeah, and that's what happened.
- Even later in life,
you're not in school anymore and still, oats,
your brain is still oats bad, oats bad.
- So Howard, also switching on and off
the circuits in the brain.
So when I was 14, 15, same stressful school period,
but also that,
I would get sweaty palms whenever stressful situations,
but also just if I didn't think about it, it would be fine,
and then suddenly it was like, oh my god,
my hands are not sweaty, and then it would become sweaty.
(Howard chuckles)
And you think like, but how do I control this, no?
How can I think about it differently?
Hay fever also,
but that was like last year, riding back on the bike,
suddenly like every year in June you'd have hay fever.
And suddenly last year I thought,
but I started riding the bike back
and I could start feel the tickling in my nose and the eyes,
and I was like, wait, wait, wait, wait, wait, wait, wait,
just stop for a second, what's going on?
And then I realised like it was a tiny bit of fear of that,
and then I thought maybe it's the fear then
going crazy in the brain about the hay fever.
And actually then it dampened it
for the whole month of hay fever,
that it was almost nothing.
So it has so many ramifications
when you start thinking about it,
in all these small details of your own personal life
of what you took for granted.
- And people always say, why do I have this?
And I say, because you're human.
Just human, we all have this, it's part of being alive.
Mind and body, we all have it.
We all have these stories.
And the more you can see it in yourself
and be open to be able to tell your story to other people,
it helps them to accept, it helps them to understand,
it helps to normalise it
as opposed to medicalizing it or pathologizing it.
It helps it to be part of something that is normal routine
and something we can deal with.
So I really appreciate your,
not that I forced you or anything,
(All chuckle)
but it's really, really, really great to say that.
Thank you, Nicos.
So if you can see this work in yourself,
it will be a great benefit for helping other people.
Because if you can see it in yourself,
and I guarantee you'll find something, most likely,
that you have had, or in the past, or have now,
or will have, whatever, that are mind-body.
And then you can investigate it,
and you can kind of do this work for yourself,
and it will help you,
and it'll help people to normalise it
if you can tell them about it.
- And how do you work when it's combined,
when there is a structural something,
and when you notice
that there are also emotional other things,
how do you deal with the,
because I guess it's more difficult
to convince someone who's got both.
- I have found it's much simpler and easier
when you can confirm
that it's completely a mind-body problem.
Much easier, in my experience.
Patients get much better quicker.
All things are good when you're in that category.
And most of the time we are in that category.
And I work very hard to be truthful and honest
and have integrity,
but look for the clues that will put us in this category.
But sometimes there's a lot of doubt, or there's worry,
or there's truly some other structural problem going on,
that we have to do both.
When we're doing both,
we're shifting away from the curing model a little bit,
and we're shifting a bit toward the coping model.
And the coping model is to help people function better
with whatever they have,
which is not a bad model, it's fine.
And many people can do very well with that model.
And many people can allay their fears
and keep moving, keep going,
and even if they still have some pain
and they accept that they still have some pain,
they've got a hip problem or a knee problem,
but they can work with it, and they can do well.
So I'm trying really hard to be truthful,
and trying really hard to look for the clues,
and look for putting us in this category.
If it's not true,
then we do more of a coping model, and we use both.
- Continuing from the question just before,
if you are going on a coping model,
is the person not really going
to the stress, tension and emotions?
- Well, as we'll see on Thursday,
you can use the emotional connecting,
emotional processing work that we do with anybody.
Tomorrow we're gonna focus
on the pain reprocessing therapy for the whole day.
That model different than cognitive behavioural therapy,
it's different than acceptance and commitment therapy,
it's different than straight mindfulness.
We include mindfulness, you'll see.
That model should be applied,
and we apply it to people who have mind-body disorders.
And pretty much,
it works when there is a mind-body disorder,
and it doesn't work as well when it's combined
or purely structural.
'Cause it's geared, it's designed for mind-body problems.
The emotional awareness work that we're doing
on Thursday, and Friday morning I think,
you can do for anybody.
And it can have the great value of helping to see things,
helping to uncover things in people's lives,
in their hearts, in their minds, in their souls.
And, frequently when you do emotional processing work,
the pain may actually go away as well, as magic. (chuckles)
And then you say, oh, look at that,
we just learned something.
We thought this might've been structural,
but hey, it just shifted.
- Just a question continuing on that,
if the person is not ready, we do the emotional processing,
they know exactly what's going on,
the pain is totally gone,
but they're not ready, and they bring it back.
- Well, the brain is complicated, people are complicated,
lives are complicated.
Many people have what we sometimes call,
I don't use this term,
but it's common term called secondary gain.
The idea that, well, there's a reason for the pain,
and the pain is helping me in some way,
and I don't really want to give it up.
I don't believe
that people really don't want to give up their pain,
'cause pain is pretty bad.
And I haven't met people who wanna keep their pain
on a conscious level.
Subconsciously, the pain may be doing
something useful for them.
Of course it is.
You know, when I twist my ankle,
I'm like, honey, can you do these chores for me,
honey, can you do that for me, honey, of course.
Who doesn't want someone to wait on them? I do.
Everyone does. (chuckles)
So these are just things that we can bring up
and hope to make the subconscious conscious
so that we can look at and help people figure out
what's really best for them, if that makes sense.
In my book, I call it barriers,
barriers to getting better that everybody has.
And it takes, like the woman that I presented
who was in the difficult marriages, and the abuse,
and she had to leave, she had to leave her whole family,
she had to leave her husband,
she had to travel 700 miles away to free herself,
amazing, amazing.
But hard. Who's gonna do that?
Many people would not be able to do that, right?
Many people would not be able to take those kinds of steps.
And so we say, well you don't really want to change,
but you know, it's hard,
change is hard.
So if someone's not ready,
maybe they'll be ready in a little while.
It took her three years of working to get to the point
where she could make some of those big changes.
And so, a lot of times people are really stuck, you know,
they're stuck in their lives, and it's hard.
- About that being stuck from a evolutionary point of view,
how come that the brain can get stuck
in these kind of scripts
that it's just repeating over and over like a bug,
that they can't get out of...
Where you think, at the same time,
it's this most adaptive tool
that can adapt to all sorts of circumstances
of the environment, of life and everything,
but sometimes it's like it's replaying over and over
a certain pattern that it can't get out of,
like, people going into abusive situations,
or going back to like this morning
talking about her boyfriend's reminding of her father,
like, what's at play, or how come that this repeating script
and being stuck like that?
- What do you think?
- Well, in a way I think it's like,
the brain wants to fix something that happened,
or like to get some justice for something that happened,
or to rebalance it,
but at the same time it's not helping you move forward,
so it's kind of a contradiction there.
- Yeah.
Yeah, the reason I asked you if you had some thoughts is
'cause one, I don't really know,
two, (chuckles) it is confusing,
and some people think of it as, you know,
somehow in your life, you keep reproducing these situations
in order to fix them, in order to solve 'em,
in order to deal with the underlying issues.
I don't know.
I mean, you know, one way to think of it is
kind of psychoanalytically,
and that you're working out the conflicts from earlier,
later on in your life.
Some people think of it in reincarnation,
you're working out the conflicts from a former life.
I don't know. But you can think of it that way.
On a behavioural level, it's easier in some ways
to think of it as learned, like the oats.
But why we would get so stuck in these patterns,
why pain would not go away?
It's hard to answer.
But the neural circuits just keep getting reinforced
over and over and over again,
so from a learning point of view,
you're just relearning and relearning and relearning.
- Isn't it also that we are seeking what's familiar,
you know, from childhood, even if it was negative?
- Yeah, because if you associate love,
I should say love, you associate love
with a certain kind of being,
then that's kind of how your brain put it together,
and it feels comfortable in that way,
and so that's another way of thinking about it.
When we're hurting in pain physically,
we're hurting in pain emotionally,
or we're having trouble in our lives,
or we're having things that we need help with
and we don't understand, we're gonna look for help.
And the help we look for is gonna be consistent
with what makes sense to us.
So the help we look for,
for some people is gonna be physicians,
for other people it's gonna be curanderos,
for other people, it's gonna be Alexander, Feldenkrais,
it's gonna be acupuncture,
it's gonna be whatever makes sense to us.
'Cause we're the ones that have to find our path, our route.
And the model that I offer is one model,
but it's not the only model,
but it's a model that we found that can help people in
that we've, you know, proven in research studies
that we'll talk about in the next couple days.
And it's amazing, can have amazing potential.
But it's not for everybody,
and it may not fit for certain people, some people.
This is a model that works best
for people with mind-body disorders.
In my view, most most chronic pain disorders
are mind-body disorders, but clearly not all of them are.
And what we're doing today was
use the best information that I have, or we have available,
to try to help distinguish
these structural versus non-structural.
Sometimes it's not easy, sometimes it's difficult,
but when we can do it,
we're in a position, from using this line of work,
as we'll see tomorrow,
to help people rewire the neural circuits in their brain.
And doing that work can be incredibly gratifying
and fun and agency producing.
So we give people the agency over their life,
we give them the tools so that they can recover,
and it's just a beautiful, beautiful thing to see.
And if you stick with me tomorrow,
we'll be playing with our brains, and trying to learn ways
of how to rewire those neural circuits.
Okay, see you tomorrow. (chuckles)
(All applaud)