UNLEARN YOUR PAIN - HOWARD SCHUBINER, MD | Being Human

Welcome to this week's episode of Being Human. I'm delighted to say I'm here with Dr. Howard Shubiner. He is the director of the MindBody Medical Center at Ascension Providence, Detroit, Michigan. He's the clinical professor at Michigan State University. He is the author of three books, Unlearn Your Pain, Unlearn Your Anxiety and Depression, and a co-author with Alan Abbas of Hidden From View, and the author of 100 papers and book chapters. Wow. Yes. Howard, welcome to the show. Thank you. It's nice to be admired. I appreciate it. You deserve some admiration. That's quite an output. You were just saying before we came on that you're old, and I was saying, even if you're old, that's a hell of a lot of writing you've done and impact you must've had. Honored to have you here. Thank you. Thank you so much. It's fun. Let's have fun. Yeah. The book that I've taken a look through is Unlearn Your Pain. Pain has been a big theme on this show. It's a role in our lives and how we can heal from pain. Delighted to dive into your take on that topic. It'd be great just to get a little bit of a background, because obviously you're interesting in that you've got a traditional medical background at a certain level, but you've taken a dive into the realm of mind-body, which, I guess, from my perspective, tends to be ignored largely by the medical establishment. It'd be good to get a bit of your background and then how you became interested in this realm. Yeah. I would love to talk about that. I had an interest in mind-body medicine back when I was younger in my college years, and then I've just been a regular doctor doing a variety of different kinds of practices in my career. But about 20 years ago, I read a book by Dr. John Sarno called The Mind-Body Prescription. A lot of people know about Dr. Sarno. He was never super well-established in the sense of his work being accepted by mainstream medicine. Unfortunately, that's still the case, but nevertheless, his book excited me. I was very interested in it, and I went to work with him for a little bit. And I just started talking to people, talking to them about their lives, their symptoms, their headaches, their backaches, their stomachaches, and began to see this incredible correlations between what's going on in people's lives and what was going on in their bodies. And for most people with chronic pain, I learned that they don't have an actual structural abnormality to account for that chronic pain. And that in and of itself is a shocking and revolutionary statement because most people who have chronic pain, when they go to a doctor, the doctor isn't going to say, we don't know or there's nothing wrong. They can't find anything wrong. So it's led me on a journey for these last 20 years of exploration with my patients into what causes healing and what causes recovery from these conditions that are very real, not in their head, not made up. But nevertheless, we've learned that the brain plays a critical role in what we experience. And that is, like I say, a revolutionary statement. Right. Yeah. And I mean, there's a whole ton in there that you've just said, I'm sure we'll unpack as we go through. I'm interested, was there like the first example of a case you worked with or a patient where they started to click and you found some resolution for a patient working in this way? Yeah. There's one woman, really lovely, wonderful person. She was in her, well, at the time, she was in her late 50s, I think. And she had headaches. She had head pain, severe, chronic, daily, constant head pain for 17 years. And no one could help her. She'd been to a headache clinic. She'd had injections. She'd had lots of different medications. Nothing helped her, 17 years of this pain. And what's a regular doctor going to do? Well, the only tools I had was to talk with her and listen with her. But what I found when you heard her story was that her father was very unpredictable. Some days he would come home from work and be happy. And other days he would come home from work and be mean or cruel. He would grab her by her collar and scream at her, what's wrong with you? Can't you do anything right? And this imprinted on her brain, this fear of unpredictability of, you know, opposing, you know, authority figure. But she did fine throughout her life. She grew up. She got married. She had kids. Things were going well. And then one day she got a new pair of glasses. And when she put those glasses on, you know how your eyes have to adjust to a new prescription, and her eyes were adjusting, and she got a head pain. At that moment, putting those new glasses on, and it didn't go away for 17 years. And they tried to change her glasses and the prescription and all those sorts of things, but that had nothing to do with it. And I asked her, what was going on in your life at the time that you got those new pair of glasses 17 years ago? And she said, well, my husband was fine. My kids were fine. My work was fine. Well, she said, I had a new boss. My boss was, I said, well, what was your boss like? She said, well, he was unpredictable. At times he would be nice and kind, and other times he'd be all of a sudden out of the blue screaming at me, yelling at me. Could that be the cause of pain? Well, it turns out our brain creates pain when it thinks we're in danger. There's a lot of research now that we know for certain that when a physical injury occurs, it's not your finger causing pain when you touch a hot stove, it's actually your brain. So our brain creates pain when it thinks we're in danger. And if we break an ankle, our brain will usually create pain. But not always. Sometimes people can have an injury and not have pain. But we also know that the brain creates pain when it feels we're in emotional danger. When the stress in our lives has built up for whatever reason that our brain feels we're in danger and pain is a message that our brain is sending us. And what happens is, is that that message and the pain can become reinforced over time and become chronic because the neural circuits, the circuitry of the brain that's causing that pain becomes learned, becomes embedded, becomes reinforced. It gets worse and worse over time. The more longer it lasts, the more we fear it, the more we focus on it, the more we're frustrated by it, the more doctors can't help, et cetera, et cetera. And that's what happened to her. In three or four months, she was fine. Her headaches were completely gone because we had learned, taught her how to interrupt the neural circuitry in her brain that was causing pain. And that was just an amazing and moving story that has played out so many times, hundreds, if not thousands of times over the next 19 years. And what is that interruption mechanism? How did you train her to do that? Well, it's basically has to do with how our brains, and when I say our brains, I'm talking about the neural circuitry of our brains, our subconscious mechanisms that are constantly on alert, constantly trying to protect us and help us see and hear and feel whatever it thinks we should see or hear or feel. And this neural circuitry has a very strong connection to safety versus danger. And so when our brain feels we're in danger, it continues to send this kind of messages. Those signals get reinforced. That neural circuitry continues to be activated and to fire in our brains, and it can cause headache or back pain or stomach pain or anxiety or insomnia or fatigue or depression or can't think straight, cognitive issues, et cetera. And what happens is that when a child falls off a bike, they look to you to see if they should cry or not. And if the adult is afraid, then the child is likely to cry because the child says, oh, my God, this is a problem. But if a child falls off a bike and they look to you and you smile and say, oh, my God, that was interesting or that was fun, can we do it again? I mean, you're okay, buddy. And then they feel safe even though they just fell off a bike. And the same process is the process that we teach people to do to teach and train their brain that they are actually safe and not in danger. And then on top of that, some people in addition benefit by dealing with the actual stresses that are causing the problems in the first place. The emotions that may have been lingering or unprocessed from events that happened in the last week or the last month or decades earlier. Right. And were you doing a combination of these with this woman and the relationship with her boss? Yeah. Usually we do a combination of those two. It depends on the person. Some people need more of one versus more of the other. But, you know, most people benefit by this kind of two-pronged approach after we help them understand how the brain works. This process that I've been describing called predictive coding, our brain predicts what it should do and then creates it. And the assessment determining if they actually have a structural problem or not. You know, if they don't have cancer, they don't have some inflammatory disease, they don't have some infection or fracture, you know, et cetera. We want to rule those out, obviously, because that's the role that medical care can provide. Right. And that's a really legitimate role for, I guess, what you might say traditional medicine is its ability to look at that. Absolutely. I never tell somebody they have a neural circuit issue or a mind-body issue, unless I'm absolutely sure. Right. But we've developed a lot of criteria over the last several years of how to do that. And oftentimes doctors are not really paying close attention to those kinds of criteria. For example, if someone has pain in their low back, but they go away on vacation and the pain goes away and then they come home and it comes back, that's pretty strong evidence that they don't have a structural problem. Right. If the pain sometimes is in the lower back and sometimes is in the neck and it switches, you know, from day to day, that's pretty strong evidence that they don't have a structural problem. So, you know, we pay close attention to those kinds of things. Yeah. Yeah. Yeah. It reminds me of some work I did. I used to get this really acute lower back pain when I was, I'm now in a stable relationship, kids, all the rest of it. But when I was dating, I'd get this really bad back pain right in the bottom of my lower back. And it would be on dates or maybe just after dates. It was all around like in a courting phase. And I traced it back to, fear of intimacy with my mother and the fear I had around my mother and some of that early life experience. And as I did more of that work through therapy, I found that I got less and less of these random back pains when I was dating. Yeah. So I can relate to that example. It's amazing when you can actually see that. And frankly, most people don't understand what you just said and what I just said. Most people really don't understand this connection or the power and the strength of these connections to cause real physical pain and other symptoms. As I mentioned, they don't understand it unless they've actually experienced it. And then all of a sudden the light bulb goes on and go, oh my goodness, it is completely amazing. But until enough people understand this, we will continue to go down a path whereby all pain is considered to be structural, where all pain is considered to be needed to be treated by medication or injections or even surgery. And there's a lot of unnecessary suffering and a lot of unnecessary medications and injections and surgery, which can be somewhat risky at times and certainly can be very expensive. And often it's counterproductive because we're scaring people more and more. When someone gets an MRI of their neck or their back and it's read as showing degenerative disc disease, that's a normal finding. It's not an abnormality. It's normal to have degenerative disc disease, even if you're 20 years old or 30 years old. It's normal to have bulging discs even if you're 20 or 30 years old. And certainly, as we age, the spine shows these changes. And we don't diagnose wrinkles as a disease, but this is akin to diagnosing wrinkles of the skin in the spine as a disease. And it's dangerous, really, because we're telling people that they're damaged or diseased, and that creates more and more fear. But more and more fear actually causes the danger alarm mechanism in the brain to go off even more. So we're actually making people's pain worse by doing that. Right, right. Yeah. And a fascinating statistic that you cite in the book is that a predictor of a requirement for back surgery is job satisfaction, right? Yeah. Yeah. There's a really, really wonderful, nicely done study from Finland where they showed that people who were working in factories, the likelihood of getting musculoskeletal pain was not related to their actual physical activity. It was related to how they were being treated by the people at work, how their leadership was. And so, you know, for people who run businesses, if you want to reduce your disability of your workers, if you want to improve lower turnover and decrease absenteeism and improve your bottom line, you have to treat people well. When you treat them well, they're less likely to get physical pain. It's amazing. Yeah. And the other one was around women, if their workload was too high and they're experiencing some bullying, there was a higher incidence of fibromyalgia. So, yeah, another... Yeah, because you're piling on the stresses. And at some point, there's a straw that breaks the camel's back and the brain says, enough. You know, basta, this is not right. You can't do this anymore. And it's really not that surprising. I mean, if you're a child and you're being bullied at school and you start getting stomach aches before school, well, hello. Of course, your brain is worried about that bullying and wants to protect you and the message is don't go to school. But it happens in adults. It happens in everybody because we all have a brain that's trying to help us and protect us and send us messages of alarm when we're in danger. And when you're in danger because of being sandwiched between work and home and kids and spouses and elderly parents, maybe, and sickness, and then the world goes crazy because there's some bizarre epidemic or something. Well, and then financial stress, you know, comes on top of it. Worry about illness. I mean, all of a sudden, guess what? You have the makings of a danger alarm mechanism in the brain that can cause fatigue, or anxiety, or depression, or insomnia, or stomach ache, or headache, or back pain. And, you know, not to be too controversial, but the data that's coming out is suggesting that long-haul COVID is more related to fear of COVID than it is to actual virus infection or reaction to the virus. And this is controversial, and people are still studying it. But there's a study from France where they have people who have long COVID symptoms, and they have their blood tests to see if they actually had COVID or not. And people who had long-haul COVID symptoms, it was more common in people who didn't have COVID than people who did have COVID infection. That's pretty amazing. It leads to a lot of hope because these conditions are reversible as opposed to incurable. Can you imagine the difference when you're sitting with all this horrible pain, or can't concentrate, or can't get out of bed, and thinking that you're incurable? Being told that this is an incurable process, we don't know why you're having it, as opposed to saying, yeah, we know exactly why you're having it. Your brain is turning this thing on. It's not your fault. You're not crazy. It's not all in your head. You're not imagining it. It's real. But it's real because your brain is activating it. And if your brain is activating it, which has happened to you, and it's happened to me too. It happens to everybody. Yeah, you mentioned your own back pain in the book. Absolutely. So there's hope. That's the point. And what I like about your message here is pain is a protector. Not only are these not necessarily things for you to worry about, and that they can be resolved, but these are actually protecting you. And in a way, this back pain I was getting on these dates, it was literally, don't get too close to this woman. At some level, it was trying to protect me. Exactly. I mean, I've seen, for example, I've seen women, I've seen several women who had a difficult husband. First husband was difficult, maybe abusive, maybe emotionally abusive, maybe worse. And now they divorce the jerk, and now they're in a new relationship, and they're just about to get married. Now, the second husband is great, right? Good guy, great guy, great relationship, everything's good. But before the wedding, they start getting these symptoms. They start getting headache, or they start getting stomach pain, or diarrhea, or the urinating all the time, or all sorts of stuff, right? And why would their brain do that? Well, the brain is like, hey, it didn't work out the first time, don't do it. And so we have to understand the message and understand that your brain is just afraid for you. The pain is not the enemy, it's just an alarm mechanism. When a smoke alarm is loud, because it has to get our attention, but we don't get mad at the smoke alarm, it's just doing its job when there's a little bit of smoke. Maybe there's only a tiny bit of smoke, but the smoke alarm goes off. Well, maybe the second husband is a great guy and the smoke alarm doesn't need to go off, but the brain's like, well, I better sound the alarm just in case. Yeah. And it leads to a different set of questions about the pain. It's not so much, where is this pain? What is this pain about? How can I fix or get out of this pain? It's like, well, why am I? It's curiosity, but directed in a different way. Why am I having this pain? How could this be protecting me? What could it be protecting me from? It leads to a different inquiry. A totally different inquiry. And again, like you said earlier, it starts with the role of traditional medicine, making sure that there's nothing wrong, but traditional medicine needs to be educated to not over diagnose pains as structural illnesses when they're actually not. Right. And your example being the bulging discs, you might be able to make a case in your mind that this is structural when perhaps it isn't. Yeah, exactly. Exactly. I just got an email today from a patient of mine, a very nice, great, great woman who is having back pain. And it was very obvious the pain was due to neural circuits in her brain. There was nothing wrong with her back. She got better. She was doing fine. She emailed me. She said, oh, my back pain came back and I went to get an MRI and I got some injections and now they want to do surgery. And I'm like, why didn't you? You know, you know about the mind body connection. We've been through it. Why did you go down that path when I'm right here? You could have called me. We could have seen you. I could evaluate your MRIs. I can help you. But it was like this. There's a strong tendency to equate pain with physical injury and physical damage, because that's how we've been living for thousands of years. But, you know, when you think about it, I heard this podcast the other day. It really was interesting to me because they were saying that, you know, basically that back in the day, you know, like thousands of years ago, humans survived because they were a clan. Neanderthals were stronger, smarter, faster, better hunters. They didn't survive. Humans survived, probably because they worked in groups. They connected. They spoke, you know, language. They developed fire. They cooked, you know, they hunted together, whatever. And so you would be in danger of your life if you got kicked out of the clan. But why would you get kicked out of the clan? Because of emotional issues. You know, you beat up somebody or sleep with somebody's wife, you know, whatever. You act bad and you get kicked out. You could die. So our brains learned, in essence, that physical danger, breaking an ankle is dangerous. And they also learned that emotional danger is dangerous. And pain became one of the ways that our brains activated the message of alarm in both physical injuries and emotional injury. Right. Right. It's like we co-opted a circuit that was originally evolved for something else to help us moderate, I suppose, our social behaviors. Yeah. I think that's the case. I mean, it's hard to prove. Right. Yeah. Yeah. It makes some sense. And yeah, it's really powerful. It's interesting how you're saying you want to check the physical first. But what I've noticed in my own sort of development, I got onto this fairly early in my twenties. And now when I get physical pain, I actually do the reverse. Like my first inquiry is, could this be, you know, emotional? Could this be psychological? And then if I exhaust that, I then might think, OK, maybe it's structural. Right. And that's reasonable. I mean, people always ask me, well, how am I going to know if I'm actually injured? And I usually say, well, use the mom test. You know, did you fall? Is something broken? Are you bleeding? You know, is this an emergency? You know, I mean, if you're having all of a sudden you get this horrible pain in your side and there's blood in your urine, no, you probably have a kidney stone. You know, you need to go to the hospital. Right. Right. Right. Right. Yeah. Where to go next with this? I guess what I suppose what's interesting to consider is why do you think medicine has developed this, as you describe it in the book, the blind spot? Why do you think we have this? Well, you know, medicine has advanced tremendously and a lot of these advances have come through kind of debunking some old ideas, some psychological theories that were overreaching, you know, and there's a there's a story I read recently where Freud had a and I don't want to bash Freud, but, you know, he deserves some bashing, I think. But anyway, he had a patient, a woman who was who was bleeding and having nosebleeds, and he had diagnosed her as having some kind of psychological issue. And it turned out she had, you know, she had a tumor or something in her nose, you know, and it's like, hey, you know, then people used to think that epilepsy was psychological in origin or, you know, things like this. So there's there was an overreach, I think, in psychosomatic theories. And as medicine advanced, we learned that, you know, ulcers could be caused by a bacteria. We learned that epilepsy can be caused by disease of neural electrical activity in the brain. You know, we learned that, you know, about germ theory and everything. So there's been a tendency to just keep going along this biotechnological path. And it's led to incredible great advances we can do. We're so much doing so much better with heart disease, with heart attacks. We're doing so much better with cancer, the two major causes of death in society. But we haven't had impact on chronic pain. In fact, chronic pain is worse now than it was a couple of decades ago. Oh, really? I didn't know that. There's more back pain in the U.S. than there was a couple of decades ago. And more back pain occurring in younger people. Teenagers are getting back pain at unprecedented rates that they never had. But what also is increasing in the society is anxiety and depression. So when you take chronic pain, anxiety and depression, these are the major causes of disability in the world by far. These are the major causes of disability and suffering in the world, even though the causes of death remain as cancer and heart disease and cerebrovascular disease. So biotechnological medicine hasn't been able to solve these problems that we're talking about here. And so now we're going back and looking back, taking the best of psychology, not overreaching, but also looking at the advances in neuroscience. The advances in neuroscience have been amazing over the last couple of decades in terms of this understanding that our brain generates what we experience. Right. Right. And so it's almost as if there was a worldview and a set of dogmas that trammeled research in a certain way. And we're now starting to see the limitations of that. Yeah. I suppose it's interesting to consider how these will coexist though, right? And where we'll end up in terms of a rebalancing. Yeah, exactly. I think it is a rebalancing and more and more people are learning about it and finding out about it because there's a tremendous need. There's a tremendous need, but there's a lot of resistance too, because the whole medical profession is built on a dogma, as you say, and financial interests and all these centers that are doing things one way. And I learned several years ago, I learned that when you go to people that are doing it one way and you say, hey, you're doing it all wrong. It's not usually a message that's taken well. And I admit I've been, maybe I haven't been as tactful as I should be. So it's hard to tell somebody they're doing something wrong when that's what they've been doing. That's what they learned and it seems to be working for them. Right. And a lot of it must be in the medical training. I mean, I saw just today on social media, a rant copy pasted from Reddit about a medical student just bashing his entire medical training and how narrow it was. But you're a professor, right? So you must have some insight into how, well, at least in the States, MDs are being trained right now. Is that shifting at all? In terms of our area, in terms of particularly education about neuroscience and pain, there's very little in medical education that's given to pain. And most of the lectures on pain now have to do with opioids and safe prescribing of opioids, dangers of opioids. That's where almost all of the education is. And at our medical school, Michigan State, we have just instituted a small bit of this into the curriculum, exactly what we're talking about today, the Mind, Body, Connection, and Pain. I'm working, my wonderful colleague at Dalhousie University, Ellen Abbas, has just got to go ahead to put in a larger block of this kind of material into the medical school there. But medical school curriculum is filled. It's full. I mean, there's a lot to learn. There's a tremendous amount of stuff to learn that medical students are bombarded by. So, you know, it's a, I would say it's a slow transition. Right. Right. And then the other thing that comes up a lot, and I know this isn't an area of focus for you, but nutrition and its role, well, in mind, body as well, right? I mean, we are what we eat physically and mentally to some degree, right? There's a lot. There's a lot that's being learned about the gut biome and how that affects behavior. There's no question about that. I'm a bit of two minds about that, I would say. There's a lot of evolving information, which is fantastic, and hopefully we'll be able to use someday. But on the other hand, I'm a little bit leery of people promoting the idea that your food, you know, what you eat is actually causing back pain or headaches or stomach pain, because usually it's not. Sometimes what happens is people begin to fear food. And when you fear food, you're activating the fear mechanisms, and the fear mechanisms cause pain. So we have to, again, be balanced, I think, along these lines, because what we're dealing with is that, remember I said I was talking about the brain operating in fields of safety or danger. And so all kinds of interventions are likely to have a placebo effect or a nocebo effect. So a placebo effect, for example, I just today I saw a advertisement for a new migraine treatment, a new device that treats migraine that's been quote approved by the FDA here in the States. And what it is, is it's a strap you put on your arm, and there's a battery, and it sends signals, it sends electrical charge to your arm, and that's going to interrupt migraine. I mean, it's silly, right? But not to say it can't be effective, it can be effective because of a placebo effect, because the placebo effect can be extremely powerful. If you have a mind-body disorder, all you need is a good placebo. Migraine can go away when you shock your arm, if your brain is saying, oh, this will make me safer, this will work. That's the placebo effect. I use the placebo effect all the time. That's what we need. Mind-body treatments need a good placebo effect. There's a nocebo effect, which is the opposite. So if you think something's going to be harmful in your brain, it will more likely cause more problems. And so we're always operating in this way, and we want, I mean, I want people to enjoy eating as opposed to being fearful of eating, because I want people to enjoy their life. And when they enjoy their life, then they're calming the danger signal in their brain. They're making themselves feel safer, happier, more purposeful, have more meaning, connect to others. These are the things that heal. Yeah, yeah. And it reminds me of that study in a US city of two Italian communities, and they couldn't figure out why one was much healthier than the other. They both had the same American-Italian diet. It turned out one group were much more socially active. Yeah. Yeah. And to your point, probably had a lot less fear and contentment, higher levels of contentment in their day-to-day lives. And we're so fearful in our lives in so many ways, and then because of stress, we get a pain, and then we start being afraid of the pain, and then it snowballs. Right, right, right, right. And so the second half of your book, you outline this 28-day process and meditation features throughout the process. Why is meditation so important? Well, it's a way of calming the brain. It's a way of stepping back. And there's a variety of simple meditative techniques that we use to interrupt the cycle of pain leading to fear of pain, leading to more pain. So I've been a teacher of mindfulness meditation for 22 years now, and everyone should learn mindfulness. It's an amazing way to help navigate the world. But the research on mindfulness for pain hasn't been that effective, which is weird. Why would that happen? And my belief is it has to do with the categorization of the problem. So if you're categorizing your back pain or your head pain or your stomach pain as a structural problem, and you're using mindfulness, and most people would do that because that's what the medical profession is telling you, and then you use mindfulness to help deal with that, you're noticing the sensations, but the underlying problem is still fear because you think you're structurally damaged. But our method is to re-conceptualize, re-categorize the cause of the sensations, the cause of the pain. And when you re-conceptualize and re-categorize it based on good medical evidence that it actually is neural circuits in the brain as opposed to structural damage, now when you apply mindfulness, it can be extremely effective because now you've categorized this pain as a thought, basically. And mindfulness is extremely effective for noticing thoughts, accepting thoughts as just thoughts, letting them go, and observing them. I mean, that's amazing that mindfulness is perfect for that. So meditation can play a very large role in this process when used within the setting of knowing this neural circuit situation. So that's interesting. So the education, like the understanding of the patient makes a difference. If I understand my pain in this way, then it's easier for me to believe that meditation could work and engage with meditation as a healing act. And that then becomes self-fulfilling. Exactly. You're having a positive spiral as opposed to a negative spiral. I mean, I often say that I'm basically a faith healer. I get people to believe that they're not broken. I get people to believe they're not damaged and then they heal. Faith healing. You're a faith healing healer and you've kept your career as a professor. That's fantastic. Yeah. But that makes a lot of sense. And you can see if I'm still categorizing my pain as being structural and physical, and I'm doing the mindfulness and it's not going away, I'm like, well, why I'm doing this mindfulness? I've still got the pain. You can see the negative cycle. Yeah, exactly. Exactly. Yeah. I had a wonderful discussion with my teacher and Don Kabat-Zinn, who was really one of the foremost people in helping mindfulness become accepted in the West. And I revere him and I love him. And I had a conversation with him saying, hey, John, I've been doing this mindfulness for years and I love it. It's changed my life, but it actually doesn't really work for pain that much. He goes, oh really? Like, let me explain. Right. Right. And then, and then to that, the other techniques that you bring in is journaling and forgiveness, acceptance of the dialogues that you introduce is that why, why that as well, as well as the meditation? Well, that falls under the category of dealing with the stressors that started the pain in the first place and the stressors that may be feeding the ongoing pain going on. You know, if you're having situations with your boss, your neighbor, your in-laws, your children, if you have situations where you were traumatized in the past, there's a lot of different ways of dealing with that. Those emotional hurts. And the more people can, and there's a lot of different ways of doing that. There's a lot of different therapies for that. And we've picked some of the ones that we think can be useful, especially useful for people even on their own, such as expressive writing as ways of helping to process those situations to help people to be less traumatized, less emotionally upset, feel safer in their, in their life. Right. So, so part of the approach is dealing with the underlying stresses and part of it is, is relaxing the mind, finding ways to quiet the mind, and I guess, building an understanding of how this pain process works in the brain. Exactly. Exactly. And, you know, like I say with, you know, when you have all treatments work, I think in this field, by having some kind of explanation, having techniques, which go to that explanation, doesn't matter if the explanation is true, like explanation could be your chi is unbalanced and the technique is acupuncture. Well, that can work because if you have a caring connection to a provider and you have hope for healing, you have four elements, an explanation, a technique, a caring provider, and hope and optimism that defines the placebo effect. So you can have fantastic outcomes when you incorporate those in ways to help people understand their problem, what we're saying is we want to help, we want to help people understand how the brain works and this mind-body connection, but there's lots of other ways that people can get better. Never really considered it in that way. And that makes sense then why there seems to be so many, just this panoply of modalities that seem to be effective for people and how people get well. It's like, there's as many ways to heal as there are fingerprints, it seems. Yeah. I mean, and they all have these characteristics, maybe there's others, but at least these four characteristics that lead to healing and recovery. So go through them again. It says it's the belief. It's an explanation. It's some sort of explanation for what the problem is. And then some technique to address that problem. In physical therapy, they say, well, your glutes are not firing or your abs need to be stronger. So we'll give you exercises for it. Okay. Makes sense. And then you have a caring person who's going to help you do that. And then you have hope and optimism that you're going to get better. And so that can work with acupuncture, with physical therapy. It can work with psychotherapy. It can work with medications, right? You get the little zap of your arm. There was a treatment for menstrual cramps I saw online a couple of years ago. And there was these little plastic flowers that women would put on their lower belly and it was attached to a nine-volt battery. Same kind of thing. Oh, cure for menstrual cramps. And they did a Kickstarter campaign. They raised like $3 million to put these little battery shocks on your abdomen. I mean, it has nothing to do with menstrual cramps, but that's not to say it can't work. It can work if it makes sense. It's something to do and you're making your brain feel safe. It'll work for some people. Wow. Yeah. Yeah. And it's kind of an assault to the ego as you share this because there's a bit of me that wants to hold on to the fact, the way that I've done it has to be the way. Yeah. One of the things that I learned that I'm continually trying to learn is be humble. We don't have all the answers. We're doing our best. We're doing this work with caring and kindness and compassion. And we need to do it with humility as well, because everybody has their own path. Everybody has different ways of healing. We're just trying to do good in the world, Richard. That's right. That's right. And what do you find in terms of the patients that tend to have success, at least with your process? What are the characteristics of the patients who do well? I would say first and foremost, it's an openness to these ideas. A lot of people have taken my book or Dr. Sarno's books and read the first few pages and threw it against the wall and discussed. I got an email about a month ago from a guy in Britain who's a scientist, a researcher, super smart guy. He was having back pain and someone said, hey, you should read this book by Dr. Sarno. He looked at the book. He goes, this is a bunch of hogwash. This is a bunch of, what do you say in Britain? There must be a better term for it. Hogwash is a very American term. What would be the British term? A load of old bollocks. Bollocks. There you go. Yeah. Bollocks. And then he went on Amazon. He looked at the reviews. There were like, you know, 10,000 five-star reviews for this book. And he's going, hmm, some people really liked it. So he got it and he read it and it started to make sense for him and he started to get better. And now he's planning, now he and I are doing a little bit of research in this area together. So there has to be an openness. Even if initially you're skeptical, there has to be at least some amount of openness to just take a look. And so one thing is openness. The other thing is desperation. You know, a lot of people have tried so many other things and they're desperate. They say, I'll try anything at this point. So that helps to make them more open. And then being willing to engage in the treatment, being willing. And it's hard sometimes because the process is often very simple, but it's not always easy, you know, for you to have pain and you to notice your pain without reacting to it, to notice your pain and smile at it, to notice your pain and separate from it, to notice your pain and just remind yourself you're okay and you're safe and this is temporary, to notice your pain and say, oh, I can take it. I can handle this. To notice your pain and feel it without freaking out. That is a skill that not everybody finds easy to do at the beginning. Yeah. Yeah. Yeah. That makes so much sense. Yeah. And along my journey, it's, yeah, you can often find people with the first two, you know, they've got a level of openness, you know, they're prepared to do the work, but can they really face the pain? Yeah. Not always. Yeah. And or face the emotion, some of the emotions, emotional situations in their lives that, that can be difficult as well. So what we're doing is we're just trying to provide people with an understanding, give them the options to look at it. If they want to give them a, a space of caring and compassion, letting them know they're not crazy. It's not all in their head. It's not their fault that their symptoms are real, not imaginary and the education about the brain, how the brain can be causing these real things and the hope that they can get better. Yeah. That's what we're starting with. And for a lot of people, they're so happy and they're saying, why didn't other, why didn't my doctors tell me about this? Why don't, why don't, why doesn't everybody know about this? You know, I'm so glad it's not in my head. And I'm so glad that it is in my brain. I mean, that is an amazing place to come to and understand, because it's really an understanding of how the human body works, how the human brain works that we now know. And neuroscientists know this now. This isn't just the theory. We know this now, but it hasn't really transfused. I'm not, I'm not sure translated or something hasn't gotten into modern mainstream medicine quite yet. Yeah, quite. Yeah. But yeah, I'm getting a increasing number of people coming on this podcast, you know, with real hope that we're at the start of a, of a major transition right back to hope actually. Right. If you want to look at it at the sort of better level, can we, can we have hope as a collective, as a community that things are changing and that, uh, yeah, the old dogmas are starting to, to loosen and we can, we can start to explore, uh, yeah. Explore our humanity in a different way. I mean, yeah, I've got huge hope for that. Yeah. Well, that's what you're doing here and being human, right? Exactly. Yeah. I mean, it's said that that's been a big part of, of what the mission of this podcast has now become is to kind of encourage this conversation, encourage this openness, give hope, um, you know, give options for people to take action. Right. Uh, yeah. And it's exciting. It's an exciting time to be around. Yeah. Yeah. And, and on that note, I know you've, you've got to run to another, another engagement, um, in terms of options for action, uh, people could check out, you know, your book and learn your pain. Um, yeah, it's all laid out and, you know, especially this education of how the brain works. I think that's really powerful. And then you've got the whole program. Um, and yes, as we said, at the start, you've got another one on your anxiety and depression for people who are particularly afflicted with that. Um, is there anywhere else you might point people who've been interested in what there's, there's a couple of, um, non-profit websites that are, uh, there's one called ppdassociation.org. Right. Isn't Paul D isn't dog ppdassociation.org, which is a non-profit professional group that we've started, uh, has a lot of information. Uh, there's another one called TMS wiki.org. TMS wiki.org. Yeah. Peer run, not a professional organization, but a peer run organization of people who've been in pain and had other of these types of, of symptoms or syndromes and have formed together to have a clearing, develop a clearing house of information on this work. So those are two I would highly recommend. Brilliant. Okay. Well, we'll put links to that in the description. Fantastic. Well, thank you so much for your time. Uh, this is, this has been a fantastic conversation. I hope people get a lot out of it. It's a pleasure. We'll, uh, we're trying to get, we're trying to get this work out of the category of bollocks, uh, and into the category of accepted, uh, science. So thank you for helping along this way. Yeah. Here's to more un-bollocksifying of the mind-body connection. There you go. All right. Thank you so much. All right. Cheers.