David Hanscom MD

[Forest]

I love reviewing Dr. Sarno's books. Each time I go back I learn something new it seems. Prompted by this thread, I went back this morning and reread the treatment chapter of The Divided Mind, as it is his most up to date book.

Here is what I found.

As documented in The Divided Mind, after his 2 lectures, Dr. Sarno had his patients do what he referred to as his educational program. The daily study portion involved reading a chapter from one of his books and also spending around 45 minutes writing and reflecting.

The following is from the Treatment chapter and is a reprint of the actual document he gave his patients.

The educational program—the lectures and my follow-up meetings—will get the job done in roughly 80 percent of people with TMS. About 20 percent will need work with one of our psychologists to complete the process. This is no disgrace since we could all profit from learning what is going on in our unconscious minds, which is what good psychotherapy is all about.

Here is the program I want you to follow:

1. If you have not already done so, read the entire book you are using a bit at a time (Healing Back Pain or The Mind-body Prescription). After that, read the psychology or treatment chapter every day. Pay close attention to what you read, especially when you see things that remind you of yourself.

2. Set aside time every day, possibly fifteen minutes in the morning and thirty minutes in the evening, to review the material I am about to suggest.

3. Unconscious painful and threatening feelings are what necessitates the pain. They are inside you; you don’t feel them.

4. Make a list of all the things that may be contributing to those feelings.

5. Write an essay, the longer the better, about each item on your list. This will force you to focus in depth on the emotional things of importance in your life. There are a number of possible sources of those feelings: [He then goes on to explore the possible sources of the painful and threatening feelings that necessitate the pain. He covers emotions generated in childhood, personality traits, external pressures, aging, personal relationships, and times when we must suppress our anger.]
[The Divided Mind, pages 142-143]​

In his summary of the daily program, Dr. Sarno writes,

You must sit down and think about these things every day. This is the way the ideas get from your conscious mind to your unconscious mind. That’s where they have to get to in order for the brain to stop the pain process. [p. 145]​

Dr. Sarno closes by writing:

Don’t give up. You have to put in time and effort to make this work.

Try hard not to pay attention to your pain. When you find yourself thinking about it, force yourself to think about the psychological things on your list.

After the lectures, patients are advised to work on the program daily for three to four weeks and then call me. There is no uniform pattern of improvement. In some, it is in fits and starts; in others, it is gradual and may extend over weeks and even months. When a patient reports little or no progress after a few weeks I suggest joining one of the weekly groups I conduct, or psychotherapy, either group or individual depending on the circumstances. Occasionally, I recommend the patient attend both my weekly meetings and psychotherapy. [p. 146. Emphasis mine in all three quotations]​

So that is Dr. Sarno's own program that he used with his team at Rusk. Someone actually gave me a copy of the "Daily Study Program" that they got from Dr. Sarno when they were his patient, and it was identical to the one in The Divided Mind. It shows, in his own words, exactly what Dr. Sarno wanted his own patients to do and is what he chose to publish in what will likely be the final book he published.

 

[Steve Ozanich]

I help people for money in order to survive because I don't have an income, and was doing so long before the Wiki came into being. But I give away many more thousands of hours of free advice because I enjoy seeing people heal. At some point it's necessary to eat food, so I ask for help from people who can afford it. However, it also must be noted that there's no such thing as a TMS degree, or TMS certification (yet). And as Dr. Sarno said, "You can go to the best psychotherapist in the world and it won't do any good unless they understand what's happening between mind and body." I see this weekly, people who have been to professional therapists to no avail. They then come to understand TMS deeper and voila, they heal. So the great doctor was right once again.

That was one reason I was interested in reading this thread. I saw Dr. Hanscom say that mindbody back pain was a neurological disorder, and that people with scar tissue have more trouble healing, and that "writing is the only way out," and that he sometimes sends them to physical therapy, and that the pain will return. I've never seen any of that to be accurate. All of these notions take Dr. Sarno's work backwards into the physical arena again. I work closely with several of the doctors and therapists Dr. Sarno trained, and none of them have seen these things either. But Dr. Hanscom has an MD after his name, so people listen closely. The great irony is that Forest and I had a similar conversation the very first time we spoke.

"Degree" does not necessarily equal understanding, but it might. The thing that matters is the degree of understanding TMS. Dr. Sarno is not happy that his work is being confused and "borrowed" in such ways. But it's the way we live, especially here in the US. Credentialed people are believed more readily. But in my life, paradoxically, the credentialed ones destroyed my health, several times over.

In my work, I mirror people's lives to show them how they are reacting, with their own words and actions. I also teach them about true TMS. Almost all of them have healed nicely (with the exception of 2 people, but I will stay with them until they do). But we rarely hear of all the successes. A guy emailed me to thank me for helping him heal. I asked him which of my books helped him and he said, "You wrote a book?" He had no idea. People are healing from hearing an interview I did here at unt Viki, and through online articles, lectures, and YouTube videos. They are healing and asking questions at such high rates that I can no longer keep up. I struggle to keep up with the demands of suffering people out there because the medical industry has messed them up so badly, but I still try. The best way for me to help is to keep writing.

There are other avenues for sufferers to gain understanding, and also a few people here that give out great advice, Fred Amir, Forest, Ellen, Walt, Herbie, Andy B, Anne, Alan, and a few others. I apologize I can't recall other names of the top but there are a few others. If the quest is to heal, the information can be had. But be careful of what and who you choose to believe. Don't fall for what you want to hear. It's what you don't want to know that is causing your symptoms. Don't immediately attach your sail to someone who tells you what pleases you. When someone gets pissed off I know I'm getting somewhere, and they always fare better because the anger lid is now opening. It is more important to seek someone you feel comfortable with, and can open up to and develop a good/trust relationship.

Even though none of the TMS books out there make a profit (or very small) it is still rewarding to help people feel better. So in the only way I am able (since I'm just a dumb laymen), I keep pushing the true message. My goal is to pass this gift forward as fast as I can, for as long as I can. The most difficult obstruction in the process is always the professionals, and even worse, those who call themselves mindbody practitioners. I recently had 2 accounts deleted in pain forums in England because I had the audacity to show that people could heal, by showing them some success stories. Success stories are rarely welcomed with open arms by any groups for varying reasons.

The list of people who have tried ISTDP and have failed grows, as does the list of people trying to journal into wellness. But! This, I believe is due to readiness. If you're ready to heal and you start to journal, then you heal. If you are ready to heal, and you try ISTDP, then you heal. If you are ready to heal, and you read my books, then you heal. Your time will come when you are ready. So relax, be patient and keep open your heart and mind. I threw Dr. Sarno's book because I wasn't ready. I returned to it when I was ready, and healed. The key is to prepare the way for this to occur. We get TMS because of the thoughts and actions we have taken to get us here. The very cause of which we ourselves have laid up and are now reaping the effects. It's a matrix phenomenon.

Journaling might bring great relief, and I remember talking to Dr. Sarno about it, it seemed to take him awhile to get fully on board. But he could not deny that it was helping some people. But it's all paradoxical by nature. The same is true for ISTDP. But the danger is in telling people that they "have" to do this, and "have" to do that. Or that things like scar tissue causes healing problems, because once the person is told these things it happens. They believe what they are told for good or bad and their body then adapts to match their deeper held beliefs. The mind has all the power to heal. Belief is the only problem, driven by need.

I'm still learning after 16 years of doing TMS work full time. As soon as someone claims to know it all they have stopped their learning. Emotional pain is held in different ways in people, and is only released under certain circumstances, and in the correct time. The biggest qualification that I have is that I am human too, with the same worries and frustrations, and questions. I talk to people as if it were me listening, talking about myself, to myself. We are all the same, differentiated only by experience and in the way we have learned to hide our shame. Dr. Sarno's work is axiomatic, however.

I'm not Frasure Crane, but I am listening and I do drink sherry.

SteveO

 

[Ryan]

I help people for money in order to survive because I don't have an income, and was doing so long before the Wiki came into being. But I give away many more thousands of hours of free advice because I enjoy seeing people heal. At some point it's necessary to eat food, so I ask for help from people who can afford it. However, it also must be noted that there's no such thing as a TMS degree, or TMS certification (yet). And as Dr. Sarno said, "You can go to the best psychotherapist in the world and it won't do any good unless they understand what's happening between mind and body." I see this weekly, people who have been to professional therapists to no avail. They then come to understand TMS deeper and voila, they heal. So the great doctor was right once again.

That was one reason I was interested in reading this thread. I saw Dr. Hanscom say that mindbody back pain was a neurological disorder, and that people with scar tissue have more trouble healing, and that "writing is the only way out," and that he sometimes sends them to physical therapy, and that the pain will return. I've never seen any of that to be accurate. All of these notions take Dr. Sarno's work backwards into the physical arena again. I work closely with several of the doctors and therapists Dr. Sarno trained, and none of them have seen these things either. But Dr. Hanscom has an MD after his name, so people listen closely. The great irony is that Forest and I had a similar conversation the very first time we spoke.

"Degree" does not necessarily equal understanding, but it might. The thing that matters is the degree of understanding TMS. Dr. Sarno is not happy that his work is being confused and "borrowed" in such ways. But it's the way we live, especially here in the US. Credentialed people are believed more readily. But in my life, paradoxically, the credentialed ones destroyed my health, several times over.

In my work, I mirror people's lives to show them how they are reacting, with their own words and actions. I also teach them about true TMS. Almost all of them have healed nicely (with the exception of 2 people, but I will stay with them until they do). But we rarely hear of all the successes. A guy emailed me to thank me for helping him heal. I asked him which of my books helped him and he said, "You wrote a book?" He had no idea. People are healing from hearing an interview I did here at unt Viki, and through online articles, lectures, and YouTube videos. They are healing and asking questions at such high rates that I can no longer keep up. I struggle to keep up with the demands of suffering people out there because the medical industry has messed them up so badly, but I still try. The best way for me to help is to keep writing.

There are other avenues for sufferers to gain understanding, and also a few people here that give out great advice, Fred Amir, Forest, Ellen, Walt, Herbie, Andy B, Anne, Alan, and a few others. I apologize I can't recall other names of the top but there are a few others. If the quest is to heal, the information can be had. But be careful of what and who you choose to believe. Don't fall for what you want to hear. It's what you don't want to know that is causing your symptoms. Don't immediately attach your sail to someone who tells you what pleases you. When someone gets pissed off I know I'm getting somewhere, and they always fare better because the anger lid is now opening. It is more important to seek someone you feel comfortable with, and can open up to and develop a good/trust relationship.

Even though none of the TMS books out there make a profit (or very small) it is still rewarding to help people feel better. So in the only way I am able (since I'm just a dumb laymen), I keep pushing the true message. My goal is to pass this gift forward as fast as I can, for as long as I can. The most difficult obstruction in the process is always the professionals, and even worse, those who call themselves mindbody practitioners. I recently had 2 accounts deleted in pain forums in England because I had the audacity to show that people could heal, by showing them some success stories. Success stories are rarely welcomed with open arms by any groups for varying reasons.

The list of people who have tried ISTDP and have failed grows, as does the list of people trying to journal into wellness. But! This, I believe is due to readiness. If you're ready to heal and you start to journal, then you heal. If you are ready to heal, and you try ISTDP, then you heal. If you are ready to heal, and you read my books, then you heal. Your time will come when you are ready. So relax, be patient and keep open your heart and mind. I threw Dr. Sarno's book because I wasn't ready. I returned to it when I was ready, and healed. The key is to prepare the way for this to occur. We get TMS because of the thoughts and actions we have taken to get us here. The very cause of which we ourselves have laid up and are now reaping the effects. It's a matrix phenomenon.

Journaling might bring great relief, and I remember talking to Dr. Sarno about it, it seemed to take him awhile to get fully on board. But he could not deny that it was helping some people. But it's all paradoxical by nature. The same is true for ISTDP. But the danger is in telling people that they "have" to do this, and "have" to do that. Or that things like scar tissue causes healing problems, because once the person is told these things it happens. They believe what they are told for good or bad and their body then adapts to match their deeper held beliefs. The mind has all the power to heal. Belief is the only problem, driven by need.

I'm still learning after 16 years of doing TMS work full time. As soon as someone claims to know it all they have stopped their learning. Emotional pain is held in different ways in people, and is only released under certain circumstances, and in the correct time. The biggest qualification that I have is that I am human too, with the same worries and frustrations, and questions. I talk to people as if it were me listening, talking about myself, to myself. We are all the same, differentiated only by experience and in the way we have learned to hide our shame. Dr. Sarno's work is axiomatic, however.

I'm not Frasure Crane, but I am listening and I do drink sherry.

SteveO

Look like someone came out of hiding... Good to see you back buddy.

Ryan

 

[jrid32]

Enough with the Trump vs. Clinton talk... Steve Ozanich for Surgeon General! Somebody make that happen!!!

 

[chickenbone]

In reading this thread, I can only say, based on my own experience, you should never underestimate your doctor's capacity to completely miss something PHYSICAL in your diagnosis. Although, I recognize all my issues as mind/body, I had a pretty obvious physical disorder that was causing a great deal of my back pain for the better part of 15 years. During that time, every doctor, and there were a lot, including Endocrinologists, did not know how to correctly read my blood tests and completely missed the fact that I had a parathyroid adenoma that needed surgical removal. This was causing calcium to leach out of my bones and into my bloodstream where it caused all sorts of problems including back pain. This disorder has 21 symptoms associated with it and 16 of them (most of them) are mental/emotional effects. This is a physical disorder that will turn you into a hypochondriac because your mind/body knows something is really wrong. I would not have recovered unless this physical issue was addressed.

It sometimes seems to me that, whereas some are trying to make the mind/body equation all physical, there are so many radical TMS'ers (of the everything is TMS variety) trying to make it all mental and emotional. Mind/body simply means that the mind and body are not separate and do not operate independent of each other.

 

[browndogisinthehouse]

Though it seems that there is an attempt to clarify the treatment of tms this thread, however it seems to have completely confused me. I have been doing journalling as a part of structured education program with no pain reduction and now I am in week number five point at the same time, I have stop focusing on pain reduction as much as I can believing in the outcome Independence theory. But from what I from the discussion about, it seems that journalling is not of much use. But at the same time I don't know what else to do. Am I just supposed to bear the pain and talk to the mind.

 

[chickenbone]

But do you understand what outcome independence really means? And do you realize that understanding it intellectually is not good enough? Your entire mind/body must believe it. It really boils down to ridding yourself of your fear that is the main driver of your pain. It has been proven over and over again that pain is highly subjective, whether the pain is caused by primarily physical or emotional factors and it is often a combination of both. You don't need to agonize over what causes your pain - your mind/body knows the cause and it will resolve over time. Just don't use your mind to obsess about it and make it worse.

 

[Steve Ozanich]

Dr. Hanscom should be commended for his work, and for his courage in stepping up against the industry and trying to help. He could easily have kept this info to himself, once he healed. He put himself out there for all the ridicule that the rest of us run into. I hope I didn't give the wrong impression that he was always wrong, he isn't. He has recently said some very important and truthful things that may get him into trouble when the powers to be hear of them. But this thread was in response to the differences between Drs. Sarno and Hanscom, in practice. There are several important distinctions between the two, some I mentioned above.

In another interview Dr. Hanscom stated that chronic pain and sleep issues were correlated, or deeply connected (I can't remember his exact phrasing). But I remember around 2005 or 06 when I began working with some of the TMS docs that Dr. Sarno trained they told me that sleep and pain were "not always correlated." I still have my m-s where Dr. Sopher wrote in the margin "Nope!!" where I said sleep would help with the problem. He told me that some chronic pain sufferers sleep very well all night with no issues, and then wake up to severe pain. A few years later I asked Dr. Sarno about that and he confirmed it, the two are not always tied together.

Anyone can draw their own conclusions on TMS practices any way they want. Readers prerogative.

Steve

 

[Tennis Tom]

In reading this thread, I can only say, based on my own experience, you should never underestimate your doctor's capacity to completely miss something PHYSICAL in your diagnosis. Although, I recognize all my issues as mind/body, I had a pretty obvious physical disorder that was causing a great deal of my back pain for the better part of 15 years. During that time, every doctor, and there were a lot, including Endocrinologists, did not know how to correctly read my blood tests and completely missed the fact that I had a parathyroid adenoma that needed surgical removal. This was causing calcium to leach out of my bones and into my bloodstream where it caused all sorts of problems including back pain. This disorder has 21 symptoms associated with it and 16 of them (most of them) are mental/emotional effects. This is a physical disorder that will turn you into a hypochondriac because your mind/body knows something is really wrong. I would not have recovered unless this physical issue was addressed.

It sometimes seems to me that, whereas some are trying to make the mind/body equation all physical, there are so many radical TMS'ers (of the everything is TMS variety) trying to make it all mental and emotional. Mind/body simply means that the mind and body are not separate and do not operate independent of each other.

This is the TMS site so we push TMS KNOWLEDGE PENICILLIN like a corner drug dealer pushes pot and crack. People here and myself in particular, are very cautious to advise newbees and oldbees who have symptoms, to be checked out by a competent physician, preferably an objective TMS one, BEFORE pursuing the TMS route. This site is plastered with boilerplate warnings to that effect. No one in chronic pain discovers this site first. It's after years of allopathic medicine failing them by not having the knowledge or the courage to tell them their pain could be emanating from their mind and not the reverse. I have NEVER seen anyone here say EVERYTHING is TMS. The common denominator is about 80% is TMS and the rest due to fracture, infection, and other REAL causes. Also, TMS can result in serious dis-eases that should be treated, along with using TMS to turn down the volume control on the pain. 99.9% of internet dis-ease sites are devoted to structural causes for dis-ease. The TMS Wiki is one of the few that deals with the mind/psychosomatic as the source of chronic pain. If every thread here warned of all the "side-effects" that may not be TMS, it would start sounding like one of those TV commercials required by the FDA to list every known side effect of an RX--including the old stand-by "DEATH"--this is the TMS wiki--don't ask a barber if you need a haircut. In your own case you mention that you had a "pretty obvious physical disorder for 15 years", that doctors missed. I don't think it could have been that obvious since you are married to a physician and he didn't recognize it either. There are mystery diseases that are very rare and hard to DX, and there was even a TV show that featured them. Modern medicine is pretty good at dx'ing the structural, even when they are not the cause of the pain but harmless anomalies, and the true cause being TMS. Like the Good Doctor says: "Surgery is our best placebo."

 

[TG957]

There are people I talk to a few times per year who were told they needed surgery, by "mindbody" doctors. But they did not need it.
SteveO

Funny, I almost feel lucky that in my case (CRPS) official medicine simply threw the towel in. My Kaiser doctors timidly offered me epidural shots, knowing well it would not work. They seemed to feel relieved when I was leaving their offices - that they don't have anything to offer and I would not show up again. Dr. Sarno, SteveO and the rest of TMS community are the only ones who give me hope that one day I will be able to feel my hands as normal.

 

[Steve Ozanich]

I think you're right TG, the docs I talk to seem to realize the shots won't work because they are the ones watching the failed effects. But they don't know what else to do, they are trained to come up with answers and people are desperate for relief.

The news is spreading though, due to the vast successes in healing everywhere. I'm working with more MDs now on their own health, and thanks to Dr. Sarno they're seeing the big picture. Timing is everything in life, especially in music!

Feeling your hands "as normal" will happen when fear is reduced.

 

[Andy Bayliss]

I was thinking about the positive aspects of journaling, and want to summarize/mention:
--It gives evidence of the pyschological, rather than physical, so it is part of the "belief in TMS process." (Forest/Sarno reference)
--It encourages more feeling, more depth of feeling, more variety of feeling, which means less has to be repressed. (With some exceptions for improvement, which you point out well Steve: some people are awash in feeling already, much of it guilt, sadness, Inner Critic activity, which, without skillful guidance, journaling may not "help.") This aspect of "feeling more" through journaling may be a way that students of TMS can do what Dr. Sarno recommended with therapy. "It helps them feel more." -from the DVD/Video Lecture, I believe. Although for this aspect of encouraging feeling more, Dr. Sarno moved patients right on to therapy, rather than more journaling!
--It can bring us closer to our own experience, which is satisfying, and a form of love, which helps soothe, and provide insight and guidance, including what we can do in our TMS journey. It is a focused time for reflection, rather than endless "symptom fixing/avoiding."
--I agree with others who say that "trying to journal yourself out of pain, or find the magic reason for pain through journaling" are only, unfortunately probably causing more tension. Which points to the subtlety of Dr. Sarno's approach, which is so easy to trammel, unwittingly, in our effort to stop symptoms. We want a real form of effective "work" without causing more tension!

 

[Steve Ozanich]

Well said AndyB, it all depends on what that person needs. When their life is laid about before them they may see something they haven't been aware of, add significance to it through recognition, and then begin to release.

I was always "going through" my mind, "I did this, this happened, could it be this?...." Mine was a constant seeking of causes and effects, mentally. I didn't need to also write it all out. To me, writing was just added work onto a life of added work: repetition of the unwanted.

But to many others it has been an invaluable tool for the reasons you mention here. This was great, "It can bring us closer to our own experience." Nice!

 

[plum]

Way back in the days before his book was published, David Hanscom generously made the working copy available as a pdf to anyone and everyone. It was this book that started my healing and gave me back my sanity.

For those who may not be familiar with his work, Hanscom is a salvage spine surgeon which means people go to him when previous surgeries have failed. He is not an instigator of such surgeries but rather a compassionate and quite courageous soul dealing with the mess others have made and do not help to put right. I believe he should be respected and congratulated for this.

Comparisons between Hanscom and Sarno are invidious and mainly serve to confuse people especially newcomers to this site and the concepts in general. The beauty of this wiki is the wide net it casts; it is inclusive and diverse and for this reason the healings are legion.

Perhaps my take and knowledge of the brain is different by dint of being a psychologist caring for a Parkinson's sufferer. I am in the field and the thick of it. I understand completely the assertion that Hippocrates made, that the physician and the patient work in harmony with nature to activate the body's own healing capabilities.

Sleep is when the brain heals itself (the glia open channels that permit removal of toxic build-up. This unique healing channel is ten times more active in the sleeping brain as compared to the waking brain. This is why sleep deprivation leads to a deterioration in brain function).

Sleep also quiets a *noisy brain* (neuromodulation). Sufferers of chronic pain and brain problems generally have a sympathetic nervous system stuck in the on position. Hence the reason so many people on this forum begin to improve and recover when they employ techniques to bring the parasympathetic back on-line. Sleep, relaxation and mindfulness are manna from heaven for healing.

Back to Hanscom, one other invaluable gift of his work is his rich understanding of the way anxiety is a factor in chronic pain, and how it interacts with anger. Every day people post here with anxiety, fear and panic attack issues. I am grateful these aspects are acknowledged now because it was a battle-royal before. (Kudos to Eric Watson for his gentle insistence that this mattered).

Recent years have seen Western Neuroscience combine with Eastern Traditions to create a most beloved love-child. We have an incredible range of techniques and practices with which to engage our mind, brain and body. We should rejoice in this rather than nit-pick over details.

David Hanscom I thank you from the bottom of my heart.
Forest I salute you for understanding that fresh insights do not replace Sarno's grand work but enrich it.

 

[Tennis Tom]

Perhaps my take and knowledge of the brain is different by dint of being a psychologist caring for a Parkinson's sufferer. I am in the field and the thick of it. I understand completely the assertion that

Nice post Plum, didn't know you were a psychologist, do you treat TMS sufferers? What do your fellow psychologist say when you tell them about TMS/psychosomatic dis-ease? I bump into a lot of psychologists in the hot-tub and none of them have ever heard of Sarno or show any interest--shocking! I consider them "paid for buddies."

I have an anecdote for you regarding "parkinson's" from my personal experience, There was a music professor I was acquainted with who worked out at the pool regularly. He had been DX'ed with parkinson's . His wife was his aide and he was able to quite remarkably, propel himself haltingly into the pool. It always looked like he would surely stumble face forward and fall flat-out onto the concrete, but he never missed. I gave him a copy of Sarno, he gave it back saying something to the effect that it was very interesting. After going to one of the best teaching hospital's nearby, he told me they said what he had wasn't parkinson's. I asked him what did they say he had, he said they didn't know.

 

[plum]

Hey Tom,

I'm not practising because my partner needs lots of tender, loving care however I nurture my passion and do my best to help folk where and when I can. Oftentimes a tangential approach helps best anyway, the confidence of strangers and all that. In the past I was involved in helping a very noble man who helped families avoid home repossessions (foreclosure) and a lot of this was late in the day intervention so there was lashings of stress involved. It goes without saying that tms has a field day in such a traumatic and heart-rending environment.

I have to say I've always been at odds with most psychologists. Many are well-intentioned, some hapless but there's a lot of conventional, mainstream and frankly lazy thinking which is not helped by the hoops people have to jump through to further careers. I've endured a lot of eye-rolling and have been called fluffy more times than I care to mention.

It's the same kind of professional indifference I see in a too many medical consultants and doctors. Nurses tend to be kinder and more well informed but then they are dealing with actual sufferers rather than barking out redundant prognosis based on outdated thinking.

Part of the reason I'm such a cheerleader for neuroscience is because a shiny new field called neuropsychology has emerged in recent years and it answers many questions, provides tangible solutions and lends hope a parachute.

Thanks for the Parkinson's story. It is an often misdiagnosed condition and neither myself or my partner are wedded to it. We take a very proactive mindbody approach and we're doing well with it. We were told he'd be dead by now. Talk about nocebos and bone-pointing! Thank the gods we made a f*** that decision from the start.

Oddly enough I have a tendency to recommend Sarno in the hot-tub too. Lots of backache sufferers there. Maybe we can start a revolution.

 

[Forest]

Kudos to you on your courage and wisdom in treating your partner, Plum. Parkinsons is tough, but you sound like a strong and inspiring couple.

I'm glad you found Dr. Hanscom's work helpful in your recovery. I've heard the same from several other oldtimers.

I, too, have found neuroscience quite helpful in understanding psychology. It helps me with understanding my own experiences and guiding myself along to a good life. Whenever, I check how my body feels to understand my own unconscious emotions, I think of the insula. When I try to think things through rather than reacting emotionally, I think of the prefrontal cortex and the amygdala and how the amygdala tries to hijack the brain as part of our natural defense mechanisms. Whenever I tell people that journaling provides a foundation but that you want to be careful not to overthink it (i.e. the feed the wolf example) I think of plasticity.

I also think of neuroscience when I remind myself that it's time to stop thinking so much and get out there to live a beautiful life. I want to feed the wolf of happiness (like Tennis Tom and Walt Oleksy does so well) by developing positive connections in my brain. (And while I don't like Joe Dispenza, I think he explains this well.)

So neuroscience for me isn't just about deep psychology. It's also reinforcing age old wisdom about meditation or feeding the good wolf.

By the way, Plum, you were the one who turned me on to Rick Hanson. I have his book, Buddha's Brain, and think it's great.

 

[Forest]

Regarding Dr. Hanscom, I think that the following article helps explain his motivations and provides some backstory for his own TMS.

We know from Dr. Sarno that the majority of TMS comes from pressure we put on ourselves, and you can only imagine how much pressure it takes to get to the top of a field as competitive as neurosurgery. All of this pressure can lead to burnout, which is a surprisingly large problem for physicians.

Dr. Hanscom wrote the article to raise awareness of burnout and to teach skills for managing stress. In it, he describes his own experience of burnout.

It takes a lot of courage to draw attention to a problem like burnout by telling your own story (you'll see what I mean), so I admire the courage it took to publish this, especially given how competitive medicine can be.

I suspect that the same thing is going on with his work on TMS. He's at the top of his profession, so why would he jeopardize his standing at a hospital by telling patients that they don't need back surgery? That's not a position that is bound to help the hospital's bottom line. (And while I don't think that hospitals are just cynical money making operations, I'm no rube, either. ) I think that he does that for the same reason that we are all here - because we have suffered and we want to help other people avoid that same suffering.

Here is the article. A longer version of it was published in "SpineLine."

http://www.thedoctors.com/KnowledgeCenter/Publications/TheDoctorsAdvocate/Back-from-the-Edge-Coping-with-Physician-Stress-The-Doctors-Advocate (Back from the Edge: Coping with Physician Stress | The Doctors Company)

The Doctor’s Advocate | Fourth Quarter 2011

Introduction by Robin Diamond, JD, RN
In this article, Dr. David Hanscom describes his personal journey toward managing stress. Dr. Hanscom, a board certified orthopedic surgeon specializing in complex spine problems, practices at Swedish Neuroscience Specialists in Seattle, Washington, and is a member of The Doctors Company.
—Robin Diamond, MSN, JD, RN; AHA Fellow–Patient Safety Leadership; Senior Vice President, Department of Patient Safety

Back from the Edge: Coping with Physician Stress
by David Hanscom, MD

Our culture expects doctors to be strong and stoic. Physicians do nothing to belie that impression—they rarely discuss their personal issues. It’s an unspoken rule that if you’re ever feeling stressed, you put your head down and persevere. That’s why I didn’t know that my close friend and fellow surgeon was on the edge. One afternoon last year, he left after assisting me in a complicated spine surgery. We shook hands and he said, “Nice case.” It came as an incredible shock when I heard that three hours later, he was dead from a self-inflicted gunshot to his head.

I later found out that my colleague was under enormous personal stress. His problems were complicated, but I know that much of his stress stemmed from his habit of constantly beating himself up. This led to uncontrollable anxiety, which had been building for several years. The tragedy is that he didn’t seek help earlier. He didn’t feel that he could.

My colleague’s story is not an isolated case. In fact, one in 16 physicians reported having contemplated suicide, according to a study published in the Archives of Surgery. This rate is higher than the general public (6.3 percent vs. 3.3 percent). Only 26 percent sought out help.1 Out of my 80 medical school classmates, four killed themselves within three years of completing their training. Another dozen colleagues have committed suicide.

I can imagine how those doctors felt before deciding to end their lives. About 10 years ago, I was driving home one evening after a busy day at the clinic. I was agitated. I was in my mid-40s and was experiencing crippling anxiety on a daily basis. My anxiety had begun to rear its head 12 years earlier, and for the past year, I had struggled. I saw no way out. I was done.

That night, I weighed all of my options and decided that was it—once I pulled into the garage, I would close the door behind me and leave the car running. But at the final moment, I turned off the car. I thought of two classmates whose physician fathers had taken their own lives during my classmates’ teenage years. I knew how devastating it was, how hard it had been on them. I had a young son. I felt that I couldn’t abandon him and leave a legacy of death. If it weren’t for my family, I have no doubt that I would have left the motor running.

Burnout
Burnout contributes to the stress that can drive physicians to thoughts of suicide. About 40 percent of physicians experience burnout, according to the California Medical Board.2 Doctors live with a combination of pressures that can result in burnout: suppressed anxiety, perfectionism, and massive amounts of stress.

Medical authorities have made some effort to limit stress on doctors. For example, there are now laws limiting residents’ work to 80 hours per week. Enforcement of these rules is spotty, though, and the older hierarchy feels that these guidelines are too lenient. Physicians face many stresses: running a business, angry patients, surgical complications, threat of litigation, partner problems, etc. As a surgeon, it’s not uncommon to operate for 10 or 12 hours and then go to the office for another four hours to catch up on paperwork.

Stress management skills are not part of the medical training process. No one provides physicians with the tools to assess their mental health. There are no preventative mental health resources, such as mental health professionals on staff; there’s no one to easily talk to about the stress. Any hint of mental distress causes the hospital to examine under a microscope the physician’s ability to practice.

Suppressed Anxiety
Physicians are conditioned to be really tough. From the first day we walk into the anatomy lab of medical school, it’s understood that we are essentially in boot camp. The intention is to quickly weed out those who cannot cut it. The ones who can suppress their anxiety are the ones who survive.

Early in my practice, I always thought I was in control. It didn’t matter what I encountered—angry patients, billing problems, even a malpractice suit—I remember thinking, “I can take it. Bring it on.” All physicians are used to being in control, especially when it comes to anxiety.

Anxiety cannot be suppressed forever. Research has shown that the more one tries not to think about something, the higher the chance it is thought about.3 Many physicians find themselves in a state of chronic anxiety. When this happens, surgeons may quit doing the bigger cases or stop doing surgery altogether. Addictions begin to surface. Other dysfunctional coping mechanisms, such as aggressive behavior toward staff and residents, are common. And then there is suicide.

Perfectionism
Doctors hold up perfectionism as one of the highest virtues of their profession. Most physicians would agree that “perfect” is the standard for our medical culture. It’s both implicitly and explicitly taught from the time they enter medical school. Unfortunately, many mentors react severely to their underlings when a given task is performed in a less-than-perfect manner.

But what does perfectionism really accomplish? Nothing. It’s a destructive trait. As doctors, our goal is 100 percent success for every patient. But that’s not humanly possible. If you torture yourself over every case that doesn’t turn out perfectly, you can’t do your job well. The energy burned up by judging yourself negatively is the energy you need to perform at the highest level.

Since there’s no such thing as perfection in the human experience, the difference between reality and expectation will determine the degree of your unhappiness. For many physicians, failure to meet the standard of perfection engenders growing anxiety, anger, and guilt that facilitate suicide.

Reprogramming
I was able to escape the perfectionist trap by using a technique known as neuro-cognitive reprogramming, which involves writing down your thoughts to create new, alternate neurological pathways. These pathways connect the thoughts with sight and feel. In David Burns’s book, Feeling Good,4 one of his tools is to write down negative thoughts and then categorize them. By using Burns’s writing methods and facing my anger, I was able to work myself out of the abyss. For me, it has been life altering.

There are other reprogramming methods. They include mindfulness/meditation, awareness, group dialogue, auditory methods, art, role playing, music, and many other techniques. Broken down, each follows a pattern of three parts: (1) awareness, (2) detachment, (3) reprogramming. Each person’s journey will be unique.

Going Forward
As a medical community, we must recognize that anxiety is not a dirty word and that it’s not a sign of weakness to admit that you have anxiety. Members of the medical community must engage in a dialogue about allowing doctors to speak openly about their stresses. Each of us is so good with our façade that we couldn’t imagine that the other physician is anything less than completely together. We are human, too, however, and we are suffering—badly. With an open dialogue, the medical community can start to heal its own members.


References

1. McCoyKL, Carty SE. Failure is not a fate worse than death. Arch Surg. 2011;146(1):62-63.
2. DuruisseauS, Schunke K. Physician wellness as constrained by burnout. Medical Board of California Newsletter. November 2007;104:1.
3. WegnerDM, Schneider DJ, Carter SR 3rd, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13.
4. BurnsD. Feeling Good. New York, NY: HarperCollins; 2000.

 

[Ellen]

Hey Tom,

I'm not practising because my partner needs lots of tender, loving care however I nurture my passion and do my best to help folk where and when I can. Oftentimes a tangential approach helps best anyway, the confidence of strangers and all that. In the past I was involved in helping a very noble man who helped families avoid home repossessions (foreclosure) and a lot of this was late in the day intervention so there was lashings of stress involved. It goes without saying that tms has a field day in such a traumatic and heart-rending environment.

I have to say I've always been at odds with most psychologists. Many are well-intentioned, some hapless but there's a lot of conventional, mainstream and frankly lazy thinking which is not helped by the hoops people have to jump through to further careers. I've endured a lot of eye-rolling and have been called fluffy more times than I care to mention.

It's the same kind of professional indifference I see in a too many medical consultants and doctors. Nurses tend to be kinder and more well informed but then they are dealing with actual sufferers rather than barking out redundant prognosis based on outdated thinking.

Part of the reason I'm such a cheerleader for neuroscience is because a shiny new field called neuropsychology has emerged in recent years and it answers many questions, provides tangible solutions and lends hope a parachute.

Thanks for the Parkinson's story. It is an often misdiagnosed condition and neither myself or my partner are wedded to it. We take a very proactive mindbody approach and we're doing well with it. We were told he'd be dead by now. Talk about nocebos and bone-pointing! Thank the gods we made a f*** that decision from the start.

Oddly enough I have a tendency to recommend Sarno in the hot-tub too. Lots of backache sufferers there. Maybe we can start a revolution.

Hey Plum,
Have you read the neurologist Norman Doidge's book The Brain's Way of Healing? There is a whole chapter devoted to Parkinson's and one man's remarkable journey of recovery. All consistent with TMS/mindbody theory.

 

[plum]

Forest, the same is true for me. I find the anatomy really gives me a place to hang my hat. Strangely in every other area of life I favour the vague and poetic but with this the hard details are grounding and reassuring. Maybe this is because it assists in making the leap of faith we do need with tms. I'm chuffed that I introduced you to Rick Hanson. He really is the best. I like how in one of his books he suggested his patient call her amygdala "Amy" and simply chat to her. Calm down Amy, it'll be alright kinda thing. He makes the science very approachable and practical. Again, good for people like me who can be a bit dense sometimes.

Honestly my dear I cannot thank you enough for your support over the years. In no small way you are a hero for me (and doubtless I have sent you wine-induced rambles to this affect ).

The backstory to David Hanscom's work truly is the epitome of courage and I am grateful that you posted it. It helps immensely and gifts more understanding than any simple explanation of theory can offer. I am aware it is considered *unprofessional* to spill ones metaphorical guts but to those trapped in one of Dante's Circles of Hell it is THE life raft. This person was drowning and they made it back to shore. Pushing that analogy to breaking point, my niece is studying to be an environmental disaster specialist and she told us that the way to survive water-based incidents is to relax. It is the fighting against the tide or current that is our undoing. If we can relax like a rag doll eventually the water will spit us out. This resonates with the whole tms thing I find.