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Alan G. Figuring out what causes flare-ups

Discussion in 'Ask a TMS Therapist' started by Ellen, Nov 15, 2014.

  1. Ellen

    Ellen Beloved Grand Eagle

    This question was submitted via our Ask a TMS Therapist program. To submit your question, click here.

    I've been working on my TMS recovery for about 18 months. After about a year of work, I was able to get rid of my chronic pain syndromes and eliminate all the medication I was taking for my symptoms. However, I still have some TMS equivalents that I'm working on, i.e. anxiety, depression, fatigue, and allergy symptoms.

    I'm just getting over a two-day major flare-up of TMS which literally put me in bed, where my unconscious threw about four major symptoms at me at once. About a day and a half into the flare-up, I finally realized that it was TMS. TMS had "overplayed its hand" and I realized it was unlikely that I was coincidentally having several medical conditions at once.:)It's hard to believe that I didn't get this sooner, but once I did, my symptoms were alleviated in a few hours and I was back to my normal level of TMS equivalents.

    So now I am trying to figure out what triggered this major flare-up, and why my unconscious was so desperate to distract me. This is my best guess, as nothing else was going on at the time: the afternoon before the flare-up I was reading this wonderful book by Thich Nhat Hahn on using mindfulness to address fear. So that evening when I went to bed I decided to use one of his mindfulness techniques to address this constant level of generalized anxiety I carry around. I attempted to really focus on the feelings and not push them away--embrace them so to speak. Eventually, I lost my focus and must have fallen asleep for awhile. Later, I woke up and began having my symptom flare-up.

    Yesterday I happened upon an interview with Tara Brach, PhD, mindfulness meditation expert and psychotherapist. She said that using mindfulness with people who have experienced trauma can cause "flooding" and result in re-traumatization. I wonder if my unconscious was trying to protect me from this by serving up a giant dose of TMS.

    I have long suspected that a childhood trauma has played a role in my TMS. At age 4 I had a serious playground accident that nearly severed my arm. The experience and the medical interventions that followed were traumatic, coupled with being in a family that did not tolerate expressions of emotion or neediness. I began having migraines shortly after this. I went to a therapist about a year ago who specialized in treating trauma with EMDR, and did about 5 sessions with no noticeable result.

    So my question is where do I go from here? Should I stop trying to use mindfulness techniques to address my anxiety, or do you feel this was not the trigger to my flare-up? Should I pursue more therapy to address possible past trauma, perhaps using another type of therapy, e.g. Somatic Experiencing? Your thoughts and advice are much appreciated.
    Last edited by a moderator: Nov 18, 2014
  2. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    Hi Ellen,
    First of all, you're putting a lot of pressure on yourself. Stop working so hard trying to figure out what caused your flare-up. 95% of thoughts and feelings are unconscious, so it's likely that you may never know. More importantly, it doesn't really matter. Did figuring this out alleviate your symptoms? No, recognizing that it was TMS and no longer buying into the fear is what did it.

    Many TMS sufferers spend a lot of time trying to identify what caused their flare-up. There is generally a very subtle but concrete reason for this: uncertainty is difficult to tolerate, so "figuring it out" makes you feel less out of control. That's it. It isn't because this information will provide some sort of transformative experience, it's because it helps you avoid a difficult state.

    Unconscious motives are sneaky, right?

    In addition to working toward better tolerating uncertainty, like I said earlier, you put a lot of pressure on yourself. Reread your question. You are working so hard.

    Let me tell you a story. During my TMS days, I decided one Sunday to wholly dedicate myself toward doing everything right. I spent 6 hours meditating. I spent three hours standing up to the inner bully. I spent some time attending to my internal state and honing my inner ally. I did progressive muscle relaxation. I reduced my anxiety. I tried to feel my feelings.

    Eleven hours into this you know what happened? My pain was worse! "Fuck this," I said. "I give up. I don't care anymore." And fifteen minutes later my pain had decreased.

    Sometimes it seems like you're doing everything right, but everyone of your thoughts and actions are tainted by pressure. Pressure increases stress. Pressure injects you into a state of flight. Pressure undermines the true goal of mindfulness- accepting what is.

    You asked a lot of questions, each one with an undercurrent of pressure. The irony is that the very questions you hope might bring you relief are actually keeping you in a state of suffering.


    Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

    The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

    Questions may be edited for brevity and/or readability.

    Last edited: Nov 19, 2014
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  3. Colly

    Colly Beloved Grand Eagle

    Hi Ellen

    Reading about your childhood trauma reminded me of the experience Dr James Alexander had. He too had suffered trauma in a car accident, and the repression of this had given him 20 years of chronic pain.

    I imagine almost losing your arm in an accident bad enough as an adult, never mind being a 4 year old... That's such a massive trauma to a child, and then not given the freedom to express this trauma is heartbreaking. Dr James Alexander describes how he did not allow himself to process this trauma, until his wife (after years of nagging) took him to a retreat where he became relaxed enough to allow this to surface. The results were remarkable - even to him being a trained and 'old-school' psychologist. His book is a must-read : The Hidden Psychology of Pain.

    It sounds like the trauma you had as a child is still trying to express itself. Do you remember in Dr Sarno's book : The Mindbody Prescription where he describes a patient who had a flood of symptoms "as a desperate attempt to prevent repressed emotions rising to the surface".

    See below link - on the "see inside" on Dr Alexander's book page 6 and 8 of the section called 'Opening to the unconscious' explains his retreat experience (page 7 is excluded sadly, and that's the enlightenment page where he processes his trauma). An excellent read.

    I agree with Alan - less is more - but I also think your childhood trauma may not have fully expressed itself yet.

    Hugs, Colly

    Last edited: Nov 20, 2014
    Ellen likes this.
  4. Solange

    Solange Well known member

    I love the advice from Alan Gordon, especially the bit that where he says it is more important to recognize the flare-up as TMS than to identify what caused it, if indeed we ever can.I have spent houre analyzing my thoughts and feelings during a flare-up, sometimes to the point of exhaustion, and often all to no avail. When I have adopted a mental 'shrug' and accepted it as TMS or diverted that energy into resolutely focussing on other things, symptoms have faded away much more quickly.

    I think a quick, cursory scan round your brain for possible reasons for a flare-up may be helpful but then, for me, it is best to leave it alone and try and just get on with life. The more I look inward, beyond a certain point, the more wound up and detached from real life I become and the worse I feel.

    Many people suffer from TMS anxiety. I would say, try journalling about what has worried/upset you thoroughly one last time and then move on and refuse to dwell on it any more. Your anxiety will leave you as other symptome have and just because it appeared at the same time as the mindfulness, does not mean that the mindfulness caused it. That is a nasty little trick your brain is playing on you. Refuse to be fooled.

    I would think that a large percentage of people here with TMS have had trauma of one kind or another in their lives and it is not retriggered by mindfulness techniques. It is like bending or sitting on soft chairs or driving. It is not those things which cause the pain, it is the BELIEF that they cause pain which causes the pain. (Thanks to Alan for that by the way, he speaks so much sense!)

    You will be fine. Relax! Do something nice for yourself even if you don't feel like it. You will soon be better.
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  5. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    Solange and Collyy. I agree. I too found that just believing totally that my back pain was from TMS
    the pain began to go away.
  6. andy64tms

    andy64tms Well known member

    Hi Ellen,
    It’s a good job I’m type A or AAA personality otherwise I would have a hard job keeping up with myself!

    I have no problem figuring out what is wrong for I am reminded, it seems every minute of the day with that internal itch that says keep going, fix the water heater now, then repair the sprinklers, oops go to the Home Depot ½ dozen times a day, for it is imperative to get a list of accomplishments to feel happy about. This must be sort of proving self worth; for I always tackle from bottom up negative approach and work upwards to that satisfying glow of “it’s fixed”.

    I am a mechanical designer by trade, happily retired away from the bustle of industry, flow charts and project planning meetings. I used to run myself ragged at work as also, I had no choice, for you are hired with the expectation of maximum performance, no exceptions. Over 45 years of work I found a hundred ways to protect myself from the tyrannies of the work place, and three years ago jumped at the opportunity to leave it all behind, thinking all was well.

    So, its retirement issues created by a self driven personality that are my problem, I just can’t stop, I have a disease called “can’t sit still itus”.
    My TMS physical neck and back pains have taken a rear seat to my desire to just slow down, and I have called them “cured” to the best possible level.

    I am doing quite well actually, at least with slowing down. I have made casual rules, (as hard fast rules are stressful) that I break and keep at my own convenience. I will mow the lawns today, then maybe I won’t, and when I do finally mow them, at my own convenience, when I am dammed well ready, I will perhaps goof off, and have a good yoga stretch at the end of each strip. It makes me laugh to know about my new found freedom.

    For me my pressure that Alan alludes to is ‘off’ in hundreds of other ways too, I am there with house budgets, income, and medical Insurance and a myriad of other lifestyle necessities. My life is tidily wrapped up in four excel files that are copied from month to month with the least amount of worry.

    I watched Howard Schubiner MD on video the other day. He also mentioned the 95% ratio subconscious. So, it is breaking a “habit” a day for me. An example of this was the other day when I frugally worked to get a hedge trimmer going for three hours, only to find a brand new one cost a mere $14. Three hours of devalued unsatisfied time, wasted forever, a sad but worthy lesson.

    With all the above said I windsurf for three months of the summer. I spend hours and hours lounging around with other contented windsurfers, with no thoughts of TMS, we think and do nothing in particular, and play at “windsurfing”, the only serious and unserious topic worth discussing. It’s strange that in a windy, ratty place with no comforts of home I’m the happiest I can be.

    As a final note to Ellen, I hope you find the exact therapy you need, but my three months of summer happiness proves for me that the best therapy is the therapy of no therapy. I’ve reviewed thousands of therapies even listened to Alan’s Interview with Dustin. It suffices me to just look at the front sheet of the advert, read a few comments and say I’m cured. But then again I am a cheapskate that doesn’t want to put pressure on myself.

    Good Luck, Andy,
    Visiting from the TMS Help Forum
  7. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    Isn't it amazing how, in retirement, some people can be just as busy as when they are a busy person in a busy job.
    I'm 84 and have been a fulltime freelance writer for more than half those years and still at it.
    I doubt I will ever retire, even if I could, which financially I can't.

    I keep busy as a writer and also as someone who shuts down at least at 6 pm and watches old movies on DVD.
    My book publisher boss never stops working. Someone asked when he would stop and he said, "When I'm dead."
    At the rate he's going, that might not be far off.

    Slowing down is very important, if only so there is time for deep breathing. That alone is one of the most
    healthful things I've learned about TMS healing techniques.

    I also learned a lot from the three dogs I've had, one at a time, over the past 40 years. They know the value of
    and pleasure in slowing down and taking a nap. I used to wonder, when I was a boy, why my father napped
    so much over the weekends or when we went on a drive and had a picnic. Napping was one of his favorite
    things, besides drinking beer. Now I do a little of both and think about Dad. He was a smart man.
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  8. Bodhigirl

    Bodhigirl Well known member

    Thanks for this. I work too hard, too. Not quite as hard as you did, but close.
    Today I told my uncon to stop it. Whatever it is, there are ten things to grieve today, three disappointments, a little rage. So what? It's weather. It passes, it is not worth this pain.
    I faced a hundred feelings, maybe understood half of them. The anxiety is a physical phenom. Spectacular in its displays.
    Fuck this, is right. Thanks, again for the reminder!!
    Penny2007 likes this.
  9. Shells

    Shells Peer Supporter


    Thank you Alan,

    I think I have been working too hard and thinking too much. Still trying to get past the fear and all of the journaling about past and present has really been making things worse. I have had a little success in the past just basically saying "fuck this, you can't steal this experience from me, if I hurt oh well. I have to have a life." I'm back in the fear of pain cycle and struggling to get out. Maybe I can get my mind back in the "I don't care" place.
    Bodhigirl likes this.
  10. Bodhigirl

    Bodhigirl Well known member

    Hi, all, and warm wishes for the Thanksgiving holiday, however it finds you...

    I have been pondering Alan's comments, which I have heard before about not worrying so much about what is causing a flare-up as recognizing that it is TMS and handling it promptly rather than letting it gain momentum.

    Perhaps because I am feeling protective of myself and women in general given so much of the triggering stuff around this recent election... this discussion is pushing me a bit to speak up. I have found that identifying triggers, connecting past patterns with present triggers and naming the helpless pre-verbal victim or rager or depressive part of me that is triggered, allows me to more compassionately address the TMS.

    I know this is an over-generalization: I taught graduate school psychology courses for a dozen years and I know there are far more similarities between men and women than differences. Still, I find that women have a deeper and more genuine need - generally - to go to the intuitive places, the places where they feel heard and understood and men find it very comfortable to acknowledge something, shake it off and move on and forward. It's understandable, given that up until about 150 years ago, women were so much safer and outside the workplace - 'in the cave' - while men were out in the world, working, fighting, deciding.

    In the 1980's a group of women at East Coast Ivy league schools did research on the different ways women have of knowing things compared to men. It was seminal to my own education. Up until then, all research on developmental psychology was done on boys. Little girls were not studied. So, we were just inferior. Women have different ways of knowing and I think there is room for this concept in our recovery from TMS. When I try to be too logical, my brain freezes. I don't see that with most of the men I have known and worked with.

    I am not trying to be provocative; I want to make space for women to explore without thinking there is something intrinsically wrong with them for being less linear in their processes. When I first recovered from TMS, I felt it would be a linear progression and it wasn't. The deeper I went, the easier it became to stop pain in its tracks but it's not been a simple process for me.

    As I have mentioned in other posts, Schubiner's book and cd address these stressors and understanding them - taking inventory of the past and seeing how it may create symptoms in the present. I got on here tonight to write because I was having the most relaxed Thanksgiving, and when my husband and I began going over diagrams of our home remodel, my back seized up and my head started pounding. Yeah, I worked out hard today but I didn't hurt until I had to think logically and mathematically - and when I have to do that for longer than I like, symptoms creep in.

    My dad was a very powerful and sometimes angry man. 97% of the time he was a wonderful dad. But when he was impatient, he made us feel stupid. When we did my math homework together, it was always a fight and I always wound up in tears and feeling stupid. I can be triggered to feel that way - when no one is accusing me of being stupid - and the symptoms begin. Knowing that, I can nip them immediately and not let them gain momentum. I can give myself compassion, I can give myself love and self care.

    I love this group!
    You guys are part of my Thanksgiving table. Have a piece of pie! Remember to stretch and breathe!

  11. tgirl

    tgirl Well known member

    The whole idea of flare ups is kind of depressing to me because my prickly, painful leg skin symptoms have been fairly constant to one degree or another for five long long years. I have experienced this before but it went away rather quickly. The first episode started during a flu, so this always haunts me. I keep thinking the flu did something.
    Having said this I will say that I have been tested by the medical world to no end. I've seen 3 neurologists, have had so many blood tests I can't even remember half of them. I've had MRI's, nerve tests and on and on. Nothing is ever discovered. Even my physician feels it has something to do with anxiety. He reminds me that in the past I've had other weird symptoms that just miraculously disappeared. I've been light headed for a long period of time along with a couple of other stress related symptoms that did dissipate on their own.

    I guess I want to know if this can be stress related in your opinion...I can't really see a TMS doctor..:((
  12. Bodhigirl

    Bodhigirl Well known member

    Welcome!!! With an open mind and the gift of desperation we become open to the possibility this is TMS. Best wishes in the journey.
    No shame in it. Most people feel as if something were wrong with them. Some of us have visible symptoms. Others struggle with the invisible types of pain.
    One day at a time may be frustrating but it is real and surely beats our routinely running to doctors who don't seem to have answers.
    Am so grateful my orthopedic Doc pushed me to Sarno. Nearly 20 years ago.
    Last edited: Nov 25, 2016
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  13. tgirl

    tgirl Well known member

    Thanks for your response Bodhigirl. Believe me I am trying to have an open mind...
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  14. Bodhigirl

    Bodhigirl Well known member

    T, an open mind is something we may cultivate all day long, only to have it un-cultivate while we sleep. I think it is just the way the ego and brain function. No matter how deeply we learn something, we can only have our mind stay awake for as long as it can handle (-:
    Hope that makes sense. I've been doing this a long time and am often humbled by how each morning is truly a new beginning. The more beginner's mind I can bring to any particular day, the better.
    Last edited: Nov 28, 2016
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  15. Bettina

    Bettina New Member

    oh this is all so helpful. I have been struggling all week to figure out why I am in pain again. As soon as I let go, I can feel my whole body relax and let go too. For me, the feeling of urgency that comes up in response to physical pain is so automatic, and leads directly to obsessive thinking and a desire to know what doesn't have to be known. It's exhausting. Thank you so much for the deeply helpful thoughts.
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  16. Bodhigirl

    Bodhigirl Well known member

    I just this. I am never far from my diagnosis!
    Just last night - out of the blue - I had this awful pain sweep through me for maybe ten seconds - the whole trunk of my body felt like I was going to die. My first thought was Oh God and my second thought was TMS, I can handle feelings, please don't give me symptoms. I went into a yoga child's pose and rested... I was feeling tired from a day of work, feeling pressure to engage when I wanted to disappear. I am an adult. Disappearing isn't an option! (-:

    Those baby feelings are constantly cycling through my unconscious. It's what I do with them. My favorite recovery phrase for this, maybe it was Sarno who said it, "Tell the unconscious that the magic trick doesn't work any more. There is NO RABBIT IN THE HAT." No sickness behind the pain. No sickness behind the pain!

    What freedom we are offered here. One day at a time. Best wishes, Bettina and all.
  17. Wavy Soul

    Wavy Soul Peer Supporter

    What a terrific thread, from Alan’s “fuck this” to Bodhi Girl’s “yes, but respectfully speaking, we women need foreplay and afterplay, we don’t fuck” ;-)

    I got a lot from all of this. I have come to the Forum today, Boxing Day, because I am super-triggered after a very social Christmas Day yesterday. A symptom came up this morning in my toe, of all places! — that matches a symptom in a finger that I have had occasional scary diagnosis thoughts about. So I’d like permission to meander femininely around what brought it on with great appreciation for all above posters.

    I went yesterday with a group of “friends” to a Nursing Home to do caroling. Oh boy — you just cannot imagine what the folk in this home were like! They weren’t particularly old people. Just people whose despair and abuse experiences had translated into becoming ill enough to be in a home. There they are free to stop trying, to just sit and do nothing, or socialize with other people like themselves, a bit. Although it was kind of hellish, there was a part of me that found it kind of attractive. Just give up, become a sickie, and get taken care of, fed, sung to. Why am I trying so hard?

    But what triggered me more than this was the social experience, before and after. I’ve been on a kind of long mystical dark night of the soul experience, as a result of my life quite literally falling apart a decade+ ago. I haven’t been in the local party/socialization circuit, although most of the people there assumed I have. I don’t even get invited to things much, and I get quite lonely, despite close one-on-one friendships. I saw that there are still a big group of people sort of “in my community” who have a busy life of belonging.

    It felt overwhelming to me, energetically, and yet I miss the endorphins that come from that belonging. Yet life seems to be guiding me towards an experience of belonging to the universe, rather than a social tribe.

    This conflict, between what my “soul,” for lack of a better word, wants, and my emotional pain-body self wants is I think the equation for an inner conflict, which takes up a lot of unconscious energy.

    And I can let go of over-thinking it. But it does help to get glimmers.

    I can totally relate about the election (which I don’t even want to think about, have been on longterm media fast, but it’s in the collective subconscious) being a trigger. Pretty much all my female clients have had old issues come up, or symptoms, and a couple of the male clients feel rage and powerlessness at a very uncomfortable level.

    (By the way, I’m a TMS therapist — or rather, when necessary I work with clients in this way, and actually quite a few have gotten better faster than me, but am obviously not writing here as an expert answering questions. There are some quite TMSish goodist be-in-control triggers about being a counselor every day, and I don’t want to lose the opportunity to get support as well as give it).

    Alan’s description of putting aside a day to process everything — and ending up worse — well, I can totally relate. I cracked up when I read that. Getting too serious about it all is part of the syndrome. I’d better get out for a hike.

    Love to all, love this conversation.

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  18. Bodhigirl

    Bodhigirl Well known member

    (By the way, I’m a TMS therapist — or rather, when necessary I work with clients in this way, and actually quite a few have gotten better faster than me, but am obviously not writing here as an expert answering questions. There are some quite TMSish goodist be-in-control triggers about being a counselor every day, and I don’t want to lose the opportunity to get support as well as give it)
    I have a feeling half of us here are caregivers, therapists, artists, creatives of some kind, Katie. Being reminded to receive support here instead of give answers is a good reminder for me, here and on the floor of our bedroom this morning when my type-A brilliant husband's back "Went Out" and I wanted to either laugh, cry or push a copy of one of my mindbody books to him while he lay there. Or at least send a link via email to his ipad which he began reading while he lay there, after he as finished cursing.
    You quoted me "Bodhi Girl’s “yes, but respectfully speaking, we women need foreplay and afterplay, we don’t fuck”" ...and i realized I must have written it because I have said it a thousand times to couples, to individuals.
    I am glad to hear the balance of men and women here. We have similar voices in some ways indistinguishable - and in other ways so very sun/moon, left/right different.
    I am taking a deep breath.
    In the middle of the night, after a depressing Christmas of missing my parents who have been dead too long, I had this pain in my hip. I tried to get comfortable and finally drifted back to sleep. When I did, I had a super-real dream: My husband and I were at a conference, he was working, I was playing and touring. We were sitting on a beach and agreeing we could live there forever. I felt so happy to know we were not going to be buried in Los Angeles traffic for the rest of our lives. We went back to the room and my face began peeling off. He began yelling at me (my masculine self, no doubt, angered that the feminine could win and we would eventually stop working and live a simple life elsewhere) and I ran until I began to fly over marshland, barely touching the ground now and then. Part of thought I was flying away from my animus like an eternal girl (guilty, I am) and part of me knew I was flying to get help for me.

    Then I woke up and the pain was gone.

    I am grateful to be listening to the pain, to its stories, to its warnings, sadness. Now, if I could just get a little more comfortable with rage, that would be simply amazing!
    Off to the movies this Boxing Day.
    Blessings and good will to all,
    two palms together,
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  19. Wavy Soul

    Wavy Soul Peer Supporter

    ha ha Bodhi Girl, sorry, you DIDN’T say that. That was my humorous/ironic/inappropriate British humor metaphor for what you said.

    (But I am blissed out to hear you say you COULD have said it. That is hilarious. You are my sisteranima. In fact, let’s chat some time if you feel like it. My contact details are at iwavenow.org)

    So glad to hear you had an integrative dream. I have recently been having disintegrative dreams — i.e. I wake up feeling worse.

    Movies! This has been an excellent movie season, almost as though a deliberate universal counter to the election stuff: Moana is brilliant, also Fantastic Beasts has a great message, and so does Arrival, although its intensity is a challenge for my sensitive nervous system. Oh, and LaLaLand, about love and life purpose, is precious.
  20. MWsunin12

    MWsunin12 Beloved Grand Eagle

    Tgirl, I think we joined the forums about the same time. I appreciate your posts. The "haunting" of something being a longterm result of an illness caught my eye. I go through the same thing after having shingles on my arm last Feb. Always haunted by "Did that permanently damage my nervous system?" especially since I have nerve issues come and go. It would be interesting to know what the end of the "haunted" feeling would be? I think I believe in TMS 100%, but then I will catch myself with negative thoughts about truly healing fully. Thanks for writing of your experience.
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