1. Alan has completed the new Pain Recovery Program. To read or share it, use this link: http://go.tmswiki.org/newprogram
    Dismiss Notice

Structured Program

Discussion in 'Structured Educational Program' started by Forest, Mar 9, 2012.

  1. Shanshu Vampyr

    Shanshu Vampyr Well known member

    *hugs Beach-Girl and Veronica73*

    I didn't for a moment mean that I am giving up. Last night with my parents, I felt a sense of peace that I do get when I allow myself to melt down (never at work, of course, although that might do me good) and a sense that something "connected" psychologically. Like you've said BG, sometimes the lessons and truths come automatically in our thinking now. The meltdown was a GOOD thing.

    But what I did mean with this whole "closure" concept--both in terms of residency: will they fail me for OB? ; and in terms of TMS: will I ever get to the finish line?--is that I've been struggling and striving to "get there" forever. Jon Kabat-Zinn, whose mindfulness meditation works I've studied (but find hard to live on a daily basis), talks about patience, acceptance, non-striving, and surrender; all qualities that as a TMSer I just don't know HOW to be. :) Eckhardt Tolle and Michael Brown (whose "Presence Process" I just started reading today) talks about the same things. It's been talked about how some TMSers try SOOOOOOOO hard to cure themselves they actually build up a lot of frustration, anger, and pessimism when they don't. "Why do some people not get along with Dr. Sarno's methods" thread talks a lot about this, on the old Wiki site. And I feel myself doing this. So, I can crack open Schubie's book. I can pick up where I left off on the Structured Educational Program work. I can even go into TMS therapy. (And will probably end up doing the latter, because the psychodynamic model really resonates with me). But at a certain point, I need to recognize that I'm stuck and stop spinning my wheels. I'm already exhausted from typical residency demands (even "normal" people would be; hell, it's April of my internship). So "closure" to me meant: accept that this is where I'm at now. And it's OK. I have not failed (at being a "perfect" resident or an "overnight" TMS success). While I know this intellectually, the perfectionist in me DOES feel a failure.

    You asked how I'm doing today. Well, basically I'm in horrible, excruciating pain right now and I may also have (another!!!) cold that I'm nursing that saps my energy and basically makes me feel like sh*t. But I know I've sort of reached the limits of my coping strategies so I'm psychologically at peace. I put a lot of pressure on myself to do this Noon lecture thing today which went off without a hitch. It always goes off without a hitch. If I can act on stage, I can certainly handle giving a spontaneous lecture without undue performance anxiety. It's just the perfectionist in me that feels like every "i" must be dotted and every "t" must be crossed, if you get my drift. So I'm accepting all of these raging pains right now. I'm not exactly detached enough to be able to laugh at it, like it was two days ago, but I'm somewhere above my body watching all that I do (Though that could be the weird head-spinniness and lightheadedness that might be from a cold). My attending today noted (nicely) at the end of the day, "You look like you're fading fast." It was compassionate. :)

    Finally, in one of your older comments Beach-Girl, you mentioned how I've probably had TMS my whole life. I've always known this was true. I've self-diagnosed with IBS since med school, and skin allergies/eczema have been a big problem since childhood. And who else develops spot baldness when they are losing their job? LMAO. :) So maybe the joint clickiness and poppiness and grindy-ness really is a really clever TMS manifestation after all. And if it isn't, I can deal.

    Morpheus would say I am walking the path now. To have hurty pains everywhere and not really be bothered by it--you're right, that IS progress.

    Thanks to all of my new friends on this Internet machine. :)
  2. Shanshu Vampyr

    Shanshu Vampyr Well known member

    Forest, I wrote that monster post above before your message showed up. And all I can say is, RIGHT ON!!! I refuse to suffer any more that I need to (emotionally) even if I feel like crap physically. :D
  3. veronica73

    veronica73 Well known member

    Yay, Phil--glad you are getting some breathing room from the mental suffering. Do something nice for yourself :)
  4. Shanshu Vampyr

    Shanshu Vampyr Well known member

    The only thing that causes me hesitation re: new MRIs is that I've never had my L shoulder scanned (it's never been the worse of the two). I just hope I don't see some "wear and tear" findings on the scan and spiral into another obsessive tailspin. :S To say nothing of the fact that I'm scared about my R shoulder.

    I sort of sat down at work this morning and wrote the following out, to sort of get back to TMS basics:

    "A few principles behind TMS philosophy, treatment and management:

    1. Sarno's TMS model has empiric validity in the hundreds of thousands of patients cured of chronic symptoms that he has seen over the years
    2. His theoretical construct is admittedly psychodynamic, which may or may not be scientifically true--repressed emotions and all of that--but it's generally NOT necessary to uncover "the" psychological conflict to be able to recover (although in my case, at least empirically the psychodynamics do MAKE SENSE). <--I have low self esteem and the drive for perfectionism because my parents were emotionally distant and very critical; I have old wounds and patterns of behavior that I'm acting out because of past hurts [i.e., "failed" residency in the past], etc etc
    3. Doubt in the diagnosis (and its practitioners) and fear of various things including slow recoveries, resuming normal physical activities, and having some wacky diagnosis are HALLMARKS of the syndrome. So is obsessing about the place in recovery you are in. DON'T LET THESE DERAIL YOU or lead you to EQUIVOCATE. You not equals fear. YOU ARE STRONGER THAN YOUR FEAR.
    4. Even inasmuch as #2 is true, TMS is also a CHRONIC INNER STRESS INDUCED DISORDER. Refer to Monte Hueftle's posts for more on this.
    5. ACCEPTANCE, HAPPINESS, and INNER PEACE are both difficult to do/be for a TMSer and also intensely threatening to it. Use them as weapons in your fight. Thus, non-striving and acceptance--which manifest as GIVING UP to the TMSer--can deal a crippling blow to TMS. Happiness and inner peace are also threatening to TMS.

    Now go out there and HAVE SOME FUN!!!"
    Forest and veronica73 like this.
  5. Shanshu Vampyr

    Shanshu Vampyr Well known member

    @ Veronica73: *hug* Thanks. How are YOU doing? Wanna grab some coffee later? :)
  6. veronica73

    veronica73 Well known member

    :) Thanks. I think we might be on opposite ends of the country but that would be fun someday :)
  7. Beach-Girl

    Beach-Girl Well known member

    How come you never asked me to coffee? Don't like the looks of the back of my head? Oh well. I live too far away as well.Oh yeah and I'm married.

    You hit on one word up there in your monolog (thanks for checking in) that hit the nail on the head: surrender. It's key here Phil. I think instead of "closure" the word that fits better with where you are is: "surrender". I too struggle with this, it's a tough thing to let go of all the crutches we use, the things we tell ourselves - to keep fear away. That don't really work but we do it anyway. It's a constant spinning dialog with me. Sometimes I feel like I am repeating myself over and over because my thought process is spinning around in my head with things I need to do, things that I didn't do, how I could be better. That's anxiety. That's (again) GAD, and that's the issue here. If we simply surrender to "life happens" then we can move on to the next step. I'm getting there, but still struggle.

    I like the idea of a TMS therapist for you. There is no such thing where I live, so my therapist is studying up on TMS. I saw Dr. Schubiner's book sitting out on her desk when I was last there. Don't know if that was for my benefit, or if it happened to be sitting there. I guess we'll go through this together.

    A book you might look at (I know you have quite the list up there of books you are reading) is one on anxiety. It's on GAD in particular and I've suggested it here on the forum many times. It's called "Dancing with Fear" by Dr. Paul Foxman. Amazing book. I saw myself on every page of that book. I learned a lot about GAD and he talks about some great coping skills. And if you read it, you'll know for sure if it's GAD or OCD. In any event, it's anxiety.

    One exercise in particular that I like is answering your own questions. The "what ifs" run rampant sometimes with me anyway and it would appear they do with you as well. So you take your "what ifs" and instead of freaking yourself out to the ridiculous, (I do this too) you answer them. "What if I don't pass my Internship?" And you fill in the blank. And not with all kinds of wild accusations against yourself, you answer it when you have a logical answer. It is a nice exercise because it takes out the fear. Pretty soon you're just asking the questions in your head and quietly and realistically answering them.

    Another point. Your parents. Is this their life? Or is it yours? I know they have expectations. Or so you think. I wonder if presented with all that is going on in your head if they would want you to be miserable and in pain and a doctor? Or if they would want whatever it takes for you to be smiling and happy? Just curious. Have you ever thought about that? Have you ever taken them out of the equation long enough to see what is best for you?

    Forest posted a new video. I like it a lot. It's about being present. I'll post the link for you and maybe you will have time to watch it. He makes some great points that benefit me. I wonder if they'd help you too?


    PS Cancel Crash cart - he's coming around on his own.......
  8. Beach-Girl

    Beach-Girl Well known member

  9. Shanshu Vampyr

    Shanshu Vampyr Well known member

    When I wrote out those TMS basics yesterday, I made a firm committment to myself to LIVE the work, not just complain about my life and my symptoms. I am keeping that promise. As I mentioned, I think I'm nursing a cold. I did come in and Round this morning as usual, but I started developing weird symptoms (in addition to my familiar pains). I get these weird dizzy spells that last for a couple of minutes and sometimes things seem really loud in my ears. Symptoms I've experienced before in a TMS context. These could be sinus related, but they could also be PPD. Anyhow I took a sick day and here I am on the forum again.

    But I've maintained an observational, accepting attitude towards my physical condition today. I plan to see a doctor to see if any treatment is necessary for my crappy sinuses. I hope to get a referral from him or her for a set of MRIs of the shoulders. Plus, going to call a suggested TMS therapist. Despite the worry. I took a Xanax just now (prescribed) and forgave myself for doing so. Hopefully it'll kick in soon.

    Going to treat myself to some TLC for the rest of the day. Thanks all.
  10. Shanshu Vampyr

    Shanshu Vampyr Well known member

    Re: books. There are quite a lot I have on my eternal reading list. But I also need to surrender. I am surrendering. Lots of pain and weird symptoms yesterday and today. My work is really a crucible even though I can't put my finger on why. But I'll let that go.
  11. Beach-Girl

    Beach-Girl Well known member

    Good on ya Phil! If only you would allow yourself the down time you're taking today. You sound calmer, and are more accepting right this minute - than you have in awhile. Wsa it the meltdown? Or the downtime? Now to connect the dots to your everyday life. That's my struggle too. I know it, just can't seem to live it very well.....yet. But I'll get there and so will you.

    I know you have a long list of books to read. But the book I suggested would be a nice addition to it. I think you'd learn a lot as it doesn't really deal with TMS, but the anxiety that so many of us carry.

    Anxiety is something we're born predisposed to. And I've carried Dr. Foxman's lessons along with me on this journey. So I'm being pushy here, but I highly recommend for you - that you read a bit on anxiety. You'll find that it is perhaps a big player in your TMS, and more importantly, that you're not alone in having this monster on your back. I only say this boldly since I have it too and like TMS, can see it in others.

    Something interesting (and a little off topic) my therapist once said to me is: "You are not afraid of the ocean, yet you have so many other fears that you constantly battle." This has stuck with me because it's true. You'd think with all this anxiety I have that I'd be terrified of the surf. But I'm not. In fact I "play" as close to the ocean as possible without getting wet. I admire its power, its rhythm, and its ability to do what it wants. The power behind those waves is different everyday. So is the power of "me" in my anxiety driven life.

    Does this make sense? Is there a place that you feel totally comfortable that would make others a little on edge? Or simply just a place? If so, then that's your "sweet spot". The place you can sit, run, walk, or anything you want. The place where anxiety and TMS leave you. Think about it. What is out there (and we all have something) that makes you totally free of all anxiety and pain?

  12. Shanshu Vampyr

    Shanshu Vampyr Well known member

    Could also be the Xanax...:)
  13. Shanshu Vampyr

    Shanshu Vampyr Well known member

    Are you sure you're not a TMS therapist?

    Urgent Care MD saw fluid behind both of my eardrums. I'm gonna be on antibiotics and decongestants again for the second time in about 5 or 6 weeks. :(

    I'm lucky to be really close to the coastline here in Erie, PA. We have this beautiful peninsula called Presque Isle that I should go to more often.
    Beach-Girl likes this.
  14. Shanshu Vampyr

    Shanshu Vampyr Well known member

    I'm discouraged by my use of the Xanax...I always feel like I'm going against Sarno when I need meds. (It took me a long time to go on Cymbalta because I worried that I wasn't being a purist and it would derail me from thinking psychologically and being able to release emotions through crying, and it doesn't do anything for my pain). I'm worried that my use will turn into a crutch, maybe an addiction, even though I feel so much better physically now. Does anyone else have thoughts on Sarno purism?

    Another question for the peanut gallery: What do dreams mean in a TMS context?
  15. Shanshu Vampyr

    Shanshu Vampyr Well known member

    "Dear Ma,

    I still feel like I'm living your life.

    Much of that is due to the fact that you seem to act and behave like I'm a child living under YOUR rood, under YOUR thumb and under YOUR ground rules. I'm so sick of when you micromanage and be domineering. It's like you run this place like it's YOUR household, not mine.
    Who's residency is this, yours or mine? Who's life is this? You act like you're uncomfortable when you're not the boss. Who's paying the rent here? You just behave however you want and it pisses me off.
    This isn't the relationship of an adult child and an adult mother living together. I hate our living arrangement. This is the relationship of a child living with his mother on whom he's dependent. And it's true that I have needed to lean on you for support a lot during this almost completed first year. But although I regress developmentally from fear due to body concerns/TMS and fear of being out in Residency World, it shouldn't automatically follow that you bark orders to me. Orders out of love, but orders all the same. You don't ask for my opinions on anything; you act out of a script that's in the past. You probably see that I'm regressed (with Bear and hugattacks) and vulnerable and this is your way of protecting and shielding me as best you can.
    And it's a double-edged sword. The TMS/fear situation and my incessant worries about residency/outcome and the big question of LIFE in general and the fact that I don't know how to answer the question of WHAT TO DO were I not an MD--and I really DON'T KNOW how to answer that question, and it scares the bejeezus out of me--make me incredibly vulnerable. Nothing's more horrifying than the fear that something is VERY WRONG with not just the career path you've been on since you were 18 (13 years!), but also something's HORRIBLY wrong with your musculoskeletal system; your very body; your very person, that, in a nutshell, is TMS. Nothing induces more fear than the thought that something is VERY WRONG with the very body you inhabit (even though you may intellectually know that you've been checked out thoroughly and anything you feel is benign). And so yes, when that fear kicks in, yes, I am a small child needing his Bear and his Mommy. And we have issues, Mommy dearest; you enacted the parenting style you were parented with, and I don't believe it was healthy. And so, because of your own neuroses--and the psychiatrist in me can list all the clinical diagnoses you have--you split us, Izzy and I; you were loving, but also emotionally distant; you had issues with Pa that may have reflected your OWN daddy issues. And so, I grew up not always--I won't say never, but not always--"feeling" that you loved me, that I was good enough just because I was YOUR SON, and not just a "gifted child" who you pushed into kindergarten at 4 just because I knew the alphabet already; pushed into Stuyvesant High School because it was the most elite NYC specialized high school; and pushed into medical school just because I had a passing interest in biology and the Home Medical Reference when I was a child.
    And so I didn't have much of a childhood in the happy-go-lucky sense; and I rarely "felt" loved by you. And so now, in 2012, after all of what happened in Syracuse '03-07 and Stony Brook '07-'08, I have a fierce need to FEEL that you love me so that I can return to some long ago forgotten developmental level and feel LOVE for MYSELF. So you didn't protect me from the bullies and the tormentors of the world! God, what kind of mother laughs it off when her preteenish age son gets mocked in the JHS newspaper with an alter ego complete with his own comic strip called "Ninja Nerd"? You betrayed me. And so developmentally I need that regression period.
    But I don't need to be "parented down" to. I am 31 years old and I need a loving mother who isn't wrapped up in her own neuroses.
    I need you to love me unconditionally, because I don't feel it. :( "
  16. Beach-Girl

    Beach-Girl Well known member

    Interesting. How are you living her life?

    Mothers can do this - I can attest to this.

    Why did you need to lean on your mom? Did she provide comfort? Encouragement? Unconditional love? There must have been some reason you leaned on her. Or felt you could because you go on to say....

    From what? What does she protect you from in your house where you pay the rent and she "barks" orders at you? What could she possibly be protecting you from? It seems to me that you have nowhere to go to simply "let down". Unless your on Xanax. I take a lot of Klonopin. Wouldn't want to see the world with all the stress I have without it, but I stray off point. I have never heard of a "child" going back to live with his mom at age 30 - and it working out well. How can you bring a girl home? Oh and this is my mother? Step into my room please?

  17. Shanshu Vampyr

    Shanshu Vampyr Well known member


    As usual your posts have my head spinning with more questions than answers (I mean that as a good thing, not a bad one).

    If I could dissociate from my parents and current career, I would probably be a lot happier. But, right now I DON'T KNOW HOW TO DO THAT. The idea that I am too afraid to take risks on what I truly want to do in life--and it's something of a creative endeavor, and not Medicine--is really scary.

    I do know one thing, and that is I am slowly assimilating the lessons from this inner work that I am doing. I have managed to not be overwhelmed by fear of pain for a little while now, and I have a weekend free that I'm planning to use to visit Pittsburgh (yes, with my parents though). Due to a colleague calling out sick for the weekend, there was a sticky situation at work where I was almost forced into being on-call by default. But I have my dad visiting from out of town and he drove all the way from NYC to visit me (8.5 hours or so). I firmly told them I'd made other plans and I wouldn't be available. So the situation was ironed out and I get to keep my free weekend. Maybe I'm over-reading the situation here, but afterwards I noticed that the pain was nearly gone in some of my problem areas--and stayed that way for a while.

    And BG, I'm not of course suggesting that I'd like to be in pain forever. Who would? But I'm afraid to walk a path that's unfamiliar to me. While I don't love Medicine, at least it's familiar to me.

    Am I condemning myself to chronic pain if I don't find my muse? Part of me is still 18 years old and not sure of what to do.
  18. Shanshu Vampyr

    Shanshu Vampyr Well known member

    What scares me is that the pain has a mind of its own. What if I were to drop out of the program, get an agent and start auditioning for roles? Or start writing scripts (something else that I really, really enjoy) and send them for appraisal? Does that mean the pain would go away?

    I really am starting to feel damned if I do, and damned if I don't.
  19. Shanshu Vampyr

    Shanshu Vampyr Well known member

    Finally, it sounds like you're saying I need to kick Mom out of my house and live on my own. I think that hopefully I'm past the acute vulnerability of last year when I first moved here. I have lived on my own before and loved it. I was great at being independent. So are you saying that having Mom cramp my style can contribute to the TMS? In words and actions, I have been trying to mend my relationship with her. At one point in time, when I was younger, we WERE close. Has she always been flawed and damaged in her own right, and therefore only capable of showing love in certain situations? Yes.

    I'm starting to think that I'm constitutionally damned.
  20. Shanshu Vampyr

    Shanshu Vampyr Well known member

    I know I can change. I cannot change overnight. Ultimately I just want to be happy. But I can only grow by making small steps at a time. I have already been helped by all of this. At a snail's pace, yes. But happiness is in the cards for me ultimately, I know this, and with that, a pain cure. But I need something to hold onto right now, and even if it's maladaptive behaviors and thoughts while I get comfortable with change, even that will help. It's strange that philosophically, I'm 180 degrees from where I was last year, when I was trying SO HARD to get into a program; and now, it is seeming that this field isn't fulfilling me very much at all. I may be reading the signals and signs wrong. But I don't feel comfortable with making drastic changes right now even if the price is continued pain.

    Anyhow...mindfulness. Rome wasn't built in a day. Should I choose to live with Mom or not; should I choose to continue with residency or not and when to make that decision; and should I choose to follow an old dream or dreams that I KNOW that my parents will unconditionally be unable to support me emotionally on (and still be OK with that, ultimately; aren't we all, in some way, shape or form, still seeking approval from parents that are now running commentaries in our heads? By the by, my parents--having witnessed my pain and anguish with this program over the past year--are fully supportive of me NOT continuing, these days. And yet, both for practical purposes and psychological, I still feel indebted to myself and to Mom-voice and Dad-voice in my head to continue...maybe even finish); those are all questions for a different day.

    For now, I'm going to enjoy Pittsburgh. Even if it is a trip with my flawed parents.

Share This Page