Dr. David Clarke | Why Deep Stress & Your Brain May Be The Cause of Your Disease or Chronic Pain

The Hormone Prescription with Dr. Kyrin Dunston

Welcome to another empowering episode of The Hormone Prescription Podcast, the go-to audio haven for midlife women seeking wellness and balance in a demanding world. Today's episode is a deep-dive into an often-overlooked culprit behind disease and chronic pain - our complex brains under the burden of deep stress.

In This Episode: Join us as we explore with Dr. David Clarke, the profound ways in which deep-seated psychological stress can manifest as physical symptoms. Dr. Clarke, an accomplished physician certified in Internal Medicine and Gastroenterology, shines a light on the intricate link between deep stress, our brain's response, and how this connection may be keeping you from enjoying a life free of pain.

For years, Dr. Clarke has dedicated his expertise to advancing awareness, diagnosis, and treatment of stress-related and brain-generated medical conditions, striving to quell the chronic pain epidemic. As President of the Psychophysiologic Disorders Association (PPDA), he is at the forefront of transforming lives through education and support.

Key Takeaways:

• Uncover why your unexplained aches might be rooted in emotional trauma or long-buried stress.
• Learn about the crucial role of psychophysiologic disorders in chronic pain syndromes.
• Discover practical tips on identifying stress-induced pain and how to address it effectively.
• Gain insights into Dr. Clarke's holistic approach that goes beyond medications to heal the mind-body connection.

Professional Insight:

Armed with an MD from the University of Connecticut School of Medicine and a wealth of clinical experience, Dr. Clarke's professional insights are a beacon of hope for those battling unseen stress-induced health struggles.

A Message to Our Listeners:

Dear listener, if you've been searching for answers to the mystery of your unresolved pain, this episode could be the key. Dr. Clarke's expertise offers not just knowledge, but also the compassion and understanding so vital during the healing process.

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Join the Conversation:

We welcome you to share your thoughts and breakthrough moments from this episode on our social media channels. Use the hashtag #HormonePrescriptionPodcast to join the growing community of women empowering themselves through knowledge and shared experiences.

Remember, wellness is not just about hormones. It's also about the mind and its powerful impact on our bodies. Tune in, tap into newfound wisdom, and transform your life one episode at a time.

Until next time, stay inspired, say goodbye to chronic pain, and hello to a vibrant you!

Dr. Kyrin (00:00):

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. Arthur Schopenhauer, stay tuned to find out about something that is self-evident to some of us practitioners, but your doctor might not be aware that could be hurting your health and your hormones.

Dr. Kyrin (00:24):

So the big question is, how do women over 40 like us, keep weight off, have great energy, balance our hormones and our moods, feel sexy and confident, and master midlife? If you're like most of us, you are not getting the answers you need and remain confused and pretty hopeless to ever feel like yourself again. As an O-B-G-Y-N, I had to discover for myself the truth about what creates a rock solid metabolism, lasting weight loss, and supercharged energy after 40, in order to lose a hundred pounds and fix my fatigue. Now I'm on a mission. This podcast is designed to share the natural tools you need for impactful results and to give you clarity on the answers to your midlife metabolism challenges. Join me for tangible, natural strategies to crush the hormone imbalances you are facing and help you get unstuck from the sidelines of life. My name is Dr. Kyrin Dunston. Welcome to the Hormone Prescription Podcast.

Dr. Kyrin (01:17):

Hi everybody. Welcome back to another episode of the Hormone Prescription with Dr. Kyrin. Thank you so much for joining me today as we dive in with Dr. David Clark into a discussion about deep stress and your brain causing chronic disease, chronic pain, hurting your hormones and lots more. This really is self-evident to a lot of physicians like me and Dr. Clark, but most physicians haven't gotten the memo when they went through med school and training. They didn't get the memo on this. They weren't trained in this. So they're probably not aware if you're going to a typical managed care physician. They also don't necessarily have the time to spend with you to discern if these issues could be contributing to your health problem. So I think this is a super important topic. I'm glad you're here to hear it. Dr. Clark has deep knowledge and experience in treating patients, in research, in teaching medical students and residents about these issues, and it really can benefit your health and your hormones.

Dr. Kyrin (02:29):

So I'll tell you a little bit about him and then we'll get started. So he's a board certified internal medicine specialist and gastroenterologist, and he is the founder of the Psychophysiologic Disorders Association, PPDA. He's got some resources to share with you. His website is end chronic pain org. And he's very modest because in his bio that he shared with me before we started, and then I did my research online, I found all the books that he has authored and co-authored and all the resources that he has for you. So he's the author or co-author of Psychophysiologic Disorders. He is an author of a diagnostic guide for Psychophysiologic disorders, that's for practitioners. He is the author of, they Can't Find Anything Wrong, Seven Keys to Understanding Treating and Healing Stress Illness. But none of this was in his bio . So he's, he's very modest, but like I said, he has deep knowledge and the time has really come that all doctors should know about the effect of ACEs and deep stress on their patient's health, but they just don't. So it's your turn. You've gotta take responsibility for your health to educate yourself about this and to put it into practice, to use your, in your health to move it towards the best it can be because you only get one life and you deserve to have the best health and best life and best vitality possible. So that's Dr. David Clark. Please help me welcome him to the show.

Dr. David (04:15):

Great to be with you. Thank you.

Dr. Kyrin (04:16):

Yes. I know we're talking about your favorite topic today and hopefully we'll tie it into my favorite topic, which is hormones. And hormones and pain, chronic pain are interrelated. If you're listening and you're not sure why you're scratching your head saying, Dr. Karen, I don't understand that. Hopefully it'll make more sense for you at the end of the episode. But first I wanna dive in . You are certified in internal medicine and gastroenterology, but you have this passion for psychophysiologic disorders. If you're not sure what that is and you're listening, just stay tuned. We'll, we'll, we'll define that for you. And most doctors certified in internal medicine, practicing everyday internal medicine and gastroenterology really don't have an interest in this, they may not have knowledge or awareness of what you specialize in. I know that you do educate practitioners, which is wonderful because we need to have more awareness. How did you become aware that this was a huge blind spot for US physicians when it comes to treating patients and become so passionate about it?

Dr. David (05:28):

Well, like you, I was very traditionally trained. I mean, I went through four years of medical school and three years of internal medicine residency entirely. Traditionally, things were going well for me in terms of my training, but all of a sudden I encountered a patient. I didn't know the first thing about how to diagnose or treat this was in the eighth year, you know, when I was a first year as a gastroenterology fellow. And this patient had been ill for two years, with very severe physical symptoms, actually referred to UCLA where I was in training from another university because they couldn't figure out what was wrong with her. We did a very specialized test on the electromechanical properties of the intestine to try to figure out what her problem was. And we were my department chair and I, we were convinced that that test was gonna be abnormal because no other explanation was possible as far as we were concerned.

Dr. David (06:21):

And so when that test was normal, two we're just at a loss and we had to essentially tell the patient there was nothing more we could do for her. But in her exit interview, I asked her about stress a few more times, and she began telling me she'd been sexually abused as a girl and not just once or twice, but hundreds of times. And this obviously was a huge piece of history from her background that I didn't think could possibly be connected to why she was physically ill 25 years later. But it definitely stood out and I was aware that there was a psychiatrist in our institution who had an interest in these mind to body connections. And I thought, well, maybe we can help this patient live with her condition a little more successfully if she talks to this psychiatrist. So I arranged an appointment, forgot all about her, and then I ran into the psychiatrist in an elevator a few months later and said, you know, whatever happened to that patient that I referred to you?

Dr. David (07:19):

And she said, oh, I haven't seen her in a few weeks now, Dave she's fine. She's, you know, no longer needs any medical care. All of her symptoms have completely resolved. And this happened just with a few months of counseling. And at that point, that just blew my mind that you could alleviate a serious physical condition just by talking to somebody. So I thought, okay, you know, if I'm gonna be a complete doctor, I should learn a little bit about how to do this. It might come in handy for a few patients every year when I get into practice. So I prevailed on Dr. Kaplan to give me a framework for how she thought about these things. And then when I did get into practice, I started using this framework whenever I couldn't find a disease or an injury that would explain the patient's symptoms and patient after patient had these deep psychosocial stresses that were going on that were connected to their illness, if you could identify them, if you could treat them, the patient's physical symptoms would improve. And unfortunately, in Portland, Oregon where I was in practice, there were no other Dr. Kaplan's there. So I ended up doing a lot of this work myself, and today we're 7,000 plus patients later than I've been doing this with. And I've been teaching other doctors how to do this because you can, it's readily possible to learn how to do this, and it just transforms your practice. This was one third of my patients for decades.

Dr. Kyrin (08:47):

Right. Well, thank you for sharing that. I, I think it's always fascinating how, why people do what they do, why they're so passionate about it, particularly when it comes to physicians who have gone off the beaten path, the mainstream of medicine where most gastro neurologists are just typically prescribing drugs and surgery, and nobody's asking about people's adverse childhood experiences, deep stress, et cetera. So hopefully that gives everybody an idea of the question of why this is important. Maybe there's somebody listening who's been struggling with undiagnosed medical illness. What are some of the statistics on undiagnosed medical illness and why is this such a huge problem?

Dr. David (09:31):

Yeah, we're talking here about people who go to the doctor for their pain or illness and no disease or injury is found to explain it. Or if the doctor thinks, well, maybe this issue could be explaining your illness, but you're not improving in the way the doctor expects, and that's the time we want to bring in a look at psychosocial stresses, either from the past or the present or both that could be contributing. And it turns out that when you look at the research, it's about 40% of people that go to a primary care physician or about 20% of the adult population in general. So this is 80% larger than the diabetic population, for example. And yet, unfortunately, it's not been part of traditional training. It's kind of like the medical clinicians are saying, well, this is a a psychological problem. This is really not in our ballpark. And the mental health professionals are saying, well, these patients have physical symptoms, they've got real pain, they've got irritable bowel or fibromyalgia or migraines or pelvic pain or genital pain or joint or back pain. And that's not really a mental health problem. So we don't deal with this either. And these patients fall into a giant blind spot in this system. It's 50 million people in the United States alone.

Dr. Kyrin (10:50):

So how would somebody who's listening know if they have a chronic illness that remains undiagnosed or chronic pain? You talk about stress related brain generated symptoms versus traditional pain and disease. How does someone even begin to sort out, is this me? Could this be affecting me?

Dr. David (11:10):

Yeah, it certainly starts with having a medical evaluation to make sure there's no organ disease or injury that's responsible. And then after that, we're looking into whether there could be a psychosocial stress behind this. And there are three main categories for that. There could be stress in your life at the moment, especially if it's chronologically linked to when and where your symptoms began or when and where your symptoms flare up. The second major issue is to make sure you don't have a mental health condition that hasn't been diagnosed. A lot of people with depression, anxiety, or post-trauma stress don't fully recognize that their symptoms are linked to that depression. Those mental health conditions can be subtle in many people and not so obvious as to have you running straight to a mental health professional. And then finally, the biggest shock of my medical education was finding out that stress when you were a child, could make you ill as an adult.

Dr. David (12:09):

The question that I like to ask my patients here is, imagine you were a butterfly on the wall of your childhood home and you were observing a child you care about growing up in the same home that you grew up in and you can't do anything. You're just watching that kid try to cope. Would it make you sad or angry to watch that child either your own or another one you have a connection to make you sad or angry to watch that kid trying to cope in that environment. And if it would, then there's a probability that there's a level of stress that went on back then it can still be impacting you today, including in the form of physical symptoms.

Dr. Kyrin (12:47):

So I wanna ask you a couple of questions about what you just shared. So you said they need to make sure they don't have any type of organ disease or a mental health diagnosis, but in reality you can have organ disease functional like a Crohn's or ulcerative colitis with an actual organ problem, and you still could be related to stress and brain issues. Correct?

Dr. David (13:12):

Well, you can have a combination of impact on your body from stress, from brain generated symptoms and a biomedical condition like Crohn's disease at the same time. And that's, that can be a really confusing situation for a physician. If you've got a flare up of symptoms, you need to then sort out, is it the inflammatory bowel disease is flaring up or is it the irritable bowel syndrome that's more directly connected to stress that's flaring up. And sometimes you have to do more diagnostic tests to see if the inflammation is more active, or you can evaluate the patient and see if there's a stress that has come up in their life that has triggered the flare up in the symptoms. So yeah, there can be people who have both of these conditions at the same time. Right.

Dr. Kyrin (14:01):

And same, I guess with the mental health diagnosis. And you talk about adverse childhood experiences, which we've talked a bit about on the podcast, but I think it bears repeating. And you mentioned a term though I had not heard called deep stress. So can you talk about what is deep stress and maybe talk to everyone about how they would know if they qualified to have adverse childhood experiences or not? I know you gave a great example there. If you look back at your childhood, would you think, wow, that was really a lot to handle, but what is deep stress?

Dr. David (14:36):

I use the term deep stress to mean stresses that people don't fully recognize they have. So they're kind of deeply buried stresses that may be affecting a person today, but they're not fully recognizing the magnitude of that stress. One of my patients, for example, was put into my hospital because of an attack of severe vomiting and extreme dizziness. And when I went to see her for consultation, she said something to me, I've never heard from any other patient, which was, thank you for coming, doctor, but don't waste your time with me. You'd be better off seeing your other patients. And when I asked her why it turned out she had good reason to say that she had been hospitalized at a major university in her hometown 60 times over the previous 15 years with no diagnosis. She had seen a dozen different specialists, she had seen a psychiatrist and none of them could find anything wrong with her.

Dr. David (15:31):

But it turned out that she had a major stress in her life, which turned out to be that her mother had verbally and emotionally abused her, starting when she was three or four years old and continuing on to the present day. She was 50 years old at the time, her mother was in her seventies and was still doing this to her. So it also turned out that, and this was the, the real key to her diagnosis. But although most of her attacks of illness, which she had between six and 10 times a year, took place in and around her home community, she would always get an attack whenever she passed through a little town, about 45 minutes from where she lived. But it turned out the only time she ever went through that little town was when she was on her way to visit her mother, who lived several hours further down the road.

Dr. David (16:21):

So she's driving to visit her mom, the emotional tension in that relationship is building and building and building. And by the time she gets to this little town, her husband's gotta pull a car over and she's throwing up all over the guardrail. So I pointed out to her that the only time she got sick was when she was on her way to visit her mother. She could drive 45 minutes in any other direction and she'd be fine. She could drive an hour and 45 minutes in any other direction and she wouldn't have any problem. So that finally made clear to her what this deep stress was that she hadn't previously recognized. And as soon in her case, just bringing that into conscious awareness was enough to alleviate her illness. She went home from the hospital the next day and she called me a year later, say, she'd gone through the entire year with no episodes. Now I wish I could cure everybody that quickly, but it's a really good example of deep stress and the impact it can have when you finally see what's going on.

Dr. Kyrin (17:22):

Right. And so what you're describing though, in terms of the physician interaction really requires a level of attention and curiosity and a level of time commitment to really sort through these issues with people that most physicians are not allotted by the current managed care system that we have. And we're not trained in that. So I know that you have so many resources, books you've authored and training programs for practitioners. I don't know that the medical curriculum has changed since I went through medical school. Are you, or residency, but how do you suspect that we're going to actually get physicians, the education and training and give them the time to be able to sort through these issues with patients?

Dr. David (18:13):

Yeah, once you see these issues, you sort of can't unsee them. And it's true that the, you know, medical office visits these days are very short. But as I tell my audiences of physicians when I'm teaching, you don't have to gather all this information in one visit. You can get the information you need about stresses passed and present a little at a time, because these are patients that tend to keep coming back to your office because they don't get better with the traditional approaches. So you gather this information over time, and the physicians I've taught to do this they absolutely love it. It transforms their practice. So one of them mm-hmm, , a family doctor, took me aside at a conference and said, these concepts have put the joy back into my work because all of a sudden you've got 40% of the people who are coming through the door to see you.

Dr. David (19:04):

That used to be a headbanging frustrating because you didn't know what to do for them. Now all of a sudden you have a positive approach that you can take that actually makes people better. Not necessarily in one hour conversation like with the last patient, but definitely over time people can see they're on a pathway toward improving their use of healthcare resources goes way down. You know, you asked about, you know, what patients can do to assess themselves. I should have mentioned we've got a self-assessment quiz on my nonprofits website. It's at end chronic pain.org. There's a 12 item self-assessment quiz. And it's set up so that the more questions to which you answer yes, the more likely it is that you have one of these psychophysiologic disorders. A combination of psychology and physiology. And that's a way that your listeners can find out or at least get more information about whether this might apply to them.

Dr. Kyrin (20:01):

Yes. Something else you said though, that this woman had been emotionally abused by her mother in my experience. So this applies to a great quote that you shared with me from Schauer before we started that I wanna share with everyone. All truth passes through three stages. First it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. And I love that because I, I don't know which stage we're in with the topics that you're talking about where deep stress, adverse childhood experience, and we're probably in the, maybe it's a little ridiculed by a lot of people. That's not an issue. And in my experience, and in a lot of the women that I work with, thousands of women, if you say, were you emotionally abused? Were you sexually abused? Did you have abuse? Did you have neglect as a child?

Dr. Kyrin (20:51):

I find that a majority of people who grew up in fairly cohesive, what I would call seemingly functional families, have no awareness actually, that they were emotionally abused, but they were, and maybe they have no memory of sexual abuse, but they were. And so I do find when I encounter patients, 'cause this is something I'm attuned to, and there are certain issues going on that have no medical explanation, and I approached these subjects, their answer is, oh no, I, my family was fine. I didn't have any problems. But if you ask more pointed questions to get to specific statements that people may have made or how people were available to them or not emotionally really in the terms of the emotional arena, people have a huge amount of denial is what I'm gonna say.

Dr. David (21:42):

You're right.

Dr. Kyrin (21:44):

So how do you, we've been socialized in America and most developed countries to believe that our body is a machine and it's a mechanical machine. When there's a problem, well, we go to the doctor to get a diagnosis, just like we take our car to the mechanic and then they figure out what's wrong and they give us a pill or they do a surgery and they fix us. And nowhere in my training or any, I just did my board recertification this year, we have to do it every year. And none of the articles on women's health had anything to do with what you and I are talking about when you and I both know that the issues we're talking about have deep consequences in terms of health for women in terms of their fertility and their menstrual regularity, their menopause, et cetera. So how do you get people out of denial and to really realize that this is a part of the problem and realize that what they did experience, although it might not have been horrific, like you see in some TV shows and movies, actually was neglectful and was an adverse childhood experience. And was Dr. Deep stress

Dr. David (22:49):

Wow, a lot to unpack there. Yes, with the Schopenhauer quote, I mean, it depends on, you know, who you talk to. But the acceptance now is really coming on. I mean, there, I'm teaching in my medical school, I'm teaching in graduate schools, and there are medical schools in Europe that are teaching this now. One of two of them are actually using my first book called They can't find anything wrong as a teaching tool, especially for their family doctors. So the acceptance is really growing. It, it's, we need more for acceptance than just me telling stories about my patients. And we have that. Now in 2024, there are half a dozen randomized controlled trials that show the value of what I call pain relief psychology or what another researcher is called, pain recovery psychology, that have compared it with a variety of placebo control groups and the, the power of the outcomes, the effect size, which is the, the statistical term is enormous for when you compare it in terms of the outcomes.

Dr. David (23:55):

One of the studies called the Boulder Back Pain Study, for example, they had people with 10 years of back pain. Their average pain scores were four out of 10. And with just one month of pain relief psychology, their average pain scores dropped from four to one. And this is after a decade, these people had been suffering. And, one month it just plummets. It's extraordinary to see the graph. It was published in the JAMA Psychiatry Journal of the American Medical Association. And the benefits were enormous. And we got similar results at Harvard, at the West Los Angeles VA Hospital where they worked with a very tough group of older male veterans, 5% of whom got better with cognitive behavioral therapy, which is the usual kind of psychotherapy that you get in the us. But with the new pain relief psychology, 42% achieved their pain goal.

Dr. David (24:51):

I mean, it was eight times as much. It's just extraordinary to see that kind of impact just from talking to people in a different way. So coming onto your question about how do we make people aware that their childhood experience was maybe not quite so good as they thought, because you know, after all, none of us has a parallel life we can compare ourselves with. If you grow up in a difficult environment, you may not necessarily appreciate how difficult it was. So this brings me back to that same idea of, you know, imagine a child that you care about growing up in the same household you did, dealing with everything you had to deal with, and you are just watching it as a passive observer. How are you feeling when you're watching that kid you care about try to cope? One of my patients was a, you know, person known to the public whom I was talking about this with.

Dr. David (25:47):

And she said, no, my childhood was really not that bad. Other people have been through much worse than I have. It turned out her parents fought with each other almost every day. Not physically, but verbally and emotionally, and she was an only child. So she took on the role of peacemaker and then her parents got divorced when she was age eight, which you would think would, you know, be a partial solution to her problem. But unfortunately, they kept living in the same house. They slept in several bedrooms, but you know, they still were fighting with each other. So from her perspective, it didn't do her any good at all. And she's telling me, no, this really wasn't so bad. So I said, okay, you have this beloved niece, a four or five, 6-year-old girl. You love this girl. You take her on with you on weekends and do fun things with her.

Dr. David (26:32):

You're just devoted to this little girl. Imagine her, your niece in that household, and you can only watch, you're watching your niece try to cope with your parents. What is that gonna be like for you? And she just stared at me. She was, you know, somebody who was very verbal, could carry on her end of a conversation all day long that just brought her to a halt. And she went on for a couple of minutes just pondering that idea. And then at the end she said, you know, after a week of watching that I would shoot myself. And that was the first time she had truly recognized just how difficult it really was. And that was the start of her treatment, which was successful. She had half a dozen different symptoms in her body for the last 20 years, and within a matter of months they were gone.

Dr. Kyrin (27:21):

I love that question. I think it's beautiful. I actually went through and took your quiz before we did the interview because I wanted to see what the questions were. And that question is on there. And I think that helps someone step out, I think people are very worried about blaming their parents and they don't wanna do that. And so that hence the denial. Most of us really appreciate all that our parents have done for us. And you know, even if there were difficulties, but when you step out as an observer and say, well, yeah, if there were a child like you, your patient said, I, I would shoot myself then, you know, and there really is no one to blame because they're only doing what they were taught by their parents and their parents and their parents and their parents.

Dr. David (28:03):

So they do the best they can.

Dr. Kyrin (28:05):

They do the best they can. So thank you for explaining that. And so people can also identify what are some of the most common symptoms that we're talking about?

Dr. David (28:16):

Yeah, I'm glad you asked 'cause we hadn't mentioned that it's literally head to toe. You can have pain symptoms and non-pain symptoms. So migraines ring in the ears, difficulty swallowing, visual disturbances, pseudo seizures, pain in the temporomandibular joint of the jaw. Neck pain, low back pain is a big one. Approximately 88% of low back pain is psychophysiologic in nature according to a recent study. Chest pain, abdominal pain, pelvic genital joint, difficulty breathing, unexplained cough, irritable bowel syndrome, fibromyalgia, irritable bowel can cause diarrhea, constipation, nausea, vomiting, bloating, indigestion, numbness and tingling in the extremities. The, the only common denominator is that people tend to have more than one symptom at a time. The more symptoms you have, the more likely it is a psychophysiologic cause is what's going on. And there's lots more that I haven't even thought to mention. Functional neurological disorder is another one. A lot of people with hypermobility disorder like Aler Danlos get all kinds of symptoms attributed to Aler Danlos that probably are not from the Aler Danlos. They're actually from psychophysiologic disorder.

Dr. Kyrin (29:37):

And so how are these symptoms triggered and why is understanding this so important to treatment?

Dr. David (29:44):

Well, the symptoms can be triggered by a particular stress that this happens most often in my patients with post-trauma, that they've been through some kind of terrifying or horrifying event. And then, the symptoms begin soon thereafter, or it could be the trauma was quite a number of years in the past, but some triggering event has happened that leads to the development of the symptoms. But sometimes the symptoms can just appear for seemingly no reason as part of the recovery process from adverse childhood experiences. For example, my very first patient, she was averaging one bowel movement per month despite taking four different laxatives at double the usual doses. And it just started when she was 35. She was the one who had been sexually abused hundreds of times. Nobody had touched her against her will for close to 25 years. But the illness just began in midlife.

Dr. David (30:40):

And why is that? Well, it turns out that there's a recovery process from childhood adversity, and at some point people reached a level where a lot of the buried emotions begin to come knocking on the door. She had a tremendous amount of outrage about how she'd been treated as a girl, but it had been repressed. In order to survive her childhood, she had to repress it. But in the middle of her thirties, it was finally time for her to confront this and deal with it. But the anger couldn't find a way into her conscious awareness. So instead it manifested in her body. And the psychiatrist, Dr. Kaplan helped her to recognize how much anger she had begun to talk about, putting it into words. And the more you can put repressed emotions into words, the less they have to express themselves via the body. And these can be not just anger, but I've had patients with fear, shame, guilt, grief, that we're responsible instead of anger.

Dr. Kyrin (31:39):

Yeah, I love that. I really think that the body is our subconscious mind and it will out picture anything that we don't acknowledge or feel, feel, feel consciously. Absolutely. And so, right, if we deny it, then our body has to express it. And that's probably an illness or pain. But when we acknowledge it and feel it and process it, then the body says, oh, thank you for doing your job so that I don't have to bring it to your attention. And I really see all dis-ease in the body as a signal. Yes, there could be some biochemical or anatomic problem if it's progressed, but it's really stemming from a lot of these emotional and psychological issues. And you talk about the effectiveness of what you call pain relief psychology for alleviating deep stress. And it consists of personality traits, triggers, and unrecognized emotions from ACEs. Can you talk a little bit more about what pain relief psychology is?

Dr. David (32:40):

Yeah, you bet. What it's all about is uncovering the stresses that a person has in their life, whether they are in the present day. I mean, a very simple example was a patient of mine who only got his pain when he was driving to work. When he was driving home from work, he was fine on the weekends when he was not at work, he was fine too . So we kind of focused on, all right, what's going on at work? And, you know, that was a huge stress going on. So that was a very simple example. But more complicated is we're, we're trying to look at the long-term consequences of ACEs and the repressed emotions is a big one there. But we can also look at personality traits. Many people who've been through ACEs cope with those issues by developing certain personality traits. Their self-esteem, for one, is likely to be harmed and likely to be much lower than it deserves to be.

Dr. David (33:30):

Kids trying to cope with adversity oftentimes become very detail oriented, perfectionists. They tend not to be very assertive. They tend to focus on the needs of other people to the exclusion of putting themselves on the list of people. They take care of a whole long list of these personality traits that can be very stressful. But when you find out how you develop those personality traits, where they came from, who taught you these things about yourself that are not true, like, you know, you're a second rate or unworthy human being, and how did they teach those things to you? And we can understand that better. And that facilitates making changes in those personality traits, which then leads to a reduction in stress level. And then finally, I like to pay attention to triggers in someone's life. These are people, situations or events that are in some way linked to the past and are therefore very emotionally triggering.

Dr. David (34:26):

And the, the most common of those by far is that there's an ace perpetrator, you know, one of your parents usually that's still in your life today and is still mistreating you in some way. And that can lead to reactions in the body. One of my more dramatic examples of that is a patient who was hospitalized for a total of 51 days for her symptoms over a nine month period of time. And none of the many people who evaluated her asked her if anything stressful had happened right before she became ill. And it turned out that yes, something stressful had happened, which was that her father had a stroke and he was calling upon her for support. 3, 4, 5 days a week she'd be in his house helping him out. And this was a huge problem for her because she'd been avoiding her father for most of her adult life.

Dr. David (35:18):

And when I asked her why, she told me this story that nobody else had heard up to that point, which was that when she was six years old and her little brother was four, mom and dad had gone off to Las Vegas for a long weekend and she was staying with aunt and uncle on the Sunday that mom and dad were due to come back. They called up the aunt and uncle and they said, we're getting a divorce and we're not coming back. And that was the last she saw of her parents for the next 20 years. So there was, you know, enormous emotional tension in that relationship. Vinny has a stroke and she feels obligated as the daughter to go and help him out. But when she does that, and only is it difficult to be in his presence, as you might imagine, he's critical. If she doesn't do things exactly the way he wants her to, you know, you'd think he'd be grateful, but instead he doesn't hesitate to criticize her, which just twists the knife a little more. And not too surprising that she became physically ill in this situation, but nobody else had thought to delve into the possibility that her brain might be causing these symptoms, which are, if I haven't pointed it out yet, they're absolutely as real as symptoms from any other cause.

Dr. Kyrin (36:30):

You know, I love the examples you're giving. I think everyone's getting a really good idea. Wow, this could be me. My parents were divorced. I had just situations that are very adversarial and negative in our lives, but I think there's not a lot, a lot of acknowledgement about the emotional impact and now everybody's learning the physical impact. It was so interesting. I was recently traveling and I was in Dubai and I was having a problem with my right shoulder and arm, and I went to a physiotherapist and he did a bunch of manipulations, which really helped. And I started talking to him about emotions related to the different muscles and right arm, and it relates to the father's representation and all these things that I've studied over the years. And he said, what are you talking about ? He said he didn't know what I was talking about.

Dr. Kyrin (37:21):

And I said, well, you know, emotions can be stored in the body in different parts of the body or associated with different emotions. And he didn't, wasn't aware of this. But like you say, once you see it, you can't unsee it. So if you're listening to this, you're now having information that maybe your practitioners aren't aware of that you are going to be aware of, and you can start looking at your life. Wow, when do I get those migraines? Oh, let me see. It's about a couple days before this, such and such family members come to visit every time. And do I get stomach aches on the way to work? And there's some periodicity or relatedness to how you're living your life and the symptoms you're having. And when you start to sort that out, you can't unsee it. So how would someone get started? They can take your quiz. It might be possible that their practitioner is not versed in this. So how do you suggest that people get started having a proper assessment of pain relief psychology or I would say disease relief psychology? How do they go about doing this?

Dr. David (38:29):

Great place to start is with your physician to make sure that there's not a biomedical cause that you don't have an organ disease or an injury that could, the doctor thinks maybe there's a connection there, but you're not improving in the way that they expect. That would be another time to look and see if this psychophysiologic process could be contributing to your condition. And that 12 item quiz is a great place to start because it's got a lot of educational elements in it that can show you how some of these ideas might apply to you. And if they do, then we've got a lot of resources on the website that people can, it's end chronic pain.org that can help people delve into this more. There's a course on, there's several courses on there. Some of them are video, some of them are primarily text that can give you more information because information is the treatment here.

Dr. David (39:23):

The more you understand how this works, the more you understand how it applies to you, the more that you can do things to lead to improvement. This one of the techniques might be if you had an ace perpetrator in your life as a kid, writing a letter to that person. It's very challenging, as you pointed out earlier, to recognize that you might have some negative emotions towards someone that you also care about. And sorting that out, writing a letter to put those thoughts and feelings in there, both good and bad, not not to mail the letter just as an exercise, to write it as a way to take emotions and thoughts and feelings and put them into words that are written down that can pull ideas out of your head that you didn't necessarily know were there. And the more that you're able to do that, the less those things need to express themselves via the body.

Dr. David (40:16):

That's one of the techniques. There are apps for this that are very evidence-based, that one of them is called curable, that I recommend to patients. There are self-help books about this. We've got textbooks for healthcare professionals, but even the textbooks are written without jargon because we wanted the medical clinicians to be able to read the psychological material and vice versa. And one of the benefits of that is that if you're a science oriented reader, you can read one of these textbooks and get a lot out of it. I, I know psychophysiologic relief therapists who are prescribing even textbooks to their patients.

Dr. Kyrin (40:56):

Oh, I love that. Yeah. So definitely go to the website, we'll have the link in the show notes and take the quiz and start to investigate this. I mean, honestly, I think if you have any chronic condition, you could benefit from this. Definitely get a proper evaluation from your regular doctor. You might wanna also consider a functional approach, which I am particularly passionate about, and we often are able to fix and find root causes that mainstream medicine isn't able to address. But this even in a, from a functional perspective, is something that I think everybody should look into. I would be remiss if I didn't mention how this ties into hormones. And so briefly, because we're running out of time, I'm just gonna say that it ties in most likely to your cortisol stress hormone. 'cause We're talking about deep stress, we're talking about adverse childhood experiences, and this is going to deal with your HPA axis, hypothalamic pituitary adrenal axis, which relates to your cortisol. So if you were wondering, Hey, Dr. Karen, are you gonna tie this into hormones? There we did it. Bam, ,

Dr. David (42:04):

Yeah, it's an additional source of stress on top of everything else. Yeah.

Dr. Kyrin (42:08):

Yeah. So Dr. Clark, any parting words before we wrap up?

Dr. David (42:13):

You know, I'll just say the bottom line here is that the brain can generate symptoms in the body, and these symptoms are every bit as real and can be every bit as severe as symptoms from any other cause. So if you're looking for the body's defects as an explanation for the symptoms and you're not finding it, then think about whether the brain could be generating these symptoms. You know, a a classic example is phantom limb pain where somebody's had an amputation and yet they feel pain at the site where the limb is, you know, no longer exists. That pain is being generated in the brain and it is very powerful. I mean, it has put some of my patients in the hospital, one of my patients was a 17-year-old who I was asked to see on their 70th day in the hospital.

Dr. David (43:02):

They were getting 10 milligrams of morphine an hour. You know, for a kid this size, five or 10 milligrams would be enough to treat the pain of a fractured leg for your patient's. Not familiar with morphine doses. This patient was getting 10 milligrams every hour. That was when we found the stress, we treated it successfully, and the patient was off of the hospital in a week and off of all opioids in 30 days. So just being aware that the brain can do this and the brain does this because of stress, which may be deep stress, it may be stress you don't fully recognize, it may be stress from far in the past. So start looking for those things. Use the quiz to help you find what those things might be. And then finally, effective treatment is available. We've got half a dozen randomized controlled trials now published in very rigorous journals that show dramatic benefits when these underlying issues are brought into the open and dealt with successfully. Yes.

Dr. Kyrin (44:00):

And when you go take the quiz, when you get your results in your email, there's a resource page that Dr. Clark has with all kinds of books and just a plethora of resources. So you'll have lots there to help you on your way. Thank you so much, Dr. Clark, for joining me today.

Dr. David (44:19):

Thank you for having me. It was a pleasure speaking with you.

Dr. Kyrin (44:22):

And I'll just wrap up by sharing another quote that you shared with me before we started recording. I'll leave everyone with this because I think it really gets to the heart of what we're talking about. And it is from Rita Cheren, who's also a doctor, and it is the work of medicine. Inconsiderable part rests on the doctor's ability to listen to the stories that patients tell, to make sense of those often chaotic narratives of illness, to inspect and evaluate the listener's response to the story told to understand what these narratives mean and to be moved by them. I hope that you are inspired to look at your own possible deep stress and adverse childhood experiences and how it might be impacting your health to take the quiz, to educate yourself. I really think that this is the next frontier that in the future at some date will be self-evident.

Dr. Kyrin (45:19):

That of course, doctors need to be addressing this with their patients. But as long as you are here and you know about it, you can use this information to take action on your own behalf. You don't have to wait for your doctors to catch up. You can get the help that's available to you now. So something to think about. Look forward to hearing your thoughts. Reach out to me on social media and let me know what your thoughts are about this and how it's helped you. I'll see you again next week. Thanks so much for joining me. Until then, peace, love, and hormones, y'all.

Dr. Kyrin (45:54):

Thank you so much for listening. I know that incredible vitality occurs for women over 40 when we learn to speak hormones and balance these vital regulators to create the health and the life that we deserve. If you're enjoying this podcast, I'd love it if you'd give me a review and subscribe. It really does help this podcast out so much. You can visit the hormone prescription.com where we have some free gifts for you, and you can sign up to have a hormone evaluation with me on the podcast to gain clarity into your personal situation. Until next time, remember, take small steps each day to balance your hormones and watch the wonderful changes in your health that begin to unfold for you. Talk to you soon.

► 12 item Self Assessment Questionnaire for brain-generated pain or illness by Dr. David Clarke.

This 12-item questionnaire is designed to improve understanding of your pain or illness. The more questions to which you answer ‘Yes’, the more likely it is that a brain-to-body disorder (a Psychophysiologic Disorder or PPD) is contributing significantly to your condition. For any concerns raised by these questions, we recommend discussion with a medical or mental health professional.

CLICK HERE to access the questionnaire.

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