This post reflects what I convey to my patients on the initial visit regardless whether the problem is amenable to surgery or not. It represents a specific starting point for the DOC process.
Imagine I have finished my evaluation of your situation and we are discussing specific next steps. If I have recommended surgery, I won’t perform it for at least a couple of months when we have optimized your situation to improve the chances for a good outcome.
“Chronic pain is a specific problem that is complicated but can be solved with the correct approach. First, the impact of chronic pain on the family is usually negative and often devastating. Pain in the household dampens the sense of closeness and play. Patients tend to vent their frustrations on their immediate family since they are the source of the deepest and most powerful triggers for anxiety and frustration. Since pain and anger are linked neurological circuits, it’s difficult to free yourself from the grip of pain unless you can become aware of and learn to process these family triggers. Conversely, the family may be the most powerful and fastest way out of The Abyss.
The first thing I ask is that every adult member of the family, living at home to immerse themselves in the DOC process. I want everyone not only reading Back in Control but to fully engage in the action plan outlined in the website, www.backincontrol.com. That means looking at Stage 1 and beginning the expressive writing that afternoon, which is combined with the “active meditation”.
Second, I point out the fifth step of Stage 1 where you don’t discuss your pain – ever; except with your medical team. It only reinforces the pain circuits and is frustrating to those who care about you but can’t help. I may repeat it several times, “You’ll never discuss your pain with anyone ever again, especially your family. But that also includes friends, colleagues and co-workers. Never!!” The patient usually widens their eyes and the rest of the room often breathes a sigh of relief. I mean it. You aren’t going to share your pain with anyone.”
Then I say to the rest of the family, “I don’t want you to ask about the pain. And if you’re having a bad day, don’t complain. You own it.” It is a little harder than you might think for everyone. People in pain usually talk about it to anyone who’ll listen and we all feel we have a right to complain. It’s a behavioral pattern that’s hard to break. I’m adamant in saying “When you walk out the door today, I want you to visualize a 10-foot wide concrete wall between you and the rest of the world with regards to your pain. It’s off the table forever.”
Third, I ask them to spend the car ride home reminiscing about the most enjoyable time of their relationship. What were the fun times? Discuss it in detail and stick with the conversation. Try to feel it. Anxiety, anger and pain have a way of taking the joy out of a relationship, not to mention how the children might feel. This step is not intended to be a “positive thinking” exercise. The intent is to wake up that aspect of your brain.
The final step and most challenging is bringing it home. I tell them, “When you walk through the door, you’ll make a commitment to never bring pain back into the house. I show them Stage 3 Step 2 of the website, which is to create safe haven in your living space. I want them to take the positive energy generated by the conversation about the best times of their relationship into the home and keep it there.
There are many layers to this step but the essence of it is that any time you are anxious or upset, you are in an automatic irrational survival mode. It is not solvable by rational means. When was the last time you really were able to solve anything by arguing? You might as well put on boxing gloves. Anger is only destructive. So just stop it. Each person must give each other permission to simply walk away from an arguement and hold each other accountable to do it. It is best if both can walk away from a given unpleasant situation, but usually one person is more fired up than the other. If you get upset, take it outside. Don’t allow your physical living space become a battlefield. You have to have some place on this planet to feel safe. This stage has many other “rules of engagement” that many have found helpful. Begin your healing journey at home
Our team has observed a surprisingly powerful and consistent response to these initial steps. I want everyone involved to begin with Stage 1 of the website, so as to get started with the expressive writing and active meditation ASAP. Nothing really happens until the writing begins. I’m not completely sure why but it is consistent.
I had one young couple in their 20’s struggling with pain, anxiety and issues around a bipolar disorder. Although it was apparent that they really cared for each other, they were struggling mightily. He had been in pain for about 10 years. I had this conversation with them and showed them the steps on the website. When they returned for their one month visit, they were so excited that they could hardly contain themselves. He was free of pain for the first time since he was 15. They were seeking counseling and she was more directly addressing her bipolar issues. They were smiling, laughing and felt they had the tools and approach to create bright future.
I see variations of this story every week. Having the whole family engage in the DOC process creates a structure from which to work from. It isn’t perfect but neither is life. My wife and I also get to practice this approach daily. Recently I was talking to her and began to complain about five different things at once. She called me right out and reminded me about the “no complaining” rule. It was challenging for me because the issues were intense and important to me. However, she was right that they weren’t her problems. I needed to get out of my victim mode and deal with them. Another humbling experience……..
Your family can be your safest and most enjoyable refuge or your deepest hell. You have a choice of what you want to create and nurture. Connecting and enjoying those closest to you is possibly the most powerful way out of “The Abyss”.