Phase III

“Out of the Abyss”

OVERVIEW OF PHASE III

Picture yourself climbing out of a deep crevasse, standing up, and looking around.  The ground you are standing on represents the life you had before you feel into the abyss of chronic pain.  You have been there for so long you are having difficulty remembering your former life. This phase is where you begin to connect with your true self before pain.  This section is about awareness. Enjoy Your Day Today

GOALS of Phase III

Education

• Learn four levels of awareness: 1) environmental 2) emotional 3) “the story” 4) ingrained patterns
• Learn to maintain your peace of mind regardless of external circumstances  The Eye of the Storm
• Learn the Mind Body Syndrome—you will have several of the syndromes.

Sleep

• Full night’s sleep with minimal or no meds–easier when anger has been successfully addressed

CNS

• Learn the awareness tools that will calm you
• “Active Meditation” as a baseline awareness
• Become aware of your “unawareness”
• Understand the power of imagery

Medications

• Pain meds decreasing
• Anti-anxiety and sleep meds decreasing

Goal Setting

• Re-connect with the best part of your past
• Begin to re-form your life vision  Your Spiritual Journey

Rehabilitation

• Resistance training three to five hours per week
• Aerobic conditioning
• Back mechanics integrated into activities of daily living

FIVE STEPS:

Step 1—Understand Awareness and Unawareness

Understand awareness

• Being fully involved in the present moment
• There numerous tools to increase your awareness
  • This section will focus on mindfulness, visualization, and meditation
  • Must actively cultivate your ability to listen and feel

Its role in the reprogramming process

• The three steps of reprogramming your nervous system are: 1) awareness,  2) detachment, 3) Creating new circuits.
  • Awareness is the first step  “C” ing Clearly

Become aware of your “unawareness

• You’ll understand the difficulty of this step only in retrospect as you learn how to be fully aware

Four levels of awareness

Awareness is a word that is tossed easily tossed around and most of us feel that we are reasonably aware of what is happening around us.  However as I have traveled own journey I have realized that true awareness is humbling and challenging to attain.  I have spent most of my life imposing my interpretation of reality onto a given situation.  Listening carefully with an open mind is a learned skill.  It has been helpful for me to conceptualize awareness at four levels:

• Environmental
• Emotional
• Judgment/ “Stories”
• Ingrained Behavioral Patterns

Step 2—Environmental Awareness-”Active Meditation”

We are a goal-oriented society that is focused outward on experiences and accomplishments.  We are spending little quiet time with ourselves and those close to us.  Connecting to the current moment is the essence of fully experiencing your life.

• Learn “active meditation”. It is an excellent method to engage in the current moment.   Choose an awareness of one your senses.  I use sound as my active meditation.   Spend as much time as you can during the day being aware of the sensation of your choice.
• Begin each day with a commitment to work on staying in that mode

Other possibilities of focus include:

• Feel/ touch
• Your breath
• Vision
• Taste

Active meditation is the “Go to” strategy that will calm you throughout the day. Enjoy Your Day-Today

Step 3—Emotional Awareness

• Notice and acknowledge your emotions throughout the day.  We instinctively suppress anxiety, as it is so unpleasant. You cannot selectively suppress emotions.  When you suppress one you are suppressing your whole nervous system.  Your range of emotional experiences will diminish.  Eventually emotions such as joy are just less anxiety, and peace is just less chaos.  Watch all of your emotions come and go.
• As you watch anxiety enter your consciousness learn to just watch it come in like a visitor and then watch it leave.  Don’t try to shove it out through the door.  You will lose that battle.  Eventually you’ll train yourself to not react to these unpleasant anxiety-producing thoughts.  This is the essence of a meditative practice and can be practiced in many forms.  You are Not Your Thoughts
• Watch what anger does to you.  It is as if a filter or screen is pulled over you eyes and you can only look out through this filter.  You cannot receive input.  It is a complete detachment from the reality of the moment.  As I lived my entire life with disguised anger as my baseline I never recognized it as anger.  I was always “right” and could not figure out why people did not see the power of my arguments. In retrospect I often was not even on the same topic.
• Use the active meditation as your baseline.  It what allows you to highlight the presence of your emotions.  What is paradoxically more distressing is that I am now aware that I do and can spend a lot of time in a peaceful state of mind regardless of my external circumstances.  When the anger switch flips on the contrast is brutal. It is humbling to me how deep and strong these programs really are.
• Remember the energy used suppressing negative emotions is the energy you need to create your life and solutions to your problems.

Step 4—Judgment/ “Stories”

“He who is without fault cast the first stone.”

• Become aware of your judgmental nature and the power that your “story” has in holding you back.  I will use an example from the world of medicine.

The culture of medicine is immersed in “high standards”, ideals, “perfect”.  Society demands perfect from physicians.  It is manifested in many ways.  The legal system, hospital staff privileging, no mercy for personal mental health issues, harsh criticism from our mentors.  Consequently as others judge us we are idealistic regarding our own standards of performance and are self-critical.  Unfortunately we are also hard on others around us.  As we label ourselves we label those around us.  Once you have a label on anyone you can no longer really “see” the essence of who they are.

Epictetus (circa 55-135 CE) was a Greek Stoic philosopher who was born a Roman slave.  His philosophy is brilliant and considered the foundation of modern cognitive behavioral therapy.  He wrote the following piece, “Call Things by Their Right Names.”

“When we name things correctly, we comprehend them correctly, without adding information or judgments that aren’t there.  Does someone bathe quickly?  Don’t say he bathes poorly, but quickly.  Name the situation as it is; don’t filter it through your judgments.

Does someone drink a lot of wine? Don’t say she is a drunk but that she drinks a lot.  Unless you possess a comprehensive understanding of her life, how do you know if she is a drunk?

Do not risk being beguiled by appearances and constructing theories and interpretations based on distortions through misnaming.  Give your assent only to that what is actually true.”

“The Art of Living” by Epictetus (Modern translation by Sharon Lebell)

“Don’t say he is a chronic pain patient but he is suffering from pain that is chronic.”

• Increase your awareness of judgmental nature of the world and the depth of anger that is the current underpinning of our society. What seems like a “normal baseline attitude” is actually very destructive to your personal sense of well-being.
  • Read a page or two of “The Art of Living” by Epictetus on a regular basis. He is very clear regarding the damaging effects of judgment both of self and others.

• Watch the movie, “Cinema Paradiso”—the shorter version.  It was the best foreign film in 1989.  It is a movie about movies.  The movie had several important messages for me.  Video: Cinema Paradiso
  • The mind works in images and they are extremely powerful
  • The mind does not work in terms of time.  If you are holding on to the person or situation that “destroyed your life” it probably seems like it just may have happened yesterday.  What does happen over time to the images is that they will be reinforced and become stronger.  Time does not always heal if you are not using tools to “let it go”.  If you want to convince yourself that you have “let it go” by suppressing it, that is your worst choice for reasons I have already outlined.
    • Imagery is why when you see an old close friend you have seen for many years and it seems like yesterday.  Your images are not filed away by time.
    • It is also one of the reasons why intense negative experiences continue to have long-term consequences on your sense of well-being. Your “story” seems like your reality
    • It is also encouraging that imagery can be used in a powerful constructive fashion
    • It is also just a great movie

Step 5—Ingrained Behavioral Patterns

Baseline patterns that seem normal but are dysfunctional

• Engage an outside party to help you see what you cannot see about yourself. If you have a resistance to that idea, that is your biggest clue that you need to “look under the hood.”  Every human is fraught with anxiety. Yet instead of just admitting it and helping each other out we spend an enormous amount of energy trying to cover it up.  The Myth of Self Esteem

The global ingrained patterns are the most challenging to tease out.  They represent your basic life view and you have always been this way.  One of my biggest paradigm shifts I experienced was the fact I had suffered with anxiety since I was a young child raised in a difficult household.  It was my frame of reference.  I missed it for over thirty years.  As a resident in orthopedics I had to go to a textbook to look up the word. My college friend recently reminded me how fearless I was in those days.  I was not afraid to tackle anything. It is sobering that anxiety is what almost destroyed me.

Discovering your own global patterns will take an open mind and a concerted effort over a long period of time.  I do not see how it can be accomplished on your own.  It requires a format where you can receive honest feedback from a mental health professional.  If your own life outlook has flaws, how are you going to see them through the same flawed eyes?

• Learn the Mind Body Syndrome in detail and see how it applies to you.
  • Read “Unlearn Your Pain” by Howard Schubiner.  He clearly describes the Mind Body Syndrome with multiple illustrations.
  • In chapter five he provides the tools to help you see if you have MBS.
  • This is not in mainstream medicine.  However using these principles have resulted in remarkable improvements in many of my patients’ symptoms.
  • As many of the syndromes are caused by our ingrained patterns of behavior and coping with stress you will have to work backwards.  In other words you will first look at your symptoms and figure out what circumstances might be triggering the pathways.

RESOURCES:

“Unlearn Your Pain” by Howard Schubiner

“The Art of Living” by Epictetus (modern translation by Sharon Lebell)

Video: Cinema Paradiso – short version

“A Course on Compassion” videos

Support person–this is the level where you will start looking upward and outward

• Life coach
• Psychiatrist/ psychologist
• Religious leader
• Healer

CRITERIA TO MOVE TO PHASE IV:

• Using “active mediation” throughout the day
• Consistently aware of the four different levels of awareness in your life: 1) environmental 2) emotional 3) Judgment/”storytelling” 4) global patterns
• Read “Unlearn Your Pain” by Dr. Schubiner
  • Take the test in chapter five to see how MBS is affecting you.
  • Regular reading a writing of Epictitus (“The Art of Living)
  • Enjoyed “Cinema Paradiso”–understanding imagery is critical
  • Be aware of the devastating effects of “labeling”–Become aware of and remove the labels you have on yourself and others. David Hanscom lecture on “Perfectionism”
  • Awareness is both a freeing and unsettling experience.  It is the gateway to a life you have not yet comprehended.
  • This phase has no time frame, as it is one you will be referring back to frequently as you move forward.