Friday, July 01, 2011

Conversation with a patient

I've started working again lately. I'm treating people who have persisting pain.
A woman I'm treating told me she has a lot of stress, has anxiety. For sure she does. For sure she does.

I told her we all have to learn to control anxiety. I said it was tied in with stress, and that stress made the hypothalamus send out a hormone that made the adrenals send out juice to make the brain learn. Taking a tip from Deric Bownds (and many others), I said that metaphorically the hypothalamus was a bit like a loyal alpha dog, lead sled dog, very big, very muscular, constantly and consistently protective. We want it to do its job but we have to learn how to not scare it with all our imaginings. That we should always check, then affirm, that "there is no bear in the vicinity".

I told her that the hypothalamus was part of a threat detector system older than humans. That it was an evolved system older than the human part of the brain. That our job as humans was to learn to tame it. That we could do that by:

  • being kind to it
  • giving it attention
  • giving it treats (the way we would with any critter we needed to tame)
Like training any wild, abused, or neglected critter, taming the self's own instinctive protective parts is similar. It requires patience and positive reinforcement. If we don't gain control of the lead dog, it will pull our sled in all sorts of unwanted directions.

It requires treats for good behaviour.

What is the most important thing in the whole world to the internal regulation system? That part of the brain that is responsible for absolutely everything? life itself? Pretty simple actually. Oxygen. Deliberate deep breathing.

That's when we were interrupted by my patient's cell phone, and the conversation ended.

Further reading:
1. Deric Bownds Mindblog Biology of Mind


Paul I said...

Hopefully the call was not about a bear.

Diane Jacobs said...

Good one, Paul I.

Paul I. said...

Nice post. And I say that as the son of a veteran with PTSD — I have a significant interest in the fates of hypothalami. Thinking both seriously and whimsically, and extending your metaphor, I imagine that the hypothalamus might well benefit from some Dog Whisperer philosophy: exercise, discipline and affection. Not draconian discipline, of course, but as Cesar Milan does it.

Diane Jacobs said...

Absolutely. Calm attention, high riding collar, short leash, solid eye contact, calm voice or no voice, just eye contact, reward only for good behaviour. Great show. Inner dog has to be tamed first though, before it can be taught.

seth paris said...

Hi Diane,

Great post. I have a question and wasn't sure where to ask it (on somasimple?.) I am wondering how all the new science on pain relates to someone who actually has tissue damage. For example, someone who has rheumatoid arthritis, where there are changes in the joints, presumably pain signals are initially coming from receptors in the joints? I realize, regardless, information from nociceptors are still interpreted by the CNS and that pain is "an output" of the brain. Would DNM still benefit someone with RA? I realize, in relation to this post, that stress is a big factor with RA and other autoimmune diseases, so oxygen intake, aka breathing, is also quite essential. I would love to hear your thoughts in this, or if you think I should pose this question on somasimple, you can tell me where it belongs!

Diane Jacobs said...

Hi Seth,
SomaSimple would be the best place to ask, because the answer will be lengthy and complex, will generate discussion, plus will require lots of links probably.

I can say here that yes, I think DNM benefits the pain from almost any peripheral condition, not the conditions themselves.

Which isn't to say that perceived peripheral pain isn't frequently mislabeled or misdiagnosed. Let's put it this way: if a painful problem labelled as "arthritis" mops up fine with DNM, then the patient never had said condition in the first place.

seth paris said...

Thanks for your response Diane,

I will post the question on somasimple. Where is the best place to do that do you think?

Diane Jacobs said...

I think the best place to post that question would be in general discussion forum.