The DOC Journey began to evolve in 2003, as I emerged from my own 15-year struggle with chronic pain. It took me a long time to figure out how I ended up being in this state and even longer to understand what had allowed me to escape. Then I was exposed to the deep neuroscience research around chronic mental and physical disease and it has become much clearer.
What I did not understand until the last few years of my practice was the impact of chronic pain on the family and the effect that the family had on pain. It turns out that the family is the strongest force that will keep you in chronic pain and also can be the most powerful one in pulling you out–with the correct understanding and approach. The bottom line is that the anger created by pain usually destroys much of the family structure, yet at the same time, the family becomes used to the situation and resists change.
But the most perverse aspect of this picture is that humans evolved through language and social connection. It is a basic need and the deeper the connection, the better. However, the stronger the connection the more powerful the triggers and irrational behavior. We crave connection, yet it sets us off. Why else would there be a 30% lifetime incidence of physical domestic violence in the US? (1)That doesn’t even include verbal abuse. (2) Why do we treat our family members who we care about worse than a stranger?
I am going to present the overall structure of the solution first and the present the problem and solutions in more depth later. This is the conversation I would have on the second or third visit with both surgical and non-surgical patients.
“Chronic pain is a complex problem that is solved addressing all the factors affecting your perception of it. The impact of chronic pain on your 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. I am asking you to consider four aspects of addressing the family dynamics around pain.”
The first thing I asked is that every adult member of the family, living at home to immerse themselves in The DOC Journey. I want everyone not only reading Back in Control but to fully engage in their version of an action plan outlined in this website. The DOC Journey quickly has you engage in calming exercises that include expressive writing, which is combined with the active meditation. I wanted them to just begin and learn the reasons why later.
Second, I asked them to never discuss their pain – ever; except with their medical team. It just reinforces pain circuits and is frustrating to those who care about you but can’t help. I repeat it several times, “You’ll never discuss your pain or medical care with anyone ever again, especially your family. But that also includes friends, colleagues and co-workers. Never!!” The patient usually widens their eyes while the rest of the room often breathed a sigh of relief. “I mean it. You aren’t going to share your pain with anyone. That also includes acting out your pain with grimaces and groans.” Then I said to the rest of the family, “I don’t want you to ask about the pain. And if any of you are having a bad day, don’t complain. Each person takes ownership of their pain – whether it’s mental or physical.”
It’s 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 extremely hard to break. I was adamant in saying “When you walk out the door of the office 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 them 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 your children might feel.
Interestingly, this was a big hurdle for most people and I would still try to have them engage in this conversation within a few weeks. Resentments build up and block this conversation.
The final fourth and most challenging step was bringing it home. I told them, “When you walk out of my office door, you’ll make a commitment to never bring pain back into the house. The intention was to create a safe haven in their living space. I wanted 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. Something in the present triggered a response conditioned by the past. It’s 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 stop it. Each person must give each other permission to walk away from an argument 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 to 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.
Our team observed a surprisingly powerful and consistent response to these initial steps if engaged at some level. The tools of expressive writing, active meditation, and not discussing their pain often had a significant early impact and I wanted have people engage as quickly as they could.
I remember 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 basic starting steps that are now part of The DOC Journey. 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.
Practice, practice, practice
I saw variations of this story every week. Having the whole family engage in The DOC Journey created a structure from which to work from. It isn’t perfect but neither is life. My wife and I also still get to practice these approaches daily. One day, 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……..
The DOC Journey will be adding a whole section on “Healing Your Family’s Pain.” 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” for you and your whole family.
- Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization—National Intimate Partner and Sexual Violence Survey, United States, (2011).Morbidity and mortality weekly report. Surveillance summaries. (2014).
- Evans, Patricia. The Verbally Abusive Relationship, Expanded 3rd edition: How to Recognize it and How to Respond. Simon and Schuster, Avon, MA, 2010.