There is deep basic science and clinical research that documents effective treatments for chronic mental and physical disease. Most of it has not entered into clinical care and our burden of chronic disease continues to grow. In fact, much of what is being done is not only risky, based on flawed data, expensive, but is seriously hurting people (YOU).
Common links to all chronic illnesses
Chronic mental and physical diseases are caused by common problems occurring at the genomic (DNA) and mitochondrial level (energy generators in each cell). These are the most basic components of evolution and maintaining life. Basic science research has brought this to light in numerous papers. The problem is the lack of communication between these silos of knowledge and clinicians to bring these critical concepts into the clinical domain.
This is short list of symptoms, illnesses, and disease states caused by exposure to chronic stress (threat), which is catabolic (consuming fuel) and inflammatory (attacking tissues). It is the reason that “stress kills.”1 The variables are the intensity and duration. The sources of threat come in an infinite number of forms and can be real or perceived.
- Obsessive thought patterns
- Carpal tunnel syndrome
- Migraine headaches
- Tension headaches
- Facial, neck, thoracic, and low back pain
- Pelvic pain
- Irritable bladder syndrome (interstitial nephritis)
- Irritable bowel Syndrome (IBS)
- Migratory skin rashes
- Tingling/burning sensations
- Chronic mental and physical pain
- Chronic fatigue
- POTS disease (postural orthostatic hypotension)
- Eating disorders
- Reflex Sympathetic Dystrophy (RSD)
- Temporomandibular joint syndrome (TMJ)
- Cardiovascular disease
- Dementia/ Alzheimer’s disease
- Parkinson’s Disease
- Renal failure
- Autoimmune disorders
- Crohn’s disease, colitis, rheumatoid arthritis, SLE (systemic lupus erythematosus), dermatomyositis, psoriasis, and ankylosing spondylitis
- Early mortality
- Metabolic Syndrome
- Obesity (core)
- Major depression/ deaths of despair (suicide)
- Peripheral vascular disease
- Bipolar disorder
- Obsessive compulsive disorder (OCD)
- Cancer – except colon cancer and melnoma
You may be wondering how so many different symptoms and disease states can be linked by a common cause. It is because under sustained heightened threat physiology, each cell and organ system responds in its own unique way and will eventually breakdown.
Each of us is unique
Chronic disease is a complex problem affected and defined by many individual variables. It is not going to be solved by information gained by prospective clinical trials on ill-defined groups of patient. There are several reasons for this problem.
- Trauma of any sort is connected to a higher chance of experiencing chronic disease.2 It is worse when it happens in childhood as it alters the structure of the brain as well as causing long-term elevations of inflammatory markers. However, chronic adult trauma, bullying, or living under societal threats also keeps one in an activated threat state.3
There are at least four patient scenarios that affect one’s capacity to heal.
- Willing to engage – Since the greatest factor predicting a successful outcome is willingness to engage and take responsibility, any clinical study has to begin here. If people can or will engage, will they heal? This seems to consistently play out and we have seen hundreds of patients heal as evidenced by many powerful testimonials. This group must be clearly defined, and then various clinical interventions can be evaluated and refined with ongoing research. The “stages of change” questionnaire is one validated tool to sort this out.4
- Emotional inability to engage – This group is one who has suffered so much trauma that they have incurred a significant mental illness and/ or have no capacity to face incredibly unpleasant emotions. They are in a mental survival state. 86% of people in chronic pain referred as an outpatient to a psychiatrist are so frail, they cannot engage.5 It is a major reason why traditional psychotherapy is not very effective for treating chronic pain. There are ways to bring this group into a better state.
- Skilled somatic trauma therapy – training one to feel safe
- ISTDP – Intermediate Short Term Dynamic Psychotherapy.6 This is a specific approach designed to teach people to tolerate unpleasant emotions and also feel safe.
- Specifically stabilizing their mental health situation.
- Don’t want to engage – Angry/ frustrated – This group is maybe the most challenging in that they are so angry that they will not engage in anything. Anger is a hyper-inflammatory/ metabolic state that causes the neocortex (thinking centers) to be less active and the survival midbrain to become more active. In other words, they cannot think clearly and process new information. They also don’t want to in that anger is destructive, including self-destructive. So, the activated physiology also blocks willingness to engage.
- There are many approaches to bring them back “online”, but it is unclear what is the best approach for a given person.
- Lack resources – There are other obstacles to learning new skills. They include illiteracy, low educational level, no access to computers or lack skills, low IQ, poor access to care, poverty, chaotic family situation, and anything that causes unrelenting threat (stress).
Treating the individual
- We are not going to be healed from data gleaned from randomized clinical trials on general populations. Each person is “programmed” by their entire past up to this moment and are infinitely unique. It is a little unclear how modern medicine has veered so far away from treating each person individually.
- The complexity of chronic disease, uniqueness of each person and circumstances, and the need to address multiple factors simultaneously makes it impossible to do randomized prospective studies on large ill-defined groups and obtain meaningful data. It simply cannot and will never be done. How can you compare a college professor with someone who is illiterate? The core basis for our “data” is deeply flawed.
- We must think differently, as current approaches are not only ineffective, but they are also making the problem of chronic disease much worse. “Data” has not helped us heal. In fact, physicians, by being more focused on the data (which they may not realize is so flawed) have become more detached from their patients as they continue to administer ineffective care. Many caregivers and patients alike are frustrated by the lack of success and have somewhat given up.
- Research has shown us solutions for specific symptoms, but it has not helped us deal with the complexity of a person and his or her disease state.
- This quote from Dr. Francis Peabody in 19277 is at the core of the problem.
Disease in man is never exactly the same as disease in an experimental animal, for in man the disease at once affects and is affected by what we call the emotional life. Thus, the physician who attempts to take care of a patient while he neglects this factor is as unscientific as the investigator who neglects to control all the conditions that may affect his experiment.
What we now know is that emotions reflect one’s physiological state and he was well ahead of this time. In 1927, he was concerned with the intrusion of technology into the patient/ physician relationship.
Big data is harming all of us because it is not granular enough. Not only is the burden of chronic disease continuing to rise, but it is also crippling our society both financially and emotionally. “Mainstream medicine” is not only actively promoting ineffective risky, expensive, and ineffective treatments, we are hurting people that trust us.
Chronic disease is solvable by applying a systematic approach that creates a healing alliance where both the patient and provider can heal. Humans are not data points. The “data-based” foundation of care is deeply flawed. Is it any wonder that the burden of chronic disease continues to crush us financially and emotionally?
It is more important to know what sort of person has a disease than to know what sort of disease a person has.
- Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
- Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.
- Takizawa, R, et al. Bullying victimization in childhood predicts inflammation and obesity at mid-life: a five-decade birth cohort study. Psychological Medicine (2015); 45: 2705- 2715.
- Carr JL, et al. Is the pain stages of change questionnaire (PSOCQ) a useful tool for predicting participation in a self-management programme? BMC Musculoskeletal Disorders (2006); 7:101-108. doi:10.1186/1471-2474-7-101.
- Abbass Allan. ISTDP in the treatment of chronic pain. Lecture to the Dynamic Healing Discussion Group (4/6/22); from the Halifax ISDTP database. https://drive.google.com/drive/folders/1k9AXx1webG69mKlCGoCU8XeUtNwTTM3q?usp=sharing
- Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
- Peabody FW. The care of the patient. JAMA (1927); 88:877-882.