- The root cause of suicide is feeling trapped and mental and physical pain are problematic.significant reasons to feel this way.
- Since mental and physical pain share similar brain circuits, they both create a lot of misery.
- Modern medicine largely assumes illnesses and symptoms are caused by identifiable structural problems. As most are created from the body’s chemistry, it can’t work.
- There is a reliable way out of chronic pain with the correct paradigm, obviating the need to escape it by committing suicide.
I recently received this letter from a close friend of mine who is a movement, dance, and rhythm specialist who uses creative tools to allow people to calm down and feel safe. Instead of you sensing danger, which creates a flight or fight response, feeling a sense of safety causes a profound shift in your body’s chemistry to anti-inflammatory. Fuel supplies are replenished, your brain becomes less reactive, the speed of nerve conduction slows down, and your pain diminishes.
Feeling safe is healing
Regardless of how feeling safe is accomplished, the outcome of seeing chronic pain resolve is rewarding. When you are no longer fighting off pain and anxiety, patients can create the life they choose and thrive at a level they never knew was possible. Mainstream medicine is focused on treating symptoms and not the root cause of sustained flight or fight physiology (how the body functions). Chronic disease, including pain, is a complex problem, and treatments must address all the relevant issues and be individualized. It is not difficult to do. She and I become a bit upset when we see what is possible compared to random symptomatic interventions being offered in mainstream medicine. Not addressing the root cause of chronic pain is incredibly frustrating for patients and clinicians. By the way, most of us were not trained with the correct paradigm of chronic pain.
Devastating spine surgery
This is particularly true in spine surgery, as we continue to witness major surgeries performed on normally aging spines. Degenerative changes of the spine have been well-documented to not be a source of chronic back pain.1 The success rate of a fusion or artificial disc is less than 30% at the two-year follow-up.2 Why are we continuing to offer this operation? There are many problems created by operating in these circumstances, and suicide is one of them.
Sad news today. I received a phone call from someone that I have successfully worked with. He has been transformed from being bed bound with ‘a broken back’ to full potential. He wouldn’t phone me unless there was an emergency, so I took the call. He was in uncontrolled misery, crying, but eventually calmed down. His sister, living with ‘a broken back’ fixed with multiple rods and screws, was in unbearable pain for years post multiple surgeries from what I can gather. She refused all help, such as our approach and relatives in general. She jumped in front of a train in France. She was killed by the train, and was described as being under unrelenting stress and pain.
A sharp reminder of why we do this.
We plod on, in my case with a heavy heart, and I remind myself that if only one person hears that is enough.
Disability, surgery, and suicide
In a series of about 300 Workers Comp patients who had undergone a lumbar fusion for back pain, there were nine suicides. This data was not published. I had two patients early on in my career commit suicides. This was in the era of my practice where I was zealously performing fusions for back pain and actually felt frustrated when I could not find a reason to perform surgery. As a referral surgeon, I was viewed as their last hope. I knew nothing about the neurochemical nature of chronic pain. I had sent one to the local pain clinic, and the other one walked out of my office and shot himself later that afternoon.
Here are some of the issues around suicide. It is a complex topic, so I am just listing a few.
- I eventually learned that when my patients were complaining of pain, they were often referring to mental pain in the form of repetitive unpleasant thoughts (RUTs). There is a clearly documented association between ruminations and suicide.
- Mental and physical pain are processed in similar regions of the brain, and unpleasant thoughts and emotions hurt. What is particularly problematic is that many disability systems won’t allow treatments for a “mental health diagnosis.” What is being overlooked is that they are the same problem. The data is overwhelming.
- Until I learned to help people with mental pain, it was nearly impossible to solve the physical pain, with or without surgery. This was true even for surgical problems.3
- Both fire up the immune system, including the immune cells in your brain. A sensitized brain magnifies everything, and life caves in on people.
- It is my feeling that RUTs are a driving force in most chronic disease states – mental or physical. You are trapped by your thoughts; there is not a protective withdrawal response as there is with physical pain. We have no protection, and suppressing them creates even more havoc.
- Failed surgery in any field of medicine is devastating. You are offered a chance at a cure or significant improvement and commit to a risky and expensive procedure. You have a lot of hope, and it is dashed. Repeatedly dashing hope induces depression.4
- Learning to deal with anger is always the tipping point of healing. With failed surgery, there is now the additional and legitimate anger at the surgeon who did not deliver on the implied relief. If you knew that the success rate of a given procedure was less than 30%, would you go through with it?
Dealing with suicide head-on
I have dealt with almost every aspect of suicide. I have over 20 medical colleagues dead from suicide, including my fellow spine fellow. I almost committed suicide myself in 2002. My employee’s husband shot himself while talking to her on the phone. I have helped pull many colleagues back from the brink of going through with it. A whole group of us tried to help a fellow spine surgeon, and we failed. He walked out of my operating room and went out and shot himself. I have had numerous face-to-face conversations with patients who have threatened to kill themselves if I did not do the surgery that they wanted. Fortunately, I was much better at understanding how trapped they felt, and each one eventually healed and went on to thrive.
I have concluded that the common denominator driving people to suicide is feeling trapped, including:
- RUTs – Repetitive Unpleasant Tho
- Physical pain
- Lack of opportunity
- Being stuck in any form of disability system
Dr. Sarno, a famous physiatrist, recognized the impact of chronic pain and used the term “rage” to describe the feeling.5 You are additionally trapped by:
- Not feeling heard
- Being labeled
- Being dismissed by almost everyone, including those close to you.
- Not having the true nature of chronic pain explained to you
- Being given the diagnosis of “MUS” (Medically Unexplained Symptoms)
- Scattered medical care dealing only with symptoms and not root causes
- Not knowing when or if it will end
There are several papers documenting that the impact of suffering from chronic pain on your life is equivalent to having terminal cancer, except it is actually worse. As bad as it is, at least you understand the problem. There is also usually a defined endpoint, hopefully for the better.6
Understand the problem – know the solution
Chronic pain, mental or physical, is consistently solvable by first understanding its nature. The current definition out of Chicago is the following: “…….chronic pain is an embedded memory that becomes connected with more and more life experiences, and the memory cannot be erased.”(7) So, procedures aimed at structural problems alone cannot and don’t work. It is one of the reasons I use the term “The Abyss” to describe the depth of despair being trapped in pain.
Conversely, although these brain circuits are permanent, you can consistently reprogram your brain around them. Like any new skill, it requires an open mind, repetition, and commitment to yourself. Your brain physically changes structure, inflammation drops down, and people often not only escape from chronic pain, but they thrive. It is also the reason I quit my spine surgery practice to pursue getting these concepts out into mainstream medicine. There is nothing more rewarding than helping patients help themselves out of this hole.
- Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM (1994); 331:69-73.
- Carragee, EJ et al. A Gold Standard Evaluation of the ‘Discogenic Pain’ Diagnosis as Determined by Provocative Discography. Spine (2006) 31: 2115 – 2123
- Perkins, FM and H Kehlet. “Chronic pain as an outcome of surgery: A Review of Predictive Factors.” Anesthesiology (2000); 93: 1123 – 1133.
- Blum, Deborah. Love at Goon Park. Perseus Publishing, New York, NY, 2002.
- Sarno, John. Healing Back Pain. Warner Books, New York, NY,1991.
- O’Connor AB. Neuropathic pain: quality-of-life impact, costs, and cost-effectiveness of therapy. Pharmacoeconomics (2009); 27: 95- 112.
- Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative neurology and neuroscience (2014); 32:129-139. doi: 10.3233.RNN-139003