Transcription
Why do 95% of people living with long COVID, ME/CFS, chronic pain never get the information that they need to recover?
People are being told, "Your mitochondria are damaged. They're broken. They'll never get fixed. You only have a limited amount of energy. You should never get your heart rate above 90. Uh you should never do too much exercise because you'll be damaging yourself and you'll be ruining your body for your life." This is completely untrue. This is completely inaccurate. There's no evidence for that.
And why does your brain keep creating symptoms even after your body has healed? Physician, researcher, and clinical professor, Dr. Howard Schubiner, the doctor leading this revolution in chronic illness treatment has the answers. And this is one conversation that you do not want to miss. Dr. Howard Schubiner, so incredible to have you here. Thanks for being with us. Oh my god, I'm so happy to be here. I was so happy to see you in the United Kingdom across the.
Yes. Yes. I was there for your mindbody master class in Manchester. That was phenomenal. And now it's just it's such uh a gift and an honor to have you here and so wonderful for the listeners and viewers here because and I understand I'm told that you are in the category of the less than 1% of doctors that are trained in effectively treating people with chronic symptoms, things like chronic fatigue syndrome, long COVID POTS, chronic pain like virtually all of my viewers and listeners have. So how did you get here? How did you get to this place of doing this work? What led you to the work you do now?
Yeah. One of the things that I put I put in this book at the end was this quote. You can only live your life forward but you can only understand it backward. And it's so odd when I look back getting older, uh, looking back at my life and seeing how these little twists and turns led here to this work that has consumed me, that has fueled me and has been my passion now for 23 years.
Wow. But it started uh you know it was a long course of learning how to be a doctor, learning how to do research, learning how to teach and speak and and being a skeptic and questioning and um all those skills serendipitously came to a point around 2002 when my new boss said, "Hey, you should read this book by Dr. John Sarno." I'd never heard of him. He's a cult hero and a hero to thousands and thousands of people. Uh, and I read the book and I was going like, "Oh, the mindbody connection. It explains all this, huh? Really? That's amazing. Is that true? Is that true?" So, I called up Dr. Sarno. I went and worked with him for a bit. Came back to my hospital. I said, "I want to check this out. I want to see if it this works." And it did work. It was amazing. Things I'd never seen before in medicine. uh people recovering from illnesses that seemed incurable, totally incurable. And then we started learning more about it, learning more about the brain, started doing research. I was fortunate enough to find highlevel researchers to do uh research with and wow, you know, we've really really come a long way, I think.
Yeah. So, right now we're going to get into what you've shared in some of what you shared in your book that is available today, Unlearn Your Pain, The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression. I have just finished reading it. I don't know if people can see, but I have like folded down so many pages. Everything is highlighted. I told you before we started, I read the crap out of this book. I've learned so so much.
And it's long. It's really long, Real. And I'm I'm so impressed. I mean a lot of people like well I skimmed it you know.
I told my husband I have this interview coming up I'm so excited and I have this book to read he's like can't you skim it.
No, take it back. I mean, you have become a cult hero to millions in this space now. It is phenomenal the way you're changing this space. So you we're going to get to into a lot of the practical stuff for people listening of you know, what do I do with this situation? Why is that happening? How do I handle this? Just a lot of those frequently asked questions that come up for people who are facing this. But I think it would be good to start with a bit of a neuroscience lesson. And you explain this in a really great way in your book. But what is happening in our body when we feel unwell? Like when we have pain, we have fatigue, we have all these symptoms and sensations. How are they created? Why are we experiencing them?
Yeah. So much of this work has focused on pain. But as I've progressed in this in the last 23 years, I've seen how many people are suffering not only from painful conditions but chronic fatigue conditions, POTS, long COVID, um, you know, mass cell activation, eranos, and anxiety and depression. It's and it's just so amazing how they all have intertwined and how they all lead back to understanding the brain. And you can't understand our body. You can't understand symptoms or sensations that we feel unless you understand how the brain works. And this has been a gamechanger for I think our whole field because when you when you talk to neuroscientists and doctors don't know this by the way and therapists generally don't know it either but when you talk to neuroscientists they say the brain works by predictive processing which means the brain creates what we experience. Okay, that sounds crazy. That sounds woo woo are your brain is creating what you experience. But it turns out it's actually true on a granular neuroscience level. We don't see with our eyes. Light comes in our eyes. It gets transformed into electrical impulses that go to the visual cortex and that's what creates our vision. And millions of fibers go to the visual cortex from our memory of what things look like. And when someone sees a crime being committed, they pick out the wrong person at the police lineup because what they saw isn't what they thought they saw. And what we hear is generated in our brain because our brain has to take in billions of bits of information and try to figure out what's the quickest, shortest way to help us survive by what we need to hear. And when you touch a hot stove, it's not your finger causing pain. It's the brain. And this is amazing. And so when you give someone a physical injury and you scan their brain, certain parts of the brain light up, what we call the danger or alarm mechanism of the brain. The brain is causing that pain because you can have an injury and have no pain. The brain is in charge of pain. The brain is in charge of fatigue. We'll talk more about that in a minute. And you can have an emotional injury and the exact same parts of the brain light up. So now we can understand that when we have a sensation in the body, it's generated by our brain, it's real, it's not fake, it's not imaginary, it's not all in our head. And it's either coming from some physical injury that's triggering the brain or shocking, some emotional injury that's triggering the brain. What could be more revolutionary than that? Really.
It's a completely different way of understanding things and it's a massive leap for most people.
Especially when the overwhelming majority of doctors aren't aware of this. So why aren't doctors aware? Why are people going to their doctor and not hearing this?
You know, doctors are trained in medical science and medical science uses the biomemed model or the biocschosocial model in some instances. But all of that is bio. It means there must be something wrong in the body when there's a sensation. And it's not necessarily true. We're just not trained in neuroscience. And when you catch a virus, the virus can directly cause nose running, throat tickling, cough can directly cause that. and it and the and the body will send out the white cells will send out alarm signals to trigger uh to trigger fever. But when you get fatigue when you get a virus infection, that's not from the virus. It's from the brain. The brain is reacting to protect us. That's its job to save energy, to protect us. And it's telling us what? Rest. Stay in bed to heal up. Which is great advice when you have an acute infection, but what happens a week later or two weeks later or a month later or six months later and you're still feeling so tired and so fatigued, but the viral symptoms have gone away? What's happening then? That is how the brain organizes itself. It's neuroplasticity, this big word that the brain organizes itself to create what it thinks it should do. And it's organized itself into creating fatigue and it gets stuck on autopilot. And those are the those are those neural circuits that are the actual underlying cause of chronic fatigue in the vast majority of people. And that is also hard to understand.
Yeah.
Yeah. I'm glad you brought up fatigue because it's a challenging one for most people to understand. And it feels like it's coming from our body that something in our body is causing it and making us unable to do things. And you shared in your book I loved a uh a study or it was participants in a research study. They were given a task causing mental fatigue and half of them were going to hear the sound of a metronome at the same time. And then on the following day, simply listening to the sound of the metronome made people feel fatigue, made them feel tired. Sort of like Pavlov's dog and salivating to the bell. Now a metronome is making people feel tired, which is fascinating.
It's exactly the power of the brain to create what we experience. And the power of these conditioned responses like you mentioned that can be really quickly learned. Really quickly learned. And our expectation is if we walk around the block, we're going to be tired for a week. That's our expectation. And it's our brain's expectation. And part of predictive processing, how the brain works is the brain will tend to do the same thing over and over again unless it gets different information.
And so if the last time you walked around the block, you got tired, this this time when you walk around the block, your brain is going to say, "Oh, time for time for severe fatigue." And it produces it and it keep will keep doing it until we change the neurocircuits and the power is immense. The power of the brain is immense and most people really don't understand that but I've seen it firsthand and you've seen it.
And it helps illustrate really well. You know, I went my whole life without hearing about Heb's law and now I don't think I go a single week without hearing the term what fires together wires together. But it shows like how if a metronome if your brain so you felt fatigue you heard the metronome it paired those right.
And now they happen in conjunction one triggers the other. So it helps you see why things that cause you extreme fatigue actually aren't things that should be causing fatigue. Innocuous things could be a metronome could be a bright light. Could be walking out your front door.
Just things in the past. Yes. We've seen so many people who when they've eaten uh this happened to Paul Garner uh his story about long co part of his story was he ate a piece of cake and he got extremely fatigued and now every time he had sugar he was getting extremely fatigued and other foods kind of pile on in there and these condition responses can mushroom. One of the other studies that's really blew my mind uh that's in the book has to do with this gene that that if you if you if you have this gene CRB CR B1 if you have this genetic makeup you're more likely to have uh fatigue with exertion and some people have it and some people don't. So this researcher did this study where he measured this gene and about half the people had it and half the people didn't. And then he had them all exercise. In addition to checking whether they had this gene or not, he also gave them uh information about whether they had the gene or not. But he randomized that. So half the people who had the gene he told did have it and half the people who had the gene he told you don't have it. The same with the people who didn't have it. And what he found was there was changes in how how much oxygen capacity people have, how much exercise tolerance they had that was more related to what they thought the gene whether they thought they had the gene or not than to if they actually had the gene or not. The power of their expectation of being unable or more able to exercise was more powerful.
Than the physiology that they. And it showed up in actual exercise capacity, right? It wasn't just their sensation of fatigue. It was also affecting how much oxygen they could use. I mean, that is amazing study.
So, what we're diving into in this conversation is neuroplastic symptoms, neuroplastic pain, and I'd like to hear you talk about the difference between neuroplastic symptoms and structural pain and structural symptoms. But first, tell us what you mean by the term neuroplastic symptoms. And I think part of what is confusing for people is that we have so many different terms. So, what are we referring to here? I've started a list, by the way. I'm up to 14 14 different terms that I hear people use.
About these symptoms. Um, but this is the dominant one uh in the US now. So, what exactly is that referring to?
Yeah, neuroplasticity means that a brain organizes itself. Simply speaking, as you say, if you have the walk around the block and you get fatigue, your brain now is producing that. It's neuroplastic. It's organizing itself. Your brain organizes itself. When you learn to play the guitar, it organizes itself when you learn to kick a soccer ball. Everything we do that becomes automatic is because the brain organizes itself to do the things that we teach it. And so that's neuroplasticity. So things that can be learned can also be unlearned. I don't remember my high school and college French anymore. I unlearned that a long time ago. Those were neural circuits that I learned from practice and repetition. I don't have those anymore.
Uh, the neck pain that I had in my 30s and 40s. I pretty much unlearned that. I don't get that anymore. I used to wake up with it on many occasion. I don't have that anymore, but I learned it for a while and then I unlearned it. That's neuroplasticity. Learning and unlearning. The brain organizing itself and and unorganizing itself or changing the neurosircuits. So, um, neuroplastic symptom is the symptom that's brain generated. It's generated by neuroscircuits in the brain in the absence of a structural disease or structural tissue damage injury that could be triggering those symptoms. So people who have neck or back pain u may have structural damage to cause it but we did a study where we found that 88% of people who had chronic neck and back pain did not have structural damage to account for their chronic pain. Therefore their symptoms were by definition neuroplastic.
So what is the difference between neuroplastic pain and structural pain? Pain that is coming from illness or disease in the body. Well, the pain is the same because the brain is generating that pain no matter which way it's being triggered to generate it. So, the pain, the experience of pain is the same. And the difference is what's triggering it. If it's being triggered by structural damage or it's being triggered by learned neural circuits that may have been learned because of emotional stress, trauma, etc. Things that trigger the danger signal in the brain. And so, the pain is the same. The fatigue is the same whether someone has fatigue from a neuroplastic condition or if they have fatigue because they have severe heart and lung disease for example.
Yeah.
It was interesting for me to read in your book and by the way I am so grateful for this book. It's the best book I've ever read on this topic. It is broken down so simply. It covers the science. It gets into all different conditions and what could be going on. It walks you through what to do about it. It's phenomenal. But I remember in one part you were talking about MRI studies and there was one from the Mayo Clinic in 2015 and it was fascinating because it had it was doing a meta analysis of studies covering 3,300 people and I think it was six areas of image findings.
Right.
And these were people without pain. So 3,300 people that were experiencing zero pain and they looked at if they had disc degeneration, disc bulge, disc protrusion, different types of degeneration, a couple more.
Yeah.
And it was covering people from their 20s all the way to their 80s. And every single one, even people in their 20s, show some of these six things. And by the time people got to their 80s, I mean, people had almost everybody had almost all of them, but none none of them had any pain. So how does this help us understand the neuroplastic symptom?
Yeah.
Process.
It helps us not be misled.
What the most important thing in medicine is getting the correct diagnosis. Is the fatigue due to a severe heart and lung disease or not? Is the pain due to a severe structural damage or not? You get the completely completely wrong treatment when you get the wrong diagnosis. And MRIs can be incredibly misleading when they're interpreted by doctors in a way that is is incorrect. So when I was in my 30s and 40s, I had neck pain on and off, on and off, on and off. And I got an MRI, had bulging disc, degenerative discs. The doctors didn't tell me that 50% of people in their 30s have those findings with no pain. They didn't tell me that 70% of people in their 40s had those findings without pain. They didn't tell me that 80% of people in their 50s had those and 90% of people in those six in their 60s had those findings. And so they're making an assumption that the this MRI is telling you the cause of your pain. It's not. It's telling you that you're got like gray hair, you know?
Yeah. The older you get, the more likely you have these MRI findings. A recent study in Finland with people with had roughly 500 some people with shoulder pain and they did MRIs on all the people with shoulder pain. 98% had either tendinosis, full or partial tear uh of the rotator cuff, 98%. Then they took another population of 500 some people with no shoulder pain and they did MRIs in them. 96% of them had the same abnormalities. Their conclusion is why are you doing these MRI? The MRIs are not helpful. They're not sorting out. MRI can be helpful if you have a tumor, a fracture, an abscess, something that's clearly responsible for pain. But when it's showing these kind of findings, it's going to be misleading. And that can really send people into a tizzy because now they think they're damaged or broken. They go down a path of more medication, more injections, even surgery for something that's not necessary.
Yeah.
And it is so sad.
Yeah.
It's so sad because so many people are suffering. You can see. I'm just thinking if I went in to see a doctor and then they showed me uh test results that showed bulging discs or something in my body, I think, okay, that makes sense because I have no idea what's going on with everyone else's back.
And thinking about the gray hair of the inside of your body, like a great example that I loved in the book, I might mess it up a little bit. Like if you're having pain in your head and you go to see a doctor and the doctor says, "Well, you've got gray hair and you've got some wrinkles on your face. How about we do a facelift and I think that should fix things?" And the person be like, "Well, no, everyone has like virtually everyone has wrinkles that can be the cause but we don't know that we don't think about that. Virtually everyone has that gray hair on the inside and the wrinkles also."
And that doesn't mean that that's what's causing your pain or your symptoms. And the same thing happens in the world of chronic fatigue. There are so many people want to find the biological biomemed cause. Which is fine if if there is one that we can find and correct. Great. We want to do that. Medicine has made great advances in cancer treatment and heart disease and stroke treatment in the last couple of decades. But when you take chronic fatigue, let's look. So, we'll look harder and harder and harder. But what happens when you find something that's there but not causative, correlated with chronic fatigue syndrome, but not causing it? Micro blood clots, cytokine abnormalities, microlevel inflammation, muscle muscle um apoptosis, the list goes on and on and on. And there's all these things and they're really scary because that's what gets reported in the news. Oh,
Long co or ME/CFS is associated with this biome medical problem, this one, this one, this one, this one, and there's so many. But yet treating those doesn't help. You know, low-level inflammation uh we people have been trying to blame that on chronic pain and chronic fatigue for a long time. But when you give people steroids, the most powerful blocker of inflammation has no effect. So how can inflammation actually be the cause of what we're seeing? And so part of the problem Railen I think is there's so much stigma against this idea of mind body. There's so much stigma that people feel invalidated or dismissed or belittled or demeaned when you say it's all in your head. And clearly.
I go to great lengths in the book to say it's not in your head. I've had these symptoms.
You've had these symptoms. They're real. They're not imaginary. They're not fake. And they can be caused by learn neural circuits in the brain because the brain is that powerful. So, let's be open to asking the question, what fits best for you?
Just before we move on from that one, a big one that comes up a lot in our chronic fatigue space is mitochondria dysfunction. Like my I have a a real physical mitochondrial disease or dysfunction that is this stuff, this neuroplastic symptom recovery approach isn't going to work for me. So, what is happening there?
Yeah. On one level, people are being told your mitochondria are damaged. They're broken. They'll never get fixed. You only have a limited amount of energy. You should never get your heart rate above 90. Uh you should never do too much exercise because you'll be damaging yourself and you'll be ruining your body for your life. This is completely untrue. This is completely inaccurate. Um, there's no evidence for that. There is evidence that mitochondria can can change their function to small degrees. They're not talking about the major degrees that we're talking about with this like doom and gloom scenario. That's not happening. But scientifically, there are small changes that mitochondria can have, but those are changeable. Those are reversible. Those can occur with stress and can re can be reversed. And Martin Peard has shown that he's even shown that mitochondrial changes can occur. People can get gray hair that can reverse. I mean, it's amazing some of the work he's done.
Oh, I need to look up his work. It's amazing. And so, but that's conflating, you know, it's it's it's conflating these these science, the true science of mitochondria that they can change their function to a small degree, that's true and that's reversible. Conflating that with your mitochondria are dead, they're damaged, they're broken, you can never do anything. And that is not that's not where the science is at. And I think people need to understand that. And look, my thumb just went up. I don't know why.
I love it. Very impressed with your answer there. Sometimes I feel like a superhuman the more I learn about brain retraining and nervous system regulation. And it reminded me in early days I started before I went to sleep making my own brain retraining activities trying to keep my hair from going gray. This was what I put put my skills to use for. Yeah.
So, another place that this understandably breaks down for people a little bit because we talk about symptoms coming from the brain versus structural issues, illness or disease in the body, but there is, you know, something that happens where something starts out as structural. So someone gets COVID, someone has a a back injury, they get in a car accident. So they have acute COVID symptoms, they have acute pain from their.
Back injury and they're like, I have a test. I can show you it's physical. I have scans. I just had the accident. But then in 6 months, a year, two years, 10 years, they're still in pain or they're still having.
Yes.
Long COVID symptoms or maybe not even the initial symptoms, it's turned into 37 other ones. So what is happening when it goes from something acute to something chronic?
Yeah, great question. And this happens all the time. There's two rules of medicine that I adhere to very strongly. One is all injuries heal. And the other one is scars don't hurt.
And injuries do heal. Uh, everyone who's had a cut, everyone who's had an injury has healed. We've been on this earth for some 100,000 years as homo sapiens roughly.
Yeah.
And people did not develop injuries that didn't heal. That just persisted and persisted. So the injury heals but the brain has learned the pain or learned the fatigue from the co infection even though the brain generated it and it then can continue be persistent. It can keep the symptom occurring despite the fact that the injuries heal. So the injuries will heal. The virus will re we will recover from the virus. But so why would the brain continue to create these symptoms and have them mushroom? There's two main reasons I think. Number one is fear. Is fear and worry and anticipation of the worst during the COVID epidemic. There was so much fear pandemic people dying worldwide. Horrible horrible things happening. Tremendous amount of fear. When someone has a back injury and they see other people who have had back injuries and they know people who've had pain for years and years, that feeds into the fear of it and then support groups can feed into it where you go online and you read about how horrible it is and how it's only going to get worse. So all that pain, fear, pain or fatigue, fear, fatigue cycle can really cause the brain to reinforce those neurosircuits and make them worse over time. The second reason is a lot of times when people have the injury or have the infection, they're undergoing a tremendous amount of stress in their life, especially ongoing stress. They're in relationships that are toxic or work situations that are micromanaging or bosses who are berating or family members who are sick or dying or children who are going astray. So much of that triggers the danger signals. You have the danger signal in the brain being triggered by the emotions and the stress of life on top of the danger signal being triggered by the symptoms themselves and the injury. In your experience, in your, you know, 23 years experience of working with people facing all sorts of chronic conditions like chronic fatigue syndrome, chronic pain, fibromyalgia, now long COVID, and a whole host of others. How often is the brain and the nervous system responsible for what's happening? Like could you put a percentage on how often it is coming from some something structural or coming from the brain?
That's a great question, Railen. And the the first answer is everyone needs an individual assessment. And what I write about in the book is how to do that assessment. The details of how to look for and determine for yourself if the condition if the symptoms are neuroplastic or structural or a combination of both. So that needs to be done on an individual level. But to your question, the answer is the vast majority of people with chronic pain, vast majority of people with chronic fatigue, anxiety, depression, longcoid, POTS, MCCAST, Ellers, hyper mobile, Ellers Danlos, the vast majority of them do have a neuroplastic condition. And the number is hard to pin down, but it's probably a lot higher than most people think. And in in the back pain study we did, it was 88% of the chronic back pain was neuroplastic. In two other studies that I've done with Yonia, uh, it was 95%. Um, and if you look at fibromyalgia, irritable bowel syndrome, headache, tension, migraine headache, it's also in the 90%. So it's a lot. It's a lot. Everyone needs an individual assessment, but there are millions and millions of people suffering and many of them are needlessly suffering and most can recover.
I'm smiling a bit because I'm thinking about the people listening and also about something that I believe you said at that mindbody master class in the UK was that uh what everyone has in common is that they think that they're the exception. So people are hearing that 99 90 95% they're like, "I knew it. I'm that 5%. I knew I knew it." Like 100% of people are in that 5% right now in their heads.
Exactly.
Well, you know, that's human nature. We really just care about ourselves and we really need to know for ourselves what's the best path. And that's why it's so great that you're here and reaching thousands of people, giving good information. That's why I'm here. That's why all of our colleagues are here and this growing movement of people to spread this knowledge and spread this word so that people can make the best decisions for themselves. A lot of time it comes down to a click moment. It comes down to a moment when you know all of a sudden it just becomes clear. One of the stories in the book is about a woman who had pelvic pain, very severe, and she was told she had endometriosis and she needed surgery. But she also looked up, well, a lot of women have endometriosis without pain. So, how do I know if I need surgery or not? How do I know am I in this percentage or that part? Right? So, she talked to a therapist and they discovered that something really important for her was that she was tremendous extreme people pleaser. She always said yes. She never said no. She always did what everyone else wanted. She never was her authentic self. And one day after having lunch with a friend, she had a huge flare in pain. And she goes, "Wow, did I eat something? What happened?" And then she realized her friend asked her to do something and she said yes. Cuz she always says yes. Which in her heart she really wanted to say no, but she couldn't. And so she with trembling and fear, she picked up the phone, she called her friend and said, "I'm sorry, but I can't do that." And she felt a little pride and a little exhilaration. And one minute later, her pain was gone. Gone. It went from 8 to zero or 5 to zero. And that was her moment. Then she knew. And when you see these moments, that can be the most powerful thing in helping you understand which group you're in, the 90% or the five the 10%.
Yeah. And it's important to normalize the doubt. Virtually everyone I interview who recovers using this approach started with doubt and thinking, "Well, maybe this once they even become open-minded to it, this could be true for other people. It sounds like it very much is, but I don't think this is for me." And just to stay curious and keep learning and looking and, you know, following the assessments, figuring out what's going on in your body and just.
Yeah.
Learning about it and you likely have a click moment. I mean, our good friend Fiona, you know, she joined the cure of to prove it wouldn't work for her.
To prove it wouldn't work. She said, "This has got to be bollocks, as they say in England."
I was going to say, which flies in the face of the noibo concept, but that's a whole other discussion.
Yeah. Yeah. And she But she kept reading about it and she the more she read, the more she realized that it did apply to her and it did make sense.
From a scientific point of view. And it made sense in terms of what she saw in her own life and that made all the difference for her.
Yeah. I'm I'm trying to do what I can for my end to get us past this place right now. I believe you were saying it as well that we have desperation on our side because virtually everyone's like there's nothing left to try. My favorite example lately is like the unicorn essence drops didn't work. The only other thing that was less credible than that was mind body neuroplastic recovery approaches. Let's give it like people say it doesn't seem like it could hurt. You know, doesn't cost a lot of money. Uh, let's give it a shot.
Yeah. You know, one of the one of the quotes I use in the book is there's nothing more powerful than an idea whose time has come.
Yeah.
And you know, these ideas are valid. We've shown in highquality randomized control trials that they work and they work better than standardized approaches that we have now. The neuroscience is on our side. More and more people are discovering them. And then they can hear from somebody else, oh this worked for me. Okay, well that is a good, you know, it's it's something that I can relate to. You're someone I can relate to. And so all that put together means that that paradigms are shifting.
Yeah. And you have how many citations in your book?
Over 800.
Yeah. So uh the body of research that exists and then continues to grow every single year is phenomenal which is wonderful and even just the evidence of people who are recovering. I know you have a list which by all means is not covering everyone on the planet but of people of what is it 750 people in the back who have recovered using these approaches and my name is in there.
You go to the California section you'll find me. I'm one of them.
And the beauty of that is people want to help. Yeah.
Something worked for them. They want to tell somebody else. They want to help others.
And this little thing of adding your name to a book, showing that this is a movement, that it isn't just a few stories in the book of people who got better. It's in in this book just hundreds of people, but worldwide or thousands and thousands of people.
Yeah.
Dating back to the work that Dr. Sarno started in the se 1970s and 1980s of doing this work and people still I still meet people who've met him all the time. I meet people who've read his books, who've been helped by his books, and I'm proud to say that, you know, he's taken a lot of abuse, frankly, lately. Uh, people who think, you know, he was always, you know, there's so much stigma against MindBody. We talked about that.
But I'm proud to say that I learned from him. And I'm proud to say that what he said was was right. And I'm proud to say that we've developed the science, the neuroscience and the medical science to show that this approach actually does work. So it's a builds on the shoulders of giants.
That's how science works. And science has to be humble. You know, there may be things in my book that are wrong that I got wrong that will be need to be corrected. Um, and that's fine. That can happen. But I'm very convinced after 23 years of doing this work that most of what in there what is in there is real is true.
And will help save someone's life that you know or that some either your life or somebody's life that you know. So, you have a five-step model for reversing neuroplastic conditions that you talk about in the book in detail, and I know we can't cover it comprehensively now, but could you tell us generally what does this five-step model look like?
Yeah, great question. So, the first step is getting the diagnosis right, doing a medical workup, making sure there's no significant structural problem that needs biomedical attention, ruling in a neuroplastic condition by the criteria that I've mentioned. And there's a whole chapter on that in the book of how to.
How to assess for that. A second step is understanding the brain. Understanding the power of the brain of predictive processing and neuroplasticity to learn symptoms and to unlearn them. The third step then is the next three steps are treatment pain reprocessing therapy that applies not only to pain but fatigue, anxiety, depression and that's how to change the neuroscircuits in the brain. How to give the brain corrective feedback so that it starts to unlearn those neurosircuits and move in a different direction so that the symptoms start to get better and start to turn off. And we do that through mindfulness type exercises. We do that through giving powerful messages to the brain. We do that by graded exposure and exposing our brain to what we can do with less fear and less worry. The fourth step is emotional awareness and expression therapy. And this is a a treatment that Mark Lumley and I have developed to help deal with stress and trauma and the underlying reasons for why a lot of these things have occurred in people. And it's a very robust and poignant and beautiful process of helping people explore feelings that they've held of anger or grief or guilt that they've held in that they can let out in safe and healthy ways. And the last step is what changes do you need to make in your life? The woman I talked about who wasn't her authentic self began speaking from her true self to her friends and to her husband who she'd never done that before, treating herself with more kindness and caring. There's a story in the book about a woman who had to leave her marriage because it was toxic and that was hurting her. And as she left the marriage, her migraine headaches got better. Amazing. So that's the five steps.
Something else that I can't even begin to imagine how many times it's been quoted, something that you have shared to help people with this is about responding to symptoms.
So uh the five Fs, the things that u you know people tend to do when or ways that they tend to react to symptoms. And it took me a long time to remember the five Fs. People who've been on my channel for a while know that I almost always only ever got four of them. Recently I got up to five.
Yeah.
Now we're up to seven. I don't know the final two. I can't remember them.
And people have been writing say, "Oh, there's some more." And I'm, "No, no, that's enough. That's already confusing."
The 27 Fs. Okay. So, but it's a really helpful concept, which is why I'm sure it's brought up by so many people in so many spaces. So, what are the seven Fs and why do they matter?
Natural to respond when you're fatigued or you're in pain or you're feeling anxious, you're going to be fearful of it. So fear of it sends messages to the brain to make it worse.
Um, focusing on it, paying attention to it, monitoring it, you know, being noticing when it's there or not there all the time. That sends signals to the brain that that it's dangerous. Frustration with it, angry with it, hating it, not understanding that the brain is just trying to send a message or trying to protect you. It's well-intentioned. And hating it creates more tension. um fighting it, pushing pushing pushing against it gives it more power over us. Trying to figure it out endlessly. And how many people have we have you seen or I seen who are going to more and more and more doctors, more and more and more alternative practitioners, more and more and more supplements, more and more physios, etc. to try to figure it out. Or when the symptom comes, it's like, "Oh my god, what was I thinking? What did I do? Why is what did I do wrong?" Figuring it out. When really it's it's the brain. That's all we need to know. It's the brain doing it. We can send it calming messages. And then the last two are trying to fix it. Trying so hard to give more and more treatments to fix it when maybe if it ain't broken, it doesn't need fixing. And the final one is being forlorn about it or being depressed. So sad and not having any hope because the last thing that we want is to not have hope cuz that's just a crushing crushing way to go through life.
So I've put together a list of five of the most common questions that I get about recovery from chronic fatigue syndrome from long COVID from long chronic pain. And so I'm thinking I'm going to put you in the hot seat here and do a rapid fire and see what your response is to these questions that come up all of the time. Are we ready for this?
Yeah.
Okay.
So, a big one that I hear a lot is why me? Like why do others experience trauma or get COVID or have high stress but they don't get chronic fatigue syndrome? They don't have pain. They don't it doesn't turn into long COVID. So it breaks down for them that this whole approach doesn't seem to make sense to me because other people live in far worse trauma than me and they got over CO just fine. So.
Yeah.
What's happening?
Yeah, that's a great question. We don't know the answer. We don't know why why two different people in the same family or in the same situation develop some after effects versus others who don't. The reasons most likely have to do with the support that people had, the resilience that they had growing up, what they learned growing up. Are they someone who is frail and weak? Are they someone who can handle things, who can tolerate stress and be with stress um and overcome it? And it's a certain situation of what happened altogether. Sometimes it's just a perfect storm that many of these things happen to people in different time frames, but for some people all of them happened at the same time. And that created the the the mechanism or the ground or the fertile soil for the brain to go into that panic danger mode and really turn on symptoms.
Yeah. I know in the book you talked about which is what you've just talked about a little bit here that there are protective and promoting factors which really help me to understand this better. But there are different positive things in your life that can outweigh many of the negative ones.
Yeah.
Which is why we see people, you know, in the same situation. Why everyone in a war zone doesn't end up with chronic fatigue syndrome or chronic pain.
Right. Exactly.
Yeah.
Yeah. Exactly. And the main thing is to not blame yourself, I think, because blaming yourself really leads to um a spiral that's not helpful.
Yeah. Okay. The next question that comes up a lot is all of a sudden I have a new symptom or new symptoms. Why do I have this symptom and why am I getting new things and could this symptom whatever it might be? Someone recently said my len left ankle is swollen and I have POTS and it's more than the right one. Could this all still be nervous system related? What is going on?
Yeah. Um, this happens all the time. One answer to why new symptoms occur is because we're human. We have a brain and we have a body and our brain responds with tests with symptoms to say, "Are you okay?" And it happens to me all the time. And so it's human to have these sensations that come up from time to time or even frequently in different places in our body. And our job is to figure out is this something we really need to worry about or not? Because if we don't worry about it, the likelihood it's going to go away is really high. The second thing is our brain maybe. As we start if the brain's danger signal is still kind of activated as you're going through a recovery process when you stop worrying about your fatigue your brain might produce anxiety because that will get your attention. Because the the danger signal is like a smoke alarm. It's got to be loud to get your attention. If you're not worried about your back it might give you a headache or a stomach ache because that's something new and different.
Yeah. So, it's just the brain's way of trying to alert us to something that's going on in our life. Um, another thing that could be happening is that our brain is trying to show us it's me. This is weird, but when you get I talking to a I saw a guy last week and he's having symptoms that are just so many different symptoms all over the place in different parts of his body coming and going. And I'm saying like, you know, your brain is telling you it's me. You're doubting, you know, you're worried that you have some structural damage in your back, but these wide ranging symptoms all over turning on and off, your brain is saying, "Look, hello, it's me. I'm doing this." Because that's the truth. When you have these such a wide range of these varying symptoms coming and going, new ones all the time, that's the that's our brain doing that. And it's asking us a question, are you okay? And our job is to recognize that we're not damaged. We're not broken. We really are okay on a deep level. And if we can communicate that to ourselves, have the wherewithal to communicate that to ourselves, I'm really okay. And communicate that to our brain, I'm really okay, is a huge factor in moving toward recovery and health.
>> I love that. That is a helpful way to understand it. And a subset of that question is always, but what about this specific symptom? Could my brain have caused this symptom? Whatever it might be, really long list. Are there symptoms you be like, nope, the brain didn't do that.
>> You know, symptoms that are sensations the the brain can always do. The brain can create almost any sensation. Dizziness, tinnitus, fatigue, uh you know, burning, itching, tingling, numbness, swelling is actually common. The brain can definitely do that. Um, uh, bleeding, probably not. You know, if you're bleeding,
>> okay,
>> pro probably not. I mean, there's some debate about that, but in general, probably not. It's funny, the brain can produce bloating, like abdominal bloating. We've seen that where the belly gets big and then it gets small. Anything that turns on and off like that >> is, you know, most likely to be brain generated. Um, you know, big big growths growths that are getting bigger and bigger. No, >> probably not.
>> It's your brain's not going to break your arm.
>> No, your brain.
>> You know, I was I don't know. It's funny. I I told this story the other day. You know, it's just how how easy it is to be scared because I love musical. I love musical theater and I and I love medicine. And one of the most poignant moments in musical theater history was when Jonath Jonath Jonathan Larson, who wrote Rent, died the day before Rent debuted on Broadway. Rent changed all of musical theater. It's transcendent, phenomenal work of art. and he died right before it came out because he had a dissecting aneurysm of his aorta that was misdiagnosed and missed by two different hospitals. They could have saved his life if they made the correct medical diagnosis. And I've been thinking about this book coming and I've been thinking like what if I die right before the book comes because that's how your that's how brains work, right? We think of all these horrible things. And so my wife was out of town last week and uh I was giving a lecture and before the lecture I felt something in the back of my throat and I had to excuse myself and put my fingers. There's something back there some food. I don't know what is it. There was nothing there. I gave the lecture I was fine and then after that I started getting this pain back of my throat. So it's like almost late at night, no one's home. I look in the mirror, I drew my flashlight, go, "Oh my god, I've got cancer of the mouth. I am going to die. this is I can't believe it like my thought I know and so I I was up all night looking up cancer of the mouth and all the different surgeons and the techniques and all this stuff and when should I tell my wife? She's coming home in the morning. So I pick her up at the airport and I don't want to tell her but I want to tell her and we get home and she looks in my mouth. She says, "Oh Howard, you bit your lip. That's not cancer." And but my vision my my my brain and my fear and my worry about the book and everything and that story >> fed into an expectation of when I saw that I didn't see what I >> saw.
>> Yeah.
>> She saw Oh, you bit your lip. It's fine now.
>> Yeah. We should probably add in that she is also a doctor. So not everyone's spouse >> is qualified to diagnose or not diagnose cancer.
>> But I'm a doctor. I should have been able. This is true. Touche,
>> but you know, we're human and we have these fears and we have these worries >> and you know, we think the worst often >> and we really need other people to be reality checks for us. And we need other people to to give us information that can that cannot lead us onto this, you know, spiral going down of of long COVID and spiral of chronic fatigue and spiral of chronic pain >> that just gets worse and worse without getting corrective information because the medical system often doesn't give us that corrective information.
>> Yeah. Okay, next very commonly asked question, one of the most common ones because we talk about a part of this process is to slowly start resuming normal activity and changing the way you respond to symptoms when they come up because they will come up.
>> So at least once a day I get asked this, how quickly should I expand activity and what do I do if symptoms come up? Should I stop? Do I wait for the symptoms to go away? It's just very confusing and I know there isn't a formula for this and everyone understandably wants one but different people explain it different ways and I find all of the explanation so helpful. So how do you navigate people through this?
>> Right. The key to doing graded exposure is is finding a level that you can tolerate not tolerate physically because physically you're not damaged or broken. The question is can you tolerate it from a fear point of view or from a worry point of view and so one can start with very lowle low-level exposure to for example walking um and that can be in your imagination so I like to start people with imagined walking or imagine doing chores or imagine getting out of bed or imagine taking the shower until they can do that without fear giving themselves messages of safety while They imagine doing the activity so that they get a win and they begin to feel confident. I can imagine doing that because imagining something is actually like doing it for the brain. And so now you're getting a very low level and then you can start with a little bit higher level. A little bit higher level. Now how much you progress and how quickly you progress and how much you do in any given day should be consistent. So you don't want to go up and then say, "Oh, I got symptoms. I better back off."
>> Go up and back off. That's not the right recipe because that's reinforcing that the symptoms are dangerous and that you have to lower. So you want to go at a level that you can tolerate from a fear point of view. If you're fearful of walking around the block, then that's too much for you because you're fearful of it. So you need to be able to imagine just walking five steps and then doing five steps. But once you get to the five step, you should stick with it.
>> You shouldn't drop back because that's what you can do. And you know you can do it and you keep doing it until with because you know you can do it without fear. That's the key.
>> Yeah.
>> And if you can if you can do five steps without fear, great. Then you can go to seven or 10 or 20. How quickly you progress is really a based is based on what you feel in your heart you can do without fear. And so that's that's the um parameters that I would suggest.
That is very helpful and a different way than I've ever heard it explained and helps me to understand it better. So my next question, this is something that I was really wanting to ask you when we were at the master class in Manchester, but I chickenened out. Big room full of people and I didn't want the mic coming my way.
>> But I've been but I've got you here
>> microphones right.
>> It's a little bit different in in in your presence and all people there in real life. But now I've got you in the hot seat and captive audience all to myself. So I can ask um I can ask this and it's quite often in these interviews I ask questions that I know the answer to or at least partly to but I want to hear it explained for our listeners. This is a question that I genuinely still don't understand. So and it's it's about how emotions cause symptoms. And I understand that it's the same emotional circuits in the brain. The brain and the nervous system are assessing danger. Emotional psychological danger the same as physical danger.
Mhm.
>> Where it breaks down for me is some of them are obvious like let's say you have a really stressful job, a toxic environment, your brain lays you out with symptoms that you can't go to work. So, it's protecting you from that environment. That makes sense. But there's so many other instances where something is bothering you. You don't something in your life and then you get back pain >> and you would need a Dr. Schuber in your pocket to make that connection. It feels like a faulty system to me. Like when I got chronic fatigue syndrome, I never in the world would have decoded what was going on. There's just no way. It feels really not intuitive to me. So I don't know if there is an answer to this.
Yeah.
>> But why is this happening? And how is the average person supposed to figure out what those messages are?
>> Yeah. It's happening because as you said that that emotions and stress code right into the danger signal, >> but specifically in terms of emotions, emotions that are suppressed, emotions that were actually unaware of are more likely to trigger the danger signal. So, if you're going through life and you have this low-level anger at your boss, let's say, this low-level anger at your cousin or sibling or something that keeps festering and festering, but you are just holding it down. You're not recognizing. You're not aware of it. You're pretending it doesn't exist. When it comes up, you just push it down. that creates a tension in in the brain because the anger is an emotion that needs to come out. It's a protective emotion. It's there to def for us to defend ourselves. If someone's attacking us, we need anger to defend ourselves. And so the brain is put into this fightor-flight situation with this chronic anger all the time that we're not addressing. And we have the capacity to address it. And that's what EAT therapy is all about. Emotional awareness and expression therapy >> is that to recognize that there's anger at something or somebody and to express it in a safe and healthy way. Not to express it in violence in the world that causes harm or puts you in jail or, you know, anything horrible like that, but not hold it in either, but express it in writing or express it in in speaking out loud when you're alone or yelling or screaming. to do that so that it comes out and you're processing it so that you can let it go and move to other emotions of caring or sadness and grief and then move to compassion. So what happens is people get stuck in anger and they get stuck in guilt. I've seen so many people who have had an affair or had used porn or something like that and they can atone for it but they feeling so guilty that that guilt is driving that danger signal in their brain. So emotions are normal and healthy. Guilt causes us to repent and atone. Anger causes us to protect ourselves. Sadness causes us to connect and love ourselves more. Be more self-compassionate and love others. So, so it's it's not that emotions are bad. It's that it's that the holding in the suppression of emotions that causes that tension in the brain that causes symptoms.
>> So, what I'm hearing is because I'm thinking that like when you touch a hot stove, you feel pain or a burning sensation. It's a very effective communication. You pull your hand away, you rest it, there's going to be pain until it heals,
>> right?
>> I have repressed anger. brain coding that the same way as danger, but it's just using the tools that it has. It gives you back pain. I might never figure that out. It feels like it's still a bit of a faulty system, but we're just very fortunate to have therapists and professionals who can help us work through it. It doesn't have a communication sensation to say, "Hey, let that anger out." So, it's like, I'm just going to use the tools at my disposal.
>> Right? But you can the other day I was in the gym with one of my gym buddies and she was saying I have this tension right up here and she said, "I'm going to get a massage and see if I can work out that tight muscle." And I go, "Yeah, that makes sense." And I said, "I wonder if you ask the question just like ask ask it ask this tension if it's it's reflective of something that's bothering you."
>> Yeah.
>> See what happens. You know, can't hurt. So she stopped in a minute and she said, "You know, I'm worried about my husband. He has this medical condition. He didn't go to the doctor. He's finally going now. He has a procedure coming up. I'm worried about him. Is that it for sure? We don't know for sure, but it certainly could be."
>> You ask the question and that can be a clue to unraveling this because this could be a message from the brain >> and it's up to us to encode it. And whether, like I say, we know that that's specifically it or not. We can't be 100% sure. But for for thousands of people that we've seen, it makes sense. It works and it helps.
>> And I imagine there was a time that where people paid more attention and were more connected to the communications from their body if we go back in history. Whereas these days, many of us just don't pay attention at all and try and override it and take medication and caffeine and sugar and just whatever we can do. So I'm pro many of us are probably just so disconnected to that even being a form of communication and it's just tapping back into that like okay what's going on here
>> the idea that the mind and the body are connected is not new.
>> Yeah
>> you know co the Russian the Roman uh poet said uh when the mind is ill at ease the body weeps. I mean this is you know 200 BC or so. So, you know, these things are not really new. I think we've forgotten them to a large degree because of the tremendous advancement in biomedical science to think that we can fix everything by looking under a microscope and finding a small finding the cause in some biomedical connection and that has worked for a lot of things. But for these multi-systemic conditions that are that are broad and wide with lots of different symptoms, it's unlikely we're going to find a single gene or a single cause like that. It's more likely we're going to see that learn neural circuits can be very powerful.
>> Yeah, you're right. Most of us, myself included, grew up, were socialized. I wasn't brought up to believe that it was my role to figure out any of this. I had any symptom or sensation, I was to go to the doctor. They were the expert. They would tell me what was going on. I didn't even waste my time trying to figure that out because who am I to know what's going on in my body?
>> So,
>> and you know, I came to this work being a skeptic. You know, prove it. Let's see if it really works or not. I come to all of medicine being a skeptic. You know, having a healthy healthy skepticism. And it includes being skeptical of what doctors tell me. It's not to say I don't trust them. You know, I have a good good buddy with cancer now and he's getting this amazing imuno imunologic cancer treatment that's working really well and I'm so grateful for that. And you know, we still can be skeptical of of anything. You know, you have to do your research and try to figure out and see what works best for you. And all I'm saying really the whole basis of this work, the whole basis of this book is ask the question. Could this be neuroplastic or not? Just ask the question. Be open to the answer. Investigate. And more often than not, good things will happen.
>> I love that people like yourself that have been doing this work for a long time can sum things up really simply. And I know in the book he said something along the lines of, you know, when you do determine that this is a neuroplastic condition, you have one sentence uh for how to sum that up. Am I putting you on the spot? Do you recall what that is?
>> I have no maybe you could tell me and it might trig or maybe I misread it, but this is what I had written down. Summed up in one sentence is don't worry about symptoms and live your life fully.
>> Yes, I've said that many times. many times in terms of in terms of the quickest and fastest way to get better. Yes, I
>> Yeah, I totally
>> Yeah, people probably need a little bit more information than that, but once you do fully understand it, that's what it boils down to. I'm going to link your last interview here when you're on the channel because it was wildly popular and really informative. So, people listening, if this is landing and resonating, this is another great conversation to check out. Uh, just hit play at the end of this video and Dr. Schubiner and I will be there waiting for you. And I'm also uh going to I just want to let you know that Dr. Schubiner sees patients virtually from anywhere in the world at uh Cormen Health. I hope I'm saying that right.
>> Cory Health.
>> Cory Health. Cory Health. We'll have it on the screen. We'll have it in the description. And his book, the best book I have read on this topic by a long shot. It is a gift. Thank you for writing it. It is available now everywhere. I believe that books are sold. Uh, Unlearn Your Pain, the science of recovering from chronic pain, fatigue, anxiety, and depression. Uh, links for all of that will be in the video description.
>> Oh my god, thank you so much, Railen. You're so kind. You're so sweet. You're so smart. You're so helpful for so many people. And I don't know if people realize, but you're so tall. When I met you in person, it's like, oh my god, my wife was taller than me. So I I you know I like I like that I like tall people. I like tall. It's a
>> there there are a ridiculous amount of tall people in working in this space. I can't believe making me feel very short. No, it's a wonderful community. Thank you for being here. This is phenomenal. Thank you for your book. Um, thanks for taking the time to speak to people here uh in this space on my audience and just for everything that you do.
>> Thank you Railen. Thank you so much. Be well.