The scariest year of my life—which includes seven harrowing trips to Iraq and four to Afghanistan between 2003 -2007—was the year I taught first year medical students Neuroanatomy.
What scared me most was my students--future pediatricians, internists, surgeons, gynecologists, dermatologists and dozens of other specialists and sub-specialists—who only wanted to learn one thing from me: what’s going to be on the test?
With a few notable exceptions, these embryonic doctors expressed zero curiosity about the way the brain and nervous system functioned. Most of them simply wanted to “check the box” on Neuro lab (as my class was called) so they could move safely on to their second year.
In fairness, their laser focus on checking the box and moving on made a lot of sense, given the crushing workload and intense pressure that they faced. But still, I worried, that, when the students someday turned into residents, then practicing physicians, crushing workloads and intense pressures—albeit different ones—would persist, making it impossible for them to devote quality time to their patients.
And indeed, the realities of modern medicine have brought my worst fears to fruition. The average primary care doctor has a panel of 2500 patients, which, if the doctors followed best practices, would require them to spend 21.7 hours/day treating patients. A 2012 article in Annals of Family Medicine observed
Data on quality of care illustrate the results of this predicament [doctors have too little time]. Patients receive only 55% of recommended chronic and preventive services. About one-half of US adults have at least 1 chronic condition. Fifty percent of people with hypertension have uncontrolled blood pressures, more than 80% of people with hyperlipidemia have not attained cholesterol control, and 43% of people with diagnosed diabetes have not achieved glycemic control.
So what happens with many harried doctors—whose paperwork burden has burgeoned with requirements for keeping electronic health records (EHR’s)-- is that when you visit them with a problem, they think to themselves “How can I make a diagnosis, write a script, document everything for carriers (insurance companies) ‘check the box’ and move on to my next patient as quickly as possible?”
I want to emphasize that this is not true of all doctors, and short doctor visits often are all that’s really needed.
And yet…the National Institute of Health estimates that 38% of U.S. adults use some form of Complimentary and Alternative medicine, out of a belief that conventional medicine can’t “fix” what ails them.
Aware of modern medicine’s limits, when I met my wife, Chris Gilbert MD PhD-- who has developed highly unconventional medical techniques, I decided to devote all my work in neuroscience to helping Dr. Chris and other physicians find more effective ways of treating patients.
One result of that work is a recent collaboration with Dr. Chris on “The Listening Cure: Healing Secrets of an Unconventional Doctor” where I describe the hard neuroscience underlying her unorthodox methods, which often succeed where western medicine fails.
Here is an excerpt from the book—starting with a case study-- that illustrates what to do when doctor after doctor has failed to identify and cure the root cause of your problem.
Cynthia came to see me for chronic throat pain that started two years prior to her first visit. It began after an argument with her husband over his refusal to take time to play with their kids on weekends. He is a hardworking man dedicated to his job and with little time to devote to his family.
Cynthia began to feel that her throat was swollen, that perhaps there was a growth in it causing her pain and discomfort. Over time her symptoms got worse, sometimes even preventing her from swallowing.
She saw many physicians: An ear, nose, and throat physician performed a larynx endoscopy, looking for a lump next to her vocal chords. Another one ordered a neck CT scan, looking for a mass that might be outside her throat, pressing on it. A gastroenterologist did an upper endoscopy looking at her esophagus and stomach with a camera to rule out cancer or an ulcer. The test revealed nothing abnormal.
Nobody found anything wrong with her. Her primary care physician gave her hope that a steroid spray would bring her relief, but it didn’t work. She tried numerous medications and supplements, but none were able to alleviate her pain, which had slowly been increasing for about two months.
Then one day she comes to see me.
As she enters my examination room, I immediately notice that she looks very distressed. As we greet each other, I hear a voice that is soft, but more importantly, it sounds very weak.
After examining her, I say, “Cynthia, I’d like to try something you might find unusual at first. I’d like you to give your throat a voice. If your throat could talk without being censored or judged, what would it say? Remember, this would not be you talking, it would be your throat.”
She looks at me quizzically, but I can also see that she is desperate enough to try anything.
Now, a little sound begins to emanate from her throat: “Dr. Chris, I don’t know! I am so weak and tired! It feels like I have a lump in me! It’s painful!”
Now I want to get her to bypass the controlling consciousness and get in touch with her body’s sensations that are closer to her unconscious. “Okay,” I say. “Throat! Tell me more!”
Cynthia is responsive, “It feels big to me, like a ping-pong ball. It is round.”
I ask her, “Anything else? Say whatever comes to mind! It doesn’t even need to make sense to you! Ready, set, go! Talk!”
In order to keep open that bridge from the body to the unconscious, I need Cynthia to talk immediately without thinking since thinking would bring her consciousness into the equation.
“I have a big ball of knots inside of me! Tense knots! I want to get rid of them! I am so angry I could scream!” Jumping back to her conscious mind, Cynthia suddenly apologizes for her outburst,
“Oh! I’m sorry! I didn’t want to say that! That was horrible!”
Before the apology, Cynthia has yelled out a key sentence: “I am so angry I could scream!” Her conscious mind doesn’t want to admit that, but her body does. Her outburst sounds like a deep truth from her unconscious but is immediately judged by her conscious mind to be “horrible.”
Over the years, I have learned to pay attention and respect what the unconscious says through the body. Now I have to confirm what she just said.
“Cynthia, that was not horrible! That sounded real! Check within yourself . . . Was there some truth to it?”
“Yes,” she replies in the small, shy voice again.
“Okay, Cynthia, what I am hearing is that your body is so angry, it could scream. Is that right?”
“Yes,” says the small, shy voice again.
The shy voice indicates to me that the unconscious body is present but is very weak, completely dominated by the controlling conscious mind. Yet, the deep reason for her throat pain has to be found in the unconscious mind, which is very tentatively speaking out for itself.
“Cynthia, I want to hear more about what your body wants to say to us. What else would your throat say if it could talk? Don’t think! Don’t try to make sense of all this! Just say what comes to mind! No censoring! Go!
Now I hear a new message from deep inside. “I am not happy.”
Then a pause.
Ah, I think, the truth is coming out. The door of the body— and with it the unconsciousness—is opening. Her conscious mind is finally releasing its control. I begin to probe more.
“You are ‘not happy’ about what?”
“I am not happy with my husband anymore! We’ve been married for fifteen years. At the beginning, he was so romantic. He was taking me to dinners at nice restaurants; he was making wonderful love to me with romantic foreplay. Then we had our two kids and the romantic dinners and everything else that was lovely in our marriage disappeared. He started working longer and longer hours. He comes back late at night. Now, he even works all weekend. He doesn’t spend any time with me and the kids. And as far as sex goes, he has no more time for foreplay. He just wants it late at night when he gets home, and now he only has time for ‘quickies.’ That doesn’t work for me! I hate it. I feel used.” Her voice breaks down and tears come to her eyes.
Here is the key to her symptom, the pain that has settled in her throat. What I’ve just heard is the deep origin of her illness.
I am not surprised. Why?
Simply because of the anguish and the intense emotion she is showing. A deep chord has been struck. She has just tapped into the emotional source of her agony.
Cynthia had been sitting on a volcano of anger with pressure mounting as, day after day, she endured the trials of an unhappy marriage. One way Cynthia kept her rage from erupting was to stifle her emotions. Part of her wanted to scream, and yet another part of her that wanted to save her marriage had restrained her voice and kept her from lashing out at her husband. This constant, unconscious tension inside her larynx stressed her throat, generating great pain.
So many of my patients come to me with similar stories originating with an unhappy relationship or marriage and accompanied as a consequence by bottled-up anger, frustration, and stress.
They come to see me with what they initially do not realize are the symptoms of their unhappiness: perhaps throat pain, backache, stomach ache, or depression or many other possible symptoms. They don’t understand that all these medical problems are really symptoms of the greater problems of their anger, emotional pain, and frustration. All because their hot anger has nowhere to go but stay inside and burn them.
Cynthia continues, “I am so unhappy, but I cannot tell him! I need to stay quiet, proper, and well-behaved like I was raised to be!” She stops talking, looking at me intently. I can see sadness in her eyes—or is it despair? She is waiting for my reaction.
Now, her controlling conscious mind is surfacing again. Here, the armor of self-protection is building up again and trying to distance her from her own anger and fear. That anger is being kept inside, a destructive force with nowhere to go.
Yes, people can be quiet, proper, and well-behaved, as their parents often teach them to be. That keeps society civil and peaceful. But what are they supposed to do when anger and frustration are fermenting inside of them? That is something that parents have never taught them because they had no clue!
Cynthia needs to understand and act upon this truth:
“Okay, Cynthia, I get it!” I say in my most understanding voice. It is important that she knows I am on her side, welcoming, accepting, and not questioning what she is saying. Then, I add, “Let’s use the pillows!”
She looks at me with a puzzled and curious expression on her face as I place six big pillows on my examination table and say, “Imagine these pillows are your husband. What does your throat want to tell him? You have permission to tell anything and every- thing that comes to mind. You even have permission to hit those pillows.”
“Really?” she asks. Her eyes widen.
“Really!” I answer with a big smile, anticipating what I know from past experience will be an immediate, drastic change in her attitude and behavior.
“Are you sure?” she says with a malicious look in her eyes. “I am sure!” I answer. I am the one curious now.Then all of a sudden, her voice changes. It becomes spectacularly stronger as she continues talking and moving up close to the pillows.
“I am angry! I want to scream at you! I could hit you!”
We are on the right track. Now I push her while being supportive. “Go on, hit those pillows, Cynthia!”
She doesn’t hesitate, hitting the pillows lightly, then with more force.
Not enough, I think. So I push her more. I want her to use more force to get a maximum amount of anger out of her body. That’s when she screams, “I hate you. I hate you. I hate you!” and she bangs on pillows harder and harder. Her outburst lasts almost five minutes.
“Oh it feels so good to let go!!!” she screams.
When her arms become tired, she says, “The pain in my throat is disappearing! This is amazing! How can this be, Dr. Chris?”
I explain to her that she has been experiencing anger and rage towards her husband for the last two years. With the pressure mounting day after day, a part of her wanted to scream at her husband, to let loose and tell him how she felt. The other part of her, the polite, nicely raised girl, wanted to keep things together, not make a fuss, and not show any emotion.
It turns out that when we think of things we want to say, but don’t say them, muscles in our larynx that control our vocal chords make small contractions as if we were speaking in a faint whisper. In Cynthia’s case, these constant subliminal contractions associated with wanting to scream at her husband likely stressed out her muscles. And, as in all cases of voluntary movement, our vocal chords have two opposing sets of muscles: one set that moves our chords in one direction, and one that moves them in the opposite direction. Cynthia’s urge to scream, and her equal desire to stifle her agony may have resulted in a struggle inside her larynx between two different sets of muscles. Both muscles may have become so tense that they were painful. This may explain her sensation of knots in her throat.
The other possibility is that the muscle layer of her esophagus was having spasms because of her stress. The only way to end this tug of war was to allow her to express her anger in a safe setting, under my guidance, against pillows.
“Wow, this was powerful! Thank you!”
And then she adds with a big smile on her face: “When can we do this again?”
[After a few more sessions Cynthia’s symptoms cleared up and did not return]
Excerpt copyright 2017 by Chris Gilbert and Eric Haseltine
As my wife Chris, my sister Florence and my niece Anna, all physicians, constantly remind me, I am not a physician, so bear that in mind before acting on my bottom line opinion about all of this.
But here’s my bottom line opinion: conventional modern medicine can work wonders, and if you find yourself with a medical problem, start with conventional treatments. Even a 5 minute office visit can often do the trick.
But if you experience only temporary symptomatic relief, or no relief at all despite multiple visits to multiple physicians, one possibility is that an unresolved emotional or behavioral problem is the root cause of your illness, and that a permanent cure will require you to do what Cynthia did and listen to your body.
The “about the author” section below includes a link to The listening cure: Healing Secrets of an Unconventional Doctor, for which this excerpt is taken, if you’d like to learn more.