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Notes from the Practice of Harold Goodman, D.O.

Live your dream.  Saturday, January 30, 2010

Today I received an e mail from a man who watched a video interview between me and another doctor. He had sought me out and asked to record an interview. It is on the net and occasionally I hear from people who watched it.

My practice here is a small one compared to almost every other medical practice in the Washington, DC area. It consists of one part-time secretary and me. A couple of exam/treatment tables, a few desks and chairs, some lights, not much else.

I have been doing this for 18 years at this point.

Over that time I have gone through a lot in my life; cancer, heart attack, etc. etc. If I had known I had to go through it I don't know if I would have been able to. Thank God, I don't know what happens next.

As I look back I really am amazed that I have made it to this point. I never realized that I was as strong as I have been. I have gone through the fire, been tempered and am here to live on another day.

I always wanted to do something worthwhile with my life.

Something that would make this a better place than I found it.

However, I had to deal with my own private demons and those of the people around me. It wasn't easy for me to trust and find peace here in this world. The alternative was so much harder that I just forced myself to keep going.

I am not really sure of what will come next. There is a part of me that craves some structure and security but life does not seem to work that way.

My work is very personal.

I want to be the doctor that I would want for me.

The one who listens, who cries with the patient, the one who does whatever is necessary to help.

I want to make a difference for each of you.

When I walk into the room I never know what to expect. I have no treatment plan or agenda. I just want to be real because, in my experience, that is our only hope for real healing.

And we all desperately need real healing.

I wrote this because I need to.

Maybe it will be helpful to someone.

I sincerely hope so.

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A missing link.  Saturday, January 02, 2010

Several years ago I saw a patient with debilitating low back pain. Since he had previously had surgery his insurance required that I contact his neurosurgeon to get permission to treat him.

The neurosurgeon was very pleasant and readily agreed for me to treat the man. " If you can help him then I have many more people I can refer to you." It was then that I learned that over 50% of patients receiving back surgery are actually worse following the procedure. In addition, of those who do get relief from the surgery, a very high percentage find that the pain later returns.

What did the surgery accomplish if the majority of the patients ended up with more pain? The "problem" was corrected, right? So why are they in pain?

All physicians have patients who seem to not respond to apparently well indicated treatment. This is a given in medicine. I certainly have had my share over the years. I often wonder why they didn't get better or, if they did improve, why the improvement was not long lasting.

Obviously, something is being missed.

All of us carry years and years of unresolved emotions, things that we basically push out of our consciousness because they are just too enormous to even deal with. This is true even of many people who, on the surface, seem at peace, who rarely get angry and appear quite optimistic.

However, on some level, things remain enormously unresolved.

We lead lives where we need, for very practical purposes, to function . There is simply no room for all this repressed baggage to emerge. As the years go by the situation of the unconscious becomes more and more untenable. There is no where for these bubbling emotions to go. They have become repressed.

We are a unified whole. No part is a solitary part unaffected by the rest of what is going on. Even though we do separate the mind and the body, for practical purposes, this is not the way things work. It is like trying to separate two sides of a coin.

Who and what we are is a process, a living, physiologic reality which, moment to moment is seeking balance.

And it has a lot to balance.

The more stress there is in our life, the more extreme the balancing act.

At some point, the unconscious can no longer be simply repressed. The maelstrom that it is must, for the safety of the entire system, manifest in some way.

One way, a very common way, this occurs is via physical symptoms.

We have feelings. The way we feel is via our body. The body is where the physical symptoms of the unconscious appear.

Back and neck pain. Pain in the nervous and connective tissue system. Pain and problems in the muscles of the various organs.

These various pains and other symptoms are never erased for too long by medical and other treatments if they are in any way a compensation for what is going on in the unconscious.

The patients wander from physician to physician without any real relief or resolution.

Naturally, they become desperate. Their lives begin to fall apart.

What has occurred is that the balanced relationship which the system craves has become seriously unhinged.

Things are out of control.

And we all know how much we like control.

Some of the cases that present to physicians are caused by serious disorders like cancer which must be ruled out before it is assumed that the pain is due to suppressed emotions of the unconscious.

When that is accomplished appropriate care may begin.

The first step in this care is for the patient to realize that there is nothing physically wrong with them.

This, in spite of the many lab tests, imaging studies and other evidence that they have a real physical problem, is the foundation for recovery.

However, this is very challenging for most patients to accept. Everyone is telling them that, for example, you have a ruptured disc and you need surgery. The fact that the majority of all people walking the streets of the USA have ruptured and bulging discs but are without any symptoms is rarely revealed to these patients.

In spite of all the medical evidence of physical illness, the only hope is to understand that they are not sick. There is nothing wrong at all.

The system is doing what it needs to do under the circumstances. It needs to blow off steam from the unconscious, so to speak. It is doing this by creating physical symptoms.

Patients rightfully resent the implication that "it is all in your head". This is not what I am saying at all. That implies, in my experience, that the clinician is saying that the patient is making it all up.

These patients are in pain, often very severe and long standing pain. The pain is very real. They are not making anything up.

However, the basis of the pain can be traced back to the system's need for balance. There is a very real reservoir of unresolved, unconscious emotions. They need not be resolved for the pain to disappear.

Rather, the role of the unconscious and the system's need for balance simply needs to be acknowledged. That is the cure.

I know it sounds simple but, believe me, for those patients who make the connection it is a life-changing matter.

Many years ago, John Sarno, MD, a rehabilitation medicine specialist at NYU Medical Center, began to discover that if he educated his pain patients to understand what was actually happening that the majority of them found that their pain would simply disappear.

He has written several books. My favorite is The Mindbody Prescription. It contains virtually everything you need to know about these matters from his standpoint.

I, too, have discovered similar states in many of my patients.

Long ago, a woman who had suffered with years of back pain, came to me. She mentioned that years before, she had journeyed from Washington, DC to NYC to watch Dr. Sarno lecture on what he referred to as TMS ( tension myositis syndrome). Following the lecture, during which she had an epiphany about her situation, all her pain disappeared. This lasted for several years.

What happens is that a light bulb goes on. You suddenly realize what is really going on. You suddenly have an ah-ha moment. You get it.

Nothing is wrong. It was all a misunderstanding based on years and years of believing that they had a physical problem which needed to be fixed by physical means. Now they know that, actually, the mind-body was simply doing its balancing act.

Once this understanding occurs the pain resolves.

For me, a totally new relationship emerges between us ( conscious mind) and the unconscious.

It is like suddenly awakening from a dream or, in this case, a nightmare.

A physician can facilitate this process. That is my role.

If I believe that a patient has what Dr. Sarno terms TMS ( tension myositis syndrome) then it is my duty as a physician to support them in getting better with a treatment that will actually address this condition, a condition of a fundamentally skewed relationship between the conscious and unconscious mind.

When this is successfully accomplished then the pain usually disappears.

Caveat

Dr. Sarno teaches that almost all pain and a myriad of other conditions fall into the category of this conscious/ unconscious balancing act.

However, not all of the TMS diagnosed patients, by his own admission, respond to this approach. The vast majority seem to respond but, like anything in medicine, this is not a panacea. I believe that the diagnosis of these patients needs to be carefully arrived at as a diagnosis of exclusion.

That being said, I am also convinced that this approach to helping patients needs to become a central feature of medical training and practice. I find a psychosomatic component in most conditions. The degree needs to be established in order to truly help the patient. I look forward to the day when the repressed emotional component of suffering will become one of the first and not the last thing to be addressed.

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