Video: Watch the full session here → https://www.youtube.com/watch?v=tmYPl1cLr30
Dr. John Stracks: Good evening, and welcome to Episode 7 of the Hope for Healing video podcast. I’m Dr. John Stracks, joining you from my office in Chicago, and here this evening with my friend and colleague Dr. Dan Ratner, who’s a mind-body medicine psychotherapist in Cleveland. Hope for Healing is a joint effort between me and the Curable app, which most of you are familiar with. For those of you who don’t know one or the other, I’m a physician who has a mind-body medicine practice in the Chicago area, focused on the reduction and elimination of physical symptoms using mind-body medicine methods. Curable is an amazing app focused on the same goal. We’ve been working together since their inception, about five years ago, and we started this series at the beginning of the COVID-19 pandemic, as we both thought about what we could do to help support people using these methods during this difficult time.
Before I introduce Dan and we get started, I just want to go over a couple of items. First, Dan and I will be discussing mind-body medicine for about 45, maybe 60 minutes, and then we’ll spend a little time taking questions at the end. We’ll sign off about 5:50 in Chicago, 6:50 in New York. Our friends at Curable will collate those questions and deliver them for us during the question and answer. So if you have questions at any point during this broadcast, go ahead and type them into the chat box in Zoom if you’re watching here with us on Zoom, or into the chat on the Facebook feed if you’re joining us on Facebook Live. Curable is monitoring those questions and will forward them to us, and we’ll do our best to answer as many as we can.
Secondly, and I’ll go over this again at the end, I want everybody to know that we’ve been able to expand our telehealth practice significantly during COVID-19, and we’re working to sustain that indefinitely, even after the pandemic ends. So no matter where you are, if you’re feeling stuck with your symptoms and would like to talk with me directly, feel free to reach out to my office at doctorstracks.com, and my staff can give you details about an individual consultation with me.
And lastly, just a minute on terminology. Many of you know what we’re talking about as mind-body medicine, which to me means that we can express in our body what’s going on in our mind or in our lives. I think that’s universal. I don’t think that’s bad. It only becomes, quote, “bad” if you enter a medical system that doesn’t understand this and assumes that all physical symptoms are physical in origin. I think humans have always expressed their lives in their bodies and likely always will, so our goal is to help you understand that and learn what to do about it, so that it’s no longer physically uncomfortable or painful for you.
Both Dan and I learned about this concept initially from a physician named Dr. John Sarno, who many of you have probably heard of as well. Dr. Sarno was a physiatrist in New York City in the 1960s who really understood that connection between mind and body and was one of the first to popularize that work. He called it tension myositis syndrome, or TMS, which is a term that both Dan and I have used for years. We now have a much better understanding of this whole concept, and we preferentially use the term mind-body medicine. Occasionally, though, you’ll hear us slip and call it TMS. No matter what we call it, we’re referring to the same concept: that what happens in our lives shows up in our bodies, which doesn’t make us bad or sick. It just makes us human.
So with that, I’m going to introduce my friend and colleague Dr. Dan Ratner. Dan has a doctorate in psychology from Widener University. He was initially a staff member and training director at Fordham University’s counseling center in New York City. In 2007 he set up a private psychotherapy practice in New York, where he practiced for many years until moving back to his hometown of Cleveland, Ohio, where he currently lives with his family and practices psychotherapy. After dealing with a multi-year course of his own chronic back pain, which he’ll tell us about soon, Dan developed a portion of his practice to treat chronic pain from this mind-body perspective. Since that time he’s been one of the foremost mind-body medicine psychotherapists in the country, actively working to strengthen his psychological treatments of pain and other symptoms in both speed and effectiveness. He’s also committed to raising awareness about this form of treatment for physical symptoms, and to do that he’s worked in a variety of media settings, including both TV and comedy. He’s working on a new podcast called Crushing Doubt, as well as a book about mind-body medicine. He’s graciously agreed to donate his time during his vacation to be with me here tonight to talk about his own personal experience and his experience as a psychotherapist working with clients to help them end their battle with chronic pain and other symptoms. Dan, welcome to Hope for Healing.
Dr. Dan Ratner: That was the nicest introduction I think I’ve ever had, including, I mean, no offense to my wedding. That was wonderful. Thank you.
Dr. Stracks: I am super excited for you to be here with me tonight. We are just getting started, and I’m going to start with a detour, who knew. When you and I first talked, I think we were both struck by the similarities in our journeys and our careers. Many of the people listening have heard my podcast, where I talk about how I learned about mind-body medicine way back in 1998, after a year of chronic pain. In a few minutes you’re going to talk about your journey with that, which also started, I think, in your late 20s. But before we get there, I want to talk a little about what happened before any of that. I graduated from college in 1991 and worked for the next six years doing social work-type work in the Chicago area, working with disadvantaged youths on the south and west sides of Chicago. You graduated in 1995 and moved to Los Angeles to work for Teach For America, which is a program that takes recent college graduates, puts them into underserved school systems, and trains them to be teachers. I was struck by that similarity, because I know that experience still influences the work that I do. What was it like to be in Teach For America back in the mid-’90s?
Dr. Ratner: Oh boy, we could do a whole podcast on that. I will try to sum it up. It’s interesting, because as we talk about TMS, one of the things I’m thinking about, I can hear our trajectory. It’s not an accident that two people who went to try to help a bunch of people ended up with TMS, discovering this, and then helping people in that manner. We’ll get into that more, and I’m sure you’ve talked about that extensively in all kinds of settings. It was just a life-changing experience, and I knew it would be, and that’s kind of why I did it. There were many reasons. I went to Shaker Heights High School, which is where I’m from, and it is 50 percent African-American. They work really hard on racial issues, but there are certain things that persist, and I think we’re really seeing it in society today, especially, I think, with white culture, which hasn’t really heard what’s happening. It’s always been my mission to hear the people who are saying they’re not being heard, because we must be missing something, right? When I graduated college, I didn’t know what I wanted to do. I thought I might want to go into psychology, and it’s not a surprise that I ended up doing that, but I had also always loved little kids and I was very passionate about race relations. I just thought, well, this is a chance to have an adventure, and I signed on. I’m a little hesitant to say this for people who’ve actually been to the army, but to me it felt like I was going to the army. I didn’t know what to expect. I knew I was in for one of the challenges of a lifetime, and it was that, but it also helped me grow and feel much more powerful in my ability to manage things, and that’s part of what I wanted to get out of it. I had already been in years of therapy, and I wanted something that would challenge me and help me feel that. Forgive the landscaping, I’m actually in East Hampton, New York, where they just do landscaping all day every day. That will continue long after the podcast. But I wanted to learn about me and challenge me and grow, and that I did. The first year was one of the hardest years of my life. For you teachers out there, I think it’s the hardest job I’ve ever done. I think teachers are underpaid severely, and that’s no secret, but it’s really weird when you think about it, because these people are taking care of the kids. It’s part of what led me to psychology, because as I was taking care of these kids, I... wow, that landscaping is really loud. I’m sorry, I can barely hear it.
Dr. Stracks: You’re all good.
Dr. Ratner: Hilarious. What I found is that I was helping the kids to have a good situation in the classroom, at least the second year. The first year I really had challenges, but then they’d go home to these situations that were really tough. I had been in therapy for a long time and benefited from it, and that’s when I decided to go there. So I tried to sum it up that way.
Dr. Stracks: It’s funny that you talk about that, the first year in teaching. I had some friends here in Chicago who did a very similar program locally, essentially a local Teach For America, and they got put into the schools. My friend said he finished his first year and went down to the store and bought himself a Subway sandwich and a six-pack of beer, and he walked out of the store and somebody on the street asked him for a dollar. He said, “Buddy, I just finished my first year of teaching, we’re going to celebrate.” So he split the sandwich with this guy and gave him a beer, and they sat there and ate and drank, and that was how he celebrated his first year of teaching. I’m sure you bring some of those experiences into your psychotherapy work. I can share some thoughts from me, but is there anything for you that stands out, things you take from those couple of years of teaching and still apply to the work you do now?
Dr. Ratner: It’s a really great question. I would actually say I apply it even more to parenting than to my psychology practice, but there’s a lot of stuff about autonomy and boundaries and helping people believe in themselves. When my kids, not my kids, my kids in the classroom, the first year, they were just walking all over me, and I didn’t know how to control them. When you think about a 23-year-old white male coming into Compton and trying to control it, it’s just not a great setup, for obvious reasons, but it also just wasn’t working. What I found is that everybody has a relationship with themselves. These kids have a relationship with themselves. If you help them feel good about themselves and the autonomy they have, you’ll do better, and that’s really what I learned there.
Dr. Stracks: I spent probably six years, two years doing after-school programs and drug prevention work and four years in child welfare working with teenage state wards, and I think what I remember most, or what I take most, is that I learned from these kids just these horrific stories. One kid told me one time how he went and sold drugs when he was like 11, on Christmas Eve, to buy presents for his kids because his mother wasn’t there. I mean, stories that you wouldn’t believe. But I’ve heard those stories, and so now when people tell me things, I can sit and I can hear those stories, and they don’t faze me.
Dr. Ratner: I love it. We have to be able to put ourselves aside and really hear. That’s endemic to good therapy, but it’s also incredibly important to the work of TMS, because I have found increasingly, and sorry, I just slipped and said TMS. There you go, first thing in mind-body work. I find that the amount of trauma people have suffered is tremendous, and a lot of times, like me, it’s not something they label trauma. In fact, they’re very uncomfortable with that. I didn’t like the idea that I had been traumatized. I liked the story that I had some really difficult stuff but I rose above it. What I’ve learned is they’re not mutually exclusive. I did both, but I had to let in that actually this stuff hurt more than I realized, and that helped me be able to hear the other people. So yeah, I can imagine the things that you heard.
Dr. Stracks: It was staggering to compare my life to theirs. There were ways in which I had a lot more overlap than you’d think, and then ways in which I had no overlap whatsoever. So anyway, I want to hear about your experience with back pain. I also just got a message that people are having a little trouble hearing you, so if there’s any way to bring your computer a little closer to you...
Dr. Ratner: I’m really close, if you want. Okay, hold on, I’m going to open up my preferences and make sure it’s loud enough as well. All right, how about now?
Dr. Stracks: That’s actually much better.
Dr. Ratner: Aha. All right, I turned the landscaping down and me up.
Dr. Stracks: Excellent. Next time we do this, we know not to do it from East Hampton. That’s what we have learned today. So anyway, like I said, I had suffered from essentially a year of pain that nobody could understand, but you had something like eight years of pain. Tell me what happened and what that was like.
Dr. Ratner: There’s no event, other than having my kids, that changed me more than that experience, and I never would have guessed it. I felt it changed me for the worse for a long time, and I didn’t guess that I would get anywhere with it. It began as a little twinge in my back, bending over to tie my shoes, and I didn’t think that much of it. But I have to say, I was like, uh-oh, I’ve heard about people with back pain, and that moment of worry is really important, because I have a part of my personality that can be prone to worry, and I think that’s one of the factors that can really set you down a path toward TMS. It just got worse and worse, and I was thinking, what is this, where did this come from? That’s one of the hard parts of the experience, the level of confusion. I don’t know what you experienced, John. I’m happy to hear you got out of it in a year, because I did not. But I would say during that year it was all I could think about, it was all I could talk about. It totally dominated my existence, and everybody thought maybe they knew, but nobody knew what it was until I figured it out. It’s a very lonely, scary, confusing experience. I would wake up in the morning and the very first thought I had was, how’s my back? And I would go to sleep at night and the last experience I would have was, how’s my back? I would wake up in the middle of the night. It got worse and worse until I had these absolutely gut-wrenching spasms multiple times a night. I didn’t sleep through the night for eight years. Well, I shouldn’t say that, actually. There were times within that period that I got the spasms under control enough to sleep through the night. But then you start to get tired and you think, well, how am I supposed to heal when I’m not even sleeping? Everything you’re hearing about is feeding just fear, fear, fear. It’s also very lonely, because even the people who care about you can’t envision it. I’m sure sufferers have had this experience, where somebody who has back pain comes to them and says, is this what it’s like? I didn’t know. And you’re like, yeah, it’s that bad.
Dr. Stracks: And the people who are supposed to be taking care of you, medical professionals, and people tell me this all the time, they kind of make it worse.
Dr. Ratner: That certainly was the case for me. I often like to put in the disclaimer that I think doctors are great for lots of things. I think they would admit this: they have not had success with chronic pain. I think it was in 2017 that the American College of Physicians released a statement basically telling patients to go to chiropractors, acupuncturists, go to alternative healers, because we do not know how to handle this. This was all coming from studies showing that whatever structural issues they were diagnosing didn’t prove to have a correlation with the pain. There’s the Jensen study, and there are tons of studies we can tell people to look up, but they all show that herniated discs don’t cause back pain, and arthritis, surprise. This all blew my mind, but I didn’t know anything about this during this eight-year journey. Nothing. So I went to doctors thinking, well, they’re the ones who have solved the problems before, and I was really disappointed in what had happened in medicine. I guess I hadn’t been to a doctor, I mean, I went for checkups, but I hadn’t been for anything major.
Dr. Stracks: You were in your late 20s, early 30s. There’s no reason you would have needed to go, at least most people.
Dr. Ratner: I was 28 when the onset happened. Now, my father died when he was 29 years old, and that thought was not lost on me either when I was 28, but I couldn’t reconcile it. I was like, yeah, okay, so maybe it’s in my head, which everybody hates that term for a reason. It took me all this time, until I discovered Sarno and sorted it out, to realize that it’s not in your head, it’s from your head, but it is real in your body. Whatever’s happening in your body is real. In fact, some people say to me, how is it possible this hurts this much? And I always say, the fact that it hurts that much tells me it is a mind-body issue. I’ve never had pain like this. It was mind-numbing. I was taking four Advil three times a day, and I knew that wasn’t good for me, but I just didn’t know what to do. I couldn’t sit in a chair for more than maybe 30 seconds without getting so stiff that when I would get up it would spasm. I was in grad school at the time, seeing patients, and I’d finish a session and I’d know what was coming. This is really important, I think, because I didn’t want to show that vulnerability to my patients. I felt like it somehow disqualified me. So I’d get up and just be like, you know, but I wouldn’t show it on my face. I’m sure I was able to hide it, but I felt damaged inside. I felt like a 95-year-old. I felt the loneliness and the hopelessness of it. When I went to the doctor the first time, I asked this question, and I really want to encourage everybody out there to think about the questions they ask, because you’re giving someone else power to answer. I understand why you would, but this is one of the reasons I’m so vocal about this kind of stuff. I want there to be resources where people can go and not get damaged by the answer to their questions. I asked this doctor, “So am I going to have back pain for the rest of my life?” And she literally said, “Probably.” She said it just like that. I’m writing a book on this, and I call her Dr. Probably. Certain people do get skewered in that book, as they should, because you don’t have to be gleeful about it. If you don’t know, you can say, look, we’re still trying to understand this. Medicine’s having problems. The bedside manner has gone way down the tubes in medicine, and not all of it is doctors’ faults. They’re swamped with paperwork and bad dynamics going on. But I think we need to work together to get medicine in a good place with this, and it’s the overlap between psychology and medicine that’s going to be important.
Dr. Stracks: Part of the language I’ll use with people is that there is a difference between acute pain and chronic pain, so much so that I sort of wish they had different names, like cancer and an infection. If you have acute pain, if you break your arm, if you leave tonight and you trip and break your arm, I don’t want you to call me and try to meditate through it. I want you to go to the emergency room and get it x-rayed and set. The pain you would have if that happened is really important, and it implies that you need a medical solution to a medical problem. It turns out that chronic pain is not a medical problem in that way. It’s not our body’s way of saying that there’s damage in the body and we need to get a medical opinion on it. What I oftentimes observe and say is that the pain we feel points to the source of the issue, but the source of the issue isn’t usually in the body, and because of that it’s not a medical problem. So when we go to medical doctors with a non-medical problem, at best they get confused, at worst they get defensive or sometimes mean. And what I said to you, I think the other day, is that “probably” is shorthand for “this is very uncomfortable for me, because I’m not sure what to do, and nobody told me in my training what to do if I don’t know how to help somebody, so I’m just going to pretend it doesn’t exist.”
Dr. Ratner: I really liked when you said that the other day. You’re pointing out that the doctor has vulnerability too. Most of them are trying to help, but when they don’t know what to do, it leaves them in a real quandary. And the patient, meanwhile, and it’s getting better now, we’re working at this, but the patient is generally like I was. I had no idea about this stuff. I went through all of the different paths. I went to the doctor, she eventually referred me to a physical therapist, he was working with me, said he knew what was going on. I heard this time and again: I know what’s happening. And then it wouldn’t work, and then they’d be scratching their heads, and I was like, how is it possible that I have a condition that leaves every expert scratching their heads about their area of expertise? It wasn’t making sense. This is one thing I loved about reading Sarno and why it worked: finally it made sense. But I’m not there yet. I have had a long time to get there. I’ll try to keep it relatively short, but I got an MRI. It showed maybe a slight disc bulge or something like that, but at the time I was like, do I have a tumor? Because I can tell you for sure this was physical. It was real. I had this muscle in my back that I called the eel muscle that would spasm, but it was also so tight it was like a metal pole. It’s all real, and you know it’s real, there’s no denying it. So I’m going through these different things, and I went to get the MRI done, then I went to a back specialist, the top-of-the-line person who’s supposed to know the most. I was the most shocked by this: the higher up the chain I went, the less they knew. Here’s why, at least in my opinion. When you become very specialized, you’re looking only at one thing. You had hand pain, and you could have ended up in a hand surgeon’s office...
Dr. Stracks: Which I did.
Dr. Ratner: Which you did. They’re going to talk to you only about the hand, and then you’re really missing the boat. You’re not looping in the mind at all. We always have to be looping in the mind. I do agree with you, and I always say this: I don’t work with anybody on mind-body issues until they have been checked out by a medical doctor, because the worst thing I could do is say, oh yeah, this is a mind-body issue, and then they have a heart issue or something that is going to compromise their internal organs. Doctors we can really rely on pretty well for life-and-death stuff, so they can clear people of things. A lot of times people ask, do I need to be diagnosed by a TMS doctor? It’s certainly not a bad idea, and Dr. Stracks is top of the line, go see him. But I also think if you’ve been to see 10 different doctors and they’re like, we can’t figure out what it is, then you have a mind-body issue.
Dr. Stracks: I totally agree with that. I say frequently that as a physician it would be quite poor form for me to tell somebody that there’s nothing wrong when there’s something seriously wrong, and other physicians clearly feel the same way. That’s one of the good parts of our training: we get a lot of training on is this person really sick or is this person not really sick. Sometimes that’s the best we can do. We can say, this seems really bad, or this doesn’t seem really bad, but physicians are good at that. So I agree with you that if you’ve seen eight, 10, 15 different people who have all said either nobody can agree on what’s wrong or nobody can come up with anything that’s wrong, that’s a pretty good indication that nothing has been missed.
Dr. Ratner: Yeah, and mind-body issues are so prevalent, we all have them. It’s part of the human condition. That doesn’t mean everybody has eight years of chronic back pain every day, that clearly was not the case. But I ran into a dead end with medicine, and at some point I was talking to a colleague while I was at Fordham, and she said she had had back pain. I’m sure chronic pain sufferers will really identify with this. I heard that past tense, we hone in on these very little words. She said, “I had back pain,” and I was like, what, what does this mean? So I asked her what she did, and she said she went to a chiropractor. I said, okay, fine, I’ve heard they can sometimes help. So I got her recommendation for a chiropractor, and this guy was great. His name is Dr. Alex Igor, and he’s in Manhattan, and he’s one of my favorite people. He’s the one who ultimately introduced me to Sarno. He did it a little bit cautiously, because I think he doesn’t believe in it nearly as far as I go now, but he really helped me. When he started adjusting me, I started spasming even worse. This was one of the worst experiences in my entire life. I felt no one could get it. I felt my life was ruined. I had to stop playing basketball, which was my favorite sport. I played almost every day for years and years, and I just thought, I guess some people get old faster. When I think about it now, it’s funny, because I think some people feel older faster if they’ve been through a lot emotionally.
Dr. Stracks: And you were like 35, 34 years old?
Dr. Ratner: Yeah. But this chiropractor helped me in a number of ways. One of the ways is that he was very confident that he could help me, but he could admit when he wasn’t understanding it or was wrong, and that said to me, okay, I can actually trust this guy. He said, “I think I know what’s wrong.” He took an x-ray, came back, and he was like, “Nope,” and I was like, ah, okay, here is a scientist. That’s really interesting, because chiropractors are sometimes maligned as not being scientific. I think that all of these different kinds of professionals and practices have some good scientists and some that aren’t, and that’s true with MDs too. In fact, all these studies that we cite, Howard Schubiner talks about all these studies in such a great way, they’re from the New England Journal of Medicine. This is not fringe medicine. I say this all the time: it’s science and logic. And Sarno says what you need is not a leap of faith, you need a leap of understanding.
Dr. Stracks: I love it. That’s great.
Dr. Ratner: But I still wasn’t there yet. I had to work through a long process with the chiropractor where he got me off of Advil like I was a heroin junkie, and I was like, I don’t understand why, when I reduce the dose, it ends up being the same. He knew it would. I didn’t understand it. I think he understood there was some kind of mind-body process, I don’t know how he understood exactly, but we stopped the spasms maybe about two and a half years after they had started. Even that was just such a blessing. I was like, that means I can live a relatively normal life. But I was still pretty defeated and confused. I’m a very optimistic person, but I was very disillusioned during that time. That’s what it does: it takes over your whole experience. When he introduced me to Sarno, I was skeptical. I was like, I feel like I’m at the bottom of the barrel, you’re telling me to read a book and that’s supposed to fix my back?
Dr. Stracks: And you were already a psychotherapist at this point. It wasn’t like you weren’t in the field of the mind.
Dr. Ratner: I grew up in a family of psychoanalysts and psychotherapists. I had been a therapist for, how long, at that point, 10 years. Even me, I was like, really? But it helped that Dr. Sarno was an MD. I say this all the time: I’m a psychologist, I happen to know a lot about it now from having done the research, but it really helps me to know there are MDs who totally agree with me, because that’s not my field. So I started reading Sarno, and really, when I started to get out of it was when I actually paired an emotional event with my pain. This happened when I was seeing a therapist who I actually had a lot of conflict with, which I had never had with any therapist. Very weird situation. As stubborn and persistent as I am, I was like, I’m going to fix this relationship, and I tried. It was when he was going on vacation that my back started hurting. It was the day that it happened, pretty much to the minute that the session ended, and I was like, I can’t deny it. I thought I was happy he was going on vacation, but clearly I’m not. When you start to pair those things, you can start to look at it. I had read Mind Over Back Pain, Sarno’s first book, then I jumped to The Divided Mind, which is a great book for people who really want to know the ins and outs of this. I wanted to know everything. And by the way, John, tell me if I’m taking too long on any particular part of the story. I think a lot of times pain sufferers really like to hear the specific story, because it gives them hope when they hear just how bad it was for somebody else and they got out of it. That’s why I’m going into detail, but tell me to be quiet if...
Dr. Stracks: Keep going.
Dr. Ratner: So the next time this therapist went away, I got back pain again, and I was like, there’s no doubt. That second time is so confirming. I contacted Eric Sherman, who had worked with Sarno. He’s a psychotherapist in New York City, in my mind one of the greatest psychotherapists of all time, and he’s a great guy. He was very good to me. But it was interesting, because I went thinking, okay, I need a specialist who can work with this Sarno stuff, and he is a specialist. What I found, increasingly, and this is how I ended up developing the kind of practice that I have, is that most people don’t treat mind-body issues with a short-term model. They basically treat it as therapy, but mind-body informed, and that’s extremely valuable, but it can be limiting in certain ways. One of the ways it can be limiting is that I wanted to see Eric, and from a psychological perspective he did the appropriate thing and said, “Well, listen, you’re in a treatment relationship, I don’t want to undermine that relationship, so I really can’t see you.” I was like, I’m at a dead end. Nobody can help. Even the people who can help me aren’t in a position to help me. But I was resourceful, and Eric was very generous about this particular thing that we ended up doing. I said to him, “Okay, can I use this session to ask you every question I’ve ever had about TMS?” He said yes. This is part of how I developed my short-term model, how I got better. I asked him, I’d probably say, 250 questions in one sitting, everything I could think of.
Dr. Stracks: Was it an hour or two hours, a double session?
Dr. Ratner: It was an hour. Some of them were fast. Some of them were like, “Is this curable?” Yes. “Did I cause this myself?” No. “Can it come from other people who bother me?” No, they can maybe exacerbate things, but this is a condition between you and yourself. I just went through all of it, and I got more out of that session, he may not even know this, than almost anything. It wasn’t just what he said, it was my own experience of knowing what I needed. I needed the questions answered, and that’s what I tell people, and why short-term consultations can work with me. A huge part of the experience of mind-body issues that most people, in my experience, even in this world of mind-body medicine, don’t talk about enough is doubt. This is my word for it. Some people have said I need to think of it as fear or confusion, whatever the word is, that’s okay. But the reason my podcast is going to be called Crushing Doubt is that the awareness of the emotions was part of the battle, but I had a lot of fear and confusion. I had so many questions, and I needed to get them all resolved, and when I did, I haven’t had a spasm since, I think, 2011, which was the time when I read Sarno and started investigating all the ways I could get better and better. I would hit plateaus in my own recovery and I would think, what is happening here? Everything I developed was because of my personal experience, and it’s one of the reasons I feel so comfortable talking about it. One of the things I really discovered is that it changed the way I do therapy, and I think this is why a lot of people, therapists and doctors alike, are scared to look at this, because it will change you. But that’s not a bad thing. One of the ways it changed me in therapy: we are taught not to disclose much about ourselves. This is supposed to be about the patient, don’t make it about you. I agree with that in principle, but what I found is that the disclosures I gave about my suffering were so relieving to the people, and we weren’t making the session about me. I wasn’t boohooing and saying, oh, I remember this time it was so hard for me. It was like people who were crawling out of a desert looking for water, and I could tell. It made me closer to the people I work with, and it made them trust me more. Don’t get me wrong, self-disclosure should be used appropriately, but I use it pretty liberally, and I find we don’t get off track. People want to talk about what’s going on for them. They’re not going to get off track on you.
Dr. Stracks: I think this idea that it’s a one-way street, that we should reveal nothing about ourselves, and I’m not a psychotherapist, even though sometimes I will play one on TV, I do think we can bring some of ourselves into the relationship, and it’s healing as opposed to off-putting. I want to hear about what you do in psychotherapy, but I also want to hear the end. You started to get better after you read his book, you had some plateaus, and at some point the pain was mostly gone or all gone?
Dr. Ratner: Okay, so when I read Mind Over Back Pain, it was still about two more months before I really got better, but it was because I paired that emotion and physical pain that second time. That was so key. The first time was key, but the second time was maybe even more key, because it was no fluke, very clear. When I read The Divided Mind, I was actually out here, and I had read The Divided Mind for about three days and all of my back pain was gone. During the day I was able to do flips in the pool, three days after still being essentially in the same condition. That’s the other thing: seeing is believing. You have to see it for yourself, you have to be convinced, your mind has to believe it. It’s not a belief system based on faith or wrong beliefs, it’s all true, but even so, if you don’t believe it, you’re not going to get there. I got it between the session with Eric, which had happened probably a week before that, and starting to read The Divided Mind and seeing that pairing. I was like, I can’t believe it, this is all completely correct. I was still actually having some, I had a couple of spasms at night, I think, during that recovery, but I just kept thinking, well, look, if it got better from my changing my thinking, then that’s what it is. I cannot heal a broken bone with my mind. But if I can change it with my mind, then it is from my mind but real in the body. I just started getting all of those things settled. Take the term “psychosomatic.” That’s a term that most people bristle at or think is outdated, but I’ve come to see that even I, as a therapist, misunderstood it. I thought it meant it comes from your head. No: psychosomatic means it starts in your head and becomes real in the body. Sarno talks about blushing as one of those examples. You have the emotion of embarrassment, and your blood flow actually changes in the real body and goes up to your face. When I started writing my book, I was probably about two years in when I suddenly realized that crying is psychosomatic. We have a sad emotion, our tear ducts change, and actual tears come out. That is a real physical reaction from the mind. We’ve got goosebumps, we’ve got all kinds of these. What started to eat away at me is: why do we think certain parts of the body apply but others don’t? That doesn’t make sense to me, and I’m just allergic to things that don’t make sense. I won’t go with that. It’s not good enough. I had many doctors and practitioners who got to a place where they were like, huh, and I would never let it go. I just couldn’t. I’m like a dog with a bone. I have to know, and I knew I had to know to get better. So that all started to get better, and I started to apply science and logic, just hammering away at it, and I think that’s when I started to recognize that there’s a doubt component. One thing that was really interesting for me is that I noticed the spasms were 100 percent related to fear. Every single time I had a spasm, it was fear. So there was a specificity to different symptoms. I also used to have a little adrenaline rush down my right side. If I get that adrenaline rush to this day, I’m feeling competitive. My body is telling me what I feel. I just kept learning and kept reading. I read Molecules of Emotion by Candace Pert, because Sarno talks about this, and that book was so great at actually telling me what’s really happening in the body. Different people need different things, but I kept working at it, and kept getting better and better. Eventually I developed an understanding of what happens when we get stuck at different plateaus, and why, because that happened to me. I got about 80 percent better and then I was kind of stuck there. I was like, who are these people who read the book and they’re all better? I say this to people all the time: first of all, those people are likely to have some other symptoms later that aren’t in the book. I’ve worked with people who cured their back pain in three days, and then they come to me later with headaches or something else, because your body is not going to stop talking if you cured it by understanding the basic Sarno stuff but haven’t understood the depth of it. Your body is going to start talking again, and nothing’s been better for me than listening to my body.
Dr. Stracks: A couple of episodes ago we had a patient of mine, David Holmes, who was talking about how he first learned about it. He read Dr. Sarno’s book, he got better, he’s like, this is great, I love this, and then he gave the book to his mother-in-law, and then six months later, then it really happened.
Dr. Ratner: Yeah. People get better in three sentences in these books because that’s what we need to do in order to get the interest, but real-life people don’t usually get better in three sentences or three days. There are various components to it, and the plateaus, and the doubt.
Dr. Stracks: When I got better, this is in 1998, for years I told the story like I got on my bicycle and I rode my bicycle and I was better. Then, after telling that story for seven or eight years, I found the workbook that I kept in that time period, and every page was like, “I don’t know, maybe I should go out to LA and see Dr. Schechter, how do I know, do I need to be examined?” It was months and months of doubt.
Dr. Ratner: I love that you said that, because I do think people can have amnesia about their own recovery. It reminds me of what people say about women and childbirth. I’m obviously no expert on that, although I’ve been in the room when my children were born, but we do have a tendency to forget, and I probably have kind of forgotten my back pain in some way. It’s one of the reasons I wrote it up so specifically. I wanted to remember every detail. I think it really is true that we have to keep focused on the fact that we were not sure, and it makes sense that nobody’s sure. How could you be sure? When people say, “Oh, I don’t fully believe it, I’m going to be in trouble,” I’m like, of course you don’t believe it. You just met me. Give yourself time. You’re a scientist, let’s explore this. What makes sense and what doesn’t? It’s really interesting, because looking back on all the old theories that I used to hear, they make me laugh sometimes now. People say things like, “We aren’t meant to sit for long periods of time,” or “too much work,” or “we don’t walk this much.” I’m like, okay, our ancestors were cavemen running away from woolly mammoths, but they couldn’t sit for an hour? Evolution is a very helpful thinking process for me about what makes sense.
Dr. Stracks: So anyway, at some point you started bringing this into your psychotherapy practice, and I want to hear about the evolution of how that shifted to more of what you do now.
Dr. Ratner: Okay. I remember the very first patient that I saw. Obviously I can’t divulge anything specific, but I’ve talked to her about this already and got permission to give some little detail. She came to me with knee pain, and I knew that knee pain shouldn’t be any different than back pain. She had been to see doctors. She was describing things like, “It hurts less when I wear my magic shoes,” all those little belief systems that we develop that are understandable. She had no information, and that’s one thought I had when the chiropractor gave me Sarno. I was like, no one in my entire life knew about Sarno, and that’s part of why I felt I have to dedicate my life to spreading the word about this. Some people call that proselytizing, but proselytizing is when you’re spreading a belief that you don’t actually know is true. So I don’t actually think of it as proselytizing. I’m spreading the science. It’s interesting to me how you and me and others, we were just tapped. We had this experience so that we could explain it. Not to get all spiritual on people, I’ve never been particularly spiritual or religious, but that experience made me feel like, oh, I am meant for something. It just flowed. It fit. Really cool experience, not at the time, but as I got better. When I saw this patient, I knew that doubt was very key for me and that I needed to address all of her questions and get her not doubting, so I worked at it, and we got her significantly better in probably about a month. Once you help somebody get better from this, it starts to add to the belief system, it starts to build on itself. But it’s very important about doubt, because I had heard this over and over, that people would say, well, actually, I heard it kind of later after this patient, people came to me and said, “I went to a doctor and they said they were 99 percent sure that it was TMS.” And I know what they heard. They heard it’s one percent maybe not.
Dr. Stracks: That is what they heard.
Dr. Ratner: Of course that’s what they heard, because they’re afraid and they don’t have answers. 99 isn’t good enough. So I knew that, and I was working on 100 percent. I was confident. She had been to see many, many doctors, so I wasn’t worried that she’s got some serious knee issue and I’m going to get her into trouble with this. She started getting better, and what I discovered after having a couple of patients this way is that they all got better from the symptoms and then they became therapy patients. They had their whole emotional lives, their symptoms were largely under control, but we would use the symptoms. I describe symptoms as kind of a waking dream. In therapy we sometimes analyze dreams that give us insights into the unconscious, but the body is doing it during waking life, so it’s amazing. It’s the best tool to make therapy go fast. My therapy was going a lot slower than it goes now, because when I would give an interpretation, it was so laser-focused, not because I’m a genius, but because the body told me exactly what was going on, and they know when it’s true, most of the time. So the therapies were all moving faster. But I also was finding, well, I have limited time, how am I going to help all these people? I thought about what really helped me, and mainly it was that one session with Eric with all of those questions, it was the readings I did, and it was my growing confidence in my own mind to find out what I needed to know.
Dr. Stracks: Just a quick question, and I don’t want to get you off track, but you were working with a therapist at the time. This is a question I get all the time: can people work with therapists who don’t know about mind-body medicine and still have it be helpful?
Dr. Ratner: It’s a great question. I think the main focus needs to be: is the relationship good? In a good relationship, that therapist should be willing to read a book by Sarno and become informed enough. The therapist I was working with wouldn’t really read it. I actually talked to Michael Galinsky, who created and directed All the Rage, and he doesn’t know this either, but he changed my life also. We were talking about the movie and I was talking about my experience, and I was like, “Yeah, I’m working with a therapist who doesn’t really believe in this,” and he was like, “How can you go to see a therapist that doesn’t believe?” I took it with a grain of salt. I was like, I don’t want to be a zealot, and this guy has helped in other ways. But I really thought about that. I think he actually said, how can you go to see somebody who doesn’t believe in this core value that you do? And I was like, that’s true, that’s really true. Probably about six months later I decided to end that treatment, and when I went to look for another therapist, I wouldn’t go to see anybody who wasn’t informed by mind-body stuff. So I highly recommend it, but I also don’t want to tank good relationships. The thing about what I do, and I love that I offer this because it’s what I needed, is that you don’t have to stop going to see your therapist if you want to come see me, because I’m like that consultant that I wanted Eric to be. That has allowed me to see lots more people and get more people relief, and it’s also been so satisfying, because I’ve cured hundreds of people of things. “Cure” is a word that we use cautiously, because there’s no cure for being human.
Dr. Stracks: Right, but kale works well.
Dr. Ratner: Yeah. I’ve got chronic conditions under wraps. And remind me, John, that we should talk about acute versus chronic at some point. That’s something I want to make sure we get to. But I was able to work with these people, and a lot of them I would cure in somewhere between one and four sessions. I had a supervisee whom I taught about this stuff, and she had nine years of heartburn where she had to take medication every day. It was very bad, and we talked about it, and the body told me exactly what was going on, because I asked what was the timing of the symptoms, and the timing of symptoms is exact. I have found, I don’t know if you’ve found this, John, that the body’s so smart, it’s telling us everything.
Dr. Stracks: Yes. And you just said that in between one and four sessions. There are probably about 300 people listening at the moment, and another thousands will listen to this over the next month or so, and 5,000 people just said to you, “What can I do to do this in one to four sessions?”
Dr. Ratner: Okay, so this is great. I really ended up developing a very structured model that was basically what I would have wished had been brought to me. What I do is collect some background information on their history, so that we don’t actually have to spend the time in session on “What were your parents like? What was your relationship like?” I want that as background information so that I can kind of thread the needle to get to the heart of mind-body matters. When they come to session, on top of trying to make them feel comfortable with me, and if they have any questions, the usual stuff, I often tell them that I suffered from this myself and I’m happy to tell any part of the story that they want to hear. Generally we’ve talked that out through email before we even get there. I tell them to bring a piece of paper and a pen, and I tell them to separate that into four columns. The first column is called emotions, and this is where I help them get their core emotional experiences articulated as they relate to their symptoms. They might have an emotional experience that just doesn’t seem that active in the symptoms, and we don’t end up writing it down. I call this whole thing a TMS map. I want it to be a personalized TMS map, and one of the reasons I like this is they’ll have it written down. I tell them, when this is over, digitize this and send it to me so I have it also, and we hone this over time. If we’re only going to meet for one session, let’s say they can only afford one session, I’ll do that one session and then do some email consults afterwards or something like that. But I try to get it articulated: what are your core emotional experiences? These are big, big-ticket items. It’s not like I ordered a sandwich and got the wrong sandwich.
Dr. Stracks: Can you give an example of what somebody’s core emotion might be that would contribute to a symptom?
Dr. Ratner: Absolutely. I’m going to use myself as an example. When that therapist went away, it felt like he didn’t care about me, and I didn’t have a father from the time I was six weeks old, so I was looking for father figures throughout my life. It hurt. That’s a big item: am I valued by a father, does anyone listen to me, does anyone care if I’m hurt? Big things that apply to everything. Am I a failure? Is there something wrong with me? These are all good examples of the kind of thing we get articulated. This list is helpful because we then can start to pair these themes with flare-ups. They’re like, “I was standing in the kitchen making dinner, and my husband wasn’t really noticing, and he’s very busy, whatever, and then my back started hurting.” And I’m like, wait a minute, were you possibly feeling unappreciated there? That fits with these themes. It’s always things that fit with the deep past and things that you’re seeing in the present. So we go through the emotions.
Dr. Stracks: I like what you’re saying, too, about how as a psychotherapist it’s so helpful for you to have the body to lean on, because you get that insight about what she was feeling in a way that she can’t articulate in words, but you’re paying attention, so you can hear it clearly and then bring it up so that she can hear it too.
Dr. Ratner: It’s amazing. It might have taken me two, three years to really understand that fully, but I just trust the body, because I know it’s told me things. Then we move on to the second column, which is doubt, and this is where I differ from a lot of my colleagues, and I really, really focus on it. I think emotions are the key to acute symptoms, to upticks, to onset, but if something is lingering, doubt is the key. You have questions, you’re not sure. Let me say it this way: there are three levels of doubt that I’ve discovered. One is, is this TMS or is it something else? We need to get that question answered, and there are thousands of questions that can be buried in that. Then there’s, if it is TMS, is TMS curable? And then the third question, which is, even if mind-body issues are curable, can I do it? Doubts about the self. So there are these three different levels, and I know which ones to start looking at. When they say, “No, no, I know it’s TMS, I know that this can be cured, I know I’ve even cured it, let’s say 80 percent, but can I do it?”, this brings me to the third column. The third column tends to be confusing for everyone, including me, but I still think it’s extremely useful. It’s called power, and I look at the person’s relationship with themselves in this column. Are they letting themselves be as powerful as they can be? Are they shying away from it in some way? That third level of doubt tends to flow over into the power column: am I allowed to? Is it safe to be powerful? There’s a lot more in that column we can talk about, and maybe we’ll leave that for questions. But the fourth column is called action steps. I always want to give people what to do, because we all know that’s what they want to know. Nobody wants to come to a session and talk about their feelings and then go home and be like, “Yeah, but what do I do? I still hurt.” They really want to know, and because of my experience, I can tell them some of those things. I’ll give you an example. I could meet with somebody who’s having neck pain, and they’re like, “Yeah, it really hurts when I do this,” and I say, okay, one of your action steps is: don’t test that neck, don’t keep checking it. It’s still going to hurt. That hurt is not going anywhere. You don’t need to verify that it’s there. Leave that alone. The reason I do that is because if they’re checking, it’s reinforcing that it is only physical. It is physical, but they’re reinforcing some of the problems they’re running into. I say, instead of doing that, think about your emotional life, and they start thinking about their emotional life, and if they do that for an hour, they lose track of the symptom, and it just starts getting better. I don’t mean getting better like healing, but just the active pain centers are not firing so much. So that’s the basic gist of what I do. In the first session, we get it articulated as best we can. In the second session, we get it articulated even more. In the third session, if we get to that point, and I try to get there as early as, if I only have two sessions with somebody because of cost or time or whatever, I’ll sometimes move even faster toward this, but eventually I want to get to: let’s make sure you understand these four columns very well. We go with a fine-tooth comb. I never know what it’s going to be. I sometimes meet with somebody and the power column is everything. I sometimes meet with somebody and the emotion column is dominating. But if there’s one column that seems to dominate most of the time, it’s doubt, because there are so many questions.
Dr. Stracks: When you work on the doubt, is what you’re doing sort of helping people articulate the questions they have and then either answering or helping them figure out how to answer those questions?
Dr. Ratner: Yes. When I came to see Eric, I didn’t need help articulating them, because I had been over and over and over them in my mind, and that’s just a strength of mine, but most people haven’t articulated them that well. I also had been to years of therapy, so there were reasons why I could articulate it. You need to get the question out there. Sometimes people will say, “Well, is it TMS?”, and we’ll look at it, and really that’s not what they’re asking. They know it’s TMS, but is it curable? That was the question they were asking. Sometimes the question isn’t what you think it is, and we have to answer the question that actually is being asked inside. So I help them get them articulated, and one thing I think people like about working with me is I know when I can be definitive. There are times when I’ll say, “Well, I don’t know yet, let’s keep exploring.” There are other times when I’m totally definitive. When they say, “Is TMS curable?”, the answer is yes, instantly. And they say, “Well, but Sarno says maybe only 15 to 20 percent can accept the diagnosis.” I love Sarno, but I also think everybody’s got their limited perspective, and I think one of the things he maybe wasn’t getting there is that 15 to 20 percent of the people he was seeing could accept it in the form he was giving it. I love Sarno, nothing against him at all. I would say 15 to 20 percent of people probably reflects people who don’t have a lot of doubt. A hundred percent of people can accept this if you pose it scientifically and logically and you resolve all their doubts. They will get better.
Dr. Stracks: Yeah, and that certainty is very important.
Dr. Ratner: I don’t say 99 percent sure, because I might as well say 50-50.
Dr. Stracks: Right. I know that some people have questions, and I want to get to people’s questions in a second. You had wanted to make a comment about acute versus chronic.
Dr. Ratner: Yeah, this is important. I’ve come to see that in mind-body issues, generally speaking, and I have started to think of them in this way, you can either have an acute situation that leads to a flare-up and a symptom and then it goes away, or a chronic condition, which I’ve come to see as acute, acute, acute, acute. It’s so back-to-back that you couldn’t see that it’s chronic. The reason I explain it this way is that what you do about that is very different than what you do about a chronic experience. It is chronic in that you have it every single moment, but if you are essentially renewing a subscription to pain second by second by second, then we can stop you renewing that subscription, and you can break that cycle at any moment. That’s very different from, say, a chronic condition like arthritis that you could do nothing about, which, we know, turns out is a chronic condition that doesn’t cause any pain. It’s totally incidental. But if you’re seeing it as acute all the way along, then every single moment you have a chance to do something about mind-body stuff. So I just wanted to say that.
Dr. Stracks: I want to go back to the doubt question for a second, because people will frequently say to me a version of what you just said, which is, “I’m 98 percent sure that this is TMS, but I’ve got that two percent of doubt.” I honestly feel like, okay, that’s okay. But you’re saying that you really do feel like people need to be 100 percent sure. I think one thing that happens is that people start to get down on themselves because they only believe it 98 percent, so we get back to this idea of “I’ve failed,” which multiple people have told me this week in my office. So you’re saying you want people to have no doubt, but you also, I think, have a way for them to get there. Is that right?
Dr. Ratner: Yeah. If somebody came to me and said, “I’m only 98 percent there,” and feels all ashamed about it, I would say to them, “You haven’t failed. We have failed you.”
Dr. Stracks: Yeah, the books have failed you.
Dr. Ratner: Yeah. I haven’t done enough yet. I believe that if you talk to any person and you deal with their mind and you help them get resolution in their mind, they will be fine, and it’s really a belief in people that makes me feel that you can get to 100 percent with anybody. For some people, they need piles and piles of research, and I’ll say, you know what, go read Mind Over Medicine by Lissa Rankin. I don’t know if you’ve ever read that book, but it’s great for all these studies that show how much the mind affects things. Or Bernie Siegel’s another one. Norman Cousins, Anatomy of an Illness. I have readings that I can assign to each type of doubt, even. I believe that every mind can be healed and that every mind can come to terms with itself.
Dr. Stracks: And you’re saying that if you still have two percent of doubt, great, let’s do what we can.
Dr. Ratner: I actually think doubt is a sign of someone who’s going to recover even more fully, because it’s the people who don’t know they have doubt who could get bitten later. The people who know they have doubt, great, you’re in great shape. I’m not afraid of any doubts. Bring it. Let’s talk about what’s making you not sure. Otherwise we’re just leaving the patient to feel alone and hopeless again.
Dr. Stracks: Right. All right, let’s take a few questions, we have a little bit of time. We’ve got a couple that are posted here. Let me read this. “I recently finished Curable groups. I’ve not experienced much of a change yet, although that’s what I expected since I’ve had TMS for over 40 years.” I don’t know how familiar you are with the Curable groups. They’re fantastic. It’s 12 weeks, a variety of topics, great facilitators, great group support. The question here, I think, is what would make it so that there wouldn’t be much of a dent in their physical condition, and part of that is what we’ve just been talking about, right?
Dr. Ratner: Yeah. When you’ve had something for 40 years, your doubt is likely to be even stronger. That was one of the questions I asked Eric: am I any worse off that I’ve had this for eight years than somebody who’s had it for one? He said, no, not at all. Now, obviously I had to trust Eric enough, but he was a trusted source because Sarno had mentioned him, and he was a therapist who understood things, and his manner made me feel like, I think this guy knows what he’s talking about. I had to get these questions answered for myself. So in my experience, and I don’t even want to say “in my experience,” because that will leave doubt, I will say more definitively: it doesn’t matter how long you’ve had it. It is an acute subscription to pain, and you’ve kept it for 40 years, which means that the system has failed you up to this point, but there is help. A person could have this for 40 years and get better in one session. I’m not saying that’s always going to happen, but I do believe if you give yourself a good number of months at least to look at things in this way, you’ll get better, and you’ll start to see it starts to build on itself.
Dr. Stracks: There’s another question here about writing, and people reading Dr. Sarno’s books or entering into this field in that way. Even Curable focuses a lot on expressive writing. Is that something that you incorporate in your treatments with people?
Dr. Ratner: It’s a great question. I know there are certain people who really swear by it, like Dr. Nicole Sachs. She has her own podcast, and I’ve never actually gotten to talk to her myself, but I assume I will at some point. She talks about journaling as one of the ways she has found to be incredibly helpful, and I think there are a lot of different parts that are filling in different places. The thing I like about doubt, though, is that it allows us to fill in specific gaps. It allows us to go anywhere. Journaling is going to work for some people, it’s going to work wonders for some people. Maybe they haven’t had a chance to interact with themselves in that way, and that’s a calm way to do it, or an organizing way to do it, or it helps them get it articulated. But every time I work with somebody, I’m working with an individual mind. I actually just made this recommendation to somebody recently. They said, “Well, I’ve been journaling, but it doesn’t seem to help. In fact, it makes it worse.” That can happen, and nothing against people who do journaling, but we’re working with individual minds. Some people’s pain gets worse because they’re obsessing about it. They keep thinking about it and they’re not going to get free of it. In the book I’m writing, in the chapter on doubt, there are basically all these different strategies that’ll work for some people and not at all for others. One thing I was struck by in my own recovery is that when I resumed normal physical activity, that was a bigger deal than I thought it was going to be. I just thought Sarno was saying you’re safe to resume normal activity. What I didn’t know is that resuming normal activity convinced me that I was fine. It made me leap forward past a plateau. I was working with a guy who had always resolved his mind-body issues by resuming normal activity, and then one time it wasn’t working and he got panicked. So we need multiple ways to solve multiple problems, and it has to be individualized to that individual human mind. But the TMS map I developed allows us to get there fast. With this particular guy, sorry, I’ll just say this one last thing, we realized it was intentional. He was paying too much attention to the symptoms. Journaling sometimes will make people pay too much attention, when what we actually want is to help you let it go.
Dr. Stracks: There are interesting brain imaging studies that say that if you activate that area of attention, you will make pain signals worse. If you think about a time you were angry and you think about it, your body can change. You’re right back in it.
Dr. Ratner: Depending on how bad it is, yeah.
Dr. Stracks: With journal writing, it’s interesting that you said that about making people worse. I hear that regularly as well. Almost always, if somebody tells me that the journal writing is making it worse, or sometimes that it’s making them anxious or having panic attacks, I say, “What are you writing about?” And they say, “I’m writing about how bad I am at this, or how bad I am in general, or how guilty I feel.” I’ve learned that we can’t do that. If we’re journal writing and we’re attacking ourselves, we have to stop that.
Dr. Ratner: That’s brilliant. I hadn’t even thought of that, and I keep learning all the time. But you just made me realize that you can’t answer the question “Is journaling helpful?” when you don’t even know what journaling means for that person. I’m sure somebody who thinks about journaling often would know some stuff about this, but you’re right. If journaling means I’m berating myself for an hour of writing, it’s not going to help.
Dr. Stracks: No, it’s not going to help. At this point, if I hear that that’s going on, I say you have to change the journal writing and focus it outward, or you have to stop, because I know it’s not going to be helpful.
Dr. Ratner: That’s great.
Dr. Stracks: This next question says, “I understand that my brain perceives negative emotions as dangerous, but what I don’t get is: what’s the brain’s motive for creating pain? Is it the result of activating the autonomic nervous system in response to stress, which causes reactions such as tension or oxygen deprivation, or is the brain causing pain to distract from the emotions it perceives as dangerous?”
Dr. Ratner: I love this question. It’s at the heart of mind-body work. Sarno poses it as a distraction, right? One of the things I write about in my book is that it is a distraction sometimes, but usually anything that the mind and body are doing, they’re doing for multiple reasons. One of the things I found is that it’s a distraction, but it is also a communication. Here’s a way to think about it: a symptom is a way of expressing ambivalence about knowing. It’s not just that you don’t want to know, it’s also that you do want to know, and the way you can do it is to send an encoded message. So what I do is I simply translate the encoded message, which is just laying it out for them. It’s amazing how different the work is when you have that at your disposal. I think every therapist should have this as part of what they do, and I think every doctor should be trained in the overlap. Easier said than done, but I think this is part of what we want to do.
Dr. Stracks: That’s the question I ask so often: what is your body saying? Let’s think about that. If we say, “Well, is it a distraction or is it a communication?”, we are missing the boat. It is both.
Dr. Ratner: Yeah, absolutely.
Dr. Stracks: This question here: “A massage therapist told me one hip was higher than the other and my pelvis was off, so recommended chiropractic. Chiropractic usually helps, which was what you were told initially, but now there’s more pain. Is it possible that there is a structural pain in the pelvis, or is it still a mind-body issue, or is it potentially both?” I guess, boiled down, the question is: can there be structural issues that don’t respond to mind-body medicine?
Dr. Ratner: Okay, I’m going to give what my take is, but I encourage everybody to think about this for themselves. I’m not the gospel, but I do think what I say makes sense. The way I think about it is that injuries heal. If you break a bone, generally the longest it takes to get better is 12 weeks. John, you tell me, but that’s about right.
Dr. Stracks: Yeah.
Dr. Ratner: So basically, if you have a physical injury, it should heal. Now, if you have an injury to one of your internal organs, that doesn’t heal. It’s interesting: my wife is a type 1 diabetic. Her pancreas doesn’t work. No mind-body influence is going to change that. I think people, when they meet with me, are very glad to hear me say things like that, because they’re like, oh, okay, you believe in reality. That’s an important thing to establish. But interestingly, my wife also can have low blood sugars when she doesn’t want to be present, and she can have high blood sugars where insulin is not getting metabolized well if she’s stressed. So the effect on physical issues is still very real. But with respect to a pelvic kind of thing, the studies are very conclusive that none of these structural abnormalities cause pain, and so my take is, completely definitively, that’s a mind-body issue.
Dr. Stracks: With that particular one, people tell me leg length discrepancy, or the pelvis is off, or the SI joint is out. I have found that almost always those are mind-body issues. I also think if it was a structural issue, doctors really would catch it. I believe in medicine, I do. I believe they would understand if there was some issue like that. What I also believe, though, is that there are a lot of false positives, far more false positives than anything else, but generally speaking, if you’ve got a physical issue, doctors are going to catch it.
Dr. Ratner: Yeah.
Dr. Stracks: All right, we’re going to start to wind down. Here’s a really good question, though. It says, “Much of this discussion has been around people with one main symptom. What about those of us who have many manifestations? I haven’t had much luck with TMS. I’m doing DNRS and I’m not having that much success with that. So many symptoms, trouble making the connection between symptoms and emotions or what’s happening. What do we recommend for people for whom it’s not just back pain, it’s not just knee pain, it’s all pain?”
Dr. Ratner: Oh wow, this is such a great question. I’m going to try to sum it up, but there are a couple of points to this. First of all, most people don’t have one symptom. That’s what they talk about, that’s their focal point, but when I had back pain, I also had headaches and irritable bowel stuff. Everybody’s got multiple symptoms, so first of all I wanted to kind of normalize that. Secondly, I think that for people with multiple symptoms, it just means the body’s doing a lot of talking. You’ve got a lot to say. I don’t think of it as any different or more complicated or dooming or anything. It just means, wow, great, you’re getting a lot of information. If you have fibromyalgia, or have been diagnosed with that, or you have chronic fatigue syndrome, or let’s say you have multiple things, you can treat multiple things. I treat multiple things every day. I think about this stuff a lot because of what I do, but it’s also because I need to get these questions answered, not just for me but for all of you. Every symptom I have, I’m on it. I have actually joked with people, this is not a joke actually, but I sometimes pass it off as a joke, I don’t even sneeze without there being an emotional correlation. You know the phrase “nothing to sneeze at”? That comes from somewhere. I’m sitting there playing guitar, and one of my daughters says, “Daddy, I need you for this,” and I’ll go, “How about you?”, I don’t want to go. So it’s really about letting in your emotional world and resolving your doubts. If you can do those two things, you can conquer a hundred symptoms at once, and it could flow around. It could be like, “Oh God, my shoulder hurts and my knee hurts,” but they all have meaning. It all makes sense. I wish I had more time to say why that is, but when my book’s out it’ll all be in there. When my podcast is out, hopefully I’ll come back here, and people can contact me. I assume there’s some way to get them my information.
Dr. Stracks: I’ll have you do that in just a second. I just want to talk about this particular topic for one minute, and then we’ll wrap up. I have found over time, and I have a handout on migraine headaches that I created a number of years ago, like, these are examples of migraine headaches, this is what people experience, this is what people do about it, and this is how you can get better. I was like, great, I wrote this handout, I’m just going to search and replace “migraine headache” with “back pain” and now I’ll have a back pain handout. I did that, and it made no sense.
Dr. Ratner: Yeah.
Dr. Stracks: I was like, oh my goodness, migraines are different from back pain. Not only that, but migraines are different from back pain for multiple reasons, and one of them is that the sufferer experiences them very differently.
Dr. Ratner: In fact, I have found headaches are one of the hardest things to alleviate, because it’s so in your face. It’s right there, and you’re like, how are you supposed to not... It’s one thing to have neck pain and be like, okay, I’ll stop testing it. If you’ve got a pounding headache at a migraine level, that’s grabbing your attention hugely.
Dr. Stracks: Although you and I will talk about that, because I have had a lot of good luck with my patients with migraines, so we’ll talk about that.
Dr. Ratner: Awesome. This is the thing: we all have things to learn from each other. I think on my topic of doubt, I can fill in some gaps for people, and they’re very important gaps, but you fill in my gaps. I can’t wait to talk about that.
Dr. Stracks: That was one of my first lessons in, okay, different symptoms mean different things for different people. We also did a study, Dr. Schubiner and I started a study when I was in Michigan, with fibromyalgia patients, and it was my job to interview them about their trauma. I had this structured trauma handout, and they just kept telling me and telling me and telling me. It was overwhelming, it was unspeakable, because I couldn’t even figure out what to do with the data, and we never published it. So when I hear people are having pain over a wide area of their body, I know that at least a possibility is that there are some very significant things that may have happened to them.
Dr. Ratner: I think not only that, but it’s often a combination between a massive amount of emotional upheaval and trauma and experiences, and the “goodist” personality, which we didn’t talk about much, the idea that people who want to help people so much and are trying to be good. The combination between that and having suffered is very hard, because those people, and I was one of them for sure, don’t let in the fullness of their suffering. And I agree with you, the ACE study is a very important study too. Essentially what it says is the more of it you have, the more symptoms you’re likely to have. This is also really important, I think, in terms of racism or sexism, racism especially. I think there are real correlates. The fact that a Black person in America doesn’t feel equal in a lot of ways, and the treatment that they get, can physically affect them so much that we are essentially killing them. They die earlier, they have higher disease rates. This is not their fault. It is societal.
Dr. Stracks: Yes, and all of that fits in. So to the person who asked that question, and the other people who are asking that question themselves, it’s about sometimes getting at some core issues that are very painful from way back. It’s about being kind. That’s one of the things I always stress to people: when we get into this place where we feel like “I’ve failed because I’m not getting better,” what you said is true. They haven’t failed. You and I have failed, because we don’t have the right information out there, or we haven’t created the program where people can talk with other therapists who understand this and can be compassionate and non-judgmental. So continue to look for the specific entry points that help people start to unlock this, but it’s not that people aren’t doing the right thing, it’s that we haven’t created the right information.
Dr. Ratner: Yeah, and it partially can be the failure of mind-body people, but also society at large is making it even worse. So we’re up against it, but we’re doing good work.
Dr. Stracks: Yeah. It has been so delightful to have you here and talk with you and hear about your experience. If people want to contact you, how can they connect with you?
Dr. Ratner: They can reach me at my email, which is dgratner, D-G-R-A-T-N-E-R, at gmail.com. You can text me if you want, it’s 718-412-1265, but email is a really good entry point, because I’ll never ignore anybody who contacts me, even if I don’t have a lot of time. I want to make sure they get where they need to go, because I remember what that was like.
Dr. Stracks: That’s good, because you’re going to get a lot of emails this week. What’s your email address one more time?
Dr. Ratner: D-G-R-A-T-N-E-R at gmail.com.
Dr. Stracks: Great.
Dr. Ratner: I’ve developed different levels. I actually have a PDF that’s just my basics of TMS, so that if they don’t have time to meet with me or they can’t afford me, I just send that to them, and then we move on to the next thing. People can get better from this in different ways. I’ve also trained people in what I do, and I’m going to do that increasingly, because there needs to be more help, and I’m working on it.
Dr. Stracks: So am I.
Dr. Ratner: Yes, absolutely. And maybe we’ll be working on it together.
Dr. Stracks: I hope so. This really was a pleasure. Thank you for having me.
Dr. Stracks: And thanks to everybody who’s been here listening and asking insightful questions, and, I know, being supportive of each other on Facebook. Every time I do this, it just reminds me how touched I am to be part of this community of people who are working this hard, in this brave and cutting-edge way. As we sign off, just a reminder: telehealth options are available from me as well. You can get in touch through my website, www.drstracks.com, and my staff will get back to you with all the details. If you enjoyed this episode, you can find the recording of this and all our previous episodes at Curable and on my Hope for Healing webpage, which is curablehealth.com/hope-for-healing. You can sign up for our office newsletter there and get updates about next episodes and everything else going on in my practice. I am headed out for vacation, not to East Hampton, but to northern Michigan, so I’ll be gone for the next few weeks. We’re going to record one of my patients, Jill, who had migraine headaches, and we’ll post that while I’m gone. Then we’ll be back live on Wednesday, September 9th. We’re working hard on getting Dr. Alicia Batson as a guest. She’s also a Curable medical advisor and a psychiatrist down in Nashville, Tennessee. So until then, thanks, everybody, for watching. Dan, thanks so much for being here and sharing your wisdom and your insight.
Dr. Ratner: You’re welcome. I hope everybody has a great rest of their summer and continues to stay safe and be healthy. So good night, everybody.
Dr. Stracks: Good night, everybody.
Dr. John Stracks practices mind-body medicine via telehealth nationally and internationally. To learn more about working with Dr. Stracks or the Cormendi Health team, visit cormendihealth.com. You can find more interviews on the Cormendi Health YouTube page.