Hope for Healing: Journal Speak and Chronic Pain Healing with Nicole Sachs and Dr. John Stracks
Video: Watch the full session here → https://www.youtube.com/watch?v=Lpt_92zVXkI
Dr. John Stracks: Good evening, and welcome to Hope for Healing. I'm your host, Dr. John Stracks, joining you from my office here in Chicago. I'm a physician who focuses on the reduction and the elimination of physical symptoms using mind-body medicine methods. If you'd like to learn more about my practice, I do practice telehealth, and my staff will be happy to talk with you. You can find more information about all our services at www.cormendihealth.com.
This Hope for Healing video cast series is one of many joint efforts between me and the folks at Curable. For those of you who are not yet Curable users, Curable is an amazing app that offers science-backed techniques for chronic pain recovery. We've been working together for about six years now, and we created this video series together because we want to help people in pain understand the connection between what's happening in their lives and what's happening in their bodies.
Today my guest is Nicole Sachs, whom many of you already know. For those of you who don't, Nicole is a psychotherapist who has dedicated her practice to the treatment and healing of chronic pain and related conditions. She's an inspiring speaker and the author of The Meaning of Truth. Nicole's passion, or one of her passions, is journal writing as a means of healing, and that's going to be the focus of our conversation today. There's a lot of talk in mind-body circles about using writing and journaling as a path for healing, and a lot of questions about how that works, so we will go ahead and dig right in. Nicole, it is delightful to be here with you and great to see you.
Nicole Sachs: Awesome to be here.
Dr. Stracks: Thanks for joining me.
Nicole: Anytime I get to spend 45 minutes with you is a good day in my book.
How Nicole Sachs and Dr. Stracks First Met
Dr. Stracks: Awesome. I was just thinking the other day about how you and I first met. I think it was about 10 years ago. Did Arnie Herman introduce us? Is that how it happened?
Nicole: You know, I don't remember. So much magical stuff has happened over the past 10 years, especially in relation to this work. I don't remember exactly how, but I do know it's been a while since we connected.
Dr. Stracks: I remember I was in Colorado for a series of workshops on psychotherapy, and you and I had been connected and were trying to talk. I called you from a coffee shop in Broomfield, Colorado. That's my memory of connecting for the first time, and you're right, so much has happened since then. We put on a conference together. We've each grown our practices in this area. Before we get into the journal writing, which I know people are interested in hearing about, I do want to talk about what you and I have learned over this decade as we've built our practices in this field. People have heard our stories, your story about healing and my story about healing, so I'm not going to delve super far into that today, but I thought it would be interesting for people to hear a little about how we got involved in this professionally. You got better, and you had talked to Dr. Sarno and healed your back pain. Were you a psychotherapist at that point, or did that come out of that work?
From "Book Cure" to Psychotherapist: Dr. Sarno and TMS
Nicole: I had gone to undergraduate and had my bachelor's in psychology, and then while I was in graduate school getting my master's in social work, that's when I was first exposed to Dr. Sarno's work via a book. I didn't know anything about him personally. I had never met him. But through reading the book and understanding his work, I eliminated my back pain completely. So originally, at the very beginning of my recovery story, and recovery is not a straight line, everyone always has to remember that, I was what they call a book cure. I understood it by simply believing that nothing was physically wrong with me. I calmed my nervous system with that really staunch belief, through connecting with his words and his description of TMS, and I was able to eliminate my pain. That was in grad school.
By the time I had my dip, what they might call a relapse, the valley in the hills and valleys of recovery, I was already a trained therapist. I'd already gotten all my credentials and passed all my boards, but because I had three kids within the span of five years, I was not actually a working therapist. When I met Dr. Sarno, in the midst of an incredibly terrifying chronic pain incident, I was inspired. I was ready to go back to work and establish a practice. Through my work with him at NYU, because I was speaking on his alumni panel every month, he said to me, "Where are you establishing this practice?" At the time he was in New York City and I was in Westchester County, New York, which was about a half-hour drive outside the city, and it availed people in the suburbs of a trained Sarno therapist. So he started referring into my practice, and that's how I started.
Dr. Stracks: Which is amazing. These days, remarkably, a lot of people don't know who Dr. Sarno is. For those of you who don't, he was a physician in New York City who passed away a number of years ago, but he was really the first person to popularize this idea that we could heal what's going on in our body by paying attention to what's going on in our lives. I had studied with him a little bit. Nicole, you had been treated by him at one point, and you and I were actually in the same room when you spoke on our panel discussion, probably in 2007, maybe, when I went out to study with him. So much has happened in the field that a lot of people don't know who Dr. Sarno is anymore, but he was one of your and my original mentors in doing this work. As you know, I'd had some pain experiences before I even went to medical school, and this was the type of practice I wanted to have all the way through. Medical school almost beat it out of me, and by the time I finished my clinical rotations I was like, "Ah, I'm just going to be a cardiologist like everybody else," and then I found renewed interest in it. So did you then practice psychotherapy in a more general sense, with people coming in for anxiety, depression, and non-pain-related conditions?
Nicole: Yes, actually. When I first established my practice, Dr. Sarno was referring to me, but that was maybe one or two patients. They were coming in slowly, so I had a general practice. My general practice was an excellent way to be informed about what's really important in this chronic pain and conditions work, because in the end it's all about what's going on for us, how we are metabolizing our past trauma, what we're avoiding, what is stored, the whole The Body Keeps the Score thing. In my general practice I was just open to being with people. The mantra of social work is that you start where the client is at, and just being with people right where they were was an excellent preparation for becoming completely specialized in the later years of my practice.
When the Body Becomes the Proof
Dr. Stracks: Did you have patients you converted from general therapy clients into working on chronic pain issues? Did you find that, over time, as you got to know people, they became more open to the idea that they could heal their physical symptoms using psychotherapeutic techniques?
Nicole: Absolutely, and one of my favorite things to watch in people is the light going on in their eyes when they realize that their body can be their proof. Let's say somebody comes in presenting with relationship issues in their marriage, or difficulty with their kids, a typical psychotherapeutic presentation. Then, by and by, we discuss, and they say, "One of the biggest problems is I always have these headaches, so it's very distracting for me. I'm trying to parent, and my kids are this and this, and sometimes I have to go lie down." So I might say, "Might I gently suggest that there could be a mind-body component to your headaches? That it could be the fact that you're so frustrated and angry, and this is an endless negative cycle?" They would say, "Well, I don't know." But they already trusted me, so I would say, "Let's try these methods and see." Then their body becomes their proof, because they come back and say, "It's the darndest thing." I love when people say, "You're never going to believe this. It's the darndest thing. I tried that mind-body work you suggested. I haven't had a headache all week." And I say, "Yes, I know, because this is how it works." Then people become real believers.
Explaining Mind-Body Concepts: "You Already Believe It"
Dr. Stracks: Thinking about how our practices evolved over time, starting with yours, how did you explain mind-body concepts to people when you first started, and what did you learn as you were practicing that sharpened your ability to help people relieve their symptoms?
Nicole: One of the first things I tell people, and I still say this, is that what I'm teaching you is something you already believe. You just don't know it yet. I could be lecturing to a room of a thousand people, and if I say, "Raise your hand if you've ever had a stressful day and gotten a headache," every hand in the room goes up. Then I say, "Okay, put down your hands. Raise your hand if the next morning you ran out for a CT scan of your brain because you're sure you have a brain tumor." All the hands go down. That's because you believe that a stressful day can cause a headache. Then we do the same exercise with "Raise your hand if you've ever heard of somebody who was in a panic and got hives," or "somebody who was terrified and got diarrhea or threw up." It's almost like helping people understand that they already are full believers in what I'm about to teach. But when pain becomes chronic and fear becomes the primary motivator, all of that belief goes out the window, and they're obsessed with treatments and specialists and injections and surgeries and what have you. That is the first way I explain it to people: this is not such a bridge that they need to cross as much as they think. And of course the biggest example ever is what happens when you get really, really sad, touched, or moved. Water falls out of your face. The most basic emotional stimulus leads to a physical reaction.
So I get people in my camp. I draw them in, because I want to do it with love. I have such tremendous compassion for people suffering, because they don't want to push away solutions. They're just terrified, and they have only one way they've ever been taught, which is the basic traditional Western medical model: if something's wrong with your body, you need to alter your body. I understand that, and I have great empathy for it, because that's how I was until I wasn't. That's my entry point.
In terms of how it's evolved as I've moved through the years, the most obvious evolution is that I don't practice privately anymore. It became apparent to me, and excuse the term, because of the miraculous recoveries I was watching hour to hour in my practice, that I needed to take this information and use all of my energy and time to bring it out on a much wider scale. That's when I wrote the book, and wrote the courses, and started all my online offerings and my social media presence, because I want everyone in the world to at least know that this work is an option. I have bold aspirations. I'm under no delusion that everyone in the world is going to pick up what I'm putting down, but I have so many people who write to me and say, "I found your work. I'm totally healed. I'm back to work. I'm having a baby. I'm getting married, and I can't believe that for so many years I had no idea this existed." That's my primary purpose at this point: to give as many people as possible an idea that this exists, and then they do what they will with it.
From Hundreds of Thousands to Millions: Curable and Mind-Body Medicine
Dr. Stracks: Thinking about what we were talking about earlier, 10 years ago when you and I first talked about this, Dr. Sarno had sold a couple hundred thousand books, not really more than that. So there were probably still only hundreds of thousands of people who knew about this concept. At this point Curable has been downloaded millions of times, and there are hundreds of therapists and physicians we're connected to through an email list that's gone on over the course of a decade. So there are literally millions and millions and millions of people around the world who understand these ideas, who have been introduced to them, and who are so happy. Isn't it amazing?
Nicole: It is truly amazing.
Nicole's Story: Degenerative Spondylolisthesis and Back Pain Relapse
Dr. Stracks: And how about your own experience? You've spoken extensively about your experience with pain and what happened. How has that informed the treatments you've done with people, both individually and now on a broader level, as you're working with populations as opposed to people one-on-one?
Nicole: I have a series on Instagram, on IGTV, called I Am Evidence. The reason I named it that is that my greatest teaching tool is myself, because I know my story more intimately than I can ever know anyone else's. Weekly, when I post these videos, I use whatever's going on with me as a teaching tool. That's been my method from the start. In terms of the journal writing, the reason I use my story is that this journal writing changed my life profoundly, in terms of the elimination of pain and the secondary change, which is everything about the way I operate. When I stopped filtering all of my life decisions and my parenting and my self-esteem and my self-worth through the lens of repressed emotions that I did not realize I was repressing, it opened me to be a person of incredible confidence and esteem and compassion. It's just incredible.
A really brief overview of my story: as I mentioned, I had this pain relapse. The book cure carried me for many years. When I was originally diagnosed, I was told that I would never have biological children, because I have an abnormality in my spine called degenerative spondylolisthesis that is seen on MRI. John, you've probably never seen my MRI.
Dr. Stracks: I have not seen your MRI, correct.
Nicole: According to the orthopedic surgeons I've spoken to, my MRI makes them feel a little queasy. It's bad, okay? On paper and film I'm quite a serious case. I was told by well-meaning doctors, at the age of 19, that I had to stop exercising, stop traveling, stop riding in a car for more than an hour because of the bouncing movement, and sleep in very specific positions with certain elevation of my knees. Most likely, carrying a biological child to term would be such a catastrophic event for my spine that it could put me in a wheelchair. With that kind of diagnosis at that age, I read a book, eliminated my back pain completely, and at the time of my relapse I had two of my three children, having exercised until the day they were born. So I already knew that prognosis was not correct.
However, and this is where I want to bring tremendous empathy and connection to anyone suffering, even I, with all that confidence and information, when my back went out when I was about 30, threw all of the mind-body stuff out the window. Like into a bucket. I was like, "See you later." And then came the shame, the shame of having pushed it and had those kids, of sleeping wrong and traveling wrong and exercising wrong, all the things I had done wrong, which I'm sure were a huge reason why my chronic pain became so severe at the time.
Meeting Dr. Sarno and the Birth of Journal Speak
Nicole: This led me to actually meeting Dr. Sarno, going into NYU and having an appointment with him. When I did, he explained to me that yes, the book cure is important, and yes, my belief carried me just so far, but I had never done the real work. This is what I needed to hear from him. The real work involved, however you go about it, shining a clear light on the darkness, the shadow work, as some people call it, of the emotions and experiences we have looked away from. The brain and the nervous system perceive our repressed emotional world as a greater predator than whatever physical pain is afflicting us. I say that life is a choice between what hurts and what hurts worse. If the nervous system is such a primitive system that it must choose black or white, fight or flight or rest and repair, it was choosing my back pain as a way to keep me still and safe and not looking at these repressed emotions.
I got what he was explaining, and I said to him, "Dr. Sarno, then what do I do?" I'm such an A student. I'm so annoying. I was like, "Okay, I get it. Let's do it. Explain to me what to do and I'll do it." I wanted my life so bad. I had these two babies who were only about one and three, so it was time to really step up. He said that, in his estimation, the quickest way to these emotions was journaling. I'd always been a natural writer, so I was like, "Oh, journaling, no worries. Let's go to it." He told me to make my three lists, childhood, daily life, and personality, and to take a bullet off each of those lists. At the time his prescription was 30 minutes in the morning and 30 minutes in the evening. The reason I have shortened it to 20 minutes a day is that nobody will do that.
Dr. Stracks: That's a big ask, yeah.
Nicole: But he knew that the more we really looked there, the more quickly we'd get better. And of course I was going to do 30 and 30. At the beginning I probably did hours of journaling. I was so dedicated. I know I'm going long on this, but essentially what happened was that I started journaling in the way I thought journaling was, which is: I'm a mom. I'm really tired. This is hard. I'm overwhelmed. I was using a lot of societally appropriate, polite words to explain how I felt. And I had what I think, to this moment and always, was a bit of a spiritual awakening. A voice came into my head and said, "This is not the truth that is going to affect your pain. On a certain level, you're lying." I said to this voice, "I'm not. I am overwhelmed. I am tired." And the voice said, "I know you're tired." It was a kind voice. It was from my heart, and it was really me. It said, "I know you're tired, honey. There's a lot of stuff in there, and you've got to be brave now. You've got to really tell the truth." In that moment, I penned the first line of Journal Speak ever written, as I teach it, which is: "I hate being a mother."
Even today, and I've told this story countless times, my eyes spring with tears because of the power of that statement. A 19-year-old who had swaddled her stuffed animals with passion and purpose since she was 10 years old, thinking she couldn't have children, then having these kids. Chills all over my body with the impact of that statement. That I had the kids, and I hated it. And I didn't know why I hated it, which is why Journal Speak is a process that unfolds once you open the door, because it doesn't stay true. First I said I hated being a mother, and then I was like, "Wait a second. I know I'm onto something, but it's not the everything." I opened my heart and my willingness, and I allowed the truth to pour out, and it went into some deep pain of my childhood, of having had such a lonely childhood. I was an only child. My parents had a lot of marital problems and financial problems, and I made a decision very young that I would have my own family. Very deep down, I thought it was going to heal all the wounds of my own childhood. And when you have two difficult toddlers, and it's not healing the pain of your childhood, in fact it's making you crazy, there was in me, and I had no idea, and this is something people need to understand, a deep psychological wound: that I had ruined everything, that I had put all my eggs in one basket, and it was a fail. And my life was going to be trapped, ruined. These are Journal Speak words, okay?
As soon as I let all that out, it cascaded into a lot of self-loathing, and it cascaded into incredibly heightened anxiety, but I let it. I just made space and sat with it. Through that experience, and it was a bit of a miraculous experience, and not everyone is going to have this, I woke up the next morning and my back pain was 80 percent reduced. I called Dr. Sarno and said, "This happened," and he said, "You go, girl. Keep going." Over the next couple of months, I just did Journal Speak on all of my topics. I didn't even get to everything on the list. My pain was absolutely gone, never to return. My MRI is exactly as terrifying, I guess. I haven't looked at it in many years. I had another child, exercised until the day she was born, carried my kids' heavy suitcases up and down the stairs, and do absolutely everything: hike, bike, run. I'm 49, and I am in the best shape of my life, and my MRI has nothing to do with my pain. So that's my story.
"I Hate Being a Mother": The Inner Child and Healing Through Honesty
Dr. Stracks: Which is an amazing story. I get chills every time I hear you tell it. And part of the story, too, is that you didn't hate being a mother. You don't hate being a mother. You love being a mother. So how did saying you hate being a mother allow you to be the mother you wanted to be?
Nicole: It's the best question I've ever been asked, and here is the answer. I never hated being a mother. There is a five-year-old inside all of us. We have an inner child, every single one of us, whether you believe it or not, who is running the show until they are given a voice. That little girl inside was like, "Wait a second. These little ones were supposed to come and rescue me. Not only have I not been rescued, but you, conscious grown-up Nicole, are all caught up in the day-to-day of taking care of them, and I have been abandoned, and I'm screaming in here." That was who needed to be heard. The words that made sense to the conscious me were "I hate being a mother," and I had to say them so I could get past that to the real truth. The truth is I was a sad, scared, overwhelmed little girl living in a grown-up body. Once that was expressed, I was open to loving them so much. That was the gift. Now my kids are 19, 17, and 13. I look at my 19-year-old, who was the one who made me this horrible failure of a person, and she and I have the best relationship, because I didn't parent her through the lens of my own dysfunction. That is the secondary incredible benefit of this work: you can come from a place of honesty and integrity, and that changes the way you interact with everyone.
Fear, the Medical System, and the Science of Chronic Pain
Dr. Stracks: And I know everybody who's listening is saying to themselves, "I want that. I want Nicole's experience." We're going to talk about that in a second, ways to start to approximate that. As you said, not everybody has that experience, and we'll talk about that as well. Two things I want to highlight in what you said. I've been doing a lot of work over the past year. You and I had the conference together at the beginning of the pandemic, so it was a year and a half ago, and even I have learned a lot about the science of pain since then, and just how much of it is related to fear, and that aspect of our brain that turns on the pain signals, and that the pain comes from that part of our brain. I say this to people all the time: what is by far the number one source of fear in people's lives when they are sick? Do you have a sense of that?
Nicole: What I would say is being more sick, or not getting better, or what might be the results of their sickness. For me, working with other people, it's always, "I'm sick, and now I'm not going to be able to go on that work trip. Then if I don't go on that work trip, I'm going to lose my job. Then my house is going to be taken, and my kids are going to starve." There's a lot of projection and anxiety. Was that what you were thinking?
Dr. Stracks: That was not, but playing the game of "what am I thinking?" is never a good one from your standpoint. It's the medical system itself.
Nicole: Right. Well, yeah, the doctor. I could see that being the answer as well.
Dr. Stracks: Just your experience of "you're going to be in a wheelchair, you're not going to be able to have kids." I think you're right that practitioners and physicians are well-meaning when they say those things, but I hear story after story after story of people who visit a practitioner and are told, "You're going to be like this for the rest of your life. You're old. You're going to be on medication. You'll be lucky not to be in a wheelchair." All of it. All that does is reinforce this area of our brain that's creating the pain.
Another important point is that our emotions are such a big source of fear, because we're human beings, and emotions are scary, and most of us didn't get great instruction when we were young about what to do with them. Of course it feels more comfortable to keep it inside than to let it out. You had put yourself in a place where it could come out, and it could come out forcefully. That's the other point I want to highlight: you and I and Michelle Grinnell, who works with us, and a number of other people who do this work, had these experiences that can only be described as spiritual experiences, or I describe it as just being tapped to do this work. We get this forceful response, right? My story is that after nine months, I got on a bicycle and rode for an entire hour, and just pushed through the pain, and pushed through the pain, and pushed through the pain until it started to calm down. Most people can't replicate that, but it allowed you to see it. It allowed me to see it. It allowed us to know that this is the kind of work we had to do. We give those examples not as examples of what everybody's going to experience, but to show this incredible power of the connection between our mind and body.
Nicole: Yes, and I will tell you I've had a bunch of those. I have a podcast, and we just hit 2 million downloads, so people are listening to these stories. I won't tell them all now, or even one of them, because we have so much more to talk about. But yes, those insane, hard-to-believe shifts in my pain and my symptoms have happened many, many times, proving over and over the absolute power of this work.
"I Am Chronic Pain-Free": Living with Pain Without Fear
Dr. Stracks: What I just heard you say, which is an important point for everybody, is that once you wrote that sentence and woke up the next morning, that was not the end. It's not that you've never had pain since then. It's probably, and you can speak to this, that when you do, you know where it's coming from. You know what it has to do. And, probably more importantly than anything else, it doesn't scare you.
Nicole: One hundred percent. That is an incredibly true statement. One thing I want to say is that there is no cure for human pain. This is not about being pain-free. "Pain-free" is a real catchphrase in this work, and I like to say, "I am chronic pain-free," because chronic pain is an epidemic of fear, and there is almost nothing that scares me. Listen, if I cut myself, and it's a deep cut and I need stitches, which happened to me twice during the pandemic because I had two pretty bad bike accidents, and I know I'm a bit of a spaz, but I was biking 20 to 30 miles a day, so two trips to the emergency room within a year and a half isn't that bad. I really injured myself, and it didn't scare me. It was a bummer, and it hurt, but I knew that if I took good care of it, and cleaned it, and did what I was told at the hospital, it would heal. That's acute pain, and so is any acute pain, like breaking a bone.
When I get things like headaches, or a stiff back, or I can't turn my neck, I'm a human being. Sometimes we feel things in our hearts and sometimes we feel things in our bodies, and they are literally interchangeable. I could be having a really stressful day and not be able to turn my neck. It's not because I slept on it wrong. It's not because anything is wrong with my neck. Because I am never worried about something like that, I give it space to move through me. And here's another thing people need to understand: it's not going to move through you right away. I've had a really difficult year in my personal life. I haven't talked about this much publicly, but I'm going to say it here because it's time, and because it's over: I got divorced. It was incredibly painful and stressful. This involves children. Anyone who's been divorced or known someone who's been divorced knows. At the beginning of this whole process, I had real pain in my scapula. The scapula is right up here, the wing. I could barely turn my neck, and I knew what it was. It was so clear what it was. But even with journaling and meditation and self-compassion practice, there was so much going on in my life that it was doing me the kindness of holding a bit of it. My heart was so heavy that I needed it to take a little bit off my chest onto my back. And it did. Because I related to it with that kind of openness and willingness and kindness, it did go, but it took a week or two, and that's okay.
What worries me for people is that if you get something like that, you get caught up in the fear, you attach the meaning, you start seeing specialists, they start saying things to you like "there's nothing we can do for you, unless you want to take opioids, and opioids won't even help you," all the things we hear. Then it becomes chronic, then it spreads to the neck, then all of a sudden you have migraines, neuralgia. There are so many things I watch happen to people because of the fear. So yes, the answer is I am not a person who does not experience pain. I'm a person who experiences pain with the open arms of a person who understands what pain really is, which is information, and I allow it to move through me, and I live a life of complete freedom as a result.
Dr. Stracks: You and I had talked about you getting divorced, and again, I'm sorry about that, and I understand how it opens up new possibilities too. But thank you for being brave enough to talk about that in front of all these people. I'm always amazed at how open you are, how willing you are to be publicly vulnerable and to talk about your experiences in ways that help people move forward.
Nicole: Thank you, John. I appreciate that, and here's the reason. I'm not here to do anything other than be with people. I know I hold myself in esteem. I know I'm an expert in this field, but my expertise has to do with me sitting beside people, knowing that because I'm sitting beside them, and because I'm willing to use my story as a teaching tool, they are exponentially helped. It's my favorite thing.
How to Start Journal Speak: Three Lists and a 20-Minute Practice
Dr. Stracks: Let's pivot and talk about journal writing, and how people can access it. Many people listening are Curable users and probably fans of yours and understand Journal Speak. I get a lot of questions about what the best way to do this is, what kind of exercises people should do. When people are trying to enter into that type of practice, or trying to deepen it, what suggestions do you have?
Nicole: The first thing I'll say is that if you're completely new to this, go to my website. I have free resources. I have a tab called "How to Journal Speak." I have it all written out. It's also a whole chapter in my book, because there's not going to be a way for me to explain everything about the foundational work right here. But in very brief terms, this is Dr. Sarno's work evolved. It begins with making three lists, because it's good to have an inventory of your life. The lists are childhood, or you can put past stressors if childhood feels too limiting; daily life; and personality. In the realm of personality, it's all the things that keep us stuck because of who we are. Are you a perfectionist? Are you a goodist? Do you feel like you're your own worst critic? Do you feel miserable if everybody doesn't agree with you or like you? Are you super codependent? Do you feel really attached to other people's feelings in order to feel good? Are you super anxious? These are personality characteristics that tend to affect every part of our lives.
You make these bulleted lists, and the way Journal Speak works is that you take one item from the list each day. I prescribe a 20-minute journaling exercise followed by a 10-minute loving-kindness meditation. The journaling exercise should be akin to what I said mine was, which is that you start by being a court reporter. You start by just saying what's going on. People say to me all the time, "How do I get to the deep stuff?" You can't push the deep stuff, because remember, this is your brain and your nervous system thinking you are so in danger from feeling these feelings that physical pain is the better option. You're not going to shake the shoulders of your brain and your nervous system and get them to give up the goods. So you just have to start with being present, opening your arms. Exactly, John, what you said to me about being vulnerable. Just be vulnerable. It's only you and you there. Nobody else is watching.
You start telling the story. If it's about your son who's having a hard time, you could say, "My son Jack is struggling in school. He doesn't have a lot of friends. It makes me feel sad. The other day he came home and he was crying." Tell the story. Then, as you're telling the story, and this is something you have to be willing to do, you will be invited from your deeper self, from your higher guides, from your heart, whatever you want to call it. Something will come up, and it might look like, "I felt exactly how he felt at my age, and it is just too excruciating to watch." It could look like that. But something will come up, and then just allow yourself to go with it. I call it putting a bunny in the snow. It might go left, and it might go right, and it might go up, and it might go down. It might start at your son, and you might be at the playground in sixth grade. You might be yesterday in the grocery store. Just allow it to flow.
At 20 minutes, when your timer goes off, if you're on a document on a computer, you select all and you delete. If you're writing longhand, you rip it up into a garbage can that nobody's going to see, maybe a public can, or maybe just the bottom of the garbage can. This is a language that other people will not understand. I have had to Journal Speak horrible things about my children, about my life, about myself, about my parents, because it's just the inner child. It doesn't stay true. I have a client who called it blowing your nose into a tissue. Throw it away. It's just getting something out. When you have phlegm and you need to get it out, yes, it's real, and it needs to come out, but it was a product of sickness. It's not anything you need to honor or cherish. Get rid of it. I really want people to feel the freedom of this expressive writing and the fact that it gets immediately deleted. There is no reason to hang on to it.
Then immediately, I prescribe a meditation. People tend to alter this in ways that make sense for their lives. I know people who work in an office job who said, "I just ran out to my car and did a 20-minute Journal Speak on the back of a napkin, and then I had to go back in to my boss." If that's what you need, you do this as you need. People are very concerned with the right and wrong way to do this. Don't worry about that. But in an ideal circumstance, you will sit for 10 minutes at the end of this in some way that helps regulate your nervous system again. When I say a loving-kindness meditation, that could be singing bowls. That could be monks chanting. That could be affirmations or a mantra. That could be a guided meditation that you download. I know Curable has guided meditations. Whatever works for you. To me, the message you're sending yourself in this loving-kindness meditation is: it's okay that I said those things. It's okay. I'm saving my own life here. So the fact that you had to say, "I hate caring for my dying mother," you deserve to say that, because it's hard for you. If you can say "I hate caring for my dying mother," I promise you the compassion with which you show up at her bedside next will be greater. Your nervous system will be more regulated, and your pain will go away. Does that do a good enough job of explaining it?
Curable Meditations and Why Journaling Works
Dr. Stracks: Yeah, absolutely. A couple of things to highlight there. You mentioned that Curable has a number of meditations that help with reregulation after the writing. Just laying these out so people can find them afterwards: the safe place visualization, imagining yourself in a serene place where you can calm down and let go; the surrender meditation, which allows people to release tension and imagine being, say, in water and floating weightlessly; and the forgiveness meditation, which is what you just said in terms of cutting that energetic cord and allowing for the fact that those thoughts and feelings are inside us and that's okay, because we're human beings and not because we are bad people. We get confused about that a lot, right? I've talked to people so often who talk about feelings they have and immediately start to attack themselves because they have those feelings or the thoughts that are coming out on paper. I've heard people say that if you're not embarrassed about what's coming out in the writing, then you're not at a deep enough level, and that's why you suggest just getting rid of it and not coming back to it, not reading it later, not trying to create a narrative out of it, but just letting it flow out and then letting it go away.
Nicole: Let me speak to one thing, because I do get this question a lot when I say the thing you just highlighted. Let's say you come across in your Journal Speak a real revelation, something that comes to you that you just did not know about yourself before, and you want to share that with your therapist or your Curable group or a trusted friend. Jot it down. I'm not saying this is all or nothing. There have been times where there was one paragraph in my Journal Speak that's nothing I'm embarrassed about, nothing I'm scared anyone else would read, but it's a revelation that maybe came from an embarrassing rant I don't want anyone to read, and I might copy that paragraph and put it somewhere for me to refer to later. So this is not all or nothing. It's just a general rule that if you want the freedom that I want you to have when you're doing this, it's best to know that it's written to be disposed of.
Dr. Stracks: There's been a lot of research on journal writing over the years, starting in the 1970s, so that body of research is almost 50 years old at this point. One of the things they found is that including both thoughts and feelings is more beneficial than just thoughts or just feelings, which is why you found that recording what was going on in your life was just a place to start. You had to get to the feelings underneath in order to get that release. The other is that they really do think it's the letting out of secrets. That's one of the ingredients that makes it so effective, which is why it's so useful to find those things we haven't said and put them down in a safe way that we can then let go of and move on.
Nicole: One hundred percent. They say you're only as sick as your secrets, and I often quote that.
Dr. Stracks: One other piece from the research that I think is helpful is that there really isn't a right way or wrong way to do it. We all want guidelines and prompts and ways to get started, and people can find those through your work on Instagram and your website and program. They can contact us, and we have handouts we can give out on journal writing. But those are tools, and the work happens within using the tools. They're not ends in themselves. They're ways to let the secrets out, ways to let the feelings out, ways to have these cathartic moments, and there's not a precise pathway to get there. Everybody gets there in slightly different ways, and that has come from the research too: there are so many different variations of this that we don't have to think there's a magic formula out there.
Resistance to Journaling Is Part of TMS
Nicole: I think you brought up a really good point: you have to do it. A lot of people with TMS tend to be over-researchers. They just want to read one more book, or have one more consultation with someone. I often say it's like going to the gym. When you go to the gym, they give you that beautiful tour. The person takes you through: this is the weight room, this is where the cardio is, this is where the Zumba classes are. You can look and say, "Wow, this is really interesting." But if you don't go to the gym and do the things they're showing you, you will not be changing your physical body or your physical health. This is really about doing it. And I'm going to tell you guys with my heart, you're not going to want to. That's okay. You will resist this process, and resistance to the journal writing is part of TMS. Your resistance to journal writing is the same as having a headache or a backache or a fibro flare, because your nervous system is looking to divert you from doing the journal writing with your own voice saying, "I'm too tired," or "This isn't going to work for me," or "I have too much going on." The whole point is to keep you from these things. So you have to say to your resistance, "Thank you. I hear you. I love you. I honor you. But we're going to go do this now."
Dr. Stracks: Do you ever have resistance?
Nicole: All the time. I hate doing my work. I love the mindset and I love the peace I feel when I know there's a solution, and then I go to sit down and it's like, we're all just human, and it's all just a function of the brain and the nervous system. When I find that compassion, almost that maternal voice of "I hear you, I love you, we're doing this now," it helps.
What If the Pain Isn't Getting Better? Surrender and Patience
Dr. Stracks: Before we start to wrap up, a couple of points I want to discuss in terms of the writing. Very few people are going to do the writing, go to sleep, and wake up 80 percent better. We talked about the fact that you and I had these almost mystical experiences, but we know that's not the rule. What happens when people do the writing, get the secrets out, and the pain isn't getting better? What are your thoughts about that, and how do we provide encouragement and hope for people in that situation?
Nicole: There are two levels of that. The first I like to talk about is: I want you to picture your brain and your nervous system like an abused animal that you just got from the shelter. You want to love it, and it's here, and it's under the bed. It's in the closet. It's trembling in the corner. Your ultimate goal, because we always have to start with the end in mind, is to have it come and sit in your lap and be your pet. Do you do that by forcing it and saying, "Get over here. Come on now. I've been waiting for three days"? No. You calmly and gently and kindly and patiently and lovingly sit a few feet away with a treat in your hand and say, "I'm here. I'm still here." Consistency and kindness and compassion are the code to breaking this pain cycle. If you're showing up with the kind of intensity and urgency of "I'm going to write this out and I'm doing it," your nervous system is going to be that trembling animal that says, "This does not look like a person to be trusted, so I'm just going to sit in the corner for days, months, weeks, years."
Honestly, the best posture for this work is to give up. I know people hate when I say this, but it's such powerful teaching. This is about surrender. This is about acceptance. This is about understanding that transformation begins with the radical acceptance of what is. It's not helped along. It's not aided. Transformation begins with opening your hands and saying, "I'm out of good ideas. I know this works, because Dr. Stracks says it works. I know this works because Curable has millions of people doing it around the world. I know this works because Nicole goes on her podcast every week, and every other week she does an interview with someone who has this miraculous recovery. I understand that it works. I just need to be in my own experience with patience and kindness for myself." If you go into it with that posture, you will get better. I can't give you a time frame, because a time frame feeds that fear, and that looking at the watch, and that staring at the animal and saying, "Get yourself over here." It just doesn't work that way. True surrender is with your own readiness, and you cannot force that either. But if you understand that what I'm saying is true, even in just a tiny pinprick of your brain, it's coming for you.
John, I get emails every day from people, and the most beautiful emails I ever get are from people who struggled, and it took a while, and they were frustrated and urgent and terrified and panicked. I got one yesterday that was amazing, and I wrote her back this morning, and she's going to come back on my podcast. She was one of my real-time heals. One of the things I do on my podcast is have people come on whom I've never met, who I know nothing about, who have just told me their symptoms and are willing to come on the podcast, and we do a cold therapy session right there. We're both totally in it, and it's revelatory. She wrote me back with tremendous joy and tears that her life is completely transformed, but she had to stop looking at the clock and just do the work and let it happen. Her name is Angela. For those of you watching, look out for probably November or December, when she's going to be back with a follow-up of her real-time heal, because she's absolutely free. She's absolutely free. That's what's waiting for you, but you just have to be patient and let it happen.
Dr. Stracks: I know that people oftentimes read stories or hear podcasts where people get better very quickly. A lot of people feel like they're doing something wrong because they're not healing quickly enough, or they start to feel ashamed that they're not going to be able to get it. That's why both you and I have tried to feature people who have had different stories. I interviewed one of my patients, Jody, probably a year ago, who had foot pain and got better about 2 percent a month over five years. That was her pathway. I still hear from her every six or twelve months, talking about the miracle of having gotten better, even if it takes five years.
Nicole: Absolutely.
Dr. Stracks: It's not a competition sport. Everybody's got their own journey and their own timeline.
Panic, Anxiety, and Symptom Shifts When Journaling
Dr. Stracks: The other related question is that periodically people will call me up and say they're doing it, their feelings are pouring out, and now they're having panic attacks, and they're getting sick, and they're vomiting. Any thoughts about dealing with that reaction, which I've heard enough to know is certainly a possibility when people are trying to get to this level in the journal writing?
Nicole: The first thing I want to say is that it's a possibility, but it is not a probability. If somebody's looking at this and saying, "Oh, well, I don't want to start vomiting," this does not happen to everyone. But I know why Dr. Stracks is bringing it up, because we never want to look past the fact that sometimes this gets worse before it gets better. Sometimes this gets different before it gets better, and often it gets different, which is not always worse. Some people could start out with back pain, and the back pain is totally alleviated, and they're having really heightened anxiety. The biggest symptom imperative I hear about is anxiety replacing a physical pain. They say, "Okay, well, I used to have back pain. That's totally gone." Let's not just skim past that. That's amazing, because obviously nothing was ever structurally wrong with you, because your anxiety could never replace your back pain if something was actually structurally wrong with your back. Now you have increased anxiety, and I say, "Yes. You've got it on the run. This is excellent news."
I know it's uncomfortable, but this is the thing about any symptom that replaces your original symptom: there is no other way out than through. I just need to say this in a way that maybe brings your nervous system down. I know you don't like it. I know you don't want it. I know it sucks. But you can't get to freedom without walking through whatever it is that befalls you on the way, and that's just the way it is. People sometimes like to say, "Well, this isn't fair," or it feels unjust. I say, "I get it. I so get it. It does feel unfair and unjust, but it's the way it is." As Byron Katie says, we can argue with reality, but we only lose 100 percent of the time. I get it, and it's unfortunate, but it's the way out. Either you stay where you are or you change. Those are always our options in life. True readiness brings us to change. When it hurts a little bit more to be where you are than the possibility of change, you change. I just want people to be gentle with themselves through any way their symptom imperatives shift or move or change, because you are on your way. You're on your way to a life of freedom, and it's not just freedom from chronic pain. It's freedom from the affliction of your secrets and your coping and the ways you've kept your life small. It's the most beautiful, magical way to live, and it's on its way to you if you just do the work.
Avoiding Self-Attack in Your Journaling: Self-Compassion
Dr. Stracks: I'm going to run one more thing by you, along those lines, about people getting worse as they're doing it. When I fielded those calls over the course of my career, and I never say 100 percent, I cannot remember a time when, as we opened up what people were doing in the writing, they didn't tell me that they were attacking themselves in the writing. Every time somebody called and said, "I'm having panic attacks, I feel so much worse," when we sorted it out, they were telling me they were spending their time writing about what a terrible person they are, how bad they are because they can't get better, how they've done all these terrible things over the course of their lives. I have gone to telling people essentially not to do that. I'm interested in your opinion on that, but I find that if people are opening up their documents or paper and writing down "I'm such a bad person, I can't believe I did this, I can't believe I did all these things over the course of my life," I have not seen that be a pathway to healing for people. In addition to being kind to ourselves on this journey, which is such an important part of healing, do you find that there's a role for not being unkind to ourselves in the journaling?
Nicole: I think it's a delicate balance. We can't deny any of our thoughts or feelings that are trying to push forward, because that will become something we have to repress. If you have a tremendous amount of self-loathing, I don't think it is advisable to not look at it at all. But I agree with your point wholeheartedly that if you get mired in it, you will get lost in it, and the shame will become the primary place you live. So I think it's about allowing the thoughts to rise, allowing them to rise enough that they are seen, so that you, as a person with some years of experience, can look at them and say, "I see what I've done. I do have regret, or I do have fear, or I do have self-loathing." Acknowledge it, and then here's a really good tool to shift the dialogue. I want you to picture your most beloved soul in your life, whether it be your child or your niece or nephew or your godchild or your pet, anything that you love, coming to you with tears in their eyes and saying, "I'm terrible. I'm this. I'm that. Look what I've done." I want you to speak to yourself in that journaling moment the way you would talk to them, because you're just a lovely, sweet, chewy human. That's all you are. Yes, you've done things you're not proud of, but we all have. You've done things you regret, but they were part of the trauma you inherited. Being gentle and kind with yourself, and if you need to look at it as somebody else saying those things, is sometimes a helpful tool, because I don't want us to deny any parts of ourselves, but I also don't want us to get lost there.
Dr. Stracks: Absolutely. Just being able to be kind and gentle with ourselves and move forward, understanding that we are human beings and we have symptoms because we're human beings, not because we've done anything wrong, not because we are bad people, but because we're human. That's part of the ride.
Nicole: I often want to tell people not to forget that having big feelings is the reason we're here. The whole reason to be alive is to connect and to feel and to get it and to hurt and to cry and to break so we can grow. So stop not wanting that, because that is literally the point.
Where to Find Nicole Sachs
Dr. Stracks: Anything else people should know before we sign off for the evening? Anything else you want to add?
Nicole: Just that if you need more support and if this piques your interest, I have a lot of stuff out there to help. Do you want me to say where people should find me?
Dr. Stracks: I do want you to say where people can find you, because people should find you.
Nicole: Come find me. I have a website called thecureforchronicpain.com. I have a YouTube channel with the same title, and I have a podcast with the same title, The Cure for Chronic Pain with Nicole Sachs. The Instagram is @nicolesachslcsw, and I spend a lot of time and energy there and have a lot of great community going on there. I also have a book available on Amazon called The Meaning of Truth. I also have two online courses available on my website: Freedom from Chronic Pain, and Freedom from an Anxious Life, which is specific to anxiety. I also have a vibrant community on Facebook. It's a closed group, so nobody sees your posts but the community. It's Journal Speak with Nicole Sachs on Facebook. And if all of those things are too much, just Google my name, Nicole Sachs. It all comes up.
Dr. Stracks: That is a lot of places to find you. You can find me at my website, www.cormendihealth.com, and anybody who's interested in working with us can connect with us that way as well. We will end there.
Nicole: Thank you so much.
Dr. Stracks: Like I said at the beginning, anytime I can spend an hour with you is a fantastic use of my time. I am so grateful to you for being here and talking about this and sharing your wisdom and expertise.
Nicole: Thank you. Thank you, John. I feel the same.
Dr. Stracks: And thank you also to everybody who's been here and listening. Every time we do this, I'm reminded what an incredible, brave, caring, loving community we are part of, with people out there being vulnerable and doing this work and understanding that there are so many pathways to healing other than medication and surgery. You'll be able to find this recording, for people who want to watch again, and all our previous episodes, on the Curable Hope for Healing landing page, which is www.curablehealth.com/hopeforhealing. You can also sign up for our office newsletter and get updates about next episodes and things that are going on in our practice. I'll be back in four weeks, on Wednesday, November 17th, at 5:00 p.m. Central Time, and I hope everybody can join us then. Until then, please stay safe and healthy, and everybody have a good night.
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.