Your Symptoms Are Real, with Dr. David Clarke @SymptomaticATNS

Hello and welcome to this episode of the Feel Freaking Amazing podcast. We have an amazing guest today. His name is Dr. David Clark. He is the president of the association for Treatment of Neuroplastic Symptoms. It's a nonprofit dedicated to ending the chronic pain epidemic. He holds an MD from the University of Connecticut School of Medicine and is board certified in internal medicine and gastroenterology. So in other words, as we say in Boston, he's wicked smart. His organization's mission is to advance the awareness, diagnosis and treatment of stress related brain generated medical conditions. And we're going to dive into. That's a lot to say. We're going to dive into that. But first, welcome, David. Thank you for being here.

Great to be with you. Thank you so much. Awesome.

Let's dive in.

All right, so I guess tell us a little bit of how. What's the kind, what's the origin story? How did you get into this? Why did you get into this?

Why'd you call it that?

Yeah, there's at least a dozen synonyms for this. But we like the term, my colleagues and I, neuroplastic, because it refers to the brain and nervous system being responsible for generating real pain and illness in the body, even when there's no physical abnormality, no disease or injury that can be identified. And the plastic part means capacity for change. So it's actually a very hopeful term. And we've found that if you can identify the stress, trauma, emotions, other challenges in life that are responsible for these symptoms, you can achieve a successful outcome. Patients of mine, one of them was ill for 79 years, and yet she was successfully treated. Another patient I was asked to see on his 70th day in the hospital for unexplained abdominal pain that had been going on for 18 months, he was getting 250 milligrams of morphine a day around the clock. You know, for your viewers who aren't familiar with morphine doses, 5 or 10 milligrams would have been enough to alleviate the pain of a fractured leg. And he was getting this every hour. And yet that patient too was successfully treated. I was GI consultant number seven on that case, and he'd seen six other people from three different institutions, but they didn't know what kinds of issues to look for. So I was just as ignorant of all this through the course of my training. I mean, I went through seven years of very traditional Western medicine training, and the last thing I expected was to encounter a patient I didn't know the first thing about diagnosing or treating but that's what happened in the first year of my GI fellowship. Patient referred to us from another university. I was at Harbor UCLA Medical center in Southern California at the time. And she was averaging one bowel movement per month despite taking four different laxatives at double the recommended doses.

So people can live like that?

Yeah, for two years.

How do you live like that? Like, truly, how do you live like that?

Because the human GI tract, or the GI tract in general, has been evolving for over 500 million years, and it keeps the bad stuff contained. And she didn't suffer any toxicity from this, which surprises a lot of people. But she didn't. She was otherwise healthy. I mean, she got checked out by the other university every which way and found nothing. So she was.

Every day, right?

Yeah, yeah. She didn't lose weight through this. You know, she was otherwise healthy. It was just, you know, I'm as baffled as you are at this point. But we had a very specialized test of the electromechanical properties, the large intestine in my department chair and I. We knew that this test was going to show what her problem was because as far as we were concerned, no other explanation was possible. But that test was normal, too. Her, you know, the electrical properties of her bowel were fine. So it was left to me to do her exit interview. And I was basically telling her, you're going to have to live with this. But not wanting the conversation to be over in 30 seconds, I started asking her about stress. And she didn't. Other people had asked her, of course, and she didn't have any. She was happily married, she had two kids, she worked halftime, and everything was fine. So I asked her about stress earlier, thinking, you know, maybe something bad had happened two years ago when she became ill for the first time. And she interpreted my question to mean the more remote past and said that her father had molested her. And I had never heard that from a patient before. I had no training that I should be inquiring about something like that. In the early 1980s, when this. When I was doing this, interviewing this patient, it was thought to be rare. We know today that it is anything but. But I didn't really know what to do with that. So I fell back on basic physician training and took a history. And it turned out her father had sexually assaulted her hundreds of times up to the age of 12 1. To this day, one of the worst stories I have ever heard. But could it, you know, this had stopped happening 25 years ago. Could it possibly be related to her illness? Had no idea. But there was a psychiatrist I had heard of who was also board certified in medicine that had an interest in this, and her name was Harriet Kaplan. And I was glad to have something I could do that was positive. So I made an appointment for this patient with Harriet and forgot all about her and went back to learning about how to put endoscopes in people until I ran into Harriet in an elevator. And this was the elevator ride that changed my career, because between the ground floor and the fifth floor, Harriet told me she had cured this patient with less than three months of weekly counseling sessions. Absolutely blew my mind that you could alleviate a serious physical condition just by talking to somebody. Nobody ever even hinted that such a thing was possible. But I wanted to be a complete doctor. So I prevailed on Harriet to teach me her approach. And by the time I finished my GI fellowship, I had the basics. But I was making two mistakes at that time. One was I thought these patients would be rare. And the second was that if I ever encountered one, I could refer them off to whoever the Harriet Kaplan was. In Portland, Oregon, where I was in practice, there weren't any Harriet Kaplan's. The knowledge that she had is what was rare. The patients were not. I used her framework whenever I had a patient whose pain or illness had a negative diagnostic workup. I do my usual thing with endoscopes or ultrasounds or Catholic CAT scans. Don't find anything. Do the inquiry that Harriet had taught me to do. And I was finding all kinds of terrible stresses in people you would never guess were carrying that kind of burden. And this turned out to be five or six patients a week, and sitting here today, over 7,000 that I've successfully diagnosed and treated.

There's a lot to unpack there.

David. Sorry.

I mean, as a woman and an OB gyn, I can't tell you how many women say to me that they go to the doctor and they're gaslit. And in fact, I do this series on Instagram where I rant and rave about gaslighting from medical providers. And so all I can think of when you're talking is all of these women who have all of these physiological issues that have their root in what you're identifying as childhood trauma. And that they're told that they're crazy, they're told they're anxious, they're told there's nothing wrong with them, but really there is. There is a physiological representation of the trauma and stress they had as a child.

Yeah, I mean, that patient who was getting the morphine around the Clock. I mean, you're never going to convince that patient or anybody who took care of that patient that the symptoms were not real. And these are absolutely as real as any other symptoms that I take care of. Two thirds of my practice was garden variety gastroenterology. Those patients had real symptoms. So do my patients with neuroplastic symptoms or brain to body symptoms? Absolutely, 100% real.

Well, this, I mean, this sounds what neurologists are now calling functional neuro. Functional patients.

That's right. Functional neurologic disorder falls into this. Most cases of migraine fall into this. It's literally from head to toe, dizziness, tinnitus, difficulty swallowing, visual disturbances, pseudo seizures, fibromyalgia, irritable bowel, most cases of long Covid, many cases of chronic fatigue, pelvic pain, genital pain, persistent genital arousal disorder. Pain in the back is very common. There was a study last year that carefully looked into the psychosocial histories and the medical histories of over 200 people with back pain and found that 88% of them, it was neuroplastic, not structural. So it's incredibly common. It's 40, 40% of people who go to a primary care doctor. This is what they have.

So it's an epidemic. You're saying this is an epidemic of breakdown?

Yeah, and it's even worse than that because most healthcare professionals, whether they're medical or behavioral or mental health, have not had any training in how to d. Diagnose or treat this, which is, you know, to me, it rises to the level of a social injustice because if you've got two people who have, let's say, the same back pain, and one of them, it's structural, they're going to get decent care and the other one is neuroplastic, they're going to get terrible care. Even though it's the same pain, it just has a different cause.

I mean, you're pointing to something. The woman who had the bowel movements every month, she was fine for a period of time and then all of a sudden was not fine. Was there something that caused her to not be fine and triggered her?

Yeah, yeah, there was. I mean, it's more complicated to explain that. It's. Ironically, it's part of the recovery process from childhood trauma that people reach a point in their lives when they are finally ready to confront the emotional underpinnings, the repressed anger and fear and rage that's going on beneath the surface. But in order to survive their childhood experience, they've learned very well how to repress Those emotions. And so when the emotions come knocking on the door, the patients are not consciously aware of it. When this patient was telling me about her childhood sexual abuse, she was very calm, using the same tone of voice you'd use to read a grocery list. I mean, there was no visible emotion there. If you didn't know better, you would assume she had processed the trauma and moved on. I certainly didn't know better at the time, but I do now that those emotions are there and they're being expressed via the body because they have no other way out. It's like the mind is trying to communicate with you in the only way that it can, that it's in a state of distress. And the treatment for this condition is to help people become consciously aware of where that distress is coming from. But it can take many years for people to reach a point in their healing process where they are ready to finally deal with this. And you know, I could go into more detail about her, but it has to do with growing your self esteem to an appropriate level. So many of my patients have had their self esteem beaten down as kids, made to feel second rate or worthless. But gradually as adults, that begins to recover. And when it does, they're beginning to feel like, okay, I have some reason to feel like I deserved better treatment back. Then the resentment begins to come knocking on the door and then the symptoms can appear. And if we can help people understand that process and become consciously aware of it, the outcomes are great. I mean, even the patient with 79 years of abdominal pain and she was a nurse, she had plenty of access to health care. Even that patient at age 87 made a good recovery.

Do you feel like you're a gastroenterologist or a psychologist, psychiatrist?

Because, well, yeah, I mean, I started out, I didn't think that was going to be going into this. It just, it happened, you know, for two reasons. One, that I so grateful that I learned from Dr. Kaplan that this was possible. And the second was nobody else was doing this work. You know, it's just astounding to me to this day that 20% of the adult population suffers from this. It's almost twice as big as the diabetic population. But, you know, who in the healthcare profession knows how to diagnose and treat these people? There's only, you know, a few hundred people that are, you know, members of the association. Symptomatic Me is our website, by the way, and for any of your viewers that are curious about whether their personal symptoms could fall into this category, we've got a great 12 question quiz. Takes less than 3 minutes to do a self assessment. And each question has some explanation about the meaning of the question. And the more questions to which you answer yes, the more likely it is that your personal symptoms are falling into this category.

We'll make sure that gets in the show notes also so people can click into it. Okay. Are there other triggers for people? So it sounds like. So one thing that I just basically heard you say is that if you have a history of adverse child events and trauma and if later in life you start to experience un.

Medically unexplained.

Thank you. Medically unexplained issues that even without your quiz it would be a pretty good. It's an easy leap to say, okay, I think it's worth exploring whether this is relating back to my previous trauma.

Absolutely. I mean it's, you know, it isn't always going to be that way, obviously, but it is, absolutely. For a complete evaluation, a complete workup, it should be investigated just, you know, the way we. And if I've got somebody with upper abdominal pain, for example, I want to make sure they don't have pancreatitis or a gallstone or an ulcer. But I'm also going to tell them, you know, even before I've ruled out those things, that it could be stress and that that's on the list. And it's, you know, in order to be holistic about this, we want to include all the possibilities and investigate for all of them or our evaluation is not complete. I'll also add that it doesn't have to be a really severe trauma.

That's what I was going to talk about because you're talking about deep trauma. A lot of times it could be just a decision somebody made when they were young, when the parents didn't pay attention to them or they weren't maybe neglectful, not necessarily trauma.

Yeah, that's right. Many of my patients say, you know, I didn't go through anything bad. Other people have been through worse. I don't think it was too terrible and I think I'm over it now. And sometimes the trauma was fairly subtle or the impact on the kid was fairly subtle. Pretty much anything that can make a child feel like a second rate human being is capable of having multiple long term impacts on the adult. One of my patients, it took him quite a long discussion before he finally recognized that when he was a kid, the only time he got praise or support from his parents was when he did something better than his brothers and sisters could do it. And he had three very accomplished siblings so it wasn't easy to do something better than they could. And he grew up feeling like a failure and I was seeing him as a 37 year old attorney and he had lots of unexplained neuroplastic symptoms and many of the other long term consequences that patients with more traumatic backgrounds have as well.

So are the majority of people whom you are working with on this approach, is it a 12 week treatment plan like, is that the average for what you find people resolve with?

Yeah, I wasn't able to get statistics like that because in the nature of my practice was I could only see patients a couple of times. My role was to try to bring the major issues into conscious awareness and then they would either work on those on their own or today, you know, there's an app called Curable or there are lots of books out there for self help. My own book is called they Can't Find Anything Wrong and they can oftentimes treat themselves with the support of these resources. Some of them needed, you know, psychotherapy, some of them for years in order to make a full recovery. Other people just bringing these issues into conscious awareness is their light bulb moment. And they're better within, you know, days or weeks. One of my patients was hospitalized at a prestigious University in California 60 times in 15 years for attacks of dizziness and vomiting. No diagnosis. They even had a psychiatrist talk to her and he pronounced her mentally healthy and sent her back to the other specialists. But it turned out all of her attacks were connected to interactions either directly or indirectly with her abusive mother who was still emotionally and verbally abusing her at the age of 50. My patient. And as soon as she saw that this was connected, she had this light bulb moment and she looked up at the ceiling. I can still remember this, said, oh my God, I can't believe it. And as soon as she saw that she was cured on the spot, she would, you know. I went to see her the next day on rounds and she was already discharged. She was gone. But she called me a year later to say she'd gone the entire year with no attacks. And previously she'd been and having six, eight, ten in a year. So that was one of my more favorite stories. But there's a lot of variation. But I would say most people get a lot better in weeks or months.

I don't mean to be wordless. I'm just processing how many people, because we see it in our practice. How many people had emotional, psychological or physical abuse or trauma It's. I mean, it's a very, very large bucket. You're talking about people in. And I always love when people come to me and they've had the full, you know, million dollar workup. So I'm like, okay, we're not missing a brain tumor, you know, now let's get down to brass tacks and figure out what's going on for you. Did you have a question or something?

I'm trying to understand because there's. There's a lot of people working. I mean, first of all, thank you for bringing this to attention to light, because this is one of our core beliefs is human beings by design have some kind of small t trauma from 6 to 9 years old, every human being, and then they live their life as if it's true, like whatever they decide about themselves, whether they're not worthy or not lovable, et cetera, so forth. And then there are people that have the big T trauma of the abuse, physical, emotional, sexual abuse. And it doesn't matter if it's a big T or a little T, It. How it comes out in the body is very different for every person. And there are a ton of. Everybody has their own approach, everybody has their own thoughts. But it's really important that as a gastroenter, I mean, I'm like, super excited that you're a gastroenterologist talking about this, because we have a lot of other people talking about this, but the regular medical field just ignores it.

Yeah. You know, the reason that I got into it so much is, you know, first of all, a lot of the patients I sent off for cognitive behavioral therapy, they came back because it turns out, and the research shows this now, that CBT is not. Not very effective for this. And when they came back, I used, you know, there was. They had no other options. So even though I was a beginner, I said, I'll. I'll. I know a few things about this. We will try it, and we will see if it helps. And it was tremendously rewarding, personally and professionally, to see people improving who had been getting nowhere in the healthcare system before that. And I, you know, I'll be honest, I had to do a lot of trial and error of different things. The. The framework that Harriet gave me was just a framework, and I had to do lots of experimentation and probably took me five years to climb the learning curve, but to see people get better just by talking to them. That patient with the 60 admissions to the university, that was cured on the spot. I went home to my wife that night and I said, I really think I'm onto something here. And I just kept, kept, kept doing it. And probably not a coincidence, at about the five or six year mark, I got a Doctor of the Year award from the Doctor of the Year award from this big HMO I was working for at the time. I was still in my 30s. That was an award that usually went to much more senior clinicians. But then the cat was out of the bag. People knew I was doing this work. And I started getting referrals of patients that did not have GI symptoms. I mean, I would, you know, be handed to somebody's chart, I would look at the reason for the referral and, you know, it would be all kinds of stuff. One gentleman with back pain for 25 plus years, another person with total body itching for three years. But they responded to the same approach. And it was, it just kept getting bigger and bigger. And then when my book came out, I started getting all kinds of invitations to speak and ended up all over North America and Europe, met other people who had found their way to this work in a way similar to what I had done. And we founded the nonprofit in 2011 and we've sponsored research, we've produced three documentary films. We put out two professional textbooks written without jargon, by the way, so that even the general public who are interested in the science can read those. It's the title has the older term of psychophysiologic disorders, which we discarded last year because it wasn't patient friendly, I think you could say. But people who find out about this absolutely love it. I mean, there was a group of doctors that took one of our training courses on our website. They started using it in their practice. And one of them took me aside at a conference and said these concepts had put the joy back into my work because all of a sudden 40% of the people coming through the door that would make most doctors beat their heads against the wall. Now she's getting good outcomes with them. And they were so enthusiastic, these three doctors. They taught 70 other doctors in their community how to do the same thing over the next year or two.

What are some of the things, what are some of the platform approaches that you take that you had gotten from Dr. Kaplan? Like, what were some, what was the framework that she gave you that you then improved upon?

Yeah, it starts with what I call a stress evaluation, where I am starting by assessing, you know, what's going on in your life right now. You know, one very simple example was a patient with nine months of abdominal pain. And it there was a clue that the pain was neuroplastic because it was moving from quadrant to quadrant on different days. You know, if you've got inflammation or a tumor, it's not going to do that. So. But, you know, she had come to me from another GI doctor who had done every conceivable diagnostic test on her, including ERCP with sphincterotomy. And your viewers who are not familiar can look that up, but it's pretty extreme. But, you know, she was suffering domestic violence two or three times a week, and it had been going on for nine months, which was the exact duration of her illness. And with the help of our social worker, we got her out of that situation. Pain went away in two weeks. Another patient.

Wait, wait, wait. Okay. Are you familiar with Louise Hay's work? You can heal your life. I'm so struck by just the idea that something she could not stomach, right? Like, she couldn't stomach it, and her pain came out in that way. And a lot of her work looks at, you know, if you have back pain, it's fear of moving forward. So what are you avoiding? Like, just. Just all of the correlations between the. The. What the brain can't deal with and the body then represents is. I mean, I learned about her work when I was 10, and I've had her book on my shelf for years. I think we might actually still have it around the office somewhere. So you're highlighting that there's often something very. I guess I'll say ironic or perfect around the way the pain comes out.

Sometimes there is. We don't always know why a particular. You know, you take two people with seemingly similar stress backgrounds, emotions, traumas, other challenges in life, and one of them gets migraines, and the other one gets chronic fatigue. You know, oftentimes, we don't know. There was a. There's a book called the Lived Experience of Abuse by a Scandinavian family doctor who tells a story about a woman who had right upper quadrant pain and abdominal pain. I'm sorry, I got to remember, it's not always professionals in your audience. And it turned out that when her father molested her, he put his hand there. You know, he put his hand other places, obviously, but he put his hand on her right upper quadrant, and that's where her pain was, right at that exact spot. Because that was something that was. You know, he always did. Unfortunately, another patient. And, you know, it just astounds me, none of his doctors asked this, but his pain only happened when he drove to work, when he drove home from work he was fine. So, you know, the natural question is, well, what's going on at work? And he had this huge stress at work that corresponded chronologically with the duration of his illness. I mean, it was a very simple diagnosis, but several other doctors had completely missed it because they weren't, you know, they're in the box of it's gotta be an organ or a structure that's responsible, and 40% of the time it's not. So I'm looking for stress in patient's life at the moment. Another big one, I have to add, is people who are so busy taking care of everybody else in their world that they never seem to get around to putting themselves on the list of people they take care of. And so they're kind of on a treadmill. They never get off, you know, constantly working to help everybody else. You know, family, spouse, workplace, social groups, neighbors. And if they get a little time for themselves, they're thinking about what useful or constructive thing they could be doing instead of. And you ask them, what are you doing for fun in your life? And not so much. So the next area I'm looking at is mental health problems that can manifest with a somatic chief complaint, a chief complaint in the body rather than mental health. This is very simple. Depression, anxiety and post traumatic stress. And my experience, a very large fraction, if not a majority of people with garden variety depression, it manifests somatically. And many of the people with that. You ask them, do you feel depressed? They will say, no. They'll say, okay, I'm frustrated, I'm stressed, I'm exasperated, I'm desperate to have you alleviate this symptom that I'm coming in to see you for. But no, I don't really feel that depressed. But you ask them other questions about the vegetative symptoms of depression. Sleep disruption, low energy, low appetite, losing interest in activities they used to enjoy, crying for no obvious reason, thoughts of harming themselves. And the diagnosis becomes clear. One of my patients with that had 22 encounters with one of my colleagues over seven months for fairly vague physical symptoms in her chest and abdomen. And she clearly had depression. And it was very clear because after I made the diagnosis, she told me the story that in between her last visit with my colleague and her initial visit with me, she had gotten out of bed at 4 in the morning, put her robe on, put a brick in each pocket of her robe, drove to the Columbia river and walked out into the river until she was neck deep. And she stood there for 10 minutes trying to decide if she was Going to keep walking out there and obviously drown herself. But she decided not to. Turned around, got back in the car, kept her appointment with me the following week. And she's in tears through most of the appointment. I mean she'd been suicidally depressed for a year and nobody knew it. She didn't think to mention it, nobody asked her about it. Diagnosis was completely missed. And there's abundant research that shows that we physicians are terrible at diagnosing depression. We miss it more than half the time in primary care.

Okay, wait, basic stupid question. What's the question to ask to get the best answer? I mean I just say straight out, how's your mood? Any anxiety or depression? But is that the question or is there something.

No, it's not. Okay. I mean I would say it is a good question, absolutely. But it's not the only question. And that a lot of people who say no, not really, not anxious have, you know, the anxiety patients, many of them have been anxious for so long that it feels normal to them and they will tell you no. The clue with the anxious patients is that their symptoms are more severe or more frequent or both, whenever they are away from what they consider a safe environment. So classic story about that is a patient of mine with sudden onset of intense abdominal cramping, followed quickly in a minute or two by diarrhea and she'd been having these attacks two or three times a week for nine months and they just seemed to come out of the blue for no rhyme or reason. It turned out though, and this is something that you specifically have to know to look for, that not a single one of her attacks took place at home, which was for her a safe environment. Now you know, statistically she spent waking and sleeping probably half her time at home. So statistically half of her episodes of these bowel attacks should have taken place at home instead, you know, if you do the math, two or three times a week for nine months is about 100 episodes and you she had not a single one happen at home. There's nothing else but an anxiety disorder that will do that. It's just the large intestine, doesn't know if it's home or away. It's dark in there, we have to bring our own light. Another example was a patient, a 16 year old girl with severe diarrhea to the point where on her bad days she was putting herself on a water only diet, restricting to water only and was taking a dozen Imodium tablets, anti diarrh medication by one o' clock in the afternoon and even Then was still having diarrhea. But. Sorry, I'll get to your question in just a second. Nobody got the history that her bad days were on Tuesdays and Thursdays. On the weekends she was asymptomatic, regular diet, no emotion. You know, there is nothing else that will do that but an anxiety disorder. She was incredibly anxious about something that happened on Tuesdays and Thursdays, which was she was a varsity SOCCE player and she was really worried about how she was going to perform. She was a key player and it just impacted her bowels. If, if on a Thursday there was no game and it was just practice, no problem.

So I have a politically incorrect question to ask.

Great. I love those.

Oh boy. Brace yourself.

So we, I'm going to say Wendy and I and our team and functional medicine doctors in general are very blessed and we've set ourselves up that we have time with our members and our patients. We have. We spend an hour with a new person, half an hour with a follow up person. So we're very blessed with time to get to know our patients and really dig into things like this.

Yeah, your patients are blessed too.

Appreciate that. My question is we've interviewed to bring doctors on board and well compensated doctors like gastroenterologists and cardiologists are compensated for procedures. Not talking. How do we change the. How do we get more doctors interested in the work that you're doing, considering they have 10, 15 minutes at best, and B, they get paid to do procedures, not to talk? How do we start changing the system? Because as long as people are incentivized to do procedures, they're not going to be incentivized to really go deep as you're talking about.

Yeah, it is a huge political issue, but one approach that I've tried to take is to get insurance companies interested in this, that there is a strong incentive for them to do this because the patients get diagnosed and treated much more inexpensively. And there is a growing number of insurance companies that are contracting out to firms that supply this service, usually by telehealth. They train therapists, behavioral health clinicians to provide this care for patients. And it works. And so many patients who might otherwise have gone for, let's say spine surgery find that they don't need it. And patients that are going to end up having years of unexplained symptoms, that process is stopped much earlier. And it saves the insurance companies a lot of money. They're finding that it's highly cost effective. So it's kind of, I think, the way forward for this is, you know, obviously changing the way doctors are paid would make a difference. You know, paying salaries instead of by the procedure would make a difference in how the incentives are structured. But having outside consultants provide this service, once insurance companies find out how effective it is, and they are in a growing number. I know of at least two companies that are in this field that are growing rapidly because of the clinical effectiveness of these concepts. So we haven't reached a tipping point yet, but we're a lot further than we were a decade ago.

I want to go back to what you were talking about. So asking straight up if someone's anxious or depressed is a good start, but then looking to see, is there a theme to the pattern or pattern to when you have a flare and what is that? Is it related to anything that you are nervous, upset, anxious, or have fear of or triggered by some interaction, like really, really probing into it?

That's right, yeah. Another patient, you know, he used the. He was from Austria, so his command of English wasn't unlimited. But he used the word stress to describe a symptom that he was having. And the symptom was tightness in his neck and shoulders. And he wouldn't have it when he woke up in the morning. He wouldn't have it if he stayed home. But when he left home, the longer he was away, the tighter his muscles got. I mean, you know, that just is a classic for an anxiety disorder. And I want to include asking about trauma as well. So many of my patients, nobody asked them, you know, have you been through a terrifying or horrifying event? And oftentimes they have. Sometimes it's remote in time from the onset of the symptoms. And in those cases, I'm looking a trigger that is in some way linked to the trauma. My favorite story there is a patient who was referred after three years of attacks of nausea, vomiting, and abdominal pain. And these would last for between five and seven days. And then she'd be okay for a couple of months only to have another attack. And when I asked her where her pain was, she formed her hand into this shape like a little boy or girl would to make a pistol. And she pointed the barrel of the pistol, her index finger, finger, at the right lower corner of her abdomen. And, you know, very unusual gesture, but, you know, took note of it. And then later, when I get to the trauma part of my stress evaluation, she said that she had witnessed the shooting of her brother and he had died. He hemorrhaged to death in the ambulance. The bullet lacerated the iliac Artery. And it was in the right lower quadrant that he had his gunshot wound. So there was an obvious connection there. But the shooting had taken place a decade before the onset of her symptoms, so it wasn't directly connected. So then I'm looking for a trigger and I just asked her, can you think of anything connected to this trauma that happened right before you became ill for the first time? And immediately she knew because her brother's killer had been convicted of manslaughter, served, you know, a decade in prison, and then he was released back into the community and nobody told her that he was out there. And she encountered him unexpectedly in a store. It came as a complete shock. Two days later, she had her first attack.

Wow, you're full of fun stories.

You know, 7,000 patients, you get some stories. But, you know, the thing is, nobody knows about these things. People carry these issues. You know, you're making me think of one that's even worse. But you can keep it.

You can keep that one.

Okay.

That one. You can. I don't have onlookers. Gory interest.

Fair enough. But, yeah, I mean, but the people that you would never guess what they are carrying inside that, you know, they could be your neighbor, they could be in the next cubicle in your workplace, and you would have no idea what they are carrying inside. And because they. On the surface, everything seems to be okay. They're. They're holding it together. It's just manifesting physically.

I'm very grateful you're doing this work, David, and I'm very grateful that you've brought this forward in a framework that we can start to talk about. I would.

Training programs also.

Yeah, and there's training programs, so absolutely, I guess.

And that's a natural extension for functional medicine. Doctors, I mean, they're already focused on the whole person.

Very much so. So I guess my question is, where can we send people to find out more about the work you're doing and anyone who wants to get involved or particip. And we'll put all of this in the show notes. So can you tell us where people can find you?

Yeah. Symptomatic Me. You know, we've. Our association name is, you know, the association for the Treatment of Neuroplastic Symptoms, but that's kind of a mouthful. So my team came up with the idea of calling the website Symptomatic Me. And it's very user friendly and it's got all kinds of resources and we really need people to support us as mem. As members. I'll be honest they pay us small annual or monthly fee and get access to. We have monthly Q&As by Zoom where people can ask questions of experts every month. And then we have one for clinicians and one for everybody, clinician or not. We've got textbooks, we've got a curated list of self help books. I've got a new podcast of my own, actually, we just launched it last month where I interview patients, some of whom have fully recovered, some of whom have not.

Not.

And we're going to be rolling those out every other week or so through the rest of this year. But it comes pretty close to what I used to do in my office with patients and how I would evaluate them and how I would respond in terms of treatment for the various kinds of stresses. So I'm really happy with how those are turning out. And we've got courses, we have an annual conference. Our next one is September 28th to the 30th 30th of 2025 in Boulder, Colorado. Two and a half days, the one last year, people were just ecstatic about it. I mean, it was such a meeting of the minds that we had. We did that one also in Boulder and people just loved it. It did sell out though. So, I mean, we had 270 people from eight countries and it sold out, you know, weeks in advance. So I mentioned that to people. But. But yeah, we've got those recorded. We have recorded conferences, people who become members. We've got a self treatment course for them and we're adding new stuff all the time.

It sounds like an amazing resource. Yeah. Okay. All right. Did you want to say anything?

No, thank you. Thank you. It's amazing work. The only thing, I'll guess, the only other quick question I have is have you related this to like the new psychedelic work and MDMA and that and work with psilocybin has that.

Yeah, we're anxious to see how that pans out. We have heard anecdotal reports of these compounds being used successfully to. In people who are already getting treatment. Along the lines of what we talk about. That can sometimes, you know, for somebody who's not making as much progress as they would like, sometimes these medications can help them jump a gap in their progress, let's put it that way.

Okay. Wow. Okay. This a lot. I'm going to put everything in there. We'll put everything in the show notes. And I have a feeling people will reach out to you because the work you're doing is amazing. So on behalf of both of us, thank you.

Thank you very much. I really appreciate your sharing this with your audience. One small area I didn't quite get to was the. I should just mention briefly the three long term impacts of childhood adversity that we see in our patients. One is personality traits that people acquired to help them survive the early adversity. Things like perfectionism, being highly self critical, not being very skilled at self care, those kinds of things. Triggers which are often an adult who was toxic for you as a kid, still being in your life is a common one. And then the third one are negative emotions that are present but not in conscious awareness yet. And all three of those are amenable to successful treatment.

Okay, that's great.

So there is hope. That's the bottom line. There's always hope.

Huge.

Okay.

Awesome. David, thank you so much for being here and to the listeners, thank you for being with us for this episode. And we hope this different. This episode of the Feel Freaking Amazing podcast made a huge difference for you. I know it made a difference for me and I'll be changing my practice questions as a result. So thank you, David.

Thank you, Wendy, Annette, much appreciated.

Thank you. Bye. Bye.