You're Not Crazy: Your Symptoms Are Real, with Dr. David Clarke

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. 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, she was cured on the spot.

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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, 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. As a woman and an obgyn, 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 for from medical providers. And so all of these women who have all of these physiological issues 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.

Yeah, 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 is, 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 increasingly, incredibly common. It's 40. It's 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 diagnose or treat this, which is 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.

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 a few hundred people that are 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, 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.

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 some.

No, it's not. Because 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. 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 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, if you do the math, two or three times a week for nine months is about 100 episodes and 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 put herself on a water only diet, restricting to water only, and was taking a dozen Imodium tablets, anti diarrheal 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 soccer 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 on a Thursday there was no game and it was just practice, no problem.

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, 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, 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 for a trigger that is in some way linked to the trauma. My favorite story, there is a patient who was referred 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, 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 full 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 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, 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, I've got. 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 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, are present but not in conscious awareness yet. But the people that you would never guess what they are carrying inside, that 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 holding it together, it's just manifesting physically. 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.

So are the majority of people whom you're 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 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, and said, oh, my God, I can't believe it. And as soon as she saw that she was cured on the spot, 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 having 6, 8, 10 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, you know, because we see it in our practice. How many people had emotional, psychological or physical abuse or trauma. 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?

The only other quick question I have is have you related this to 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 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.

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 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 people 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 a, have 10, 15 minutes at best, and B, they get paid to do procedures, not to talk? How do you. 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 it's, it's. We haven't reached a tipping point yet, but we're a lot further than we were a decade ago.

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.

There's training programs also.

Yeah, and there's training programs. So.

Absolutely. I guess 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 participate. And we'll put all of this in 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 a 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. 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 of 2025 in Boulder, Colorado. Two and a half 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 weeks in advance. So I mentioned that to people. But yeah, we've got those recorded. We have recorded conferences, people who become members. We've got a self treatment course for and we were adding new stuff all the time.

It sounds like an amazing resource. 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 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.

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