Beyond the Medical Model

During a recent webinar focusing on the multi-dimensional nature of pain, the presenter suggested that many chronic conditions may be “autoimmune” in nature, and I felt myself recoiling a bit. I had been taught that in these conditions the immune system, which protects us from disease and infection, attacks the healthy cells in the body by mistake. When I was diagnosed with interstitial cystitis, I would occasionally hear the condition described as a possible autoimmune disorder, and the idea that my body was self-destructing made me feel helpless and fearful.

Over the years I gradually came to appreciate that this description of what is happening in the body is not the absolute truth, but rather one perspective from Western medicine. In the Middle Ages, the study of the body was separated from the investigation of the mind and considerations of the spirit, and medical science grew out of the need to fight off infection. The definition of an autoimmune disorder is a good example of this focused perspective. Symptoms are a direct reflection of mistakes made by the immune system, and the purpose of this system is to protect the body from invasion.

Over the healing years I had many experiences that challenged this perspective and broadened my view of the body from a machine to an intelligent organism. I began to appreciate that my body’s symptoms often reflected what was happening in my mind and spirit too, and sometimes my symptoms were directly related to my beliefs, thought patterns and emotional state. I began to appreciate that my body was not creating problems or attacking me. It was always trying to do its best to survive even when it got stuck in fearful and non-productive patterns. My body was never the enemy, but sometimes it needed help.

Challenging our perspectives about the body can change our beliefs about our illness and alter how we go about helping ourselves to heal. For example, in the case of an autoimmune disorder, the body could be seen as a machine that is attacking itself or as a protector whose responses are in a state of heightened alert. With this second perspective, instead of feeling helpless and afraid, we are empowered and encouraged to find ways to calm and support the body and to give the mind messages that it is safe.

It is true that we are definitely biological beings and the body often benefits from medical intervention. This singular focus has lead to vast knowledge of the body and advancement in medicine. Perhaps we are now ready to recombine this knowledge with an appreciation of our holistic nature. With this new mindset, we can learn to use the connection between our body, mind and spirit to help us heal on all levels.

The Fear Factor


Kate came into my office in despair. She had suffered with sciatica for several months and she had just seen her MRI which showed a mild lumbar spine disc bulge and some pressure on the nerve root. She was worried that the pain would be there for the rest of her life or she would need surgery in order to get better.

Kate is not alone; many of the people I see in pain are frightened about the diagnosis they have received or by the scans they have been shown. This was my experience too, and remember being stunned and afraid when I saw my cervical disc bulges on MRI and when I was diagnosed with interstitial cystitis.

Kate visibly relaxed when I told her that the level of pain is not always directly related to the  severity of the structural problem in the body. As a physical therapist I have heard stories of clients with scary MRIs that are pain free, and others with just mild issues on the scan who are experiencing major pain. There is also evidence that physical signs on Xray and MRI are not directly related to the onset, duration severity or prognosis of low back pain.

To her surprise, Kate was pain free during yoga, meditation and after our session of holistic bodywork.  I too was surprised when I was pain free during yoga class at the start of my chronic pelvic pain condition. For both of us, the physical condition didn’t fully resolve during these therapies, but the pain decreased and this made us wonder if there was something more to our pain than a physical issue.

While we may have physical problems, pain is transmitted by the nervous system and is interpreted in the brain, and there are many factors related to whether these signals are transmitted. Studies on pain perception from the neuroscientist, Lorimer Moseley suggest that the level of pain experienced by a person may be directly related to the perceived threat of the stimulus. The brain receives all types of inputs and it filters out those that it deems crucial for survival, and when an input is considered threatening we may experience it as pain.

This theory matched my personal experience.  It has been eight years since my chronic pelvic pain began, and even though I am pain free on most days, my bladder pain and pelvic floor spasms rear up occasionally. Even though I have the same symptoms, I am now much less fearful  and can remain calmer in the storm. With this mindset, the condition seems to resolve more quickly, and the same symptoms are not as bothersome. When I worked to heal from my chronic neck pain, I attributed my decrease in pain to my physical therapy and home program and changes at the body level. And while this is true, I can now see how the resolution of my pain was related to mental/emotional factors too.  Finding therapists I trusted and actively working to recover gave me a sense of empowerment, and this decreased my fear. During both of my bouts with chronic pain, there seemed to be a direct feedback loop between my level of fear and the level of pain I experienced.


My Top Pain Management Strategies








For those with chronic pelvic pain…here are the top six ways I manage my pain condition and deal with flare-ups when they occur:
1. Myofascial release techniques to affected areas in physical therapy and on my own.
2. Meditative activities that focus on the body such as diaphragmatic breathing, progressive relaxation meditation and yoga.
3. Reiki/ energy work: Treatment from therapists and on my own every day.
4. Introspection: Acknowledging my stress and looking within to determine thoughts/behaviors/emotions that may be contributing to a ramp up of my nervous system.
5. Singing (without restraint): This activity releases emotion and diaphragmatic breathing relaxes the pelvic floor muscles.
6. Activities that bring joy. For me this is visiting with friends, sitting at the ocean, and petting the neighborhood cat.

Breaking the Stress Link


IC/PBS can create pain and inflammation in the bladder, and stress can be a big factor in creating this inflammation.

The human body reacts to stress by pumping adrenaline and then cortisol into the bloodstream to focus the mind and body for immediate action. This amazing response has ensured our survival throughout the ages.

Cortisol in small doses is very helpful, and it turns off the inflammatory response. But when the stress is prolonged and the cells are exposed to a relentless stream of cortisol, they can become desensitized to the hormone. This can create excessive inflammation in the body.

 Consider these ways to break the link between stress, inflammation and pain:

  1. Eat wholesome, anti-inflammatory foods and consider adding fish-oil and supplements to your diet.
  2. When it possible, limit your exposure to situations and people that ramp up your stress.
  3. Look within and consider what thought patterns and emotions might be increasing your stress and try to change them in a positive direction.
  4. Release stress through exercise. When you are hurting, consider low impact activities such as swimming and walking.
  5. Find ways to turn on the parasympathetic/relaxed mode of your nervous system. Consider some of these activities that have been supported by research: meditation, creativity, massage, yoga, tai chi, friends, work you love, laughing, exercising, and playing with animals.

Photo by: Jacqueline Meltcher Baker

Navy Seal Demonstrates “Unwinding”

This Navy Seal and I did not know that the body had an innate capability to spontaneous release in this way until we experienced it ourselves. This physical response can also be accompanied by a release of emotion or recollections of past experiences/traumas. My CranioSacral therapist, Karen Axelrod CMT, D-CST, sent me this link and told me that the movements demonstrated in this video mimicked how my body moved during our treatment sessions. These spontaneous movements are often called “unwinding” and they can take many different forms. When my pain condition ramps up- moving in this way calms my nervous system, relaxes the muscles throughout my pelvic area and legs, and decreases my pain.

Everything Strange Is Not Pathology

A few years ago, I joined a discussion group that shared information that pertained to reality beyond what one could pick up with the five senses. People brought in information from science, religion and personal experience, so one week I shared my experience with spontaneous movements often referred to as “unwinding”. (See “unwinding” blog post for a description).

When I finished speaking, a woman frowned at me and said, “A few years ago, whenever I saw pizza it smelled like popcorn. I went to the doctor and found out I had a brain tumor.”
“Are you suggesting I get an MRI?” I asked.

I understood this woman’s viewpoint, because before my illness I would have written off many of my experiences as an alteration in the brain due to the chronic pain, depression, or the side effect of some medication. I still don’t have concrete explanations for these happenings. But for me they are real and related to my personal healing, and not just a sign of pathology.

After one doctor heard about some of my experiences, she commented that it was important to first rule out that the changes weren’t happening because of some disease process, and then you could entertain that it was related to something more.

Over the years, these happenings gradually shifted my perspective and I began to accept them as real, meaningful and related to my healing. I learned that everything strange is not pathology.


DSCN5392It all began eighteen months into my illness during an acupuncture session. After lying there for about fifteen minutes, I felt tingling in my left foot, which then progressed up my left leg. Slowly and spontaneously, my chin started to tuck and my neck elongated. It felt like my head was being gently pulled away from my body. I wasn’t moving this way consciously; it was just happening to me. I could stop the movement at any time, but if I relaxed, it continued. It is an understatement to say that this was a really strange experience, but I wasn’t afraid and didn’t resist. The movement felt just like the cervical traction I had undergone to alleviate the pain of previous neck injuries, and that familiarity was comforting to me. It was also easier for me to accept because it was happening in response to acupuncture, and I knew that this type of treatment had been healing for me in the past.

A few days later, I woke up one morning and my neck began moving just like it had during the acupuncture session. Then, every day for a full month, right when I woke up or right before I fell asleep, my body would spontaneously move with new movements being added to the repertoire. The pattern of muscle activation and the timing were always different. Sometimes, there would be long-held postures; other times, slow or fast oscillations would occur. At first, the movements happened only when I was relaxed in bed. But after a while, my entire body would move spontaneously whenever I allowed it and in any position, even standing.

When I showed the movements to my doctors, they said they had never seen motions like that before. They told me it was obvious the movements were not in my conscious control, but they didn’t think they were pathological. The movements seemed to be related to healing because my overall discomfort lessened as soon as these movements began.The movements seemed to calm my nervous system and release the tension in the muscles and tissues of my body. On several occasions, my body went into its spontaneous movement while my physical therapist was working on a stiff/inflexible area of my body, and the area she was working on completely softened and felt like normal tissue.

Both of my doctors hypothesized that these movements might be a way my body was releasing tension and trying to heal itself. The movements seemed to be related to moving or releasing energy, because once the movement stopped, I would feel light tingling throughout my body, similar to how I felt during other energy work, like acupuncture and Reiki.

Later, when I took courses for the complementary treatments, CranioSacral Therapy and Myofascial Release, I witnessing many people moving in a similar way and found out that these types of movements are sometimes referred to as “unwinding”. I have also met other people who experienced these movements without having prior knowledge of them. Just like me, their movements were not directly linked to belief, group dynamics or the power of suggestion.

This was one of the most surprising experiences on my journey to health, and it helped me appreciate the natural, self-healing potential of the body. I also learned that not everything  weird is pathology!

The Nervous System Link

1069149_542842402443143_483982884_nInterstitial cystitis often coexists and overlaps with other syndromes such as fibromyalgia, chronic fatigue, and irritable bowel syndrome. A new study in the Journal of Clinical Rheumatology suggests that an overactive sympathetic nervous system may be the common factor linking these conditions. The study reviewed 196 published, case-control studies that investigated the performance of the sympathetic nervous system in people with these conditions. The common methods used to evaluate sympathetic function included: heart rate variability analysis, sympathetic skin response, tilt table testing and genetic studies. A majority of the studies (65%) described sympathetic nervous system predominance, providing some evidence to support this factor as a possible reason for why these syndromes often occur together.

Heightened activity of the sympathetic nervous system was a key factor in my condition, and I directly experienced the connection between my nervous system ramp up and my physical symptoms (pelvic floor muscle spasms and bladder pain). Treatments like yoga, meditation, deep breathing, walking in nature, and CranioSacral therapy helped to calm my nervous system and decrease my pain. I also worked for years with a therapist and uncovered unconscious trauma, beliefs and thought patterns that may have heightened my sense of threat and put my nervous system on high alert.

Over the years, my body gradually calmed down, and I am currently pain-free on most days without medications. Now, my body no longer screams in pain when it is stressed. It whispers and I listen.

(Photo by Mariane Gabriel)

The Body Speaks

IMG_0146I met Ana, a young photographer, at a beautiful beach-side resort and we spent the morning strolling around shooting author pictures.

When I told her that my life was now very quiet, she confided that her life had a manic pace, and she needed to stop running around so much. A bit later, she told me that her sister died two weeks before from liver cancer, and it was shocking because she was in her twenties and had lived a very clean life. When we walked up the steps near the beach she commented that her legs were tired and sore.

An hour later, I mentioned that I had just seen a TED talk by Dr. Lissa Rankin where she described how suppressed emotion could cause internal stress and compromise health. Manda replied, “I’ve been trying to exercise to relieve some of the stress, but I’m just so tired. I usually jog about three miles, but last night I could only walk, and today my legs feel like I ran a marathon.”

“Your body knows. What do you think it’s telling you?”

“Stop running.”

On some level, Ana already knew what she needed to do to heal, and now she was listening.

Anatomy of the Mind/Body Connection

In her TED talk, Dr. Lissa Rankin gives the following simple explanation of the mind/body connection.

2014-03-08 13.29.21 HDRIn a stress response, negative thoughts/beliefs/feelings are perceived as a threat. This signals the lower parts of the brain. Messages are sent from the amygdala to the hypothalamus to the pituitary gland. The pituitary gland signals the adrenal glands, which then excrete the hormones cortisone, norepinephrine and epinephrine. This stress response triggers the sympathetic nervous system, and puts us into the fight/flight mode.

According to Dr. Rankin, most people have 50 stress responses a day, and some people can have more than twice as many. I suspect that my body was often in this stressed, fight/flight mode throughout my life, and this contributed to the development of my pain condition.


The parasympathetic nervous system gives us the counter balancing relaxation response and contains the hormones oxytocin, dopamine, and the endorphins. Dr. Rankin postulates that when the nervous system is relaxed, the body’s natural self-repair mechanisms flip on. Some activities that the research shows may turn on the parasympathetic/relaxed side of the nervous system are: meditation, creativity, massage, yoga, tai chi, friends, work you love, laughing, exercising, and playing with animals.

To heal my pain condition, it was helpful to discover my unconscious thoughts/beliefs/feelings that were stressful, and work through them. Then they no longer became a trigger for the fight/flight response in my body. It was also helpful to actively engage the parasympathetic nervous system, and many of the activities that were effective in the research were also helpful for me. When I learned to live on the calmer side of the nervous system, it helped to restore my happiness and health.