513: Psychophysiology Breakthrough Cure For Long Haul and Pain

Unlock the secrets to overcoming chronic pain and illness as Dr. David Clarke, a trailblazer in psychophysiologic disorders, reveals a revolutionary, drug-free path to recovery. Our latest episode goes beyond the surface of physical ailments, exploring the deep-seated emotional traumas that often fuel persistent health challenges. Dr. Clarke's expertise shines as we traverse the landscape of mind-body therapies, offering hope and transformative healing practices for those afflicted by conditions like long-haul COVID, chronic pain, and unexplained medical symptoms.

Ashley James And Dr. David Clarke

Highlights:

  • Treatment for Chronic Pain and Illnesses
  • Mind-Body Connection in Chronic Pain
  • Discovering the Mind-Body Connection
  • Long-term Impacts of Childhood Stress
  • Top Therapies for Chronic Pain
  • Understanding and Treating Chronic Pain
  • ACEs' Impact and Coping Strategies
  • Childhood Trauma and Its Physical Impact
  • Effective Therapy and Preventing Chronic Stress
  • Combined Therapies and Introduction to Timeline Therapy

Intro:

Hello True Health Seekers and welcome to another exciting episode of the Learn True Health podcast. I am so excited. If you listen to today's interview with Dr. David Clarke, it's possibly one of the most important interviews I have ever done in the last seven years and will ever do. 

He presents today the now proven treatment that is drug-free, that very quickly helps people to recover from chronic pain, from unexplained illness, from those mystery illnesses. Right. When the doctors are like, well, we've done everything we can do and you still are sick, those kind of things get resolved and even long haul covid. It's restoring people back to their true health and I'm just so thrilled that we can get this information out there. Please share this with those you care about, share this with everyone, because we've got to get this out there. This one interview, the information that Dr. David Clarke has the potential to completely change the entire world of medicine, the entire world of healthcare. That's how exciting it is, and before we get to that, I'm going to blast through six sales that are coming up or have just started that I want you to know about, because these are my favorite health companies and they're giving us huge discounts for Black Friday for the Thanksgiving 2023. 

But if you're listening to this and it's no longer Thanksgiving, I want you to go to learntruehealth.com/awesome. That's learntruehealth.com/awesome to get the latest discounts that I secure for my listeners. All my top favorite health things that I want you guys to know about. The list is always there and it's always going to get updated to the latest stuff, so go check that out. But right now, if you're listening and you just dropped this episode and you're just listening during November 2023, here's the sales I want you to know about. I'm going to go through this list really fast and then we're going to get to the episode. Analemma, which is the structured water device. I did two interviews on it. Fascinating. I've been using it with my family for a whole year. We absolutely love it and love the health effects that we get from it. The discount is 25% off all their products, including they have a whole house unit, and there's some great studies coming out about how bathing in this structured water, significantly, improves heart health and other biomarkers, even your cellular energy production, the ATP production, and your mitochondrial health is improved and your microbiome of your gut is improved. It's very cool. So listeners can use the coupon code LTH25. LTH is Learn True Health 25 and that's going on from November 17th until November 26th. Use the link learntruehealth.com/structuredwater to get there and check it out. That's coupon code LTH25. 

Sunlighten is my favorite sauna. I've got my sauna right here beside me in the office and I absolutely love using it, especially in the fall and winter time. But even in the summer I'll jump in there because there's nothing more refreshing than detoxing in the sauna any time of year. Learntruehealth.com/sunlightensauna.Pre-Black Friday sale goes from November 13th to the 25th, so that's already started. You save up to $1,149. That includes free shipping on certain models. You just want to call them really and just say, Hey, Ashley James sent me from Learn True Health podcast. You guys give us a special discount because they do, and they specifically give my listeners a special deal and I talk to them about that. And then after the November 27th to December 1st, they are doing the biggest savings on the Amplify, which is one of their models, and it's going to be over $950 off. And I believe that also includes free shipping, because that's what we get for my listeners. 

The next one my favorite Magnesium Soak. I've been raving about this for about six years now, along with the magnesium cream and the magnesium muscle cream. Right now, when you go to livingthegoodlifenaturally.com, it says 25% off. However, at the checkout, use coupon code LTH. Make sure you always use coupon code LTH on that website and it'll add an additional 10% off, bringing it to a total of 35% off. I always stock up every year when it comes to this big, big sale that she does and she gives us an extra discount, and that's really nice of her. 

Now the Aloe Drink. The medicinal aloe drink. I have three interviews about this. The medicinal aloe drink you can go to learntruehealth.com/aloe. Make sure you use the coupon code and this is going to expire on the 26th of November. BFLTH as in Black Friday, Learn True Health, so BFLTH. That gives you 7% off. I know that's not much, but he has really low margins and this is the best medicinal aloe drink I have ever found, so I'll take it. I'll take the savings. And also, before the Learn True Health listeners use that link, he does throw in his amazing aloe cream and I absolutely love it. It's my favorite hand cream. 

Okay, second to last Organix Bed. I've been sleeping on this for several years, and I will never sleep on another mattress again, if I can help it. When we go on vacations, we actually like, really don't look forward to any beds and except our own, and we love coming back for our vacations because of how amazing this mattress is. This mattress is healing for the back. I've done several interviews about this. I've raved about it before. 

You can go to learntruehealth.com/organix with an X O-R-G-A-N-I-X learntruehealth.com/organix. Now here's the new deal, because they already give us a really great discount and everything we get 10% off, free shipping. We get a free mattress protector, free bamboo sheets, you can choose the sheets, or you can choose two non-toxic, chemical free, healthy pillows. Plus, I'm going to give you the latest copy of my book, which is about to be published. 

If you do decide to go for the Organix mattress right now and that deal is ending soon so if you are up for a new mattress, we're supposed to replace it every five years. If you can believe that it's kind of crazy. Organix mattress lasts for over 25 years. You will be buying this mattress and it's possibly sleep on it the rest of your life. It's that amazing and it doesn't break down like regular mattresses. It's paying for two mattresses but then you're getting six mattresses out of it. It is so like heaven sleeping on this thing. 

Lastly, the InSuit for Integrative Nutrition, which is where I went to become a health coach. They're offering the biggest sale I've ever seen them do. They recently merged with Dr Chopra. All of his courses are also offered there. If you're like I'm not interested in being a health coach, well, they have other courses. 

You got to go check it out. Please go to learntruehealth.com/healthcoachtraining. That's learntruehealth.com/healthcoachtraining. Be sure to use the coupon code AshleyJames20. I couldn't get them to do LTH, just their system needed more letters or whatever. AshleyJames20. In total, you're getting 45% off their health coach training program right now and the sale ends on the 25th. That is huge. I've never seen them do that significant of a discount. It is an amazing program. I highly recommend checking it out. If you're curious and you just want to see more and get a sample class, go to learntruehealth.com/coach. That gets you a sample class. It's 45% off for the health coach training program with coupon code AshleyJames20. When you go to learntruehealth.com/healthcoachtraining, it's 35% off, I believe for their other trainings. They've got a ton of them. Go check it out. It's really cool. 

There's a few other health-related Black Friday sales that I'm seeing coming up that I'm going to possibly be talking about next week, just to let you guys know but these are the major ones. Thank you so much for sticking around and listening to them.

Today's interview is mind-blowing and I'm so excited to bring it to you. Please come join the Facebook group, the LearnTrue Health Facebook group, so we can have a discussion about this afterwards. I just really think it's important that we get together as a community to talk about this, to share our thoughts on it and to learn from other people's thoughts and experiences. Come join the community. Let's chat about this. You can always reach out to me. You can email me, ashley@learntruehealthcom. I'd love to hear from you if you have any questions or comments, but, really, the Facebook group is where we all get together as a community. The listeners get to learn from each other and share and feel a part of something. It's kind of a lonely world out there. When I'm just talking into a mic and you're just sitting there listening. It kind of feels lonely. But I'm reaching through the mic, I'm giving you a hug and I'm saying we're here, we're all in this together and I support you and we support each other. Come join the Facebook group so we can do that with each other. 

Also, go to my website, learntruehealth.com, and sign up for my newsletter, if you haven't already. It's not really a newsletter. I just like maybe send one or two emails out a month on average, just sharing the latest news in this arena when it comes to helping you achieve true health. With that being said, I hope everyone has a wonderful Thanksgiving in America. To all my American friends a wonderful Thanksgiving, and, around the world, I wish all of you true health. Enjoy today's interview. 

Ashley James (09:58.011)

Welcome to the Learn True Health podcast. I'm your host, Ashley James. This is Episode 513. 

I am so excited for today's guest. We have Dr. David Clarke on the show endchronicpainorg. This is such a fascinating topic to get into. The mind, is something we're just beginning to understand, we're just beginning to explore. I kind of imagine us like we're in the 1500s and we're discovering the Americas and we're discovering all these new areas around the world. That's where we are when it comes to understanding the mind. We know so little and we're always amazed by how much we can learn. And when I saw the study that you're here to talk about today, where they have such a powerful breakthrough when it came to long haul covid, I just had to have you on the show. Now, you are the president of and let's see if I can even say this correctly Psychophysiological Disorders Association. Is that correct? 

Dr. David Clarke (11:05.409)

Almost, yes. We dropped that little AL at the end because it's got way too many syllables as it is, so we call it the Psychophysiologic Disorders Association, and the easiest way to think about it is that it's a blend of psychology and physiology.

Ashley James (11:22.683)

Which makes perfect sense because when we go to the doctor, the doctor says, oh, it must be in your head, go to the shrink. And we feel really hurt by that because it's like, no, my pain is real, my suffering is real, and you're telling me I'm just making it up. And that's not necessarily what they're saying. They're saying that the mind and the body are intimately connected and that the mind does impact the physical body and vice versa. And it's so interesting that you get to explore this area. It's so unchartered, right? It's worth learning new and new things every day about the mind-body connection, how powerful it is. I have been fascinated by this subject my entire life. I remember a teenager reading books on the mind-body connection. And here we have your studies showing how you can turn off chronic pain, like endchronicpain.org. And now with your new study on how we can help those who are suffering from long covid. I'm so excited to have you come and teach us today. 

Dr. David Clarke (12:34.152)

Thank you, I'm delighted to be here. And you know, patients should be angry when they hear that something is supposedly all in their head because that's the last thing it is. We've found real anatomic changes in the brain in people that have these conditions. That's why we have physiology in our name because those are the processes of the body. And there are anatomic differences that have come about because of stress.

And the stress is largely unrecognized. When you would think that a stress that was severe enough to produce physical illness in somebody's body, pain or otherwise, that the stress would be obvious, but actually it's not. And the stresses can come from the remote past, from adversity in childhood, they can be going on in the present day, but just simply not recognized for how powerful they are. But all of this turns out to be good news because if we can identify what those stresses are, and we know how to do that in 2023, we can almost always treat them successfully. And when we do that, as was shown in this study, people's physical symptoms, even severe, long-lasting, multiple symptoms can respond dramatically. And the long covid study was a group of people who had been suffering for an average of nine months. They had 23 adults under the age of 60 that were studied. And this was done at Harvard, but it's just one more example of what psychophysiologic work can accomplish. So these patients had been very ill with their long covid, and they were treated with exactly the approach I was just outlining, uncovering the sources of stress, which can include emotions, it can include things that are triggering for you in the present day, it can include long-term impacts from the past, such as personality traits that are stressful, and they help people identify these, work through them, and in a matter of weeks, there was dramatic improvement, 80% improvement in shortness of breath, 77% improvement in how pain was interfering with their activity, 74% in pain anxiety, 67% improvement in brain fog. Other body symptoms improved 60% and on down the line with physical limitations, average pain through the day, gastrointestinal symptoms, and even fatigue was 44% better. And the other dramatic finding that was a standout to me is that a majority of the patients had experienced that exercise made their symptoms worse. But after eight weeks of treatment, only 4% was that still the case.

Ashley James (15:35.715)

Oh my gosh, that is so cool. Because long haul covid, there's all these different symptoms and we think this virus destroyed my body and I'm left ravaged. And there's over 8 million people suffering from it. We know it's a real thing. And they're just wondering, do I ever get my body back? Is this something like mono where we have to wait a whole year? Do I ever get my body back? And that was so stressful. I mean, the last few years have been stressful for everyone. But people who have suffered from covid and survived, it was such a traumatic event for so many people, myself included, and then to then have day-to-day suffering compounds the stress. So, it's this catch-22 because the past was stressful. Now the present is even more stressful because they're stressing about their current symptoms. And then you're saying that finding the causes of stress and helping to relieve them and solve them was the key to helping their body get on the other side of long haul covid.

Dr. David Clarke (16:44.593)

Yes, absolutely. It's a perfectly natural assumption that if you are feeling something in your body, if you've got pain or illness, that there must be a disease or injury going on that is causing it. And that if only you can find the right doctor or the right diagnostic test or the right treatment, that you're going to be able to do something about that disease or injury. And people go from doctor to doctor, they get specialty evaluations, they go see alternative health clinicians, they try different diets, they try medications, they try supplements, sometimes depending on the symptom, they will try various manufactured devices, all with this intense focus on there must be something structurally wrong with the body. But it turns out that you can have just as severe symptoms, just as long lasting, even multiple symptoms that are generated by the brain. The classic example that's kind of an analogy for all this is what's called phantom limb pain, where a person has had an amputation, but they feel pain in the location of the missing limb. Now, obviously, the limb isn't doing that because it's not there anymore. The only place this can be coming from is in the brain.

And it turns out that the brain can do this literally from head to toe in people who've never come close to having an amputation. And the reason why the brain is doing that is again because of this stress. So that means the whole focus of diagnosis has to shift, that we need to move our attention from what's going on in our bodies to what is going on in our brains. And from there,

to what's happening in our lives or happened in the past. And when we do that, that's when the solutions begin to appear. 

One of my patients, I'll just give you an example of how dramatically this can turn around. She was hospitalized at a major university medical center on the West Coast 60 times in 15 years. And no diagnosis. She had her attacks were nausea, vomiting, and extreme dizziness, just to describe her symptoms. And she saw gastroenterologists like myself. She saw a neurologist. She saw ear, nose, and throat specialists. And when they all were unsuccessful, and she saw a dozen of them, they had her see a psychiatrist in the third year of her illness. And he evaluated her according to the normal approach that mental health professionals are taught, looking for depression, anxiety, post-traumatic stress, personality disorders, and she didn't have any of those things. And so he sent her back to the medical doctors and said, she's fine mentally, which is true from the vast majority of my patients. They're very strong people actually. But she happened to have one of her attacks when she was in Portland, Oregon, which is where I'm based.

When I went to see her, she said something I'd never heard from any other patient, which was, thank you for coming, doctor, but you're wasting your time. You'd be better off seeing your other patients. She was in such despair. But you can imagine, 15 years, major university hospital, no answers. But even though this was early in my career, I knew what to look for, which was to find a stress, either in the present day or the past. And it turned out she had significant amounts of both that were directly linked to her attacks of these dizziness and vomiting episodes. And just by showing her that connection, she was well on the spot, just bringing the stress into her conscious awareness when she could see it, think about it, do something about it. She went home from the hospital the next day. She called me a year later. She'd gone the entire year without a single attack.

Ashley James (20:57.941)

Oh my gosh, this doesn't make sense when we think about the brain, its job is supposed to help us survive, right? The brain's job is supposed to get us through life and, anything that's not conscious, right? All the autonomic functions, everything about the brain is to keep the heart beating, to keep the blood flowing, to keep us hunting or gathering and for another day, mating, right? It's supposed to keep going. And yet now we're seeing when we have a certain amount of stress, it could be emotional, mental, physical, spiritual, we've got some kind of stressor or unresolved stress from the past that we're bringing into the now, that the body is just manifesting things physically. It's breaking down and manifesting things physically. And that doesn't make sense because isn't the brain's job intended to protect us and keep us in, keep us living.

Dr. David Clarke (22:00.071)

Yes, and you're talking about the fight or flight nervous system and that absolutely the sympathetic nervous system absolutely is designed to keep us alive in a stressful situation. But the reaction to that is when the stress goes away, your fight or flight nervous system can settle down and then the rest and digest nervous system can take over. So it's natural to have a back and forth between the two.

But if you are feeling like you are constantly under threat, then your sympathetic nervous system is turned on all the time and it begins to have its impact on the body. And you're constantly under threat when there is a stress going on in your life that you're not recognizing. It's impacting you, but you don't know how to make it go away because you don't know where it's coming from. And until you recognize it and bring it into your conscious awareness and get some help in reducing it, it's going to be impacting your sympathetic nervous system. Everybody's had a psychophysiologic stress at one time or another, or psychophysiologic symptom at one time or another. A classic example is blushing with embarrassment. That's a mind-to-body reaction. Same with feeling a knot in your abdomen when you're in a tense situation. That's a mind to body reaction. There are countless expressions in our language that wouldn't exist without there being a brain to body or mind to body connection. And that's something like a spine tingling excitement or heart pounding thrills, for example. There's scores of those. But the good news is that if you know what to look for, we can uncover what's going on, bring it out into the open where we can see it, think about it and do something about it. And then people get better like that patient who was hospitalized so many times. I wish I could say I get people better that quickly in every case. I certainly don't. There are many patients who need up to several years of psychotherapy to achieve the same outcome. But even those patients once they've identified the stress, they can see that they're on a pathway toward recovery. They can see that they've found the source of the problem, that it wasn't in their body, and that they can use their cognitive skills to overcome it.

Ashley James (24:40.342)

So before you became a doctor, you received a degree in psychology. Is that where you started to see this, that it was so important to look at the stressors in someone's life? Did you have an aha moment or is it something you pieced together over time?

Dr. David Clarke (24:55.946)

No, there was definitely an aha moment. My degree in psychology was just a bachelor's degree and it didn't really include a lot of information about individuals who were struggling with these issues. It was more just general background. Honestly, I never expected to use it again. I was on a pathway toward becoming a garden variety gastrointestinal specialist. We put camera tubes inside people and do all kinds of interesting things in their GI tract. That's what I was headed for. And I was having a good career up to that point. My formal training years were going very well. I got an award for excellence in medical school. I was at a top training program at Harbor UCLA Medical Center. I was passing my board examinations with excellent scores. So I was completely unprepared to run into a patient that I didn't know the first thing about diagnosing or treating because this isn't taught in medical school, even to this day. This huge issue that affects 40% of people who come to see the doctor in outpatient care is just simply not taught. So when I met this patient, she was a 37-year-old woman who had been referred from another university because she was having an average of one bowel movement per month. And…yes, that's what I said. I mean, I'd never heard of such a severe disruption. And she had already had almost every diagnostic test. The reason that she was sent to us is that we did very specialized testing of the muscle contractions and the nerve impulses in the large intestine. And my department chair and I were completely convinced that test was going to be abnormal because what other explanation was possible or so we thought. And this woman was taking four different laxatives at double the usual doses and it wasn't doing a thing. So we knew this test was going to be abnormal. But we were very surprised and perplexed when that test was perfectly normal also. And we just threw up our hands and it was left to me to do the exit interview with this woman and just basically tell her she was going to have to live with it.

I didn't want to just walk in and tell her she was going to have to live with it and walk out. So I asked her about stress, knowing it was going to be a waste of time because everybody else had asked her about stress and she didn't have any. She was happily married, she had two nice kids, she enjoyed her job. And then I asked her about, well, were you under any stress earlier? Thinking, well, maybe something happened two years ago when her illness first started.

And she interpreted the question to mean way earlier. And she said, well, my father molested me. And when I heard that, I didn't know what to say because I had no training in asking people about childhood abuse. I had no experience with it. I was worried that if I asked her too many questions about it, it might make her very emotional and cause her a lot of pain to have to discuss that. But I didn't know what else to do. And so I fell back on my early training, which was take a history, find out the details, get the exact story of what happened. So that's what I did. And she seemed to be perfectly calm about it. I mean, she was describing what happened to her in the same tone of voice you'd use to read a grocery list.

And it turned out that her father had sexually abused her hundreds of times, up to the age of 12. And then he stopped. And for the next 25 years, nobody touched her against her will. So I'm sitting there thinking, this can't possibly be relevant. I mean, she's been away from this horrible, horrible event for 25 years how can it possibly be connected to this very severe physical illness that she has? I didn't think that was possible, but I knew of a psychiatrist at UCLA that was certified in internal medicine as well that had an interest in patients like this. So I thought at least I've got something I can do for this patient. At least we can maybe help her live with this condition a little better.

So I arranged for the patient to see the psychiatrist, Harriet Kaplan, and forgot all about her for the next several months, until I ran into Dr. Kaplan in an elevator. And just to make conversation, I said, whatever happened to that patient that I referred to you? And she said, oh, I haven't seen her in a few weeks. She's fine now. And that just upended my world.

Because the idea that you could alleviate a really serious physical condition just by talking to somebody for, in her case, an hour a week for 10 weeks is what it worked out to be. That was impossible as far as I was concerned. I was in the eighth year of my formal training and nobody had ever mentioned that such a thing was possible- just completely shocked me. But I decided, if I want to be a complete doctor, I should know a little more about this because if I've seen one patient with this condition, I might see a few more over the course of my career. So I prevailed on Dr. Kaplan to teach me her framework for how she thought about this kind of illness and how she approached it, what kinds of questions she asked, and over the next year and a half of my training before I went into private practice in Oregon, learned the basics, never thinking I would use it very much. And now we're 7,000 plus patients later.

Ashley James (31:21.962)

Did you follow up with that patient to hear her side of the story or like how do we know that she is having healthy bowel movements now?

Dr. David Clarke (31:33.769)

Well, that's a good question, but she was welcome to return either to me or to Dr. Kaplan at any time and never needed it. She was, according to Dr. Kaplan, she was even able to stop taking all of the laxatives. It basically went all the way back to normal. It was like my patient with the attacks of severe dizziness and vomiting, who in her case, didn't even need 10 weeks. I mean, just in the course of, one 50-minute conversation, that was the end of her condition.

Ashley James (32.12:990)

God bless you. Just the intuition you had to listen, even though it was uncomfortable, and to get curious and ask questions and to want to explore this. There's so many doctors out there that would have shied away from that. And you leaned in towards it and look what it's achieved. Look how many people you've helped and how many people you're helping. I'm just so ecstatic for the work that you're doing.

Dr. David Clarke (32:41.931)

Thank you. Well, it turned out to be among the most rewarding in my practice, to be able to alleviate someone's serious physical condition just by talking to them. Sometimes your best medical instrument is your brain and what it knows. And we don't necessarily always need the high technology that was, frankly, heavily used in two-thirds of my practice.

But the other one third, being able to see people recognize what was happening, being able to make the connections to stresses that were often not obvious at all. We had to do some real searching to find what the connections were that were making people ill. But it was just tremendous to be able to do that. And I've seen this with other doctors too.

We have a course on our website, the endchronicpain.org that you mentioned earlier that some doctors in a medium-sized city that I worked with, took the course, just three of them and their psychologist they collaborated with. Took the course at first, and it just transformed their practice. They suddenly the 40% of patients who had been a tremendous source of frustration for them.

They couldn't help them, they didn't know what to do. The patients were truly physically ill in a variety of ways, but the doctors, after looking for biological explanations and not finding any, didn't know what to do next. So after they took the course, then they knew what to look for, just as I'd learned from Dr. Kaplan. And all of a sudden, these patients started getting better. And one of the doctors took me aside at a conference and said, these ideas, have put the joy back into my work. That was wonderful to hear. And then three years later, it had spread. They had such enthusiasm for this that it spread from the original three doctors to now, as of a year ago, 72 doctors are using these ideas.

Ashley James (34.55.521)

Well, I want to keep spreading that. Everyone who's listening, share this with your doctor. This is something they could also be trained in. I think every doctor should be trained in this. What did you say the percentage was of people who come into the doctor's office? What percentage was psychophysiologic?

Dr. David Clarke (35:18.093)

A review article that looked at that question in 32 different studies from two dozen countries around the world and the average was about 40% that had real body symptoms but no organ disease or structural injury to explain it. So it's about 20% of the adult population or 50 million people in the United States alone.

Ashley James (35:45.756)

Well, the pharmaceutical companies do not want that to get out because they would get a significant pay cut if like 20% of adults were able to resolve their issues by getting to the root cause of their stress and managing it.

Dr. David Clarke (36:04.832)

Yes, it's definitely going to change medical practice once these ideas become common knowledge. Even better news is now that we have gold standard science that backs up the anecdotes that I'm sharing with you. We have randomized controlled trials. In addition to the long covid study, there are studies of pain patients from Harvard, from Detroit, from the Boulder back pain study is a great one. And there was one of older male veterans, usually a very difficult group to treat successfully for chronic pain. And they got dramatic results in Los Angeles. And these are controlled trials. This is very solid gold standard science that is showing that if you know how to talk to patients, what issues to bring up and how to discuss them, that you can make a huge difference. The Boulder back pain study, they had three groups of 50 patients each, and the 50 that got the pain relief psychology, which is the sort of umbrella term for this kind of work, they just got eight sessions, two sessions a week for four weeks, and their pain scores dropped dramatically. After an average of 10 years these people had been suffering with low back pain, their pain scores dropped from over four down to one on average in four weeks. It was just astounding. Nothing like this from talk therapy alone had ever been seen in a randomized controlled trial. But it's just exactly what I saw in my office every day.

Ashley James (37:54.738)

And that is so exciting. A lot of the listeners, are familiar with the concept of fight or flight, the sympathetic nervous system response, and then rest and digest, the parasympathetic. But we're not all aware of what are the physiological changes that take place when we get stuck in the sympathetic nervous system response. So like we shunt blood away from the core, away from our organs, our digestion kind of like goes on hiatus, shunt blood away from the logic centers of the brain, but could you kind of walk us through, like, let's say we're stuck for one day, one week, one month, what begins to break down in the body? There's even epigenetic changes that can take place when we are stuck in that stress response for too long.

Dr. David Clarke (38:48.544)

Yes, the differences over time can be, let's say, significant and profound. All the details haven't been completely worked out, but it definitely has long-term impacts. There's increased rates of a variety of conditions.

One of the places you can get the hard and fast data is from the ACEs study. And I should say ACEs studies because there are now scores of them where the stress was inflicted on people as children. ACEs stands for Adverse Childhood Experiences. And these were categorized into 10 different groups in the original paper from 1998. And the more of the 10 that you had the more likely you were to suffer long-term consequences. So some of the long-term consequences are psychological and behavioral. For example, depression, suicide, intravenous drug abuse, alcoholism, obesity. But there are also organ disease impacts as well. There's higher incidences of heart disease, cancer, diabetes, autoimmune disease. And the working theory at this point is that stress in children turns on the inflammatory system in the body, has effects on the immune system, and that chronic inflammation is what leads to the damage in what we call the end organs, the heart, the circulatory system, the fat tissue, and produces these long-term effects on the body. My particular focus is not so much the organ diseases as it is the processing of signals that are coming from the body and being interpreted as painful by the brain. Again, coming back to that idea of the phantom limb syndrome that the brain is interpreting signals from the body as being painful. And that if we can help people understand the stresses that have changed the circuits in the brain, we can change them back. The Boulder Back Pain Study included, as part of the work that they did, scans of the brain. And what they found was that the pain relief psychotherapy actually changed the brain back to a healthy pattern. It rearranged those circuits so that was why the pain was relieved.

Ashley James (41:43.710)

Many years ago, I read the book Healing Back Pain by Dr. John Sarno, who is just fascinating. I'm sure he would have loved the work you're doing. Back pain that was not explained by scans. There was nothing on the scan to say that it could be causing his back pain. And what he saw was that the brain was creating ischemia. For example, the quadriceps lumborum, which is like the low back muscles would be grabbing. And so ischemia, for those who don't know, it's like cutting off blood flow. So you can imagine if like maybe you sit on the toilet too long, you get pins and needles, it's really painful, right? If you continue to sit there, and then when you get up that pins and needles, it can be like very, very painful. But what he saw was that there was definitely something going on where the brain was grabbing ahold of and squeezing and making almost like a spasm in muscles like the quadriceps lumborum. And to the touch, when you examine it would feel cold. Like it would seem like almost white and cold, like there was less blood flow in the area. And this definitely sounds like stress to me, but specifically when they were shoulding themselves, like I should like my job, I should like this, and even though they hated it. So if they really hated something, it was very stressful in their life, but they were kind of suppressing their feelings around it, and when they suppressed their emotions around it, wouldn't listen, that's when it would present as this ischemia in the muscles. And if they could just listen and ask their body, like what is this, I'm listening, what emotion is present, what emotion is present.

And as they began to feel it, the pain would subside and the muscle would release. And I ended up using that technique with my clients and a lot of them had a really great success, which was just mind blowing. But again, the brain is in the body are affecting each other and this is exactly what you do in your work. And I love that there's so much science now behind it that we can get

other doctors on board, because man, if we could help that, like between 20 and 40% of those people that you talked about that are, you know, coming to the doctor, going to the clinic and they have pain or discomfort or disease or they have symptoms and there's no physiological explanation, then instead of just putting, here's some pills, go home, I have nothing for you, instead of giving up on them we can actually go deeper and find the root cause.

Dr. David Clarke (44:39.772)

Yes, it's very exciting. I should mention that on that same website, the endchronicpain.org, there is a 12 item self-assessment quiz for people that are listening and wondering if perhaps they might have this condition themselves. It's arranged so that the more questions to which you answer yes, the more likely it is that a psychophysiologic disorder or PPD for short is responsible for your symptoms. So that's something easy that people can do. But you're absolutely right in the approach that you took. Many of my patients have, probably a majority of them have experienced adverse childhood experiences and we can't go back and change those, but we can change the long-term impacts. We can make a difference for the effects that those ACEs have had on people in the present day. One of those effects has to do with the emotions. Many of my patients have had anger, fear, shame, grief, or guilt that they're not fully aware of because they've repressed it. But if we can help people connect with those emotions, put them into words, then they can alleviate them. The more of those emotions that are put into words, either written or spoken, the less they need to express themselves via the body. And that's an approach that's helped a lot of people. One of the techniques that I use to help people connect with these unrecognized emotions is to have them imagine themselves as a butterfly on the wall of their childhood home. And to imagine also that a child they care about, whether it's their own child or someone else's, is in that home and is having to cope with whatever adversity there is in that home, while the patient, as a butterfly on the wall, is only allowed to watch and to see what's happening. And this is a very difficult exercise, as you can imagine, but it helps people recognize much more accurately the reality of what they went through because so many people, when they look back, they have a strong tendency to minimize how bad it was. And until they see the reality of it, until they're able to feel the emotions that would be appropriate for someone who is going through this adversity, then those emotions are going to be locked away with the only outlet being into their bodies.

Ashley James (47:32.108)

Wow. I just totally went there. I had my son in my childhood home and I'm already seeing some stuff. I haven't seen before. That's a very interesting exercise. 

Dr. David Clarke (47:43.045)

It’s been very, very useful for my patients, that one. And it's not easy and I see the facial expressions of my patients often change dramatically when I ask them to do this, but it is so useful in cutting through the layers of repression.

Ashley James (48:06.343)

Repression, like you said, we minimize it, or justify it. But if we put someone we care about as like a child in that situation that we were in, and then watch, and then we have empathy for that child, it's like, oh, that empathy is actually for me when I was going through it. Right.

Dr. David Clarke (48:27.585)

That's exactly right.

Ashley James (48:29.884)

Right. Do you have any other exercises that you like to share?

Dr. David Clarke (48:34.165)

Yes, for reaching the emotions, there's one that's kind of completely different, that you cast your mind back to a difficult person or event or situation from the past and just think about that for a moment and then start writing down words and phrases that come to mind about that person, event or situation, just as fast as you can, trying not to worry about spelling or grammar or syntax or whether it makes any sense, just to scribble down every word or phrase that comes to mind about this past event. And keep writing for five or ten minutes, however long it takes, until you feel like you've got every conceivable idea out of your head. And the reason for writing them down so fast is to bypass your cognitive brain. We don't want you thinking about this. We wanna reach into your subconscious and just pull out whatever is boiling and bubbling away in there and get it onto the page. And then once you're done with that, take a look at it, think about it, and start writing complete sentences about what it all means. Try to figure out why those particular words and phrases wound up on the page and start writing complete sentences about the meaning of what you scribbled down. And that is another way to tap into emotions that you might not have been aware of before.

Ashley James (50:16.378)

There are so many different kinds of therapy out there, right? Some types of therapies might be better suited for certain personalities, but as far as your experience with helping people, for example, with chronic pain or PPD, psycho-physiologic issues, do you have like a top three or top five types of therapy, like cognitive behavioral therapy, or, can you say like, oh, these ones have the best results in helping people get to the other side of it and then they resolve their symptoms.

Dr. David Clarke (51:03.323)

Yes, that's a really important question because the new form of treatment that's been developed by a number of us around the country and overseas, what I call pain relief psychotherapy, basically covers three very closely related types of treatment. 

The first is pain reprocessing therapy, which is relatively new, but also straightforward. Straightforward for patients to apply to themselves and for psychotherapists to learn. And then the next one is emotional awareness and expression therapy, which is what I use in combination with the pain reprocessing therapy, but it's emotional awareness and expression is the one that I rely on the most heavily, particularly since the patients that I see tend to be the most complex and severely afflicted and they need kind of a higher level of delving into those repressed emotions and then the third closely related type is intensive short-term dynamic psychotherapy or ISTDP, which is strongly associated with Clinicians based in Halifax, Nova Scotia and it's not as widely available in the United States.

But all three of those share a lot of characteristics. There are chapters about them in our textbook, Psychophysiologic Disorders, that I edited with three other people. And that book is written without jargon. So people who like to read about science even if they're not a healthcare professional, can perfectly easily read that and learn about these forms of treatment.

And it turns out that because we are shifting people's attention toward, from their bodies to stress, because we are delving into repressed emotions, and there are two other whole categories we haven't talked about yet, but because we are focusing on those things, the results are far better than they are with other forms of psychotherapy, because you're right, there are hundreds of different kinds of psychotherapy. 

The dominant one is cognitive behavioral therapy, but it has been scientifically compared with these new forms of treatment and it falls far short, unfortunately. The Los Angeles Veterans Hospital Pain Study, for example, with cognitive behavioral therapy was given to those veterans, only 5% reached the goal for pain relief that they had set before doing the study.

With emotional awareness and expression therapy, it was 42% achieved the goal. So a vast difference, an eightfold difference, just because of a different kind of talking that the patients were getting, that it was delving into emotions and getting people to focus on sources of stress. This is really new. This is not widely available, but there are books about it, as I mentioned, my first book is called They Can't Find Anything Wrong. The Psychophysiologic Disorders textbook is written by 16 different people that had found their way to these same principles. And there's an app now called Curable that I highly recommend. It's taken all of the best ideas in this field and put them into a user interface that you can have on your smartphone or computer.

Ashley James (54:53.346)

Oh, very cool. Well, I'm going to make sure the links to everything that you just discussed is going to be in the show notes of today's podcast at learntruehealth.comCurable app. That's really neat. So someone's listening to this somewhere in the world, not in Canada, like not on the East coast of Canada, so they wouldn't necessarily have access to the ISTDP. Is that what you say? Yep. And how would they get access to all this? Do you have a list of practitioners that can work with them remotely?

Dr. David Clarke (55:29.456)

Yes, we do. On the endchronicpain.org website, we have a practitioner directory and there are practitioners there from around the world who have found their way to these concepts and have taken the available training in it. And there are lots of resources now for professionals who want to learn how to do this. We have the online webinar course on the website. There are other practitioners who provide training in this. The Dr. Abbass who does the ISTDP is regularly traveling around the world giving trainings to professionals. I do presentations on this topic for professionals all the time. A couple of weeks ago, I did 13 hours of presentations in four cities in seven days. So we are definitely trying to get the word out.

And there's going to be a new course in January. I'm very excited about this one. I finished filming for it in late September and the video production company is furiously working away on editing all the footage and we're planning to release it in January. It's going to be a really advanced course about challenging cases, but again, going to be done completely without jargon so that anybody can comprehend it.

Ashley James (56:55.605)

So this course, anyone can take it, but any kind of doctor or practitioner should definitely take it.

Dr. David Clarke (57:05.872)

Yes, I think not only medical professionals, but mental health professionals, because the medical professionals don't learn the psychology of this condition, and the mental health professionals are not taught the particular kinds of issues that can make people physically ill as opposed to having mental health challenges. That's why the psychiatrist at the West Coast University failed to diagnose my patient with the extreme dizziness and vomiting because he didn't know the kinds of issues to look for in somebody who was physically ill. So that's what we teach in the courses. And that's why it's a giant blind spot in the healthcare system that 50 million Americans fall into, because they don't have a biomedical cause for the doctors to find. They don't have a classical mental health condition for the mental health professionals to find and deal with. They kind of fall right in the middle and neither group of professionals really feels like they have the expertise to deal with it. But that absolutely can change and we've seen it change in numerous locations around the world.

Ashley James (58:24.879)

But it's important to grasp that this happens to relatively healthy people. Someone who's listening might go, I don't think I have any trauma. I feel normal. I feel emotionally normal, day to day. But someone could be bumping along in life and then there might be a trigger they're not aware of and then they start having these symptoms and they could be relatively healthy people. And like you said, your patients are strong. They're resilient people. And it just happens, it just starts. It can just start, like for the long haul people, there was like a very known trigger, but when you go deeper, there might've also been adverse childhood experiences. There might also have been stress that they were suppressing emotions that they were suppressing and it compounds.

Dr. David Clarke (59:28.120)

Yes, this is a condition that can happen to anybody. Most of my patients were not aware of the level of stress that they were coping with, mostly because they'd been coping with stress their whole lives. And so it just didn't seem like it was out of the ordinary. I've had countless, countless patients who have told me that their childhood wasn't really that bad. And then when we get into the discussion about it, we begin to see that, well, yes, there were some things that were pretty bad. And then when I do the exercise of having them imagine themselves watching their own kid try to cope with the same stuff, and they get this horrified expression on their faces because they've never truly appreciated before just how tough it really was. I think of my patients like champion weightlifters who are suddenly being asked to carry a weight that's 50 million Americans fall into, because they don't have a biomedical cause for the doctors to find.

They don't have a classical mental health condition for the mental health professionals to find and deal with. They kind of fall right in the middle and neither group of professionals really feels like they have the expertise to deal with it. But that absolutely can change and we've seen it change in numerous locations around the world.

Ashley James (58:24.879)

But it's important to grasp that this happens to relatively healthy people. Someone who's listening might go, I don't think I have any trauma. I feel normal. I feel emotionally normal, day to day. But someone could be bumping along in life and then there might be a trigger they're not aware of and then they start having these symptoms and they could be relatively healthy people. And like you said, your patients are strong. They're resilient people. And it just happens, it just starts. It can just start, like for the long haul people, there was like a very known trigger, but when you go deeper, there might've also been adverse childhood experiences. There might also have been stress that they were suppressing emotions that they were suppressing and it compounds.

Dr. David Clarke (59:28.120)

Yes, this is a condition that can happen to anybody. Most of my patients were not aware of the level of stress that they were coping with, mostly because they'd been coping with stress their whole lives. And so it just didn't seem like it was out of the ordinary. I've had countless, countless patients who have told me that their childhood wasn't really that bad. And then when we get into the discussion about it, we begin to see that, well, yes, there were some things that were pretty bad. And then when I do the exercise of having them imagine themselves watching their own kid try to cope with the same stuff, and they get this horrified expression on their faces because they've never truly appreciated before just how tough it really was. I think of my patients like champion weightlifters who are suddenly being asked to carry a weight that's 50 pounds more than the world record for their weight class, that would break down the strongest person. Their bodies would break down, they would feel like failures, they would not know why they couldn't carry the load anymore. It comes as a big surprise that there's stress involved. 

People have trouble imagining that stress alone could make you physically ill like this. So yes, it comes as a big surprise to people. And the level of illness that you can get from this, that's one of the myths is that it's going to be mild. Absolutely not. I've had many patients in the hospital with this. One of my patients I was asked to see after she'd been in the hospital 70 days, she was getting morphine around the clock, in doses you would normally give to somebody with widespread cancer. You would never convince her in a million years that her pain was due to stress, but it was, we uncovered the stress. She was out of the hospital in a week, and she was off of all the opioids in 30 days.

Ashley James (1:01:44.794)

Amazing. I have friends in my life, I'm thinking of two of them specifically who have had surgeries because of chronic pain, multiple surgeries, and the pain persists beyond. And I've, you know, I'm going to be sharing this episode with them. And I can imagine those who are listening are thinking of their friends and family who have chronic pain. And it's not just chronic pain. Like you said, that there could be the woman who had the vomiting or had another woman who had the constipation. It can be these odd illnesses that don't have an explanation. And but sometimes they get a doctor who says, I know what to do. Let's cut this body part out. That's the problem. And then the problem continues to persist and now they have less body parts.

Dr. David Clarke (1:02:35.068)

Yes, that's unfortunately true. And there are lots of non-pain symptoms, dizziness, trouble swallowing, visual disturbances, seizures that are not due to epilepsy, chronic coughing, difficulty breathing, all kinds of gastrointestinal symptoms, as we mentioned, problems with the pelvis, with the menstrual cycle, with the genitals, with bladder spasms, numbness and tingling, certain kinds of rashes can happen from this. The only common denominator tends to be that people with this condition have more than one symptom at a time, more than one location in the body, or the symptoms can move from place to place. They don't have to, some people just have the one symptom, but the more symptoms you have and the more different locations they are, the more likely it is that PPD is responsible.

Ashley James (1:03:33.542)

Do you have any way to measure stress? Like for example, heart rate variability, is there any way that you could hook someone up to a machine? I know there's blood tests that measure cortisol, but is there any way that you would say you could measure their chronic stress and go, oh right, now we can put this device on you and we can see your stress lowering?

Dr. David Clarke (1:03:57.216)

Yes, I really wish there was. I wish there was a blood test for this condition. If we had a blood test for this, then you can bet that every health care professional would learn how to diagnose and treat this condition, because we could get a blood test for it. And we could see, oh, your PPD level is high. We need to find your stresses, and we're going to make you better because of that. But unfortunately, we don't have that. And I don't expect to see that anytime soon. But when you think about it, because we don't have a blood test, it means that we should spend even more time training healthcare professionals how to figure out what's going on, because it's not so simple without the blood test. But people who have had stress for a long period of time, they get accustomed to it. And when you ask them, do you feel stressed or depressed or anxious, frequently they say no, because they've been living with this for years.

One of my patients, my personal record patient, had PPD symptoms for 79 years. And even that patient, once we uncovered the stress and helped her with it, she got about 60 or 70% better, even after all those years.

Ashley James (1:05:17.027)

Amazing, but, yes, you become habituated to your stress. You become habituated to your environment. So, yes, of course. 

Now this pain, the typical chronic pain that persists, does it come and go? Is there any commonalities? Is it always there? Does it come and go? Does it act almost like a migraine that comes on and there's telltale signs that's coming, or all of the above?

Dr. David Clarke (1:05:45.867)

Yes, all of the above. Everybody's different. And migraines definitely are part of this, fibromyalgia, irritable bowel, all of those are part of this spectrum. But everybody's different. But we definitely, if the patient's symptoms are moving around, if they're highly variable, from with respect to any kind of triggers, then we get suspicious that PPD is responsible. It's really hard to have an organ disease or structural damage cause symptoms that migrate from place to place, or that are highly variable in terms of what triggers them. But I should go back to the point you made earlier about having surgery for this. It comes up most frequently in low back pain because a majority of people over 40 and a large number of people younger than 40 have abnormalities in their spine on an MRI. And this is in people with no symptoms whatsoever, it's just part of the normal aging process. But if you have PPD related back pain and you go to the doctor and they image your spine one way or another, and they find these age-related abnormalities, it is very tempting to say, okay, you've got pain, you've got this abnormality there, let's go in and do surgery and fix this and that's probably going to alleviate your pain. But it turns out that the success rate of surgery for pain is about 30%. If you have evidence of nerve damage, then it's better. But most patients don't have any evidence that they have a damaged nerve. And if they get surgery for back pain, the success rates are terrible. And there was a study from the 90s where they took a whole bunch of patients, I think it was 87 patients who had lumbar spine surgery, low back surgery, and looked at the success rate of the surgery. And they compared it with their ACE score, the adverse childhood experience burden that these individuals had suffered. And it turned out that if you had no ACEs, your success rate from the surgery was pretty good. It was about 95%. But if you were in the top range of people with a lot of ACEs, the success rate for the surgery fell to 15%.

Ashley James (1:08:23.029)

I've never opt into a surgery that had only a 15% success rate, but I guess if you're in chronic pain, you might roll the dice, you know, if it meant, if that was the only answer, right. And now, now you have the answer and we need to get this information out there. Please, everyone listening.

Share endchronicpain.org with your doctors, with your practitioners, with your friends and family. Share this episode with those you care about and everyone. If we can get this out, we could be part of the movement to completely change the way medicine is practiced and the way people are helped. We got to get this information out there. I am so, so thankful for what you do. And I said earlier, God bless you. And I mean it. God bless you for the work that you're doing.

Dr. David Clarke (1:09:20.637)

Thank you.

Ashley James (1:09:21.704)

Absolutely. Now you had said that there's two other categories we haven't even touched on. Can we, can we touch on those?

Dr. David Clarke (1:09:28.571)

You bet. This is a long-term impact of ACEs. And the first category that we did talk about was repressed emotions. That turns out to be the most challenging to diagnose in most cases. But the other two are stressful personality traits that grow directly out of the child's attempts to cope with their adversity. And the third one is triggers that are going on in the present day that are in some way linked to the traumas or stressors of the past. And the personality traits that can be stressful include the most fundamental and important is low self-esteem. This is the common denominator, and my patients who've survived ACEs is that they are made to feel like second-rate human beings, or in some cases, made to feel like worthless pieces of crap. Other personality traits that are kind of linked to that include being excessively self-critical, much more critical of yourself than you would be of others, for example. Having limited self-care skills, people who are devoted to the care of everybody else in their world, but have difficulty putting themselves on the list of those they take care of. So if you ask them, what do they do for fun? They have trouble coming up with very much.

People who are perfectionists, people who are living on high alert all the time, people who suffer from anxiety or depression, people who are focused on pleasing others, who tend to choose narcissistic partners to be in relationships with, or partners who have significant issues or problems that need to be solved. That's, a direct outgrowth from growing up in a home where there were problems in that home and the child trying to survive, trying to make the best of that situation, ends up focusing on trying to solve those problems. So it's not a big surprise when they end up choosing relationship partners for themselves that need a lot of support and they end up in relationships that are not mutually supportive, not balanced, but where the giving from them is not balanced by getting back from the partner. Other ones, self-sacrificing to an excessive degree, difficulty setting boundaries, not being very assertive for your needs, fear of abandonment, need for external validation. And in more extreme cases, you get into coping mechanisms to try to deal with the emotional pain of all this.

And those can include eating disorders, can include self-mutilation behavior, can include all kinds of addictions, not just to substances, but to behaviors like work, sex, food, gambling, exercise, even shopping I've seen in one or two cases. So all of these, as you can imagine, are highly stressful.

And people struggle to make changes. A lot of psychotherapists just accept them as largely a given and don't even try to intervene. But when people see where these came from, that one of the questions I'll ask people is, who taught you these false assumptions about yourself that you need to be the caregiver for everybody, for example, or that you are a second-rate human being. Who taught you this and how did they teach you? And when people can understand where that came from, it truly facilitates making changes.

Ashley James (01:13:36.226)

Oh, man, that is such a good question. Wow. You describe so many people I know and some of me, I was feeling called out there for a sec. I was like, wow. I've done a lot of personal growth work through the years and I can see where I have overcome actually a lot of that. And my parents did the best they could, but I definitely had to go back and work on stuff and heal stuff and I mean, I'm seeing so much of this, exactly what you described, in so many people. 

Dr. David Clarke (01:14:13.071)

Yes, those are the most difficult. I was just working with a patient last week. Her parents clearly meant well, meant the best, but they created an environment of extreme pressure without realizing what it was doing to their child.

Ashley James (01:14:37.175)

Yes. It's not always obvious, right? Emotional abuse or mental abuse. That's the hardest because it doesn't leave a bruise, a broken bone. You know, we can say, Oh, I didn't have abuse as a child. My childhood was fine because there wasn't an alcoholic throwing bottles at my head, like it's not always like Hollywood style, right? And like you said, we do a lot of times we'll repress, we'll justify, well kind of almost blank out. I've talked to people who they sort of don't remember most of their childhood, like big chunks of it, until you start really talking about it and then they start remembering.

Dr. David Clarke (01:15:21.962)

Yes, it can be very difficult to recognize. And so many of my patients have told me, no, my childhood was okay, and then we start talking about it and they start remembering. 

We just have this conversation. One of my patients, we talked for well into my lunch hour because I wasn't finding the stress. And he finally just stopped and said, the only time I ever got praise from my parents was when I did something better than my brothers and sisters could do it. And he had three siblings and they were all very accomplished kids, academically, extracurriculars, athletically. It was not easy to do something better than those siblings could do it. So he ended up rarely, if ever, being made to feel good about himself. And it had a lot of those consequences that I mentioned. He was in a very bad relationship. He was addicted to his work. And he was having all kinds of physical symptoms.

Ashley James (01:16:30.773)

If we were friends with that kid growing up, we wouldn't think, oh, my friend's really abused. Like that's a really bad household. We wouldn't imagine that's abuse, but internally, what's going on? The stress levels over time and that self judgment and like you said, the poor self esteem. So, so I think it's worth it for anyone, especially if they're having health issues, right? And you said this even affects immune. So if someone is having immune problems, always sick, always catching every cold, it's worth diving in and doing the work. I mean, what's the work? It's not going to hurt, right? There's no negative side effect of self-personal growth, other than you might have to shake up a few relationships, learn how to enforce healthy boundaries. But transformation, at the end, only good comes from it.

Dr. David Clarke (01:17:29.395)

Yes, all these issues are worth assessing and treating for their own sake. And I have patients who say, well, I'm not sure that these issues are contributing to my pain or other symptoms. And I'll just say, well, let's work on them anyway. They deserve attention for their own sake. And we'll see if your physical symptoms improve in response to that. And a very large number of patients will experience physical improvement as well.

Ashley James (01:18:04.282)

Is this something that you're going to be able to have colleges, universities start to teach? Is this something that we can get into the curriculum?

Dr. David Clarke (01:18:14.488)

We are working on it. I taught a class at the University of Rochester last year and I've just been invited to teach it again. I taught for 10 years at Arizona State. I taught at Cummings Graduate Institute in Arizona. I've taught a class on this since the late 1990s at Pacific University here in Oregon. So I'm teaching in the medical school now, short module on this topic. So it's growing. I mean, when I think back to 15 years ago, in terms of widespread acceptance in the healthcare community, especially the educational community, we were really nowhere. But today, 2023, it seems to be growing exponentially, to be honest.

Ashley James (01:19:06.164)

Good. Well, we need to get it to where it's in the meme, to where it's common. 

Dr. David Clarke (01:19:12.807)

Now you are helping with that Ashley, I appreciate it.

Ashley James (1:19:15.743)

Absolutely. And I hope my listeners will as well. I mean, I am on fire about this.

Dr. David Clarke (01:19:20.419)

I should finish before I forget about that third long-term impact of the ACEs, which are the triggers. Just say a few words about that. These triggers are people, situations, or events in the present day that are in some way linked to the past. And the most common example is someone who was an ACE perpetrator, someone who created the adversity for my patient as a child who is still in the patient's life today. And because of some of the other personality traits that I mentioned, it can be very difficult to set boundaries with such a person, to assert yourself with such a person, and to limit your interactions with that individual to the point where they're not making you physically ill. But it starts with just realizing that this person is still creating issues for you and is triggering for you. It turns out that patient who was having the attacks of dizziness and vomiting, who was hospitalized so many times, it was her emotionally and verbally abusive mother that was responsible for the attacks. All of the attacks, it turned out, were linked to interactions with that mother who had been verbally and emotionally abusive, starting at the age of three with that patient and continuing for the next 47 years. The patient is now 50 years old, mom is in her 70s, and mom is still doing it. But the patient, having experienced mom doing this since she was three, it just felt normal to her. She was completely blind to the idea that it was triggering her episodes, even though there were giant screaming clues that were saying exactly that, which is what made it so straightforward to diagnose her, let's put it that way.

Ashley James (01:21:24.955)

Well, that's the habituation. When I remember that moment somewhere in my early teenage years, when I realized that my household that I grew up in isn't a carbon copy around the world. I thought everyone did what my parents did and lived like we lived. And then started to go over at friend's house to see. Wow, other parents act really differently, have different rules, have different boundaries or no boundaries and different communication styles. Some are abusive, some aren't, some are very more loving than my parents are outwardly loving, some are less. And just realizing that the person you have in your whole life, if it's an abuser, we go, this is normal. This is who they are. This is normal. 

Dr. David Clarke (01:22:18.799)

Yes, none of us has a parallel life to compare ourselves with.

Ashley James (01:22:21.355)

Right, exactly, and I love that exercise with the butterfly where you're putting someone else in your shoes, because then you go, wait a second, if you have a child, you can do this. If not, you can think of someone you really care about as a child, but putting them in that situation that you were in, oh man, I just wanna go save that child as soon as possible.

Dr. David Clarke (01:22:46.013)

Yes, one of my favorite stories about that is I get some interesting consultations because my name is out there and one of them was a Hollywood type actress and I found myself in a very pleasant bar having a conversation with this impossibly good looking person who was telling me she had suffered physical symptoms in many locations in her body for 20 years.

We got around to talking about her childhood and it turned out that her parents were verbally and emotionally abusive of each other but not her and she was the peacemaker and she was the only child so it kind of fell on her to try to keep the peace. When she's eight years old the parents get divorced but unfortunately, they kept living in the same house They slept in separate bedrooms, but they lived in the same house.

So for her, nothing changed. But she was telling me this story and every other sentence was, this didn't bother me, it wasn't that bad, there was no abuse, they didn't drink too much, I could deal with it, I'm over it now, I'm out of that household for a long time. And she just was not accepting that this situation was sufficient to account for her 20 years of illness. Until I told her to do the butterfly on the wall experiment with her beloved niece, whom she spent a lot of time with, who was six years old at the time, and just said, imagine your niece is in this household, and you're there watching your niece try to cope with your parents for, let's say, just a week, how is that going to be for you? And she just stopped talking and stared at me for probably two minutes, but it seemed like longer than that because she was a very verbal person, as you can imagine, and just stared at me. And I just let her stare. You know, I was going to let her process this thought experiment. And then finally she said, ‘At the end of that week, I would shoot myself.' And that was the first time that she realized just how bad it had really been.

Ashley James (01:25:10.501)

We love our parents. And if it's not that outwardly like, all the alcoholics throwing bottles at your head or whatever, like if it isn't this very stereotypical, that's definitely abuse, right? But if it's something like she said, well, they weren't yelling at me, I know they loved me and they meant well, as children, and then when we grow up, we love our parents and we in some ways want to protect them because we don't want to necessarily say, oh, they were abusers, that they're the cause of my pain. Like that would almost feel like betrayal, saying something that negative to someone you care about. And the thing is, what we have to get is they're human. They did the best they could with the resources they had. Of course they didn't mean to hurt you. Unfortunately there's some very sick people out there, not the majority, but there are some who actually did mean to hurt people. However, if you love your parents and you know they loved you, we want to say they did the best they could. They loved you the way they could. And unfortunately, the way it turned out, it was a stress on the body. And there's stuff to process. There's ways that our mind protected ourselves. We justified, we coped, we suppressed, but we have to process it, and we can do therapy and still love our parents and honor and respect them while also admitting that the experiences we had were traumatic and that they hurt us.

Dr. David Clarke (01:26:53.943)

Yes, and that leads directly into a key idea that I think a lot of therapists don't emphasize nearly as much as they should, which is that when you finally recognize the reality of what you went through, you have to also give yourself credit for having gone through that. I like to use the analogy of being born on the far side of Mount Everest or born in the middle of a dangerous jungle, that through no fault of your own, you found yourself in this very difficult place. And again, even when the parents are doing this from a place of love or doing the best that they can, from the child's perspective, it can be, far side of the Himalayas or middle of the Amazon. And I want my patients to give themselves credit for having endured that. It takes truly heroic levels of perseverance to pull yourself through these situations when you're a child. And you need to respect that. You need to recognize that you're truly meeting the dictionary definition of heroic when you've come through an environment like this. A hero in our society is somebody who's overcome a difficult mental or physical challenge for a good cause. And my ace surviving patients have done exactly that. And it is a truly critical foundation for their future recovery that they be able to think of themselves in these terms, that they respect what that kid did to get through that situation. And once they can do that, once they can engineer that 180 degree flip in their self-image, all kinds of other things change. It makes it vastly easier, for example, to make changes in those stressful personality traits that I was mentioning earlier. My patient who was the actress, she was in a dysfunctional relationship with a boyfriend at that time, one of those unbalanced, giving way more than you're getting back kind of relationships. She dumped that guy the next day. She began building her self-esteem. And a year and a half later, she met the love of her life.

Ashley James (01:29:20.439)

Oh, that's awesome.

Coming back to this idea that it's not all in your head, there's physical experiences, the body has been changed physically, but the stressors are something we need to process. So it's the heart and the mind and that we can see and now measure results. So we can see and measure, like for example, with the long haul, that they had shortness of breath. It's hard to measure brain fog and fatigue, but you can measure shortness of breath. You can measure, there's certain things that you could measure before the study began to see that they were physiologically impaired by the long haul and other people like that woman you talked about that sparked much of this, the woman who pooped once a month, which I can't even imagine. And it was very clear, you could definitely measure that. It is a physical thing that's happening. And by healing the heart and the mind and going through the process of that.

So it's not taking a drug, it's not taking another antidepressant, it's not another, just one drug after another, one surgery after another. Those are bringing the wrong tools to the table, right? Like they say, a carpenter, every problem is going to be handled with a hammer, right? Like so when you come to a doctor, he's going to use the tools he has.

Dr. David Clarke (01:31:12.199)

That's right, when your only tool is a hammer, every problem looks like a nail.

Ashley James (01:31:16.075)

Right, but this 40% of the people, and you said it was somewhere around 20% of adults, at the time, it's not a nail. Don't bring your hammer anywhere near me, it's not a nail. So the long haul covid sufferers who went through the study and went through the therapy, how much therapy did they receive?

Dr. David Clarke (01:31:45.287)

Well, most of their improvement took place after just four weeks. So these are people who had been ill for an average of 40 weeks. And after four weeks of treatment, they achieved the majority of the results that I mentioned earlier. But yes, you're right. It's not that often that we are able to document real biological changes in the body as a result of this. It's more a subjective, internal to the brain, a kind of perception that's going on. But one of my patients had a completely paralyzed stomach. There's a special test called the gastric emptying test or the stomach emptying test where we have them swallow a very slightly radioactive material and we just watch it with a specialized camera and see if the stomach empties it. And we know how fast the stomach is supposed to empty it. And when we did this test on this gentleman, it didn't move at all. It just sat there for two hours and they said, well, we don't need to watch this anymore. We know it's abnormal. So they stopped the test. But I had never seen or heard of somebody with a psychophysiologic complete paralysis of their stomach.

His symptom was vomiting naturally. I mean, if nothing was emptying in the forward direction, it would eventually empty in the backward direction. And I know that it was psychophysiologic because we uncovered the stress in his case, successfully treated it, and his eating and digestion went back to normal.

Ashley James (01:33:31.111)

Oh, that's so exciting. But just that we have cases where you can demonstrate through imaging, you can measure and show here's an impairment. We go through four weeks of very specific therapy that's proven to be the most effective so far, right, until something better comes out. But so far, this is the best we've found. And we're always striving for excellence, right? That's the thing, especially in the case of mental health, and I'm just so disappointed that people still practice archaic mental health techniques that have been proven to be insufficient.

I know that not everything's for everyone, right? Sometimes you got to pull out different tools for different personalities, but you found something that is incredibly effective and in a short period of time. 

Dr. David Clarke (01:34:31.329)

Yes, it's really dramatic. I mean, I'm a bit of a statistics nut and there's a statistic that really captures the power of this new pain relief psychology and it's called effect size. And basically what it means is when you apply a treatment to a group, how big an effect did you have? And normally with things like cognitive behavioral therapy or mindfulness-based stress reduction, you get an effect size that gives you a number of 0.2 to 0.5. Those are just the numbers that are associated with this and those are considered small to moderate effects. Rarely do you see anything better than moderate. A large effect would get you a number of 0.8.

The effect size in the Boulder back pain study for Pain Relief Psychology was 1.5. I don't know, if it was a football game, the score would be 150 to 30, something like that. The lead researcher for this was very skeptical. I met with him. Some other people in my organization met with him. And we said, we truly believe, based on our clinical experience, that you are going to get excellent results from this. And he's a psychologist, he knows about pain. He'd been researching pain for several years. And he said, I don't really believe that this is going to happen, but I'm willing to do the study and we'll see what kind of results you get. And he was just blown away.

Ashley James (01:36:26.273)

That's so exciting. So we've talked about people who have this and the things they can do, especially going to your website, endchronicpain.org and check that out, do the quiz, they can find a practitioner, they could take your courses, they could read your books. What about prevention?

So everyone, it would be good for everyone across the world. We already discussed this to do personal growth work, to dive into our childhood, just learn and forgive and process. It's a joke, life is crazy, can't get it alive. None of us are going to survive this, right? We've all been through something. It's good to process.

So let's just assume everyone is going to take this really seriously and go do some really great therapy and get super healthy mentally, emotionally. What can we do starting today and for the rest of our life to prevent chronic stress? What are the top things? Like you love statistics, so what are the things that are the most impactful? Is it meditation, exercise, breathing, deep breathing? Is it hugging everyone you love for 90 seconds every day? What are the things that are the most important? What are the things that you do to make sure that you stay on top of managing your stress so that it doesn't become this big problem?

Dr. David Clarke (01:38:07.267)

Yes, that's a great question. You can go on the internet and find all kinds of highly valid techniques for reducing your personal stress level. And I have no issue with any of those. I do them myself. I go for walks with my wife along the river that we have here in Portland.

I played soccer as an adult on up to three teams at a time for over 20 years. That was a great one. I ride a bicycle. I do photography. I play chess with my grandchildren. My wife is a fabulous cook. Her meals alone are wonderful for just general stress reduction. All of those things are great and I absolutely recommend them. 

But if you have what could be called deep stress, if you have issues that are the result of long-term impacts of adverse childhood experiences and those have not been recognized, then you are essentially swimming against the tide in trying to reduce your own stress level. There is this tide of long-term impacts that is going to limit your success with all of the stress techniques that I just mentioned. So it's worth the exercise of looking back and taking a serious review of how you might've been impacted as a kid, doing some of the exercises that we've discussed earlier today, and figuring out what some of those long-term impacts might've been. 

The two biggest, the self-esteem, having a realistic sense of your own value in the world, contrary to what you might have been taught as a kid, is very important. And that in turn facilitates the second important part that gets the tide working with you instead of against you, and that is to set aside regular time for self-care. Regular time, every week, ideally several hours if possible, for activity with no purpose but your own joy. What we're looking for is the moral equivalent of finger paints for a four-year-old. The four-year-old doesn't care who sees the finger paintings, that doesn't care about the quality of the work, doesn't care about how many pictures per hour they produce. They just know they're having fun and everybody needs that. 

One of my patients was a champion athlete as a girl, but she did her sport before school, after school, on weekends, starting at the age of four. And she never really got to be a kid. I mean, there was no time to just self-indulgently play, which every child needs. And by missing out on that, she never really learned self-care skills. So now she's in the emergency room at seven in the morning, where I'm looking over her records, where she'd been the entire night getting tested for sudden abdominal pain. Everything was normal. So I'm talking to her about her lifestyle, and she's working full-time. Her husband's working full-time. She's got two kids. She coaches the kids in her sport. She's on the athletic club board of directors. She's driving kids to out-of-state competitions.

She's coaching other people's kids. And I asked her, what do you do for fun? And she had to really think about it. She said, well, you know, maybe every other month I go out to the movies with my husband. That was it. So her treatment was to carve out a regular block of time and her family was 100% behind this idea where she would just do trial and error to learn how to play.

And at first, she's just looking at me, what am I going to do? Because she, age 32, she had no idea how to go out and have fun because she never had in her entire life. But what she ended up doing was going for walks in a park. And that wasn't enough, but while she was walking, she was thinking. And one day she hit on the idea of taking piano lessons, which came as a surprise because she'd never done anything musical before, but she absolutely loved it and her physical symptoms just melted away once she started doing that.

Ashley James (01:43:02.309)

Wow. I love it. I love it so much. Oh, Dr. Clark, you are a godsend to this world in this day and age. So I don't know if you know about me, but I was sick for many years. I had polycystic ovarian syndrome, type two diabetes, chronic adrenal fatigue. So bad. I couldn't process human language in the morning. It was really odd. My husband would talk to me first thing in the morning and it would be like being on Charlie Brown and hearing the parents, he would just be like, whoom, and I would just put my hand up, I can't even understand what you're saying, just hand me four cups of coffee. It was bad, I suffered for many years, and also had chronic infections, and it was wicked. And that's where I found natural medicine and resolved these issues. Also been big into, like I said before, personal growth and working on myself, right? Working through all this stuff. I've been through the wringer when it came to doctors. One doctor after the other told me, I'll never have kids after a battery of tests when I was 19, the endocrinologist said, I'll never have kids. I wait with this beautiful eight-and-a-half year old boy who is our whole world and he impresses me.

I look into his eyes and I recognize that God exists because of how amazing this child is and how life is so beautiful. Life is filled with so many beautiful things. And being a mom is so amazing. And I'm so grateful that I was able to overcome. If I had believed that doctor, if I had just believed her and had not taken the steps, I would have never had my child in my life. And just the impact that the words doctors have when they say you can never do this or you'll never be able to do that is sickening. I was told I'd always have diabetes. I was told I'd always have these problems and I overcame them and I don't have them anymore. And that's why I started the podcast is I suffered, I cried daily, I was suffering in my body. I felt like a prisoner trapped in a sick body every day. And I created this podcast because I wanna reach out to all those people who are crying, they're suffering. And they don't need to. And this podcast is for them. It's a lifeline. I'm throwing the lifeline, the giant flotation device, I'm throwing it and hopefully reaching them. And we can help them. And you have the answer to millions and millions of people suffering. If all the doctors I had been to were trained in your work, I wouldn't have had to suffer as long as I did. Let's just put it that way. And so you're going to help so many people. 

So everyone listening is going to share this with those they care about. And frankly, share this with those you don't care about. Jesus talks about how we need to treat the least of us is how we actually treat Him. So just like, share this with your enemy. Let's mend some bridges. Let's share this with everyone.

Dr. David Clarke (01:46:14.971)

They might become a nicer person too.

Ashley James (01:46:18.377)

If someone has shared this with you, they're going to be like, well, wait a second, do they like me or am I their enemy? Share this with everyone. We've got to get this out there. The impact of what you're doing is so important. And I'm so honored to have you here today. I want to make sure that we've covered everything you wanted to cover. I know you've already shared a lot, but is there any homework? Is there anything to wrap up? Is there anything that you didn't get to say?

Dr. David Clarke (01:46:48.671)

You did a great job with asking questions, and I think we covered a huge amount of material. I can point out that these ideas that we're sharing aren't especially new, but they are largely unknown to the healthcare professionals of this world, and that's why my colleagues and I created the nonprofit, and why I do teaching all over North America and Europe and speak on wonderful podcasts like yours. 

There was a Harvard professor named Francis Peabody who gave a speech in 1925 and it became one of the most famous speeches in American medicine. It was published in the Journal of the American Medical Association in 1927. It's easy to find on the internet. It's a 6,000 word speech. He covers a lot of the same ideas that you and I have covered today. This was 100 years ago almost. This was before the discovery of penicillin is how old that speech is. And all those ideas that we've discussed today are in his speech. So this is kind of timeless wisdom that we're trying to bring back amid the tsunami of technology that has overtaken medicine today. We need the technology. I used it in my practice for 30 years. I've benefited from it myself. I'm all in favor of technology, but we absolutely don't need to lose the humanistic side of medicine in response to the technology.

Ashley James (01:48:39.311)

Right, exactly. This should be foundation. This should be something dealt with first, not last. Unfortunately. I'm sure you've heard it, that people come to you after they've already been through a battery of tests and trials and, wouldn't it be wonderful if this was the first thing we tried and not the last thing we tried.

Dr. David Clarke (01:49:00.723)

Oh, absolutely. It makes doctors happy when they learn how to do this. It saves a ton of money. It saves complications from diagnostic tests. It alleviates vast amounts of human suffering. 

Now, one of my patients had been ill for 55 years. Volume three of his paper chart was three inches thick, and he was cured in less than 30 days, just by bringing these issues to the surface.

Ashley James (01:49:32.475)

Oh my goodness. I would love nothing more than to watch like a documentary of following people's lives. Did you have that in the works? I know you've been a producer of three films. Do you have the intention of covering this in a documentary?

Dr. David Clarke (01:49:49.411)

It is covered in three different documentaries. I participated as a producer and helped as a consultant with the editing. The first was All the Rage, and the second was This Might Hurt, and the third was Pain Brain, and links to these are on our website, and you can easily track them down through the titles on the internet. They're all different. But they're all excellent and provide information about different aspects of this. So yes, those are great. You pay a few bucks to watch them, but the filmmakers did outstanding work.

Ashley James (01:50:33.938)

Very cool. Well, holidays are coming up. I think one of your books would be make an excellent stocking stuffer. I think listeners should go and check them out. I keep saying share this episode, but also get the books, watch the movies, check out endchronicpain.org. I'm very excited, even though this is like you said, timeless wisdom. It wasn't really until recently that you have been able to put together the three types of therapies in that order that were the most effective, right? So it took many of you to come together and create the system that is working and be able to measure the system that is working, which I'm so grateful for, cause it's one thing to be, cerebral about it and it's another thing to put, where rubber meets the road, right? Where we actually have to go do it. So we can be cerebral and go, just knowing that this is the cause of your chronic pain isn't going to solve anything until you get into action and do it and do the therapies and do the work. But what's showing across the board is in a very short period of time, sometimes as little as one month, you can have tremendous results, which is really exciting. 

Dr. David Clarke (01:51:58.432)

Yes it’s. People get the insight into it, and even if they don't experience complete relief right away, they can usually see that they are on a pathway toward recovering, and that's tremendously reassuring for people.

Ashley James (01:52:12.568)

Oh yes, especially if they've been through the wringer for many years. One therapy I definitely want you to check out, cause there's so many out there is a Timeline Therapy. It was created by Tad James and I studied underneath him of no relation. We just happened to have the same last name but Timeline Therapy is a wonderful tool and I'd love for you to look into it and see if it's something that, you'd like to add.

I did have a client with chronic back pain. I was able to do a Timeline Therapy session with them, took one session over eight hours over one day. We did an intense session. And I'm a master practitioner and trainer of NLP and Timeline Therapy. And we were able to resolve her chronic pain in that one day. I mean, that's just one person, but for her, it was her whole world. But Timeline Therapy incredibly amazing as a technique for resolving trauma. And it would be great for you to check it out and see if it's something you'd wanted to add to your repertoire, if it helps, if it advances your cause.

Dr. David Clarke (01:53:23.644)

Yes, I'm happy to take a look at it. I hadn't been familiar, but especially if the timeline goes back to day one, I can imagine a lot of ideas that would overlap with the work that I do.

Ashley James (01:53:35.580)

Yes, so actually, so with Timeline Therapy, you're in a light state of trance, so you're conscious of the unconscious mind and you're conscious the whole time because it's a light state of trance. And then we go back to the root cause, the very beginning, and kind of do the fly on the wall thing so they're not completely immersed in the emotion and they're able to then get a non-mirror image reverse of the event because we go above and beyond it, but it's a little hard to explain without a visual, but the way in which they're visualizing the beginning of the trauma and then they gain positive learnings from the experience, very quickly they're able to then go into the event and the emotion is gone, it's resolved, and they've gained positive learnings and they're seeing things from different perspectives. So it's very cool.

But like I wouldn't say it's the only thing to do. I would just say I'd love to add it to your tool belt because I think everything you're doing is wonderful and in addition to what you're doing, I think it'd be really cool for you to have Timeline Therapy. I think it's just timelinetherapy.com or the Tad James company that teaches it and there's many practitioners out there now. I studied it with Tad back in 2005 and 2006.

Dr. David Clarke (01:54:56.086)

Very cool, I'll check it out.

Ashley James (01:54:58.562)

Dr. David Clark it has been a pleasure having you on the show. I'd love to have you back or any of your colleagues. Anytime there's new advancements, you guys want to come back and share more as things develop. You are always welcome back. And I will definitely be just like screaming from the rooftops for everyone to go to endchronicpain.org.

Dr. David Clarke (01:55:20.774)

Yes, thank you. The research that I described today has opened the floodgates for money from National Institute of Health and other places to do even more research. So I'm sure those will be published in the next couple of years and is just going to help accelerate this snowball rolling downhill for more and more people to become aware of this.

Ashley James (01:55:44.450)

Beautiful. That's so exciting. Awesome. Well, it was been a pleasure having you on the show and please come back anytime.

Dr. David Clarke (01:55:51.660)

Thank you.

Get Connected with Dr. David Clarke

Website – Psychophysiologic Disorders Association

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Psychophysiologic Disorders

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Ashley James

Health Coach, Podcast Creator, Homeschooling Mom, Passionate About God & Healing

Ashley James is a Holistic Health Coach, Podcaster, Rapid Anxiety Cessation Expert, and avid Whole Food Plant-Based Home Chef. Since 2005 Ashley has worked with clients to transform their lives as a Master Practitioner and Trainer of Neuro-linguistic Programming.

Her health struggles led her to study under the world’s top holistic doctors, where she reversed her type 2 diabetes, PCOS, infertility, chronic infections, and debilitating adrenal fatigue.

In 2016, Ashley launched her podcast Learn True Health with Ashley James to spread the TRUTH about health and healing. You no longer need to suffer; your body CAN and WILL heal itself when we give it what it needs and stop what is harming it!

The Learn True Health Podcast has been celebrated as one of the top holistic health shows today because of Ashley’s passion for extracting the right information from leading experts and doctors of holistic health and Naturopathic medicine

 

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