My family are always very helpful when looking for “the” Xmas present for me. This year we had a different version of Secret Santa called Bad Santa – where you have a price limit (which almost nobody appeared to pay any attention to) and you buy a present that might suit quite a lot of different people, and either sex. Everyone’s names go in a hat and one by one names get drawn out. When the first person has chosen a wrapped parcel and opened it – it’s then on the open market for the next person to say ‘I like that’ and steal it! Each present can only be stolen twice and there has to be an agreement that if you very partial to a particular present and you didn’t get it, tanties and pouting are not allowed – the shops will be open the next day and you can go and buy yourself one.
Now there were a couple of presents that seemed to be targeted directly at me. I would have thought there wasn’t much more I needed to read about poo – studying many journal articles regularly, having read Giulia Enders book called Gut and changing Beau’s nappy quite regularly, but I got a facts book about poo called What’s your poo telling you? by Josh Richman and Anish Sheth. It’s really quite interesting with some funny facts and useful advice and anything that gets us all comfortable with discussing our bowels has to be a good thing. In fact here are two links to some bowel blogs I have written before.
It didn’t even register with me when Jimmy opened his present (the poo book amongst other things) – it took some prompting from a Croft child to say ‘I think that was meant for you, Mum’ and so some stealing occurred and it became mine! The next present opened, that was targeted at Bob and/or I, was a book (the thickest travel book I’ve ever seen) on Rough France. Word had got around that after our successful hiking holiday to the Swiss and Italian Alps, the French Alps are next on the bucket list. To say my travel appetite has been whet is an understatement. So plenty of reading happening on the (glorious) Sunshine Coast Beach.
Another book I have bought to help me understand anxiety and the brain with my patients is called The User’s Guide to the Human Mind: (Why our brains make us unhappy, anxious and neurotic and what we can do about it) by Shawn T. Smith. It’s a great little book with practical advice and patient examples to clarify explanations. Anxiety plays a huge part when patients have overactive bladder symptoms (bladder urgency or urge leakage), faecal incontinence (gas or bowel motion incontinence) or persistent pain conditions (dyspareunia -painful sexual intercourse; vulvodynia; endometriosis; anal pain) and we know that the stress hormones released with anxiety may make all these conditions worse.
In the book, Smith talks about the mind giving us things we don’t want – thoughts, feelings, memories, anxieties, moods and even physical sensations like a pounding heart or sweaty armpits. Sometimes it happens out of the blue. I experienced this quite recently and it really brings home to me the potential drama the brain creates for us with perceived traumatic events. On Melbourne Cup Day, a car was pulled over by the police and the driver and his passenger (dressed in suits, appearing to have attended a Melbourne Cup function) got out of the car and had obviously over-indulged.
While the driver was being breathalysed, the passenger moved to the Studio driveway and in full view of myself was physically sick and lost control of his bladder. Now I had a very visceral response – I felt ill myself, I got the shakes because all the dance ladies were arriving and while I was cross with him, at the same time I felt his shame at this happening in front of everyone. We started the dance class and the first song was called Mambo No 5. We had been doing that song for weeks and I had it nailed. It’s a bit complex with leg and arm moves and that day I just couldn’t manage it.
I kept visualising what had just happened. I kept feeling angry it had happened and sick in the stomach. And I just couldn’t get the timing of the song right. Every time that we do that song, I get a flashback. As time goes on, the visceral response is less, and I am back to being coordinated with the dance but none the less it still is having an impact of some sort 7 weeks later. And that was just that innocuous episode. Imagine the response to a really traumatic event. The brain and the second brain (the gut) would have a field day.
Other times the mind throws a fit because we have dragged it into a situation it hoped to avoid (like a first date when rejection is a real possibility). He uses as an example a common fear among humans: public speaking. Other animals don’t posses this fear simply because they don’t make speeches. But he makes a funny observation (for all of you out there who are dog vs cat people….. and it is a very definite love hate thing this: ‘I love dogs, no I love cats’) that dogs being pack animals would probably suffer public-speaking anxiety because placing themselves in the spotlight might affect their standing in the pack. A poorly executed presentation on begging for table scraps could lead the other dogs to question the speaker’s competence. That could snowball into ostracism. Cats being more solitary could probably deliver a speech with the confidence that arises from a complete disregard for social acceptance. (page 14, 15)
He goes through examples of irrational thinking – while he uses the example of public speaking we could just as easily substitute some of the conditions I treat every day: bladder urgency and leakage or the overactive bladder (OAB), faecal incontinence (FI); painful intercourse. Let’s try and use his explanations for each of the categories.
All or none thinking – ‘If I fail (which I must not do) at retrying sexual intimacy, then I am not worthy of love or respect’ ;
Catastrophizing – ‘I had my first faecal incontinence episode at those shops, I can’t face going there again’;
Focusing on the negative – ‘Because it is unacceptable for my bladder to misbehave and it often misbehaves my life is no good;
Disqualifying the positive – ‘When he says I look beautiful he is only being kind, I am really overweight and ugly’;
Minimisation – (I’ll bring it back to the giving a speech example): ‘If the speech goes well, it’s due to luck, if it goes poorly it’s because I’m completely incompetent’ ;
Personalisation- ‘Everybody is looking at me, I must have soiled and there’s an odour’.
Once identified and put into words, evidence can shoot down irrational logic. If all goes well, the mind backs down, as we realise thoughts don’t match reality. But the problem is an anxious mind doesn’t calmly defer to logic. (p17)
Smith reminds us how busy the mind can be, buzzing along at 500 thoughts per hour. Many people with busy minds would agree that it would be nice to walk away from the mind’s chatter. Tibetan monks talk about monkey thoughts. When these thoughts and this chatter becomes overwhelming, breath awareness……the good old tummy breaths are good for calming things down. Anxiety can be useful though – if you are in a dangerous situation then the body responses from anxiety can cause you to avoid that situation. Athletes can benefit from moderate levels of anxiety to improve performance, but problems happen when the mind tries to save our lives, when our lives really aren’t at stake. In large doses, anxiety (and depression) can be debilitating.
Another important thing to remember is thoughts are not facts. Smith reminds us that thoughts are reasonably accurate representations of the world, but they can often be misleading and inaccurate. Even when the thoughts are accompanied by strong emotions, which can strengthen the illusion of credibility, the thought remains merely a thought. Emotions do not turn thoughts into facts. (p40). Emotions tend to come with strong physical symptoms. Racing hearts, restless bladders, hair standing on end – we have no control over these experiences than the emotions that pawn them. (p44)
Psychologist Marsha Linehan suggests a useful exercise is to describe the emotional responses in words. For example someone experiencing fear before an exam might say: “I’m noticing my mouth is dry and my heart is beating fast” as opposed to “I’m going to fail my test, get kicked out of school and lose all my friends”. Applying this theory to say someone having repeatedly painful sex due to vulvodynia : “I feel my heart is racing, my legs and pelvic floor are gripping and I can’t breathe properly”. This would allow them to identify the problem areas and concentrate on relaxing their adductor (inner thigh), abdominal and pelvic floor muscles and invoke some tummy breathing, while visualising a comforting scene such as the rolling waves at the beach.
This may stave off the wave of anxiety, the release of cortisol and adrenaline and enable them to recognise what is happening for what it is – a combination of memory – failed experiences at pain-free intercourse; getting more ‘practised’ at this anxious response to the same situation and a non-relaxing pelvic floor. In the book ‘Teach us to sit still’ by Tim Parks this sentence hit home powerfully with me when he said (p42) “It was true that my body and I weren’t the best of friends these days; we hardly communicated except through pain”. I think this is a common feature of persistent or chronic pain patients – assessing what is really going on with their body; what caused that violent response, that unpredictable response, is hard because the only time these patients listen to their body is when there is a pain response. Not only are they not communicating well with their body, their brain gets better and better at producing the pain.
What I related to with my patients and their pain issues, or their OAB issues or their FI issue is- the belief that they cannot move forward until their thoughts and emotions are in order. They tend to feel stuck until their minds are under control. With unruly, overprotective minds, patients can spend a lifetime waiting until they feel they are ready to act. (p49)
The book is full of gems of information and practical examples – I would recommend it to you as some reading, to better understand the grip anxiety can have over you.
And to finish on a great quote from another book on the holiday reading list called The Alchemist by Paul Coelho:
‘The secret of life is to fall seven times and get up eight times.’
So no matter how compelling the sense of failure, incompetence or rejection may be, dust yourself off and get up and have a sense of self-belief and get on with “living the shit out of life” (Rob Cook – he broke his neck in a helicopter accident in 2009 and is confined to a wheelchair ever since.)