Follow along with the transcript below for episode: Ease Your Stress for Better Health With Dr. David Clarke
[INTRODUCTION]
[00:00:02] PF: Thank you for joining us for episode 488 of Live Happy Now. Since the pandemic, there has been a 70% increase in stress-based illnesses. And today’s guest says that’s no coincidence. I’m your host, Paula Felps. And this week, I’m talking with Dr. David Clarke, whose practice in internal medicine and gastroenterology led him to explore how stress and emotions create chronic pain.
As president of the nonprofit Psychophysiologic Disorders Association, he is dedicated to educating people about stress-related, brain-generated medical conditions. He’s here to talk about what’s driving the rise in stress-related illnesses. And importantly, what we can do about it. Let’s have a listen.
[INTERVIEW]
[00:00:48] PF: Dave, thank you so much for joining me on Live Happy Now.
[00:00:51] DC: Great to be with you, Paula. Thanks so much for having me.
[00:00:54] PF: This is a topic that I have wanted to talk to you about for a little while because the work that you’re doing is so important. We’ve known for a long time that stress and illness are related. But right now, you’re saying that we’re seeing an explosion in stress-based illness. I guess, first of all, what do you see is driving such a significant increase in it?
[00:01:15] DC: It’s everything you’re hearing about in the news. It was the pandemic for a long time. Now, that’s improving in 2024. But we’ve all become more isolated so much working at home. We’re a little bit more wary of being in big crowds. There’s been a tremendous pressure on our young people who were out of school for a period of time and now they’re trying to reintegrate. We’ve got a lot of political unrest in the United States right now. A lot of division between different groups of people in our society over politics, which really should be just a tiny bit of how we interact with each other. But it’s blown all out of proportion now as we’re coming up less than two months from an election. One reason after another.
But what’s not recognized by a lot of people is that stresses from long ago, even stresses in the present that are not fully recognized can be having an impact on people’s physical health. As well as they’re trying to move toward greater happiness. It can be like swimming against the tide when you’ve got these issues lurking in the background and you’re not necessarily fully aware that they’re happening.
[00:02:25] PF: When we’re talking about stress-based illness, what is that? Because, as you said, we may not even be aware things are happening. What are some of these illnesses that take place because of stress?
[00:02:36] DC: Yeah. Well, let’s start with the fact that they are real symptoms. They are pain, they are illness anywhere in the body. But in the absence of any physical reason for those symptoms to be there. In other words, there’s no organ disease. There’s no damage to the structures. The symptoms are actually generated by the brain. The most modern term for these is neuroplastic symptoms, which means that they’re nerve-generated. But they can change. That’s what the plastic part means. but they’re absolutely real.
Migraines, dizziness, ringing in the ears, trouble swallowing, visual disturbances, fibromyalgia, irritable bowel, pain in the pelvis. Many cases of chronic fatigue. Many cases of long COVID. Pain in the back or the neck in the spine. Pain in the joints. Certain kinds of rashes. The list is virtually endless. The only common denominator is that patients with neuroplastic symptoms tend to have more than one symptom at a time. Sometimes many symptoms simultaneously. But they’re all real. And the good news is that if you uncover the stress that’s behind them, you can treat them successfully even after years of being ill.
[00:03:48] PF: But that requires getting a practitioner who recognizes what is going on. And that sometimes, I know as a female, a lot of times things can be dismissed as hormones, as mood, as things like that. How do you go about separating the symptoms in your body with it all being in your head? How do you do that? And then how do you find that practitioner who can work with you on that?
[00:04:12] DC: Yeah. That all-in-your-head business is a phrase that should be banned. These symptoms are so absolutely real. One of my patients was – I was asked to see her on her 70th day in the hospital. She was getting morphine around the clock for unexplained abdominal pain. Those symptoms were as real as they get. But you do have to rely on our medical clinician colleagues to make sure that there’s not an organ disease or structural damage going on.
Once we’ve determined that there is no explanation like that or if the symptoms are blamed on something physical but the treatment doesn’t work the way the doctor expects, that’s when we need to start looking for sources of stress that could be responsible for this. And it can be stress in your present-day life or it can be in the past.
A great place to start, we have a 12 item self-assessment quiz on the endchronicpain.org website. Takes less than three minutes. And it’ll give you a lot of ideas to start thinking about where those stresses might be coming from. And once we start looking into those, trying to do something about them therapeutically is the next step. And then, usually, we’re going to see Improvement in the symptoms after that. May not completely go away. But we’re going to start to see progress. And when we see that, we know we’re on the right track dealing with these stresses.
The hardest part though is to identify the real magnitude of what’s going on. Because it can be stress from childhood. It can be adversity that you suffered when you were a kid that is still having an impact on you today. And many people don’t recognize just how big that can be.
[00:05:52] PF: Where do you start unpacking that? Is it with a therapist? Is it with a medical doctor? It’s a big ship that you’re trying to turn around. Where do you start?
[00:06:01] DC: Well, the best place to start, especially if it’s with the childhood stress, is just to make a list of everything that you went through that you would never want a child of your own to experience. And then start writing about the emotions that come up as you’re thinking about this.
For example, one of the exercises that I have my patients do is to imagine a child of their own or another child that they care about living through exactly what the patient did when they were a child. And what kinds of emotions come up is there sadness, is there anger, grief, shame, guilt. Any of those things that come up, start writing about those.
You might even, as I have many of my patients do, write a letter to the person who mistreated you as a kid. Putting all your thoughts and feelings down onto a piece of paper or a computer screen. You don’t necessarily need a therapist for this. There’s also some great self-help books out there that are evidence-based, scientific evidence-based. My own book is called They Can’t Find Anything Wrong. We also have a jargon-free textbook. It’s a little higher reading level for people that are interested in the science. That’s called Psychophysiologic Disorders. It’s kind of a mouthful. But it captures what’s going on between the brain and the body. Just starting with the books, with the writing exercises can take a lot of people a long way down a road toward recovery for this. If those aren’t enough, then, yes, there are therapists out there that have special extra training in the kinds of issues that can make a person physically ill.
[00:07:34] PF: I’m very curious to find out what started you on this journey. And what made you so interested in exploring and exposing this to people?
[00:07:44] DC: Yeah. I wasn’t supposed to be doing this. I was supposed to be a normal, ordinary garden variety gastrointestinal specialist. And I was cruising along doing very well. And the last thing I expected was to encounter a patient that I didn’t know the first thing about diagnosing or treating. But that’s what happened to me in the eighth year of my formal education. A patient who was having an average of one bowel movement per month. It shows you how severe these symptoms can get. She was taking four different laxatives at double the usual doses wasn’t working.
She came to us from another university where they couldn’t find anything wrong with her. We did some specialized testing. That was normal too. I was doing her exit interview. I was basically telling her she was going to have to live with this. But we got talking about stress. And that was when she started telling me she’d been molested as a girl by her own father. Not just once or twice, which would have been bad enough, but hundreds of times.
And this shocked me. I had no training in how to respond to that. But there was a psychiatrist at UCLA where I was in training that I knew had an interest in these mind-to-body connections. I sent the patient to Harriet Kaplan not thinking for a moment that anything would come of it. But then I ran into Harriet three months later, and this was the elevator ride that changed my career, and Harriet told me she had cured this patient with less than three months of counseling.
I had no idea you could alleviate a serious physical condition like that just by talking to somebody. But Harriet gave me the framework that she uses for evaluating and treat treating patients like this. And I’ve been using it ever since for over 7,000 patients now in the last 40 years.
[00:09:37] PF: That is absolutely incredible. And that ability to change our lives and let us identify those stressors, I mean, it just has a ripple effect on everybody then that they interact with. I think that’s just such an incredible calling that you have. And as we look at these stress-based illnesses, what are some of the most common symptoms that you see? I know you said it can be anything. But what would be some of the ones you see most frequently?
[00:10:04] DC: Yeah. Well, as a gastrointestinal specialist, certainly, irritable bowel was very big early in my career. But as word got out that I was taking care of people with all kinds of mysterious symptoms that seem to have no explanation, I began to get referrals from patients who had problems from head to toe. Migraines are big. Fibromyalgia. We’re seeing a lot of long COVID now.
In some places, these symptoms are being blamed on something called Ehlers-Danlos syndrome, which is a connective tissue genetic disorder. But the vast majority of the time, the symptoms are not from Ehlers-Danlos. They’re actually stress-related instead. Pelvic pain, genital symptoms, bladder spasms. Back pain is a huge one. Recent study found that 88% of people with pain in their spine, it was actually a brain-to-body condition.
But, again, the good news is that, if we uncover the stress, all of these can be successfully treated. Even that patient who’d been in the hospital for 10 weeks getting morphine around the clock, we uncovered the stress that was responsible. She was out of the hospital in a week. And she was off of all the opioids in 30 days.
[00:11:20] PF: Oh, my gosh. That is amazing. I’m sure that people who are listening is like maybe ringing some bells with things that are going on with them. Is there a difference between symptoms and illnesses that are stress-based versus the other kind that are injury-based? Do the symptoms look different?
[00:11:38] DC: No. The symptoms are essentially the same. I mean, it’s chronic pain. There are lots and lots of non-pain symptoms. Pseudo-seizures, ringing in the ears, stiffness in the joints. Let’s say the temporal mandibular joint of the jaw. Visual disturbances. All kinds of symptoms from head to toe. And they overlap a lot. That’s why you need a medical evaluation to make sure there’s not an organ disease or structural damage.
But once those things have not been found, once they’ve been ruled out, then we can start doing what I call a stress evaluation. Whether it’s by the self-assessment quiz on our website or whether it’s a formal interview in the office. And I’m looking for stress that’s in your life right now.
One of my patients was only getting his symptoms while he was driving to work. When he drove home from work, he was fine. On the weekends when he was not at work, he was fine. It was all connected to stress in his workplace. I’m also looking for anxiety, depression, post-traumatic stress. Have you been through a trauma at some point prior to your symptoms beginning? And then, finally and probably most importantly, adversity when you were a child.
Some kind of treatment that knocked your self-esteem down on a long-term basis. Whether it was something obvious like the sexual abuse that my first patient suffered or something more subtle. Like nothing you do ever being good enough. All of these things can weigh a person down over a period of time. People that listen to your podcast that are trying to develop their skills at happiness, they are going to be swimming against the tide if they don’t address these underlying issues whether they’re causing physical illness or not.
[00:13:27] PF: And so, oftentimes, if we do go to a doctor and they don’t know specifically what’s causing it, we’re given medication. What does that do to us if we’re just kind of masking it and we’re not healing the cause?
[00:13:42] DC: Yeah. When we do that, we’re just treating the symptoms. This was the huge problem with the explosion of opioid prescriptions that took place in the 90s. That it was just treating the symptoms. It wasn’t treating the underlying cause. And so, people tended to need more and more opioids over time. And we’ve seen the outcome of that in tens of thousands of opioid overdose deaths every year in the United States.
It’s absolutely essential to uncover the cause. To realize that the brain can produce pain or illness anywhere in your body in the complete absence of any physical reason for those symptoms to be there. And we can go after the causes and treat it successfully. The new pain relief psychology has got new numerous gold-standard scientific studies now. Randomized controlled trials from research centers all across North America that are showing dramatic outcomes from this.
There was a study just in June of 2024 from the Los Angeles Veterans Hospital looking at a very tough non-nonsense population of older male veterans. You aren’t going to convince them with a bunch of psycho babble to get better. You have to go after something real with a group like that. And they did. They got 63% of their patients to achieve the pain relief goal that they had set compared to only 17% reaching that goal in the control group. Almost a fourfold greater success rate with the new pain relief psychology techniques.
[00:15:23] PF: That is incredible. What are some of those techniques?
[00:15:26] DC: Yeah. It starts with the idea that we are going to try to relieve your symptoms. We’re not just going to help you live with it. We are going to try to relieve it. One of my patients who had been – I love to cite this case because it was so dramatic. She had been hospitalized at a major prestigious university 60 times in 15 years. Saw a dozen specialists, including a psychiatrist, and had no diagnosis at all. She was having attacks of severe dizziness and vomiting that would last for up to several days. And they had no idea what was causing it.
It all turned out to be connected to interactions with her abusive mother. And that abuse had been going on for over 40 years. And all of her attacks of illness were connected to that. As soon as I was able to show her that connection, she set some firm boundaries with her mom and the attacks never came back. We can get really dramatically better outcomes by searching for the underlying stress. Finding that connection. That’s the second big feature of this approach. Number one, to be aware that the brain is causing these symptoms in the body. Number two, to go after the stress. And number three, to treat it.
The long-term impact of stresses when a person was a child include personality traits, like excessive self-criticism. Excessive devotion to the needs of others. Poor self-care skills. Low self-esteem. We can help people with that. Another long-term outcome is repressed emotions, anger, fear, shame, grief, guilt that we can bring to the surface and have people talk about in a therapeutic way. And the third one is the triggers. The patient who was hospitalized at the university who was having the dizziness and vomiting, finding out that her mother was the trigger made a huge difference in her outcome.
[00:17:27] PF: And how long a process is that to get to the root of the triggers? Because I know with therapy, it can take years to really peel back all the layers of that onion. And you’re not taking yours. You’re getting to the problem faster than that.
[00:17:42] DC: We are going directly after the kinds of stresses that we have seen cause physical illness in thousands of patients. My own practice, over 7,000 in the last 40 years. It doesn’t take as long as a lot of psychotherapy does. Now, there are some patients, they were so severely afflicted as kids that they do need a number of years of treatment.
But in the Boulder back pain study, for example, done in Boulder, Colorado, the patients had their back pain for an average of 10 years before they were enrolled in this study. All they got was two sessions a week for four weeks. A total of eight hours of pain relief psychotherapy. And their pain scores came down from four to an average of one and stayed down for the following year. They didn’t get any more treatment. They just got one month of treatment. Brought the pain scores from four to one. And then it stayed down after that. These are people who had back pain for an average of 10 years. One month of treatment and it came down.
[00:18:49] PF: That is incredible. We’ve talked about the hidden stress, that childhood trauma. Do long-term stressors and short-term stress affect us differently? Say if I’m in a situation where I know there’s a finite end to it but it’s really affecting me at that time, is that effect going to be different than something that’s ongoing like the abusive parent?
[00:19:10] DC: Yeah. Absolutely. Your system is set up to react with fight or flight to a short-term stress. If somebody is trying to grab your handbag in a parking lot. If you’re being chased by a bear back in cave person days. Those are short-term stresses. The sympathetic nervous system, fight or flight spikes up all those hormones and circulation changes that enable you to run away or to fight. They’re short-term. They come right back down as soon as the threat is over. That’s the way the system is designed to work.
With my patients, the stress level goes up and it stays up sometimes for years. And that begins to have a long-term impact on people. And if you’re not able to deal with the stress because you’re not recognizing the magnitude of it, then the expression of that stress continues via your body.
Your body is actually your friend in this case. It’s not doing this to physically hurt you or disable you. It’s trying to tell you something. It’s trying to tell you that there is an issue going on in your life that needs to be addressed. And in that sense, it’s a positive thing. But we just have to make the connection. We have to understand what the stress is that’s producing this. And then the outcome of that is not only are you physically feeling better. But a huge mental issue has also been addressed at the same time.
[00:20:40] PF: I’m sure you see incredible changes in people’s entire lives when they go through this. For your patients, is there a certain age group that seems more afflicted? And gender. How does it divide along gender lines?
[00:20:51] DC: It does divide along gender lines. I would say something like two-thirds to three-quarters of my patients are women. And we can talk about various reasons for why that might be. But what I’m seeing is that a lot of men are taking their stresses and externalizing them. They are expressing them out into the world.
When you read about somebody who has committed domestic violence, when you read about somebody who has committed road rage, well over 90% of those people are men. They are taking their stress and they are externalizing it into the world. They’re probably not winding up in my office with a physical symptom connected to internalizing their stress. The women who tend to do that more often in our society, they are the ones who become physically ill. And they show up in my office.
In terms of age, it’s across all of the ages. My own practice went down to early teenage years. I didn’t see kids younger than that. And it went all the way up into the 80s. One of my patients was 87 years old. She had been having brain-to-body symptoms since the age of eight. She was my personal record patient in terms of the duration of her illness. 79 years. And she was successfully treated too.
[00:22:14] PF: That’s incredible. And what about epigenetics? We know that emotions are passed on from one generation to another. How does that play into this when you’ve got that situation?
[00:22:27] DC: Yeah, it definitely does. The research on that is ongoing. But epigenetics refers to which of your genes are turned on and which are turned off. And long-term stress can result in certain genes being switched on. And in some cases, those switched-on genes can be passed on to the next generation.
What we’re trying to do with our treatment is identify the underlying causes of the stress. Bring those issues down. Make changes in the person’s life so that they don’t come back. And then we expect. We don’t have the scientific data to prove it yet. But our expectation is that the epigenetics are going to change. We know already from research on the brain using functional magnetic resonance imaging that the circuits in the brain actually physically change with pain relief psychotherapy. And we’re optimistic that the same thing can happen epigenetically.
[00:23:25] PF: And at the beginning of the show, we talked about how much stress there’s been recently. COVID was such a game-changer. And it seems like the world’s gone a little bit crazy since then. And just the stress levels have gone up. If you can do more healing at this level, do you see our society getting back to a calmer place? Because right now, I know people are concerned about the direction our world is headed.
[00:23:52] DC: Yeah. Our world is headed in a lot of difficult places. But if we look back, there are times in our history – I mean, I’m old enough to look back quite a long way. And there have been times in our history when the society in the United States was deeply troubled. Let’s put it that way. And, yet, we’ve come out of that still strong as a nation.
I can’t change the course of history. I can’t predict what is going to happen to our society in the decades to come. But what I can do is help people learn how to cope with their own personal stresses and with societal stresses in a healthier way. We’ve seen that happen. When people are relieved of their physical symptoms from this cause, their capability for dealing with many other issues is improved. And most importantly, their close personal relationships change for the better as well.
[00:24:48] PF: And so, we also talked about the elections. And here at Live Happy, we’ve been talking about election stress. We have an email course about it. It’s a big topic. And what are some of the ways that it could be affecting us physically and mentally? For any listeners that might be having certain things go on, what could be happening because of all the turmoil around the election?
[00:25:11] DC: That’s a whole topic in and of itself.
[00:25:14] PF: That’s our next episode.
[00:25:15] DC: What I hear the most is when you have family members who are opposed to you politically. And we have tens of millions of dollars being spent to make us angry at the other side, to make us disgusted by the other side, to make us hate the other side. And now you have one of those people or several of those people in your family. Or let’s say that you are a blue-oriented political person living in a red area or vice versa. So, you are surrounded by people who disagree with you politically. And you see the signs of that. Literally, the signs of that all around you. That’s going to make you uncomfortable.
There are people who have figured out that in order to get votes, in order to get political power, in order to get donations, they have to use all of the modern 21st-century marketing techniques to get you angry and hateful. And I think if we can, as a society, realize that the people on the “other side”, their political views are just a tiny fraction of who they are.
And if you sat me down for dinner in the environment with somebody who was completely opposite to me politically, I’m sure we would have a wonderful encounter as long as we didn’t talk about the presidential election. I’m trying to help people recognize this that these political views are just a tiny slice of who we are as people. And that we have a lot more that we share than that we don’t share as Americans.
[00:26:55] PF: That’s a great thing to keep in mind. And as I let you go, what can our listeners do to start identifying and addressing the stress-related illnesses that they have in their life or in the lives of their loved ones?
[00:27:08] DC: Yeah. I spent days working on this 12 item self-assessment quiz to boil that down to just these dozen questions that take less than three minutes to fill out. It’s going to give you some insights into whether some of these issues might apply to you personally. And then you can go from there and dig deeper into this. Find out more about what might have happened to you as a kid that is having more of an impact on you today. What personality traits might you have, for example, that are a long-term residue of what you went through as a kid? Are there any triggers in your life right now that you’re not realizing are having an impact? Are there some emotions that you repressed as a kid and that are now starting to bubble up as an adult and trying to make themselves heard? These are all very fruitful places to pursue if you’ve got physical symptoms that don’t have a good biological explanation.
[00:28:07] PF: That’s excellent. Well, we’ll give them a link so they can go check that out. Take that quiz for themselves and get started on the road to recovery from their stress-related illnesses. Dave, thank you for the work you’re doing. And thank you so much for sharing this with us. It’s fascinating. It’s something that’s not talked about enough. And I really appreciate what you’re doing to get the word out there.
[00:28:27] DC: Thank you, Paula. It’s been a pleasure.
[OUTRO]
[00:28:33] PF: And that was Dr. David Clarke talking about stress-related illnesses and what you can do to treat them. If you’d like to learn more about Dave, take his free self-assessment quiz on brain-generated symptoms, check out his books or follow him on social media. Just visit us at livehappy.com and click on this podcast episode.
That is all we have time for today. We’ll meet you back here again next week for an all-new episode. And until then, this is of Paula Felps reminding you to make every day a happy one.
