TODAY'S GUEST: Dr. Howard Schubiner, somatic symptom disorder and pelvic pain specialist

I'm extremely happy to welcome Dr. Howard Schubiner to Hard Conversations!

Dr. Howard Schubiner is the director of the Mind Body Medicine Center at Providence Hospital in Southfield, Michigan and a Clinical Professor at Wayne State University and Michigan State University School of Medicine. He has authored over 60 scientific publications and lectures nationally and internationally. His program uses both meditative and psychological techniques to help individuals with chronic pain, somatic symptom disorder, TMS and other psychosomatic conditions. He has also pioneered randomized, controlled research in the field of Mind Body Syndrome. He has been included on the list of the Best Doctors in America since 1996.

• WEBSITE:

  https://www.unlearnyourpain.com/

• https://www.tmswiki.org/ppd/Howard_Schubiner,_MD

• Book:

• Unlearn Your Pain A 28-day process to reprogram your brain ...

YOU'LL LEARN

• The brain behaves in ways that we’re not used to thinking about

• How neural circuits impact erections

• The potential for the brain to create sensations in us that aren’t necessary

• How the brain protects us

• Why certain conditions become chronic

• The importance of freeing yourself from pain and worry

• That someone saying “it’s all in your head” is being cruel

• How to be more mindful of chronic symptoms

• The importance of training yourself to be calm in various situations

• The importance of re-training your brain

• How fears activate danger signals following feelings of being trapped

• Explanation - Technique - Hope - Relationship

• And more!

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About the Show

Introducing Hard Conversations, a podcast about male sexuality, and all things erectile, from the latest natural erectile dysfunction treatment to the best ed medical treatment. Therapist Tim Norton expands the conversation about male sexuality, adds context to why we struggle as a society to have hard conversations and breaks down how in a sex-positive environment there really is no room for taboos, judgment, or shame when it comes to penises.

YOUR online sex therapy and couple’s therapy HOST:

Tim Norton is a sex positive sex therapist working in private practice. He offers online therapy, online sex therapy, online sex coaching, and therapy and coaching for somatic symptom disorder.

Tim obtained his bachelor’s and master’s degrees from the University of Southern California. Tim is a proud member of American Association of Sex Counselors, Educators, and Therapists (AASECT), the Los Angeles Sexological Association, and works part-time with the Pain Psychology Center in Beverly Hills.

Hard Conversations Podcast Transcript

Tim Norton: Hello, and welcome to hard conversations. Really excited about my next guest, Dr. Howard Schubiner, who is an internist and the director of the mind body medicine center at Providence park hospital in Southfield, Michigan. He has a clinical well professor at the Michigan state university college of human medicine.

And as a fellow in the American college of physicians and the American Academy of pediatrics, he has authored more than 100 publications in scientific journals and books. And lectures regionally, nationally and internationally. Dr. [00:01:00] Schubiner has consulted for the American medical association, the national Institute on drug abuse and the national Institute on mental health.

Dr. Schubiner is the author of three books on learn your pain on learn your anxiety and depression and hidden from view written with Dr. Allen ABIs. He lives in the Detroit area with his wife of 34 years and has two children. We're going to be talking about two things today. Psychogenic pelvic pain and penises that don't get erect for psychological reasons.

There's a lot of crossover between these two topics. And even though Dr. Schubiner primarily deals with chronic pain, his approach to treating these conditions is perfect for working with psychological erectile issues. Note to the listener, the beginning of this recording, where we say hello, and thanks for being on the show got cut off. So just know that I did say the things that one says when they first meet someone. And I don't just start off conversations with people asking about [00:02:00] erections before saying, hi,  how can a guy have pelvic pain? And it not be something structurally or biologically wrong with 

Dr. Howard Schubiner: him. Right. And that's a great question.

In fact, most people would think if your arm hurts, there's something wrong with your arm. If your penis hurts or something wrong with your penis, that only makes perfect sense. But when you dive deeper into what pain is, and if we have time, I can explain that a little more deeply.  it turns out that statistically speaking.

Most pain is not due to a structural tissue damage problem in the body, which is pretty surprising, but take headaches probably 15 to 20 million Americans have, have headaches, chronic headaches. And if you ask any neurologist. The vast majority of those 95 to 98% do [00:03:00] not have a structural cause for their pain.

In other words, when you scan their brain and do x-ray their sinuses, you don't find sinus disease. You don't find tumors, infections, inflammatory conditions, you just have headache, it's pain. And so that pain is not due to a structural problem in the head. Well, it turns out if you look at abdominal pain, it's virtually the same thing.

And if you look at pelvic pain, the vast majority of people with chronic pelvic pain do not have a structural problem where they're feeling the source of the pain. It's, it's shocking. Really? That's true. And 

Tim Norton: could that apply to not just pain, but. Burning urination burning, burning after your jacket plate, numbness, tingling all the, like the golf ball and the butt feeling, right.

[00:04:00] Dr. Howard Schubiner: Is that I've seen it. You've seen it all. Some of them, myself. Oh man. Yeah. It's pretty common. In fact, the majority of people have had some sort of pains, tingling, numbness, burning.  at some point that was not due to a structural problem and I have so the, any, and any, and all symptoms can be caused purely by the brain.

And certainly most symptoms can also be caused by a structural problem in the body. If you have. No gonorrhea infection or a chlamydia infection you're burning after urination. Well, okay. That's an, that's a infection. That's an inflammatory condition. That's triggering the brain to activate pain, but you know what happens sometimes is somebody might have a structure, a cause for pain, say a chlamydia infection and their brain learns that pain.

The [00:05:00] infection gets treated. Infection is cleared. Cultures are negative, but the pain can continue. And that's because the neurocircuits that are actually activating the pain are still going. So when you touch a hot stove, it's not your finger that's causing pain. It's actually a neurocircuit in their brain that gets triggered by the injury that causes the pain.

Tim Norton: Interesting. So yeah, why don't, why don't we get more into what pain is? You said that you could, you could give an explanation of that. So how does that neurocircuitry plan to 

Dr. Howard Schubiner: this? Well, if you think of it from an evolutionary point of view or intelligent design, if you prefer the brain has to be able to do two things with pain.

Number one has to turn on pain when there's an injury and.  at times. And certainly [00:06:00] if you imagine,  one of our forebears running across the Savannah, trying to chase down a deer long time ago and they break their ankle. Now, if you don't get severe pain, you're going to keep running, destroy the ankle, never hunt again, and never reproduced.

So, but it's not the ankle that's causing the pain. It's the brain that's activating severe pain. It turns out that stress and emotional,   insults or assaults activate the exact same parts of the brain that cause pain. So the brain can turn on pain as if it were a physical injury in the absence of a physical injury.

Because the brain knows that's how it's designed. That's what it does. And so research shows that people who have, for example, the famous story we always tell is there was a guy who jumped off the scaffolding in Britain few years ago onto a nail. The nail [00:07:00] went clear through his boot screaming, yelling, rush to the hop in medication.

They take his boot off when the eldest precisely between his toes, no injury at all. But that pain that he had was severe and real. Hm. 

Tim Norton: And so, so Y 

Dr. Howard Schubiner: well, it's a protective measure. If we, children who were born without the ability to feel pain, often die at an early age. So pain is a signal. It's like a smoke alarm and it's warning us.

There's something wrong when you break your arm, your pain is warning. You telling you there's something wrong and that you need to go to the hospital and get a cast or whatever. When you're in a situation in your life where your partner's cheating on you or your bosses. Criticizing you and micromanaging you or your kids [00:08:00] are acting up or using drugs or whatever your brain can produce a warning signal and that signal can be pain.

It can also be anxiety or depression or can't sleep. Pain is a common alarm mechanism that the brain knows how to do and it, and that pain can be burning, tingling, numbness, shooting, pain, sharp pain, throbbing pain, pain that comes and goes it's up to the brain to whatever it wants to do. 

Tim Norton: And so why does it stay chronic?

Dr. Howard Schubiner: Well, what happens is, is the alarm signal goes off,  to tell us there's something wrong. And if someone's talking to you and you don't listen, someone will typically talk louder. Okay. So that's kind of what the brain is doing because it's trying to get your attention so it can talk louder. Can [00:09:00] talk longer.

And then what happens, and this is the critical point. Most chronic pain is due to the fact. That the pain itself causes fear and worry and attention to it and monitoring of it. And that fear and attention and monitoring puts more focus on the pain. And the more you worry about the pain, the more the pain itself is driving the danger alarm mechanism in the brain to create more pain.

And that's the vicious cycle of chronic pain. Okay. 

Tim Norton: And that that's something that I do hear a lot with guys who are struggling with, with maintaining erections or achieving erections, is that they're afraid they're not going to get another one. And you know, they'll probably get one when they masturbate, but they're afraid that they're not going to get one when it comes, when there's another person in the room.

Dr. Howard Schubiner: Exactly. The more fear, the more worried about it, [00:10:00] the more pressure to perform. The worst it gets. And that's why,  when there's less pressure, if they're masturbating for example, or,  there was another, not a person in the room, but a computer,  then the pressure's off and then the system works fine.

Hmm. 

Tim Norton: So is it, how do we get better? Do we get it? Do we just face our fears? Is that 

Dr. Howard Schubiner: well, yeah. It's first of all, from my point of view is making an accurate diagnosis. Knowing what the problem is. If one thinks they have a structural problem or hormonal problem or whatever, it's going to be pretty hard to turn off the fear of it to turn off the dangerous signal.

So the first step is recognizing what the problem is, and that's usually done through getting normal medical testing.  making sure there's nothing structurally [00:11:00] wrong, which is usually pretty easy. Hormones are normal.  cat scan is normal,  physical exam by doctor's normal. And that's usually the case.

As I mentioned before, 90 some percent of people with chronic pelvic pain don't have anything structurally wrong with them.  so that's the first step. The second step is. Become is freeing yourself from the fear and the worry. So once you have the diagnosis that, you know, there's nothing wrong, it doesn't mean the pain is real.

It's very real, not imaginary. Anybody who says it's all in your head is either ignorant or cruel or both. But once you get, if you can get past that, When you can realize it's not your fault, there's nothing wrong with you. And this is just part of being human. Then every time you get a discomfort or you're in a situation where you need to perform [00:12:00] sexually, you just need to stop worrying about it.

Stop focusing on it and train yourself to calm in the face of. Pressure or stress or pain, calm your brain. And when you do that, then you're turning off the dangerous thing and then this, and then you get better. 

Tim Norton: So you, there's a couple of things that I want, I want to address with that. So one of the things you said was that,  and this is what we run into when dealing with mind, body medicine all the time is people, people don't want to think or hear, Hey, it's all in your head.

And, and you describe that statement as, as ignorant and cruel. Could you elaborate on that? Because on the one hand, you're saying, you know, the brain is causing the pain,  the brains in the head. And so, you know, that's why, why are we not saying that it's all in your head? 

Dr. Howard Schubiner: Well, that's an important distinction because all in your head has pejorative terms.

It [00:13:00] implies that the pain isn't real, you're imagining it. Well, that's not true. It's real pain because all pain is caused by the brain. It's implying that it's your fault, that there's something wrong with you. That you're nuts. You're wacko. You're mental. That's not true. As I pointed out earlier, I've had many instances of pain in my stomach, back neck,  rectum.

Scrot you name it over the years. It comes and goes when I'm crazy. For mental or deficient, it's part of being human. So that's the key is taking the guilt away, taking the shame away and recognizing that these symptoms are very real, not, not someone's fault. So that's why we say it's not in your head, right brain.

It's the brain that's doing it. You can't control your brain. The brain has, you know, has. It's way [00:14:00] of doing things and you can't go in there and just turn off the pain in your brain. You have to work with the brain and train it and rewire it and reprogram these neurocircuits that have become learned over time.

Tim Norton: Yeah. And how, how do we retrain those? Neurocircuits. 

Dr. Howard Schubiner: Exactly. Well, that's, that's what we do. And that's, that's why I've written books on this. And that's why people at the pain psychology center in Los Angeles, as you do teach people how to do this. And the key is recognizing that the pain is not dangerous.

When we recognize that it's not dangerous, then you start training your brain. That is not dangerous. So when it occurs, you train yourself to separate from it rather than to react to it. So the reaction is fear, frustration, worry, monitor, constant monitoring, stopping what you're doing, acting like you can't do [00:15:00] anything.

This, so the opposite is, is, is recovery. It's acting like it doesn't matter. It's treating yourself like the pain doesn't matter. It's kind of like a bullet, you know, bullies feed on fear of their victim. The more fear, the more the bully is emboldened. And they keep tormenting their victim. But when the victim either fights stands up to the bully and fights back and says, you know, you can't do this to me anymore.

Punches him in the nose. Or the victim says to the bully. Oh, you're saying I'm stupid. That's a good one. Ha I don't care. You're in essence, laughing at the pain now, is that easy to do? No, not always. It's simple, but it's not always easy to do and it can take several weeks or months for people to retrain their brain.

Tim Norton: Yeah. And especially if it's been happening for a long time, 

[00:16:00] Dr. Howard Schubiner: you'd be surprised though. Yes, that's true. But it's amazing how sometimes quickly these neurocircuits can turn on and off because they are in essence. Neurocircuits. It's not a hardware problem. It's a software problem.

Tim Norton: Interesting. So emotion. So you, you were, you were talking about fear and I recently watched one of your talks. I think he gave a talk at Google,  sometime ago. And there was a lot, there was a, there was mentioned in that, and there's a lot of talk in the psychogenic pain world about pain being. Connected to emotions.

 could you speculate on what emotions might be coming up for someone with erectile issues? 

Dr. Howard Schubiner: Well,  yeah, their research shows that emotions activate the exact same areas of [00:17:00] the body as an injury. Does. So the brain is wired to produce pain or other symptoms when emotions occur, because,  we feel like we're in a situation which is dangerous.

If someone, if we feel like someone's judging us, that would, that would qualify as feeling endangered. Maybe not physically endanger, but emotionally endangered, but it's the same thing. The brain responds the same way. So if you're performing in. Work gymnastics, golf or sexually, you're still performing.

And it's a question of how do you feel judged here now? Do you feel embarrassed? Do you feel guilty? Those are powerful, powerful emotions. Am I good enough powerful feelings. That can produce,  significant,  and real symptoms, like real [00:18:00] psychogenic symptoms. Right. 

Tim Norton: And then I, yeah, I've, I've looked at unlearn your pain.

I've looked at that book. I quite extensively. And there are, there are a lot of passages in there where you're really you're writing about your emotions. 

Dr. Howard Schubiner: Yeah, exactly.  there's several ways. To deal with the emotions that come up in our daily lives. And if we don't deal with them, don't don't can either not recognize them or not express them.

We can suppress them. Pretend they don't exist. Anger is a common one. Many people are taught. Anger is bad. You shouldn't be angry. You shouldn't be an angry person. Bad people are angry. Violence needs to horrible things. And violence does lead to horrible things, but anger is a healthy and normally emotion that oftentimes we need to help.

Our patients recognize that it's [00:19:00] there,  allow themselves to feel that allow themselves to express it in a safe and healthy way. For example, in writing or when they're alone, verbally, not necessarily to the person.  guilt is a very powerful emotion that people commonly feel that can trigger pain or other,  psychogenic disorders.

 unexpressed sadness and grief, same thing.

Tim Norton: And as you say that, I think about how different anger is,  to fear. And I wonder sometimes when people are, you know, when working with people on this, if I can see that when they're angry about it, there, it almost seems like they're. They're less afraid that they're, they're kind of moving past that they're, they're 

Dr. Howard Schubiner: empowered.

[00:20:00] Yeah. I've seen it many, many times,  because this, the life stress and the life situations,  that where someone feels powerless, for example, at work or in a relationship.  creates a tremendous amount of fear if you're powerless to do anything.  and that fear activates the dangerous signal, which can cause pain or other psychogenic disorders.

But when you're trapped and feeling powerless, oftentimes you're angry about them. And anger leads to action. Anger is a powerful and positive emotion that leads one to express oneself. And as long as you're not expressing anger in a way that creates violence or creates harm or creates defensiveness, or, you know, you can ruin a relationship easily by expressing anger.

[00:21:00]  so what we've learned to do is help people express anger and private ways that.  don't ruin relationships and then go back to the relationship to express,  to be assertive, but civil, but that makes sense. It 

Tim Norton: does. And, and I'm, I'm, you know, I deal with this stuff a lot. So I'm trying to put myself in the shoes of a client and we, we kind of glossed over some of the stuff.

And I, and I'm wondering, you know, guys are told they have. CPPs, they have chronic pelvic pain syndrome and they have prostititus and they have a host of other things. And are you saying that this process and these mechanisms that they'll apply to those conditions or are any of those separate from, from the psychotic pain?

Dr. Howard Schubiner: Well, what I'm saying is those conditions are labels, which we [00:22:00] often mean nothing, chronic pelvic pain syndrome as a label, which means virtually nothing other than you have pain chronically. And the reason it sounds horrible. And if you look it up online, you can read about people who suffer for it for years and keep going from doctor to doctor without any care, because when you treat.

A psychogenic pain syndrome as if it were a medical syndrome with drugs or injections or surgery. Oftentimes it'll just get worse because you're not addressing the underlying cause. And the reason they give a diagnosis of chronic pain syndrome or chronic prostititus is usually because there's, they haven't found anything.

So they're just giving it a label which describes in a sense where the pain is or. No.  you know, pudendal neuralgia is another one of those is saying, well it's though, which just means pelvic neurologists means pain. That's like a nerve pain [00:23:00] is completely meaningless. So those are three diagnoses that we commonly see that are in fact a psychophysiologic or a psychogenic pain disorder period.

There's nothing wrong physically, but 

Tim Norton: with a nerve. Can't they get in there and see that the nerve is 

Dr. Howard Schubiner: no, not at all. When you're given a diagnosis of moralgia it just means you have nerve like pain nerve, like pain. Yeah. And so, like you said, remember, you were saying earlier, well, you cannot be tingling.

Can it be burning? Can it be scratchy? Can it be itchy? Can it be sharp? And lancinating, it can be any of those things. And so the brain chooses a pain that is like a nerve like pain, then they'll call it. On their answer, but it's really meaningless though, that that term is given. Like I say, when the tests are normal, when the cat scan or MRI of the area is normal.

So what does that [00:24:00] mean? It means there is no tumor. There's no infection, there's no inflammation. There's, there's nothing structurally wrong and it's just hard. Sometimes to explain that to people because we, as a society are so steeped in the knowledge that pain equals physical damage and shockingly, most of the time, that is an incorrect statement.

And it 

Tim Norton: does just get worse with medical treatments that, that kind of reminds me of with the erectile issues. A lot of guys, especially if they start taking.  one of the PDE five inhibitors, Viagra early on that eventually they don't work very well. And if you've been taking that for 10, 15, 20 years, I mean, it's only been out 20 years.

 D you might need a higher dose, so you might have to start having way more side effects. And it might've been something that it could have [00:25:00] been treated, you know, with, with dealing with emotions and things that we're talking about and, and retraining the brain.  had you just not had a medical treatment to begin with, 

Dr. Howard Schubiner: right.

And most, you know, when you, when you look carefully at the studies,  there's a high likelihood in many medications, including opiates, including Viagara, et cetera, that the, the effect of the medication is a placebo one, rather than the actual effect of the medication. And so over time, The kind of placebo effect wears off, you know, because we haven't, as you point out you haven't addressed the underlying, you haven't addressed the underlying issue, the underlying issues ongoing and may get worse.

Over time. I saw a guy who had testicular pain,  so bad that he ended up having his testicle removed. [00:26:00] Oh, man. Not the reason I saw him of course, is that the removal of the testicle didn't stop the testicle from hurting because the pain wasn't due to an abnormal testicle. And in fact, they knew it was not an abnormal test to go before they removed it, but they were at their wit's ends and he was in such severe pain.

It turned out that,  in this case, he. He had found out that his wife had, had had a quote emotional affair with one of his friends and that precipitated the onset of the testicular pain, kind of like getting kicked in the nuts, so to speak. Sure. And,  smooth things over and things we're going to find for awhile.

And then he found out that no, she wasn't having an emotional affair with these guys. She was actually having a. Full-blown sexual affair with this guy and then the pain [00:27:00] skyrocketed to the roof and wouldn't go away. I saw, I saw a guy who had,   you got hit in the, in the, in the scrot  on a basketball court by a ball.

You know how, when someone's going out of bounds, they throw the ball real hard back into the court and get them square in the nuts. Annie. You know, doubled over how many guys have that happen to them, millions doubled over and walked it off. He can finish the rest of the game and the pain never went away.

So we had an injury and the injury healed there wasn't like anything was wrong. He went to numerous doctors, but the brain took that pain and just kept it going, kept going, kept it going. And the more he worried about it in theory, Hmm. 

Tim Norton: Fear that there was something wrong. 

Dr. Howard Schubiner: Fear that there was something wrong and just fear of the pain itself and frustration at the pain and [00:28:00] frustration at the doctors for not finding anything or frustration at the doctors for not doing anything, we're doing things that don't work and then getting invasive procedures that were even more scary like injections or, or,   you know, there's a diagnosis.

Another similar diagnosis is pelvic floor dysfunction, pelvic muscle tension, which again, in my mind, points to a psychophysiologic disorder and some of those people get internal pelvic therapy. That's not pleasant. Man, it's embarrassing and it's comfortable and they're pushing on the muscles and they're trying to make the muscles relax and maybe the muscles relaxed for a while.

And then they get tight again, because it's not the muscles. Aren't the problem. The muscles aren't damaged or disease. They're just reacting to tension in the brain.

[00:29:00] Tim Norton: What role does a person's. And environment play. I was watching your talk and you were talking about repetitive strain injury.  I don't know what that is, but that you, you commented that the work environment. And then I was just wondering work environment, pressure of marriage.  does, does that impact these, these 

Dr. Howard Schubiner: symptoms?

Well, oftentimes the brain will choose so to speak a symptom that makes sense. In some way, it makes medical sense. For example, RSI is pain with typing, basically being with writing or typing for the most part. And so, I mean, it can occur in the elbow or other joints, but usually refers to wrist pain and hand pain, finger pain with typing and,  [00:30:00] So you're typing and then you get this pain and maybe you're getting this pain because your work is you're overloaded at work or deadlines are coming out of here.

Your colleagues are obnoxious or your bosses ruthless or micromanaging, or you're not getting promoted. And all those things can come out in the hands. And what is the brain saying? Get out of there. Don't work. You shouldn't be, you shouldn't be typing as too much for you. So the message is there's something wrong with your job, but the interpretation of the message is often there's something wrong with my hand or my wrist or the ergonomics of the situation is really bad.

So you get a new chair and you get an economic gutter. Better keyboard or whatever, all those things. And maybe it helps for a while. But the point is, is that you got to treat the underlying cause, which is in the [00:31:00] brain.

Tim Norton: One thing that I've noticed working with these clients is that in those situations,  sometimes they do respond quite well to.  physical therapy and I have a theory about why that might be an, and I was wondering your 

Dr. Howard Schubiner: thoughts on that. What's your theory. 

Tim Norton: My theory is that there are, there are some, some pelvic floor specialists out there, some, some, some physical therapists in any profession.

And in fact doctors, all doctors before penicillin, I feel probably had really great bedside manner. And I'm really psychologically sound.  Ways of communicating with people so that they were able to do all these things that you're talking about face their fears, [00:32:00] feel, hope, you know, believe that they're going to be okay.

You know, all the things that doctors today are telling them that, that they're, they shouldn't feel right. That they're, they're going to have a condition for the rest of their lives. And there's really not much they can do other than manage of it. That, that a really good practitioner instills that sense of.

You're going to be, you're going to be good. You're you're going to be this. We're going to work on this and you're gonna get bad. 

Dr. Howard Schubiner: It's that? And more,  first of all, so there's three major components of a very powerful,  clinician, client relationship. And this has powerful effects.  one is giving an explanation that makes sense.

Hmm. So if the provider and the patient agree on the explanation, that's a powerful force, binding them together, and the explanation can be your pelvic muscles are, or that, you know, you need to change your ergonomic thing or whatever. It doesn't matter what the ex the next nation might be, or she is [00:33:00] off, or your shockers need adjusting.

Any of those are perfectly valid explanations, as long as both, both parties agree on it. The second thing is then you need a technique, something to do. So the technique of the physical therapy or the acupuncture, or the,  adjusting the shock Rose or, you know, whatever that is, is powerful again, because you believe it.

And the third part. Is the hope and the optimism and the relationship of a caring provider. And so when you put those together, you get a very powerful effect that the psychophysiological disorder, that's all you need. And the research has shown that,  for example, in acupuncture,  studies showed that are kind and caring.

Acupuncture said much better results than a brusque. And non-caring an acupuncturist sorta makes sense, obviously. Yeah. 

Tim Norton: So explanation, technique, 

Dr. Howard Schubiner: hope and 

[00:34:00] Tim Norton: relationship, relationship. Okay. I love that cause that that's so inclusive. I hate ruling out all the other disciplines and, and, and everybody, you know, but that, that's really saying as long as you and your client are on the same page and you have hope and you have a, and you have a path that, that that's what really counts.

Dr. Howard Schubiner: When people are coming to me because,  you know, my explanation is what I consider to be the truth. That there's not the instruction when that's the case, when there's nothing structurally wrong and that's the brand doing it to me, that's from my point of view, it's the best, best path because it doesn't require somebody else to treat you and you treat yourself number one.

Number two it's it's cheap and inexpensive. You're not getting long treatments and expensive treatments for the most part.  and still self-efficacy in the person that they can take care of it. And then over time as. [00:35:00] When which is often the case new psychophysiologic or psychogenic problems occurred because they're still human.

They have the tools to deal with them. So when I see somebody who had an acupuncture treatment, then their symptoms completely resolve. They say, Oh good. Now we know what your brain is. Acupuncture actually works on the brain. When you get,   nerve symptoms completely go away. When you get a shocker adjustment symptoms completely go away from my point of view, as, as a medical scientist, I'm saying, instead of saying, Oh wow, that's a good thing.

You got your cheek corrected. I'm saying, no, that was a great mind body therapy or a great placebo therapy. However you want to think of it because all those four characteristics were in place. And. Symptoms went away. Cause we're looking for helping people eliminate their symptoms rather than simply cope with them.

Tim Norton: And, and I have a feeling that a few hundred years ago, the, the way that,  a [00:36:00] doctor or a witch doctor or the way somebody stayed in practice was being really good at that, you know, and saying, okay, this is what you've got to do to get in alignment with the gods that. Are, you know, bestowing these injuries upon you in this pain upon you and because of their status in their community.

It had a really profound effect 

Dr. Howard Schubiner: on people. Oh yeah. Completely. They, if you look at a healing in the native native communities and healing,  you know, across centuries, you find that the,  That the explanations make sense within the context of the community.  it's often delivered by a powerful and respected,  shaman or doctor or whatever.

 there's this famous story of a native American young man in the Pacific [00:37:00] Northwest true story.  and he would see all these. Native healings, shamanistic healings. And he thought it was all a bunch of crap. You know, he thought, Oh, they're just, you know, it's just all Hocus Pocus and for show. So he decided to, to join the training, become an apprentice to be a shaman himself.

So he could expose this. No, this whole thing. So they taught them all the things and the different incantations and the rules and the tricks. And one of the tricks was they used to have this thing where they would. If someone had say abdominal pain, they would put their mouth to this, to the person's stomach and they would suck out the bad humors and they would spit them out and they would spit out all this blood and guts and stuff.

Well, it turned out what they had done prior to putting their mouth on the person's abdomen was put a bunch of junk in their mouth, bite their tongue. So it got bloody. So their own blood was [00:38:00] there. And when they spit it out, you know, there were. Whatever feathers and guts, whatever it was, they put in their mouth was there with blood.

And so it was very, you know, she had a great show. It had a really powerful effect on people. I mean, the bigger, the effect, we know the greater than placebo shots work better than pills. Casinos surgery works better than shots. So, so anyway, so he was ready to do his own healing. And this young Indian princess came with a domino pain.

And she was suffering so much and she was so beautiful and he did the treatment just like he was taught and she, and she got better and he's like, Hey, this is pretty good stuff.

So he never, he didn't expose it. He became, you know, he, he used it because it works. 

Tim Norton: I like that point that you say [00:39:00] surgeries work better than shots. And, and I think about the context of these surgeries, first of all, you know, our, our shamans are these, a lot of men and women and white lab coats and tall, clean, sterile buildings that have.

People admitting you and, you know, upheld by structures and insurance policies and, and waiting rooms. And then you go in there and that's, that's quite a show. And then, and then there's a surgery, there's these instruments, there's,  anesthesia and all of the various things that are going on and other people standing around and assistance.

And, and, and that's that, that, that's, that's a pretty big 

Dr. Howard Schubiner: deal. Yeah, the higher tech, the,  the more elaborate and the higher tech, the intervention, the stronger the placebo effect, the more it costs, the stronger that placebo effect that's been shown pills that are more expensive, have better [00:40:00] effect on pain pills that are less expensive.

 you can get very elaborate treatments,  for back pain where people take your blood and. No, mix it up and centrifuge it, or your bone marrow and injected and people are claiming, you know, you can cure almost anything with that. You can go to Germany for back pain and spend $30,000 on these elaborate treatments.

And you know, the farther you go. And I had a patient who,  Young woman who had horrible pain, horrible fear. And I worked with her and she didn't get better. And I worked with her and she didn't get better. And then the year or so later, she traveled to Brazil. She went into the countryside. She went to the sacred compound of this healer named John of God.

Well, no, [00:41:00] he does workshops in the States here as well. And,  and she,  he had her lie in her back and put her hand over her heart and, and pray and think and meditate or whatever. And miraculously, you know, she got better. So more power to him. 

Tim Norton: Yeah. I think the longer I do this, I try to suss that out in the beginning of treatment, like.

What, what, what treatment they believe in the most generally speaking. So in grad school, I remember reading this study where one of the best indicators as to whether a psychotropic medicine was going to work, like, like an antidepressant or something, was that a person believed he was going to work. And oftentimes, you know, someone will say, do you think I need medication?

And I'll say, look, I'm not a psychiatrist. I can't prescribe you any medication, but I'll just ask you point blank. Do you think it's going to help you? Because that's, that's going to make a really big [00:42:00] difference. And I had somebody 

Dr. Howard Schubiner: just go ahead. I write a prescription for something. I, I tell people how it's going to work and why it's going to work.

And,  you know, how beneficial this will be. And if they ask about the side effects, I'll say, yeah, there can be, there can be these side effects, but they don't occur in, you know, most people don't get them and, but most people do get the benefit. So,  I'm using the placebo effect of the medication to my advantage as must as much as possible.

Yeah. 

Tim Norton: But then we run into, so even when there's the explanation, the technique relationship and hope. If they have some intense underlying stressor or source of anxiety, the symptoms are going to return. 

Dr. Howard Schubiner: Right. That's one of the part of our treatment is to look at their life. Let's see what's going on. Are they in a dangerous situation, a [00:43:00] physically dangerous, emotionally dangerous situation?

Is there some boundaries that you need to set? Is there something they need to do? The other thing is that people who have adverse childhood events who have had abandonment, emotional abuse, physical abuse, sexual abuse, and assault are much more likely to get. These kinds of psychophysiologic disorders.

And sometimes it's necessary to take steps to deal with the traumatic events that are currently going on in their life or have gone in there, on, in their life, in the past. Yeah, 

Tim Norton: definitely. And one of the reasons I wanted you as a guest was I feel like.  a penis not getting hard. And having that having to do with emotions is not even, it is not, not even nearly [00:44:00] as big of a leap as thinking of, you know, like a burning or, or,  an ache that lasts for months and years at a time,  that could be caused by emotions and an avoidance of emotions and compounding fears.

Dr. Howard Schubiner: Or, or simply by this vicious cycle of pain, leading to fear, leading to more pain. Yeah.  it is,  it's from my point of view, it's sad that we've gone on a path where that possibility is rarely recognized in most people with chronic pain. When in fact it's the most common. Cause of chronic pain. And so our medical profession has veered in a direction which is highly technological and I'm not against technology and medicine.

I'm a physician. I value the advances that have been [00:45:00] made in the last 70,  80 years. But we've thrown out our understanding ending of the effects of the mind and the brain on the body. 

Tim Norton: What's what's up with that path. Why, why do we throw out so much when, when we started to get a handle on, on just basically on penicillin and on some of these drugs and 

Dr. Howard Schubiner: surgeries?

Yeah. Well,  So I'm not,  an expert in history of science, but several things have happened. One of course is the rapid rise of technology. So technology becomes so effective for certain things that we feel that it will be effective for all things.  30 40 years ago with the rise of all these antibiotics that we had,  we thought we would cure all infectious diseases and it turned out [00:46:00] that wasn't the case.

 and so there's the tendency to think that technology will solve problems. On the other hand, there's also been a degrading of psychology.  a backlash against Freud and Freudian analysis because some of his theories were a little bit wacko and off the rails. And so people threw out all of his theories, but he was a giant and he had really important things to tell us about the effect of,  the mind on the body.

And so,  so that kind of got thrown out at the same time in psychiatry itself when in a direction of biological psychiatry, thinking that we could solve our psychiatric problems by looking at neurotransmitters and by psychiatric medications. So those three factors, I think, are the ones that I would point to.

[00:47:00] Tim Norton: So what is the shift going to look like? 

Dr. Howard Schubiner: Yeah. I think the shift is, is profound, but in some ways it's extremely simple. I mean, what is, how hard is it to recognize that? For example,  I have,  a friend who, when she was,  a little girl in elementary school, she got,  one day she came in from recess.

And had a note on her desk and it said she looked, she read it and said, we don't like you. You're not like a, something like that just mean girls stuff. She looked at. If she looked around, wasn't clear who sent it. And day after day, she kept getting those kinds of notes. And within a week or two, her mother took her to her pediatrician because she was having stomach pain.

So the pediatrician felt her belly. He didn't order any tests. [00:48:00] He just felt her belly.  realized that I was fine. And he looked at her and he said, honey, is there something bothering

simple and so profound? And she looked at him and said, no, no, not at all. But she knew exactly what it was. So he made the connection for the next day. She go away, have to recess. She took the note. She didn't read it. She dropped it in the trash. And it, she got a couple more notes and she didn't read any of them.

She dropped them in the trash. They stopped coming and her stomach was a profound example of wisdom now, because the wisdom is, is that when you have people who have common syndromes in the absence of. Any,  you know, bleeding or tumors or infections and simple tests don't show anything most commonly it's a psychophysiologic disorder.

And so if we were [00:49:00] recognized those, if people would recognize them in their own lives, families would recognize them. If that was part of our culture, if it was part of our medical culture and our medical diagnosis, it's really not that hard. The big shift would have to occur in. In doing less invasive procedures for chronic pain.

Tim Norton: And that's really gotten out of hand. 

Dr. Howard Schubiner: The cost of chronic pain to our society is more than the cost of cancer, diabetes, and heart disease. Combined currently

is huge. No we're spending billions and billions less estimated $60 billion a year on chronic pain. 

Tim Norton: And is the majority of that like back surgeries or is it a lot of costly meds or, 

Dr. Howard Schubiner:  it's around 10 to $20 billion in back surgeries. [00:50:00] And. And roughly $10 billion in injections. I figured these out, roughly these are rough estimates.

Don't hold me to the number.  you know, there's less money in opiates, but more deaths. Right. And those are more suffering and more addiction. Yeah. 

Tim Norton: Yeah. It's, it's, it's staggering. And I find it sometimes pretty frustrating when you. See advertisements or people talking about those kinds of things. When we've seen so many people recover from, from, from mind, body techniques, from, from facing fears and processing emotions and reducing anxiety 

Dr. Howard Schubiner: and the effects of our mind body techniques will only get better over time.

As more people recognize these disorders. [00:51:00] Recognizing how common they are recognizing them earlier and people having support for, or using these types of therapies from their friends and family, as opposed to now, oftentimes someone will say, Hey, I read this book about this kind of mind, body connection.

And I think that's the cause of my pelvic pain in my back pain, my headache. And then there. Their siblings or their parents or their children say, are you kidding? You know, that's ridiculous. You know, go see a real doctor. 

Tim Norton: Right, right. And there's no support, but even that step, have you learned a trick along the way where when somebody's talking about something that sounds like psychogenic pain to offer.

Your ideas. I, I've kind of learned the hard way that unless they come to me because they've heard about what I do or [00:52:00] what I'm talking about or what I know that they don't, people don't respond really very well to it. 

Dr. Howard Schubiner: Yeah. People can be very defensive because of the same problem of feeling. It's majority of peoples.

Assuming that their pain is not real. They're not validated. So yeah, the first thing that you always want to do is to validate their pain is to empathize with them, is to see, make them know that you know, that their pain is real and that they are truly suffering. So you have to do that right up front and then.

 you can ask what they've all done and what path they've been on, because oftentimes they've been to doctors and they've tried a whole variety of things that haven't worked. And then you can begin to ask about what it's like. And so I've got a whole method and that I've written about in my books about how to accurately more accurately [00:53:00] diagnose this condition.

 so the medical testing is negative. First of all, second of all, that the characteristics of the pain or the symptoms fit into a psychophysiologic pattern. For example, they may turn on and turn up. That's typical of a neurocircuit problem. You mean better in the morning and worse in the afternoon, or are they're triggered by Somner they're lighter.

Something that suggests that it's triggering the brain. There's a whole variety of those things that we look for. And so that gives us more clues that it is a psychophysiologic or a psychogenic disorder.  and then we're looking at kind of the circumstantial evidence. Did it start at a time of great stress?

Do they have adverse childhood events?  is it worse with stressful situations? Have they had other psychophysiologic disorders at different points in their life when you put all that together. [00:54:00] And then at some point you have to say, well know, I know how much suffering you've had, and I know that you're not crazy.

I know this isn't all like in your head, but it turns out that many people, including myself have had symptoms like this that are caused by a neurocircuit. And you might be interested in reading about them. We're looking into that. 

Tim Norton: Hmm. I like the neural circuit term, as opposed to saying, you know, this might be caused by a by repressed emotion, 

Dr. Howard Schubiner: right.

It takes the psychology part out of it. Right. Neurological type. Of disorder. We've talked in our community of doctors and psychologists and social workers and physical therapists work in this vein. We've talked a lot about that and, and we are coming and be like the sobriety of terms from you is [00:55:00] neuropathway disorder and neurocircuits disorder, physiologic disorder, psychophysiologic disorder,  neuroplastic disorder, neuroplastic pain disorder, et cetera.

Tim Norton: Yeah, those are good, because like we were saying at the beginning, literally everything happens in your head, in your brain. Do you? Can't see, you can't hear you. You can't breathe. If, if there's something wrong with your brain and your brain processes, why you don't even know you're in reality without. The use of your brain and we, we might not, we might not be in reality, right.

We might all be a part of a computer that's just tapped into our brains. But that, that is, it's a moot. It's a, it's a meaningless statement. You're it's all in your head. Yes. So our ability to have this conversation is taking place 

Dr. Howard Schubiner: somewhere in our head. We there's been a tremendous amount of advances in neuroscience and neuroscience of consciousness.

 And also the neuroscience of how our brain [00:56:00] controls our body. It turns out that we don't see with our eyes, we see with our visual cortex in the brain, and basically we see what our brain expects to see. We hear what our brain expects to hear. We feel what our brain expects to feel. So these are all neural circuits and the neuro and the neuroscience term that people are using for this is predictive coding.

The brain codes for what it predicts will happen. If you expect to have pain every time you bend over. And this is not a conscious expectation, it can be of course, but it's really a subconscious, that's a brain expectation and a coding and neural circuit of having pain. When you bend over every time you bend over your brain is actually turning on pain and it's up to us to recognize what's going on and change that pathway.

Tim Norton: And we might be expecting to not get an erection or expecting to lose an erection. 

[00:57:00] Dr. Howard Schubiner: Exactly. It's a very powerful thing. And research has shown that,  you know, that expectation effect has powerful physiologic effects on the body.  people who were told that they, if you take people who are given a, a smoothie to drink, And you'd tell half of them, it's a high calorie smoothie and the other half, it's a low calorie smoothie, even though the smoothies are all the same.

The people who got the high calorie smoothie have,  their brain turns on secretion of the hormone Greenland, which is produced when you're, , when you've had enough to eat. So you think you're eating, you think you've had enough to eat your brain response by turning on the hormone, which says, yeah, you've had enough to eat.

That's pretty amazing study. 

Tim Norton: That is amazing. And, and you mentioned sight and hearing, I've heard some amazing studies with, with that as well [00:58:00] with, with seeing things that we are expecting to see or not seeing things that we're not expecting 

Dr. Howard Schubiner: to see exactly. There's the famous one with the gorilla where 

Tim Norton: the, where everybody sees an intro to psych where they're passing the basketball to one another and a gorilla walks right through.

This group of people passing. I remember I watched that in a, probably 300 person auditorium at USC in intro to psych. And then they asked us to, you know, everybody had to raise their hand and say, did you guys see a gorilla? You know, 

Dr. Howard Schubiner: maybe 

Tim Norton: 30 or 40 people raise their hand. And, and I was not one of them. I was like, there was no gorilla.

Then they show the video again. And there's, 

Dr. Howard Schubiner: there's a gorilla. What am I, the story I like to tell about that. My wife every morning has the exact same breakfast, sliced Apple, granola, yogurt. And,  so that's what she has. And one morning,  she was up early and I was still in bed and [00:59:00] our room was dark and she had an extra slice of Apple and she came up to the bedroom.

It was all dark. She took the Apple and she, she just fed it to me. Basically. I opened my mouth and I bit down on it. And my immediate and powerful reaction was disgust. This tasted horrible. It turned out it was a peach,  and, but it was a good peach. It was not a rotten peach and it turns out my favorite fruit is peach.

Wow. What my brain was expecting a crunchy Apple, and I got a soft. Sweet pea sweet sensation, but I didn't taste it as sweet at all. I tasted it as disgusting as rotten. My brain turned on the sensation for discussed and, and,  and,  you know, rotten sensation in the mouth purely because of expectation.

And that's, that's amazing that that could have is so powerful. 

[01:00:00] Tim Norton: That is amazing. Did you read the,  Lisa Feldman Barrett book about emotions? And she talks about her. Twelve-year-old having a sleepover party and they, they put lemonade in a catheter or something like that. And everybody was just so grossed out thinking that they were drinking pee and yeah, it's our brains.

Do those things in so many ways. 

Dr. Howard Schubiner: I mean, I, you know, I mean, you're a police officer. No, you get called to a park, you get called to a scene of something you're on a chase and you know, you get there and what do you see? Well, you see what your program to see what you expect to see what you're afraid of seeing.

And, you know, sometimes police officer in the situation where they shoot innocent people or kids even,  because their brain is registering something that is not really, they're really scary. 

[01:01:00] Tim Norton: That is really scary. So what are you, what, what,  what are you working on at the moment? What are what's what's in the works for Dr.

Schubert? 

Dr. Howard Schubiner: Well,  you know, we've written,  written a couple books for patients. We have a new book for professionals called hidden from view by,  with the Dr. Allen. They have this fantastic and wonderful psychiatrist from Halifax.  we. We recently last year we published a, the first study to show that,  one psycholog, psychological intervention for pain is actually superior to another.

And that was the case where we compared in emotional expression intervention that we devised to the standard cognitive behavioral therapy intervention for people with fibromyalgia pain were. We're working on a back pain study,  at the university of Colorado in Boulder. [01:02:00] And we've randomized people to getting the mind body intervention versus a placebo injection or a treatment as usual.

And all those patients are getting functional MRI of the brain pre and post the intervention. And those results will be coming up this year. Hopefully. So,  we're doing research, we're teaching a lot of people. We were teaching seminars for physicians, nurses, psychologists, social workers, physical therapists, health coaches,  all over the country.

So, you know, trying to make this. Paradigm shifts,  happen sooner or later. Yeah. 

Tim Norton: And you're, you're doing really great work and really inspirational work.  I'm realizing that I haven't done the best job of, of, of making the analogies between a lot of what you're saying to the erectile issues. And even as [01:03:00] you were talking about,  that last process of assessment.

 it, it sounded like all of that stuff could, could really apply, you know, like you, you get erections when you're alone, when you don't get them when you're with other people. And,  there was an experience that, that,  where this started happening and it's been happening ever since. And I was just wondering if, you know, with that in mind, if you had one piece of advice to tell clients out there with erectile issues and one, one, one nugget that you could leave them with, what would that be?

Dr. Howard Schubiner:  for the most part,  assuming that again, there's no major vascular and neurologic issue,  which is the vast majority of people with erectile dysfunction situation.  the best advice is to recognize that you're not damaged, that you're perfectly normal and try to be in the moment [01:04:00] and,  Try to enjoy what you're doing sexually, as opposed to worrying about what you can't do, what, what might happen, what could happen.

And those thoughts will come up, but you have to just keep going back to the back to the moment where you can hopefully be as,  As engaged as possible and, and what's important and what you're doing and then yourself and then the other person, not so much out of your head. And then the other person is probably the best piece of advice, really?

Because if you're all in your own head, so to speak, your brain is going to get in the way, right. 

Tim Norton: It really is going to get in 

Dr. Howard Schubiner: the way. All right, 

Tim Norton: Dr. Schubert. Well, thank you so much for your time and for this interview. I, I think if there was, there's been a lot of really helpful information and, and thank you so much for the work that you do.

You're really a pioneer out there, and then you're doing good [01:05:00] stuff. 

Dr. Howard Schubiner: It's a pleasure, Tim. I really appreciate being here. 

Tim Norton: One thing I wanted to ask you is how can people find you on the internet and out in the world? 

Dr. Howard Schubiner: My website is unlearn your pain.com. Unlearn your pain.com. So that's really the best way to find me.

 people can friend me on Facebook or, or,  on Twitter. But,  through my website and my email's available there. 

Tim Norton: Okay. Good. All right. Well, have a, have a wonderful rest of your day and weekend 

Dr. Howard Schubiner: then I'll, I'll see you around take care. Bye-bye

Tim Norton: Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sexual podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.