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- [00:00]
A
As a caregiver, we should all recognize that whether we want it or not, when our patients feel helpless, independent, and when they feel least uncertain about trusting us with their care, they automatically identify with us. You can't stop that. That's hardwired in all mammals, I believe. And your words, your ideas, they become the ideas of the patient. And that can be very, very powerful because it goes in, as it were, unconsciously, and those ideas become operative quickly.
- [00:45]
B
Hello and welcome to pursuing health. I'm Dr. Julie Fouche, family physician and former CrossFit Games athlete. Here I bring you information and inspiration to help bridge the gap between fitness and medicine and and support your journey toward your healthiest self. Thank you so much for joining me. Now let's get started with this week's episode. Welcome back to Pursuing Health. I am very excited to be here today with Dr. Steve Bierman. He is the director of the Noetic Medicine Institute at the Andrew Weil center for Integrative Medicine at the University of Arizona. He's also the author of two award winning books on noetic medicine, Healing and the End of Worry. He's a graduate of Northwestern University School of Medicine and was board certified in and practiced emergency and family medicine. He's also a diplomat of the American Board of Medical Hypnosis. He teaches noetic medicine or mind medicine around the world, reminding caregivers that mind matters and that the words of a caregiver can harm or heal. So thank you so much for joining me today, Steve.
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A
It's a pleasure, Julie. I look forward to it.
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B
And before we dive in, I would love to give a little bit of background on how this conversation came to be for listeners. So anyone who's been listening to the podcast for any period of time probably knows that I've been fascinated by the mind body connection and its implications on healing. And I think this for me has always been a fascination. It was cultivated by one of the faculty in my residency program, also in family medicine, who directed our own integrative medicine program. And he really talked to us about the power of suggestion in our communication with patients. And I've also had guests on through him I was connected to Dr. Wayne Jonas, who, you know, talks a lot about placebo and the meaning response. And he's been on the podcast a couple of times but recently was introduced to you, Steve, and this concept of noetic medicine and your book Healing Beyond Pills and Potions and going to get into it. But this reading your book was one of those light bulb moments for me. I can think of Only three others that I've had over my course of learning about health and healing. That just changed the way that I think about health and healing and that I know once you see it, you can't unsee it. And it's going to become, you know, part of my practice moving forward. And so I'm very excited to share that with, with all of my listeners and talk to you about the details of that model. But before we get into that, I would love to hear about your path. I think I'm always fascinated. What are the experiences and the events in people's lives that lead them to a specific path, in your case, to developing noetic medicine. And so let's start with just what led you into medicine in the first place.
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A
I'm a third generation physician in my family. My grandfather was a family practice physician in East St. Louis. My father was an ophthalmologist in Santa Monica, California. And so early on it seemed the natural path. I think like many I had to wrestle with that. But ultimately I came to terms with it as my true fate and calling. And so I pursued at the beginning a rather traditional allopathic pathway. Went to UCLA undergraduate, Northwestern School of Medicine, and then family practice residency here in San Diego at ucsd. But I then leaving family practice, I'll tell you why, perhaps later, but I started my emergency room practice and I was full time board certified emergency physician at Scripps hospital in Encinitas, California for 20 years.
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B
I think your decision, I loved reading about your decision. One, some of the feelings you had around pursuing family medicine. I know you talked about being at Northwestern and choosing family medicine wasn't necessarily the most common path. And sometimes I felt very similarly. When I was at the Cleveland Clinic, I still very clearly remember our capstone course sitting around everybody telling, you know, their specialty and where they're going next year and feeling like, oh gosh, it's, you know, it's ophthalmology, it's dermatology, it's ent, it's very subspecialized fields at these prestigious centers and feeling a little like, oh, family. But I knew for me that family medicine was the route that I wanted to go. And I had such a connection to, you know, really trying to help patients be as healthy as possible and have long term relationships with them. And that's what drew me in. But I think it's so interesting the different pressures that we feel or stories that people might have about the direction you go in medicine.
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A
Yeah, I confess I felt inadequate in family medicine at the End of my three years, I sensed from having been in clinic for three years that the vast majority of the ailments that would be presented to me by my patients had some mental component to them. And I realized that although I trained really hard to understand psychological pathways to healing, I felt totally inadequate to that task. And looking back, I was inadequate to it. And so I did what every red blooded coward would do. I ran to a place where there was much, much less insecurity. I was well trained for er and so working emergency medicine, no one could really dispute the value of it. And so that was sort of a easy place to hide out, you might say, in the allopathic world. Because we should all recognize that perhaps nowhere better, there are other venues, but perhaps nowhere better is allopathic medicine applied than in the emergency department when things have gotten so bad that they've reached criticality. I will tell you though that what happened there, and I think this happens to all of us as we practice, is I came to realize that the ghostly whisper of, you're missing it, there's something deeper, there's other things going on that ultimately caught up with me in the emergency room. I recognized early on that the number one diagnosis of virtually every patient in the Edge is anxiety. That's diagnosis number one. Then I also recognized that they were coming in either in pain or I was causing pain, or both by virtue of the procedures that I would perform. And so I was looking for a way to initially to eliminate pain and anxiety in my patients and aed. And so I studied nlp, neuro linguistic programming with John Grinder, one of the two founders. And I studied medical hypnosis. And as you mentioned, I got certified board certified in medical hypnosis. And I applied that readily in the emergency department. There were times when I would have six to 12 people in various stages of trans going from the ED to radiology down to the, all over the hospital. And that was sort of a wonderful time in my career. There were, I think I was publishing papers and word got out. A couple major network TV crews followed me around and got to watch the wonders of traditional trans hypnosis. That, that was kind of a heady time, but I was able to operate that way because in those early times I had a relatively slow patient flow. I'd see 20 or 30 patients per 10 hour shift in the ED. So I had time to pause and do trans inductions on asthmatic kids and people with joint dislocations and so forth. What happened though, and I think this was critical, is Things sped up. And from seeing 800 patients a month, very quickly, we were seeing 1600 patients a month, one doc. And so I didn't have time to really slow down and do formal trance inductions. I could still adhere to certain aspects of hypnotic method, meaning I could watch my words and gestures and I could establish rapport, which is really a mimicking or mirroring type of relationship with patients. Those more subtle things I could do. But I had no time for deep trance inductions and management. And what I discovered was, and I know you know, this trance was utterly unimportant. In fact, I could induce the same stunning outcomes, meaning hemostasis for major and minor hemorrhages, elimination of pain and anxiety, non manipulative reduction of dislocated joints, cardioversion without medication. I'm not recommending that. I'm just saying it can be done. And I have successfully done that with almost all the presenting arrhythmias you deal with, except of course, BFIB and the emergency department converting two or three patients with VTACH and diminishing vital signs with words and words alone and many, many other applications. So then I was confronted with the classic question, what the hell is going on?
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B
This is working.
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A
Yeah, this is working. But how is, why is this working? What's making this happen? And that was really the beginning of my quest to, to understand the nature of the relationship. What hypnosis is and is not, it is not France. I will tell you about. And what of caregiver in a position where patients tend to identify with you because they're helpless, independent at the time, what a caregiver can actually bring about with his or her words and deeds.
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B
So powerful. And just to illustrate too, I'd love to zoom into what you just described because it's very incredible what the things that you were able to see and do in the emergency room setting. And I want people to be able to really understand that. So, you know, for example, and you gave several examples of this in your book, but for example, you know, having a child come in that's screaming because they broke a bone and that needs to be relocated, or needing to have a suture, you know, have a laceration and have that sutured up. What would that look like when you were using hypnosis?
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A
I think those two cases, for example, I did induce trance. The first in a young boy with angulated both bone fracture of the forearm. His mom was panicked, there was a lot of screaming and frenzy around that. And I had learned a nonverbal induction technique and so was able to induce trance as the first response to my suggestions, and analgesia and anesthesia after that as secondary response. And it's very important to understand that trance is one response, but there are many, many other. And they're not consequent to trance, but per se, they're consequent to the patient's perception of me as a trustworthy authority figure in a time of need. So there were those moments in the ED regardless, when trance seemed appropriate and could be quickly induced many, many other times, and I would say with virtually every patient that I saw, once I learned this approach, I use my words and gestures to suggest some kind of salutary outcome. If they were bleeding, to stop bleeding, if they were in a dysrhythmia, to correct that back to normal sinus rhythm, if they were giving birth, to widen the birth canal, if I was intubating someone to relax the airway so it could receive the endotracheal tube without resistance. And all of those phenomena and many more, as I lay out in the book, those were broadly induced with words, with suggestions offered in a way that would not evoke resistance. But the point being that as a caregiver, and I think this is a key learning for me as a caregiver, we should all recognize that whether we want it or not, when our patients feel helpless, independent, and when they feel least uncertain about trusting us with their care, they automatically identify with us. You can't stop that. That's hardwired. And all mammals, I believe, and your words, your ideas, they become the ideas of the patient. And that can be very, very powerful because it goes in, as it were, unconsciously, and those ideas become operative quickly. The idea that you can stop your bleeding, and I need you to do that now, that's a powerful notion. And we weren't trained to this in medical school, but in fact, every person listening has the capacity to stop their bleeding with a mental switch. I've not seen that fail, and I've done it literally hundreds of times. And to relieve themselves of pain and to heal rapidly. Let me give you outside the ED example, just so people don't mistake this as something peculiar to a crisis. For the last, I think 30, 40 years, I've seen one, sometimes two patients a week for pre surgical hypnosis, and sometimes I use trench, but often I don't now yet I suggest that we all have this capacity to stop bleeding, reduce or eliminate pain, and accelerate healing. You say that by saying you can keep your own blood, you don't want to say it in the negative, Keep your own blood, keep every drop a dry feel, which is where the surgeons operate. Completely dry wake with delightfully surprising comfort. Surprising perhaps, you and all of those around you so comfortable that the word pain. How's your pain? How. How much pain do you have? Do you want a pain pill? The word pain becomes a trigger for even more comfort and really, really rapid wound healing. Really rapid wound healing. Now, I just had a beloved patient undergo a left hemiculectomy for colon cancer. And you'll find this very hard to believe. I know that in advance because I have to say I'm not sure. I still can scarcely believe it, though I was witness to it. Her surgery took 2 hours and 15 minutes. She had no bleeding, though the doctor, wonderful guy at Tri City Hospital, wrote 5 cc's because, quote Steve, I had to write something. She had her first bowel movement, the return of normal function in 12 hours. That should stun, I think, most people listening. And she was discharged from the hospital in under 72 hours with healed wounds. Her wounds were actually closed and healed. We were all stunned. I mean, the nurses were afraid to write the notes as they were recording this with just reason. But we all have that capacity and other capacities. And the task of the caregiver, whatever your path, is to somehow elicit the innate healing capacities of our patients.
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B
Like you mentioned, that story is incredible. The idea of calming a child, having pain relief without medication, converting an abnormal heart rhythm into a normal rhythm without medication is something that our allopathic or western, you know, paradigm doesn't, doesn't know how to place. But yet is. Is real and you've seen it over and over again. And we see it in research on placebo and nocebo effects. And I think what you said about doctors not, not even being aware of how important the words that we say can be for our patients, both in facilitating healing, like you just demonstrated in this woman, you know, with, with incredible healing after her surgery, but also, if we're not aware of it, our words can be harmful. And that's, you know, what we see in a lot of the, the nocebo research. And so how do you look at placebo and nocebo research and what did you draw from that that helped inform your own work?
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A
Well, I think it's really important to understand what is going on with placebo and nocebo. I would say to date, the research has been interesting in that it discovers multiple phenomena, it proposes explanations, none of which I accept, by the way. And it draws our attention to these phenomena, but often not in a productive way. You think of placebo, that's a particular kind of effect. The strange name, Latin root, so forth. Nocebo seems to be the reverse. But what's going on? Is that a different mechanism? It's a different Latin root? You know, it's one of these misty topics, I would say, until the paper that I sent you, which Dr. Andrew Weil, Stephen Dahmer and myself published just recently, entitled Placebo and the Law of Identification. What's. What's critical is understanding first what's going on there. Here's what's going on. Okay, I'm going to cut through a very dense scientific paper and get to the.
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B
The meat. The law of identification.
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A
Anyone who's interested can find that article.
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B
Absolutely. And we'll link that in the show notes. I recommend checking it out.
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A
Yeah, wonderful. What's going on is this whether it's in a clinical study or whether it's in a psychology lab. A lot of great work, for example, has been done up at Stanford. There is an authority figure. There is someone who commands the greatest trust, let's say. And there are subjects who are relatively helpless. They can't determine the outcome of the experiment or clinical outcome. And dependent. They need an external source for that. So this law of identification says, and I've hinted this already, your patients or your subjects in clinical trials will identify with you, meaning your ideas become their ideas in direct proportion to their helplessness and dependency and an inverse proportion to their uncertainty about you. If they have no uncertainty about your ability to help them, you are likely to be maximally identified with. And what that means is when you offer a suggestion, an idea, that idea becomes their idea. People say, but wait a minute, in the clinic, in the trials, these are all kinds of different treatments. I mean, the placebos can range from sham surgeries to just ideas to sugar pills and other nostrums. Right. So what is it? And I can tell you, I discuss this in excruciating detail in the article. But the bottom line is that those are props and we should not mistake the prop for the underlying suggestion, the kernel of it all. And the kernel is in all of these instances and inherent in every clinical intervention that we, that we engage in with our patients is the suggestion, I call it the generic placebo instruction. The suggestion that if you do X, X being the intervention, take this pill, have the surgery, undergo this treatment. If you do X, then Y, the prescribed outcomes, positive or negative, meaning placebo or nocebo, the prescribed outcomes will Happen. That's the suggestion. And like I can say that to, say, someone in my house, and they know me, they know I'm sometimes right, sometimes wrong, often a fumbling doofus. They're not going to. I don't have the hypnotic influence that you all have in your offices. And that white coat scientists have in their laboratories, you don't have that at home, but you have that where you work. That's why Bernard Lownd, the Nobel Prize winning cardiologist, decades ago said, words are doctors most powerful tool, but they can maim. That would be the nocebo effect, or heal. So think about this. Every single placebo controlled randomized trial performed since say, 1909 to the present day has demonstrated again and again, without fail, that this generic placebo instruction, if you do X, then Y will happen, is when driven by a trusted authority figure, actualizes in the patient or subject. In other words, this mind over matter effect, if you will, is in my view, and I believe it should be in everyone's view, because this is indisputable, is the cardinal fact of clinical medicine. It has more supportive data behind it than anything else in all of clinical practice. Right. And if you want to summarize it, it's simple. Ideas matter, words matter. Mind your words.
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B
So powerful, but yet so underutilized. It's not something that we learn about in medical school and so many doctors are unaware of the power of their words. And I think as you talk about the law of identification and the idea of the importance of authority, right. When it's maximized, as you talk about in an emergency setting in the er, when someone's life is in your hands, and maybe a little less so if you're in an outpatient family medicine clinic, but is still there. And I think you also mentioned how this is how we're hardwired as humans. You think about even you said maybe some people in your house might not see you with the same authority now, but when you have children, they are in that position where they look to their parents as the authority figure because they're dependent, completely dependent on them. And that's often how we form our beliefs and our view of the world.
- [27:31]
A
Well, absolutely. Bernie Siegel, who you may know or know of, he wrote a beautiful book entitled Love Medicine and Miracles some time ago. A surgeon, no less. He was, I think, one of the first to point out that our parents are our first quote, unquote hypnotists. Not that they induce trance, but that we're identified with them and therefore their reality becomes our reality. At the deepest, deepest levels. So, yeah, it is hardwired into us. I often have students say, well, you know, Dr. Booman, I don't know if this was true in your generational training, but in ours, we talk about shared decision making, and we're very, very anti medical paternalism. And I understand that concern. I'm profoundly sympathetic to it. And I think that both those points are correct and worthy of teaching. But we should also understand that these notions are relatively new to the culture of healing. They're less than 100 years old. And the wiring I'm talking about is deep neurologic wiring. In our species, millions of years, you cannot override that with a couple of generations of conscious verbal training. We still have the biological underpinning of our species. And so when you sit down with a patient to do shared decision making, which of course, I highly recommend, if you think you're sitting down as two equals and that your opinion doesn't carry more weight in that circumstance than say, it would in any outside circumstance, you're making a grave mistake. And it's a mistake that has consequences. At best, you'll miss opportunities, opportunities to heal, to offer salutary ideas and suggestions. But at worst, you'll speak inadvertently cursing the patient. So I ask every patient I see, and I have done this for decades, tell me, as part of my history, tell me what you've heard from your various caregivers or friends that you wish you had not heard. And from my vantage point, this is a critically important question to ask. Because if some authority figure has already cursed them with something like, oh, you'll just have to learn to live with this, or this, a chronic illness, or God forbid, I'm seeing a patient later today, he was told three years ago, you have five to 11 months to live or all the many, many other curses that are out there. Side note, let's stop using the word chronic ways, because chronic is a curse. You don't realize that we're all taught, oh, hypertension, that's chronic disease.
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B
Does it have to be?
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A
Yeah, maybe a long standing illness with someone or condition. Long standing is an okay word because it doesn't predict the future. Chronic says, and it'll go on and on and on. And we're not prophets. We don't know the future. So we have to really inspect our words and watch what we say. But the hard wiring is there, and we do benefit to our patients when we recognize it and then use it to their best advantage.
- [31:37]
B
I'd love to go through a few examples of this One for anyone listening who is a caregiver, but also for anyone who is a patient who may have received some of those, as you say, those curses in the past and how we can mitigate against them. So maybe we start with an example of different types of informed consent. You're starting a new medication for a patient and there are some potential risks and potential side effects and potential benefits. How does that conversation typically go? And then how can you have that conversation in a much more informed way using what we're talking about here?
- [32:20]
A
Yeah, that's a perfect question, Julie. So let's first acknowledge, I think almost none of us were taught how to do this right. And so informed consent, especially when it involves patients who are feeling in that moment helpless and dependent and trusting you. Informed consent is one of these critical moments when if you do it right, your patient ends up with a sense of hope and alliance with you and at an unconscious level, perhaps some deeply embedded positive suggestions. If you do it wrong, it can do real harm. And I sadly must say I see that real harm almost every day. Let me give you. Here's how you do it, Ron. Okay, let's just make it simple. It's a antibiotic pill I'm giving someone and it can cause nausea, vomiting and say, photosensitivity. Okay, here's the wrong way to do it. Well, you know, I have to tell you the risks and benefit of this pill I'm recommending. And so with your permission, I'd like to do that. Okay, sure, doc, I'm listening. Well, I'm recommending this pill because it can help you, but you should now that you're probably going to have some nausea. Chances are if you accidentally take it on empty stomach, you will have vomiting, and there's a lesser chance, but you certainly have some likelihood of reacting to sunshine. So if you feel hot or sunburny, make sure you get out of the of the light really quickly. And if you get, you get any one of those, or even all of them, I need you to call me right away and I'll try to help you with one medicine or another. And we can hope that works. And if not, we can try something else. I have to say, Julie, it's hard for me to do that.
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B
It doesn't sound like you.
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A
I haven't given informed consent that way for a long, long time. The problem there is you will. You probably you this, you that. And then the word try implies an obstruction. Everyone is a parent who knows that you say, kids, you know, I'm really tired of this Mess, I need you to clean it up today. And they look up at you with these innocent eyes and say, oh, we'll try, dad. You got your answer right. And when you tell a patient, you know, I'll try to give you something for relief or I'll. Well, I'll try to minimize your bleeding or I'll try to help you out. You're implying an obstruction. We should be more careful. Informed consent, done right is really simple. You need to know a couple things. There's a sharp linguistic distinction between when you refer to you, a direct prentual index, you are yours, as opposed to some people, others, those people, patients, generic referential indices, as they're called. And we want to be very, very careful where we put the. You. The direction. And so using that distinction and realizing that in clinical medicine, let me assert we never have sufficient certainty to say you will. Our knowledge is statistical and anecdotal, observational. And so that kind of knowledge can teach us probabilities about groups, but it can never give you the certainty when you sit one on one with the patients and say you will. You might. You could, you can. You may is more accurate of the probability information you possess. Okay. The only other thing you need to know to do this right is that I can put. I'm going to slide back so your viewers see this. I can put the risks over there on the one hand and the benefits right there on the other.
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B
And for people who are. Who are just listening, you can see when you're talking about the risk for others, your hand is moving away. And then the benefits for you, you're pointing your hand directly at the patient.
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A
Thank you. That's correct. And so this becomes very, very simple. Now, let's do it right. So, as I've mentioned, I'd like to give you this pill to treat the condition we've discussed, but I'm required to give you informed consent. The risks, on the one hand, you see, I'm placing it out there away from them already. And the benefits. Would you like to hear that? Well, yes, Doctor, of course I would. Please, please proceed. All right. Well, with your permission, let me talk about the risks first. Again, my hand goes out away from that. There are some people. See how I've gone to some people. Mind you, there are some people who might have nausea and they or others could also have vomiting. Could as well. And there's also a slight risk of photosensitivity, sensitivity to sunlight that others might have. Some others could my. And those are our risks, if, of course, they were to have that if, which always implies if not. If they were to have that, I need them to call me right away so I can give them what they require for comfort. It's very simple and it's very honest, but there are no implicit curses there. And I've given all the rest. On the other hand, now my hand goes toward them. I have patience, perhaps, I have to say, perhaps, to be honest, perhaps just like you do very, very well without complications on this medicine. Now, what I've done is I've extended my hand toward them. I've looked them in the eye at that point, and after, perhaps, like I say, you do very, very well without complications. I'm embedding that suggestion. Okay, I tell you what. Why don't you call me tomorrow and let me know how well you're doing? I'm presupposing an outcome and offering that suggestion. Goodbyes are your last opportunity in that encounter to implant a therapeutic suggestion. Why would you not? This is the placebo moment. Why don't you call me tomorrow and let me know how well you're doing? And then as they're packing everything up and getting ready to go, I'll do an oh, by the way. Now, oh, by the ways are wonderful in medicine because all the resistance is down. It makes it appear as if what you're about to say is really inconsequential. It's an afterthought. You're just throwing it out there. Hey, oh, by the way. And I do this frequently. Almost every time I say to my patient, they're leaving. They might even be out the door. And I say, oh, by the way, do me a favor. They're happy to return a favor. So please don't be opposed to pleasantly surprising yourself. Now there's a double negative. Don't be opposed. While they're untying that knot I've implanted. Pleasantly surprising. So think of this. Two sentences and a goodbye, right? Why don't you call me tomorrow, tell me how well you're doing? Oh, by the way, please don't be opposed to pleasantly surprising yourself. If you think of that and realize that you could say that at home with no impact at all on one of your buddies who you've known for 40 years or 20 years. And they're like. But when you say that in the office, the ideas contained within those two sentences are driven to actualize by the law of identification. That's what makes placebo effects happen, and that's how you prevent nocebo.
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B
Amazing. And so powerful and so like you said in a couple of sentences, and intentional choices of words can have a healing effect that doesn't take any additional time or anything else. You mentioned earlier, the patient who was told previously about having at most 11 months to live and is now three years out from that conversation. I think this is one of the other things that's most difficult for patients is receiving a difficult diagnosis in the prognosis. How would you deliver that information to a patient in a way that's again, informed consent, but also creating a possibility for this patient to heal and have, quote, unquote, miraculous healing? I love your question. Thank you.
- [43:04]
A
This is so critically important and I have a lot of experience to suggest that this can have life or death consequences. I would say first to patients who feel as if they've been cursed or as Dr. Weil says, medically hexed. Here's what I tell those patients. Let's say there's a doctor. I'll randomly choose a name. Dr. Zimmerman.
- [43:43]
B
Sorry, Dr. Zimmerman's out there. This is a non specific example.
- [43:48]
A
I'm not speaking to them. Let's say Dr. Z met. I would say, well, I don't know Dr. Z, but I'm sure he or she is a loving and compassionate person. It's important to understand that doctors aren't really taught how to speak, how to deliver information, and so all of us make mistakes. Now, I guarantee you this, if you went up to Dr. Z's, let's say, wife and asked her, well, your husband's quite admirable. I'm curious, how often in your experience have his predictions been. Is he 100%? Well, right. I mean, she'd fall over laughing because she knows he's human. And of course, none of us are prophets or capable of at least reliable prophecy, let's say, with respect to our patients. And so she would laugh. And what I'm doing is I'm creating a little more uncertainty. If I know that doc, or even if I don't, I'll say something like, well, I understand they said that. I think it's important for you to understand that there is no class in medical school on prophecy. And so the likelihood that that doctor is 100% correct is about the same as any doctor, which is zero. We're not profits and the nature of our information is statistical. He undoubtedly read a paper where the statistics suggested an x percent chance. But that you have to understand, as the doctor seems not to, that that percentage is not your percent likelihood. It's the percent within that group. We don't even Know if you share a commonality with that group, you're talking to me, a noetic medicine physician. Nobody in that group, I guarantee you, was. So I don't know that you're matched to that. I expect probabilities are very different. And we won't know. We won't know that you are going to beat this thing and that your chances of doing that were 100% until we're looking back, until it's in the rearview mirror. So I'll frequently say that to people who have carried the curves, and I might work it a little stronger over time if I'm sending. This happens commonly, Julie. And I think all caregivers need to know this. If I'm sending someone, let's say, to a neurosurgeon, okay, Or a cardiothoracic surgeon, Those folks have worked so hard on their skill. They've often neglected the information delivery part of the art. And I can understand that. And I think we should all recognize those are probably the last people to learn noetic medicine. But I'm recruiting their help to place a shun on someone with normal pressure hydrocephalus. And so I tell them, look, this is a doc. I have confidence in his techniques. He's a wonderful, loving person, not so good with words. The knowledge is statistical and anecdotal. It does not ever relate to you. And while he may not fully understand that, you can, and I certainly do. And so let me give you a shield so that if inadvertently some misspeaking comes your way, you'll know how to fend it off. And I tell them, when you hear a curse, because people know when it's happening. When you hear a curse, say to yourself, you don't have to interrupt the person or defy them. Most people haven't got that kind of courage. Say to yourself, three times, not two and not four. Three times, you don't know me. You don't know me. You don't know me. And that will bounce out their suggestions. So I give them that mantra and instruction to guard them against the inadvertent curses of other authority figures. I think it's very important.
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B
It's incredibly important. And you see the damage from it, from people who are not empowered with that information. How would you better deliver information about a prognosis for a certain case condition, maybe a cancer that was newly diagnosed?
- [49:05]
A
Yeah, I think there's a. I have to say again, Julie, such a perfect question. There's a really simple format once you've learned this. On the one hand, on the other Technique, which I'd like to assure everyone. Do it three times, you'll mess it up maybe a time or two, maybe not. Maybe you'll nail it the first time. But after you've done it three or four times, you realize how easy it is to do informed consent, right? When you're delivering a dire diagnosis like cancer, for example, realize that once they hear the word cancer, they're in sort of a psychologic shock. And the notion of that they're going to absorb and understand anything. After that moment, it's reduced. And so you need to take special care. So here's my approach. Step one. Well, we have our diagnosis, and I'm going to share that with you. But before I do, there's something even more important that I need you to really, really know, okay? That when a patient hears that, it's even more important. I need you to really, really know this. What that does is that focuses their attention. You have every strand of their attention. You're not looking to or listening at anything else. And so I tell them you can use whatever word you want. Miracles happen. Wonders happen. Positive outcomes occur all the time. We're told early on that miracles are rare. They're not rare. I see them almost every week in my office. I truly do. And so I want you to know that for all we know, I'm sitting here with the next miracle I'm going to witness. And it's important that you and I bear that in mind. So step one. Miracles happen. Wonders happen. Positive outcomes occur frequently. Not rare. Step two. Unfortunately, the diagnosis is not what we had hoped. We. I'm forming and maintaining the alliance in that moment. You're not getting this alone. You're getting this together. We're receiving this news together. Unfortunately, it's not what we had hoped. Diagnosis is cancer, okay? Now, at that point, I have to feel and know what's going on in the patient and watch the reaction, feed it back to them in some empathic, sensitive way. I can see that's a shock. I understand that's not what we were hoping for. But then I'm going to go on, okay? But let me tell you this, okay? And now I'm going to give the information that I know. So I'm going to take some information, say it's a horrible pelvic osteosarcoma, okay? She looks up and she says, well, what are my chances? And I said, well, I'll be very honest with you. Your chances, I don't know. And no doctor knows. And we won't know until after you're over this thing and we look back and we can assess. But what I can tell you now, I'm going to put this out over there where risks. I can tell you that in a recent study of, let's say, 100 patients, 81 did not make it. On the other hand, patients perhaps just like you, something special in their immune system and their genetics, something perhaps just like you, survive this and go on to live normal, healthy lives. I said you with my eyes and hand and vocal emphasis, you survive this and go on to live a normal, happy life. I'm going to recommend the following. So that's step three. Step four, I'm going to recommend the following treatment protocol, and I lay that out. I give informed consent. On the one hand the risks, on the other the benefits. And that's step four. Okay? And then I say, as you've heard me say before, again, let me remind you, miracles. And I'm putting my hand toward them. Miracles happen commonly. Okay? And I will be with you throughout the entire course source of this thing. And let's see together how well you do. And please, I'm going to ask this of you. Please don't be opposed to pleasantly surprising yourself. Let's look back on this thing. This is our hope. Of course, let's look back on this thing when the treatments are over and be able to say that your chances were 100%. So I've gone through steps 1, 2, 3, 4, 5, delivering dire diagnoses. But I'll tell you the difference now. And I know this from tearful conversations, but tears of joy. With my patients, that moment is formative. It forms the springboard from which they recover. And if you do that right, what you've done is you haven't guaranteed, but you increase the likelihood that the innate healing capacities within your patients will be ignited rather than extinguished. And that through your formed alliance, you'll actually bear witness to his or her
- [56:02]
B
which is so, so powerful, the patient leaving that conversation with this belief that, you know, no matter what other information they may take in in the following days and weeks, believing that they are in among the group of people that do well and that, you know, experience miracles and that that also must protect them against a lot of this other information they may encounter versus someone who leaves that initial conversation thinking, you know, I have this disease in which I only have, you know, maybe the doctor has told them, you have 11 months to live. It's a very different outlook that they then go forward with.
- [56:46]
A
That's right. Or that doctor might have Said, you have an 81% chance of dying. That would be a horrible curse. And of course, that's in my book. I know someone who actually did do that to a patient, but they said, oh, I had to do it out of honesty. Let me address that because I know some of your listeners are thinking, well, I want to be honest. I'm not sure that's honest. Well, go back and listen. What I said is more honest than telling someone they have an 81% chance. That's actually a nonsensical sentence. No single individual has an 81% chance based on the data that you have. Someone came up to me once and said, well, doc, that's just not true. If I flip a coin, it's 50, 50. It's going to be head or tails. I know the likelihood that that coin will land head or tails, 50, 50. And I said, no, you don't. You don't know that at all. You haven't understood your information. There were, you know, 5, 10, 20 coins flipped a million times. Some statistician, you work it out, and in that group of, you know, hundreds or thousands of flips with multiple coins, it's 50, 50. Now I'm giving you an individual coin, and it's been in circulation, so it's got some chips and nicks and knocks irregularity. It may have some goo or gobs or other things that affect its center of gravity. And so when you flip that individual coin, it may be that there's only a 48.2% chance it lands on heads or tails. You don't know that. And that's the very point when you get down to the individual. Your statistical information can only hint at certain likelihoods. But you don't know, and you cannot. It's the nature of statistical.
- [58:53]
B
And as you mentioned, so many of these studies are studying certain populations of which the patient sitting in front of you might not perfectly align with.
- [59:03]
A
Yeah, say, for example, in that study, I'm thinking of the osteosarcoma that the 19% who survived, they have a certain gene that the others didn't, and we're not aware of that gene yet. Or they had a certain epigenetics, or they had a certain exposure or other immune capacity that will be identified, let's say, six months from now. Okay, it was some marker. So you could then say, oh, you have the marker. Well, you're, you know, your likelihood of survival is quite high because we don't have that today. Why would you sentence someone to the other cohort to death? You Just simply don't know. And so this is one of those very important moments where of course we need to understand the nature of our information, but also we have to avoid the hubris we're taught in our medical training. It's a certain kind of arrogance. It's one way of coping with the vast uncertainty of our task, but the other way is to just accept that we're human. From time to time we may fail. And to accept that with humility and drive forward with that humility, you'll make fewer mistakes.
- [60:32]
B
I think that's such an important point. I think thinking about, you know, there's many factors as to why information is delivered so often in the way that it is. And like you mentioned, we're not taught about this at all in medical school or how powerful our words are. Oftentimes in our training we're seeing the worst cases, right? We're seeing the people who get readmitted to the hospital with complications, not the people who are doing great. And we don't, we don't see again. So we have a skewed perception. And then we also, just as you mentioned, this sort of, this idea of humility, I think it's something I've experienced personally as I've come to understand myself better. But so many doctors, although, you know, we cling to trying to have certainty and control over, you know, health and healing, which again, as you've illustrated, there is no 100% for anything that we can do. And that idea of fear of failure or getting something wrong or letting someone down sometimes can influence how we speak because we don't want, we don't want to get it wrong. We don't want to miss something. We don't want to not inform a patient about a side effect that they then later get and come back to us. And so there's so many factors that go into why as a, you know, on average we aren't delivering this information in a way that's informed, you know, as you, as you've demonstrated,
- [62:05]
A
right. And yet the simple antidote to that is what I've said, understanding the nature of our information, which then gives us cause for humility, restraint, forbearance and caution. It's not really complex. And all of the things I'm teaching, they become, as you practice them, simple second nature ways of dealing with people. And you know, of course there's a learning curve, but it's not that long. If you do really, really attentive wordsmithing and gesturing for two, three months, both in your regular Life and at work, there's no reason to separate them. It really becomes your second nature and it's quite easy. And your patience, you'll see the sort of appreciation you get back and you get bathed with a sense of deep, deep gratification in your work, which I think is what keeps us going to the opposite.
- [63:28]
B
Absolutely. It's powerful. And so we spend a lot of time understanding how powerful our words are as physicians. But there's another aspect of this that impacts for patients their symptoms and their disease presentation. And that is the power of these unconscious ideas and beliefs that a patient may be contributing or may be influencing their condition. And so you came across this and started develop this by asking a question of your patients in the er. Can you share what you learned from what that question is and what you learned from it?
- [64:12]
A
I'm happy to do that, Julie. I have right here at my desk I have this wonderful book entitled the Merry M E R R Y the Merry Heart by Robertson Davies. And I recommend this for everyone. This is a brilliant man of letters, Canadian author and at Johns Hopkins quite long ago he delivered a lecture entitled Can a Doc? Which is in this book Can a Doctor Be a Humanist? And I was reading that in 1985 when this idea struck me. I think, I think there's a question I can ask and a way I can ask it that will elicit from my patients the contributory noetic causes, mental causes of their illness. And so I hatched this idea alone at my house and I couldn't wait to go back into the emergency department and try it out. And I'll tell you the story. It's in the book. The first chart I picked up, it was a 40 something year old guy with left testicular pain. Okay, get in there, do the exam. I've got the labs all back and long story short, he's got epididymitis, no real suspicious exposures. But I treated him and gave him a referral. It was a super busy night evening in the ed and so normally I would just blast out of there and onto the next one. But I had this question I wanted to ask and I thought, well, it's now or never, but pay attention to how I ask it. So I'm halfway out the door, I turn around and say, hey, by the way, I'm just curious and why did I do it that way? Because when you hey, by the way, I'm just curious, what you're saying is this is not important, it's just an afterthought thing. And so You've lowered resistance, right? It's like you're just going to have a sort of offhand casual here. By the way, I'm just curious. I imagine you could have had this two months ago, two weeks ago, two or three days from now. We're not going to know. You're not going to know, and I'm not going to. Let's not pretend to know. But if you had to guess, and I mean just guess, why today? Why now? It's very important you ask it in that sort of casual manner. The word just means and nothing else. So when I say just guess, it means no thinking, okay? Because I don't want thinking. I want a whisper from the unconscious. And patients almost always will answer back the same thing. They'll go, well, I don't know. You're the doctor, you tell me. That's the first answer you get to which I'll always say, well, you're right, you don't know. And I am the doctor. I'm just pacing them, I'm repeating their words. But as I said, I too, don't know. We're not going to know. Just guess. And at that moment, usually there's a pregnant pause. And I always say pregnant pause in my mind, so I just shut up. It's hard to do. It took some training to do that. You got to be patient there, because it's percolating up. It's not on the tip of their tongues, it's coming up from a deeper source, and it almost invariably comes out as a question. So he's got his pants up, he turns around, he looks at me and he goes, yeah, I don't know, Doc, you think this could have anything to do with the vasectomy my wife wants me to get tomorrow? Right? And then, you know, that was the grand aha. It's like, oh, there it is. I'm on to something. Now. I've had that question, you know, since 1985. Think about it. It's quite some time. And I will tell you, you don't have to. No one has to believe me on anything. Just ask this question as I've suggested, and what will come at you will be the inevitable torrent of answers, all contributory noetic causes like the one I gave you, and they fall out into multiple categories. This one, for example, was the no matter what wish, or what I call a baleful wish. I wish I could get out of this vasectomy no matter what. And that's, by the way, that's the most dangerous wish. When You're a kid and you need to get out of school no matter what. You can have your sore throat when you're adult and you need to get out of something undesirable. It's not no matter what, it's in a healthy way. Your unconscious is listening. You're instructing. I need to get out of this in a healthy way. Which if you think of that guy, might have been what I would call a normal adult conversation. But at any rate, if people start asking this question, you'll be convinced yourself of the impact of ideas on health and healing. And that's what noetic medicine is so beautiful.
- [70:25]
B
And brings us to the model. You call it the expanded causal model of disease, which for me was the light bulb moment, how this all fits together. And I think for me there's been a few other moments like that when there are certain things you know to be true, but you have a hard time getting them all to line up into, you know, one easy, easy model. And that that was certainly the case for me. I think the other few moments where I experienced this light bulb first was when I took the CrossFit Level 1 seminar and there was a model called the Sickness Wellness Fitness Continuum. And all of these models, by the way, show up in yours. So this is the next evolution of a lot of different pieces of information coming together into one. And that Sickness Wellness Fitness Continuum, the, the main concept there is that we all it. The more fitness we have or health we have, the more buffer we have against disease. When we, you know, get in an accident or have an injury or an infection, we have more buffer against disease and more resilience and in bouncing back to health. And then the second one for me was in learning about functional medicine. So when I was at, in medical school at the Cleveland Clinic and the mark, Dr. Mark Hyman came to open the center for Functional Medicine, I heard him lay out these concepts of looking at the body as an integrated system as opposed to disparate organ system categories, and the idea of addressing the root cause of symptoms as opposed to treating individual symptoms with individual treatments. And that just felt, wow, this is, this feels so true. How can I practice any other way? And then more recently, as I've studied more from Dr. Gabor Mate, who talks a lot about the beliefs that we develop, often unconsciously in childhood and how those later can influence symptoms later in life. Or you think about the Adverse Childhood Experiences questionnaire and how children with more traumatic childhoods are more prone to disease later in life. But being able to combine all these into one model is what I experienced in learning about and reading your expanded causal model of disease. And so I'd love for you to lay that out for us. It's in chapter six and seven of the book. So for anyone who's going to read the book, pay special attention to those chapters. But you use this great metaphor of a gyroscope to describe our health. Can you. Can you describe that? And then we'll go into the model.
- [73:19]
A
Well, sure. We have these words, and we grapple with. With their definition, and we do need to be careful. Often, you know, we cross communicate using the same word in a different way. And so I wanted to explain what I mean by help with that metaphor. You know, I don't have one here in the office. I used to. I used to play with it. You know, I don't know. Somebody must have taken it. But a gyroscope, you know, you've got to spin the top in the middle. And once that top is spinning, and the faster it spins, the more stable it is. Of course, there's a whole big world out there, so it's subject to various perturbations from all quarters, just as we are. And yet the greater the spin, the greater its ability to recoil to center. If it gets knocked off center, it'll recoil to center. And that spin, that central spin, defines, if you will, the health of that gyroscope. It's a simple metaphorical notion, but it. It tells us, you know, let's say somebody with just seeming perfect health goes into an airplane where he's exposed to an overwhelming inoculum of some virus. All right, well, that's the perturbation. But don't forget, he's got the centrals. And so he may get knocked down, he may get symptomatic, perhaps a fever, runny nose, et cetera, who knows? But what matters there is how quickly and how solidly he returns to center. And that'll be determined by a central spin, his host defenses, homeostatic mechanisms, if you will. I reference Walter Cannon because I'm such a big admirer of what that one mind was able to achieve in a single lifetime. The man who coined the word homeostasis. And so it was with that central metaphor in mind that I began to look at what's right and wrong about our current, say, biomedical model, which, as we all know, is based on materialistic reductionism. And the model says, let's say, for example, someone has. Let's say someone has code.
- [76:25]
B
Great example.
- [76:25]
A
Okay. The model says, well, they have these ACE2 receptors sitting there on their nasopharynx. And this virus came in and attached to those receptors and the following causal chain, a sequence of physical events ensued, resulting in these signs and symptoms. That's classic. That's the classic model. And of course it has real value because if you can interrupt any one of those steps along the way, you stand the chance at least of interrupting the full sequence. And signs and symptoms won't ensue. And that's been a very good model in western medicine. But it doesn't answer this. I'm going to remind everyone this, this is a buried fact. When the initial native Covid came out, before there were, before everyone started running for their various outposts, it was mentioned that 42% of people with antibodies had in fact subclinical disease, right? They were asymptomatic. So let's pause for a second. What accounts for that 42%? When the model I just laid out says that absent some interruption from some physical intervention, signs and symptoms will inevitably ensue. Turns out that's not true, right? And we all know that. So we have an incomplete model. I don't want to throw that beautiful baby out, though, with the bathwater. So as that model proceeds from, let's say, the ACE2 receptor contact on, there must be something in front of that that were missing. And I call those Zone 1 causes. Now, Zone 1 causes can be extrinsic, and in this case, of course, one such cause is, you know, the COVID virus. They can be intrinsic and intrinsic. I'll give you an example. Let's say it's someone up in Norway who's been unexposed to sunlight, takes no supplements, and has a vitamin D level of 11. Okay, that's intrinsic, but it can also be noetic. And I'll tell you, this may shock some, but it'll resonate with many, many, many others. Toward the end of the, let's say, pandemic experience, a lot of people had been living in fear and anxiety for so, so long, and they were sick of it. They were sick of living that way. And many people, and I'm talking not hundreds, tens of thousands, maybe millions, but tens of thousands said to themselves, with some prompt, I'm so sick of this. I'm so sick of living this way. I wish I could just have it and get it over. And there, my friends, you see yet another baleful wish. I wish I could get this over with, no matter what. It takes that form. All right? And those people and I treated Many of them. Those people then went on to have Covid. Now, as I lay out the expanded causal model, there are these intrinsic, extrinsic and noetic zone one causes. They confront our host defenses and not one cause. In my experience, with the rarest exception, no one cause can penetrate host defenses. It takes multiple causes. And my experience is, and I love
- [80:51]
B
how you go from zone one with the causes you call zones two through six. And maybe we can simplify these. The symptom maker, problem solver, which then spits out on the other end zone seven, which is the signs and symptoms that someone might experience.
- [81:10]
A
That's right. I mean there are details in there that I needed to explain what I knew about physiology and the nature of things. But the bottom line for patients is you have a part you're not conscious of. So let's call it an unconscious part within you. An agency that looks at These Multiple Zone 1 causes and tries to solve for them. Right, how do I deal with this? And it'll use its principle of parsimony. It tries to find one solution for all the many wishes and intentions that it's bombarded with. And you'll see this in patients, you know, they have a heart, you know, why today? Why this heart attack? Oh, I don't know, doc. You think it has anything to do with my mother in law moving in with us for five months or you know, things like that. And so the symptom maker, this problem solver within us, absent instructions which you, the doctor can give it, it has to operate in a healthy way. It can't operate like its child self and give you a tummy ache or a fever when you've got to get out of a book report revealing how I got out of my book reports. It's got to operate with a new principle, only healthy solutions. And that's what as a noetic medicine practitioner I hammer that in. It's only healthy solutions from now on. Symptoms I tell my patients are for kids. Symptoms are for kids. You don't have a whole lot of latitude as a child, you do as an adult. You're unconscious. Problem solver must solve with only healthy solutions. And I think that's a key preventative instruction that we can all give our patients. No matter what wishes they've got, they've got to disappear. It's the wish to get through this problem in a healthy way.
- [83:29]
B
And without that awareness or the influence of someone to help change those wishes or those beliefs, you know, we see different diseases presenting. Could you give an example like walk us through an example of what this model would look like. We could use the, you know, the epidymidis example or another one for how this could play out in a patient.
- [83:55]
A
Well, sure. I would say, since you're referencing that chapter, that in my view, you don't understand your patient unless you can draw a causal diagram where you show all the various causes resulting in, let's say, the single point, whether it's, you know, an infection or a cancer, that proceeds sequentially to the various signs and symptoms. And I laid that out in the book. But I'll give you so many patients to choose from. I'll give you the example of a patient I'm currently treating. This is a guy who was told, you have five to 11 months. He was diagnosed, misdiagnosed, actually, with what he was first told as a neuroendocrine cancer. And I can't recall if he got some kind of transient treatment or not. I believe he did. It didn't work. The thing got worse and worse. He got re. Biopsied, and it turned out this is an adult. An adult with a neuroblastoma. Right. So my questions when I meet patients like this are, I always want to know. I'll give you some quick example. I want to know. You don't need to tell me where you are spiritually today. How were you brought up religiously as a young child? And the reason I asked that is I want to know if the guilt concept. The guilt concept was inculcated and if it was, I put a little star. If they say, oh, Catholic, Jewish, you know, Southern Baptist, et cetera, the whole range. I'll put a little star there, which tells me look for guilt as possible cause. You know, sometimes I'll even say to someone, yeah, you know, we're all. If there's, you know, really deeply religious and your religion. I. I know you think of all of us as sinners. Like, tell me what your worst sins are. Are. Right. And then you might discover something really critical, as I often do with people. So I'll ask that question. I'll ask the why today Question. I'll learn about their parents, what kind of people they were. So I know who they identified with. Mom, dad, grandpa, uncle, older brother, who was the authority figure. There are many, but who was primary. I'll search for reasons why a person might have uttered a baleful wish. And I'll look for retained childhood misconceptions that often lead in the long run to disease and curses. So I just gave you the main categories of noetic. In this case, this patient, an adult with a neuroblastoma. What happened was he was in a terrible marriage with a very psychologically abusive woman. She was suing for custody, which he greatly feared would harm his beloved children. And he was running out of money and running out of energy to fight. He was trying to finance two households and so forth. And the baleful wish entered. It's like, I've got to get out of this situation no matter what. And even as I. As I said, well, do you think you ever said something like this to yourself? When I said that no matter what, he goes, doc, I can tell you the moment I said that. And then. So you see, then you have a handle. Now, did he have an epigenetic lapse? Of course he did. But who's to say that wasn't on account of this pale force wish? Did he have a predisposing mutation? Yeah, of course. In all likelihood, that was there. Were there defects in host defenses that didn't scour out the first errant cell? Yeah, that too. But all of those drove to an abnormal single cell and then cluster, and then the. The mess he found himself in. And so in addressing his ailments, it became obvious to me, and there were a couple other contributory noetic factors that. That was my business, that I needed to get at those and extirpate them immediately, as well as take all the other measures that we know as integrative practitioners to supplement the treatment he was going to have. And I'm happy to say, as I think, you know, it's three years in, he's not without tumor, but it's regressing rapidly. And it continues to regress from the beginning of our treatments. And. I think he's going to be one of those miracles to many. He already is. I think we have other ways to go.
- [89:49]
B
That's powerful. And I think, you know, having such specificity for identifying what those noetic causes are is so powerful. I know we've talked about this before, but there's. And it's helped me to restructure how I think about stress and disease because I think before understanding your work, I would have heard his story and said, oh, wow, you know, he was under a lot of stress going through this, you know, marriage, divorce, custody battle and whatever. You know, his unique predisposition based on his genetics, based on his lifestyle factors, that was a threshold of stress at which his body could no longer. Longer maintain balance. And now disease has presented itself in this way in him versus, you Know, another person may have had the same stress, but because of their unique genetic makeup and lifestyle, it may have presented as an autoimmune disease or something else. But as you've laid out, it's not just the stress that then leads to symptoms. It's actually much more specific.
- [91:04]
A
You know, I. So I'm sitting here. Before me is a window that looks out over the beautiful California coastline. There are trees and bushes and, you know, nature abounds. And I. I think we all understand that out there. Whether it's my cat who's on the prowl or the birds or any of the other animals out there except the apex predators, they're all under constant stress of being eaten. Stress is part of life. You know, Hans Selye, who first coined the term, stopped using it because it got so abused. And it's still abused. It's what I call a cowardly nod to the possibility of noetic causing, say, oh, stress did this. Of course, stress can do a lot of things. You know, it can compromise your sleep and your eating and therefore diminish host defenses, which is a part of the expanded causal model. But what you know, you don't see massive heart attacks and cancers among all the creatures in nature. And they're under more stress than most of us. Constantly. Constantly. So it doesn't work. What stress does do is it squeezes. Often it squeezes an intention out of us. And sometimes that intention is, well, damn. This is a fascinating challenge. I can't wait to see what I'm going to learn from it and how I'm going to get myself the hell out of this. But I'm going to in a healthy way. And at other times, it squeezes the no matter what wish out. And I will tell you, Julie, this is the most common noetic cause of illness, okay? The no matter what wish. Why? Because it's so heavily reinforced in our childhood. Get your tummy ache. You don't only get out of going to school. Now we're going to put some Pavlovian rewards. You're going to have jello or ice cream and cartoons and special loving attention from your mother or father or somebody. And that's a heavy reward. You do it again, it's rewarded once again, before you know it, you've got a habit established. And that habit must, must be broken in adulthood. Less, something terrible ensue. You've got to really, really work on that. But stress squeezes baleful wishes out of people. And it's important to understand that the way this unconscious Problem Solver works is it's not sitting there listening to every random thought or idea you have. It's listening for intention, for real powerful wishes that you're intending to come true. And it responds to that. And so when your intention is no matter what, Lord have mercy, watch out.
- [94:25]
B
Watch out. Well, thank you for tying this all together in such a clear and beautiful way. And I hope that for people listening, this sparks interest in learning more and reading your book and implementing some of the tools that you shared with us. In this conversation. I'd love to close with a couple of tools that maybe people can implement in day to day life or experiment with. And so one situation I thought of is let's say you're a parent and you're taking your small child to the pediatrician or the family doctor for vaccines. How might you use your language to help reduce anxiety and pain and have a better experience for your child?
- [95:16]
A
You know, Julie, you're the best questioner. I've done dozens.
- [95:20]
B
Well, thank you.
- [95:21]
A
What a compliment. Honestly, I have to give you credit. You're just marvelous at this. This. It's a great question. The first thing I would say is let's all, you know, we know where we are in the country now with respect to vaccines. Everyone study up. Understand that your doctors are doing their best. They may not have spent as much time as you have studying up. So figure out what you want to do and do it according to your best understandings and the advice of your trusted caregivers. So given that you're going to the doctor and let's say you've just decided on a particular vaccine that you think is really, really important, we all need to know that. And there are many studies on this. There's anyone who wants the data. It's actually in the placebo article. I gave you two wonderful studies. Shots of any kind, whether it's starting an IV or giving them vaccination or medication, do not need to hurt. They hurt largely because people are told this is going to hurt. So when you have a nurse or doctor saying to a kid a little bee sting, when was there ever a little bee sting, Right? When did I have a bee sting that didn't hurt? So the kid's automatically looking for pain and pain ensues. So you know those curses, let's hope they don't befall your kid when you're in there. But you're the primary authority, the parent. You're the one whose reality becomes their reality. So the first thing you can do is know what I just Said is true. It does not need to hurt, right? You don't need to be fearful for your child. They're queuing off you and so realize that they're about to receive something protective that will help to keep them healthy and immune to whatever it is you're attempting to prevent. And hold that thought in your mind calmly. Because again, you're the center of their world, you are their authority figure, your reality therefore is their reality. And then when you're there, you want to occupy their consciousness with something non tactile. So you get their attention by wondering, I wonder what that is up there. And then find something curious, I wonder what that is up there. And how many what rays, streaks, fibers, some counting tasks, because that's cognitive, not feeling. How many are there? If you can tell me that just count just means don't feel, just count, just look. If you can tell me that. Let's go get some ice cream. When this is over, just watch, I'm watching you watch with me something as simple as that. Unless it's interrupted by an uninformed other authority figure, like a nurse saying, a little prick, a little bee sting or something. So if you can get them into a non tactile sensory modality and say, just watch, just count and hold in your mind calmly as I say the notion that this is something really, really good that's happening for my child, that's the best parent can do in that situation, right? You can prep them for that. If you want to get a little more detailed. There are hypnotic techniques, NLP techniques you can use. But really that's sufficient. I've given, and I think I mentioned this in the book, I've given now thousands, thousands of injections, wound injections, medications and so forth. Once I learned this simple technique, capture their attention, direct it to a non tactile modality, use the word, just be earnest and hold it in your heart and mind. Once I learned that nobody felt pain, some people might have say, oh hey doc, I felt that. I said, well, how was it? Yeah, not bad, I'll accept that, right? Probably had, honestly, maybe out of the thousands, a dozen or two. Say something like most people don't know. You can also, if I can give you another one, you can also say, now, Sarah, I want you to close your eyes because there's going to be a sound and it's a very, very important sound. So just listen. I don't, it might have started already. I don't need to know when it's starts. Listen, listen close and tell me when it Quits. Just listen. And so you're taking it into the auditory mode. I love that one. Because 50% of the time after it's all over, say, okay, now tell me, what is it over? Did it stop? What was it? And you'll hear they had an auditory hallucination. It's like, yeah. Most people say it was either a high pitched thing or that was a strange crunching sound. What was that? Okay, you need to be earnest and exude confidence. And if you don't have confidence, my advice is just fake it till you make it.
- [101:28]
B
That's amazing. That's amazing. Well, another situation, you mentioned the importance of authority. And one situation, situation that people may find themselves in. Where that is maximized is going in for a procedure where they're receiving anesthesia. And in that moment where you're just drifting off into anesthesia, there's a lot of opportunity for suggestion. What might. I'm guessing most anesthesiologists are not aware of this yet. Hopefully they will be. But what might. Could you give the anesthesiologist something to read to you or something to say in that moment as you're drifting off?
- [102:06]
A
Wow. Okay. A triple plus to you. Now you did. People listening. Julie doesn't know this, but right now at the Andrew Weil center, we're prototyping a clinical trial that I've written out where in that very moment, that crucial moment where identification with the authority figure is maximal, he's about to assume control of your vital functions and get you through whatever the procedure is. Your trust is implicit and your helplessness and dependency are maximal. Therefore, according to that law of identification, you identify with him. His or her words become your reality. And so the three sentences that we're scripting the anesthesiologist to say in that moment are the following. And I'll say it as if the anesthesiologist is. But you can hand this to them now, as you close your eyes and begin to receive this pleasant sedative, isn't it nice to know? Okay, that's the lead in. I'm going to give you the three suggestions. Isn't it nice to know? One, you'll keep your own blood. Every drop. No bleeding. Keep all your blood. A perfectly dry field. The field is where they operate. A perfectly dry field. Two, when you wake from this safe and comfortable procedure, you will wake with delightfully surprising comfort. Surprising, perhaps you and those around you so comfortable you've heard this now that the word pain will be a trigger for even more comfort. And three, really, really rapid healing. Really, really rapid healing. Again, surprising, perhaps, you and your doctors. Really rapid healing. And I say that really rapid. My experiences now, I haven't counted them, but it's hundreds of patients who I have given that pre surgical. Now I'm not giving a sedative. I'm not in the position of maximal authority. It's in the office. So I do induce trance. Trance enhances my authority. That's the only reason to use it in clinical medicine. And so I've given those three suggestions to, like I say, hundreds of patients. And virtually everyone has minimal bleeding. There may be, you know, 5 to 15 ccs of blood, but never more. That would be, you know, less than a tablespoon. And I have learned that I have to tell patients, if your doctor says, come in in 14 days for a staple or suture removal, tell a white lie. Oh, 14 days, that's tough. But it's a family event I have to be at. Can I come in 12 days? And when they're, when they go in on day 12, go two days earlier. When they go in on day 12, they'll hear, I've heard this again forever. The doctor will say, wow, I'm glad you came in early. Any later and I would have had to dig these out. That's what they always say because your healing will be so fast. And so you can give those suggestions to yourself as you're lying on the gurney. You can script that and ask the anesthesiologist to say that as he's giving the pre op sedative. Either way works. I have friends who have just said it to themselves as a mantra. 1, 2, 3. And regardless, some have been really, you know, complex surgeries. They've all managed through really quite well, extraordinary results. So I would wish that anyone listening?
- [106:34]
B
Right. What do you have to lose? Right? You can pleasantly surprise yourself at that one. Well, I want to close. There are three questions I ask everyone to close the podcast and so I'd love to hear your answers. The first one is, what are the three things you do on a regular basis that have the biggest positive impact on your health?
- [106:59]
A
I know that for me, sleep is number one. I don't get sick unless I sleep. I, I exercise and I use forced exercise. If I'm swimming my last two laps, I push hard, I'm bicycling the last half mile, I'll push hard. If I'm surfing, I'm pushing hard all the time anyway. And so exercise, push hard at the end, but don't over exercise. I Do believe the Greeks had it right. You know, moderation in all things. In terms of the third, it's really hard to separate out clean water, clean air, good food and supplements. So let's call this the intakes. And I would say to everyone, we're at a phase on this planet where if you're not triple carbon filter and reverse osmosis cleaning your water, then you are taking in, in all likelihood, maybe not, but in all likelihood forever, chemicals, endocrine disruptors and other fluids that are not reported in your local by your local water authorities. If you drink water like I just described, of course you're going to have to supplement minerals. And there are good, easy ways to do that and maintain your health. But, you know, sleep, exercise and healthy intakes, that's great.
- [108:46]
B
What's one thing that you think would have a big impact on your health but you have a hard time implementing it?
- [108:53]
A
Well, I don't have a hard time implementing the one thing that I believe I can do in addition to what I've named and. And I practice Taoist qigong. But in addition to those, of course, because I'm familiar with noetic causes, I want to scour out whatever no eta causes might enter in. And so I think it's important to stay vigilant. What are my wishes? Do I feel guilt? Am I that identification I had in my case with my father, is that entering in here in an unhealthy way, I need to cut that cord? If so, do I have some retained misconception that's working against me? Has someone inadvertently curse me? So I'll scour those things out from time to time? It's not that it's hard, it's just that it takes in touch.
- [109:57]
B
That's a great one. Last question is, what does a healthy life look like to you?
- [110:04]
A
Well, I still see patients regularly and patients often come. And at every encounter I establish the goal because the goal tends to move. And the goal initially is for the absence of symptoms. But at the end of the day, it might be the third or fourth or sixth time we're together. And I said, what's the goal? We've evolved to the point where the goal is health and happiness. Physical health and mental health. What does that look like? It looks like you're becoming your best you every day. I'm older now. I can tell people that in my experience, happiness, it's not a frolicking, rollicking, top of the roller coaster. Happiness is a slow, rolling, cumulative sense of contentment and of fulfillment and a Sense of. I wouldn't, I'd veer away from purpose. I'd say just, you know, a sense of fulfillment. If you're satisfying your curiosities, you know, real life allows you to. The chances are you're going to be happy. And I wish that for everyone. And I think it's achieved.
- [111:36]
B
Beautiful. I love putting that out into the world. A wish for all of us. Well, this has been a wonderful conversation. I'm so grateful for you and the work that you've done done and how you are sharing it with the world and your willingness to sit down and chat with me. Where can people learn more? Obviously your book is a great place to start but where can people learn more about what you're doing and about noetic medicine?
- [112:05]
A
Yeah. So I think you're right. The book is Healing Beyond Pills and Potions and it's, it's a nice little compendium of this world of noetic medicine. I do have a YouTube channel. I think you just Google Steve Beerman YouTube. And it's up and the first day of one of my European courses is there multiple other discussions are there at the Andrew Weil Center. We will soon be launching meaning August 1st of this year and then January 1st next year the introductory and advanced no medicine courses. So look for those and thank you mentioned I have a tiny book out, I think it's under $15 called the end of Worry. You know the chief complaint most of us confront in our practices is fear, anxiety, worry. By the way, if someone says I'm anxious, you need to drill down and find out what they mean. And I teach that in this tiny little book, a protocol. And I think if you want to really make a simple but profound difference in your patients lives learning this protocol. It's four steps, it's simple and administering it to your patients can be and in fact is for many life changing. I've even seen unexpected results from its implementation like the disappearance of lifelong ocd. Never expected that. We were all taught, you know, those are permanent traits and the release of worry energies which can now be spent on things like artistic pursuits. I think those are good starting points. You know the books and YouTube and then watch for the courses as they come out. If you take the course it's, you know, I think the first is maybe 10 hours and the second is 15 hours, 25 hours of CME and you can really reach a very, very high level of refinement.
- [114:33]
B
Amazing. Well, we will link to all of those resources including your book, including the article you've mentioned. That was recently published and I look forward to continued conversations. And thank you again so much for the time.
- [114:48]
A
Well, this was great. You're amazing. I thank you. Joy,
- [114:57]
B
Thanks so much for tuning in. If you enjoy listening to the podcast, please consider subscribing and giving it a five star rating on itunes. It really does help to get the word out to more people.