179 - Dr David Clarke - Decoding Your Body's Secret Language

Dr. David Clarke shares his 40-year journey as a medical consultant specializing in neuroplastic conditions—real physical symptoms generated by the brain in response to stress, trauma, or emotional challenges. He explains how these conditions affect 20% of adults and 40% of doctor visits, yet remain frequently misdiagnosed despite being highly treatable.

• Neuroplastic symptoms are physical manifestations created by the brain in response to stress or trauma
• These conditions affect strong individuals carrying burdens they've normalized, not "weak" or "neurotic" people
• Adverse childhood experiences (ACEs) can create lasting impacts through stressful personality traits, triggers, and unrecognized emotions
• Brain circuits physically change with chronic stress and can change back with appropriate treatment
• The brain creates all sensations—even with physical injuries, pain signals originate in the brain
• Long Covid and similar conditions may involve neuroplastic mechanisms that maintain symptoms after initial triggers
• Recovery includes reframing self-perception from weakness to strength, setting boundaries, and processing emotions
• Transformation extends beyond symptom relief to improved relationships and becoming "who you were meant to be"

Visit Symptomatic Me to take a 12-item questionnaire assessing for neuroplastic symptoms, and check out "The Story Behind the Symptoms" podcast where Dr. Clarke interviews patients about their recovery journeys.

Symptomatic.Me

For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com

(music credit - Brock Hewitt, Rule of Life)

Chapters

• 1:51 Welcome to Dr. David Clark
• 2:41 Dr. Clark's Journey Into Brain-Body Medicine
• 8:30 Understanding Neuroplastic Conditions
• 17:17 Adverse Childhood Experiences Explained
• 25:31 How Stress Manifests in Mind and Body
• 36:18 The Link Between Viruses and Neuroplasticity
• 47:07 Healing Pathways: Building Self-Esteem
• 55:23 Transformation Beyond Physical Recovery

Transcript

Jackie Baxter: 0:56

Hello and welcome to this episode of the Long Covid Podcast. I am absolutely delighted to welcome Dr David Clark. This evening we are going to dive into all sorts of stuff. Dr Clark has got many years of working with chronic illness, which now, of course, includes Long Covid. So, yeah, I can't wait to find out where we're going to get to this evening. A very warm welcome. Thank you so much for being here.

Dr David Clarke: 1:24

Thank you, Jackie. It's great to be with you and I'm looking forward to the discussion.

Jackie Baxter: 1:30

Amazing. So before we kind of dive in I keep saying dive in and I've been told that I need to stop saying it, so I'm just embracing it. We're diving in Can you just say a little bit about yourself and what it is that you do?

Dr David Clarke: 1:46

I am a board certified gastrointestinal and internal medicine consultant in the United States and have been for 40 years, and I got interested in this subject of brain to body conditions Toward the end of my training years when I encountered a patient. I didn't know the first thing about diagnosing or treating, and she had a very serious, very real physical condition, but it wasn't caused by organ disease or structural damage. But I stumbled on the fact that she had been dealing with a lot of stress as a girl and that this was possibly playing out into her adult years. And there was a psychiatrist at UCLA that had an interest in these mind-to-body conditions and so I got an appointment with this patient for her for the psychiatrist. And so I got an appointment with this patient for her for the psychiatrist, never thinking for a moment that the patient's serious physical illness would ever change. I just thought, you know, maybe the psychiatrist can help her live with it a little better. But three months later I ran into the psychiatrist in the lift and it was the lift ride that changed my career because it turned out this patient had been cured with less than three months of weekly counseling sessions, which absolutely stunned me because nothing in my very traditional Western medical training up to that point had even hinted that such a thing was possible. But I thought, you know, if I'm going to be a complete doctor and be able to manage patients who come through my door with just about anything, I should know a little bit about this because it was so amazing and I might see one or two patients a year that have a similar condition and I should have some basic competence in what to do. Well, it turned out that I had a lot of patients that would have pain or illness real pain or illness but no organ disease or structural damage to explain it.

Dr David Clarke: 3:51

And when I was in private practice in Portland Oregon, I would use the framework that the psychiatrist had taught me to ask questions about, you know, people's lives and the stresses they were coping with. And I was finding five or six patients a week that had these very real physical issues generated by the brain because of stress or trauma or emotions or some other challenge in life or some other challenge in life. And it didn't happen to people who were, as you might guess, weak or neurotic or that couldn't handle their stress. It happened to people who were strong. It happened to people who were very capable in the rest of their lives and accomplishing a lot, and yet it was also very treatable. If you knew what to look for, you could identify issues that you could make a difference about and people got better, sometimes quite quickly.

Dr David Clarke: 4:50

One of my favorite stories was a patient who was hospitalized at a prestigious university 60 times in 15 years for unexplained attacks of severe dizziness and vomiting that would go on for days and nobody knew what was wrong with her. They had a dozen specialists see her. A psychiatrist interviewed her, but they as is typical for Western trained doctors, they didn't know the kinds of issues to look for. And I uncovered a major stress in her life and I found that it was directly connected to her attacks of illness and I brought this into her awareness. She never had another attack. She was completely well after that. So I was hooked the ability to alleviate symptoms in people, real symptoms just by listening to people tell their stories about their lives and then talking to them about what changes they could make. It was just a remarkable thing to be able to do, and today we're 7,000 patients later that I have successfully diagnosed and treated. I'm the president of the Association for the Treatment of Neuroplastic Symptoms.

Dr David Clarke: 6:07

Which is what we call these things Neuro, because they're connected to nerve changes in the brain and plastic because they're capable of change, which is very hopeful, change which is very hopeful, and our website is symptomaticme, where we have a 12-item questionnaire that people can use to assess themselves for whether they might be having this condition.

Jackie Baxter: 6:33

Amazing. And you know I think you know you've touched on quite a few things just there and you know this kind of unexplainedness, this out of controlledness that we feel in our bodies when we experience something like this. You know it's such a scary experience and you know, I think part of that is not knowing what to do, absolutely what to do and not having any medical professionals that you come across knowing what to do either.

Jackie Baxter: 7:03

You know you've got millions of other people out there experiencing similar or relatable conditions who also don't know what to do, and yet there are people that are recovering and there are people that are helping people to get better. So it's absolutely so important to talk about the things that we can do Now. You'd used a couple of terms just then. One was was it body to no brain to body conditions, yes, and the other one was neuroplastic.

Dr David Clarke: 7:36

Which essentially mean the same thing.

Jackie Baxter: 7:37

Yes, so the same thing. So can you just explain a little bit about what that actually means, because I feel like this is somewhere that you know we say the term mind-body or brain-to-body or you know these sorts of terms, and that's where people can often think that the message is that these symptoms aren't real or that it's quote unquote all in their mind and things like this. So I'd love to just tidy that up a little bit.

Dr David Clarke: 8:05

Yeah, those are the false assumptions, and you know, it's embarrassing to me as a physician that they're often still communicated to healthcare professionals today, that these symptoms are imaginary. They're all in your head. They're not real. They happen to people who are neurotic. They happen to people who can't handle their own stress. There's no diagnosis that's possible for you. There's no treatment that's possible beyond just trying to manage the symptoms. You're going to have to live with this. It's not really something that a physician should feel responsible for taking care of. Physicians should be taking care of organ diseases and structural damage, and if you don't have either of those things, then there's really not much we can do. So all of those statements that I just made are false and in fact, for most of them, the exact opposite is the truth. These symptoms are 100% real.

Dr David Clarke: 9:09

The ability of this was something I had to learn is the profound ability of the body I'm sorry of the mind to affect body function. I mean my very first patient. She was averaging one bowel movement per month despite taking four different laxatives at double the recommended doses. Another patient, you know, was bedridden. You know, had to crawl from her bed to the bathroom and back. That was all she could manage for well over a year. Again, from the brain doing this to the body. Another patient of mine completely paralyzed stomach, not the abdomen but the organ of digestion stomach, absolutely frozen, was not contracting at all, 100% from the brain doing this. Another patient I was asked to see a 17-year-old girl on her 70th day in the hospital for unexplained abdominal pain. She was getting doses of morphine around the clock that are usually associated with patients who have advanced cancer. She had already seen six other consultants before I was asked to see her over the previous year and a half. Another patient had abdominal pains for 79 years.

Dr David Clarke: 10:34

I mean, these are absolutely real symptoms, just as severe as symptoms caused by any other form of illness, but absolutely treatable as well. And they don't happen to people who are weak. In my practice they happen to people who are actually quite strong mentally. They are just carrying a much bigger burden of stress than they realize Most of them. If you ask them, are you under an unusual amount of stress? They would say no, not really. I mean not more than anybody else. And it turns out that they have been carrying so much stress for so long that it feels normal to them. Much stress for so long that it feels normal to them. But if we took that stress and we put it on some other random person off the street, they would be crushed by it.

Dr David Clarke: 11:31

Typically, you know there are so many examples, but you know that very first patient, who was you know she told me she didn't have any stress, she was happily married, she worked half time in a bank, she had two children. You know her life was going along quite well as far as she could tell. But she had been sexually assaulted by her father as a girl hundreds of times, 25 years in the past, yes, but still having a profound, stressful effect on her at the age of 37. And you know I had not before that patient I had not heard a story like that before. Before that patient I had not heard a story like that before.

Jackie Baxter: 12:27

But stories along those lines are quite common for me to hear now. Yeah, and I think what I kind of learned, I mean similar to some of the things that you've just said. You know, I didn't think I was that stressed and now, with the benefit of hindsight, I was thinking oh, my goodness, what was I doing to myself? Someone used the analogy of the frog in the hot water. Yes, so if you put a frog into hot water, it will jump out because, like holy hell, it's hot. But if you put the frog into cold water and gradually warm it up, it doesn't realize until it's well, you don't need to be any more graphic there.

Jackie Baxter: 13:05

Yeah, and I think I was the frog in cold water. I was getting heated up and up and up and up and up, over and over and over, and the body eventually said no, whereas now, every time I start dipping my little froggy toe back into boiling water, I'm like whoa, let's not be going there. That's not very nice. So it's amazing how that kind of benefit of hindsight and experience, I suppose, can you know. Well, that's why it's called hindsight, isn't it I?

Dr David Clarke: 13:37

guess. Yeah Well, one of the most profoundly useful exercises that I have my patients do is when they've told me about the stress that they've been under and they're telling me, you know, it wasn't that bad. Other people have been through worse. I think I've successfully dealt with it.

Dr David Clarke: 13:57

I will ask them to imagine a child of their own going through the same experience that they did as children, and it's not always surprisingly.

Dr David Clarke: 14:08

It's not always something as horrible as sexual abuse. It can be almost anything that puts pressure on a child, even when the pressure is well-intended, even when the parents don't necessarily know how much pressure they're putting on. One of my patients told me that the only time he got praise or support from his parents was when he did something better than his brothers and sisters could do it, and he had three very accomplished siblings and it was not easy to do something better than those brothers and sisters could do. So he ended up feeling like a failure most of his early life, and when he was in my office he was 37. He was a successful attorney, but the rest of his life was a disaster, including his physical health, and it all could be traced to this horrible experience that he had as a kid that when he looked back he didn't think of it as being anything excessively difficult, until I asked him to think about a child of his own going through the same thing, and then he got a very sober expression on his face.

Jackie Baxter: 15:25

Yeah, I think that perspective is so important, isn't it? You know, and I think it's very easy to fall into blame as well and be like, oh, how did my parents do that to me? And it's like, as you say, you know, very well-meaning people, you know, can miss the mark, you know, through. You know it wasn't like they did it deliberately. But I think you also said something incredibly wise that I think we all do. You know, oh, someone else has it worse. Therefore, my experience isn't valid.

Jackie Baxter: 15:58

Or you know that trauma, that, you know trauma is big stuff. You know, I don't have trauma, I just have a little bit of something kind of thing, and we tend to then dismiss our own experiences rather than I don't know, exploring them and and learning from them, maybe, and processing them. So you have a sort of beautifully illustrated bit on your website about what you call ACEs or adverse childhood experiences, and I'll put a link to that in the show notes if anyone wants to go and see the nicely illustrated kind of graphic. But I'd love to kind of dive into this in a bit more detail, because what does count as an adverse childhood experience? How do we know if we've had them and how does that kind of relate to what we can?

Dr David Clarke: 16:55

do I suppose yeah, well, my definition is anything that happened to you as a child, that if it happened to your own child or a child that you care about, it would make you sad or angry to see that.

Dr David Clarke: 17:12

Or another way to look at it is that any experience that you had that made you think less of yourself, that made you feel like you weren't measuring up or you weren't as good as other children or, in more severe cases, up or you weren't as good as other children or, in more severe cases, that you were a worthless person, so anything that had that effect. And then, taking that idea a little bit further, we can sometimes see the outcomes of the ACEs even more clearly than we can see the original ACEs themselves. And the outcomes for an adult tend to fall into three categories. One of them is stressful personality traits.

Dr David Clarke: 17:55

Many children trying to survive an ACEs environment will develop any of a range of personality traits that create problems for them as adults.

Dr David Clarke: 18:09

They can have low self-esteem, for example. They can be perfectionist. They can be extremely self-critical. They can be so devoted to the needs of other people in their world that they forget to put themselves on the list of people they take care of, that they forget to put themselves on the list of people they take care of. They can. And then you know you don't necessarily have to have all of these, but the more of them that you have, the more likely it is that they came from an ACEs background. Another one is choosing partners in your close personal relationships that have a lot of needs. Many of my patients grew up in homes where they had to focus their attention on the needs of other people in that household, trying to solve problems, and so, as adults, they end up choosing people to be in relationships with who have problems, have issues, need support for one reason or another, and the relationships, especially the ones earlier in a person's life, tend to be unbalanced.

Dr David Clarke: 19:14

Where you are, giving a lot more than you are getting back area is people not carving out time during their week for regularly having activity that's got no purpose but their own joy, so purely doing something for fun. So many of my patients in ACEs environments. They didn't get enough chance to play as children, and it's not only from trauma. I mean, one of my patients was a champion athlete as a girl, but she did her sport before school, after school on weekends, starting at age four and, you know, right on up through her teenage years. So she never really got to be a kid and so she never really learned how to play and so that her life as a 30 something was nonstop focused on everybody else's needs. And you can't do that indefinitely. Your body is going to protest and, you know, sometimes that's the only way that my patients ever get a break is when they're in so much pain or they're so exhausted that they have to take a break. So that's one area.

Dr David Clarke: 20:32

Two other major long-term impacts of ACEs are. Triggers is the next one, and these are people, situations or events that are highly stressful for you because they are somehow reminding you of adversity or stress or trauma that you went through in the past. The most common example is that there's a parent who caused trouble for you as a kid who's still in your life, but there are other possible examples of triggers. And then the third major area, which is the most difficult, are unrecognized emotions.

Dr David Clarke: 21:17

People can be harboring significant amounts of anger, fear, shame, grief, guilt without knowing it shame, grief, guilt without knowing it. And the most difficult are and one of the most common is being really angry at somebody that you also care about, and so people take that emotion and they bury it somewhere and sometimes it comes out. Sometimes people will have an outburst of some kind that you know they'll be suddenly very angry or extremely sad and they'll wonder you know, why did that come out? What, what made that happen? There was, you know, seemingly not a sufficient trigger for the amount of emotion that was released, and it's because many of my patients are like dormant volcanoes on the outside with boiling magma of emotion on the inside, and helping people to connect with those emotions and put them into words is a big part of the treatment.

Jackie Baxter: 22:20

Yeah, we become unwell with something like long COVID or ME-CFS or any of these what we call, you know, unexplained illnesses. You know that there are, on top of any emotions that may have built up throughout our lives, there's all those really hefty emotions that come along with our entire lives being completely torn to shreds as well. Um, so your kind of bubbling, dormant volcano is kind of getting more and more piled on top of that, isn't there?

Jackie Baxter: 22:54

and I think you know it's, yeah, emotions certainly for me, is something that I have always kind of repressed, because I'm british. We don't talk about emotions, you don't show any of that, you bury it and you bury it and you bury it. And we have t-shirts that say keep calm and carry on. They're basically it's the instruction manual for repressing emotions. So, yeah, you know, I think it's something, certainly, that I have noticed in myself now that I am much more able to I'm not perfect, but I am much more able to. I'm not perfect, but I'm much more able to actually notice and acknowledge emotions in a way that I would have just shut them up and zipped up before.

Jackie Baxter: 23:33

Um, so, yeah, um, but this is, this is so fascinating because I think one of the things that have really just kind of lightbulbed for me just there is that idea that actually it doesn't have to have been a malicious, a big or a kind of obviously bad thing to have happened to you as a child. Um, some of them could probably have be, you know, almost insignificant, unless you really understand, um, and you know sort of those off-the-cuff comments, even that that a parent or another adult can make, or even another child maybe, um, when you were growing up can actually really sort of get their claws into you and impact you much, much later in life. Um, so that's totally. I've totally had a bit of a light bulb moment there um, but what I would love to know I mean you've talked about all of these experiences and how they can kind of manifest in different behaviors what's actually going on in the body and the nervous system, in the brain, when we experience those sort of experiences? For want of a better word.

Dr David Clarke: 24:50

Yeah. Well, there is research on the brain and these conditions that shows that the circuits have actually physically changed. And there is one study that showed that when people get an appropriate form of treatment, which we're now calling neuroplastic recovery therapies, the brain can physically change back to a healthier pattern. So there is a real cause for this. People who are claiming that someone like myself is saying oh, this is all in your head.

Dr David Clarke: 25:24

No, it's not all in your head. It's in your brain, which is an important distinction about this. The brain actually is where the sensation of pain comes from when you whack your thumb with a hammer.

Dr David Clarke: 25:41

You are not getting a pain signal from your thumb. What you are getting is a signal of damage, and the signal of damage goes up to your brain. And your brain then has to decide what to do with this signal of damage. And if it's your thumb that's just been hit with a hammer, it's going to give you a pain signal in your thumb so that you won't do further damage to it. But let's say that instead you are running from a predator and you sprain your ankle. Your brain is going to get that damage signal, but it may very well decide not to give you a pain signal because you need to get away from the predator, and it will let you feel the pain only after you are safe.

Dr David Clarke: 26:26

And there are countless stories about situations like that, often from people in military combat who don't feel the pain of their wounds until they are in a safe place. And the opposite can happen as well. The brain can create pain where there is no damage. There's a famous story from the British Medical Journal about 30 years ago of a construction worker who impaled his boot on a nail, and they have a picture showing the sharp end of the nail sticking up through the top of his boot that had gone in through the bottom of his boot. So he's instantly in agonizing pain. He is rushed to the emergency room, he's given morphine by vein to alleviate the pain, and then the boot is carefully cut away, only to reveal that the nail had passed cleanly between his toes.

Dr David Clarke: 27:24

He didn't have a scratch, but the brain had created that pain there and the brain can also send signals into your GI tract and various other places, your bladder. You can get migraines from this dizziness ringing in the ears, nausea, vomiting, diarrhea, constipation, pelvic pain, genital genital pain joints. The low back is a big one, you know. Recent study 88 of pain in the lumbar spine was brain to body neuroplastic pain, you know, and certain kinds of rashes can be from this. A lot of cases of long COVID ME, cfs, irritable bowel fibromyalgia, functional neurologic disorders, complex regional pain syndrome, I mean the list just goes on and on. Brain fog, temporal mandibular joint visual disturbances, lump in the throat, um, temporal mandibular joint visual disturbances, lump in the throat, and I've seen all of these. One of my patients had itching over every square inch of his skin for three years and his doctors were at a complete loss. Um, he was 95% cured after we uncovered the reason for it.

Jackie Baxter: 29:27

Yeah, and I suppose that you know we talk about you wake up one morning and suddenly you have 500 different things wrong with your body, but actually if they're all stemming from the same place, it's one thing that's wrong rather than a million.

Dr David Clarke: 29:44

Yeah, and it's hard for any disease other than a neuroplastic condition to produce, more than you know, five or six symptoms at a time.

Dr David Clarke: 29:54

I mean it's possible, I mean if you've got a really serious immune condition, autoimmune condition.

Dr David Clarke: 30:01

But usually if you've got an autoimmune condition producing that many symptoms, the diagnostic tests are going to be abnormal.

Dr David Clarke: 30:09

So the more symptoms you have in the absence of any abnormal diagnostic tests, the more likely it is that you've got a neuroplastic condition. I mean this is 20% of the adult population have this, almost double the number of diabetics that are out there. It's 40% of people that go to the doctor. So if you're just walking into the doctor with a symptom or two or three, you have a 40% chance that you've got a neuroplastic condition before they even lay a hand on you to examine you. If they then do the diagnostic tests that are appropriate for whatever your symptom is and they don't find anything, you've probably got over a 90% chance that your condition is neuroplastic. And if we then do an assessment for stresses in your life, both in the present day and in the past, and we find some things that are significant, the probability of it being neuroplastic goes even higher. And if we then treat you for those stresses and you start to improve. Then we're approaching certainty of the diagnosis.

Jackie Baxter: 31:22

Yeah, I know you said a moment ago, and you mentioned earlier as well, the sort of diagnostic testing and you know I imagine everyone listening has been to their GP and they've had the experience where they said I don't feel good, I have all these symptoms, maybe I had COVID and it showed up after that, or maybe it was a different trigger, and they run all the blood tests and sometimes they'll run some other tests.

Jackie Baxter: 31:51

They'll do your ECG, they'll do your this and your that, and some people might get sent to a anologist or two and more often than not they will come back within normal range, at which point you're like, well, that's great, but also, uh, what do I now? But what is now showing up in several scans around different sort of research are sort of changes in sort of what is it different? Immune abnormalities and clotting and you know different sort of pathologies that are showing up. So these are tests that are showing some abnormalities. So does that mean that those people don't have a neuroplastic condition or is it that those things that are showing up in the tests are as a result of the brain and it's misfiring?

Dr David Clarke: 32:43

Well, we're still waiting for the definitive research answers on that, but it could mean any of those three things, that there are people with long COVID or ME-CFS that are not caused by a brain-to-body condition. If that's true, we don't know how many of them there are, we don't know the proportion of that. But we also know and we've known this for 40 years that the brain can influence the immune system, and so inflammatory markers that appear in people may have been connected to brain activity. There's, you know, dr Robert Ader, a-d-e-r, I believe, from Rochester in the American state of New York, found this initially in rats, and it's been confirmed in people that the brain can physically affect the immune system.

Dr David Clarke: 33:40

And then, finally, it's possible that you can have a brain-to-body and some other condition at the same time. A more common example is somebody who's got arthritis and the pain seems to be greater than the degree of arthritis would normally produce, and so you can have both neuroplastic pain and arthritis pain in the same person at the same time neuroplastic pain and arthritis pain in the same person at the same time. Some of my patients have had ulcerative colitis and irritable bowel syndrome at the same time, for example, and they only got better when we treated both conditions Right.

Jackie Baxter: 34:22

So it comes back to what can we do? And it's worth exploring anything really, isn't it? Certainly if it's low harm, low risk, because if it helps, then great, If it cures you, even better. But even if it makes that 1% of difference, then that's better than not having the 1% of difference, yeah absolutely.

Dr David Clarke: 34:44

Percent of difference? Yeah, absolutely. And the if you have the kinds of stresses in your life, past or present, that are capable of causing physical symptoms in the body, then you know those are worthy of treatment for their own sake, and it doesn't mean that we are writing you off as somebody who doesn't have a physical condition.

Dr David Clarke: 35:10

We're just trying to look at every possibility and successfully address those that we find and, if we're lucky, addressing the brain-to-body condition will provide somebody with complete relief of their condition. The person that I mentioned earlier, who was crawling from bed to bathroom and back for over a year, made a complete recovery and she was actually a film director from Hollywood film director from Hollywood and she came to our conference last year in Boulder, colorado, and set up a studio in one of the conference rooms and filmed 110 people for us to make a video about this condition which is on the symptomaticme website. It's seven minutes long and it captures researchers, clinicians, patients. Incredible job that she did. She had 20 hours of footage and she boiled it all down to seven minutes.

Dr David Clarke: 36:40

I was just amazed and you can learn a tremendous amount in seven minutes. Let's put it that way. And then that inspired me to start my own podcast, which we've just begun. I'm 171 episodes behind you, but it's where I interview patients and talk pretty much like I used to do in my office. I'm not seeing patients anymore, but for the podcast I'm interviewing people about their lives, past and present, and their symptoms, and try to provide insights from those stories that can help anybody who watches. It's called the Story Behind the Symptoms.

Jackie Baxter: 37:24

And again, I'll pop a link to that into the show notes for anyone that wants to follow that up to the show notes, for anyone that wants to follow that up.

Jackie Baxter: 37:35

Um, so, coming back to things like stresses and traumas and adverse uh child experiences and emotions, um, and this kind of like melting pot of stuff that we have experienced throughout our lives, and then we have the covid virus, in terms of long covid or any other virus that may have caused ME-CFS past, present or future. So again, I think one of the things that tends to come up is people become very resistant because they say, well, my illness isn't caused by prior stress, trauma, childhood experiences, emotions. It was caused by the virus that made me sick. And I mean clearly that is true, because it was the virus that made them unwell that they then didn't recover from. But also all of this stuff that came before has obviously created the environment into which we put that virus. So how does this link up? Do these stresses and traumas and prior experiences cause or hinder recovery or contribute to? What's your take on that?

Dr David Clarke: 38:57

Yeah, it's not something that the research has given us a definitive answer about, but my own impression is that if you have a lot of stressful issues that you are coping with and they are beginning to reach a significant level, and then a virus comes along and lays you low for a period of time, it teaches the mind that this is a way to find needed relief from the levels of stress, that if the amount of issues that you're coping with are getting to a significant level getting to a significant level to the point where you really do need to turn away from the world and focus on your own needs for a while the virus kind of teaches your brain that, hey, this is a way for you to do this and by extending the same symptoms that you had with the virus on into the indefinite future, it gives you the space to kind of send that message that there are issues you need to work on.

Dr David Clarke: 40:28

The problem is that the body doesn't speak English or any other verbal language. It just speaks symptoms and it's up to us to figure out what the mind is trying to tell us and when. The mind is inflicting symptoms on the body and forcing you to rest, and it's also trying to tell you that there's something that it is distressed about, something that it is very unhappy with, but it really can't say any more than that, and it's my job as a clinician to try to help people understand what that might be. What is it that the mind is unhappy with? What is it that the mind is trying to communicate? That it's in distress about very common patterns, that people have been through stresses as kids, the magnitude of which they don't fully appreciate, and it's had impacts on their personality traits and their emotions and it's left triggers in their lives. And if we can bring all of those into conscious awareness, then we can deal with them successfully and we can interpret the message that the mind is trying to communicate.

Jackie Baxter: 42:01

So it really is learning that language of the body, isn't it? You know, I'm a musician in my previous life and we talk about music being a language of itself, you know, and you have to learn that language in order to read your music and play your music, and the body is kind of well, it's the same but different, isn't it? You know, it has its own language and it speaks in symptoms rather than notes or words, and it's our job to work out what it's trying to tell us, isn't it? And it's not easy.

Dr David Clarke: 42:37

No, and that's a wonderful analogy with music I had not heard that before, and I think that is so accurate.

Jackie Baxter: 42:47

Yeah, I just made it up, so I'm glad it landed.

Dr David Clarke: 42:55

No, that was inspired, uh, and it is, I mean we, uh. You know, one of the reasons why I think human beings love music is that it touches our emotions and you know it touches our emotions in ways that, um, other things do not.

Dr David Clarke: 43:09

And you know we all feel emotions in our bodies as well.

Dr David Clarke: 43:13

You know, if we're afraid, you know there's the expression heart pounding excitement. Or if we're tense or nervous, the phrase butterflies in the stomach, or feeling a knot in your stomach, and those are all brain to body reactions. We, you know, even people who've never come close to long COVID, have experienced those. Blushing with embarrassment is another brain to body reaction, and this form of illness is just a more severe and long lasting version of that same phenomenon. But the problem is that in my patients they are not aware of what the emotion is that's creating this.

Dr David Clarke: 44:01

If you're about to have a job interview and you really want this job and you know there's a lot of competition for it, you might get a knot in your abdomen, but you know why you might get a knot in your abdomen, but you know why you've got a knot in your abdomen. But if you are dealing with a stress from long ago that you've carried for a number of years and that feels normal to you, you may get the knot or the fatigue or the brain fog or whatever it is, and you're just completely at a loss to know where it's coming from whatever it is, and you're just completely at a loss to know where it's coming from.

Jackie Baxter: 44:40

Yeah, so it's coming back to that translation, isn't it? Yeah, what's your story? Yeah, so what do we do? You know, it's very empowering to kind of have understanding of all of this. And you know, awareness is step one, isn't it? Awareness is step one because then we can work out okay, what do I do? So, you know, it's obviously not going to be as simple as you do this, then you do that, and then you're all good. But what? Where would you go next with somebody with sort of exploring and trying to work through?

Dr David Clarke: 45:09

go next with somebody with sort of exploring and trying to work through any of this stuff, stuff with a capital S? Yeah, definitely with a capital S. You know, once we've identified what the issues are for a particular person, then we want to address those one by one, and one of the most important is the self-esteem. You know, if a person's been made to feel like they're not as good as other people, I want them to imagine a child of their own going through the same thing and to recognize the magnitude of the burden that they have been carrying from that and to recognize it accurately. Another thought experiment is to imagine that I took control of your mind and forced you to raise your own child exactly the way you were raised, or inflicted experiences on that kid that match what you went through and what's it going to be like for you to be doing this to your own child and you can't help yourself. You know how painful would that be. And the reason for that exercise is not to torture people. It's to help them understand the reality of what they had to overcome and to appreciate the heroic perseverance that they had to endure those experiences. That they had to endure those experiences, and to give themselves some credit and think of themselves as actually quite strong. I think of my patients like Olympic weightlifters who have been asked to carry 50 pounds more than the world record for their weight class. Anybody's body is gonna break down under that kind of strain, but they can also be very proud of themselves for having held up under that kind of burden, and the more pride they can feel, the more readily they will be able to put the weight down, and when they do that, they will see how strong they have been all along. And so we're trying to flip somebody's self-image from being weak and second rate to being strong and heroic, which is only being more accurate. It makes it much easier to set aside regular time for yourself for activity that has no purpose but your own joy, and many of my patients do not have anything like that in their lives Because you're a cello player. I'm remembering a patient of mine that she had never done anything musical in her life, but she also had. This was the person who was the athlete. As a little girl who never played, when she hit on taking piano lessons she absolutely loved it, and it was the first time she'd ever had something that was just for her joy. That was when her pain went away, so taking that time for joy, and then also the more heroic you realize you have been.

Dr David Clarke: 48:14

Another analogy I use is that my patients almost like they parachuted into the Himalayas as toddlers. They found themselves, through no fault of their own, in a very challenging environment and they had to find their way out somehow and they should be very proud of themselves for having done that. And when you internalize that pride, well, you don't have to be perfect anymore. You can cut yourself some slack. You can give yourself a break when you make a mistake. You can, instead of coming down on yourself hard when you make an mistake, you can, instead of, you know, coming down on yourself hard when you make an error, you can come down on yourself no more than you would your best friend who made the same mistake. So that's a big one.

Dr David Clarke: 49:04

Then the triggers. If there are any triggers in a person's life, if you are thinking of yourself in heroic terms, it becomes easier to set boundaries. You know you. Suddenly you are feeling like you know what. I do not deserve to get triggered all the time. I am going to set some hard boundaries with this triggering person, event or situation so that I don't have to suffer from it as much anymore.

Dr David Clarke: 49:30

And again, feeling that personal pride in how much you've had to overcome makes it easier to set those firm boundaries. And then finally, again, we come last to the emotions, and for those we need to recognize that you can be really angry at people you also care about or you might like to reconcile with. But that doesn't mean we're going to bury the anger anymore. We're going to give it the attention and the care and the expression that it deserves. I have a lot of my patients write letters to the people who mistreated them as kids. Not to mail it, just to write it and to put down all the good things too, but to put down the reasons why they were transgressed against and the reasons why they have justifiable anger about what happened to them. No-transcript.

Jackie Baxter: 51:01

Yeah, and I think again as a creative, a lot of people find art or painting or drawing as a useful way to help to process some of those emotions, as well, you're right.

Dr David Clarke: 51:06

Yes, one of my friends was a music therapist.

Jackie Baxter: 51:10

Yeah, I know people who do art therapy, so yeah, yeah, that too, that as well yes.

Jackie Baxter: 51:19

Yeah, and you know it's. It's simple, but it's not simple, isn't it? You know it's? It's like you've just outlined the blueprint. This is what we do. But doing that and working your way through it in a safe way, with a safe person, possibly, you know it's, it's a long old slog, or it certainly can be, can't it? And it's? You know it's a long and painful journey. Certainly, in my experience and I think, like you say, you know this idea of actually some of the strongest people are the people that sort of become unwell with these sorts of illnesses, but that's maybe also the strength that will get us out of it as well.

Dr David Clarke: 52:04

Absolutely right. Yes, and you know it can be fearful. You know, I think a lot of people cling to the idea that their condition must be 100 percent physical, because they're afraid to look at these other issues, that they worry that they are just going to be overwhelmed.

Jackie Baxter: 52:26

They're fearful, aren't they?

Dr David Clarke: 52:27

Yeah, they are, they are. They're painful, aren't they? Yeah, they are.

Dr David Clarke: 52:29

They are, but the outcome of the journey of finally looking at these issues in the face when you're ready, is that you become the person you were always meant to be, that you know. People have certain qualities and abilities that can be distorted by the way they were raised, by the aces that they had to go through, and what we want to do is bring the person back, as I say, to the kind of individual they were always meant to be, the kind of individual they would have been if they'd not had to go through these difficulties. And so it's transformational, not only for your health, but for the rest of your life as well.

Jackie Baxter: 53:16

Yeah, and there's a wonderful quote. I can't remember who it's by, but it's something along the lines of rather than becoming something, it's unbecoming things that you're not. I think I'm paraphrasing something. It's unbecoming things that you're not. I think I'm paraphrasing um, but um. I thought that was a really nice way of putting it because, you know, sometimes it is, you know, rebuilding your own life, but rebuilding it in a way that is actually what you want, and certainly that was my experience. You know, having built up this new, exciting, wonderful life from the ashes of my old one, almost, which sounds quite poetic, doesn't? It Didn't feel like that, it felt very painful, but you know that life beyond is possible and it's really freaking awesome.

Dr David Clarke: 54:02

Yes, yes, it is amazing to see the outcomes that people have. You know so often when people get physically well. I don't see them anymore in my practice and so I don't hear about how their lives were transformed.

Dr David Clarke: 54:18

But every once in a while I do, and it's just so amazing what people have done. Another way that I put it for people is that I am trying to learn what my patients were taught about themselves as children. That isn't true, and we want to unlearn that. We want to replace those false assumptions with the reality of the quality of the person and the strength of the person and the worthiness to indulge in self-care, and everything changes, not only the health but the personal relationships.

Dr David Clarke: 55:01

One of my patients was actually known to the public public and she came to me because she had five or six different physical symptoms for 20 years. And you know, we got into a discussion about her childhood and it was, you know, not very good, but she was insisting that it was, you know, relatively minor. Her parents used to fight with each other verbally and emotionally on almost a daily basis and she was the only child, so she would try to be the peacemaker and because she's just a child, she wasn't very successful. And then her parents divorced when she was eight years old and you would think that would solve her problems, but unfortunately the parents continued living in the same household and so, from her perspective, nothing changed. They slept in separate bedrooms, but you know from, in terms of fighting with each other, nothing happened.

Jackie Baxter: 56:02

So you know, here she is, you know in her late 30s and she's still having all these physical symptoms, symptoms, but she made a remarkable transformation yeah and um, and, as you said, you know whether this is the full story or part of the story, it's work that's important to do, because even if it just helps a bit, then that's it's got to be better than not doing it and uh and not seeing any improvement. Um, thank you so much for coming along. I feel like you've blown my mind a little bit. Um, I think we've covered a lot of stuff. Um, I hope some of it is useful. I'm sure all of it will be useful. Um, I'll make sure that I put all those links that I've mentioned into the show notes. So if anyone wants to check out your website, your beautiful graphic, your podcast or anything else that we've mentioned, I'll make sure that that's all linked. So, thank you so much for giving up your time. It's been so amazing chatting.

Dr David Clarke: 57:05

Thank you for all you do, Jackie. I know you're helping a lot of people.