| T O P I C R E V I E W |
| Dr. Zafirides |
Posted - 03/15/2012 : 20:38:09
Hi Everyone,
My name is Peter Zafirides. I am a psychiatrist in Columbus, Ohio. I have been treating patients with TMS for over a decade now. This is a really wonderful forum. Congratulations to all of you for the community you have developed. In my opinion, the validation gained from a community for those afflicted by TMS can be invaluable in one's healing. Never doubt how truly powerful you are!
- Peter
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| 20 L A T E S T R E P L I E S (Newest First) |
| Dr. Zafirides |
Posted - 04/16/2012 : 18:29:48
quote:
Originally posted by merilevy
Thanks for starting this thread. I am a Marriage and Family Therapist Intern and have dealt with TMS myself (in my case it was wrist tendinitis that lasted several years). I see clients in the San Francisco East Bay area and I really enjoy working with clients overcoming TMS-related pain. Do you know of any listings of TMS therapists that I could join to get the word out?
Thanks!
Meri Levy, MA
Marriage and Family Therapist Intern
Oak Creek Counseling Center
www.merilevy.com
Meri,
We are planning to develop a network of TMS clinicians through our non-profit organization, the PPDA (Psychophysiologic Disorders Association).
The PPDA will announce the formation of that network in the future. Stay tuned!!
Kindly,
Peter Zafirides, MD
http://www.thehealthymind.com |
| merilevy |
Posted - 04/04/2012 : 15:54:24
Thanks for starting this thread. I am a Marriage and Family Therapist Intern and have dealt with TMS myself (in my case it was wrist tendinitis that lasted several years). I see clients in the San Francisco East Bay area and I really enjoy working with clients overcoming TMS-related pain. Do you know of any listings of TMS therapists that I could join to get the word out?
Thanks!
Meri Levy, MA
Marriage and Family Therapist Intern
Oak Creek Counseling Center
www.merilevy.com |
| Back2-It |
Posted - 04/02/2012 : 20:59:59
quote:
Originally posted by Hillbilly
If you have panic attacks AND pain, you don't meet any existing criteria, so your treatment is not clear. This is tragic, in my opinion, and so unnecessary.
Yes.
"Bridges Freeze Before Roads" |
| Neo Veloci |
Posted - 04/02/2012 : 08:40:45
Thank you. I do have one follow up question though, if you'll permit me... I posted it in the other thread. |
| Dr. Zafirides |
Posted - 04/01/2012 : 22:02:14
quote:
Originally posted by Neo Veloci
Hi Dr. Zafirides,
Your contributions to this forum are very interesting.
Would you mind if I trouble you to give your opinion on my anger issue as mentioned in this thread?
http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=7291
I could your use your opinion on the child/parent equation.
My question: When I'm angry, I'm sure I could bend the negativity spiral back to positivity but isn't that just my inner parent trying to rationalize things? Won't my inner child still be angry and keep my pain level up?
Looking forward to your reply. Now I'm going to buy Dr. Schubiners book. 
Neo,
Posted a reply on your thread. Just FYI.
Dr. Z
Kindly,
Peter Zafirides, MD
http://www.thehealthymind.com |
| Hillbilly |
Posted - 03/29/2012 : 07:31:13
Dr. Z,
I would like to hear more about your treatment program. It seems to me that you view these issues as arising more from "core anxieties" than from some protective strategy the brain employs to distract us from really dangerous, hidden emotions.
My experience was that I had anxiety decades before I had pain or other bothersome symptoms. Once the symptoms got bad enough that I struggled to function, I naturally (and erroneously) saw my problem as something physical and sought treatment through physical therapy, a cadre of doctors, and ultimately lost nearly a year of my life in the search for an answer.
I found the core of my answer in the writings of two doctors: Claire Weekes and Abraham Low, both of whose writings predated Sarno's, but neither of whom specifically mention pain as the predominant symptom. It wasn't until I started to see the pain the same way that I saw my insomnia, inability to pay attention, constant diarrhea, and many other symptoms I was having as arising from a single issue that I got better. I am now symptom free and enjoying a full life.
While I was reading Dr. Low one afternoon, a statement he made virtually "leaped off the page" and convicted me. He stated that the reason we don't get better is because we constantly think erroneously about our symptoms. We seek relief, alternate explanations, avoid doing things that bring them on, and otherwise behave irresponsibly when we have a wholly benign condition in which our natural stress responses have gone into overdrive and must be retrained to reach homeostasis.
I believe this to be the single largest barrier to recovery. I work as a volunteer with people in my community who have been dealing with stress problems. Their symptoms, like mine, are varied and troubling. Most are disabled, or so they think, so they don't work, don't interact with others, and do not follow the advice of the doctor who is in charge of the group. I lived this, so I know just how powerful the fear is to going back to living and accepting the explanation that the symptoms are nothing at all to concern themselves with.
The point of my writing all this is to make a plea to you and others who are working in the world of treatment but who also have sway over the diagnostic criterion for these conditions. I have opined here for years that the pain known as TMS is exactly the same thing as the muscle tension mentioned as a symptom of GAD. But currently these disorders are listed with separate symptoms as though they exist in a vacuum or box of some sort, which further adds to the confusion and dismay of patients who want to inform themselves and venture to the DSM-IV or online equivalent for information. If you have panic attacks AND pain, you don't meet any existing criteria, so your treatment is not clear. This is tragic, in my opinion, and so unnecessary.
I would like to see one small, powerful change made to the DSM in its new iteration. Please, please, please insist that idiopathic, chronic pain be listed as a symptom of anxiety disorders, and try to have it listed under all of them if they must be broken up and listed separately. I thank you for taking the considerable time to read this.
___________________________________________________________________________________________
Aided and abetted by corrupt analysts, patients who have nothing better to do with their lives often use the psychoanalytic situation to transform insignificant childhood hurts into private shrines at which they worship unceasingly the enormity of the offenses committed against them. This solution is immensely flattering to the patients—as are all forms of unmerited self-aggrandizement; it is immensely profitable for the analysts—as are all forms pandering to people's vanity; and it is often immensely unpleasant for nearly everyone else in the patient's life.
Dr. Thomas Szasz |
| Dr. Zafirides |
Posted - 03/28/2012 : 19:57:54
quote:
Originally posted by ajm222
speaking of anti-depressants, i always suggest people read "Anatomy of an Epidemic" before relying on them too much. i personally believe (and have experienced) that AD's can be very dangerous and should be used at most for no more than 6 months or so. with all the studies showing how meditation and cognitive therpay and even placebos are just as effective, i see no reason to use them. they are indeed powerful and i can personally attest to their effectiveness. but i believe long-term they can cause changes to the brain that can be very dangerous. just my opinion, based on lots of research and experience.
Anti-depressants should always be seen as a small part of the road to health, never the whole road. They just don't work that way. I understand your concerns about long-term treatment with meds, but there are long-term consequences to not properly treating depression and anxiety that affect the immune system, the cardiovascular system, the inflammatory system, etc. It is a complex question with no clear black or white answers. Some peoples' lives have been absolutely transformed with the meds, while others continue to struggle.
There is still so much we don't know in medicine. We just must be aware of that fact. Great points though!
Dr. Z |
| theohiostateq |
Posted - 03/28/2012 : 15:27:56
Dr. Zafirides:
Did you read the article in today's Cols. Dispatch about Thad Matta? Any opinions from a distance? |
| 2scoops |
Posted - 03/27/2012 : 20:57:07
Dr. Zafirides,
What are some other options? Do you have an idea of what I would need to do to get a counseling degree, since I have a BS in Marketing? Thank you for the reply. My heart is definitely into the mind, body and spirit. I'm ready to take the next step. |
| Neo Veloci |
Posted - 03/27/2012 : 05:57:56
Hi Dr. Zafirides,
Your contributions to this forum are very interesting.
Would you mind if I trouble you to give your opinion on my anger issue as mentioned in this thread?
http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=7291
I could your use your opinion on the child/parent equation.
My question: When I'm angry, I'm sure I could bend the negativity spiral back to positivity but isn't that just my inner parent trying to rationalize things? Won't my inner child still be angry and keep my pain level up?
Looking forward to your reply. Now I'm going to buy Dr. Schubiners book. |
| ajm222 |
Posted - 03/26/2012 : 06:58:37
speaking of anti-depressants, i always suggest people read "Anatomy of an Epidemic" before relying on them too much. i personally believe (and have experienced) that AD's can be very dangerous and should be used at most for no more than 6 months or so. with all the studies showing how meditation and cognitive therpay and even placebos are just as effective, i see no reason to use them. they are indeed powerful and i can personally attest to their effectiveness. but i believe long-term they can cause changes to the brain that can be very dangerous. just my opinion, based on lots of research and experience. |
| catmac |
Posted - 03/25/2012 : 13:30:42
I won't get into the details of Existential Psychotherapy, but in a quick snapshot, in EP the main forces that dictate all our behavior comes down to core issues of:
1. Meaning and Purpose
2. Existential Isolation (Aloneness)
3. Freedom and Responsibility
4. Mortality and Death
From an EP perspective, these core anxieties are part of the human condition. We ALL feel these anxieties - on conscious and unconscious levels. For some however, when we get too close to these core anxieties, we begin to have emotional (and I believe, physical) symptoms.
Hi Dr Zafirides,
I have just read the above in your post and it knocked the nail completely on the head for me.
I had about five months of stressful events which finished in a routine endoscopy. The day after the endoscopy I woke up in immense physical pain and remain in pain now. I dont know why I ended up in pain (everything went fine and all tests clear) but the only thing I know is that I was absolutely full of fear on the day I had the procedure.
I read the part in your post about getting 'too close to the core anxieties' and it made perfect sense to me as this is exactly how I feel now.
So thanks for the post, I will definately pursue this if I dont start to improve soon.
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| Dr. Zafirides |
Posted - 03/24/2012 : 10:56:38
quote:
Originally posted by wrldtrv
Thanks for joining the forum, Dr Zafirides. Also for your thoughtful and helpful responses.
I know nowadays, especially with pressure from HMO's, the type of therapy Dr Sarno recommends, Insight Therapy, is pretty much obsolete, in favor of CBT, Interpersonal, or other short-term therapies. But, it's not all cost; apparently outcomes are much better with CBT, for example, than the analytical versions. I can see Sarno's point, that TMS requires the kind of deep digging that analytical provides, but analytical can also be a ditch with no bottom, that in the end is all very interesting, but changes nothing. What do you think?
Also, in terms of meds, Dr Sarno cautions taking antidepressants, for example, because the brain may find another more harmful way to get our attention. There are many drug purists on here; I'm somewhere in the middle. Certain disorders, eg, bipolar, schizophrenia, are wholly biological so there is no going without drugs here. But even with depression or anxiety, if extreme, and if the person has tried all the standard techniques without much success, I think one should do what is most practical. What is your opinion here?
Thanks very much, and again, welcome to the board.
Great questions!
There are various psychotherapy approaches that have been utilized in the treatment of TMS. While Dr. Sarno's theories are based in Freudian, psychoanalytic terms, I believe the biggest reason this happened was geography. If you study the history of the spread Freudian theory in America, it all started in New York City - specifically Greenwich Village. New York City has always had one of the largest concentration of psychoanalysts in the entire world - even to this day. So, it makes perfect sense that Dr. Sarno would develop a psychoanalytic explanation of TMS.
I am not taking anything away from psychoanalytic theory, mind you. I had extensive training in psychoanalytic theory during my psychiatry residency at Ohio State University, including my choice to undergo personal psychoanalysis. That said, I was much more profoundly influenced by the Existential Psychotherapy approach and the works of the brilliant psychiatrist, Irvin Yalom. Additionally, the outstanding writings of Victor Frankl and Rollo May deeply have influenced my psychotherapy approach.
The overarching reality though is this - the specific type of psychotherapy is really secondary. The MOST important part of psychotherapy is the relationship between the individual and the therapist. An individual MUST feel their therapist is fully aligned with, engaged in and caring about the person they are treating. The relationship is where the true healing occurs , the specific type of therapy comes second, at least in my opinion.
I won't get into the details of Existential Psychotherapy, but in a quick snapshot, in EP the main forces that dictate all our behavior comes down to core issues of:
1. Meaning and Purpose
2. Existential Isolation (Aloneness)
3. Freedom and Responsibility
4. Mortality and Death
From an EP perspective, these core anxieties are part of the human condition. We ALL feel these anxieties - on conscious and unconscious levels. For some however, when we get too close to these core anxieties, we begin to have emotional (and I believe, physical) symptoms.
Keep in mind, this is MY orientation in therapy. That is the only point I am trying to make in this entry. I am not commenting on the validity/effectiveness of psychoanalysis or any other type of psychotherapy, for that matter. People have been - and continue to be - helped by all different type of approaches by therapists who have devoted their entire lives to helping people with the knowledge they have acquired. We are blessed to have the variety of approaches in helping individuals out during the difficult times in their lives.
-Peter |
| Dr. Zafirides |
Posted - 03/24/2012 : 10:11:23
quote:
Originally posted by 2scoops
Dr. Zafirides, I would very much like to get involved in helping people tms. Its a passion of mine. Problem is I have a business degree. I was thinking of doing counseling, even christian counseling. Not really sure where too start. Guess i have been afraid to start in this economy. Any tips our advice? I am in Dayton and would be open to setting up an appointment with you.
2scoops,
There are a bunch of options to consider. Ideally, going back to school to get a degree in counseling is the best option. That said, so many people have been helped by others who have struggled with TMS. Forums like this can be invaluable to people who feel so isolated in their struggle and misunderstood. Follow your heart, the answer will make itself known.
-Peter |
| wrldtrv |
Posted - 03/19/2012 : 19:43:21
Thanks for joining the forum, Dr Zafirides. Also for your thoughtful and helpful responses.
I know nowadays, especially with pressure from HMO's, the type of therapy Dr Sarno recommends, Insight Therapy, is pretty much obsolete, in favor of CBT, Interpersonal, or other short-term therapies. But, it's not all cost; apparently outcomes are much better with CBT, for example, than the analytical versions. I can see Sarno's point, that TMS requires the kind of deep digging that analytical provides, but analytical can also be a ditch with no bottom, that in the end is all very interesting, but changes nothing. What do you think?
Also, in terms of meds, Dr Sarno cautions taking antidepressants, for example, because the brain may find another more harmful way to get our attention. There are many drug purists on here; I'm somewhere in the middle. Certain disorders, eg, bipolar, schizophrenia, are wholly biological so there is no going without drugs here. But even with depression or anxiety, if extreme, and if the person has tried all the standard techniques without much success, I think one should do what is most practical. What is your opinion here?
Thanks very much, and again, welcome to the board. |
| Stryder |
Posted - 03/19/2012 : 09:10:26
Hi Peter,
Thanks for your very thoughtful reply. I agree its very complex and appreciate your support of moving TMS theory along to the next step.
... [Dr. Schubiner] also has been give a multi-million dollar grant to research his treatment method further. Clearly, the people with the purse-strings are listening...
Thanks for sharing this very good news. Evolution takes time. This study and the genesis of the PPDA is recognizable forward progress.
Take care, -Stryder |
| 2scoops |
Posted - 03/17/2012 : 17:21:55
Dr. Zafirides, I would very much like to get involved in helping people tms. Its a passion of mine. Problem is I have a business degree. I was thinking of doing counseling, even christian counseling. Not really sure where too start. Guess i have been afraid to start in this economy. Any tips our advice? I am in Dayton and would be open to setting up an appointment with you.
|
| Dr. Zafirides |
Posted - 03/17/2012 : 13:00:20
quote:
Originally posted by Stryder
Hi Peter,
Thanks for stopping by, gald you like the forum. You can thank austingary for starting, Dave for sustaining it, and all the members.
Curious about your opinion on something, why the medical complex is not doing oodles of clinical trials and studies on TMS ? Is it because there is no "product" to back the study ? Do you think it really does come down to making more dollars with physical treatments ?
Question prompted by the last two paragraphs of the recent U.S. Senate testimony by Dr. Sarno...
"Judging by the reactions of doctors in my immediate environment, most either ignore or reject the diagnosis. A few physicians in my own specialty say that they see the validity of the diagnosis but find it difficult to treat such patients. One hopes that the younger generation of physicians will be more open to this diagnosis.
There is a need to raise consciousness both inside and outside the field of medicine to help change people’s perception of the cause of the common pain syndromes which represent a major public health problem. Science requires that all new ideas be validated by experience and replication. It is essential that these ideas be subjected to research study in the future."
Full story... http://www.help.senate.gov/imo/media/doc/Sarno.pdf
Take care, -Stryder
Stryder,
This is a very complex question to answer fully, but I will do my best.
First off, we must realize the realities of western medicine today. In my opinion, we have veered terribly off track with such attention to symptom-based treatment. The proliferation of specialized medicine - while critical in health care - has tended to lose sight of the person as a human being. We see that changing because the marketplace of patients is demanding it. Holistic and integrated medical centers are growing everywhere - and for good reason. People are people, not symptoms.
For example, when I see a person for depression, I may write them for an antidepressant. But I take the time to educate them on how they should understand the medication's role in their health. The meds play the part of reducing the "noise", if you will, that is cause by the depression or anxiety. How a person progresses in their life after that has happened is all their responsibility. THEY are making themselves better, not the pill. The medication may get some of the "noise" out of the way, but it should ALWAYS be seen as a very small part - and NEVER the whole - of the treatment.
I tell people they WILL be better. I tell them they should EXPECT to get better. I tell them it is part MY FAULT if they do not feel better and that I will will work with them to get them to health. I don't say this to give a person false hope or to patronize them. I TRULY BELIEVE THIS. People are simply that powerful. They really are, they just don't believe it or they doubt themselves. Part - perhaps the most important part - of what all of should do as physicians is to empower our patients and have them truly understand the capacity they have to improve their health on their own. No one should ever feel that the only reason they feel better is because of a medication - or because of a doctor. It just simply isn' the case at all.
People get healthy - and stay healthy - because they believe in themselves and are active participants in their lives. We seem to have forgotten that as physicians today. We have relegated people to their symptoms - the depressed patient, the back pain patient, the hypothyroid patient - rather than understanding them as a whole human being. It is a sad irony today. We have the best technologies, the brightest minds in medicine, the brightest minds in research - and we still have unbelievably high levels of illness (cardiovascular disease, cancer, diabetes, depression, chronic pain etc) in this country.
Something is wrong.
There are very real financial influences in the medical industrial complex as it exists today. Don't get me wrong, I am a believer in the free market. That said, we must understand that money will also drive the advances that come in medicine today. It is simply a fact. I am not sure how you create an incentive to take risk of researching medical advances - and shouldering the risk of failure - without an incentive to be rewarded for your work. I think we can all agree upon this basic premise. But with TMS - and its treatments - vast amounts of money CAN BE SAVED. I think this will be the main platform for advocacy within the PPDA and TMS movement going forward. Those that control the purse-strings will listen when you can convincingly show them it is in their best interest, financially, to listen.
But how do you get them to listen? PROOF.
One of the most important aspects of any treatment gaining acceptance is EVIDENCE of efficacy. All of us here DEEPLY believe in both TMS and its treatment. But that is simply NOT enough for mainstream acceptance as a valid treatment. I think that is a reasonable standard though. Just because WE believe TMS exists and its treatment works does not necessarily mean TMS actually exists and its treatment work for everyone. This is not a criticism of TMS, we just need to be aware of our bias. We must continue to produce research and evidence for the treatment of TMS for it to gain traction in the medical community at large. Advocacy can only take you so far. I am not saying this to be defeatist. On the contrary actually. To those who believe in TMS, we can offer individuals great hope and profound relief. I am simply talking about why we don't see this talked about in medical schools, residencies (except at OSU where I finally have secured a lecture course on emotions/pain/TMS) and in the doctor's office.
We need evidence. With evidence, we gain traction and acceptance. This is why I advocate and support Dr. Howard Schubiner as much as I do. He has clinical proof of improvement - via his research - in the pain of Fibromyalgia by using the treament methods outlined in his book "Unlearn Your Pain". In my opinion, Dr. Schubiner is the embodiment of the next generation of TMS progress, with the additional clinical PROOF of treatment via his published research in peer-reviewed, medical journals. He also has been give a multi-million dollar grant to research his treatment method further. Clearly, the people with the purse-strings are listening. They see the potential - even if it is simply in terms of in cost savings - within health care.
So these are some of the challenges. Patients and doctors need proof to have their minds - and actions - change. Even with proof, a change in treatment doesn't always follow. Habits and preconceived understanding is hard to extinguish. The Truth is not always enough.
So we pick our battles. We advocate as best we can and treat those who dare to take a look at their pain a little differently. Every day we progress that much further. We put our thoughts out there. We set "brush fires" of TMS in the collective mind our culture and society. We do the all we can - the best that we can - with honor, respect and dignity.
One day, one of those brush fires will catch hold of the collective consciousness as it relates to TMS.
Of that, I really have no doubt....
-Peter |
| Dr. Zafirides |
Posted - 03/17/2012 : 12:02:39
quote:
Originally posted by lynnl
Dr Zafirides, you made no mention as to whether, or not, you personally had been at one time a TMS sufferer yourself.
Offhand I would expect so. Otherwise I'd be a little surprised that someone, even trained in psychiatry, would be so receptive or convinced of the validity of Dr Sarno's TMS model as to undertake the treatment of TMS as part of their vocation. Perhaps that's just a reflection of my (admitted) ignorance of psychiatry.
My reason for asking is a curiosity about the likelihood of obtaining meaningful assistance from the normal, "garden variety" psychiatrist who's totally ignorant or unfamiliar with the TMS process. Would you care to elaborate on that question?
Lynn
Lynn,
Great question. I have always had an interest in the physical expression of emotional symptoms. This goes back to my residency, well before I ever knew of Dr. Sarno or TMS. I had purchased his book (Mind Body Prescription) in the middle of my psychiatry residency based on my interest in this area of psychiatry - but truthfully - it sat in my bookshelf for about 5 years before I read it!! :)
I did suffer a back injury in 1999 which was very problematic for me. I actually had to stop practicing for a while as I was in so much pain. I started to feel better with "traditional" treatments, but on a whim, I pulled out Dr. Sarno's "Mind Body Prescription" - and it changed my life forever.
Within a matter of weeks, my pain was resolved - and I have never looked back. It took me a while to gain confidence in myself and being active - so I can really relate to the personal fear of "hurting my back again" by being an active human being. Once I shed that ghost, the pain has never been a problem again. Of everything in my recovery, fully believing in myself and the fact there was no physical injury was the hardest thing to reconcile and come to terms with, personally. Once that happened though, the pain lost its control over me.
Based on my experience, I realized I had to learn all I could about TMS. I realized I had to spend some time personally with Dr. Sarno in NYC. I wanted to learn more about his methodology and how I could apply it to bring relief to individuals. He was kind enough to have me join him in his clinic and learn from him. He is an amazing human being. Dr. Sarno is, without a doubt, one of the two biggest influences in my professional career (the other is Dr. Irvin Yalom, the renowned psychiatrist and author multiple books, including "Existential Psychotherapy").
I have considered it one the highest honors of my medical career to have had Dr. Sarno personally refer patients to me for TMS treatment when they have been unable to make the trip to see him in New York City. He truly is an amazing man whose groundbreaking work has forever changed the way we understand pain and suffering.
-Peter
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| Dr. Zafirides |
Posted - 03/17/2012 : 11:32:30
quote:
Originally posted by bryan3000
Hey Doc,
Enjoy the podcast. Hope you increase the frequency. Very helpful.
Bryan,
Thank you so much for your kind words. I will do my best to keep providing the best content I possibly can.
-Peter |
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