Vert Mooney, MD

Vert Mooney died yesterday afternoon on his way home from work, apparently from a heart attack or stroke.  He was a pioneer in so many aspects of rehabilitation and one of the world’s foremost spine surgeons, a wonderful husband and father, and a friend and mentor whose absence will be deeply felt.

I woke up in the wee hours this morning feeling his absence.  His voice is still fresh for me, “Onward and upward, man!”

I’m certain that there are many aspects of Vert I will miss that will come to mind in the coming days, but the very first that I’ve noticed is how much I value his firm graciousness and his insistence on respect for all opinions.  As a pioneer in medicine, it wasn’t uncommon for him to be attacked by vested interests and by people whose cages he enjoyed rattling.  I recall a scientific meeting many years ago in which we presented several research papers to about 500 orthopedic surgeons and then took questions.  Our work was obviously controversial because we had scientifically demonstrated the efficacy of alternatives to expensive surgical procedures; not exactly what spine surgeons wanted to hear.  One of our group was so concerned about the reception of his paper that he actually fainted at the lectern and had to be revived.  After we presented, Vert was the moderator, taking questions from the floor.  Immediately he was hit with angry “questions” that were really diatribes by angry red-faced surgeons who were used to telling other people what was what.  Vert, with deep roots in the scientific and academic communities and as a founder and past president of all of the major pertinent professional associations simply responded with, “Thank you for your question” and asked for the microphone to be passed.  He was polite and not dismissive, allowing people to have their say, trusting that our findings, based on good research, would stand on its own, which was true.  As the diatribes diminished and actual questions began to surface, he encouraged all of us, but most especially the junior members of our research group to respond, which, with Vert having our back, we were able to do.  That was a very special moment for me and provided a template for how to be a mentor and senior scientist.  Being a pioneer is fun, but it is often difficult and the absolute best way to defuse difficult situations is with grace.  Vert was firm, not backing away from a fight, but always treating everyone in the conversation with grace and respect.

Today, I send prayers to Vert’s family and many friends, for our shared loss and thanking God for his gift of Vert’s presence.  Millions have benefited from his work, many of us directly, and the world is so much better because he led and inspired us.

Why God-Wired?

God-Wired is a collection of stories about young people and old people, rich people and poor people, famous people, and people of whom you have never heard and their magnificent brains.  The experiences described in these stories have moved me from the life of a rebellious and cynical scientist who found God inconvenient and embarrassing to become a rebellious and optimistic scientist who finds God valuable and necessary. 

These stories have caused me to seriously consider the Bible as not only the inspired word of God but consistently revealed in every neuroscience conference and scientific journal and textbook describing the structure and function of the human brain. 

These stories also include methods by which you can implement the invitation of the Apostle Paul more than 2000 years ago:

“Do not conform any longer to the patterns of this world but be transformed by the renewing of your mind.  Then you will know what God’s will is for you, his good, pleasing, and perfect will.”

 God-Wired is based on this message from the Apostle Paul who was inspired by God to lead people to transformation, through the grace and redemption made possible by the life and death and resurrection of Jesus.  Before God sent Jesus to offer you the opportunity to be transformed, He designed your mind to be renewed.  The offer still stands, which is the focus of the Bible.  God’s design of your brain and its ability to help your mind be ready for transformation is the focus of this blog. 

 In God-Wired I will share with you recent discoveries about your brain’s ability to renew your mind.  The first lesson is this: Your brain is constantly trying to renew your mind, which poses a challenge to each if us; how to be responsible for our renewal.  It’s a responsibility that we can’t avoid because our brain is constantly changing in response to what it experiences, which is sometimes controlled by us, and often influenced by those around us.  This is a crucial part of God’s free will that we can’t turn down because we can’t stop our brains from developing

How we accept the responsibility for the renewal of our minds through the development of our brains is an important focus of my practice as a psychologist and is the primary focus of God-Wired, where I have included several exercises I use with my clients to help guide their development that I now offer to you with humility and respect for the power that God has put within our grasp. 

If you are a believer, I hope that God-Wired will help you become even more excited about God’s potential to use you to do His work and perhaps learn how to move closer to “His good, pleasing, and perfect will” for your life.  As a faith-based neuroscientist, that has been my experience.  Have you gone too long without awe and inspiration?  Well, in God-Wired, you will find information about your brain that will amaze and inspire you.  If you are like me, you will develop a new appreciation for how magnificently God has created you and you will be humbled by the intricacy and complexity of your brain.  Although the magnificence of God is found throughout nature, I believe that His most amazing creation is your brain, helping you to understand these words and get excited about what you are learning, a brain that is developing as you read this, right now!

If you are a faith-seeker, considering a relationship with God, I hope that God-Wired engages your curiosity and inspires you to take the step of faith.  Because you haven’t yet developed a relationship with God, perhaps the most amazing thing about reading God-Wired will be that learning how your brain works will help you understand how God wants you to live.  This glimpse of the potential to renew your mind will lead you closer to God, as it has moved me and many others.

If you are a faith-skeptic, I hope that you will postpone judgment as I share my story and the stories of others who have been transformed through the renewal of our minds, facilitated by the science that I once thought required me to reject God, but I now realize was crucial to my faith journey.  I believe that an open mind that is curious and always asking questions inevitably moves towards a relationship with God.  That has been my own experience, beginning my career 40 years ago as a God-rejecting scientist-in-training moving casually through life, and given the opportunity to step into the lives of people with severe disabilities who had reason to seriously question and be angry with God, but often found God necessary as their minds were renewed to meet their new circumstances.

Why do I say God-Wired?  Because I believe that God is the Architect of your brain, with approximately one trillion cells packed into 3 pounds of matter.  In that space, God has organized 100 billion neurons, with 10,000 connections each, to be the foundation of your mind, your personality, and your abilities, with millions being added every day.  What is even more amazing, in relationship with each other my brain is wiring your brain and your brain is wiring my brain, every moment we interact.  We are doing life together in a very fundamental way, and we should be intentional about how we carry that off.

Although all of the information in God-Wired is available in the scientific literature and is taught in graduate schools, I believe that this is the first place it’s been made available from a Christian perspective, helping to bridge an unnecessary gap in modern society.  God-Wired includes the latest from the fields of neuroscience and psychology that is bringing about a revolution in how to help people transform their lives.  Important scientific studies are referenced and you will find additional resources in God-Wired that can help deepen your understanding and appreciation.

One final thought; this blog-thread is an opportunity that I have to pay back to my patients and colleagues and teachers and family some of the most important lessons I have learned that go beyond what they have individually taught.  The confluence of knowledge and experience that is found in every life should be offered to others in the hope that they may benefit.

The Hippocampus – Your Autobiographical Memory

The neurons in our brains are organized into about 150 different areas, each of which has a specific function.  These areas interact within our brains and with our body and are affected by other areas in our brains and by parts of our bodies. 

One of the most important parts of our brain is called the Hippocampus, which is in both sides of your brain just above where your ears are attached to your head.  If you were to look at the brain from the outside, you would not be able to see your Hippocampus because it is covered by the temporal lobe of the cerebral cortex, one of the four large areas on the surface of your brain.  The Hippocampus in each half of your brain is about as big around and as long as your index finger, becoming more slender as it moves towards the back of your brain to attach to the Hippocampus on the other side of your brain.

The Hippocampus is the center of your autobiographical brain, how you see yourself and what you believe about yourself and your place in the world.  The Hippocampus is a crucial brain area for the development of your sense of self.  In the Hippocampus, information about the episodes of life is briefly stored before the information that is more important gets processed into memories.  Early information is pushed out by later information and information that is less important vanishes after a few hours.  Important information pushes out information that is less important, with less than 1% of the information that comes in each day being transformed into permanent memories.

In the Hippocampus of a happy and successful person, the information that gets processed into memories helps her develop belief in her courage to handle difficult situations, self-esteem by appreciating her successes, her character and responsible habits, her helpful personality and skills in cooperating with others, and an attitude of respect and grace for others.  The happy and successful person has developed the ability to select which 1% of the information that comes in each day gets transformed into permanent memories, allowing her to write a thoughtful and intentional autobiography.

Whoa!  She is able to select the 1% that comes in each day and write her own autobiography?  How is that possible?  Well, it is only possible if she has the attitude that she is going to be the manager of her life, if she refuses to “conform any longer to the patterns of this world…” so that she can be transformed by the renewing of her mind.  She has to become as careful about what she puts into her Hippocampus as she is about what she puts into her body, which begins with being “healthfully selfish”, something I encourage all my clients to become. 

But we’re getting ahead of ourselves.  Let’s take a look at a very practical and useful exercise that you can do today to begin the renewal of your mind, the…

Happy Hippocampus Brain Exercise

We can take advantage of the temporary information processing of the Hippocampus by using the “Happy Hippocampus” brain exercise.  Okay, I know that’s a real corny name for the exercise, but it’s very accurate and it’s easy to remember. 

Recall that the Hippocampus is where information is processed before it is sent to other parts of the brain to become permanent memories.  Most of the information processed in the Hippocampus does not become a permanent memory, simply because it is not that important.  The information that is more important stays in the Hippocampus longer so that it can be distributed to other parts of the brain, where it develops into a picture of us, how we see ourselves. 

Although the Hippocampus was our biographical brain as we were children, being written by parents and teachers, as we go through adolescence, we begin to write our own stories, and the Hippocampus becomes our autobiographical brain.  What I mean by this is that we can decide a lot of what gets written in our autobiographical brain by deciding what gets put into our Hippocampus.  Obviously, since we want to write the best autobiography we can, we are going to be careful about what we put into our Hippocampus.  Along with this, we want to put good information into our Hippocampus in such a way that it has full effect, that it gets written with indelible ink.

I want you to start the Happy Hippocampus brain exercise by identifying what you want to develop in your autobiographical memory.  For a simple example, let’s start by choosing to develop your courage, one of the behaviors that successful and happy persons consistently demonstrate and model for others.

What is courage?  Courage is the ability to do something in spite of being afraid.  To see ourselves as courageous is to see ourselves acting in spite of our fears. People are courageous when they act with integrity in spite of opposition.  Courage is extremely important.  CS Lewis writes, “Courage is not simply one of the virtues, but the form of every virtue at the testing point.”  When each of us is tested and maintains our integrity, courage is involved.

One very interesting aspect of courage is that it reinforces itself, becoming self-fulfilling.  When a person acts courageous in a situation and her courage is successful, the next time the situation arises, she is more likely to be courageous, and she will gradually see herself as a courageous person.  If she sees herself as a courageous person, she will more often act with courage.  This is a very important point.  If we think of ourselves as more courageous, we tend to act in ways that are more courageous.  If we act more courageous, we tend to think of ourselves as being more courageous. 

Stop for a moment and consider this: As I think, so I become, and as I act, so I think.  This means that how I think is at the root of how I act and how I act is at the root of how I think.  This is what Paul was talking about when he wrote, “Do not conform any longer to the patterns of this world, but be transformed by the renewing of your mind.”   We are wired by God to act in ways that are consistent with how we think, and think in ways that are consistent with how we act.  This is both wonderful and troubling because I can either think and act well or think and act horribly.  What is most exciting about the close relation between how I think and how I act is that you and I have responsibility for both how we think and how we act.

Oops!  “I thought that I am only responsible for my actions, not what I think.  What I think is sometimes much worse than how I act.” 

Unfortunately, although people looking at you from the outside can’t tell exactly what you’re thinking, your thinking does influence your behavior.  Sometimes the influence is very subtle and sometimes the influence is very strong.  The bottom line is that how each of us thinks influences how we act.  Using our autobiographical brain to think healthy thoughts is absolutely crucial if we are to act in healthy ways.  We can use the Happy Hippocampus Exercise to develop the autobiographical brain that we need to have a healthy life.

The Happy Hippocampus Exercise is deceptively simple and is much more influential than you will first appreciate.  It works gradually to write an autobiography that conforms to how you want to be.  It has these simple steps: 

Every day for the next month, pick three episodes 1 that demonstrate the behavior you want to develop, in this case ways in which you were more courageous today than you were yesterday.  Use a note pad to help keep track of this during the day.

Write a few words on the note pad that will be episode cues, reminding you what you did to demonstrate the behavior you want to develop, in this case, courage.

As you get ready for bed each night, review the note pad to refresh your memory about the three episodes.

After you go to bed and just before you drop off to sleep, pray a gratitude prayer, thanking God for your family and your other blessings.

After your gratitude prayer, recall the episodes and allow them to be the last information that you process before you fall off to sleep.  If you have to keep thinking through these episodes, that’s fine, just stick with it until you drop off to sleep.

If you awake during the night, use your episode cues again to help get you back to sleep.  Recall these thoughts in place of any thoughts that awakened you, especially if they were troubling thoughts.

Several important things are accomplished by the Happy Hippocampus Exercise.  Let’s review what is accomplished by using courage as our example, helping you to develop more courage as a personal resource.

Remember that earlier information in the Hippocampus gets pushed out by later information.  Since the most recent information in your Hippocampus is the three examples of how you were more courageous during the day, this information will hang out in the Hippocampus longer.

The longer the information about you being more courageous sits in your Hippocampus, the more likely it will be to be distributed to other parts of your brain.  This helps to make the information into memories.  Memories are chunks of information that are resistant to loss and help to influence how you think about yourself.  So, by giving your Hippocampus three thoughts about how you were courageous during the day, you are developing new memories that have to do with courage.

As the information about you being more courageous sits in your Hippocampus, it distracts your brain’s attention from how you didn’t act courageous during the day.  This is an extremely important point.  None of us is perfect and we all have some things each day that we do well and some things that we don’t do well.  If you select episodes that describe your courage, another part of your brain can stay silent, the amygdala.  This is important because the amygdala is responsible for processing information about threats and shortcomings to get you ready to defend yourself.  If you go to bed and your last thought is about how you weren’t courageous, it will trigger your amygdala, causing your body to go on alert.  Although you may still go to sleep because you’re exhausted, your sleep won’t be as restful.

When you wake up in the middle of the night worried about a problem, the discomfort you feel is your amygdala getting you ready to defend yourself.  Unfortunately, the amygdala doesn’t fully appreciate that you need a good night sleep and that there is nothing to be done about that traffic ticket or unpaid bill until the next day.  Fortunately, the neurochemicals that your amygdala has triggered only last for about 90 seconds.  As long as you don’t keep thinking about what is worrying you, after 90 seconds, you will be ready to go back to sleep.  So, as an alternative to thinking about your worries, use those 90 seconds to get up and go to the bathroom and go back to bed and choose to think about your three Happy Hippocampus episodes from the prior day.  You might have to throw in another gratitude prayer, but this will definitely be more helpful in getting you back to sleep than lying in bed obsessing about that traffic ticket or unpaid bill and feeding your amygdala threatening thoughts.  We’ll talk later about how to get along better with your amygdala.

Recent research has shown that the brain actually grows new neurons in two locations.  Guess what?  The Hippocampus is one of the areas!  Right now, reading this blog and learning about the Hippocampus is actually causing stem cells in the Hippocampus to start growing new neurons.  In about 3 weeks, the neurons that are being born right now will be fully mature and ready to go to work for you.  So, if you stimulate new neurons and every night for 3 weeks keep working on courage, guess what happens?  Right!  Those new neurons are going to work to preserve your more-courageous self-image.  We could call these your “courage neurons” because if you keep processing information about how each day you act more courageously, those neurons become part of your God-wired brain, with you as the co-author.  Pretty neat!

The final and very important point I’d like to make is that you are not only thinking about being more courageous in the Happy Hippocampus Exercise; you are gradually changing your behavior.  It’s probably going to be difficult to find three episodes from your day in which you were more courageous than the day before, at least at first.  Without these episodes, the exercise won’t work.  Don’t try and fool yourself by pretending to be more courageous.  Being courageous takes practice and requires skill.  You develop the skill to be courageous gradually, learning how to better handle people and situations that used to baffle you or intimidate you.  You can’t just think it and do it.  You actually need to take opportunities each day as they come along and practice being more courageous in ways that are likely to be successful, but feel risky.  Research has shown that “fake it till you make it” is not only ineffective, but can also cause problems.  We’ll talk about this more in another blog entry that is titled, “White Lies and the Devil”.

So, that’s the Happy Hippocampus Exercise.  It requires that you be thoughtfully intentional, looking for opportunities each day to develop an aspect of yourself that you value.  The opportunities have always been there, now that you are looking for them, they will become more obvious.  Once you recognize an opportunity, you can choose to use it or not.  There will be plenty of opportunities, so choose with thoughtful intentionality.

  1. I call each example an episode because this is the type of memory you will be accessing, called “episodic memory”.

God-Wired Foreword

“Do not conform any longer to the patterns of this world, but be transformed by the renewing of your mind.  Then you will be able to test and approve what God’s will is – His good, pleasing, and perfect will.”  Romans 12:2

Neuroscience is starting to catch up with the Apostle Paul, who spoke with assurance about the transformational capacity of the mind more than 1900 years ago.  Paul asked his readers to accept by faith what neuroscience has recently demonstrated.  In the past few years, neuroscience has not only identified many of the processes by which the renewal of our mind takes place, but also the responsibility that we have to do this carefully and with intention. 

 This blog-thread presents my approach to counseling, psychoneural transformation, which assumes primacy of the mind over the brain, using the brain’s capacity for development.  Our brain is constantly renewing itself in interplay with our mind, a process that is rapid and chaotic in childhood and adolescence and continues to be vibrant and powerful throughout adulthood, on into very old age.  This constant renewal is both hopeful and exciting, but it also has a dark side, which is why Paul encouraged the focus of transformation on God’s “good, pleasing, and perfect will”, guided towards a God-honoring life.

 This blog-thread is about the intersection of faith and neuroscience that produces healthy transformation, presented from a perspective that argues that faith and neuroscience must be jointly considered, each respecting the other.  Currently, this is a minority perspective, because most scientific communities and most faith communities have not matured to the point where respectful conversations accepting of each other’s positions are commonplace.  There are of course, wonderful exceptions, and I hope that this blog contributes in some small way to these conversations.

 This blog-thread reflects my personal transformation and presents case studies of the transformation of people I have worked with professionally as a counselor and psychologist in the field of Rehabilitation.  Most of these are presented anonymously, out of my professional responsibility as well as my respect for them and their families. 

An important pattern that will become apparent is that my professional abilities have always been limited by my knowledge and worldview, with my early work less effective than my recent work.  But this is true for all of us, carpenters, mechanics, attorneys, physicians, counselors and psychologists.  We all serve our clients better as we develop expertise with greater knowledge, skills, and abilities. 

 What is different for psychologists, counselors, and many healthcare professionals is that whenever faith is important to our patients, our resistance to addressing faith as a legitimate issue unnecessarily limits our effectiveness.  The faith of their clients is not a pertinent issue for carpenters, mechanics, or attorneys, and many physician specialists such as radiologists or pathologists.  But for those of us who interact with the minds of people to whom we provide professional care, whenever their minds are affected by their faith, our ability to facilitate transformation is limited to the degree that we ignore their faith. 

 And yet the contributions of science to healthcare are not to be ignored.  My recent work is more effective than my early work not simply because I allow my clients’ faith to be a legitimate part of our work together, but because I bring to this work my expertise with scientific knowledge, skills, and abilities.

 Do I force faith into my work with my clients?  Of course not.  The last question in my intake interview is, “Who do you turn to for emotional support?”, with a follow-up question, “Do you have a particular faith or believe in a higher power?”  By asking the question, I make available to my clients the space for a conversation about faith’s place in their lives.  By making it the last question, I allow the issue to be bypassed comfortably when the 20% of my clients who either have no faith or are antagonistic to the idea of faith describe their position.

 How do I integrate faith into our professional relationship with the other 80%?  It depends on the client.  When faith is a peripheral issue, it usually will not be an aspect of our interaction.  When the person’s faith is a central issue, it will have more prominence, but it will not crowd out science.  In these situations I can only honestly share my experiences and those of other people of faith that science illuminates faith and faith gives meaning and purpose and a moral compass to science and scientific practice.

 This blog describes my life in Rehabilitation, as a person and as a professional.  Rehabilitation is the venue for the “bad things-good people” God-challenge to be actively addressed every day, with meaning and hope arising from the fear and sadness of catastrophic life events.  My primary message here is that Rehabilitation is the ultimate proof of how God designed us for resilience, meaning, and happiness, implemented by a God-wired brain in concert with other God-wired brains.  Rehabilitation is the best modern example of God’s work with the Apostle Paul that led him to encourage us to be transformed by the renewing of our minds so that we can know what God’s will is for our lives “his good, pleasing, and perfect will.”

SMART for Chronic Disabling Pain

The only scientifically validated strategy to help patients handle chronic pain without strong analgesic medication or surgery involves a cognitive behavioral counseling approach that focuses on developing strategies for negotiating with the pain.  I call this “Symptom Management and Rehabilitation Training” (SMART).

 At first, most patients who are experiencing chronic disabling pain are unable to imagine that anything but medicine or surgery can handle their pain and that they cannot become an agent of change where their pain is concerned, but that some medicine expert is necessary.  Well, I am an expert and I can tell you that you need to help yourself.  If we can get you to accept that you are able to participate in your pain management by being intentional about what you think, we can probably help you handle your pain! 

 There is strong scientific evidence for the relationship between how pain is experienced and how a patient thinks and handles stress.  There is a direct relationship between mind and body that we can take advantage of; what a patient thinks is directly related to how they experience pain. 

 The first question to ask a patient with severe chronic disabling pain, is, “What makes it worse?”  Listen carefully for the response that indicates that personal agency is lacking.  Ask yourself, “Is the patient in charge or is something else in charge?”  If the patient responds, “nothing, it’s always as bad as it can be”, you don’t have an opening for change because the patient is closed off to the possibility of personal agency.  Similarly, if the patient responds, “my medicine is the only thing that helps”, the patient has identified something over which they don’t have complete control.  This response greatly limits the possibilities of developing an attitude of personal agency, but does not close it off entirely.  Better responses to the question include any degree of activity-relatedness.  That is, if the patient says, “whenever I stand more than 15 minutes or walk more than 10 minutes on a concrete floor, or climb two flights of stairs, my pain gets much worse”, the stage has been set for teaching symptom negotiation.

 Symptom negotiation is just like it sounds.  SMART helps the patient learn to negotiate with their symptoms, neither giving in to them nor ignoring them.  The analogy I like to provide my clients is that of the Olympic champions in long-distance running.  Whenever Joan Benoit Samuelson started a race, she monitored her body symptoms over the first few miles.  A tight calf muscle or a pulse that was above the expected range immediately led to a change in her race tactics.  Her stride was lengthened or she would take on more water or change the depth of her breathing; anything to bring her body back to dependable symptoms.  Because she was the first female Olympic Marathon champion, she knew that she could not run her race optimally without dependable symptoms and she knew ahead of time that winning the race would require that she negotiate with her symptoms.

 The real champions do not ignore or avoid symptoms, they negotiate with them.  They push themselves hard to enough so that they become symptomatic; if not they’d never win a race.  But they don’t let the symptoms win; they do everything they can to adjust the symptoms, to negotiate with them.

 In SMART, symptom negotiation is easy to introduce, but can be somewhat difficult to integrate into everyday activities.  If the patient is involved in a therapy program that is dependably consistent day today, symptom negotiation can be much more easily learned.  There are two great examples of this.  The first is the work of Selvester and Rice and Ice and the early pioneers of cardiac rehabilitation.  The second is the work of Mooney and MacKenzie and Mayer and Gatchel and the early pioneers of spinal pain rehabilitation. 

 In the cardiac arena, helping a patient learn to use (and trust) angina pain as a “safety signal” is a very effective strategy to avoid “cardiac cripples”, patients who become so afraid of their anginal pain that they retire to the couch and gradually become irretrievably disabled.  Working with Dr. Ron Selvester and Dr. Harry Rice and physical therapist Randy Ice at Rancho Los Amigos Hospital, part of the University of Southern California, we taught patients that level 1 angina pain meant that their pain was just noticeable and nothing needed to be done.  At level 2, the patient was required to change the way they were working or walking or breathing.  Level 3 angina required the patient to do all this and to also use sub-lingual nitroglycerin.  At level 4, the patient was required to immediately ask for emergency help.  The psychological impact of this helped the patient to develop an attitude of personal agency; to control their symptoms, rather than to have their symptoms control them.  Imagine!  We were teaching people to pay attention to the symptom that told them their heart wasn’t getting enough blood!  What had previously been frightening became a useful symptom that made pain much more manageable.  Instead of being afraid of angina, the patient looked for it and accepted it at a particular level of activity and then adjusted their response according to the symptoms.  They learned to negotiate with their symptoms!  That’s SMART.

In the spinal pain arena, helping the patient to learn that most pain of this type has a dependable source and a relationship to posture and activity facilitated the development of effective alternatives to surgery for the control of disabling spinal pain.  Working with Dr. Vert Mooney at Rancho-USC, we developed pain diagrams and rating scales and invented the work hardening program, all of which were found to be very useful in educating patients about symptom negotiation.  Dr. Mooney brought physiotherapist Robin MacKenzie from New Zealand to educate Rancho staff and, eventually all spinal pain professionals in North America on the benefits of diagnosing and treating spinal pain from a mechanical perspective.  He would put a patient into postures carefully so that the pain was elicited, and then work with the patient to develop alternative postures and movement patterns. 

 The psychological impact of this perspective also is very positive, helping the patient to develop an attitude of personal agency based on posture and their participation in conditioning activities.  Dr. Mooney took these strategies to the University of Texas where he mentored Tom Mayer and Robert Gatchel, who developed the PRIDE program, where they invented work conditioning and the concept of the industrial athlete and continue to be the world’s foremost experts with chronic disabling spinal pain, demonstrating scientifically – validated success as an alternative to spinal surgery.

 What is the common thread among these approaches?  The patient must accept ongoing responsibility for pain.  In order to manage pain, the patient must develop an attitude of personal agency.  You can wish away pain or hope that you can be pain-free some day if you get the right medicine or surgery, but if you really do have chronic disabling pain, that is all in your past and you need to move on and get back to living by being intentional about the messages you give yourself.  How you thinks affects how you feel.  SMART focuses on helping you become more aware of these messages and how to tweak them so that you negotiate with your symptoms and can finish the race like a champion.

 Here is the caveat: When the pain patient has cognitive or emotional limitations due to a brain injury or serious psychiatric disorder, SMART is much more difficult.  Patients who have a combination of chronic pain and either brain injury or stroke are extremely difficult to work with due to their inability to develop an attitude of personal agency.  Similarly, patients who are severely depressed, who have problems with maintaining contact with reality, or who are intellectually impaired and have a difficult time with learning are less likely to be successful in developing personal pain control strategies.  Although some of these patients can be helped, the rehabilitation process is quite prolonged and the outcome is much less likely to be successful.

 On the other hand, patients who easily develop an attitude of personal responsibility are often quite easy to work with.  Many athletes, actors, dancers, police officers and firefighters, politicians, military service officers and armed forces personnel are quite successful in developing strategies for handling chronic pain.  In each of these occupational areas, these people experience pain, discomfort, and illness that they must push through no matter what is expected.  Each person entering the field is mentored in that regard.  For athletes and dancers, the mentoring often begins in childhood so that, if the person abandons a career in athletics or dance in adolescence or adulthood, the early experience puts them in an advantageous position with regard to chronic pain that is similar to adults who come from these careers.  It is always helpful to ask about a patient’s occupational background as we begin to address chronic pain.

 Specific SMART strategies for dealing with chronic pain will be presented in future blogs, given sufficient interest from readers.  In the meantime, look at Personal Prayer Relaxation and the Happy Hippocampus; both are helpful for what may ail you.