For more information about Dave and his work, check out: 

EndChronicPain.org (PPD website)  

They Can't Find Anything Wrong! (Amazon link to Dave's first book)

Psychophysiologic Disorders (Amazon link to jargon-free textbook)

Get in touch with Dave here: drdave@stressless.com

Transcript of the conversation, July 22, 2024

Nancy RJ: Dave Clarke--great to have you here! I'm delighted that you wanted to talk about your really interesting work with us here today as part of our story series. You’ve had a fascinating medical career as a gastroenterologist and internal medicine doc who has specialized in psychophysiological disorders—I have to say that several times just to make sure I get it right—otherwise known as stress illnesses. Can you describe stress illnesses and how you became interested in identifying and treating them? 

Dave: You bet. It absolutely was not part of the plan. It came as a surprise that I got into this at all. I didn't know anything about it the first seven years of my formal training but then I encountered a patient that nobody could diagnose or treat successfully except a psychiatrist at UCLA where I was in training. He cured this mystery patient with less than three months of counseling. That was what kind of opened the door. Most people assume that if you've got pain or illness that it's got to be due to disease or injury, but it turns out—and there are numerous randomized controlled trials now that back this up and hundreds of other research papers as well—that your brain can generate pain or illness in your body. Real, not imaginary, physical symptoms that can be incredibly debilitating. 

I've had many patients in the hospital with symptoms for decades. It can be almost anything: migraines, fibromyalgia, irritable bowel, brain fog, many cases of long COVID, many cases of chronic fatigue, back pain is a big one, pain pretty much anywhere. Again, very real symptoms, but the good news is that if you can uncover the psychosocial stresses that are responsible—and they're not always obvious, either—then [that’s the key]. That’s part of the skill of diagnosing these patients: to find what the stress is. Many times it's all the way back when the person was a child and they suffered some adversity [that’s played out] over the course of their lives. If you uncover the stress, you can treat it successfully and alleviate people's symptoms even more successfully than we can [alleviate symptoms for] the rest of our patients. 

Nancy: Wow. Actually, that was my next question: how do you successfully treat [psychophysiologic disorders]? We'll just call it PPD right now. Can you give an example of a patient who overcame debilitating symptoms under your care? 

Dave: I love to tell the story of a patient that's actually the first one that I shared in my first book. The book is called “They can't find anything wrong!” The title is taken from this patient because that's what she told me when I first went to see her. In fact, she recommended that I not waste my time with her, that I'd be better off seeing my other patients. She had good reason for saying this because she had been hospitalized 60 times over the previous 15 years at a prestigious University Medical Center where she saw a dozen specialists including a psychiatrist and they still had no idea what was wrong with her .By then I had learned—and this was back in the 80s, I was still fairly new at this—

Nancy: What symptoms did she have? 

Dave: Attacks of severe dizziness and vomiting that would just come out of the blue, somewhere between six and ten times a year. Half of them were bad enough to put her in the hospital because they would last for a couple of days. She went through every test you can imagine, but it turned out there were only two pieces of information that were needed to figure out what was going on. 

Number one was that she had been verbally and emotionally abused by her mother starting at age four, [abuse that] was still going on now that she was age 50. So she had enormous emotional tension in that relationship as you can imagine. 

The other clue was that she always got one of her attacks whenever she passed through a little town about 40 minutes from where she lived. The only time she went through this little town was when she was on her way to visit her abusive mother. If she was going the same distance for any other reason, she would never get an attack. So there was clearly a link there. 

Her husband, when he heard this, remembered that she would get her attacks after phone calls from her mother: the attacks that happened in and around her home community always followed a phone call from her mother. So when she saw how this was all connected, she was able to set strong boundaries around her mother's behavior and how much contact she had with her, and the illness basically just stopped at that point. It's a good example of looking for stress in the person's life right now, looking for adverse childhood experiences that they went through years ago that can play out in long-term impact for years or decades later. I also look for unrecognized depression, anxiety, or post post-traumatic stress that happens surprisingly often. You can have those conditions and not be fully aware of it.

Nancy: Yes. You’d quoted this line, this question, that I found so powerful: “What did you learn about yourself as a child that isn't true?” That has really stuck with me, because, boy, that gets you digging deep.

Dave: Yes, it's such an important question for my patients who went through adversity as children because many of them underestimate or repress how much they went through. I will often ask them, “Well, how would you feel if your own child or a child that you care about went through everything you did as a kid? Would that make you sad or angry?” That helps people recognize the reality of what they experienced. 

I'll also want to find out [per that question you posed], what did people absorb from that experience as fundamental assumptions about themselves that that aren't true? Did they learn that they're a second-rate human being, that it's their main job in life to solve other people's problems and devote themselves to the needs of others? That puts you on a very stressful treadmill that is hard to step off. When people see where they learned this from, how they absorb these false assumptions from their early environment, then they can begin to make changes and the stress level starts to come down.

Nancy: Wow. You're a founder and the director of the Psychophysiological Disorders Association, also known as the PDA. You describe its mission as Awareness, Education, Diagnosis, and Treatment. Can you tell me more about this association and what you've accomplished and are looking to accomplish?

Dave: Yes. I've had a tremendously rewarding experience there. It was started by me and a bunch of colleagues from a whole range of different healthcare professions in 2011 and I've been the president ever since. We have sponsored two major research studies, three documentary films, and two textbooks. We’ve put on multiple live and virtual conferences. We have our next conference coming up September of 2024 in Boulder, CO. We've got professional training courses that are video based on our website, [including] one for patients. We do monthly Q&A's via Zoom that are international, where people can join and ask questions of experts. 

We’re trying to get the message out about this. We've got a bibliography of over 200 research papers that support the work that we do. I get invited to give presentations all over North America and Europe. I'm speaking in London next year. Last October, I gave 13 hours of presentations in four different cities in just the one week so there's a lot of interest in this, especially with the opioid epidemic. We offer a viable alternative to throwing narcotics at people's pain.

Nancy: Didn't you mention that just recently you talked to a filmmaker who was so excited with her own recovery that she talked about wanting to do a documentary?

Dave: Yes, this is an actual real-live film director who does feature films. She got long COVID and was ill for well over a year until she found our materials and recovered as a result of using our approach. She’s so enthusiastic that she wants to do a documentary film for us at bargain rates. We couldn't turn that down! She's going to come to our conference and film all the experts who are coming there and a number of the patients who [attend] as well.

Nancy: Wow, that’s fantastic. Who does the conference target—who are the people that you most wish would attend? Are these lay people or mostly medical professionals?

Dave: Mostly medical professionals. We have a lot of mental health professionals that do this work. 

The problem with this whole condition is that it's a giant blind spot in the healthcare system. The medical clinicians don't learn the psychology of it and the mental health professionals don't learn about people who are physically ill, who have pain or non-pain physical symptoms. So there’s nobody who’s specifically trained in what to do for this population of patients, which is 20% of the adult population. It’s 40% of people that go to see a primary care doctor. It’s 50 million adults in the United States alone. We invite everybody to come to our conference: we’ll have medical clinicians, physical therapists, mental health professionals, and people from the general public who have been suffering from this condition and want to learn more. We emphasize a jargon-free conference so that everybody can understand the material that's being presented. 

Nancy: I've been interested in this whole concept of stress illnesses for decades. But I feel like you've got quite an uphill climb in that people [think of the term ‘psychosomatic], which can be denigrating and dismissive, the idea that it's all in your head. How are you choosing to work through that barrier of perception?

Dave: Yes, we’re actually thinking of changing our brand a little bit and calling them just stress-based conditions, because that's what they are. There's less of a stigma to having stress: Everybody's got stress these days. The idea that your brain can generate real symptoms in your body is, we hope, a small step from there. 

Once people recognize that, they'll start to think, “well OK, if I've got stress causing problems in my body, what's the stress?” We want to shift the attention from what's happening in your body when the diagnostic tests are not showing anything—which means your body's OK—to finding the stress. We’ve obviously got lots of good ideas for where people can look for this. We have a wonderful 12-item self-assessment quiz on our website that takes less than 3 minutes. It's set up so that the more questions to which you answer ‘yes,’ the more likely it is that your symptoms are brain generated. 

Nancy: We’re going to include links to your website when we post this. One last question: I'm curious about how you've applied what you've learned about stress illness in your own life?

Dave: Number one, I think, would be gratitude that I didn't go through any of these issues myself. I was so fortunate not to have suffered what so many of my patients have in their lives. When I would interview a patient like this during the course of my day, which was more days than not, I would go home and hug my wife and kids a little longer just because I didn't have to go through what they did. But it helped me change how I raised my own kids. Listening to story after story about the difficulties that people had gone through even from well-intentioned parents who wanted the best for their kids but who were creating inadvertently enormous amounts of pressure. My wife and I tried to create in our home an oasis of support for our own kids. Then, when they left the home, [we knew] they were going to face a lot of challenges, but we wanted them to know that we had their backs. 

Today both of them are just amazing to me—their wives and families, their professional success; and they competed nationally as athletes, both of them, and they're just amazing kids.

Nancy: Fantastic. This has been terrific; I really appreciate it. I hope people follow up and want to contact you because I'm certainly interested in learning more about what you're doing and getting a copy of your book. Thank you so much, Dave, and I do hope that you're going to be at Reunion because I'm sure people will want to talk to you then about all kinds of things!

Dave: I'm planning to be there Nancy, and thank you so much for your interest in this.