The event I spoke at was a regularly scheduled Qualitätszirkel, a sort of grand rounds where someone presents a patient’s story and the group of physicians and therapists who attend discuss and sometimes argue about how best to care for the patient. So here I was, presenting my own case in front of about 12 German-speaking clinicians from all backgrounds, with clinical experience ranging from 6 months to 40 years. One of the biggest takeaways from the event, which I had been mulling over a lot since I healed, was that unless a person has the decades-long history of exposure to the brain-body mindset that I had, convincing that person they have psychosomatic or neuroplastic pain is not so easy. This has been born out time and again in research (Gonzales at al., 2022, is a recent example) and in my own experience talking to people with nonspecific pain or other persistent physical symptoms. Many people just fully reject a brain-body explanation out of hand. I had personally rejected a brain-to-body origin for many, many unexplained symptoms in my past—all of which were 100% triggered by social-emotional upheaval and pain, I can see so clearly now. So I know what that confusion and defensiveness feels like on the part of the patient. I touch on this a little bit in my interview with Dr. Clarke. But I also know from experience that the way I align with and stay with a person who is afraid to accept the brain-body message matters. It’s the same theory behind motivational interviewing: Stay with and validate the person in front of you, never rejecting them as a person, showing them you care and are working with them to find the solution, while also being confident in your own knowledge without pressing the point or denying how the other person feels. Many of the clinicians asked me what I would do with a patient who just wanted all the expensive tests and referrals to this and that specialist, even though the doctor knew that would be a waste of time and money. I said some version of this: Listen. Ask them what their biggest fear is. Confirm that you can imagine how scary it (whatever “it” is) must be. Then, if you already have a trusting relationship with your patient, be “the one who knows” for a minute. Just for a minute, explain that even though you agree the pain is entirely real and physical, it can’t be caused by a structural problem. That you suspect something in the social environment is triggering the brain to instigate a symptom as protection against some social threat. But because you know how unusual this sounds and you absolutely want them to feel safe--because feeling safe is the only way it will be possible to heal--you’re going to order the test, the referral, etc., without judging them, shaming them, or being exasperated with them. And you also want them to make another appointment with you to follow-up. You want to be the safe one that they know they can turn to. Saying something like, “I know this sounds impossible. You’ve told me that you’re scared. I hope you can lean on me and my confidence that your tests will come back normal. And no matter what the results are, we will find a way forward together.” One of the docs present said, “That’s too exhausting, being there for so many people. GPs won’t be able to do it.” My thinking is, “Yes, this is a job for a psychotherapist who is highly trained and has resources for their own support. But until it’s normalized and non-shame-inducing for patients to be referred immediately to psychotherapy for sudden-onset or widespread pain that is clearly not structural, GPs and internal medicine docs are the ones who need to be the safe haven for patients. Don’t make them hate and avoid you as well because they feel dismissed and invalidated by you, too!” (See Okuhara et al., 2026, for some recent, devastating examples of such dismissal and its effects on people in pain.) The medical system is broken. (My entire PhD thesis, especially Chapters 1 and 6, makes this abundantly clear.) I don’t ever expect the system to change. There’s way too much money in keeping people sick and engaged in the system of “coping with symptoms” instead of healing. I was happy to hear, though, that in Germany, the clinicians who were present seemed satisfied with the structure they had to work within—but that system only worked when a patient would accept the psychosomatic diagnosis. If they did that, they would get the care they needed. Many of the therapists present had had patients fully heal. This was great and unexpected news. But then, they were trained in emotion-focused therapies like EMDR and psychodynamic therapy, where a cornerstone of therapy is healing relationships (not changing behavior, like with CBT). All of these ideas and struggles and conflicts arose in this 1.5-hour discussion. I’m far more comfortable working in my native language, but overall, it was a good experience. If anything, it set me up well for my next conference presentations, "There is no biomedical cause for this person’s chronic pain: What do I say? What do I do?" and "Addressing distress: Supporting clinicians to safely navigate emotions in chronic pain care," a workshop co-presented with my colleague Dr. Miriam Dillon. More on those soon. References:
Gonzalez, A. I., Ramtin, S., Ring, D., Donthula, D., & Queralt, M. (2022). People Have Mixed Reactions to Both Physiological and Psychological Explanations of Disproportionate Pain. Clinical Orthopaedics and Related Research, 480, 1387_1398. https://doi.org/10.1097/CORR.0000000000002163 Okuhara, T., Okada, H., Yokota, R., & Kagawa, Y. (2026). Listening to the silence of pain narratives: A qualitative study of epistemic injustice in patient–clinician communication on medically unexplained chronic pain in Japan. Patient Education and Counseling, 142, 109402. https://doi.org/10.1016/j.pec.2025.109402
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