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My Best Advice for the *Worst* Days
"for when the pain's above a 6"

Welcome to What’s Helping Today, a newsletter about the everyday work of staying alive on earth, written by author and journalist Sandy Ernest Allen.
Hi subscribers,
This post got long! It’s also more of a 201-level, say, in terms of Me and My Rants...
So if you’re newer to this newsletter and me/my work in general, I strongly advise you instead skip this one for now and perhaps start here for example, or here, or here. Or here or here. (Or here or here or here.)
I’ve wanted to write a post about something that’s on my own mind often but especially these days — in part because lately, despite myself, I’ve fallen into telling a few people a bit about all this, in one-on-one conversations (because I’ve observed them in such misery for example).
What follows is adapted mostly from therapist and author Nicole Sachs, who adapted it (like much of her work, which I’m often going on about) from her late physician and mentor Dr. John Sarno.
Put succinctly, my main point here, said the way Nicole Sachs usually says it, is like: When the pain’s above a 6, just work on self-soothing.
What’s meant by this? I’m gonna break it all down a bit, in case it’s of help to anyone. Some of this will probably at times repeat stuff I’ve discussed before…
First Some Caveats re: Numbers and Pain
I think it’s important to first talk about for example numbers and pain-scales, especially for those of us who are neuro-divergent and / or who may not conceptualize numbers well (myself certainly included). Some of us may not have a great sense of our own selves inside (what’s called “interoception”). Some of us have perhaps long trained ourselves — or have been trained — to ignore our own feelings, physical and emotional alike.
So, if I were to rephrase it perhaps, this newsletter’s main point is like: When your pain’s over a certain pretty-high threshold, just focus on calming yourself down.
When I say pain, as I’ll unpack more, I’m talking about any number of overwhelming (negative) emotional states like anxiety/panic/fear/rage/self-pity/worry/terrible mood/insomnia, so on. I’m also talking about emotionally-influenced other symptoms like (many instances of) chronic pain / other ailments…
Stress Is Key
I wanna underscore: I am not saying that all physical pain is emotional in nature; it’s clearly not. Years ago I was trying to describe JournalSpeak and Nicole Sachs’s work to a new friend who’d been mentioning about an intermittently but to them randomly painful “old injury” — the sort of thing I’d heard Nicole speak about on her podcast often before. Despite myself, I tried to describe all this and how it’s helped me.
My friend responded skeptically, like: You mean to say if I had a bullet in me, I could just meditate it away?
To be clear: No, I do not mean that. Nor does Nicole Sachs, nor did Dr. John Sarno. To explain, because this is a potentially confusing albeit crucial point: The target of JournalSpeak and this oft-called “mind-body work” are chronic conditions that are fueled by stress (whether new and/or old). So not all but some pain and immune conditions or allergies or anxiety or depression etc. can be helped by doing this sort of work…
My point isn’t that you shouldn’t go to a doctor. If you’re in pain: Please do go to a doctor. If you’ve got a bullet in you obviously rush to a hospital. But if you have (chronic) pain or any of the aforementioned, go to a doctor; rule out physical causes (as Nicole Sachs is often saying and I always like to repeat as well when writing about all this.)
This mind-body work is for those patients, like yours truly, who’ve been diagnosed with (myriad) conditions that are, ultimately, pronounced even by physicians as being mysterious and probably “just stress related.”
Answer Chasing
I’ve mentioned all this before but this used to be my life: I’d have some awful pain, like back spasms so bad they’d have me flat on the floor crying and screaming, for example. I’d go to specialists. I’d chase answers.
The awful back pain started back in perhaps 7th grade, as did the chiropractors. I went to more chiro in my twenties in Brooklyn, and various doctors back then, in my twenties, too — for a while a sports medicine-seeming-one because I guessed that’d be good, who referred me to a PT. That guy mostly seemed to touch my body a lot and look at me while I did all these exercises with big rubber bands. I dutifully replicated the exercises at home and they did … nothing for my back pain, which was near-constant then and sometimes debilitating.
At some point in the city, I was told to strengthen my back so I did CrossFit, strength training, Olympic-style weight lifting — squats, jerks, cleans. Some months later, I stopped all this weight-lifting stuff, more concerned than ever about my “bad back”, as others would often express to me too (which was still never better). My back was always not better enough it couldn’t always, seemingly out of nowhere, incapacitate me with a spasm, maybe one that lasted days.
I went to so many massage therapists and acupuncturists throughout my life I can barely remember them all now. My options according to doctors ultimately seemed like take opioids forever (which I didn’t want to do) or … not do that.
They’d frown at me; they’d give me tests. They’d take scans. Always, they’d rule out anything “real” that could be causing my pain. Well, besides the ever-familiar question: Are you stressed?
Hilarious.
I still went to acupuncturists up until a few years ago, on and off. It was only in a community acupuncturist’s intake once back in the city that I had a practitioner look at my whole mess of scribbling and then say, “sorry about your grandfather,” responding, first and foremost, to the bit I’d disclosed about how my grandfather had died, like, that week. (In hindsight, I’ve wondered what helped me more than day, their needles, the 30 minutes of quiet on the table, or such recognition of what probably actually caused my back-pain that day.)
For me, as I’ve said, there was the digestive stuff too — all those specialists I went to, since way back. The endoscopy and colonoscopy in my twenties. The other gut doc back in college whom I’d have to mail specimens of my poop (sorta hilarious/sorta humiliating). It was all invasive, being real. And my eventual diagnosed as ‘I’m-just-stressed’ IBS remained frequently inconvenient and painful — my mornings spent circling back and forth to the toilet.
Then there were the UTIs — the ten+ years I got recurrent UTIs, sometimes super bad ones (which makes more sense now). I shudder, remembering the internal exams. Or remembering the stand-downs I’d get into with nurses in gynecologist’s offices sometimes, they insisting or demanding I pee into a cup, even if I promised I wasn’t pregnant and swore I can almost never pee in public — especially not in such medical settings (for reasons somewhat confusing back then to me and not at all so now, my stress was always worse in gynecologist’s offices).
There were the headaches, which I got as a kid up through high school at least — debilitating headaches sometimes. Many hours spent alone in dark rooms. There were the stomachaches, which began back then too, and looking back as a kid they were my worst ‘symptom imperative’ (as Sarno/Sachs would say) — stomach-aches always mysterious to me and ever threatening. I don’t recall any doctor ever taking my stomach complaints seriously. The stomach aches would tend to take me out most often around about 5 or 6 pm, which again now makes more sense. Like clockwork, I’d wind up in my bedroom alone in pain, or on some sofa somewhere, moaning, crying, while everyone else enjoyed the party or the restaurant, whatever.
There was the wrist pain in high school, diagnosed by my pediatrician as carpal tunnel and I wore a wrist support sometimes on and off sometimes (until I like, threw it out once I started this work). There was the tailbone pain I got as a very young kid. There were all the (always to dermatologists who’d be asked about them mysterious) rashes and skin allergies, the endless hours spent in various offices and scratching red skin, the diagnosed eczema on my hands and feet, the endless steroids, ointments, creams.
Then there is of course: my lifelong depression, my also basically lifelong what shrinks would call occasional/persistent suicidal ideation too. Then there’s my anxiety of course, and my other sometime worst symptom still, other than insomnia, are the panic attacks.
Starting in my late twenties especially, I got panic attacks so awful I’d get taken out. Usually I’d come to on the floor, paralyzed in some odd position, brain having been offline. I’d wind up frozen for minutes that felt like hours but could stretch into actual hours, occasionally, all the while me managing to only gasp for air and / or let out bursts of sobs.
In the fall of 2020, I felt the few-seconds-of-warning-I-get-before-a-panic-attack while I was driving 55 mph, a passenger by my side. I managed to pull over just in time.
Scary as all hell to remember, that few seconds, even as I type it now.
The whole incident frightened me so bad I didn’t drive for a few years after — as folks like me who’ve been diagnosed before with CPTSD and high anxiety sometimes decide is wisest for all involved. And for a while I passionately told others this was me.
Then I started re-trying driving kinda on a lark just a year ago, mostly I think in hindsight because I wanted to drive myself to Camp Lost Boys, given I’m an adult, not a child. Also candidly probably so I’d have the freedom to drive away if I hated it a lot.
But yeah, back during the fall of 2020, I was driving in rural Western Massachusetts on a two-lane highway, going about 55 mph, when I felt that brief unmistakable warning inside. I pulled over just in time before that sudden all-consuming internal —
[NOTHINGNESS…]
Maybe those of you who’ve never had a panic attack don’t understand that this is what they’re like, from the inside. I find them near-physically painful, if not merely because of the horrible loss of control. But I can find them oddly peaceful as well, maybe like standing inside a tornado’s funnel might be horrible-but-peaceful.
This is because one has had one’s neocortex pulled offline, I know nowadays and as one of my wise mental health-type professionals is often repeating to me anyway. Mid-panic-attack, so to speak, whenever we are that disassociated, we aren’t in touch with the rest of what the brain knows, like, facts.
Facts including perhaps how to walk or drive or get out of this very “trance,” to repeat the term he sometimes does use with me. I’ve queried him if anything can break this sort of panic-attack trance and he’ll furrow his brow and offer: shaking, like a wet dog. (To reset the Vagus Nerve, the mental health journalist in me understood right away.)
Bu of course it’s tough to remember to shake like a dog if I can remember … no facts. Not even who I am or like, that I’m standing with one foot mid-air, mid-stride, whatever.
It’s also tough to have someone else explain shake like a dog for example to me-mid-panic-trance — I’ve found — if I am unavailable to receive any information. So if someone else for example tries to suggest some idea to me when I’m in such a state, even practical and good-intentioned ideas, I often can’t really process what’s said to me, but will only sense that I’m disappointing someone (however wrong this impression actually may be of their state of mind, this interpretation made by my sorta half-functioning brain).
When one suddenly arrives into that quasi-offline mental place, there can be great danger, back in reality, not peace — depending on the situation your actual body-containing-your-brain are in at present, like if you are operating a vehicle going 55 mph with someone else beside you.
For me, a lot of my life these days, is about not letting myself ever get to such a very overwhelmed place…
My "Piece of Paper”
Some years back, my aforementioned wise mental health-type professional, he recommended I write down “all my triggers” on a piece of paper.
At first I laughed really hard at this suggestion.
He wasn’t joking.
But, I complained to him, me writing down all my triggers, this was actually absurd. Someone like me — with my domestic abuse background, or like, living these days as a trans American — there is no way I could ever write down all my triggers.
He basically said, in his way, I should try to do it anyway. We often have exchanges like this. So, later on, I tried to do what he’d said. I sat down with a legal pad and tried to write down everything that I knew was especially hot to the touch for me, say. Especially likely to activate my nervous system, to launch me into not rest/repair (and that more rational, considerate self) but instead that fight/flight/freeze/fawn self (and its … less-considered choices). Everything I wrote down on my piece of paper was something I hated thinking about, maybe because it would bring up some terrible memory, some shameful time, some violent scene.
The page quickly filled with words. Concepts big and small, some of which I circled to emphasize, and then wrote other related words around them. The page became entirely full, crowded, almost indecipherable in places. But it all made sense to me.
The next session, I told my wise mental health-type professional alright fine, I did your exercise, holding up my paper. Now what? He asked me to share one example.
I shared one, a lighthearted one seemingly, a musical artist. He basically said, pick an “easier” one like that and work on it. So listen to said artist. Cover him.
I’d already been doing this sort of thing for years, in truth. Regarding other musicians for example, or other pop cultural references that were on my piece of paper, I had over time let myself enjoy some of them despite whatever bad stuff they’d been associated with for me. In so doing, I had created new memories for myself related to such stimuli. In so doing I had desensitized them as triggers, whether somewhat or totally. Like I’d already reclaimed Joni, I told him and he was pleased.
His point isn’t that this is easy work. It is hard work and (for the likes of me at least) endless kinda given my graphite-to-white-space ratio on my piece of paper. (And no doubt I could have written down more.) His point was: Start somewhere you can and try, work on it. Go from there.
The other reason I’ve explained this to you all, why I’ve found this ‘piece of paper’ exercise helpful to me: It’s helped me to sometimes identify when something or another is “on my piece of paper.” Like if some situation really sets me off, maybe in hindsight I recognize, oh there it is: piece of paper.
It’s helped to have this framework because this alone sometimes, just recognizing the presence of a triggering something (dynamic, situation, concept, person, anything), this can even help take my own temperature down.
Okay, WTF is “Self-Soothing”
So, the thesis of this (again long) newsletter is — when the pain’s over a 6, focus on self-soothing. We’ve arrived at the ‘self-soothing’ portion… Self-soothing is what it sounds like, in brief. And it’s always relative to you, and to your situation.
So… Sometimes self-soothing might look like… logging off. Taking a break. Perhaps delegate, as possible; do less. Perhaps cancel something, or a lot of somethings. Really try to make anything/everything easier on yourself — especially if you are typically quite self-critical internally, and over-achiever, a non-stop do-er, and / or a people-pleaser. (I’m pretty much all of these.) Practice relentless self-compassion especially if whatever-and-all-it-is has that has you so stressed is (mostly) actually out of your control — like horrific world events that may or may not impact you personally.
Sometimes self-soothing might look like … taking time to calm down. Taking time away from something over-stimulating you in a bad way, or from somebody who’s upset you. Maybe it’s just a few minutes away. Maybe it’s hours or days. Maybe longer. If you can, let your own cloudy waters settle again before you make decisions; per Brené Brown, once more, when we’re activated, ‘don’t talk type text.’
So: Wait out your own (worst/first) impulses, especially if something’s really on ‘your piece of paper’ perhaps and therefore it’s gotten you good, despite yourself. Also take time away if you are just nearly already there, proverbial emotional reservoir-wise (to borrow Nicole Sachs’ metaphor) and one more drop, one more bit of bad news, one tiny inconvenience, risks you’re totally flooded, you’re underwater.
Sometimes ‘self-soothing’ might look like … getting help. This might mean reaching out to a trusted friend or loved one and just, asking to talk. Don’t approach someone who’ll likely just add stress, as hopefully goes without saying. In addition to having strong, mutual friendships, (always excellent!), we basically all need outsiders to advise us as well, I really do feel… So this might mean finding yourself a professional, like a therapist or other such mental health-type counselor and / or a peer-support group. Therapists or support groups may sound daunting, true.
It’s nonetheless important to remind yourself: You don’t actually have to do whatever or go through whatever it is alone. As I’m often recommending: Seek out mental health support that actually fits you. I have joined online peer support groups, myself, during one spell in particular (some years ago now) when I then didn’t have a therapist (yet again) but really needed whatever support I could find. But also at other times in my life, I’ve sought such peer-support rooms, whether IRL or digital.
Sometimes ‘self-soothing’ might look like … telling someone else you are feeling overwhelmed or are experiencing pain or whatever else you are living despite right now, especially that which others aren’t necessarily aware of, like pain, emotional or physical. So maybe you say to a loved one or partner or your kid or your neighbor or coworker you were short with, like: Hey I admit I’m having a hard time lately related to other stuff and I’m sorry I’m (grumpy or short-tempered or distant or too uptight [or whatever you’re doing that’s also challenging for those around you]). I’m struggling with everything I have going on. Something like that. This won’t always apply but: As I’ve heard observed lately and does seem right, you can’t say the wrong words to the right people.
Sometimes self-soothing might look like … getting grounded. Getting embodied. Focusing on your body — again this might sound unappealing perhaps, especially if like me you’ve a tendency to get lost in your head, in your thoughts, in your feelings, your anger, your sorrow, your disappointments, your fears, your worries, whatever. Many ways to ground oneself, like physical movement — walking, dancing, exercise, breathing, many other such practices. Key to self-care as ever is: Do stuff you actually like, at least that which you don’t totally hate.
My own aforementioned wise mh-type professional is in his 70s and from what I gather very devoted to aikido (amongst other practices, including long distance running). He has had me read a few books about aikido, not to try aikido myself but just to learn about the concepts — when it comes to the work of disarming attackers (as is a part of life and as is a part of my life for example as a trans journalist on social media). Anyway, for my own grounding, he often encourages my own daily meditation habit, which I began once we started our work, and my long-cultivated, daily-ish yoga practice, amongst everything else I do along these lines, like daily walks and all the gardening.
Sometimes self-soothing might look like … just chilling out. Napping. Crying. Taking a bath. Reaching out to a dear friend — again, someone who will comfort you, not worsen things. Perhaps it may help to view yourself as a 3-year-old or 5-year-old (or whatever young age) and do whatever that person might find most soothing. Perhaps it’s putting on some certain comfort watch, or listening to such music, or fixing yourself some particular (favorite/nostalgic) meal or snack.
Time
Last but not least, perhaps obvious but true: Sometimes the only thing that will help the pain, seemingly, is time.
And, I often try to at least remind myself, time usually helps whatever might have me so activated, so upset. And, on those days when nothing else helps, I’ve had my own best advisors usually say the likes of: This pain, which I get is quite severe, it will lessen, at least shift, given sufficient time. Even the most awful storms, they do eventually pass.
So if today is horrible, am I saying you’ll wake up tomorrow and everything will feel magically 100% better? Absolutely not.
But I am saying: If you’re ever having a really tough one, try to survive just that day, is my best suggestion. It’s one lots of wise people have echoed throughout my life and on my own least-survivable-feeling-days, one backed-up by my career spent reporting on topics like this, and one I’ve learned about lots of my own experiences, suffice to say…
So maybe it’s just that bad enough today that nothing helps except waiting it out. Numbing and distraction, however you can most safely and best do so. Sleep.
If/when my back pain is at a 9+ for example, you’ll find me on the couch with my heating pad, probably watching something that’ll make me laugh or space out. I’m often taking a strong indica edible and if my pain is sufficiently high, some Advil too.
But: being honest, given everything I do these days, especially the daily-ish JournalSpeak and near daily meditation, my own back-pain rarely gets there… ever, anymore.
But it can happen. As do panic attacks. As does insomnia. And other unwelcome but often quite familiar visitors…
When such things occur, per Sachs and Sarno, I try to not see this as a “failure.” I take it as a sign that the pain is just that formidable, the storm that severe. So, again, my new plan becomes: Self-soothe.
To Recap
The overall point here is, again:
When your (stress-related) pain is over a certain high-ish threshold, try to just focus on calming yourself down.
Because when we’re really activated, that isn’t a good time to make decisions — especially not big decisions.
When we’re really activated, that isn’t a good time to have conversations — especially not big conversations.
When we’re really activated, the best thing we can do is try to get less activated — before we make any other decisions.
Sending you love and strength especially if today is a tough one for you,
Sandy
p.s. What’s Helping Today: Trying to follow my own best advice and logging off.
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