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Review: Total Recovery by Gary Kaplan

total recovery

Chronic pain is common in our society, and so are depression, anxiety, and many autoimmune conditions.  Despite all the advances of medicine, there seem to be more and more people that modern medicine is not able to cure or even make comfortable.  It almost seems as though the current medical paradigm is faulty and a new one is needed.

Perhaps that is the case, and perhaps this book is on the cusp of a breakthrough that will dramatically alter medicine—and many people’s lives.

Dr. Gary Kaplan, a pain specialist with training in many other medical specialities, sees patients with intractable pain who cannot find help anywhere else.  For years he has been trying to understand what causes chronic pain, and here are some of the things he has learned:

  • Disease is a process, and health and illness form part of a continuum.
  • Pain, depression, and many other disease states are closely related.
  • Chronic use of pain medication (from Advil and codeine to Valium and pregabalin, and all related medication) is counterproductive in the long run, because it interferes with the body’s natural pain control mechanism.  “Although it blunts pain initially, it makes the pain receptors more vulnerable to pain in the long run, so the solution is short sighted.” (p43)
  • Pain is neurodegenerative.
  • Pain, depression, and many disease states are caused by inflammation, and the inflammation is, in turn, caused by both physical and emotional assaults on the person.  Both physical and emotional pain can, in a sense, be stored in the body and make it more susceptible to future problems.

Of course, this is a pretty theory, but to justify it one needs to find a biological mechanism…and it seems Kaplan may have identified one when he studied the function of microglia.  These cells have only recently become a major focus of study.  Their role includes cleaning up cellular debris, identifying and disabling infectious agents and toxins, promoting regrowth of neural tissue after damage, and more.

Microglia are an essential component of the immune system of the brain and central nervous system, and when there is an invader the microglia cause inflammation to combat it.  In other words, whenever the central nervous system is stressed, the microglia react, causing inflammation.  (p96)  According to Kaplan, the medical literature shows that every injury, toxin, infection, physical trauma, and emotional blow triggers the microglia (as do neurodegenerative diseases), and the effects are cumulative.  Yes, even emotional trauma has a measureable effect, and if it is not dealt with properly, its memory can keep retriggering the microglia. (p 96ff)  Thus any lingering issues of poor sleep, infection, physical trauma, or psychological trauma can put ones health at risk. (p186)

There is even more:  depending on an individual’s resilience, there is a point at which, if the microglia are turned on too often, they become hyperreactive, keeping the brain in a chronic state of inflammation, and this state can last for years.

Thus Kaplan concludes, “…chronic pain and depression are neuroinflammatory diseases…[ and]… microglia are the mechanism behind this inflammation.” (p105)

Furthermore, neurodegeneration can result from sustained low-grade inflammatory states.  It makes sense, therefore, for all, especially those with pain, depression, anxiety, and autoimmune disease, to reduce inflammation as much as possible. 

So, how can we reduce inflammation caused by overreacting microglia?  Kaplan’s health-giving list is similar to the ones we encounter everywhere:

  • Eat a low-inflammatory diet (fruits, vegetables, rice, chicken, fish), identify food sensitivities, and use supplements if necessary.  Especially magnesium, vitamin D, and omega 3 fatty acids exhibit great anti-inflammatory effects on microglia.
  • Be active, with at least 30 minutes of aerobic exercise every day.
  • Sleep well, and get tested for sleep problems if you regularly awaken unrefreshed.
  • Be at peace in your mind.  Kaplan suggests meditation and he often recommends psychological therapy even for people with physical pain.  (Christians would include an emphasis on prayer and forgiveness.)

Here I need to clarify an important point.  In this summary I have focused on simple explanations and on self-care measures.  A whole lot more is involved and you do need to understand that Dr. Kaplan’s pain clinic includes highly educated specialists in a variety of fields and that people in serious pain usually see a whole team of them, working together.  If you are dealing with chronic pain or depression, you need more than the self-help suggestions here, although they will most likely make your situation more bearable.  It is my hope that the simple explanations given here will enable you to make connections that you would otherwise not have made and will encourage you to read Total Recovery for yourself. 

What did I get from this book?  First of all, it has given me some tools that, over the last while, seem to have helped a family member who suffers pain regularly.  For myself, although I am not well, I can function quite well and do not have either chronic pain or depression; that could be because my holistic MD has long encouraged all the things that Kaplan mentions.  Also, over the years I’ve discovered that I need an enormous amount of omega 3 fatty acids and a high dose of magnesium to function, just as Kaplan suggests.

Another thing I learned is that the connection between emotional turmoil and physical disease is at least as strong as suggested by Dr. Gabor Mate. In The Body Says No Mate discusses the different personalities and emotional backgrounds associated with different autoimmune diseases.  Both Mate and Kaplan thus suggests that emotional pain has profound and measurable physical effects on the body.  We humans can be very fragile, and there is a limit to what a person can withstand without succumbing to disease.

Finally, I wonder—and this is speculation—if the neurodegenerative diseases  (e.g. Alzheimer’s,  Parkinson’s, MS, AIDS-related dementia), which are so poorly understood, may not also themselves be a result of various traumas as Mate seems to suggest.  In that case, they would not only trigger the microglia, as Kaplan says they do, but would also in turn be caused by upregulated microglia in a deadly vicious cycle.  These are questions that should be asked by researchers, and I pray funding will be available for such projects.

Of course other causes and mechanisms (including the microbial gut imbalance theory, which has been popularized in Brain Maker by Perlmutter) have been advanced to explain these and other poorly understood diseases, and research is ongoing.  In all likelihood such diseases will turn out to be related to a variety of interconnected issues of which current theories are each only a small part.  However, what’s encouraging about the newer discoveries and theories, like Kaplan’s, is that they often point to non-pharmaceutical interventions and simple lifestyle changes that may help some people.

Leaving all such speculation aside, in Total Recovery Kaplan has given us ways to reduce the burden on our microglia and on those of our families, as well as a deeper reason for much of the health advice that is so often given.

For those who wish to learn more, I highly recommend Kaplan’s book Total Recovery: How We Get Sick, Why We Stay Sick, and How We Can Recover.  It is a rewarding book to read, full of case histories and of Kaplan’s search to help those with intractable pain.  Occasionally it gets a bit technical, but I do not think that would be a problem for most readers.  The bonus is that some of the knowledge can be applied immediately.

Disclaimer:  I am not a medical doctor and am not qualified to make medical judgements.  However, I am a scientist with some experience in health research, and as such I find these ideas worth a closer look.

This is yet another book in the in the 52 Books in 52 Weeks Challenge and is also linked to Saturday Reviews, Booknificent Thursdays, Literacy Musings Monday, What to Read Wednesdays and The Book Nook.  For more encouragement see Raising Homemakers, Titus 2 Tuesday, Tell it to Me Tuesday.

Disclosure: I borrowed this book from our library and am not compensated for my reviews.

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