William Shatner & Habituation

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One disconnect I see on this forum is that people like me... And apparently Dr. Nagler... have seen our own thinking about our own tinnitus go through absolutely radical changes over time. And thus we tend to assume this can be true for anyone. On the other hand we have people who's thinking about their tinnitus has stayed relatively stable over time, who thus tend to believe that it will remain so forever. And, I do not know, they may be right... Far be it from me to claim to know someone else's psychology better than they do!

The petulant, cynical 18 year old in me says "lol people stuck in a rut should go sit with the Navajo, imbibe some peyote and then come tell me how rigid and inflexible their ontology is", but at this point in my life I'm not convinced that ever helps, I think that those drugs can cause transformative changes in people who want them, but can make other people just get more stuck wherever they are.

I personally believe that pitch and volume matter a lot... But that they may matter less than various psychological factors. That doesn't mean you can think your way out, though... The ability and willingness to completely let go of one's conception of self may not be something that anyone can learn, any more then it would be possible for me to learn to be a better pianist than Beethoven.

 

[Dr. Nagler]

The ability and willingness to completely let go of one's conception of self may not be something that anyone can learn,

Actually, my friend, I very much agree with you.

The point I was trying to make in my Post #210 is not that you need to be willing and able to completely let go of your conception of self in order to overcome your tinnitus. But what is necessary is for you to be willing and able to admit that there is the most remote possibility that you might perhaps be wrong about one single aspect of that conception.

Since that post is at the very bottom of the previous page, I am going to take the liberty of copying it below. I personally think it may be one of the most important things I have ever written on this board. In fact, it may be the only important thing I have ever written on this board.

Best to all ...

...................


Post #210:

Back when I developed severe intrusive tinnitus in the mid 1990s, relatively little had been written about TRT. There were a few articles in the literature, but that was about it. There was no Internet to speak of, at least as far as tinnitus boards or discussions about TRT were concerned. And thus, when I went up to Baltimore to see Dr. Jastreboff in abject misery and total frustration (having already tried a bunch of other approaches to no avail), I had no preconceived notions regarding what TRT was about. All I knew was that there was a fellow in Baltimore with a relatively new approach to treating tinnitus patients ... and I was desperate.

So my wife and I spent several hours in Dr. Jastreboff's clinic (like we had spent in a number of other clinics), and we listened to what he had to say after he evaluated me. And what he said made absolutely no sense to me at all. What he said was that habituation (a new term to me) was all about reaction - and using his TRT approach, the loudness and pitch of my tinnitus were irrelevant. My thinking was that this guy seems very nice and very sincere, but he really doesn't have a clue about what I am going through ... because my tinnitus is not just loud, it is thunderously loud. My tinnitus is not just high-pitched, it is a screaming teakettle. But I figured I was up there in Baltimore already - so what the hell. I went through my first TRT counseling session, got my wearable broadband sound generators, paid my bill, and returned to Atlanta. My wife was at my side during the entire visit, TRT counseling and all, save for when I was in the audiology booth.

Well a day or so after I got home, I told my wife that while Dr. Jastreboff seemed to know a good bit about tinnitus, he could not possibly know a thing about my tinnitus - because first of all he could not hear my tinnitus ... and second of all there was absolutely no way that he was right about loudness and pitch being irrelevant - TRT or no TRT.

So my wife asked me if I was 100% convinced that loudness mattered. And I said that yes, I was 100% convinced that loudness mattered. Moreover I told her that because my tinnitus was so incredibly loud, there was absolutely no possible way that TRT could work for me and that once again we were wasting our time and money. I apologized to her for how I was ruining our lives and burning up our savings, I said that TRT could not possibly work for me, and I collapsed sobbing in her arms. I was done with TRT. It was a pipe dream, and there was no way that it could work for me - not as loud and high-pitched as my tinnitus was.

All true.

After I settled down just a little bit, my wife asked me a question that pretty much saved my life. She asked me if there was even the most remote possibility that I was wrong about what I had just said. Or was it really and truly a 100% certainty. I responded that I could not see how Jastreboff could conceivably be right about the loudness thing - especially given how loud my own tinnitus was - but, yes, from a logical standpoint I guess there was just the tiniest possibility that I might be wrong about that.

She looked me in the eyes and said, "Then I think we should continue with it."

You know the rest of the story.

 

[tinnitussufferer]

could it not be true that a cure to any medical problem is not beneficial to the drug companies who profit from illnesses so there are reasons to prevent a cure from being found?

I would ask anybody who has been ''cured'' with TRT, how can you say on the one hand that you have found relief, and on the other, say that you would not hesitate to accept a genuine cure if it existed?

 

[Dr. Nagler]

I would ask anybody who has been ''cured'' with TRT, how can you say on the one hand that you have found relief, and on the other, say that you would not hesitate to accept a genuine cure if it existed?

To All -

Consider a very loud external sound. Just as an analogy.

There are people who because of financial reasons or whatever find it necessary to live near the Heathrow Airport flight paths with a combined 1300 take-offs and landings a day. Visitors to their homes wonder to themselves: "How can these folks stand that incessant racket?" And maybe three or four times a day those who live there wonder the same thing to themselves. But other than those three or four times a day, they are pretty-much oblivious to the sound of the planes overhead ... while their visitors hear it constantly.

Given a choice would those who live near the airport prefer to live farther away? Of course they would. But since they have largely habituated the sound of the planes, they are aware of it only a few times a day - while the same can hardly be said of those who visit them.

So, too, it is with TRT. First of all, TRT is not a cure. And nobody is suggesting that it is a cure. So TS's use of the phrase "'cured' with TRT" in the above post is misleading and not at all helpful. But what TRT can do, is decrease the percentage of time you are consciously aware of your 24/7 tinnitus (the 1600 flights a day) until such a time that a genuine cure is found. And just like those living near the airport would prefer to live elsewhere, those who have succeeded in TRT would prefer to not ever be aware of their tinnitus.

Which is why given the opportunity to be truly cured of their tinnitus with little or no risk of side effect, every single person who has succeeded in TRT would do so. I know I would!

 

[tinnitussufferer]

My point is, the only way to test whether option A is preferable to option B and to what extent, is to compare them in a blind test. Option A is tinnitus and TRT. Option B is no tinnitus. That is not possible to do for obvious reasons. Consequently it is not possible to judge just how effective option A is. Its only when you remove that horrible screeching noise from your head, that you can appreciate what silence is again. Its only then that you can think clearly enough, to appreciate the joy that silence can bring. We simply dont know what effect permanent noise exposure does to humans as there have been no such studies. Could it for example lead to increased stress levels?
Habituation is just another word for FORGETTING the sound of silence. The constant tone just makes your mind numb and unable to remember what silence is.

 

[Dr. Nagler]

My point is, the only way to test whether option A is preferable to option B and to what extent, is to compare them in a blind test. Option A is tinnitus and TRT. Option B is no tinnitus.

There is no reason to compare them in a blind test at all! Option B wins every time. Only a fool would choose Option A. The problem - at least in 2015 - is that Option B is not an option at all. So in 2015 our options are (1) tinnitus and TRT and (2) tinnitus and no TRT. I chose the first option. You chose the second. And I'm totally fine with that.

 

[tinnitussufferer]

Dr Nagler what do you say to those that dont find TRT good enough? Do you accept that there are some of us who cant find relief and that its not their fault?

 

[Martin69]

@Dr. Nagler
Your explanations above are really important for us and helpful (at least for me).
They show how much you suffered and how one can get out of this misery.
Post #210 describes exactly what many here go or went through. And also #216 shows a lot understanding - of course you went through the same.

I still don't know if I can ever get unaware of my T for longer time like hours, but I hope so.
In fact, there are moments and minutes where I am unaware of it.
It is a huge mountain to climb, the highest ever in my life.

We are not always the same opinion, but thanks for taking your time being on this forum.

 

[Dr. Nagler]

Dr Nagler what do you say to those that dont find TRT good enough? Do you accept that there are some of us who cant find relief and that its not their fault?

Absolutely.

See here's the thing, my friend. Because of the lack of standardization and credentialing in TRT, something to which I have referred on numerous occasions, I can only tell you how I personally do things. Which I guess is what you are asking in your question. But it requires a bit of an explanation.

When a person contacts my clinic for an appointment, that person receives a phone call back from me. Nobody gets an appointment without talking with me first over the phone. And that conversation, which obviously is free of charge, generally lasts in the neighborhood of 30 to 45 minutes. The range of topics that are discussed can vary, but four things are always included:

(1) I explain my "1 to 10 scale" and ask the person where he or she falls on that scale. (And only after getting the answer do I explain that I only see 9s and 10s - and an occasional 8.)

(2) I explain exactly what habituation is and what TRT can and cannot accomplish in that regard. Here is where I make it perfectly clear that in my own clinic (i.e., among the 9s and 10s that I personally treat) approximately 10 to 15% will not do well through no fault of their own. And I also offer them a guarantee: I guarantee to do everything I know how to do ("use every trick in the book," as they say) to minimize the possibility they they will ultimately find themselves among that 10 to 15%.

(3) I discuss the Cochrane Collaboration findings and the abysmal (in my opinion) overall quality of the published TRT studies to date. Included in that discussion is a frank explanation of why I feel comfortable offering TRT in spite of the lack of quality studies attesting to its efficacy.

(4) I discuss cost and try to assess whether or not the individual is so financially disadvantaged that he or she cannot TRT.

In other words, I do not offer TRT to anybody without a thorough explanation. I realize that every clinic does this sort of thing differently. But I tell you how I personally do it in the hopes that when any of you seek care anywhere - TRT or otherwise - you will try your best to ascertain these sorts of things ahead of time.

Lastly, I explain to my prospective patients that TRT is a "want to" and not a "have to." It is only after all that has been accomplished that I discuss with them appointment availability, hotels in the area, airport transportation, etc.

 

[Dr. Nagler]

We are not always the same opinion,

And just think how boring it would be if we were! The thing of it is, Martin, when you and I have disagreed, we have always done so with civility and mutual respect.

but thanks for taking your time being on this forum.

You are most welcome.