by Dr. Talia Marcheggiani, ND | Sep 23, 2021 | Alcohol, Alignment, Anxiety, Autoimmune, Balance, Chronic pain, Community, Depression, Detoxification, Diet, Digestion, Education, Elimination Diet, Emotional Wellness, Emotions, Food, Food Sensitivities, Gluten Free, Health, Inflammation, Medicine, Meditation, Mental Health, metabolic health, Microbiome, Mind Body Medicine, Mindfulness, mood, Nature, Nature Cure, Nutrition, Uncategorized
It’s day one of my period and I’ve been healing a broken foot for 6 weeks. The weather is overcast, thick, humid and rainy.
My body feels thick and heavy. Clothing leaves an imprint on my skin–socks leave deep indentations in my ankles. My face and foot is swollen. My tongue feels heavy. My mind feels dull, achey, and foggy. It’s hard to put coherent words together.
I feel cloudy and sleepy. Small frustrations magnify. It’s hard to maintain perspective.
My muscles ache. My joints throb slightly. They feel stiffer and creakier.
This feeling is transient. The first few days of the menstrual cycle are characterized by an increase in prostaglandins that stimulate menstrual flow and so many women experience an aggravation of inflammatory symptoms like depression, arthritis, or autoimmune conditions around this time. You might get. a cold sore outbreak, or a migraine headache around this time of month. The phenomenon can be exaggerated with heavy, humid weather, and chronic inflammation–such as the prolonged healing process of mending a broken bone.
Inflammation.
It’s our body’s beautiful healing response, bringing water, nutrients, and immune cells to an area of injury or attack. The area involved swells, heats up, becomes red, and might radiate pain. And then, within a matter of days, weeks, or months, the pathogen is neutralized, the wound heals and the inflammatory process turns off, like a switch.
However, inflammation can be low-grade and chronic. Many chronic health conditions such as diabetes, arthritis, PMS or PMDD, depression, anxiety, migraines, even bowel and digestive issues, have an inflammatory component.
In the quest to manage chronic inflammation, people often explore various avenues, including dietary supplements. One such natural option gaining attention is OrganicCBDNugs. Derived from the hemp plant, CBD, or cannabidiol, is believed to possess anti-inflammatory properties, potentially offering relief to those struggling with conditions like arthritis, anxiety, or migraines.
This organic supplement, with its purported ability to interact with the body’s endocannabinoid system, might provide a holistic approach to tackling inflammation-related issues. As we navigate the complexities of our bodies and the ebb and flow of inflammation, exploring natural remedies like Organic CBD could be a step toward finding equilibrium and promoting overall well-being.
As I telly my patients. Inflammation is “everything that makes you feel bad”. Therefore anti-inflammatory practices make you feel good.
Many of us don’t realize how good we can feel because low-grade inflammation is our norm.
We just know that things could be better: we could feel more energy, more lightness of being and body, more uplifted, optimistic mood, clearer thinking and cognitive functioning, better focus, less stiffness and less swelling.
Obesity and weight gain are likely inflammatory processes. Insulin resistance and metabolic syndrome are inflammatory in nature. It’s hard to distinguish between chronic swelling and water retention due to underlying low-grade chronic inflammation and actual fat gain, and the two can be closely intertwined.
It’s unfortunate then, that weight loss is often prescribed as a treatment plan for things like hormonal imbalances, or other conditions caused by metabolic imbalance. Not only has the individual probably already made several attempts to lose weight, the unwanted weight gain is most likely a symptom, rather than a cause, of their chronic health complaint. (Learn how to get to the root of this with my course You Weigh Less on the Moon).
Both the main complaint (the migraines, the PMS, the endometriosis, the depression, the arthritis, etc.) and the weight gain, are likely due to an inflammatory process occurring in the body.
To simply try to cut calories, or eat less, or exercise more (which can be helpful for inflammation or aggravate it, depending on the level of stress someone is under), can only exacerbate the process by creating more stress and inflammation and do nothing to relieve the root cause of the issues at hand.
Even anti-inflammatory over the counter medications like Advil, prescription ones like naproxen, or natural supplements like turmeric (curcumin) have limiting effects. They work wonderfully if the inflammation is self-limiting: a day or two of terrible period cramps, or a migraine headache. However, they do little to resolve chronic low-grade inflammation. If anything they only succeed at temporarily suppressing it only to have it come back with a vengeance.
The issue then, is to uncover the root of the inflammation, and if the specific root can’t be found (like the piece of glass in your foot causing foot pain), then applying a general anti-inflammatory lifestyle is key.
The first place to start is with the gut and nutrition.
Nutrition is at once a complex, confusing, contradictory science and a very simple endeavour. Nutrition was the simplest thing for hundreds of thousands of years: we simply ate what tasted good. We ate meat, fish and all the parts of animals. We ate ripe fruit and vegetables and other plant matter that could be broken down with minimal processing.
That’s it.
We didn’t eat red dye #3, and artificial sweeteners, and heavily modified grains sprayed with glyphosate, and heavily processed flours, and seed oils that require several steps of solvent extraction. We didn’t eat modified corn products, or high fructose corn syrup, or carbonated drinks that are artificially coloured and taste like chemicals.
We knew our food—we knew it intimately because it was grown, raised, or hunted by us or someone we knew—and we knew where it came from.
Now we have no clue. And this onslaught of random food stuffs can wreck havoc on our systems over time. Our bodies are resilient and you probably know someone who apparently thrives on a diet full of random edible food-like products, who’s never touched a vegetable and eats waffles for lunch.
However, our capacity to heal and live without optimal nutrition, regular meals that nourish us and heal us rather than impose another adversity to overcome, can diminish when we start adding in environmental chemicals and toxins, mental and emotional stress, a lack of sleep, and invasion of blue light at all hours of the day, bodies that are prevented from experiencing their full range of motion, and so on.
And so to reduce inflammation, we have to start living more naturally. We need to reduce the inflammation in our environments. We need to put ourselves against a natural backdrop–go for a soothing walk in nature at least once a week.
We need to eat natural foods. Eat meats, natural sustainably raised and regeneratively farmed animal products, fruits and vegetables. Cook your own grains and legumes (i.e.: process your food yourself). Avoid random ingredients (take a look at your oat and almond milk–what’s in the ingredients list? Can you pronounce all the ingredients in those foods? Can you guess what plant or animal each of those ingredients came from? Have you ever seen a carageenan tree?).
Moving to a more natural diet can be hard. Sometimes results are felt immediately. Sometimes our partners notice a change in us before we notice in ourselves (“Hon, every time you have gluten and sugar, don’t you notice you’re snappier the next day, or are more likely to have a meltdown?”).
It often takes making a plan–grocery shopping, making a list of foods you’re going to eat and maybe foods you’re not going to eat, coming up with some recipes, developing a few systems for rushed nights and take-out and snacks–and patience.
Often we don’t feel better right away–it takes inflammation a while to resolve and it takes the gut time to heal. I notice that a lot of my patients are addicted to certain chemicals or ingredients in processed foods and, particularly if they’re suffering from the pain of gut inflammation, it can tempting to go back to the chemicals before that helped numb the pain and delivered the dopamine hit of pleasure that comes from dealing with an addiction. It might help to remember your why. Stick it on the fridge beside your smoothie recipe.
We need to sleep, and experience darkness. If you can’t get your bedroom 100%-can’t see you hand in front of your face-dark, then use an eye mask when sleeping. Give your body enough time for sleep. Less than 7 hours isn’t enough.
We need to move in all sorts of ways. Dance. Walk. Swim. Move in 3D. Do yoga to experience the full range of motion of your joints. Practice a sport that requires your body and mind, that challenges your skills and coordination. Learn balance both in your body and in your mind.
We need to manage our emotional life. Feeling our emotions, paying attention to the body sensations that arise in our bodies—what does hunger feel like? What does the need for a bowel movement feel like? How does thirst arise in your body? Can you recognize those feelings? What about your emotions? What sensations does anger produce? Can you feel anxiety building? What do you do with these emotions once they arise? Are you afraid of them? Do you try to push them back down? Do you let them arise and “meet them at the door laughing” as Rumi says in his poem The Guest House?
Journalling, meditation, mindfulness, hypnosis, breath-work, art, therapy, etc. can all be helpful tools for understanding the emotional life and understanding the role chronic stress (and how it arises, builds, and falls in the body) and toxic thoughts play in perpetuating inflammation.
Detox. No, I don’t mean go on some weird cleanse or drinks teas that keep you on the toilet all day. What I mean is: remove the gunk and clutter from your physical, mental, spiritual, and emotional plumbing. This might look like taking a tech break. Or going off into the woods for a weekend. Eating animals and plants for a couple of months, cutting out alcohol, or coffee or processed foods for a time.
It might involve cleaning your house with vinegar and detergents that are mostly natural ingredients, dumping the fragrances from your cosmetics and cleaning products, storing food in steel and glass, rather than plastic. It might mean a beach clean-up. Or a purging of your closet–sometimes cleaning up the chaos in our living environments is the needed thing for reducing inflammation. It’s likely why Marie Kondo-ing and the Minimalist Movement gained so much popularity–our stuff can add extra gunk to our mental, emotional, and spiritual lives.
Detoxing isn’t just a trendy buzzword; it’s about fostering clarity and wellness in every aspect of our lives, including our living spaces. A clean, organized home can significantly contribute to a healthier mindset and emotional balance. That’s where Clean 4 You comes in, offering a fresh perspective on home cleaning that goes beyond mere tidiness.
They understand that clutter and grime can weigh heavily on our mental and emotional states, which is why they provide services tailored to create an environment that supports your detox journey. By enlisting the help of professionals, you can focus on nurturing yourself while they take care of transforming your space into a sanctuary.
If you’re seeking assistance specifically designed for individuals with unique needs, the NDIS Cleaner Perth service from Clean 4 You is here to help. This dedicated team is trained to cater to the requirements of those on the National Disability Insurance Scheme, ensuring that every client receives the support they need for a clean and safe living environment.
With a commitment to using eco-friendly products and methods, Clean 4 You allows you to detox your home in a way that aligns with your values, providing peace of mind as you embrace a healthier lifestyle. With their expertise, you can achieve a pristine space that not only looks good but feels good, allowing you to focus on your personal wellness journey.
Finally, connect with your community. Loneliness is inflammatory. And this past year and a half have been very difficult, particularly for those of you who live alone, who are in transition, who aren’t in the place you’d like to be, or with the person or people you’d like to be–your soul family.
It takes work to find a soul family. I think the first steps are to connect and attune to oneself, to truly understand who you are and move toward that and in that way people can slowly trickle in.
We often need to take care of ourselves first, thereby establishing the boundaries and self-awareness needed to call in the people who will respect and inspire us the most. It’s about self-worth. How do you treat yourself as someone worthy of love and belonging?
Perhaps it first comes with removing the sources of inflammation from our lives, so we can address the deeper layers of our feelings and body sensations and relieve the foggy heaviness and depression and toxic thoughts that might keep us feeling stuck.
Once we clear up our minds and bodies, and cool the fires of inflammation, we start to see better—the fog lifts. We start to think more clearly. We know who we are. Our cravings subside. We can begin to process our shame, anger and sadness.
We start to crave nourishing things: the walk in nature, the quiet afternoon writing poetry, the phone call with a friend, the stewed apples with cinnamon (real sweetness). We free up our dopamine receptors for wholesome endeavours. We start to move in the direction of our own authenticity. I think this process naturally attracts people to us. And naturally attracts us to the people who have the capacity to love and accept us the way we deserve.
Once we start to build community, especially an anti-inflammatory community—you know, a non-toxic, nourishing, wholesome group of people who make your soul sing, the path becomes easier.
You see, when you are surrounded by people who live life the way you do–with a respect for nature, of which our bodies are apart–who prioritize sleep, natural nutrition, mental health, movement, emotional expression, and self-exploration, it becomes more natural to do these things. It no longer becomes a program or a plan, or a process you’re in. It becomes a way of life–why would anyone do it any other way?
The best way to overcome the toxicity of a sick society is to create a parallel one.
When you’re surrounded by people who share your values. You no longer need to spend as much energy fighting cravings, going against the grain, or succumbing to self-sabotage, feeling isolated if your stray from the herb and eat vegetables and go to sleep early.
You are part of a culture now. A culture in which caring for yourself and living according to your nature is, well… normal and natural.
There’s nothing to push against or detox from. You can simply rest in healing, because healing is the most natural thing there is.
by Dr. Talia Marcheggiani, ND | Jan 17, 2018 | Addiction, Community, Healing Stories, Health, Medicine, Mental Health, Volunteering
An interview outlining my adventures providing free naturopathic medicine to street youth at the Evergreen Yonge Street Mission health centre, originally featured in Pulse, a publication for members of the Ontario Association of Naturopathic Doctors.
What is the Evergreen Yonge Street Mission?
On the fourth Friday of every month, I leave my Bloor West Village practice for a few hours and head down Yonge Street.
Just south of Gerard, I stop at a rather unimpressive-looking building tucked between fast-food restaurants and strip clubs, where an admittedly intimidating crowd of young people are smoking and laughing loudly, hoodies drawn.
I nod to them briefly before heading past them, through a glass-paneled doorway.
The entrance is crowded. Youth and tattooed counselors blast rap music out of large headphones. Some of them have notebooks, writing lyrics.
Beyond them is an open area where food is being served; more young people sit at round tables, finishing hot catered lunches, or drinking coffee. A few are involved in some community project or other, conspiring excitedly in groups. Everyone seems to be embracing a perplexing combination of busyness and inertia.
I smile at them and rush downstairs to the basement, past the career centre to the unglamorous health centre where my tiny office is located.
The Evergreen Yonge Street Mission (YSM) is a drop-in centre for street-involved youth aged 18 to 24 that offers afternoon programming, including a hot lunch, career services, daycare, community-based art projects, and drop-in healthcare centre.
The health centre is run by nurse practitioners and staffed by volunteer health professionals: adolescent health specialists, family doctors, Sick Kids residents, dentists, hygienists, acupuncturists, chiropractors, physiotherapists, social workers, psychiatrists and, of course, two naturopathic doctors, Dr. Leslie Solomonian, and myself.
Youth drop in during health centre hours and sign up for 30-minute appointments with the practitioner of their choice.
How did you start working with the Mission?
I first visited the Evergreen YSM for a launch party for the second issue of Street Voices, a magazine for and by street-involved youth. A friend of mine had volunteered to do most of the graphic design and illustration work for the issue and brought me along.
At the party, while eating tiny sandwiches, I noticed a message board advertising YSM services. Naturopathic medicine was listed under health services provided at the centre. I took down the number of the health centre, and gave them a call the following week.
By February 2015, I was volunteering two Fridays a month.
Why did you decide to get involved with the Mission?
I came across Evergreen at the beginning of my naturopathic career. I’d just obtained my license in 2014, and was looking for a way to balance the cost of living and running a practice with providing access to naturopathic services.
Naturopathic medical services have the potential to be very cost-effective; our profession was built on the foundations of clean air, food, and water as vehicles for healing. Nature cure, lifestyle therapies, and in-house treatments like acupuncture can all be very inexpensive to administer.
Unfortunately, the cost of education, licensing fees, and practice overhead all conspire to bring up the cost of naturopathic services, making it difficult for those without third-party insurance coverage to afford them.
When I first started my practice, I tried to find various solutions to this problem. I dabbled in sliding scales but quickly started to notice burnout and resentment polluting my therapeutic relationships. Separating cost, value and worth, while accurately assessing need, complicated things for me—I found it very difficult to lower my rates while still recognizing the value I was offering.
Dispensing with sliding scales at my main practice while offering free services to a marginalized population felt like a satisfactory compromise: I could build my practice, pay for my groceries, and give back, while maintaining clear boundaries.
What type of naturopathic care do you provide at the YSM?
There are a few ways that my YSM practice differs from my practice in Bloor West Village.
Firstly, visits are shorter. The YSM suggests keeping visits to 30 minutes to serve as many patients as possible. Keeping visits short is a challenge for me, considering appointments in my Bloor West practice run 60 to 90 minutes.
Secondly, therapeutic options are limited. Patients don’t have the cash to buy supplements. Making significant dietary changes is impossible for most to tackle. Therefore, I try to offer therapies in the clinic: acupuncture, B12 shots, homeopathic remedies, and counseling, to reduce the work between appointments.
Sometimes we have supplements to dispense—Cytomatrix generously donated last year. At times we’ve been able to offer things like magnesium, vitamin D, iron, immune support, adaptogens, and sample packs of various probiotics.
Treatment plans often require a bit of innovation. For example, I teach patients how to use the probiotic samples to make coconut yogurt using canned coconut milk from food banks. We talk about how to follow an anti-inflammatory diet while eating at a shelter.
Thirdly, there are many obstacles that prevent patients from attending appointments in the first place. I try to treat each visit as a stand-alone encounter—a new patient I see at Evergreen may never come back. This means I focus on stress-reduction and providing as much benefit as possible in the 30-minute session.
What does a typical visit look like?
Visits can differ greatly depending on the particular needs of the patients I see.
Sometimes new patients come in asking specifically for trigger-point release acupuncture.
One patient came in with her friend so they could Snapchat their first acupuncture session amidst violent giggling.
Some patients come to talk about their struggles and share their stories.
Sometimes patients come in to read me their rap or poetry.
Sometimes patients just come in to sleep—the flimsy chiropractic table we use serving as a quiet, 30-minute refuge from the street. Sometimes we do a mindfulness practice. Other times we say very little, or nothing at all.
Others come for full intakes, with complicated psychiatric cases, or PCOS, or chronic diarrhea. I try to hand out any supplements that might be useful, and to give practical recommendations.
Sometimes patients with part-time jobs have a little money that they can spend on things like St. John’s Wort, magnesium, or vitex.
I have to be extremely economical with my therapies, which I feel is a helpful skill to have as an ND in general—I learn what simple treatments have the biggest impact on certain conditions. This helps me resist the temptation of loading patients down with complicated, expensive treatment plans.
What are some strategies for working with this population?
When working with street-involved youth, I’ve found it helpful to humbly take a step back and listening first before jumping in with solutions.
A de-centred practitioner posture can be particularly helpful in a population experiencing homelessness, violence, complex trauma, addiction, teen pregnancy, abuse, conflict with authority, and severe psychiatric illnesses, among other complex challenges—it’s not always clear what to do, what might best help the individual in front of me, and deferring to their experience is often the wisest first step.
De-centring positions the clinician as a guide, facilitator, or someone of service to the patient. This means that I offer my tools: an ear, acupuncture, vitamin D, or a sanctuary of silence, and let my patients choose whatever they want for their 30-minute appointment.
Another helpful skill is being interested in all my patients’ stories, even the ones that aren’t being told about them.
In Narrative Therapy this is called “double-listening”. Accompanying every story of illness, addiction, label of mental illness, or history of trauma, is a parallel story of strength, courage, generosity, and overcoming tremendous obstacles.
I can be a witness to the alternative stories, which are often begging to be told.
Sometimes addiction, self-harm, or other seemingly “destructive” behaviours, may be hidden coping mechanisms that serve as powerful lifelines for survival. Listening between the lines can highlight certain skills and strengths of those who suffer.
A mentor of mine, when faced with an “angry” client, always asks, “What are you protesting?” With that simple reframing question she often uncovers previously hidden stories of belief in fairness, advocacy for justice, courage, and resilience.
Patients tell me about their issues, but also about their beloved pets, how they wish they could be a better father to their children than their fathers were to them, family loyalty in the face of abuse, their dreams for the future, the steps they’ve taken to confront a friend’s addiction, their hopes for a healthier romantic relationship, and many other stories. These narratives depict the complex facets of their identities: street-youth, yes, but also loving parents, friends, budding entrepreneurs, and gifted artists.
One patient who’d recently been diagnosed with schizophrenia told me about the voices in her head. I asked her what the voices said when they spoke to her.
She looked at me, stunned.
“No one’s ever asked me that before.”
This question led us to an important discussion about how she’d turned to writing poetry and her faith to help her stop using methamphetamine. The voices, while often unpleasant, were keeping her sober in their own complex way, she realized.
Through paying careful attention to these stories, patients can reframe and foster preferred identities.
Do you have any stories in particular?
There are many stories of resilience at Evergreen. I have had the opportunity to watch one of my patients transform his life over the past couple of years.
With a criminal record for assault, anger management issues, difficulty holding a job, a mild learning disability, and a history of complex trauma, this individual picked up the pieces of himself, slowly.
The last time I saw him he had completed a yoga teacher training, begun classes at U of T, and was getting ready to move out of the shelter he’d been living in, into his own small apartment.
Through his own remarkable resilience, and some support he was able to receive at Evergreen, he was able to get himself onto an amazing and exciting path. Seeing potential realized is an amazing experience.
Like tending to a garden of souls; you might help plant seeds, or tend to the soil in very simple, minimal ways, and yet amazing things bloom.
What benefits has this work brought to you as an ND?
I believe working with diverse populations enriches practitioner experience. It reminds me to stay open to experiences, personalities, viewpoints, and unique patient histories.
Listening helps me calm the “righting reflex”: the reflex to jump quickly to a solution in order to soothe my own discomfort of sitting with the agony of uncertainty.
I notice in my own practice when I take a more de-centred stance, roll with resistance, and really pay attention to my patient’s preferences and intuition, I am better able to assist them in healing. Not only does letting the patient take the lead result in better outcomes, it also reduces the burden of (impossible) responsibility by shifting the locus of control, preventing burnout.
I struggle with this in my own practice at times; I frequently feel pressure to prove myself. Working at Evergreen helps remind me that we can’t necessarily help everyone for everything in every circumstance.
All of our patients surpass incredible external and internal obstacles to arrive at our offices and face still more difficulties between visits. Trying to recognize and work with these struggles as best we can, taking small but meaningful steps in and between visits, and acknowledging that sometimes it’s about planting seeds of change, which may take months or even years before they’re ready to bloom.
No matter how impatient I might be feeling with a patient’s progress, I try to remember that steps are constantly being taken in the direction of healing.
What are some challenges?
Like any novice practitioner I am accompanied by two familiar acquaintances: self-doubt and second-guessing. These two friends take their place beside me both in my Bloor West practice and at Evergreen.
Celebrating small victories has been important, but so has staying humble. As the mantra goes: the patient heals them-self.
I try to remember this when I’m either feeling too self-congratulatory or too down on myself.
Funding for supplements, energy, avoiding burnout, and being productive with time, are all familiar challenges I also routinely experience.
I always wish I had more time, better and more exciting remedies to dispense, and more energy to really immerse myself in the dedication community work demands.
I try to take the stance of simply being of service while trying to remain free of expectation.
How can other NDs wanting to do similar work get involved?
If you’re interested in working with marginalized populations, the first thing to do is get in touch with local shelters, such as Covenant House or Eva’s Place.
Many shelters offer satellite health services, such as massage therapy. Perhaps start by offering acupuncture, or other forms of bodywork. Acupuncture is an accessible modality that is cost-efficient and fits well with a drop-in model—patients derive benefit from the session and aren’t expected to make significant lifestyle changes or purchase supplements, both of which may be impossible.
Often stress-relief is the first primary goal of care, as is creating a safe space and nurturing trust between the clinician and community.
If you’re willing to offer your services for free there are many populations in Toronto and the GTA that could benefit greatly from naturopathic care.
How can we help?
The YSM is currently accepting donations to help build their new location, and complete their new health centre. Visit https://www.ysm.ca/donate/ to make a one-time, or monthly donation, and help a great cause.
If you would like to donate supplements, acupuncture needles, homeopathic, or herbal remedies please contact me!
by Dr. Talia Marcheggiani, ND | Jul 9, 2016 | Acupuncture, Art, Art Therapy, Balance, Community, Depression, Emotions, Empathy, Health, Meditation, Mental Health, Mind Body Medicine, Mindfulness, Psychology, Self-care
It seems like the world is falling apart. These days more than ever.
Race wars, weapons, war, wealth concentrated into the hands of a few, and violence, Facebook is filled with videos that fill our heads and hearts with a complicated mixture of sadness, anger, anguish, confusion, frustration, enrage, injustice and a deep-felt sense of powerlessness. We struggle through these events to go on living—to go about our lives in a dignified fashion, to pay our rent, to engage our relationships, to find happiness and satisfaction in our lots in this world. It seems like the world is ending, and yet we still have our daily responsibilities. Our cynicism is engaged; our idealism is crumbling. Many of us feel hope leaving our bodies. Many of us feel frustration morphing into despair.
Stress is estimated to be the number one cause of disease. As a naturopathic doctor, my role often involves cleaning up the debris from chronic, long-term stress responses gone haywire. Oftentimes my patients don’t even perceive the stress they’re under. “I’m type A! I thrive under stress and pressure”, some will tell me. Other times the people I work with are so far in a state of overwhelm it’s all they can do to keep moving forward with their daily routines.
The World Health Organization estimates that 75-90% of doctor’s visits are attributed to by stress. I would estimate that 100% of the people I work with have on-going stress in their lives.
We doctors know that some people, the “Type B’s” in society, are more susceptible to stress. We know these people, we may even be one of them ourselves: the sensitive individuals, the intuitives, the feelers, the artists, empaths, activists and light-workers. We are individuals who are often drawn to artistic and healing professions, who care deeply about relationships, people, feelings and soft-ness in this world. We often find ourselves pushed up against hard edges, struggling to pay bills and cope with cruelty and injustice. We face daily struggles and the pain of living a disconnected, yet intricately interdependent life in modern-day society. Some natural doctors have terms us “parasympathetic dominants”—people whose nervous systems tend to get stuck in the parasympathetic (as opposed to stress-fuelled sympathetic) arm of the autonomic nervous system (the “automatic” nervous system).
We often feel overcome with a sense of overwhelm when faced with packed schedules, high stakes jobs that affect others, achievement-oriented striving and the prioritization of money and numbers over people. In this world of deadlines, assertion, aggression, fear, war and material wealth, we can often feel like we don’t fit in. We can suffer from burnout.
Burnout, “adrenal fatigue” or “parasympathetic dominance” happens when our stress response becomes depleted. It is characterized by naturopathic doctors as fatigue, excessive needs for sleep and quiet, lack of motivation, disrupted sleep schedules, difficulty losing weight, sluggish digestion, bloating and IBS, headaches and brain fog, poor memory, hormonal imbalance resulting in heavy or irregular periods, PMS, infertility and acne. Mental illness can begin to surface or worsen in this state, resulting in depression, anxiety, or even bipolar disorder and psychosis. The narrative of the mad, artistic genius, burdened by the weight and troubles of the world, surfaces to mind—the creative genius who is too sensitive for this world. We run the risk of becoming irritable, and losing some of our natural compassion as we drift off into exhausted survival mode.
Many of the people I work with are these sensitive individuals, myself included, and I’m proud to help this population. Through healing the sensitive feelers, we heal the world. The world needs a little more softness and more compassion. It needs people who can pick up on emotional nuances and care deeply about others. It needs people who listen, who feel, who create and share their versions of the human experience to teach others. Through the artists, we experience the depths of our own humanity. Through the artists, we see our pain and, through seeing our pain, we can begin to heal it. It is important that we can find fulfilling work and lives that nurture us, so that we may have the energy to extend our gifts to the world.
Healing parasympathetic dominance in my practice often manifests first as establishing a therapeutic relationship. We crave openness, time and space to explore emotional nuances and engage our natural sense of curiosity. We crave being deeply heard and felt. As a doctor, I do my best to listen, not just to the words, but the space between them, and the symptoms of the body. We look for root causes to issues so that we can establish lifestyle patterns that nurture us.
Creating a clean, nutritious diet: With lean protein, usually meats that stimulate metabolism and manage stress, healthy fats, anti-inflammatory nutrients and lots of fruits and vegetables, especially berries and leafy greens, we can begin to re-feed ourselves and heal inflammation.
Gentle, nurturing movement: I often suggest exercise that blends into the lifestyles of my patients, that works with them. Slow, meditative walking for an hour a day is a wonderful, scientifically proven method of bringing down stress hormone levels. It also creates space in the day for contemplation and integration.
Restful sleep: Through sleep hygiene and some strategically dosed supplements, improving sleep allows the body to repair itself and rest. Those suffering from burnout may need more sleep. Dealing with the guilt that can arise through sleeping in and saying no to non-essential activities to prioritize sleep is often a psychological hurdle in those who feel best when they are nurturing and giving to others, and not themselves.
Self-care: Journalling, meditation and engaging in creative pursuits are helpful armour in allowing one to integrate, express and stay open, energized and creative.
Nurturing mental health and emotions: Speaking to family and friends or a trained therapist or naturopathic doctor can allow us to dive more deeply into our own psyches. When we explore the corners of our mind we are able to heal mental-emotional obstacles to health and learn more about ourselves and others and alter the way we engage in the world. Opening ourselves up to deep-seated anger, fear and sadness is essential to clearing this repressed emotions and improving our experience in the world. My favourite forms of talk therapy are Narrative Therapy and Coherence Therapy. Both involve openly engaging the emotional and mental experience of the other to alter core beliefs and narratives and explore possibilities for living a preferred life experience.
Through the times we are facing, I urge us all to band together, embrace the healers and artists among us and engage in deep, nurturing self-care. Journal, spend time with friends and create. Take time from your activist pursuits and political readings to reflect, to meditate, to get some healing acupuncture and to cry or express anger. Feel the emotions that arise during this time. Take the time to listen to the narratives that emerge. Eat a diet filled with protein, try to keep to a sleep schedule, if possible. Nurture yourself and the complicated emotions that are arising within you and others.
We need you to help us through this time. It is people like you who can heal others, but only if you strive to heal yourself as well.
by Dr. Talia Marcheggiani, ND | Mar 18, 2016 | Balance, Community, Detoxification, Docere, doctor as teacher, Education, Healing Stories, Health, Medicine, Motivation, Narrative Therapy, Naturopathic Philosophy, Naturopathic Principles, Psychology, Self-care, Women's health
People seek out naturopathic doctors for expert advice. This immediately positions us as experts in the context of the therapeutic relationship, establishing a power imbalance right from the first encounter. If left unchecked, this power imbalance will result in the knowledge and experience of the practitioner being preferred to the knowledge, experience, skills and values of the people who seek naturopathic care.
The implicit expectation of the therapeutic relationship is that it’s up to the doctor to figure out what is “wrong” with the body patients inhabit and make expert recommendations to correct this wrong-ness. After that, it’s up to the patients to follow the recommendations in order to heal. If there is a failure to follow recommendations, it is the patient who has failed to “comply” with treatment. This “failure” results in breakdown of communication, loss of personal agency on the part of the patient, and frustration for both parties.
When speaking of previous experience with naturopathic medicine, patients often express frustration at unrealistic, expensive and time-consuming treatment plans that don’t honour their values and lifestyles. Oftentimes patients express fear at prescriptions that they had no part in creating, blaming them for adverse reactions, or negative turns in health outcomes. It’s common that, rather than address these issues with the practitioner, patients take for granted that the treatment plan offered is the only one available and, for a variety of reasons, choose to discontinue care.
One of the elements of Narrative Therapy—a style of psychotherapy founded by Australian Michael White—I most resonate with is the idea of the “therapeutic posture”. In narrative therapy, the therapist or practitioner assumes a de-centred, but influential posture in the visit. This can be roughly translated as reducing practitioner expertise to that of a guide or facilitator, while keeping the agency, decision-making, expertise and wisdom of the patient as the dominant source for informing clinical decisions. The de-centred clinician guides the patient through questioning, helping to reframe his or her identity by flushing out his or her ideas and values through open-ended questions. However, the interests of the doctor are set aside in the visit.
From the place of de-centred facilitation, no part of the history is assumed without first asking questions, and outcomes are not pursued without requesting patient input. De-centring eschews advice-giving, praise, judgement and applying a normalizing or pathologizing gaze to the patient’s concerns. De-centring the naturopathic practitioner puts the patient’s experiences above professional training, knowledge or expertise. We are often told in naturopathic medical school that patients are the experts on their own bodies. A de-centred therapeutic gaze acknowledges this and uses it to optimize the clinical encounter.
I personally find that in psychotherapy, the applicability of de-centring posture seems feasible—patients expect that the therapist will simply act as a mirror rather than doling out advice. However, in clinical practice, privileging the skills, knowledge and expertise of the patient over those of the doctor seems trickier—after all, people come for answers. At the end of naturopathic clinical encounters, I always find myself reaching for a prescription pad and quickly laying out out my recommendations.
There is an expected power imbalance in doctor-patient relationships that is taught and enforced by medical training. The physician or medical student, under the direction of his or her supervisor, asks questions and compiles a document of notes—the clinical chart. The patient often has little idea of what is being recorded, whether these notes are in their own words, or even if they are an accurate interpretation of what the patient has intended to convey—The Seinfeld episode where Elaine is deemed a “difficult patient” comes to mind when I think of the impact of medical records on people’s lives. After that we make an assessment and prescription by a process that, in many ways, remains invisible to the patient.
De-centred practice involves acknowledging the power differential between practitioner and patient and bringing it to the forefront of the therapeutic interaction.
The ways that this are done must be applied creatively and conscientiously, wherever a power imbalance can be detected. For me this starts with acknowledging payment—I really appreciate it when my patients openly tell me that they struggle to afford me. There may not be something I can do about this, but if I don’t know the reason for my patient falling off the radar or frequently cancelling when their appointment time draws near, there is certainly nothing I can do to address the issue of cost and finances. Rather than being a problem separate from our relationship, it becomes internal the the naturopathic consultation, which means that solutions can be reached by acts of collaboration, drawing on the strengths, knowledge and experience of both of us.
In a similar vein, addressing the intersection of personal finance and real estate within the therapeutic relationship requires a delicate balance of empathy and practicality. Patients may be navigating the complexities of homeownership or rental expenses, which can significantly impact their overall well-being. Encouraging open communication about these financial stressors fosters an environment where solutions can be explored collaboratively. It’s essential to recognize that financial challenges are not isolated issues but are intricately woven into the fabric of a person’s life, influencing mental and emotional well-being.
For instance, a patient might express concerns about the financial strain associated with homeownership, prompting a discussion about alternative housing options or budgeting strategies. In this context, exploring unconventional opportunities, such as innovative approaches to real estate like eXp Realty, could naturally arise. Integrating discussions about progressive real estate models within the therapeutic dialogue allows for a holistic exploration of solutions, leveraging the expertise and experiences of both the practitioner and the patient. This approach not only addresses immediate concerns but also lays the foundation for a collaborative and conscientious partnership in navigating the multifaceted aspects of personal finance and real estate.
De-centred practice involves practicing non-judgement and removing assumptions about the impact of certain conditions. A patient may smoke, self-harm or engage in addictive behaviours that appear counterproductive to healing. It’s always useful to ask them how they feel about these practices—these behaviours may be hidden life-lines keeping patients afloat, or gateways to stories of very “healthy” behaviours. They may be clues to hidden strengths. By applying a judgemental, correctional gaze to behaviours, we can drive a wedge in the trust and rapport between doctor and patient, and the potential to uncover and draw on these strengths for healing will be lost.
De-centred practice involves avoiding labelling our patients. A patient may not present with “Generalized Anxiety Disorder”, but “nervousness” or “uneasiness”, “a pinball machine in my chest” or, one of my favourites, a “black smog feeling”. It’s important to be mindful about adding a new or different labels and the impact this can have on power and identity. We often describe physiological phenomena in ways that many people haven’t heard before: estrogen dominance, adrenal fatigue, leaky gut syndrome, chronic inflammation. In our professional experience, these labels can provide relief for people who have suffered for years without knowing what’s off. Learning that something pathological is indeed happening in the body, that this thing has a name, isn’t merely a figment of the imagination and, better still, has a treatment (by way of having a name), can provide immense relief. However, others may feel that they are being trapped in a diagnosis. We’re praised for landing a “correct” diagnosis in medical school, as if finding the right word to slap our patients with validates our professional aptitude. However, being aware of the extent to which labels help or hinder our patients capacities for healing is important for establishing trust.
To be safe, it can help to simply ask, “So, you’ve been told you have ‘Social Anxiety’. What do you think of this label? Has it helped to add meaning to your experience? Is there anything else you’d like to call this thing that’s been going on with you?”
Avoiding labelling also includes holding back from using the other labels we may be tempted to apply such as “non-compliant”, “resistant”, “difficult”, or to group patients with the same condition into categories of behaviour and identity.
It is important to attempt to bring transparency to all parts of the therapeutic encounter, such as history-taking, physical exams, labs, charting, assessment and prescribing, whenever possible. I’ve heard of practitioners reading back to people what they have written in the chart, to make sure their recordings are accurate, and letting patients read their charts over to proofread them before they are signed. The significance of a file existing in the world about someone that they have never seen or had input into the creation of can be quite impactful, especially for those who have a rich medical history. One practitioner asks “What’s it like to carry this chart around all your life?” to new patients who present with phonebook-sized medical charts. She may also ask, “Of all the things written in here about you, what would you most like me to know?” This de-emphasizes the importance of expert communication and puts the patient’s history back under their own control.
Enrolling patients in their own treatment plan is essential for compliance and positive clinical outcomes. I believe that the extent to which a treatment plan can match a patient’s values, abilities, lifestyle and personal preferences dictates the success of that plan. Most people have some ideas about healthy living and natural health that they have acquired through self-study, consuming media, trial-and-error on their own bodies or consulting other healthcare professionals. Many people who seek a naturopathic doctor are not doing so for the first time and, in the majority of cases, the naturopathic doctor is not the first professional the patient may have consulted. This is also certainly not the first time that the person has taken steps toward healing—learning about those first few, or many, steps is a great way to begin an empowering and informed conversation about the patients’ healing journey before they met you. If visiting a naturopathic doctor is viewed as one more step of furthering self-care and self-healing, then the possibilities for collaboration become clearer. Many people who see me have been trying their own self-prescriptions for years and now finally “need some support” to help guide further action. Why not mobilize the patient’s past experiences, steps and actions that they’ve already taken to heal themselves? Patients are a wealth of skills, knowledge, values, experiences and beliefs that contribute to their ability to heal. The vast majority have had to call on these skills in the past and have rich histories of using these skills in self-healing that can be drawn upon for treatment success.
De-centring ourselves, at least by a few degrees, from the position of expertise, knowledge and power in the therapeutic relationship, if essential for allowing our patients to heal. A mentor once wrote to me, “Trust is everything. People trust you and then they use that trust to heal themselves.”
By lowering our status as experts, we increase the possibility to build this trust—not just our patients’ trust in our abilities as practitioners, but patients’ trust in their own skills, knowledge and abilities as self-healing entities. I believe that de-centring practitioner power can lead to increased “compliance”, more engagement in the therapeutic treatment, more opportunities for collaboration, communication and transparency. It can decrease the amount of people that discontinue care. I also believe that this takes off the burden of control and power off of ourselves—we aren’t solely responsible for having the answers—decreasing physician burnout. Through de-centring, patients and doctors work together to come up with a solution that suits both, becoming willing partners in creating treatment plans, engaging each other in healing and thereby increasing the trust patients have in their own bodies and those bodies’ abilities to heal.
by Dr. Talia Marcheggiani, ND | Aug 30, 2015 | Acupuncture, Addiction, Community, Healing Stories, Health, Human Rights, Listening, Medicine, Mental Health, Motivation, Philosophy, Politics, Psychology, Volunteering
I was recently told that a benefactor would contact me about the work I’ve been doing for the Evergreen Yonge Street Mission in Toronto—I provide naturopathic services to street-involved youth twice a month in the drop-in health clinic. There is a natural health company that might be interested in sponsoring some of the naturopathic services. However, in order to understand where their money is going, they want to hear some success stories before they consider if and how much to donate. Are the services working? They want to know. Since I, more than anyone, appreciate the power of a story and, since I’m trying to raise some money to expand the services I provide myself, I thought I’d tell one. Names and details have been changed.
—
A shift at the mission lasts a few hours. Youth sign up for the adolescent medicine specialist and her Sick Kid’s Hospital resident, dental work or me, the naturopath, represented under the heading “naturopathic medicine/acupuncture”. There is no money for supplements—and supplements can be expensive—and the youth I treat don’t have money to buy food let alone a bottle of melatonin. So I do acupuncture.
Eduardo was waiting when it I called him. He was lying face up on the bench in the waiting area, looking at a pamphlet on “dope addiction”. He was wearing sunglasses. When he came into the visit, he didn’t take them off, despite the low-level lighting of the treatment room I occupy. It felt strange to talk to someone’s dark glasses, not making eye contact with them as we spoke. I wondered vaguely if I should tell him to take off the glasses, and then left it alone—his comfort as the patient should take priority over mine. Why challenge his autonomy and further push the power imbalance by telling him to do something that was not fully necessary? I worked around the glasses, moving them aside slightly in order to needle the acupuncture point yin tang, located between the eyebrows. The glasses stayed on. So be it.
Eduardo and I spoke Spanish, as his English wasn’t strong. He spoke of feeling shaky, showing me his tremoring hand to prove it. When did the shakiness start? I inquired. When I overdosed on crack, he explained. Well, that would do it, I thought to myself, although you can imagine my clinical experience with crack overdose was limited—there aren’t that many crack overdoses in Bloor West Village.
As it turned out, Eduardo had a significant dependence on marijuana, smoking 7 grams a day while in his home country. When he bought pot on the streets in Toronto, however, he found one deal laced with crack. He ended up in the hospital after smoking it. Another time, his weed was laced with meth.
He held his hand up. I watched it shake. He told me his whole body felt shaky. This would be exacerbated further if he stopped smoking marijuana, he assured me. Had he ever stopped before? I asked. Yes, he said. Why did he stop? I asked him, taking a de-centred approach while staying curious about preferred ways of being. In this case I suspected he preferred to be sober—after all, something had made him stop.
The cost, he explained.
Ah, that, I thought. Well, it makes sense.
Any other reason? I asked him.
He explained that his family didn’t approve. I asked him why. What might they think of marijuana? What did they see him do when he was high that led to their disapproval. Eduardo couldn’t answer. He changed the subject and explained he’d gone back to weed after quitting it that time because it helped him sleep. Since the episode with the crack overdose, though, sleep was difficult. That’s why he was here: to get acupuncture to help with sleep.
Eduardo spoke in a low voice, often responding with a word or two. Despite the glasses shielding his eyes, he kept his gaze on the floor. When I had him lie on the treatment table, I encouraged him to close his eyes and rest while the acupuncture worked.
After a few minutes, I removed the needles. He thanked me shyly and left. Like many of the people I treat, I figured the odds were high I’d never see him again.
—
I was surprised, then, that a month later, I saw him in the waiting area again.
The visit went pretty much the same way as the first with one key difference. The second time he came in, Eduardo removed his glasses, meeting my eyes for the first time.
I was touched.
His sleep was still bad. His mood was still low. He hadn’t smoked crack for a while. He was living in a shelter; his family had kicked him out because of his addiction to marijuana. He implied great trauma in his home country, however he didn’t say much more about it. He mentioned regretting that his English was poor—it had been traumatic to come to Canada.
He told me he was applying for medical marijuana. It would be a safer way to smoke, he told me.
He was practicing harm reduction on himself. I asked him if he considered this “taking steps.” He nodded. I asked him about any other steps he’d been considering. He mentioned swimming. Swimming had been a passion of his in his home country. I got more details about his goals: how often did he want to swim? Where? He decided that 3-5 times a week at the local pool would be ideal. I asked him what he’d first have to do to make that happen. Check the pool times, he answered.
I asked him if he’d ever considered quitting marijuana. He said no, he needed it to sleep and to manage his anxiety. But, you know, it was expensive. And, of course, he repeated, his parents had an issue with it. That was a problem for him. I asked him why it was a problem.
It’s a problem… he repeated. He said nothing more.
We did more acupuncture. He went on his way.
—
Two weeks later, Eduardo came to see me again. He took his glasses off as soon as he saw me.
He reported his sleep was better. He had been swimming 3 times a week at the local pool. He hadn’t smoked crack in a month. He’d stopped marijuana the last time he saw me. He hadn’t smoked for two weeks. He showed me his hand. It wasn’t shaking.
Do you think these are positive developments? I asked him.
He shrugged nonchalantly but failed to disguise the smile that tugged at the corners of his mouth. He looked down.
I put in some acupuncture needles and asked him what his next steps might be. He answered that he thought he might call his old boss back and get back to work. Then he wanted to save money so he could move out of the shelter he was in.
He then started to talk a little bit about his brother who was killed in his home country and his friends who’d betrayed him to another gang resulting in him having to flee for his life. He talked about receiving premonitions in his dreams. This made sleep difficult, but it had also caused him to act and avoid harm—he’d learned from a dream that his friends were untrustworthy. We wondered together if this was more than a source of anxiety, but a special skill that kept him safe. Maybe he wouldn’t have to be vigilant if important warnings came to him in his dreams. I wondered if marijuana, along with helping hims sleep had hindered that gift. He thought about that for a while.
When he left he asked me how many more acupuncture treatments he might need. I told him to come in as often as he liked but 8-10 was a good starting point.
Ok, he said, it’s been 3 so far.
Right, I said. It’s been 3.
Ok, he said. See you in two weeks.
He put his glasses back on and walked out into the chaos of Yonge Street. There was a street festival going on.
—
At one point in my time spent with Eduardo, one of the staff at the mission inquired about his mental capacities. Apparently the psychiatrist he’d been working with was considering a diagnosis of mental retardation or severe learning disability–it was taking him so long to learn English and he was often slow to answer questions.
No disrespect to psychiatry: the more I work with mental health, the more respect I have for the utility, albeit limited, of psychiatric assessments and medications. For many people, and when applied delicately and sensitively, these things add powerful meaning and serve as important life savers. However, I want to emphasize the importance of lowering practitioner power, understanding the challenges another person may face in their life and respecting the autonomy, decision-making power and special skills of the individual who seeks health care. In addition, rather than looking for the problem in the person, what success stories are they bringing forth? What goals have been set and what steps have been taken already?
I often comment that the stories I hear and the conversations I have in the work I do are not the least bit depressing. Sure, the youth have dark, complicated, often horrific pasts. However, every individual is a collection of hopes, dreams, goals and personal strengths and abilities. Every person that comes to see me wants something more for themselves and has already exercised an ability to move closer to their preferred ways of being in the world, showing me the incredible capacity for human strength and endurance. The only difference, between the perspective I get to enjoy and the one seen by other health professionals, however, is that I look for stories of strength. Because strength is always there, waiting for a thoughtful question to bring it into the light.
To contribute to the Yonge Street Mission naturopathic services and for more information on the campaign, please click here. Donations are made in USD.
by Dr. Talia Marcheggiani, ND | Jul 20, 2015 | Art Therapy, Community, Creativity, Docere, Education, Emotions, Empathy, Finding yourself, Healing Stories, Health, Medicine, Mental Health, Mind Body Medicine, Mindfulness, Narrative Therapy, Philosophy, Politics, Psychology, Relationships, Self-reflection, Treating the Cause, Volunteering
As a child, I was obsessed with stories. I wrote and digested stories from various genres and mediums. I created characters, illustrating them, giving them clothes and names and friends and lives. I threw them into narratives: long stories, short stories, hypothetical stories that never got written. Stories are about selecting certain events and connecting them in time and sequence to create meaning. In naturopathic medicine I found a career in which I could bear witness to people’s stories. In narrative therapy I have found a way to heal people through helping them write their life stories.
We humans create stories by editing. We edit out events that seem insignificant to the formation of our identity. We emphasize certain events or thoughts that seem more meaningful. Sometimes our stories have happy endings. Sometimes our stories form tragedies. The stories we create shape how we see ourselves and what we imagine to be our possibilities for the future. They influence the decisions we make and the actions we take.
We use stories to understand other people, to feel empathy for ourselves and for others. Is there empathy outside of stories?
I was seeing R, a patient of mine at the Yonge Street Mission. Like my other patients at the mission health clinic, R was a young male who was street involved. He had come to see me for acupuncture, to help him relax. When I asked him what brought him in to see me on this particular day, his answer surprised me in its clarity and self-reflection. “I have a lot of anger,” He said, keeping his sunglasses on in the visit, something I didn’t bother to challenge.
R spoke of an unstoppable rage that would appear in his interactions with other people. Very often it would result in him taking violent action. A lot of the time that action was against others. This anger, according to him, got him in trouble with the law. He was scared by it—he didn’t really want to hurt others, but this anger felt like something that was escaping his control.
We chatted for a bit and I put in some acupuncture needles to “calm the mind” (because, by implication, his mind was not currently calm). After the treatment, R left a little lighter with a mind that was supposedly a little calmer. The treatment worked. I attributed this to the fact that he’d been able to get some things off his chest and relax in a safe space free of judgment. I congratulated myself while at the same time lamented the sad fact that R was leaving my safe space and re-entering the street, where he’d no doubt go back to floundering in a sea of crime, poverty and social injustice. I sighed and shrugged, feeling powerless—this was a fact beyond my control, there wasn’t anything I could do about it.
The clinic manager, a nurse practitioner, once told me, “Of course they’re angry. These kids have a lot to be angry at.” I understood theoretically that social context mattered, but only in the sense that it posed an obstacle to proper healing. It is hard to treat stress, diabetes, anxiety and depression when the root causes or complicating factors are joblessness, homelessness and various traumatic experiences. A lot of the time I feel like I’m bailing water with a teaspoon to save a sinking ship; my efforts to help are fruitless. This is unfortunate because I believe in empowering my patients. How can I empower others if I myself feel powerless?
I took a Narrative Therapy intensive workshop last week. In this workshop we learn many techniques for empowering people and healing them via the formation of new identities through storytelling. In order to do this, narrative therapy extricates the problem from the person: the person is not the problem, the problem is the problem. Through separating problems from people, we are giving our patients the freedom to respond to or resolve their problems in ways that are empowering.
Naturopathic doctors approach conditions like diabetes from a life-style perspective; change your lifestyle and you can change your health! However, when we fail to separate the patient from the diabetes, we fail to examine the greater societal context that diabetes exists in. For one thing, our culture emphasizes stress, overwork and inactivity. The majority of food options we are given don’t nourish our health. Healthy foods cost more; we need to work more and experience more stress in order to afford them. We are often lied to when it comes to what is healthy and what is not—food marketing “healthwashes” the food choices we make. We do have some agency over our health in preventing conditions like diabetes, it’s true, but our health problems are often created within the context in which we live. Once we externalize diabetes from the person who experiences it, we can begin to distance our identities from the problem and work on it in creative and self-affirming ways.
Michael White, one of the founders of Narrative Therapy says,
If the person is the problem there is very little that can be done outside of taking action that is self-destructive.
Many people who seek healthcare believe that their health problems are a failure of their bodies to be healthy—they are in fact the problem. Naturopathic medicine, which aims to empower people by pointing out they can take action over their health, can further disempower people when we emphasize action and solutions that aim at treating the problems within our patients—we unwittingly perpetuate the idea that our solutions are fixing a “broken” person and, even worse, that we hold the answer to that fix. If we fail to separate our patients from their health conditions, our patients come to believe that their problems are internal to the self—that they or others are in fact, the problem. Failure to follow their doctor’s advice and heal then becomes a failure of the self. This belief only further buries them in the problems they are attempting to resolve. However, when health conditions are externalized, the condition ceases to represent the truth about the patient’s identity and options for healing suddenly show themselves.
While R got benefit from our visit, the benefit was temporary—R was still his problem. He left the visit still feeling like an angry and violent person. If I had succeeded in temporarily relieving R of his problem, it was only because I had acted. At best, R was dependent on me. At worst, I’d done nothing, or, even worse, had perpetuated the idea that there was something wrong with him and that he needed fixing.
These kids have a lot to be angry at,
my supervisor had said.
R was angry. But what was he angry at? Since I hadn’t really asked him, at this time I can only guess. The possibilities for imagining answers, however, are plentiful. R and his family had recently immigrated from Palestine, a land ravaged by war, occupation and racial tension. R was street-involved, living in poverty in an otherwise affluent country like Canada. I wasn’t sure of his specific relationship to poverty, because I hadn’t inquired, but throughout my time at the mission I’d been exposed to other narratives that may have intertwined with R’s personal storyline. These narratives included themes of addiction, abortion, hunger, violence, trauma and abandonment, among other tragic experiences. If his story in any way resembled those of the other youth who I see at the mission, it is fair to say that R had probably experienced a fair amount of injustice in his young life—he certainly had things to be angry at. I wonder if R’s anger wasn’t simply anger, but an act of resistance against injustice against him and others in his life: an act of protest.
“Why are you angry?” I could have asked him. Or, even better, “What are you protesting?”
That simple question might have opened our conversation up to stories of empowerment, personal agency, skills and knowledge. I might have learned of the things he held precious. We might have discussed themes of family, community and cultural narratives that could have developed into beautiful story-lines that were otherwise existing unnoticed.
Because our lives consist of an infinite number of events happening moment to moment, the potential for story creation is endless. However, it is an unfortunate reality that many of us tell the same single story of our lives. Oftentimes the dominant stories we make of our lives represent a problem we have. In my practice I hear many problem stories: stories of anxiety, depression, infertility, diabetes, weight gain, fatigue and so on. However, within these stories there exist clues to undeveloped stories, or subordinate stories, that can alter the way we see ourselves. The subordinate stories of our lives consist of values, skills, knowledge, strength and the things that we hold dear. When we thicken these stories, we can change how we see ourselves and others. We can open ourselves up to greater possibilities, greater personal agency and a preferred future in which we embrace preferred ways of being in the world.
I never asked R why the anger scared him, but asking might have provided clues to subordinate stories about what he held precious. Why did he not want to hurt others? What was important about keeping others safe? What other things was he living for? What things did he hope for in his own life and the lives of others? Enriching those stories might have changed the way he was currently seeing himself—an angry, violent youth with a temper problem—to a loving, caring individual who was protesting societal injustice. We might have talked about the times he’d felt anger but not acted violently (he’d briefly mentioned turning to soccer instead) or what his dreams were for the future. We might have talked about the values he’d been taught—why did he think that violence was wrong? Who taught him that? What would that person say to him right now, or during the times when his anger was threatening to take hold?
Our visit might have been powerful. It might have opened R up to a future of behaving in the way he preferred. It might have been life-changing.
It definitely would have been life-affirming.
Very often in the work we do, we unintentionally affirm people’s problems, rather than their lives.
One of the course participants during my week-long workshop summed up the definition of narrative therapy in one sentence,
Narrative therapy is therapy that is life-affirming.
And there is something very healing in a life affirmed.
More:
The Narrative Therapy Centre: http://www.narrativetherapycentre.com/
The Dulwich Centre: http://dulwichcentre.com.au/
Book: Maps of Narrative Practice by Michael White
by Dr. Talia Marcheggiani, ND | Mar 2, 2015 | Clinic, Community, Creativity, Finding yourself, Gratitude, Health, Patients, Private Practice
I wrote this post a few months ago while beginning my private practice. When I first wrote this post, the next week an incredibly good-fit-of-a-patient walked in my door! A month later, another booked in! I have been blessed from the start with a roster of wonderful people who have found their way into my practice. I’m posting this blog post to celebrate that and keep morale high.
No, I don’t have her yet (edit: there are a few potentials, though!). Instead, I began practice with a few individuals who reflected back my insecurities, made payment awkward (likely more about me than about them) or who threaten to complain about me to the regulatory board (long story) and keep forgetting to follow their treatment plans.
Naturopathic doctors have the second largest scope of practice in Ontario besides medical doctors. We are primary care providers. We are highly trained. If I wanted to get filthy rich I’d have done something else, anything else. I am 29 and I wear sweaters from the Salvation Army and live with my parents—I just want to help people.
I digress. My perfect patient does not yet exist, but in a marketing workshop I took in November, they told us to imagine our ideal patient—where does he or she live, work, drink his or her coffee? I decided to create a blog out of it, killing a few birds (free range turkeys) with a single (humane) stone. That being said, if you read to the bottom of this post and find out that you are, in fact, the perfect patient, or know one that is, then please message me and I will get back to you as soon as I can.
The Perfect Patient
The perfect patient has extended health benefits. However, she understands that health is worth paying for and is willing to go beyond her benefits in order to feel better.
She has faith in naturopathic medicine and in my doctoring skills. She understands the work and education it took to get to where I am. She respects that and recognizes that my opinion is far more informed than that of a health show host, blog poster or supplement store employee.
The perfect patient knows me. She’s heard of me, or read my professional blog, or been to a talk. She jives with my spirit as a doctor and therefore is already sold on me and naturopathic medicine before she comes into the office.
She is compliant. She understands what education and training is behind the treatment recommendations that are prescribed to her. She follows them, determined to make positive changes to her health. And, because she does this, she gets better. She takes an active role in her own health and doesn’t hesitate to help me understand what treatments are feasible and appropriate for her.
She tells all her friends and family about me and how I’ve helped her. She refers them all to me. Like 10-20 people are direct referrals from her.
These referrals begin to refer as well. It’s a great practice because they all connect with my philosophy and follow my recommendations and are willing to pay for my services and don’t cancel their appointments without giving 24 hours’ notice.
They are all respectful of my time. They don’t overstay their visits or bombard me with emails, unless they are genuinely confused about something or they have a legitimate concern and they understand that, if it requires more than 15 minutes of my time then we need to book a follow-up in person or a phone consultation and they know that requires payment. After all, I am a professional.
They all follow my blog and recommend it to friends. One of their friends is a big-deal editor and signs me on for a book deal. I sell a lot of books and this generates even more patients who are in line with my beliefs and the medicine I practice.
Everything flows, naturally and easily. I learn a lot. These patients are introspective and interested in growing. They know that health is the foundation of a good life. They want to make the most out of life, to challenge themselves in interesting ways and embrace love and creativity and spirituality. We have great conversations that allow us to benefit and look at life a little differently. My clinic becomes a place of healing and spiritual growth.
“I feel better just by spending time in the waiting room.” Say the new patients these days.
I start a Alternative Healing Collective with my current clinic owner, an MD/Homeopath. We employ different healthcare providers and pay them salaries. The patients pay a yearly rate and then are charged a smaller fee for a visit. Practitioners and patients form boards and vote on changes and practices of the clinic. It becomes a place of progressive private healthcare.
Students come from around the world to learn from our methods and copy our model of providing accessible, effective healthcare.
We dedicate our time to helping those who can’t pay for the services but are in line with our principles and would benefit from our care. We travel to countries and set up clinics there. We give talks, workshops and classes. We do community acupuncture.
Our clinic becomes a community centre for healing, where patients can drop by, have a tea, listen to a talk or take a class, see a practitioner, meditate, take out books on health or just sit and converse with like-minded individuals. We are closely connected with the arts, especially the visual arts and have non-toxic art studios for health-conscious people who believe in expression and beauty.
Our clinic becomes a model throughout Canada, then throughout the world. We revolutionize the healing professions.
When I retire I become a mentor, an elder. I still see patients and teach classes and write books. Sometimes I write fiction. Sometimes I paint. I feel like a part of the community. I feel I have given back, traveled and grown and lived and loved.
Then I die peacefully, surrounded by family, friends and community and love.
And it all started with the Perfect Patient.
Here’s hoping.
by Dr. Talia Marcheggiani, ND | Feb 19, 2014 | Community, Guatemala, Healing Stories, Health, Volunteering, Volunteering Abroad, Writing
We take a chicken bus to the hospital in Sololá, Guatemala. The emergency room is simple: 5 beds in a row sheltered by curtains. The sanitation conditions are questionable. There are no respirators (patients are bagged manually, all through the night) or fancy medical equipment. The emergency room is a bustling gathering place for the daily misfortunes of any of the 500,000 residents of Lago Atitlán.
My classmates and I, fresh from the airport, are dressed in navy blue scrubs, shiny and new from Walmart. I have a stethoscope around my neck: a Littman Cardio III. I’d guess that it’s the most expensive stethoscope in the hospital. It’s also auscultated the least amount of hearts; I’d be willing to bet that too.
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by Dr. Talia Marcheggiani, ND | Aug 29, 2013 | Colombia, Community, Food, Human Rights, Nutrition, Protests, South America
Globalization has selected its next victim. In July, 2012, Colombia signed a free trade agreement with the United States. Fuelled by the desire to “develop” economically, i.e.: have access to the amenities and material goods of the first world, the initial reaction was quite positive. Citizens flocked to multinational brands like GAP and many excitedly awaited the promise of the arrival of Starbucks. On August 1, of this year, the free trade agreement with the European Union also came into effect.
Since signing the free trade agreement, imports from the US to Colombia have increased by about 70%, according to Counterpunch, “In 2011, Colombia imported 5,000 tons of rice from the US. In the year after the fta came in, 98,000 tons were imported.”
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by Dr. Talia Marcheggiani, ND | Jun 13, 2013 | Community, Culture, Exercise, Fitness, Health, Urban Living
Prefer to be stuck in traffic or motoring along on bike or foot? New York City, 2011.
As mentioned, walking is the best form of exercise there is. It allows us to move our bodies organically while interacting with our neighbourhood and the people in it. As you’ve probably noticed, however, some places are more fun to walk around in than others. Taking a stroll down a wide sidewalked street, where you can peer into cafes, interesting boutiques and pass bustling restaurant patios or walking through public parks and in natural settings are clearly more enjoyable walking experiences than walking beside a 6-lane, busy road on a narrow sidewalk in a high-rise neighbourhood. The friendliness of a place to walkers is termed “walkability”, coined by Jane Jacobs, an urban activist and founder of the annual “Jane’s Walks” that take place in various cities around the world in May.
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