I talk about 5 essential tools for caring for your mental and emotional health. These are powerful self-care practices that can help balance your mind and emotions.
Hello, everybody, my name is Dr. Talia Marcheggiani. I am a naturopathic doctor with a focus in mental health and hormonal health.
Despite the increasing amount of research into mental health conditions and psychiatric conditions, and the increase in interventions and early recognition and pharmaceutical therapies that come with mental health diagnoses, we’re actually seeing more debility in mental health outcomes: more debility, more morbidity. So we’re seeing worsening of outcomes even though we’re applying more interventions.
So, how could this be? You expect that the better the drugs that we’re developing, the less disease we should encounter, if those drugs are actually working to counteract the disease process. We’re not seeing that in the realm of mental health, especially when it comes to the common conditions such as depression and anxiety.
And when it comes to disease in the west, we’re not really winning the war against disease. So, things like cardiovascular disease, cancer, hormone imbalances such as diabetes, hypothyroidism, mental health conditions such as depression and anxiety, ADD and ADHD, infertility, neurological disease such as MS and Parkinson’s, autoimmune disease, such as, again, MS and things like Hashimoto’s Thryoiditis and myasthenia gravis, and immunodeficiencies such as HIV. All of these diseases are on the rise, all of these chronic, lifelong diseases. And so, despite these advances in research and drug development, we’re not seeing an improvement in our ability to manage these diseases or prevent them.
And there is obviously not one simple solution to this problem, but one thing I want to point our attention to is this increase in stress and this connection to stress and the diseases that I mentioned. Obviously it’s not just one cause, that would simplify the entire system to an almost ludicrous degree, but there is an estimation that 75-90% of hospital visits are either directly or indirectly related to stress.
And some of the symptoms of stress, so chronic stress or even acute stress, are an increased heart rate, elevated blood pressure, elevated blood sugar, decreased memory and cognition, disrupted levels of serotonin, leading to depression and anxiety, disrupted levels of the other hormones such as dopamine and norepinephrine, and addiction to stress, so a chance in the opioid receptors and the brain structure, altered hormone synthesis, increased inflammation, altered gut flora, etc., etc., and a change in the immune system. So, basically, every system of the body is affected by stress. And being in a prolonged, acute state of stress is lethal to the body.
So, we can look at the rise of cardiovascular disease and diabetes and the fact that stress increases our heart rate and increases our blood pressure and increases our blood sugar. And we can make some of those connections between the symptoms of stress and the diseases that are increasing in our society.
When it comes to mental health, we see how our neurotransmitters and our brain structure and our gut and our immune systems are affected by chronic stress and we can infer that some mental health conditions are either caused by or aggravated by this chronic stress situation. And, so, by not addressing stress and by not looking into stress and finding healthy ways to manage it, we’re doing ourselves a disservice in the management of these diseases and the prevention of them,
So, there’s a few theories that connect—there’s that Monoamine Hypothesis when it comes to mental health, that people with depression and anxiety have this inherent brain imbalance. So they don’t make enough serotonin, or their brains for some reason aren’t responding to serotonin. Again, it’s a very reductionistic model because it reduces all of the experience of depression and anxiety and conditions such as ADD and ADHD and bipolar down to one single neurotransmitter and it oversimplifies the entire system and the entire constellation of symptoms that people can experience and the life situations surrounding these conditions and the fact that they’re comorbid with things like stress and poverty and childhood trauma and those kinds of things.
But there’s some other theories that we can look at, and some other kind of pieces of the puzzle that we can add to create a more inclusive narrative. So there’s a theory called the Mind-Body Theory and this kind of arises as a counteraction, or a counter-philosophy to what Descartes discovered or decided that he discovered, which was that the mind and body are separate entities—this dualistic hypothesis. We know absolutely that that’s not true but our mind and body are completely connected and that our mind probably doesn’t reside only in our brain because our nervous system extends throughout the entire body and our minds are also inter-relational, so they’re a product our environments and our relationships with other people as well.
We know that the gut is the second brain, for the amount of neurons that it inhabits and the neurotransmitters that influence its function. Our gut health affects our mood depending on how healthy it is. And we call this connection, another word for it, a more scientific word, is “Psychoneuroimmunology”. This is the connection between the immune system, the nervous system, and our psychology, our mood: our thoughts and emotions. So, we know that everything in the body is interconnected and you can’t prescribe an antibiotic and not expect that there’ll be sequelae or consequences, or side effects that affect a different body system. And we see that all the time now, but we have to understand how tugging on one thread in this interconnected web is going to affect another piece of it further down the line.
There’s also this Energetic Model of mental health, and that’s that the emotions have their own energy. There’s this theory that the emotions can manifest as physical symptoms and we see this in the work of Gabor Mate, who writes extensively about stress and addictions and mental health, in his book “The Body Says No”. He talks about how the health of our thoughts and emotions impact our physical stress. And so it’s not just that our thoughts and emotions can impact our mental health, but also our physical health and might set the stage for us to get conditions like cancer, or autoimmune disease, and all of the other diseases that I mentioned.
So, when it comes to stress and our mental health and emotional wellbeing, we need to take a proactive approach. Just like we do with getting vaccinations, and preventing colds and flus, and getting proper nutrition, and exercise and all of that, we need to be strategic about how we manage our stress.
The World Health Organization defines mental health as “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” So, notice that this definition isn’t simply the absence of disease and it’s not necessarily a normalizing—being “happy” or not having a diagnosis. This definition is about realizing one’s potential and experiencing emotional “wellness”, for lack of a better word. So, an ability to cope with life’s stressors and to live a life of meaning and purpose.
So I want to talk about 5 tools that are really important for establishing a self-care and emotional wellness routine, for improving mental health. These strategies may not be sufficient enough for more serious psychiatric conditions, but I believe that they form the foundation of proper lifestyle strategies to help with increasing our emotional wellness and our ability to cope with life’s stressors.
So the first one I want to talk about is something called “Self-Care”, which is becoming kind of a buzzword in high-stress communities such as universities, and even some offices and corporations. So, one of the first things I want to talk about is the power of saying “No”. Sometimes saying No, especially for more agreeable individuals, and a lot of the time for women, saying no is a difficult thing for us to do.
When I give this presentation to a group I always ask them, “Why is it hard for you to say no? What would happen if you didn’t say no? Let’s say a friend invites you out and you’re just not feeling it, or you’re invited to a baby shower and it’s just more than you can handle and you wish you could say no, but you don’t.” And, one thing that everybody says is that they’d feel guilty, if they said no. This is sort of universal. And so I ask them, “What would happen if you didn’t say no? What would happen if you went along with it, even if you just didn’t have the energy to devote to this commitment?” And people say that they’d feel resentment. And so when it comes to deciding what things to take on and what things to discriminate against in terms of the tasks that we take on, the commitments that we make, we’re kind of stuck between this dichotomy between feeling guilt and resentment spectrum. One of my mentors, Gabor Mate, in his book “The Body Says No”, talks about when faced with this choice between guilt and resentment, especially when we’re more prone to guilt-avoidance by saying yes more often than maybe we should, he said “choose guilty every time”, because the feeling of guilt, and obviously this isn’t a hard or fast rule, but the feeling of guilt is more indicative that you’re taking care of yourself.
His theory as well is that resentment tends to build up in the body and contributes to the cause of more disease such as cancer and this cancer personality that he writes about is the woman that will say yes to things and is scared to say no out of guilt. So, resentment is far more damaging for the body and therefore, when trying to avoid guilt, maybe move towards guilt, especially when you know that you might be taking on more than you should. And also pay attention to the idea that when we say yes to things we’re saying no to other things. So, we’re always saying “no” and “yes”. We only have 24 hours in the day and so, by saying yes to that baby shower that you’d rather not go to, what are you saying no to? Are you saying no to doing a yoga class for you, or getting extra sleep, or saving your money for a family vacation? So, paying attention to those commitments that we make. There’s a great article online called “The Law of F- Yes! Or No.” And this law is, if you’re faced with a decision and you’re not feeling like this, “F- Yes!”, then say no and save that time and save those commitments for something else that you’re more enthusiastic about.
When it comes to self-care, there’s another great article that talks about the BACE method, so that’s BACE. And this stands for these 4 pillars of self-care. And the first one of body-care. So that’s making sure you have a healthy diet, that you’re supporting yourself nutritionally, that you’re getting movement in, that you’re sleeping enough. A is acceptance, just allowing the emotions, and that self-care, that self-love to come through. C is connection, so establishing those interpersonal relationships and prioritizing them, especially relationships that feel nurturing, where you can be your authentic self. And E is enjoyment, finding activities that are fun and cause a sense of enthusiasm and enjoyment in your life. And this is something that’s often a problem for a lot of adults with lots of responsibilities that, when I ask them to rate on a scale of 1 to 10 how much fun they have, or how satisfied they are with the amount of fun in their life, they often rate it pretty low.
A lecture that I attended, there was a woman who was talking about self-love and improving self-worth and recommends asking oneself this: “what would someone who loves themselves do? Or say?” and that can be pretty powerful for just examining how our internal dialogue is manifesting and how we’re talking to ourselves and treating ourselves. Would someone who loves themselves eat that? Or say that? Or do that activity or say yes to that commitment? And, you know, just sitting with that question can be really helpful for changing some behaviours, or adding perspective to our daily lives.
There’s also this, lastly in the realm of self-care, there’s this idea of Wu Wei, which is a Taoist idea, which is translated roughly into the art of “effortless action”. In our society we’re kind of educated to pair action with effort. So, we don’t feel like we deserve success unless our success was the result of a massive amount of effort that we’ve put in, and stress. And, according to wu wei, this idea that action is objective, we can measure it, but effort is subjective. So, you can see if you’re performing an action, but the perception of effort behind it is this kind of subjective and thought-based experience. So, we can do the laundry or DO the laundry. We can do laundry from a place of self-love and self-care, like “I want to care for my clothes, and to have nice clothes to wear tomorrow and I’m going to do this for myself and I’m going to be mindful as I do it”. And I’m going to do this out of necessity, but also out of a natural drive that’s coming from this place within. Or I can have laundry on my to-do list that’s causing me stress. So, sometimes even wu wei is about doing less and not feeling guilty for that.
The second tool for emotional wellness is journalling and writing. This is one of my favourites. So, journalling allows us to keep a record, to get creative, and to engage in self-expression. And when we write we engage both sides of our brains: the motor centres, the language centres, the centres that are involved in language perception and in language generation, also our visual centres. So, a lot of the brain is lit up in the act of writing and that can help integrate some of our deeper thought processes.
Writing down things leads to clarity and focus. We’re forced to deepen our thought processes and remove ourselves from some of the cognitive loops we might be engaged in. We can complete our thoughts and reach their inevitable, often ridiculous conclusions and this kind of comes from some core beliefs, or, we call them “automatic thoughts.” Like, “I’m a failure” or “I’m worthless”. Those kind of things that our brain generates based on past experiences that may not be relevant anymore to who we are now. Through writing we’re forced to look inside of ourselves, to causes and explanations for how we feel. We’re also able to express ourselves and rid the body of pent up emotions, such as anger and aggression and sadness, shame.
I often recommend that people write a letter. Especially if there’s someone in the past that’s done damage to them, or hurt them. Someone that they miss, sometimes remembering somebody through a letter: sometimes people wish that they could communicate with someone who’s passed away or is no longer in their life anymore and, through this letter-writing, you’re able to.
I also have people write letters to themselves from the perspective of their personality at age 80, and this can sometimes provide perspective for patients who are depressed and young, because it gives them an idea; it increases the perspective of their lives. And sometimes I have people personify and anthropomorphize their problems or addictions and write letters to that or write letters from that and through that process can learn a lot about the relationship between themselves and alcoholism, for example.
There’s another great activity I like called the “God Jar”, for people that have constant worries or wake themselves up at night and process things or who are anxious about the future—The God Jar or the Wish Jar. And so, you get a mason jar and little pieces of paper and you write things that you’re worried about or things that you’re anxious about or thinking about and you scrunch them up and throw them into this jar and, in essence, symbolically, you’re giving those problems to “God”, or to the universe or you’re just simply filing them away for later use. And this is sort of a subconscious, or conscious, dumping of your problems, especially if you don’t have immediate control over them. I mean, in the middle of the night you’re not going to be able to finish your taxes when you’re supposed to be sleeping, or solve a problem at work. And that can often worsen our problems, when we’re not getting enough sleep. Then I sometimes have people open up that jar 6 months later and take a look at some of the things they’ve written and that can also generate feelings of accomplishment and achievement and perspective when you find out that those things that you were so worried about 6 months ago are no longer even relevant and you barely remember them. So, it’s pretty powerful.
Another great exercise is something called a Gratitude Journal. And there’s a Ted Talk about this that, for 21 days, and I like to tell people to do this for a full month, 28 days. If you write 3 things that you’re grateful for at the end of the day for 21 days, it actually changes your brain structure and helps you see things in a more positive light and focus on the blessings, rather than the things that you lack. Our brains have a negative bias. So, they’re wired to pay attention to the things that we’re missing out on and that we’re lacking and when we focus on and acknowledge the things that are going right for us, it can sort of change our perspective. And, throughout the day, as you’re doing this exercise, you’re going to be paying attention to things that you’re going to have to write down later, so you’re paying attention to the things that went well, that you want to include in your gratitude journal. And this can have profound effects.
There’s some studies about journalling. And there was a study that showed that patients with HIV or AIDS, who wrote about their life for 30 minutes had an increased CD4 T cell count—and that’s the cells in the body that are affected by the HIV virus. So, by simply writing about their lives, something profound, it wasn’t just a grocery list. But writing something profound about their lives, such as sharing their life story, actually increased their immune system’s ability to function in the face of the HIV virus.
And then, similarly, there was another study in patient with rheumatoid arthritis—this is an autoimmune condition—they had these patients write for 20 minutes a day, for 3 days, and they found that their symptoms went down and their immunoreactivity went down. So we’re seeing these two studies, and we’re not exactly sure of the causal effect, these studies are a little bit correlative and very difficult to control for, because patients who are in the study, subjects know if they’re writing in their journal or not. But these studies were controlled against people who were just kind of mindlessly writing about grocery lists. So, it was writing about more profound concepts and sort of outlining a significant life event, or life story, or significant events that were happening in the day that had an emotional charge to them.
So, we find that engaging in journalling, even 20 or 30 minutes a day, can actually modulate the immune system. So, if you have a immunodeficiency issue, like HIV, it can increase immunoreactivity, and if you have an autoimmune disease like rheumatoid arthritis, or asthma, if can lower that immunoreactivity and inflammation. So there’s this evidence that journalling and our thoughts and emotions are directly impacting our immune system and our immune system’s ability to function and balance itself.
The third tool for mental and emotional wellness is interpersonal support. And, being a naturopathic doctor who does a lot of counselling in my practice, I tend to favour psychotherapy and counselling as a form of social support for people that don’t feel that they can be authentic or have that deep connection with people in their lives.
There’s evidence that loneliness is the new epidemic, especially in our society and, as social animals, connecting with others is part of our biology, part of who we are. Through therapy, what I really like about it, is it can help us reframe the past and our personal identity. We can start to identify some automatic thoughts and core beliefs, which are deep-seated beliefs that may not serve us anymore in the present and may actually be contributing to feelings of low mood or behaviours that are unwanted. It can also allow us to rewrite our life story, so, looking back on the past and reframing certain events, from the perspective of someone maybe with more resources and power. For example, someone with a history of trauma may have an idea of powerlessness and being victimized and, in every single story of trauma that I’ve encountered, people have always responded in some way. Either psychologically, mentally, emotionally, if not in action, and sometimes just recognizing these responses changes our whole perception of the event and our identities in the present, our ability to act in the present. So, there is evidence that stress is related to our perception of things that happen, not actually what happened. So, for example, imagine somebody that’s just broken up with their girlfriend and they were very in love. And you can image what their mental and emotional state would be like. Maybe the next day they don’t feel like getting out of bed, there’s clothes all over the floor, they haven’t brushed their teeth, they’re feeling extremely sad, and crying. And nothing has changed biologically in this person, but the situation surrounding their life has changed. Then imagine that this person wakes up the next day and they’re in this state of low mood and depression. And they get a phone call. And it’s their girlfriend saying, “you know, I’d like to get back together, I made a mistake, I’m in love with you and I don’t want to be broken up anymore.” So you can imagine that this person’s mood is going to change rapidly as the situation changes. And so, there is a change in their circumstances, but not in their physical biology.
And sometimes, in past events, there’s the story that our minds create around what happened, and then there’s the actual events that happened. So you might call your partner and they don’t pick up the phone, and we start to create a story about why that is. Maybe it’s because they don’t love us anymore, they want to break up with us, that we’re worthless, that no one’s ever loved us, that we’ll never find love, that we’ll always be alone. But, in actuality, we don’t know those things and the only thing that’s happening is they’re just not picking up the phone and there’s thousands of explanations for that.
We perceive situations based on our personal histories, our physical conditions, our state of minds, etc., and things that we’ve learned in the past and also our core beliefs. So, we filter our experiences through our perceptions and our identities and personalities and so, by understanding more about these things, we can understand why we pick out certain events and draw conclusions from the connection between those events rather than others. There’s some people that, when they fail a test, they just think, “Oh, it was a hard test, or maybe I didn’t study hard enough.” And there’s others that think “I’m a failure, I’ll never pass anything, there’s no point in trying, I’m dropping out of school.” And so it’s not just the event but our perception of the event that change our thoughts, mood and behaviours.
Another great thing that therapy and social support can do, is help us identify our passions and purpose in life. So there’s a psychological that I really like to listen to called Jordan Peterson that talks about how the purpose of life is not necessarily well-being and happiness, because happiness is a state that can be derived chemically, through doing things like cocaine, or substance abuse, and happiness might just be a disposition that certain people embody better than others and that life is suffering. And this is present in Buddhist philosophy that no matter how we live, we’re going to encounter events that are devastating for us, and that are hard for us to deal with. And so, in those situations, we’re not going to feel happy, so what’s going to drive us? What’s going to push us forward? What’s going to keep us going in those times and so his theory or idea is that we should look for what makes it worth it: what adds meaning to our life. What is our potential in life? What is our purpose? What gives us that sense of meaning such that, when we encounter these situations of suffering and hopelessness that we’re able to continue on. So, having a direction for our lives, and having a sense of identity and purpose that gets us up in the morning and makes us move forward, even when we’re not particularly feeling happy that day.
Therapy and social support are also great for just self-acceptance. So, having other people mirror back to us who we are and how we’re being in the world.
The 4th tool for emotional wellness is mindfulness and meditation, so very very powerful tools. It’s arguably very difficult to be healthy in this day and age without some form of mindfulness meditation, or meditation practice to combat the increase in stress that we encounter in our society. So, mindfulness is—there’s many different techniques, but the main tenant is just taking the perspective of the compassionate, detached observer to our thoughts, emotions and physical sensations. So, when we split our mind or watch our thoughts, we can get a better sense of awareness of how emotions and thoughts arise in our body, pass through our bodies, and how we’re not them—that there’s this observer role that we can also take, that we can watch ourselves from.
Mindfulness allows us to stay in the present and reframe certain situations and just slow time down so that we’re not victims to the whims of our biology, that we’re able to understand it a little bit more. And there’s a great resource on the internet called “Mindfulness-Based Stress Reduction” that’s a secular kind of meditation by a man in Massachusetts called Jon Kabat Zinn and you can download body scan meditations or take a course in MBSR in your town. I highly recommend them; they’re really great for developing mindfulness practice.
There’s also yoga, and qi gong and tai qi, and these kind of integrated, mindfulness-based and physical exercises that can help slow us down, bring us into the present and help us observe our minds and emotions a little bit better. And there’re amazing for managing stress. There’s good evidence building about them helping us deal with stress and manage our mental health conditions.
And the 5th tool for mental and emotional wellness is to look at that mind-body connection that I mentioned before. The mind-body theory sees our thoughts and emotions as energy that can impact our cellular biology, from that idea of psychoneuroimmunology. And there’s increasing evidence about this and how calming our thoughts down, doing some mindfulness meditation, can affect our heart-rate and can affect our blood pressure, and journalling can affect how our immune system responds.
There’s this idea that if our thoughts and emotions aren’t processed properly they can become trapped and stagnated in the body and contribute to disease. So, Gabor Mate mentioned that resentment can build up and lead to things like cancer. It’s one of his theories that he’s observed through working with patients.
We know that there’s this connection between physical manifestations of symptoms and physical conditions and certain emotional causes. In medicine we know this because every time a study is done, a randomized control trial, two groups need to be divided amongst the subjects. One is given a placebo, an inert pill. And this idea that someone who believes they’re taking medicine will notice a positive effect, is something that we just take for granted, but we build into every single study that we do, if it’s a good study. So, this idea that you can take a pill, believe it’s helping you, and actually physically notice a change in your body is really remarkable. And this just proves that there’s this connection between the mind and body, that we can further explore and exploit.
So, there’s things like herbal remedies that help our body increase our cells’ resilience to stress and help manage the stress hormone cortisol. And these are some herbs called adaptogens. So, they literally help us adapt to stress. And these are things like withania or ashwaghanda, rhodiola, ginseng, even nervine herbs like St. John’s Wort and skullcap can help balance our neurotransmitters and our stress hormones and lower inflammation in the body.
Doing self-care things like getting a massage, or getting acupuncture can help. And there’s a study that compares acupuncture to Prozac, so getting one acupuncture session a week for 6 weeks was actually comparable to Prozac for decreasing symptoms of depression and anxiety.
In my practice I always address diet and gut health and just make sure people are absorbing their nutrients, that they’re guts are producing the proper amounts of neurotransmitters, that there’s the proper bacterial balance, that there’s no inflammation being caused by a gut dysregulation. And we also want to remove those external stressors that can be contributing to an impaired digestive system. So, there is this saying that “we are what we eat,” but more accurately, we are what we absorb, because you can eat a lot of stuff, but, depending on how you’re digestion is functioning, we might not be absorbing all of it and incorporating it into our body, into our cells.
So, inflammation in the gut, caused by a bacterial imbalance, or food sensitivities can impact our health and we have some evidence that depression and anxiety can be caused by some latent levels of inflammation in the brain. And we know that there is an impact on gut health and increasing levels of inflammation and also stress. And really lowering that stress response, healing the gut, can have huge impacts on our mood. Establishing routine, and sleep are major pillars. So, I don’t think I’ve ever encountered a patient who felt mentally healthy when they had disrupted sleep. A lot of the time having a ritual around sleep and getting into a routine and waking up at the same time every day, really working on getting deep sleep—so avoiding electronic use before bedtime, trying to get as many hours before 12 am of sleep as possible, so preferably having a 10pm bedtime or winding down around 10 pm. Doing things like teas, or hot baths, or reading a book before bed or doing some yoga or stretches or meditation before bed to teach the body that it’s time to start relaxing is really important and has huge impacts on health, on our mood, on our emotional wellness, our ability to cope with stress, our ability to heal from stress, and our ability to balance inflammation and the immune system.
There’s evidence that exercise—I mean exercise is arguably the first-line therapy for someone with depression, especially someone under the age of 24. Instead of reaching for pharmaceutical interventions, such as selective-serotonin reuptake inhibitors, more psychiatrists are recommending exercise to young patients, which is wonderful. I’m so happy about that! And, so 30 minutes of a moderate to intense form of exercise such as weight training, or running or moving your body, can help release some of those trapped emotions, as well as boost those neurotransmitters and help our body increase its resilience against stress.
And then, finally, I just want to point out that making sure that we’re supporting our neurotransmitter synthesis through diet is really important. So, making sure that we’re getting enough magnesium, zinc and B vitamins, and proteins and amino acids, which are all helping us create the neurotransmitters like serotonin and dopamine that are going to impact our mood and mental health. So, we can journal, but we are physical beings, and we are a product of our biology. So, by supporting that biology through proper nutrition, we’re able to incorporate those nutrients and create the proper components of our body for proper mental and emotional wellness.
So, I also like to ask people this miracle question. So, this is the final thing that I’m just going to conclude on. The Miracle Question is from a modality called “Solution-Focused Therapy”. And this question is, “if you woke up tomorrow and all of your issues were completely gone, you woke up in an amazing 10 out of 10 state of energy and physical well-being and mental and emotional well-being, what would be possible for you? What would your day look like?” If you can stand in that place and sort of write down what you’re aiming at, what you’re aiming towards, it helps set the stage for taking the proper actions that preserve your mental and emotional wellness. And it also helps you stand in a new territory, one that’s not of disease or illness, but one of possibility.
And, finally, I was at this free meditation circle as we were talking about self-love, and we were talking about how difficult it can be to love oneself. Because, oftentimes we have these core beliefs that drive our psyches and oftentimes these core beliefs are negative. And so what was said was that it’s often hard to stand in a place of self-love when you’re intent on changing things and you’re not happy with where you are now. And so, he said, the person running the meditation said, “self-love is like a garden. So, you can nourish the soil and water the seeds, but you can’t actively force the garden to grow.” So what you can do is, you can take care of the things you love in yourself, all the things that you have in your right now, rather than trying to be somewhere that you’re not currently at. And this is kind of like when you have, for parents out there, if you have a child, you love your 4-year old child, and you don’t put expectations on them that you would a 25-year old. So, you’re loving your 4-year old at where they’re at, but also recognizing that this is somebody who is developing and so you’re loving their potential to develop, just as you’re loving their 4-year old incarnation, their 4-year old manifestation of their personalities. So you’re loving their potential to grow, just as you love the seeds that you’ve planted in your garden, but you’re also loving things where they’re at. And through that act of self-love and tending to the garden, or tending to your child, you’re encouraging that growth and development in the directions that you want.
My name is Dr. Talia Marcheggiani. I’m a naturopathic doctor and I work in Bloor West Village, in Toronto.
When a successful person is asked to share the secrets of his or her success, the unanimous response is that success requires “effort” and “hard work”. Other popular euphemisms are that success demands “sweat, blood and tears” or “1% inspiration, 99% perspiration”. In grade school we’re lectured on working harder and reprimanded for not trying hard enough. Put in the time and effort to get the grades that will land you the job that will require similar or increasing levels of time and effort. Olympic athletes are lauded as modern-day heroes for their early mornings, punishing workouts and restricted diets. Our society reveres those who put in 80-hour work weeks, despite their implausibility, as we all need to sleep, eat and defecate, which take up hours that are obviously not spent working. It’s a shame to some that we’re limited by these earthly, time-consuming bodies that have been the disdain of capitalism since it’s inception. I see more youth in my practice, who are already bearing the weight of society’s expectations. They are working hard, as instructed, and this “hard work” is taking a physical, mental and emotional toll on their lives. But what can they do? Success requires effort, goes the mantra of our times.
This effort shows up on faces and in bodies. Our minds exhaust us with chastising inner talk; teeth clench, jaws grind and shoulders hunch around ears, creating a new neck-less species, The Hard Worker, inhabiting the earth in increasing numbers.
70% of people today admit to being under stress. When I asked my patients if they feel “stressed”, many shrug, deny or tell me their stress is nothing that they can’t handle, and then proceed to rank their stress levels as 6 out of 10 or higher, 10 being a hair-pulling, crazy-eyed, stressed-out-of-their-wits state—I find it significant that being more than halfway to our limits still qualifies us as not being stressed.
It’s likely that admitting to stress and overwhelm is a weakness in our effort-driven society. If the bodies we inhabit fail to perform, we’ll be replaced by someone more able-bodied, or someone more able or willing to push their limits and sacrifice their health for short-term success—or maybe a machine. Machines don’t need paid vacation or sick leave. While the future seems bleak, it certainly helps with the healing business, as 75-90% of doctor’s visits are either directly or indirectly stress-related. We know that stress has the power to wreck havoc on the body, contributing to diseases, inflammation, decreased immunity, proliferation of cancer and premature aging. We know that stress is implicated in the rising incidence of mental health conditions. We know that things can’t go on as they are, the system is simply not working.
And so when modern society is failing us, it helps to turn to ancient ideas, before it all went wrong, such as Taoist philosophy, to look for answers. The Taoist principles of wu wei, or “effortless action”, tell us that action does not always originate from effort and stress. Effective actions, like creativity and good ideas, can occur spontaneously and of their own accord.
In a society where relentless growth and production are imperative for the survival of the economy, it’s hard to image any action in the absence of sheer effort. Incessant production can’t rely on the eb and flow cycles of natural inspiration and creativity to dictate when, how much or how hard we work. And yet, this perhaps says more about the societal necessities of the work available to us, and our enjoyment (or lack thereof) of such work, than it does about human inspiration. I’ve been planning this blogpost for a while and although it might have been written sooner if set to a deadline, I’ve eventually gotten around to it; here it is. It is a fact that when things need to get done, they will. The doing might happen later than we’d like it to, and yet it still happens, inspired by a genuine desire or necessity, rather than pressure-cooker of stress.
I’m often asked, as a doctor, to help support my patients’ bodies in periods of intense stress—”periods” that have gone on for years with no apparent end in sight. While there are several remedies that can help the body recuperate from the wear and tear of effort or help the adrenal glands secrete more cortisol to continue producing more and faster, there’s also only so much that can be squeezed out of tired organs. Oftentimes, as I’ve written before, the path to healing is paved with introspection and a serious reconsideration of lifestyle. Can we continue to produce and strive at our current rates and still expect to feel fit, healthy and energized? We can build faster computers and smarter phones but our bodies are very much limited to the tools nature has slowly evolved over time, including the natural medicines available to us. Perhaps our lifestyles, like the economy and the stress on the environment, are simply unsustainable. Perhaps it’s time to question how many of the activities in our lives are worth the effort.
While it may not be possible to quit our jobs, pack up and move to the Bahamas, perhaps there are small nooks in our routines where wu wei might fit and flourish. It may be possible to ease up on our own expectations of ourselves, or give up some of our conventional ideas of success. After all, is the journey to success worth slogging if we won’t be happy or healthy when we get there? Finding space in our lives to allow action to arise spontaneously may be crucial in doing the necessary, healing work of stress-management.
Applying wu wei might mean examining the intentions behind our actions and our current lifestyles. Here are some questions to ask yourself.
When is effort appropriate and when is it wasted?
Where am I trying to get to? What is my definition of success?
Is there a day/afternoon/hour in my week when I can “schedule” unscheduled time?
Are there tasks I can ease up on, laundry for instance, that I can trust will get done on their own time?
Can I agree to forgive myself when I fail to meet deadlines or choose to take a day off?
What would it feel like to stop paddling and let the current carry me for a while? Can I do this at work? At home?
In what area of my life could I allow myself a little more room to breathe?
What are my top ten values in life? What goals align with those values? What actions would help me move closer to those goals? How much does thinking of those actions excite or inspire me?
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.
According to James Altucher, author and entrepreneur, it is possible to reinvent yourself in 5 years. In his book, The Power of No, he tells us how to reinvent our lives by first saying a big, fat No to all the things that don’t serve us—toxic friendships and relationships, stagnant 9-5’s, harmful behaviours, negative thought patterns and, well, just things we simply don’t want to do—in order to free up our lives for greater happiness, abundance and creativity.
It is now the end of May. For me, May has been a month of reinvention. For the past 10 years it has been the month of closing and good-byes, specifically the end of the school year. The Canadian College of Naturopathic Medicine class of 2015 has graduated, as I did last year. Last week my Facebook feed was infiltrated with pictures of flowers, long black gowns and tearfully heartfelt thank-yous to the friends and family that got my colleagues through their gruelling 4 years of naturopathic medical education. Last year that was me—I remember the black gowns, the face-ache from smiling, drinking a little too much at grad formal and winning an award (“Most Likely to Write a Best Seller”—complete with misspelling of “bestseller”) while eating Portuguese chicken at my house afterwards with my friend F and his family. This year, one year later, I watch these events from afar. May 2014 offered new beginnings and chance for reinvention. I was dating, enjoying the sunshine, looking forward to a trip to India, looking forward to beginning a practice as a naturopathic doctor. Mostly, last May was about the death of one life—that of a naturopathic student—and the birth of a new one: a complete reinvention.
This year the rest of my life stretches before me like one long expansive road. My career is underway. My dating life is stagnant. The next steps are more like small evolutions rather than massive, monumental milestones. I most likely will not don a black gown again, but I can reinvent myself by following the 20 steps below. I can always check back into these practices when I’m feeling stuck, alone or afraid. When life is not going my way, there is always a chance to begin a reinvention of some sort. And, I remind myself, my current reinvention is likely well underway. Since I graduated last May, I have been in the process of reinventing: just 4 more years left until I complete my obligatory 5. While 4 years sounds like a long time, I know from experience that 4-year cycles turn over within the blink of an eye.
What stage are you on in your own personal reinvention? Wherever you are, follow these steps to reinvent yourself:
1) Say no. Say no to all the things that you don’t want to do. Say no to things that cause you harm: emotional harm, mental harm, physical harm, loss of time, loss of money, loss of sleep. We need to say no first before we can free up the time and energy to say yes to the things that we actually want. In fact, say “no” to all the things you aren’t saying “F#$% YES!” to. Read this article for more information.
2) Re-examine your relationships. Who doesn’t make you feel good? Who makes you doubt yourself? Who do you feel will reject you if you act like your true self around them? Gracefully begin to distance yourself from these relationships. You might feel lonely for some time, but loneliness is sometimes a good thing.
3) Clear out your junk. Get rid of everything you don’t use, don’t like and don’t need. Marie Kondo, in the Life-changing Magic of Tidying Up, tells us to donate, trade, sell or dispose of everything we own that doesn’t bring us joy. I think that that is a wonderful litmus test to decide what we should be holding on to. Personally, one thing that did not bring me joy was an awful old desk in my room. It was uncomfortable and ugly. I replaced it with a free desk someone I knew was throwing away. I also donated 7 garbage bags of things: books, clothes and keepsakes from when I was a child. Since then, I feel like my room has been infused with a little bit more joy. Remove all your joyless items from your life and observe how your energy changes.
4) Sit in silence. This could be meditation, staring at the wall, chanting or simply breathing. Do it with eyes closed or open. I start at 20 minutes of meditation—a meditation teacher I had told me to always use a timer to increase self-discipline—and work up to 30 some days and an hour on really good days. Start with 5 minutes. Sitting in silence helps to quiet the mind and bring us back to the present. You’ll be amazed at what you discover when you sit in silence. Read some books on meditation or take a meditation course for specific techniques, but simply sitting in silence can offer amazing benefits as well.
5) Explore the topics that interested you as a child. When I got back into painting in 2008, after getting a science degree when I’d always been interested in the art, my life changed a little bit. I started a blog in 2011; it happens to be the one you’re reading now. Get back into whatever you were passionate about as a child, even if it’s just a cartoon you used to watch.
6) Start a gratitude jar. Once a day write down something that you are grateful for—use as much detail as possible—and toss it in a jar or shoebox. When you’re feeling low, open up the jar and read the messages you’ve left yourself. I also tried a similar exercise with things I wanted to manifest or achieve. A few months later I read my entries and realized I’d achieved every single one. It’s amazing what kind of energy glass jars can attract.
7) Read. According to James Altucher, you need to read 500 books on a given topic in order to become an expert on something. You have 5 years to reinvent yourself, so start your reading now. Read one book and then, from that book, read another. It’s interesting where reading trails can lead us. I read one book, which mentions another book, read that book and then end up in a new world I never knew existed. I personally feel a little anxious when I don’t have a book beside my bed, but if you’re new to reading, start small. There are two books that I’ve already mentioned in this blog post; start from either of them and then go from there. The next on my list is The Artist’s Way, by Julia Cameron, which was mentioned in The Power of No. Who knows where that one will lead me.
8) Get 8-9 hours of sleep a night.
9) Eat your vegetables, especially leafy greens. Avoid sugar, moderate alcohol and caffeine. Eat healthy protein and healthy fats (if you don’t know what those are, welcome to my blog! browse more of my articles on healthy eating or book an appointment with a naturopathic doctor like me!—shameless self promo).
10) Exercise. Enjoy some movement every day.
11) Exercise your idea muscle. According to James Altucher, creativity is a muscle that we need to exercise lest it atrophies, like any other muscle. He recommends getting a journal and writing 10-20 ideas in it every day. They don’t have to be good ideas, just any ideas. Removing the filter of self-judgement is important for allowing creativity to flourish. We need to strengthen that muscle.
12) Get some psychotherapy. Start dealing with childhood wounds and meeting your inner critic. Address your erroneous beliefs about yourself, the world and the past. Contact me to learn where to get quality psychotherapy in Toronto at an affordable price.
13) Expand your social circle. If you find that after following step 2 your social circle has gotten smaller, start to find ways to expand it. My favourite way to reinvent my social interactions, and thus begin to reinvent my life, is to look up a meetup.com group and start attending. If you’re not sure about a meet-up group you’ve attended, give it 2 more tries before deciding not to go back. In 3 tries, you’ve either made new friends and connections or decided that the energies of the group aren’t right for you. Online dating is another cool place to start meeting people outside your social sphere and getting over social anxieties.
14) Establish a self-care routine. What would someone who loved themselves do every day? Try to do at least some of those things every day. It could be going for a 15-minute walk before doing the dishes. It could be doing the dishes rather than leaving a messy kitchen for your more tired future self. Think about what things will make you feel good and then do them. Most of the time this involves bubble baths—light some candles while you’re at it. Read this article on self-care to learn more.
15) Write a Have-Done List. Instead of writing a list of things you have to do today—your standard To-Do List—write a list of things you’ve done at the end of every day. This fills people with a sense of accomplishment from looking at everything they’ve done. It definitely beats the stress and anxiety of looking at the list of things that must get done looming before them.
16) Treat other people as if it were their last days on earth. We’ve all been told to “live each day on Earth as if it were your last.” But what if you lived as if each day on Earth were everyone else’s last? You’d probably treat them a little more nicely, be open with them, be honest with them and not gossip or speak badly about them. You might appreciate them more. The idea is James’, not mine, but I like it. I think it’s a good rule for how to treat people.
17) Pay attention to what you’re jealous of and what you despise in others. The things we are jealous of in others are often our disowned selves. If I’m jealous of my friend’s Broadway debut I’m probably disowning a creative, eccentric and artistic side of myself that it’s time I give love and attention to. The things we’re bothered by in others often represent our shadow sides, the negative things we disown in ourselves. I used to tell myself the story that my ex-boyfriend was selfish; he took care of his needs first. However, maybe I just needed to start taking care of my own needs or come to terms with my own tendencies towards selfishness. Our negative emotions in relation to others can provide us with amazing tools of enlightenment and prime us well for our own personal reinventions.
18) Let go of the things that were not meant for you. Past relationships, missed opportunities, potential patients that never call back, “perfect” apartments, etc. Say good-bye to the things you don’t get. They’re for somebody else. These things are on their own journeys, as you are on yours. If you miss one taxi, know that there are other, probably better, ones following it. So, rather than wasting time chasing after the missed taxi, meditate on the street corner until the next one comes along.
19) Listen. Ask questions. Show curiosity. When someone finishes speaking to you, take a breath and count to 2 before responding. It’s amazing how your relationships change when engaging in the simple act of listening. I love the Motivational Interviewing technique of reflective listening. In reflective listening, we repeat back the other’s words while adding something new that we think they might have meant, looking for the meaning between the person’s—your friend’s, patient’s or client’s—words. I find that this has helped the person I’m speaking with feel truly listened to. If I get the meaning wrong, it gives the other person a chance to correct me and thereby ensure that we’re really communicating and understanding each other. This one simple tool—reflective listening—has transformed my naturopathic practice and interviewing skills.
20) Be patient. Personally, I’m terrible at this. But, like you, I’ll try working on the other 19 steps while I wait for the next stage of reinvention to take hold. I’ve ordered my next book from the library. See you all in 4 years.
PCOS, or Polycystic Ovarian Syndrome, a condition which affects an estimated 10% of women in North America and is the most common endocrinological dysfunction in women.
Its symptoms and the people it affects are as diverse as there are people affected; it’s one of my favourite conditions to treat.
Signs and Symptoms:
PCOS is characterized by hormone dis-regulation. Oftentimes it presents with cysts on the ovaries, but not always. In PCOS there is often elevated blood glucose and other markers of insulin resistance. There are often issues with menstruation: the absence of periods (amenorrhea), or heavy and irregular bleeding (dysmenorrhea). Weight gain is common—although some women with PCOS can be thin—as is hormonal acne and hirsutism, a nice word for male-pattern hair growth: excess hair growth around the chin and upper lip, the chest or navel region. Pelvic pain around ovulation may occur when cysts rupture. Infertility is common in women with this condition.
PCOS is a syndrome, rather than a disease, which means it presents as a collection of symptoms that can be varied in their presentation and severity. Lab work may read that estrogen, testosterone and LH (a hormone produced by the pituitary gland and ovaries) are high and progesterone and FSH (a hormone released by the pituitary gland) are relatively low. However, what brings a woman with PCOS or PCOS-like symptoms into my office is varied and usually consists of any combination of visible symptoms: hair growth, weight gain, acne, menstrual irregularities or infertility.
Etiology:
We are uncertain how the collection of symptoms that is PCOS arises. One prominent theory is that issues with blood sugar and insulin regulation create ovarian cysts or disruptions in the secretion of sex hormones. This causes the ovaries to release more LH, which has the power to raise testosterone. High insulin, testosterone and estrogen can cause weight gain, hair-growth, acne, absence of ovulation (anovulation) and the inability to maintain the uterine lining and therefore carry a pregnancy to term.
Diagnosis:
PCOS is diagnosed by symptoms. It involves a combination of symptoms: amenorrhea (or absence of menstrual periods), infertility, hair growth on the face, acne and insulin resistance. The presence of ovarian cysts, as detected on an ultrasound were once diagnostic, but many patients present with symptoms and are cyst-free. An increase in LH and testosterone, with lab values indicating insulin resistance and metabolic syndrome, can also lead doctors to suspect PCOS, when appearing in conjunction with other symptoms.
Because it is a syndrome, patients often come into my practice with a variety of complaints. Some come in to deal with their skin health, others want help with fertility or menstrual cycle regulation and many others come in with weight loss goals.
Conventional Treatment:
Treatment in conventional medicine is simple: oral contraceptives. If your testosterone is high and estrogen and progesterone are out of whack, the conventional medical system tells us to simply override natural hormone production, or lack thereof, with synthetic versions of the same thing. For my professional opinion on regulating hormones with oral contraception, see my post on the birth control pill (which I no longer take). These birth control pills often contain chemicals that prevent the secretion of male hormones. This helps clear up acne and hair growth.
Medication for type II diabetes, Metformin, is used to help regulate insulin. Patients experience weight loss on Metformin, as it helps control insulin resistance, however it also depletes vitamin B12, which means that regular injections of B12 are necessary to avoid deficiency symptoms. Further, Metformin doesn’t address the root cause of insulin resistance, which is most likely lifestyle and hormonal imbalance. This means that patients will be medicated (and therefore receiving B12 injections) for life.
I do not mean to negate the fact that oral contraception and Metformin have helped countless women. I respectfully acknowledge the fact that the lens I look through is one of a different, more natural and whole-bodied approach to medicine that aims to treat the individual by addressing the root cause of disease.
In short: I prefer to try it the naturopathic way first.
Naturopathic Treatment:
Lifestyle. Naturopathic remedies are very effective, but often quite involved. They begin with lifestyle modifications—a low glycemic index diet like the Mediterranean or the Paleo diets, that emphasize whole foods, like fruits, vegetables, healthy fats and lean protein and eliminate sugar, white flours and white carbohydrates. Exercise is important in treating PCOS. One of my professors advocates intense cardio, such as high-intensity interval training, or weight-lifting 5-6 days a week. This must be done for several months before effects are seen and blood sugar and other hormones are regulated.
Supplementation and botanicals. Myo-inositol, a B vitamin, is a first-line treatment for PCOS in the natural health world. The amount of research steadily growing behind its use should probably make this gentle and effective treatment first-line for treating PCOS in all healthcare fields. Studies show that, when dosed properly, inositol can regulate blood sugar, assist with weight loss and regulate menses, even promote fertility.
Herbs like Vitex agnus-castus, or chaste tree, can help regulate the balance between estrogen and progesterone. Spearmint and Serenoa repens, or saw palmetto, can help decrease male hormones in the body. Gymnema and berberine are other therapies useful for regulating blood sugar and helping with weight loss.
Ensure that you are receiving counsel from a licensed naturopathic doctor before supplementing. The dose and quality of supplements and herbs is essential to feeling better—don’t hack it in the health food store alone!
Acupuncture. Acupuncture has been shown to be effective for promoting fertility. I have had some good success in promoting pregnancy and fertility with acupuncture in my practice. Fertility clinics in Canada now use acupuncture before and after IVF treatments to ensure treatment success. It also helps to relieve stress and lower cortisol, which helps with insulin-lowering and blood sugar management.
In Traditional Chinese Medicine, PCOS can manifest as dampness, Qi or yang deficiency or issues with the Spleen or Kidneys. Acupuncture can help tonify and balance these patterns.
Homeopathy. I have had success using homeopathy in conjunction with lifestyle and supplementation in treating PCOS. Homeopathy acts deeply on the energetic level of disease, working on the level of emotions and sensations and working to address the energetic cause of disease. It involves a thorough interview and an individualized prescription from a licensed naturopathic doctor or homeopath.
Mind-Body Medicine. The ovaries are located at the level of the second chakra, which is an energetic centre in the body associated with sexuality and creativity. Christine Northrup, MD, asserts that the presence of ovarian cysts represents an energetic blockage in our creative power and unmet emotional needs. Louise Hay, author of “You Can Heal Your Life” tells us that ovarian cysts represent some sort of past hurt that we can’t let go of. Crying, journalling and identifying repressed emotions can help to remove these energetic blockages. In many women with PCOS, there is an imbalance in the identification with their femininity, or what it means to be a woman.
Sometimes our bodies alert us of imbalances in our emotional lives through the presence of physical symptoms. As a naturopathic doctor, it is essential I address all levels of the person—mentally, emotionally and spiritually, not simply physically.
PCOS is a diverse and challenging condition to treat that can cause a lot of hardship for the women who suffer from it. However, a diagnosis of PCOS can be an opportunity for growth and transformative healing through naturopathic medicine. For this reason, I find it can be one of the most interesting and rewarding conditions to treat. Contact me to find out more.
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.
I know about the healing power of art. Sitting in front of a painting and quietly filling in a private world of colour helps to open up the right side of the brain, dissolving the hard edges of worn thought patterns and softening us to possibility. I know that wonderful realizations arise from the quiet space that art can provide. Bright colours draw attention to inner darkness. Self-criticism becomes louder and steps out into the light, allowing us to properly examine it.
Therefore, when I decided to attend an art therapy workshop, I figured myself to be already part of the choir who I thought would be preached to. I knew that art held the magical power to do deep psychological work. I was just curious as to how that would look in a therapeutic setting.
A classmate recently lent me a book that introduced me to the intriguing field of “narrative medicine.” The book is called Narrative Medicine: Honoring the Stories of Illness, written by Rita Charon, MD, an internist practicing in New York City. Narrative medicine combines the practice of medicine with simultaneously learning to recognize, absorb, interpret, and be moved by the stories of illness.
According to the book, the practice of narrative medicine builds empathy and compassion for patients by giving meaning to their experience through stories. It allows doctors to bear witness to the patients and their suffering and to enable those who are suffering to be heard, thus making their care more effective and, by virtue of the doctor’s presence and ability to testify to the patient’s pain, the pain is lessened somewhat.
The Need for Narrative in Modern and Natural Medicine
Rita writes, “the medical impulse toward replicability and universality has muted doctors’ realization of the singularity and creativity of their acts of observation and description.” In medical school we come to learn that, when asked to choose between a) b) c) d) or e), all of the above, there can only be one right answer. Through these educative measures, we are led to believe that there is no room for creativity or individuality in medicine. Narrative medicine, however, begins to challenge that belief. According to Dr. Charon, there is a struggle in medicine to balance the need to properly observe the phenomenon of the individual patient and his or her particular clinical presentation before us, with the need to fit people into diagnostic categories. Oftentimes, the scale tips to the latter, simply by nature of patient volume or ease of the encounter. When we fit people into categories we can ease the anxiety that comes with uncertainty. We are soothed by the security of being right, the same way we are soothed by correctly choosing c) on a multiple choice exam. Patients, however, have come to resent this aspect of modern medicine. Rita writes, “patients complain that doctors or hospitals treat them like numbers or like items on an assembly line. They lament that their singularity is not valued and that they have been reduced to that level at which they repeat other human bodies.” In Rita Charon’s eyes, however, we are beginning to see a new emergence of both doctors and patients taking back the right to patient individuality in medical care. We naturopathic doctors hear this often, when asking why a patient decided to come to see us in lieu of a medical doctor, and hearing that they were driven by the need to be treated “like a person”, not just a disease.
Our bodies and our health are integral parts of the narratives of our lives. And so a personal medical history that, in the case of a medical school exam, takes about 8-10 minutes to complete, actually carries in it the patient’s life story. Everything that the body have been through the self has also been through and whatever has happened to the body remains ingrained in the self and forms a part of the patient’s narrative. Kathryn Montgomery, a colleague of Rita Charon’s once said, “you can accomplish an entire medical interview by simply asking a patient, “tell me about your scars.'”
Dr. Rita Charon writes, “without doubt, the teller and the listener in the clinical setting work together to discover or create the plot of their concerns. The better equipped clinicians are to listen for or read for a plot, the more accurately will they entertain likely diagnoses and be alert for unlikely but possible ones. To have developed methods of searching for plot or even imagining what the plot might be equips clinicians to wait, patiently, for a diagnosis to declare itself, confident that eventually the fog will rise and the contours of meaning will become clear.” Narrative, we learn, is essential for understanding illness.
Receiving a Patient History
Sir Richard Bayliss, another colleague of Charon’s, writes, “not only must the physician hear what is said but with a trained ear he or she must listen to the exact words that the patient uses and the sequence in which they are uttered. Histories must be received, not taken.”
Rita Charon’s current method of “receiving” a patient history is described eloquently in her book. It differs so much from the style we are taught in medical school, that I feel it is worth sharing. She writes that, when she first meets a patient, she begins by saying, “tell me what you think I should know about your situation.” She then makes the commitment to listen, without speaking or writing anything down. In medical school we are taught to organize a chart by history of presenting illness, past medical history, family history, etc. However, Charon realized that, by allowing the patient to direct his or her own clinical interview, the information all comes out eventually. She believes it is crucial to allow the patients to narrate their own history, allowing the information to take its own order, to formulate itself into not just a coherent plot but also a literary form, so that the entire story becomes apparent, and free from her own bias and internal or external editing. While the patient tells his or her story, Dr. Charon listens as intently as she can, registering diction, form, images and the pace of speech emitted from the patient’s mouth. She tries not to interrupt or confer signs of encouragement, pleasure or disapproval. She refrains from asking questions. And, she takes the time to absorb the metaphors, idioms, accompanying gestures, plot and characters involved in the patient’s narrative.
Once her patient has finished with his or her telling, Dr. Charon proceeds to the physical exam portion of the clinical visit. She tries to capture what has been said by writing the story down in her chart while the patient changes into his or her gown and readies for the physical examination.
Dr. Charon writes that it has taken her a while to perfect this form of receiving a patient history. As unorthodox as it may seem, she writes that she has come to thoroughly enjoy the individuality and humanity of the stories that come from each person, each one so different from any other and each belonging to a singular person and body. It has helped her understand her patients, maintain empathy for them and provide them with what she believes is more effective care.
The Parallel Chart
Rita Charon believes that, not only is the use of narrative helpful for the doctor-patient relationship, it can be used to help physicians and other healthcare practitioners digest their experience as well. In one of her years as a clinical supervisor, she developed a practice called the Parallel Chart. As medical students and doctors, we are required to write our patient’s stories in the form of medical charts, following a specific format, creating what can be viewed as an entire literary genre used solely among medical professionals. Medical students and doctors alike are expected to learn to write and maintain a coherent medical chart, according to the standards of this genre.
However, as a clinical supervisor, Rita Charon also has her young precepts write a Parallel Chart, one that will not be filed for reference but that is just for the benefit of the practitioner, written in plain language, about one of his or her patients. She tells her students, “every day you write in the hospital chart about each of your patients. You know exactly what to write there and the form in which to write it. You write about your patient’s current complaints, the results of the physical exam, laboratory findings, opinions of consultants, and the plan. If your patient dying of prostate cancer reminds you of your grandfather, who died of that disease last summer, and each time you go into the patient’s room, you weep for your grandfather, you cannot write that in the hospital chart. We will not let you. And yet it has to be written somewhere. You write it in the Parallel Chart.”
After giving her students these instructions, Rita Charon meets with them in a group once a month and gives everyone the chance to read a Parallel Chart entry of their choice out loud. After the reading, she proceeds to comment on the genre, temporality, metaphors, structure and style of the text that has been written, using her literary background as a guide. The other students then have a chance to respond to the text, creating a dialogue surrounding their clinical experiences.
She reflects that her students in the past have written about their deep attachment to patients, their feelings of helplessness in the clinical encounter in their role as mere medical students, the rage, shame and humiliation they experience in the face of disease as well as their awe at patients’ courage. Dr. Rita Charon claims that the students who undertake the task of keeping a Parallel Chart have found that they are more in touch with their own emotions during the clinical encounter, feel deeper empathy for their patients and fellow colleagues and are able to understand their patients more fully. Research is even being conducted at Columbia University to evaluate the effectiveness of Parallel Charting, finding that physicians who engage in this practice are more proficient and effective at conducting medical interviews, performing medical procedures and developing doctor-patient relationships with patients.
In many ways, naturopathic medicine already acknowledges the importance of patient story-telling when it comes to healing from disease. We treat people as individuals and look for the root cause of illness, taking into account the story behind each of our patient’s “scars”. However, as our school curriculum becomes more medicalized and primary care-focused, I believe that our need to conduct efficient medical interviews and develop effective treatment plans is in danger of displacing our inherent philosophies. Taking the time to read Rita Charon’s book opened my eyes to the importance of patient individuality and respect for patient narrative. To understand illness, it is essential to integrate narrative into the framework of the clinical encounter by giving patients the space to tell, while also giving ourselves, the practitioners, the space for our own telling with the intention of becoming better, more empathetic doctors.
If we weren’t broke before coming to this program, after about 2.5 years you’ll bet we are now! There’s no time to get a job and no money to be spent on expensive, luxurious gifts. So, what’s a naturopathic student to do? In order to partake in the materialism of the holiday season (and I actually do love giving gifts), here are some very cheap, fun, healthy and easy gift ideas for the entire family that will actually be used and enjoyed!
My art is mainly inspired by nature or by places I’ve traveled to or read about. It doesn’t tend to emphasize detail and, when humans are included in the composition, they are usually faceless, depicted as chunky, cubist blocks of colour. People are rarely the main subject of my paintings. And, unlike Frida Kahlo, one of my painting idols, I have never entered the world of portrait painting, much less self-portrait painting.
When painting the facial features of other people, one must pay obsessive attention to detail. This is a skill I don’t have when it comes to painting. It’s almost as if, through painting, I can leave the burden of fussing over details behind to pursue a sense of therapeutic self-pleasing aesthetic that focuses on colour and shape, rather than the fine lines and subtleties. I tend to spend far too much time obsessing over details in real life and so I view painting as an escape from that. When painting life-like portraits, however, such an escape is impossible.
But, like Picasso, I want to become an artist-of-all-trades or, at the very least, claim experience with different subject matter. So, besides feeling that the experience would be tedious and slightly narcissistic, I decided to attempt a self-portrait.
The thing about self-portraits is that we know our own faces very well. From my teenage years through young adulthood I remember countless hours spent obsessing over my reflection: squeezing zits, plucking eyebrows, willing my nose to shrink and wondering what made my face less poetic than that of a famous actress or singer, almost like there was a secret beauty ingredient I might have been born lacking. Painting a self-portrait demands an attention to detail unlike any other mirror flirtation ever performed. From the exact shape of the mouth, to the way the cheeks are outlined, I found myself staring at parts of my reflection that I had never experienced before.
Because I’m not experienced in portrait-painting, the painting started out rough. My oil-painted face was taking on a deformed, misshapen quality, it didn’t look like me, and I found myself criticizing the painting, judging it, and then my own abilities. I then realized, painfully, that this was akin to the way I would criticize my real-life reflection. After a while, though, I found myself comforted by my outline’s familiarity and that comfort turned into a sort of visual satisfaction. This was my face: the window to the person I am who lies beneath and the signature that accompanies everything I say or do in this life. I began to make peace.
Creating art allows us lots of space for reflection. Perhaps that’s why it’s so therapeutic. As I mix colours and apply paint to canvas my mind relaxes and wanders, uninhibited, into new terrain. I find that while painting it helps to have a notebook handy because one artistic pursuit nurtures another and I find myself inspired to not only paint, but write as well. On this portrait-painting day in particular, I felt a relaxing space open up for reflection on who I am now, at 26 years of age. My reflection may have changed some, but behind the wide gaze, I could still see the smirk of that 9-year old, in the Universal Studios sweatshirt, who was imaginative, idealistic and shit-disturbing, all at once. I wonder if this 9-year-old knew that in a few years’ time she would be studying something called naturopathic medicine.
This summer has been dedicated to reviewing basic medical sciences for NPLEX and working as an English as a Second Language (ESL) teacher in Toronto. I haven’t made much time for long contemplative walks, reading literature, laying on the grass, socializing or, most of all, painting or drawing. The way I structure my day is a reflection of my disbalance, not my actual interests and priorities and, as I paint, my evolving painted self stares back at me from it’s canvas home and asks me, “is this what you wanted?”
I’m not sure. But portrait painting shows me that there is a link between borderline narcissism and self-contemplation. Maybe that’s why it’s called self-reflection.
