About a month ago I fractured my right 5th metatarsal (an avulsion fracture, aka “The Dancer’s Fracture” or a “Pseudo-Jones Fracture”).
As soon as I laid eyes on the x-ray and the ER doctor declared, “Ms. Marcheggiani,” (actually, it’s doctor, but ok) “you broke your foot!” things changed.
I have never broken anything before, but if you have you know what it’s like. In a matter of seconds I couldn’t drive. I could barely put weight on it. I was given an Aircast boot to hobble around in, and told to ice and use anti-inflammatories sparingly. My activities: surfing, skateboarding, yoga, even my daily walks, came to a startling halt.
I spent the first few days on the couch, my foot alternating between being elevated in the boot and immersed in an ice bath. I took a tincture with herbs like Solomon’s Seal, mullein, comfrey, and boneset to help heal the bone faster. I was adding about 6 tbs of collagen to oats in the morning. I was taking a bone supplement with microcrystalline hydroxyapatite, pellets of homeopathic symphytum, zinc, and vitamin D.
We call this “treatment stacking”: throwing everything but the kitchen sink at something to give the body as many resources as possible that it may use to heal.
My brother’s wedding came and went. I was the emcee, and the best man. I bedazzled my boot and hobbled around during set-up, photos, presentations, and even tried shaking and shimmying, one-legged on the dance floor. The next few days I sat on the couch with my leg up.
I watched the Olympics and skateboarding videos. I read The Master and the Margarita and Infinite Jest. I got back into painting and created some pen drawings, trying to keep my mind busy.
I slept long hours–an amount that I would have previously assumed to be incapable. The sleep felt necessary and healing. I was taking melatonin to deepen it further.
I closed down social media apps on my phone to deal with the immense FOMO and stop mindlessly scrolling. I journaled instead, turning my focus from the outside world to my inner one.
It was a painful process, and not necessarily physically.
I was confined to my immediate surroundings–not able to walk far or drive. I was at the mercy of friends and family to help me grocery shop. The last year and a half has made many of us grow accustomed to social isolation and a lot of my social routines from years prior had fallen by the wayside.
My world, like the worlds of many, had gotten smaller over the last 18 months. With a broken foot, my world shrunk even further.
The loneliness was excruciating.
It would come in waves.
One moment I would relish the time spent idle and unproductive. The next I would be left stranded by my dopamine receptors, aimless, sobbing, grieving something… anything… from my previous life. And perhaps not just the life I had enjoyed pre-broken foot, but maybe a life before society had “broken”, or even before my heart had.
I thought I would be more mentally productive and buckle down on work projects but it became painfully obvious that my mental health and general productivity are tightly linked to my activity levels. And so I spent a lot of the weeks letting my bone heal in a state of waiting energy.
My best friend left me a voicemail that said, “Yes… you’re in that waiting energy. But, you know, something will come out of it. Don’t be hard on yourself. Try to enjoy things… watch George Carlin…”
During the moments where I feel completely useless and unproductive, waiting for life to begin, I was reminded of this quote by Cheryl Strayed. This quote speaks to me through the blurry, grey haze of boredom and the existential urgency of wasting time.
It says,
“The useless days will add up to something. The shitty waitressing jobs. The hours writing in your journal. The long meandering walks. The hours reading poetry and story collections and novels and dead people’s diaries and wondering about sex and God and whether you should shave under your arms or not. These things are your becoming.”
These things are your becoming.
Something will come out of it.
When I did a 10-Day Vipassana (silent meditation) retreat in the summer of 2018, I learned about pain.
It was Day 3 or 4 and we had been instructed to sit for an entire hour without moving. The pain was excruciating. The resistance was intense. I was at war with myself and then, when the gong went off and there was nothing to push against, I noticed a complete relief of tension. I was fine.
The next time I sat to meditate (another hour after a 10 minute break), I observed the resistance and released it. It’s hard to describe exactly what I did. It was something like, letting the sensations of pain flow through me like leaves on a river, rather than trying to cup my hands around them, or understand or making meaning out of them.
The sensations ebbed and flowed. Some might have been called “unpleasant” but I wasn’t in a space to judge them while I was just a casual observer, watching them flow by. They just were.
And when I have intense feelings of loneliness, boredom or heart-break I try to remember the experience I had with pain and discomfort on my meditation cushion. I try to allow them.
“This too shall pass”.
When I have a craving to jump off my couch and surf, or an intense restlessness in the rest of my body, the parts that aren’t broken, I try to let those sensations move through me.
I notice how my foot feels. How while apparently still, beneath my external flesh my body is busy: it’s in a process. It’s becoming something different than it was before. It’s becoming more than a foot that is unbroken. It’s becoming callused and perhaps stronger.
Maybe my spirit is in such a process as well.
The antidote to boredom and loneliness very often is a process of letting them move through, of observing the sensations and stepped back, out of the river to watch them flow by. A patience. Letting go.
I can’t surf today. But, it is the nature of waves that there will always be more.
Pima Chodron in her book When Things Fall Apart also references physical pain and restless in meditation while speaking of loneliness.
She writes,
“Usually we regard loneliness as the enemy. Heartache is not something we choose to invite in. It’s restless and pregnant and hot with desire to escape and find something or someone to keep us company. When we can rest in the middle, we begin to have a nonthreatening relationship with loneliness, a relaxing and cooling loneliness that completely turns our usual fearful patterns upside down.”
She continues,
“When you wake up in the morning and out of nowhere comes the heartache of alienation and loneliness, could you use that as a golden opportunity? Rather than persecuting yourself or feeling that something terribly wrong is happening, right there in the moment of sadness and longing, could you relax and touch the limitless space of the human heart?
“The next time you get a chance, experiment with this.”
Quentin Crisp says, “Repeat yourself loudly and often” and so I’m repeating myself on blood sugar regulation.
I guess if I had to leave a legacy in the world of natural health and lifestyle medicine, if I could sum everyone’s problems down to one key major concept and one key take-home action plan it would be: blood sugar regulation and: eat protein.
Last week was pretty busy in my little homegrown virtual naturopathic practice and I found myself repeating myself loudly (well, in a normal volume voice) and definitely often, the importance of eating protein at every meal and the connection between their symptoms and blood sugar with virtually every patient I saw.
All of my patients last week seemed to be suffering from some combination of the following symptoms:
Fatigue, anxiety, overwhelm, disrupted, restless, and non-restorative sleep, sugar cravings, emotional eating, binge-eating/stress-eating, nausea and bloating, PMS, migraines, low focus and concentration, low libido, low motivation, poor exercise recovery, and weight gain/puffiness/body image issues.
Of course, many of these symptoms were presented as being unrelated to the other. Perhaps stress and stress-eating were related, but sugar cravings and low motivation weren’t necessarily related in my patients’ minds. Neither were their sugar cravings, overwhelm and low libido.
And yet, the common thread that connects all of these symptoms is, you guessed it: blood sugar.
I explained to one patient: even if I gave you a magic wand, that you could wave to make all of your life’s problems disappear, you would probably still be feeling that deep, disconcerting, restless, anxious, “all-is-not-well” feeling in your gut. The reason for this? Blood sugar dys-regulation.
Our body has certain physiological mechanisms that it likes to keep tightly regulated. Among them are blood levels of our sugar (which controls the amount of fuel our brain has for its minute-to-minute functioning), carbon dioxide, salt, and water. When these levels drop in the body we start to feel off. Our stress response is triggered.
Imagine the feeling of holding your breath, as carbon dioxide starts to build up in your blood, you’d pay someone a million dollars to be able to take a breath. Similarly, if you’re seriously thirsty it’s likely all you can think about.
When our blood sugar drops, we feel terrible. The symptoms are anxiety, shakiness, fatigue, low mental energy, burnout, decision fatigue, waking up in the middle of the night, irritability, dizziness and weakness, and an unsettled, doom and gloom feeling. Most of all, however, we crave sugar.
Despite all of the symptoms my patients were expressing last week, one of the main issues they were contending with were sugar cravings. “I just don’t have the motivation to cook a meal”, one patient expressed, “and so I end up eating a bag of chips for dinner, even though I’m not really hungry.”
“You are hungry,” I explained, “the hunger is just not manifesting in the way that you’re used to.
Let me repeat this loudly, ala Quentin Crisp: if you ever find yourself at the end of a bag of chips, or a plate of cookies, or a pile of donuts–you were hungry.
Eating disorder expert Tabitha Ferrar highlights a phenomenon in people recovering from anorexia as “mental hunger”. Physical hunger, the grumbling, gurgling, empty feeling in your stomach is the result of ghrelin and gastric motility, which builds up when leptin levels fall and our stomach is physically empty and creates what many of us assume are the sensations of “true hunger”.
However, these symptoms require energy form our body to produce. This is the reason why people with hypothryoidism are constipated–gastric motility takes metabolic energy.
If your body is malnourished, such as the case of anorexia, or even chronic stress and under-eating throughout the day, we often don’t get these signals of “true” hunger.
Our bodies simply don’t have the battery power to create these symptoms. And yet, we need nourishment, particularly we need to elevate our blood sugar to supply our brains with energy.
And so our body sends our signals of “mental hunger”, that feeling of “I can’t stop thinking about the chips in the cupboard”, that often leads to mindless binging as our body tries to replenish its reserves.
If you’re craving sugar, emotionally eating, devouring chips in the afternoons or evenings, or feeling decision fatigue/ or “lack of willpower”, you might need to start focussing on your blood sugar.
Blood sugar dysregulation is also tightly connected to our moods. Think of our body’s homeostatic mechanism as a tightly regulated machine, a fuel gauge on our body’s resources, which are needed in times of stress. When our blood salt, sugar or water levels dip, and our blood CO2 levels rise, we start to feel uncomfortable. This can be remedied by drinking water, sighing, deep breathing, or eating something. When these levels fluctuate and we fail to notice, our body releases stress hormone.
Cortisol is our stress hormone, but it’s also the hormone that plays a role in blood sugar regulation. When blood sugar dips beyond homeostatic levels, cortisol steps in to save the day. Low blood sugar is a stressor on the body. This might look like morning anxiety, feeling tired and wired, waking in the middle of the night unable to fall back asleep.
Again, you might not feel hungry during these moments–just overwhelmed, anxious, irritable, unsettled, weak, dizzy, and fatigued.
You’re in a fight with your partner. You’ve been cleaning out the garage and it’s hot out. You’re annoyed at the way he breathes, at the slow methodical way he goes through your stuff. The mess feels overwhelming, the heat feels stifling. You leave in a huff, ready to set fire to the entire operation.
Grumbling and fuming, you go inside. You take a breather, you eat something, you exhale deeply, you drink some water.
Gradually, as your body starts to shift into physiological neutral, your perception starts to change. The garage feels slightly more tolerable. It’s really just above moving one box at a time, going through it and then starting on the next one. You can do it.
Before you know it, you’re done.
When blood sugar is low our prefrontal cortex, the “ego”, “decision-maker”, executive functioning, planning and cognitive part of the brain, becomes depleted. We might call this “decision fatigue”, “willpower fatigue” or “ego depletion”.
“Administering glucose completely reversed the brain changes wrought by depletion…
“When glucose is low, [your brain] stops doing some things and starts doing others. It responds more strongly to immediate rewards and pays less attention to long-term prospects.”
In essence, you stop being able to make calm and effective decisions.
Brain sugar levels (the brain uses up 60% of available blood sugar) directly contribute to the feeling of being “solid”–able to make rational decisions, to respond to fears and anxieties, to emotionally regulate, to make competent and calm decisions.
When our blood sugar levels dip we start to spiral: we might think erratically, gloomily, catastrophically, and irrationally.
I had a patient who crashed at 3pm everday after school, when his major depression would “come back”. I asked him what he had for lunch, to which he replied he often worked through lunch. Breakfast was a croissant or piece of toast.
His first real (and only) meal was at dinner. The rest of the day was a sea of grazing on ultra-processed foods, sugar and white flour. No real food in sight.
Scarfing down an emergency granola bar every time blood sugar drops is one solution, however whenever we eat carbohydrates on their own, particularly the quick-release carbs like white sugar, or refined grains, our blood sugar spikes. Soon after, insulin is released, causing it to drop again.
Many of us start the day without food, or with a measly breakfast of toast or cereal, or some other carb-only meal. As I tell patients, though, a serving of carbohydrates is not a real meal.
You know what I mean: a bagel for breakfast, a sandwich and pb for lunch, a plate of pasta for dinner. Carbs, while an important part of a complete meal, are completely inadequate at keeping you fuelled for the hours of mental, emotional and physical labour you engage in between meals.
Does this mean you should eat low-carb? No, not necessarily.
What it means is that a meal contains fats, carbs, and protein. Therefore all meals, especially breakfast, and even snacks, should combine those three macronutrients to assure proper fuelling and blood sugar regulation.
When you eat a proper meal in the morning, your blood sugar rises slowly. It requires less insulin to get the fuel into your cells. Your blood sugar is metered out slowly throughout the next few hours instead of being rapidly absorbed.
This means no more spikes and crashes–in blood sugar, energy, mood or cravings. A proper meal provides hours of calm focus, more willpower, and more ability to concentrate and emotionally regulate.
Instead of just toast in the morning, add about 20g of protein to your meal: a scoop of protein powder, 3-4 eggs, a piece of chicken, 3 tbs of collagen powder– in essence, have a proper meal.
Then, for lunch do it again–have a chicken breast on your salad, or a piece of salmon or beef.
Make yourself a smoothie with protein powder. Have a cold soak oats with collagen powder. Make yourself an omelette. Have a bean soup with 1 cup of beans.
Substitute your wheat or rice pasta (which is just carbohydrate) for a legume pasta made of mung bean or lentils, or black beans, which contain fibre and protein and are easier to make into a fast, complete meal.
When patients start having complete meals, starting with breakfast, their change in mood is often dramatic. They feel more mentally and emotionally stable. They have more energy.
Often we feel we get our second wind in the evening: (“I’m more of a night owl”). But so many of us work through our morning meals and only sit down to a complete meal at dinnertime. Maybe your “second wind” is actually just your first wind, purchased from the proper meal you had when you finally sat down and nourished your body.
What about intermittent fasting? Whenever I speak about breakfast there’s at least one DM or question, or “but I thought that…” and the topic of intermittent fasting almost always comes up.
Giving the body a break from eating is a good idea. For about 12 hours, if possible, stop eating.
This usually means stopping eating 3 hours before bedtime and creating an eating window from something like 7am to 7pm.
12:12 (12 hours of fasting and 12 hours of eating) can be great for resting the digestive system and supporting sleep. However, many of my patients use more extreme version of “intermittent fasting”, such as the 16:8 (16 hours fasting and 8 hours feeding) as a go-ahead to skip breakfast.
They wake up and get through the morning on coffee (with cream and sugar, which isn’t actually a real “fast”), and then eventually binge on sugar and chips after dinner, when they finally give their bodies permission to eat. It’s rare that they see the connection.
Most of us attribute the feelings of lack of control around food an issue with emotional eating and willpower. I find that in 99% of cases, “emotional eating” us usually just a result of blood sugar dys-regulation, protein deficiency and under-nourishing earlier on in the day.
A morning without food is a stressor on the body. Female bodies in particular respond to stress by becoming more insulin resistant, which further affects blood sugar dys-regulation and affects metabolic health–this is not what you want.
If you’d like to restrict your eating window, research shows that removing any after-dinner snacking (when our bodies are naturally more insulin resistant) is the way to go.
It’s also important to take a Protein Inventory. Sometimes I just have patients track their protein intake on a website or app like cronometer.com
The exercise is often enlightening, as patients are able to see how the protein density of their diet connects to their mood and energy.
I often get them to track their food for a few days to a week and then ask them: How do you feel on a higher protein day, where you meet your nutritional needs vs. a low protein day? What is your energy like? Your sugar cravings? Your mood? Your mental focus and clarity?
Conditions like OCD, ADHD, depression, anxiety, PMS, PMDD, cognitive issues, dementia, diabetes, pre-diabetes, weight gain, and bipolar all have roots in blood sugar regulation.
Blood sugar dys-regulation, over time can start to result in insulin resistance (often detected far before any changes to lab blood glucose start to show up).
Insulin resistance is the process in which the cells stop responding to insulin, requiring more insulin to be released. This causes inflammation and weight gain and, over time, elevated blood sugar. Insulin resistance can contribute to mood and hormonal issues, cognitive issues, like dementia, and metabolic conditions over time. This is definitely something you don’t want.
If you think you might have insulin resistance (characterized by sugar cravings, fatigue, abdominal weight gain, difficulty losing weight, hormonal issues, mood issues, low energy, and cognitive issues) consider getting your fasting insulin and fasting glucose tested. These two numbers can give you a HOMA-IR score, used to gauge insulin resistance, so you can work to reverse it before it progresses to pre-diabetes and type II diabetes.
Often insulin resistance, inflammation and stress are a never-ending cycle and all need to be addressed, with blood sugar regulation as a key strategy to getting your body’s insulin signal working again.
Signs that your metabolic health is healing are more energy, less cravings, better mood, better sleep, and some weight loss (which usually starts occurring about 6 weeks into a lifestyle change program).
Low calorie diets can also be a significant stressor on the body affecting blood sugar. Making sure that your fat and protein intake are sufficient (aiming for about 1 g of protein per lb of body weight for an active person) is essential to regulating blood sugar, cravings, mood and energy.
So, how do you take control of your sugar cravings today?
Here are some places to start:
Start your day with a complete breakfast that includes fat, carbs and 20 g of protein
Eat full meals regularly throughout the day
“front-load” your calories, eating 60% or more of your food before 1pm
Aim for 1 g of protein per lb of body weight, or 90g of protein as a minimum
Track your protein intake along with your mood, energy levels and cravings so that you can have more agency over your food choices, dietary patterns and symptoms.
Have ready-to-grab protein sources like pumpkin seeds, eggs, protein powder, legume pasta, precooked chicken breasts, canned salmon, and so on.
If you’re going to try Intermittent Fasting start slowly, begin by avoiding late-night snacking or snacking before dinner.
Finally, book an appointment if you feel ready to support your metabolic health and get your nutrition right to support your hormones and mood!
For more on how to regulate your blood sugar (as well as nutrient levels and inflammation levels) to eat for your mood, check out my course Feed Your Head:
In my last post on “I Treat Stories“, I talked about the spectrum between perfect “health” (perhaps better defined as “potential”) and disease, and death. The Disease Spectrum, perhaps we can call it.
And I also talked about the conflict many naturopathic patients experience when they are clearly not feeling well but are dismissed by the medical establishment because “there is nothing wrong”, i.e.: their signs and symptoms don’t fit into a disease classification.
I talk about functional conditions like insulin resistance and HPA axis dysfunction or estrogen dominance (or IBS, depression, anxiety) as these conditions in which functioning is impaired in someway, or the person doesn’t feel like themselves, and yet they are dismissed.
I want to correct this, however. I don’t believe that these conditions, even most diseases, per se, are the result of the body malfunctioning.
Instead, I think we should look at symptoms, and so-called pathologies and diseases, as the body adapting in a very functional way to circumstances that might be challenging, or malfunctioning.
Depression and anxiety are terrific examples of this.
In these conditions (which do fit a disease classification system, with which I very much do not agree–these classification systems rely only on symptoms, therefore they cannot possibly be viewed as true “diseases”), patients are told that they have an inborn malfunction–their brains don’t work properly. They might be told they have a chemical imbalance, or something to that nature, and that they require a lifetime of medication.
This can’t be farther from the truth.
Firstly, there has never been any evidence of these so-called brain imbalances. And there are no concrete physical signs of these “diseases” either. There are no universal changes to the brain, nothing that shows up on blood tests, and no issues with brain chemistry.
Even the therapies, usually SSRI medications, actually cause brain imbalances–there is no evidence that they solve them. There is also no evidence that they are safe and effective long-term (and limited evidence that they are safe and effective in the short-term).
What we do know is that animals in the wild become anxious when they are threatened.
And that animals in the wild become depressed when their anxiety response (their fight or flight survival response) is burnt out.
And that is the story I hear again and again in patients.
They have a history of anxiety–their nervous systems are wired “up”. This could be because of early childhood trauma. It could be attachment trauma, receiving insecure attachment or inadequate attunement from their caregivers. They might be contending with a great deal of conflict at the time of diagnosis. They may have psychological schemas about not being enough, leading to perfectionism and self-criticism, which their nervous system perceives as constant attack. They may have experienced anxious modelling from a parent or caregiver who suffers from anxiety (generational trauma, essentially).
They may be suffering from nutrient deficiencies, or a metabolic issue, giving their nervous system the input that there is a food shortage, one of our main historical stressors throughout human history.
And so on.
Ultimately, there is something happening in the environment in which their nervous system either lacks adequate safety signals or is receiving signals of danger or threat.
When patients present with depression they often describe a history of anxiety. Maybe they experienced it as “active” anxiety: feeling shaky and jittery, hyperactive, fearful, etc., or more “passive” or “mental” anxiety: worrying, ruminating, narrating, over-thinking, constant striving, self-criticism, thought loops, etc.
Not that anyone has ever asked them before reaching for the prescription pad, but when I talk to my patients presenting with depression they almost always report a baseline level of anxiety that has gone on for some time, followed by a period of acute stress, or shock, or loss, that led to this collapse of sorts.
At this point they experience extreme fatigue, low motivation, shut-down, paralysis, and intense self-criticism, even suicidal thoughts and intense feeling of hopelessness. The world starts to seem pointless. Their bodies and mind “shut down” in a sense.
And, of course they eventually seek solutions, firstly from the medical system (because we have been trained to medicalize the problemm–something has gone “off” with the machinery of the body. We locate the problem within ourselves, not with our situation.) and the response is pathologized, and most often medicated.
And then we talk about ending the stigma of mental illness (when in fact, many cases, if not most are not illnesses at all). What could be more stigmatizing or disempowering that the way we currently frame mental health?
Depression and anxiety are not sicknesses, or weaknesses. They are adaptations.
Depression is an inflammatory shutdown state that results from chronic overstimulation of the fear response in the nervous system. It is a symptom. It reflects the health of your very well-functioning brain and nervous system and their ability to adapt to adversity.
This adversity can be biological (infectious, a nutrient deficiency, metabolic issues, inflammation, etc.), mental, emotional, and environmental. It can (most often) be a confluence of one or more of these categories.
When a deer is trying to escape a predator and their fight or flight response fails to get them out of harms’ way, their nervous systems shut down. Their body releases opiates. They feel far away. Their limbs go limp. They can’t escape in body, so they escape in their minds and emotions. They despair. This is depression.
This is why the story is so important.
Without story, we can’t possibly understand what is going on for you specifically. We can’t possibly understand your situation. And, therefore, we can’t figure out what to do to help.
Is someone asking you about your story? Or are they just cataloguing your symptoms?
Are they asking about your family history, your history of trauma, the circumstances going on in your life? Are they talking to you about your thoughts, or your tendency to self-criticism and perfectionism? Are they asking you what you eat, how you move, how well you sleep, and how you recover from stress? Are they ruling out anemia, nutrient deficiencies, thyroid issues, fatty liver, insulin resistance, hormonal imbalances, and chronic inflammation, or gut issues?
Are they asking how content you are with your job? What your dreams are for the future? How fulfilled and loved you feel in your primary relationships? Are they asking you about poverty? Discrimination? Whether you feel safe in your neighbourhood? Whether you felt safe growing up as a kid?
Are they misdiagnosing your grief?
Does your healthcare practitioner get you? Can they connect the dots for you? Does talking to them give you a glimmer of hope, even in this hopeless time? Do you feel empowered and strong when you walk out of their office?
Or are they telling you you have a brain imbalance, or a in-born defect?
In reality, you are not defective. You are incredibly strong. Your body is adapting. It is resilient. And in its process of adaptation it is giving you these symptoms. Now, you don’t have to just tolerate these symptoms. There is so so much we can do. Perhaps pharmaceuticals are supportive for you while you start to compassionately look deeper.
But, there is so much more to the puzzle than just pharmaceuticals.
It’s worth asking,
What are you adapting to?
To learn more about nutrition and mental health, check out my course Feed Your Head.
“The problem with depression is, you can’t see the end.”
Depression is like a ditch. Sometimes you head into and get stuck, but you manage to wiggle out. Other times you’re in a major rut and can’t get out at all. In those cases you need to call someone. It happened to me once. I was driving in the winter to a hiking spot and I thought that a flat-looking patch of snow was the side of the road and before you know it I’d driven into a ditch. I couldn’t get out. I tried gunning it, putting rocks under my tires, getting a friend to push. Eventually I just had to call someone. Within a few minutes, a tow truck came. The man driving it unceremoniously and unemotionally told me to put the car in neutral. He hooked a giant chain to my bumper. He yanked me out of the ditch. And then he drove off. Roadside assistance. In my last post I said something akin to “health is not emotional”. It’s sometimes just an equation. With patients I educate them on their prefrontal cortex, on brain inflammation, on Polyvagal Theory and the nervous system and how depression is a normal response of the nervous system to abnormal circumstances, and how to they can work with their body and environment to get the help they need to yank them out of the ditch. But I also talk about the people around us. We need them. We need them to be our prefrontal cortexes (because when you’re depressed or anxious yours isn’t working at full capacity–you CAN’T just yank yourself out a ditch, you need a tow truck, a chain and an unceremonious dude who knows what to do). You need a strategy. You need a hand. You need help. Who’s your support team? Who are the people around you?
I talk to my patients about bringing their loves ones on board to help them set up systems to regulate their nervous systems, nourish their brains and bodies (don’t even think for a second that I didn’t have a snack to munch on while waiting for the two truck–this fact is not even metaphorical. You NEED a literal snack to fuel your brain), and reduce inflammation.
There is a theory of depression that it is an ADAPTIVE state meant to get us through a difficult time.
Famine. Capture by a predator. Infection or illness. Isolation from the group.
These may have been the historical hunter-gatherer inputs that caused depression but now it seems that depression can be triggered anytime our bodies are in a perceived or real “stuck” state with no way out.
Many, if not most, or all, depressive episodes I’ve worked with follow a period of intense anxiety. Our body’s stress response burns out, we can no longer “get away from danger” and we shutdown and collapse.
We turn inwards. We immobilize. We ruminate (possibly as a way to THINK our way out of danger).
This is why the 2a serotonin receptors that encourage “active coping” or things like BDNF, which is involved in making new brain cells, have important roles in the treatment research for major depression.
I’ll bet you’ve been told you have a disease, though. Something incurable that you’ll deal with your whole life.
But what if, rather than a disease, depression is a STATE you visit, and sometimes get stuck in that follows anxiety, stress and certain triggers?
How might that change the way you see yourself and your mental health? How might that change the way you seek solutions to how you’re feeling?
“The Adaptive Rumination Hypothesis by Andrews and Thomson posits that depression is not a pathology but a set of useful complex thoughts and behaviours that enable troubled people to withdraw temporarily from the world, deliberate intensively about their social problems, and devise solutions.”
From the Psychiatric Times
The major problem with depression that keeps us stuck in the state is when we turn our rumination back on ourselves and engage in self criticism.
Imagine that you’re stuck in the middle of the Amazon forest. You have no idea where you are. You’re terrified and hungry.
All of a sudden a man (or a woman) emerges from the bushes. They tell you, “I can help you get out of here. I can help you find your way home”. With relief, you follow them.
They slash through the bush with a certain confidence. They feel comfortable to be around. But after some time, doubt fills your mind.
A little while later you, still following this guide, but mind racing with doubt, both come upon someone else, coming from the other direction.
“That’s not the way out,” this new person exclaims, once you’ve greeted one another, “Follow me, I know how to get you out of here.” And there’s something about their scent or voice, you’re not sure what, but you like them better than the other guide, or maybe the same, you don’t know, but for whatever reason you choose to follow them.
And so you leave the first guide, thank them for their help (they really were helpful after all, but this new guide, well they’re really something) and all, and say, “My heart says I should follow this new guide”. And now you’re off, travelling in an entirely different direction, on what you hope is your way out of the jungle.
The truth is, every way is the way out. Perhaps some ways are faster than others, but one thing is certain, if you continue to travel in any one direction for a long enough period of time, you will eventually leave the dark woods.
What will keep you in the jungle, however, is switching direction, switching guides. Imagine you’re almost out of there: a few hundred metres away, and you find a new guide, turn around and immediately follow them further into the bush.
So it is with healing.
Sometimes we need to pick someone–a therapist, doctor, teacher, mentor, sometimes for no better reason than we like their voice or their website or we resonate with something they’re sharing from the heart–and we need to choose them and let them guide us.
No, we don’t need to do everything they say. We don’t need to follow them blindly. We can follow them with a sense of integrity and skepticism, of course, but if we choose their guidance, and their path towards healing, perhaps we need to see it through.
I find that, as it’s often the case with anxious patients, we constantly feel the need to reach for the new solution, the new single ingredient that will make us healthy and whole. That extra thing. That missing thing. That shiny new theory, or condition, or treatment.
“Perhaps I have histamine intolerance”
“Maybe I’m eating too many lectins”
“I think I need to test my oxalates”
“Maybe I’m zinc deficient”
“Maybe it’s my estrogen dominance”
It could be any one of those things, but if you find your wheels spinning, flipping from one therapist to another, and preventing any one of them from really getting a sense of who you are or what you need then I suggest you… stay.
Who do you stay with?
Stay with the one who listens.
If anyone is offering you a simple solution, a one-trick fix (and if any one is a one-trick pony, you know them, the ones who apply their theory to everyone they work with), then please run.
Your health and wellness does not boil down to one thing, one practice, one supplement, one root cause.
Stay with the one who listens. The one who repeats back to you what you said and adds more to it. The one who synthesizes and summarizes your problem in a way that clicks something into place.
Stay with the one who talks to you, not their team of followers.
The one who has your case information, not the yoga instructor you chat with after class while you’re putting your shoes back on, not the supplements salesperson who said “It’s probably your hormones” and hands you a bottle of 15 ingredients, not the documentary you watched on Netflix that applies one-size-fits-all diet advice to you and 6 billion others without even knowing your name.
Or, maybe stick with them… but stick with one of them. See their advice through to the end.
Maybe stick with the one who says, “Hm, this sounds like…” and proceeds to connect the dots for you, in front of your eyes. Who seeks to educate you. Who thinks about your case between visits. Who says things like “I consulted with my colleagues about your case to ask and…” and things like “I was thinking about/reviewing your case the other day and thought about…”
Stay with the one who refers you to other practitioners. Stay with the one who answers your pointed health questions with “It depends” or “Normally yes, but in your case…” or “A lot of the time no, but it’s possible that in your case…”
Psychoanalyst Francis Weller urges us to practice restraint. To pause. To reflect on our needs. He urges us to practice humility.
I love working with patients who show up humble, kneeling at the alter of their own healing, saying, “I found your website” or “My friend referred you” and then proceed to tell their stories, and receive my assessment.
They help me practice humility as well. To receive their cases with humility (not with my already always listening). To receive them with patience. To take my time. To do my research. To check in: “How does this sound…”.
I kneel at the alter of healing beside them.
We set an intention of working together–walking together—out of this wilderness.
Our beliefs come from external factors: our research, others’ stories, things we read, things we see, and internal factors: personal observation of our own experiences.
My beliefs about food have formed through reading scientific studies and nutritional studies, to an understanding of biochemistry and anthropological data, to my own embodied experiences and my clinical experience.
These beliefs inform the way I practice and form biases in the way I do further research or understand patient experience and my own experience with food. These beliefs informed the way I put together my foundational program and how I position food on Instagram and on Youtube–these are the beliefs that form the messaging and the medicine.
I thought it would be interesting to write them down to declare them explicitly and examine them.
What do you believe about food and nutrition?
I believe that food contributes to our health and to disease.
I don’t believe that food is the ONLY factor in contributing to these things, obviously. I think food plays more of a role in our health (much more) than conventional medicine would claim. But, I also believe it is less of a direct factor in our health than many Instagram influencers or nutritional salespeople (you know the ones I’m talking about, the ones who write books call “The Cure for X Disease” and things like that) would assert.
For example, I don’t think that you can cure cancer with carrot juice.
I also don’t think that, if you’re sick or know someone who is sick in some way that you or they got there because of your food choices. Chocolate cake didn’t give you diabetes. Gluten didn’t cause your depression.
But I do wholeheartedly believe that food plays a key role in shaping us: our physical and emotional and mental bodies. Food contains the nutrients we need to function. It feeds our cells, our microbiome, it shapes our bodies.
Food is one of the important ways that our bodies receive input from the outside environment. This information is communicated through specific plant nutrients, like resveratrol found in red grapes, or in the foreign compounds and toxins that pollute the regions where we live.
Through food we can heal. Through food choices, over time—nutrient deficiencies, or surviving off of too many things that aren’t really food—disease can start to form.
Food connects us to the earth.
2. I believe that our bodies are intelligent. Our bodies have evolved mechanisms that can communicate to us what they need–if we listen.
Our taste receptors tell us about the quality of the food we’re consuming. Freshly picked in-season fruits and vegetables taste very different than out-of-season, bland ones. The richness of flavour often corresponds to the richness of the nutrients present in the foods we eat.
We crave animal fat. We crave sugar. We crave salt.
We crave these things because they represent a density of nutrients that our bodies need.
We’re drawn to colours, because colourful foods represented foods that were fresh and ripe and packed with nutrition.
I look at a lot of things in medicine through the lens of evolutionary biology. A lot of people in my field and in science do. I trust that the way my body is formed as a response to an environment that is ever changing.
The humans who were most drawn to ripe, nutrient-dense fruit, or the saltiness of animal protein, or the delicious texture of fat, ate more of these foods. And eating more of these foods gave them an evolutionary advantage, allowing them to survive and pass on their genes to future generations who inherited preferences for these tastes.
Therefore I believe that consuming animal fat and sweet foods and salty foods is not bad.
Craving these foods is not bad. Cravings and taste preference represent a complex chemical system that evolved over hundreds of thousands of years to bring us to the things that helped us thrive.
I actually believe that we should listen to our cravings–they can be quite sophisticated. However, I also believe that:
3. Big Food has highjacked our taste buds.
There is something called “The Dorito Effect” where food companies high-jack these natural drives, these cravings, these taste preferences to get us to eat more frankenfoods. A Cheeto has been engineered to get you to consume the whole bag.
Therefore I don’t think we can trust our cravings when we’re consuming a high amount of “fake” foods–foods grown in a lab, foods made in a plant, foods that have 5+ ingredients that didn’t exist in 1913 or whatever.
How much of these foods is appropriate to eat? I try to minimize my consumption as much as possible. I’m not sure what the right answer is for you. I do know, however that I can’t let my body take the reins on what foods I might be needing if I consume too many of these processed foods.
How do I know I need more carbohydrates when I crave sugar or if my body is just chemically addicted to Sweettarts? I try to satisfy cravings with the whole food version of the thing and I find that that often works create an ongoing, trusting relationship (which takes time) between my taste receptors, the environment, my stomach, my mind, and my cells.
I believe that these relationships can help my body relax and know that it will be fed, like a crying baby who knows its caregiver will respond to its cries.
4. I believe that humans should consume a combination of plants and animals.
This may be a fairly controversial belief.
Of course there are many animal rights activists, vegans and plant-based diet advocates who would tell me that you don’t need animals to be healthy. There are many people who swear the Carnivore Diet cured their autoimmune disease.
And, maybe they’re both right. However, I believe that humans evolved eating some sort of combination of animal and plant foods and that there are distinct nutrients that are rare in plants and others that are rare in animals.
I can’t personally get enough protein on a plant-based diet. And, after eating a diet that is too meat-focused I start to crave salads, whole grains and beans.
High-quality protein, iron, choline, Vitamin D, EPA and DHA (marine omegas), zinc, tryptophan, B12, and other nutrients are hard to get enough of in a plant-based diet while preserving ratios, keeping the body’s hormonal systems (like blood sugar) balanced, and honouring cravings.
5. I don’t necessarily think, however that the Paleo Diet is the best diet.
I don’t think any diet is.
I think in principle Paleo was a cool idea: we humans spent the majority of our time in a hunter and gatherer before food processing and agriculture made things like grains and legumes digestible.
Therefore, like we should feed dogs like wolves, and we should eat like our primal ancestors, as our bodies haven’t evolved fast enough to keep up with high fructose corn syrup, etc.
I agree with the premise. But I also think that there is evidence that grains and legumes were consumed before agriculture, perhaps just not as in high amounts. Our bodies are different from the way they were when we were hunters and gatherers: we have more stress for example and higher complex carbs may help us manage this stress.
Also, animals fats, while good for us evolutionarily now exist inside of the context of an environment that is filled with thousands of chemicals. Animal fat is where chemicals are sequestered and therefore consuming lard, butter, and tallow as the main fats in the diet may not be as good for us anymore.
I’m not sure, but I think we need to appreciate our modern context and consume foods that are relatively unprocessed and well-digested that weren’t necessarily available when we were hunting and gathering our own food.
In essence, I think the research points to the fact that whole gains like oats and buckwheat and legumes like lentils are good for us.
6. Food is social. We don’t make nutrition decisions in a vacuum.
We use food to communicate: I love you, thanks for lending me your Back to the Future DVD set. Sharing food is an important part of our biology, of the human existence.
Humans are social creatures. And our socialness orients around food for a variety of reasons: celebration, socialization of children, peace-making, reward, pleasure, art.
I eat differently depending on who I’m with. I eat differently depending on the foods available at my local grocery store.
When I’m with my ND buddies I eat differently than when I’m with “muggles” or, non-NDs.
Navigating food in the social realm can be difficult–a balancing act between our own internal values around food and our values around connection–not offending someone, for instance.
I have suffered when my food choices didn’t fall into the realm of the society I was living (for example, being a vegan while living in South America) and trying to live with my Nonna, my Italian grandmother, while also learning that gluten was making me sick.
We may have conflicting values about food. But I believe that that’s ok.
I believe certain foods can contribute to inflammation but I also believe that they can help soothe my troubled emotions and overwhelm at times, and that that is anti-inflammatory.
To be honest, I don’t really like wearing socks and shoes–they feel weird on my feet.
I would rather prance around barefoot as the bonafide urban-dwelling earth-child I know myself to be deep down. But, I’m aware that we live in a world where the ground is sharp, and cold.
Sometimes it’s not safe, or socially acceptable to walk around barefoot.
And so I don’t. Because even though I love being barefoot, I can’t always do it. It’s not always appropriate.
And so it is with eating ice cream. Sometimes you’re trying to avoid it, but other times it’s appropriate to have some.
Under certain circumstances, eating ice cream might be the healthier choice.
7. Food obsession and shame have no place in health.
Of course eating well can bring is closer to health. However, steer the ship slowly. Be patient with yourself. Be curious about the process and learn to pay attention.
8. Embodiment is the key to bringing us back to nature and understanding our relationship with food again.
Sometimes we need help with our relationship with food.
Sometimes we need to unwind the years of food shame and diet culture to figure out what we even like, let alone what’s good for us.
I sometimes tell patients to have protein every time they crave something.
Just try it. See what happens.
Sometimes a craving for salty snacks means you need protein. It doesn’t mean it’s bad to satisfy a salty craving with popcorn, but if you do how do you feel? Is the salty craving gone?
Sometimes cravings for carbs and salt is the body asking for more protein. And then, in that case, it might be better to try having some protein. Just like sometimes you’re tired and food can help but so can a nap and a nap might help more.
It’s a process that involves trying things, from a place of curiosity, not judgement. And paying attention to how you feel.
If someone asks you for directions to a coffee shop in a language you don’t understand, and so, trying to be helpful you send them to a greenhouse.
They’ll love the greenhouse, you think. It’s beautiful there. And it is a beautiful place. But, they actually wanted a coffee and a piece of pie. And your intentions were pure. You were trying to help, trying to listen.
You just didn’t speak the language.
So I tell patients, have protein when you experience cravings and that might help you get enough protein.
Cravings aren’t bad. They’re essential. They’re a language.
Feeling stuffed isn’t bad. It’s another language. So is hunger. Hunger, satiation, cravings, mind-hunger, feeling stuffed to the gills, are all important syntax in the language your body uses to talk to you, to tell you how to feed it.
It’s hard to listen in a room full of shame, so it can take time to learn.
Is anyone else feeling wet dog in a bathtub-level lonely? With this pandemic loneliness is on the rise. And we already lived in an epidemic of loneliness. Humans are social creatures with attachment needs–and many of us are alone or surrounded by people who make us feel more alone. Sometimes loneliness doesn’t make sense.
This is a time when loneliness has turned from epidemic to global pandemic.
As we physically distance, the emotional distance between each other becomes greater.
I don’t have a solution to loneliness, but the great minds of neuroscience, psychology, literature, philosophy, and spirituality have written on it a great deal, and so I’m going to examine some of it in the following paragraphs.
1. “Saying Hello Again” When I first announced this project, many people reached out to me and talked about their grief: the loss of a spouse, a beloved pet.
Many more of us are grieving relationships with those who haven’t died, but who we don’t get to interact with as much anymore. Grief is a tricky subject. In our society we don’t have established rituals for grieving. In the DSM if you’ve lost a loved one more than two weeks ago, and your grief coincides with the symptoms for Major Depressive Disorder, you’re considered mentally ill.
Imagine losing someone important to you and not feeling depressed for more than two weeks…
In many instances we NEVER “get over” the pain of losing someone. And yet, in many ways, grief that interferes with our productivity and way of being is pathologized. Narrative Therapy invites us to grieve in ways that I have always felt were the richest and most helpful. It does this through a series of “Remembering Conversations”. (For more, I’ve linked to the paper “Saying Hello Again” by David Denborough.) You can speak remembering conversations out loud with a friend or therapist. You can write them down, or walk in the woods and reminisce. Find a quiet space where you can think of your loved one. It could be someone real, currently alive but not present–a religious figure, or a famous person. A stuffed animal. A pet. An ex-lover. Or someone who has passed away. Call them into your memory, and consider the questions. – What did [your loved one] see when they looked at you through loving eyes? – How did they know these things about you? – If they could be with you today, what would they say to you about the efforts you are making in your life? What words of encouragement would they offer? – What difference would it make to your relationships with others if you carried this knowledge with you in your daily life?
2. Feeling Lonely vs. Being Alone. “You come home, make some tea, sit down in your armchair, and all around there’s silence. Everyone decides for themselves whether that’s loneliness or freedom.” Surely solitude and loneliness are related but not equivalents. My patients and friends who are married with children crave alone time. My single friends who live alone crave company. What most of us want, however, is the feeling of freedom that comes with being ourselves. And we all know that this feeling can arise alone in the comfort of our own company or in the presence of those who fully accept us. The Dalai Lama has repeatedly claimed that he never gets lonely.
When he was asked the question “Do you get lonely?” at a speaking forum, it took the translator a while to convey the concept to him before he was able to answer. According to him, loneliness is not a condition of solitude. It’s a condition of mindset.
He weighs in: “We often are alone without feeling lonely and feel lonely when we are not alone, as when we are in a crowd of strangers or at a party of people we do not know. “Clearly the psychological experience of loneliness is quite different from the physical experience of being alone. “We can feel joy when we are alone but not when we are lonely… Much depends on your attitude. If you are filled with negative judgement and anger, then you will feel separate from other people. You will feel lonely. “But if you have an open heart and are filled with trust and friendship, even if you are physically alone, even living a hermit’s life, you will never feel lonely.” The loneliest I’ve felt is when I was in a relationship with someone whose love I couldn’t feel. But, I’ve felt completely at home and accompanied while traveling with strangers. When do you feel you can truly be as you are?
3. On being socially awkward and telling ourselves stories. We were in the midst of … isolation and so my friends cancelled their baby shower. They asked for books (if we were compelled to send gifts) and something else, I don’t remember…(clothes?) So I hopped on Amazon and happily ordered a few books I remember loving as a kid: Amos the sheep who doesn’t want to give up his wool, Frances the badger who gets conned into giving up her porcelain tea set in lieu of a plastic one, and so on. My friend is a therapist and I was sure he’d appreciate the psychotherapeutic subtext of these stories: finding self-worth, developing boundaries, etc. Anyways, I sent the books off and forgot about it. Then, one lonely evening I sat on the couch alone and let my Default Mode Network run rampant. I started ruminating on the books–they must have arrived. I hadn’t heard from my friends. Maybe they were going to send out more formal thank you card.
Or maybe something was wrong. Then I realized that they were about to have a BABY, a mere fetus+1 day. And I realized in horror I had sent them a pile of children’s books–for 3-5 year olds.
I felt out of touch, self-absorbed–I felt ashamed. And then I felt ashamed at my shame–surely this wasn’t such a big deal? What was wrong with me? I tried to Cognitive Behaviour Therapy my way out of this thought trap–this story about being weird and disconnected. I couldn’t do it. I eventually reached out to another friend who has two kids. She played the role of my prefrontal cortex (using others for emotional regulation is extremely helpful). She assured me that babies can’t read anyways and so, whatever, any kind of book is fine. Duh… then I realized: this is the collateral of isolation.
If the gifts had been unwrapped in person, I might have realized they were slightly age inappropriate and would have made a joke. People would have laughed, we would have moved on. Instead, my mind was free to fill the silent void with stories. Eventually I confessed my neuroticism to my friends, embarrassed. They laughed and thanked me for the gift. We tell ourselves stories about how others see us all the time. About their judgements and prejudices, motivations, anger, hostility and failings.
What story are you telling yourself about the people in your life?
4. The Power of Art. Remember this scene from the movie Good Will Hunting? Sean : [during a therapy session, after coming from the job interview with the NSA] Do you feel like you’re alone, Will? Will : [laughs] What? Sean : Do you have a soul mate? Will : Define that. Sean : Somebody who challenges you. Will : I have Chuckie. Sean : You know Chuck; he’s family. He’d lie down in fuckin’ traffic for you. No, I’m talking about someone who opens up things for you – touches your soul. Will : I got – I got… Sean : Who? Will : …I got plenty. Sean : Well, name them. Will : Shakespeare, Nietzsche, Frost, O’Connor, Pope, Locke… Sean : That’s great. They’re all dead. Will : Not to me they’re not.
This exchange has always come to mind when I think about the loneliness of trying to find a soulmate–someone who knows the secrets and truths that lie deep in our hearts. Do our soulmates need to be living people who we share our lives with? People we can converse with on a daily basis? Ideally yes. However, many people in literature will speak of the phenomenon about feeling alone in a crowded room, with no one to share their private thoughts. When we read someone’s deep thoughts and feelings and relate it… makes us feel less alone, especially if what we’re reading speaks directly to our own hearts. You know that sensation, when you’re feeling something really deeply and then you read or hear someone else (maybe someone you know, maybe someone famous, or dead) describe that phenomenon in a way that is far more eloquent and articulate than you feel you ever could?
That feeling of being deeply validated and understood. Literary soulmates. People who have thought long and hard about this particular existential human experience you’re going through right now.
Not only have they lived it, but they’ve taken the trouble to put it into words, images, music. To remind you that you’re sharing a nervous system with 8 billion other living human beings . To remind you that you’re not alone.
5. Making Friends as an Adult aka Going After What Lights You Up. “You can’t make friends in your 30s”.
My friend’s brother is an investment banker in Manhattan and this was his claim a few years ago. My friend, a bonafide hippie (they are hilarious opposites) and I wondered if it was true. I’ve spent pockets of my adult life wishing I had more friends. I’ve had long conversations with patients who wish they had more friends, or are looking to date and having trouble meeting people. One of the things I was grieving during the last few months was loss of the spontaneity of meeting people.
No more picnics on the Island where a random group of people invite me to share their wine and then write letters to my Nonna.
No more “networking” events I decide at the last minute to drop in on, where I meet a friend who introduces me to someone who would soon be a best friend. No more of that randomness. A contraction of possibilities. The same friend wrote to me, in an email we sent to each other in our early 20s when we were out of school and trying to find our way. “I don’t even know what it is about making friends. It can just be so random the way you meet someone in passing you might really connect [with] or you might ignore each other after 5 minutes and never speak again.
“The philosophy is right — if you go after what lights you up you are bound to stumble upon someone else who is lit on that in their own way and for their own reasons so you are bound to connect on some level!” And, of course we’ve heard this so many times: go after what you’re passionate about and the people will trickle in, like a kind of osmotic current. And it’s easier said that done, finding out what lights you up. I suppose it starts with creating an open question and waiting for the answer to show itself. Lake surfing was one of the answers that manifested itself to me. It’s been a blessing for me in so many ways–from even finding out it existed, to randomly meeting people in the line-up to my regular surf buddies, to the photographers who celebrate us on social media, the sport, although technically a solo one, is all about connectivity. Water is sticky. so are we.
6. Self-Soothing. Will scientists and drug companies create a pill for loneliness? Hormones like oxytocin, endogenous opioids (our body’s own morphine) and allo-pregnenalone, a steroid hormone related to estrogen, progesterone, testosterone, and cortisol, are all common targets for “medicating” loneliness. We can medicate loneliness ourselves, however through self-soothing. Self-soothing behaviours include: – talking about your emotions with others – social and physical warmth (getting cozy and Hygge) – Touching, including self touch and self holds – Soothing music – Satiety through consuming high-calorie foods (chocolate, anyone?) – And even drugs, although engaging in the above self-soothing behaviours tends to protect against drug addiction in the research–if you’re able to reach for a cozy sweater and a puppy in order to self-soothe you’re probably less likely to turn to alcohol. Self-soothing behaviours increase oxytocin in the brain. They calm areas of the brain like the insula and amygdala that are associated with anxiety. Self-soothing boosts endogenous opioids (research shows that opioids like morphine help calm the sting of social rejection, which our brain perceives to be the same as physical pain), and serotonin and dopamine. Self-touch or self-holds is an excellent way to self-soothe. In my podcast on Polyvagal Theory with Dr. Steph Cordes, we talk about self-touch: things like putting a hand on your chest, wrapping your arms around yourself, child’s pose, or cupping your face in your hand. Sometimes speaking your own emotions can be helpful (“I feel sad right now” or “This is hard”). Also, particularly where these emotions pertain to loneliness, invoking a common humanity can he a helpful tool for feeling less alone and can help soothe and process hard feelings. “Everyone feels this way sometimes”, or “Suffering is a part of life”. In Mindful Self-Compassion, invoking a common humanity is an important step in taking the burden of our feelings off of ourselves and recognizing that we’re all interconnected in the emotional space. How do you self-soothe?
7. Attunement. “[Attuning with others] is at the heart of the important sense of “feeling felt” that emerges in close relationships. “Children need attunement to feel secure and to develop well, and throughout our lives we need attunement to feel close and connected.” – Dan Siegel, MD Attunement is the process of responding to another’s emotional cues. Infants first learn attunement from their parents. When a parent can read a baby’s expressions or hear her cries and respond appropriately: with comfort, food, warmth, a diaper change, it builds a sense of trust in the infant’s body. The baby feels seen and understood by the world. A lack of attunement can cause attachment insecurity: leading to feelings of anxiety, distrust, emotional avoidance, depression, and relationship dissatisfaction. It’s ultimately lack of attunement that results in mental health challenges in an adult’s life. Attuning to others can be hard if you didn’t receive the proper attunement from your parents. However, we can still learn to attune to ourselves and others as adults.
Here are some tips for learning how to be more attuned: – Attune to yourself first: starting by recognizing what you feel in your body: what thoughts, emotions and feelings are present? How are you breathing? – Practicing mindfulness can help you understand what is going on in your body and mind, as you learn to attune to yourself emotionally. – When trying to attune to another, limit distractions (turning off the TV, putting away cellphones, etc.) so that you can fully pay attention to the emotional space. – Make eye contact and mirror the others’ physical cues: mimic their postures, gestures and even tone of voice. Physical mirroring is a hallmark skill of attunement. – Listen carefully with compassionate curiosity: seek to understand before seeking to be understood (a useful cliche). Can you give the other person the benefit of the doubt? Can you try your best to relate to what they might be staying and hold them in what Carl Rogers called “Unconditional Positive Regard”? – Can you try to identify what emotions someone might be experiencing as you talk to or sit with them? What are you feeling in your own body?
8. Sharing the Things that Matter “Loneliness isn’t the physical absence of other people – it’s the sense that you’re not sharing anything that matters with anyone else.”
— Johann Hari, from his book Lost Connections. Johann also writes: “Be you. Be yourself… “We say it to encourage people when they are lost, or down. Even our shampoo bottles tell us—because you’re worth it. But what I was being taught is—if you want to stop being depressed, don’t be you. Don’t be yourself. Don’t fixate on how you’re worth it. It’s thinking about you, you, you that’s helped to make you feel so lousy. Don’t be you. “Be us. Be we. Be part of the group. Make the group worth it. “The real path to happiness, they were telling me, comes from dismantling our ego walls—from letting yourself flow into other people’s stories and letting their stories flow into yours; from pooling your identity, from realizing that you were never you—alone, heroic, sad—all along. “No, don’t be you. Be connected with everyone around you. Be part of the whole. Don’t strive to be the guy addressing the crowd. Strive to be the crowd. So part of overcoming our depression and anxiety—the first step, and one of the most crucial—is coming together.” And, “Now, when I feel myself starting to slide down, I don’t do something for myself—I try to do something for someone else. I go to see a friend and try to focus very hard on how they are feeling and making them feel better. “I try to do something for my network, or my group—or even try to help strangers who look distressed. “I learned something I wouldn’t have thought was possible at the start. Even if you are in pain, you can almost always make someone else feel a little bit better. Or I would try to channel it into more overt political actions, to make the society better. When I applied this technique, I realized that it often—though not always—stopped the slide downward. It worked much more effectively than trying to build myself up alone.” I think what Johann is saying is that a sense of meaning, purpose, belonging can’t coexist with loneliness.
Psychoanalyst Francis Weller says it another way,
“at some point we have to stop being the one looking for homecoming and be the one offering it.
“As long as I identify as the homeless child who didn’t get welcomed back I need to make a pivot and say ‘I can also, because of that wound find the medicine of welcome’.”
In what way does being of service help you feel more connected?
How have you learned to deliver what Francis calls “the medicine of welcome” to others?
9. Needs are the doorway to the Inner Child, Imagination, Desire and Purpose. James Hillman, the great Jungian psychoanalyst urges us to use our needs–loneliness being one–to explore the depths of our soul. Loneliness, according to Hillman is, like any other need, “a voice that demands to be satisfied”.
We believe that loneliness represents a void that can be filled by something external: a person’s physical presence, or the actions or words of another that fills the space inside. But a need is actually a doorway: to the Inner Child, who opens the door to the imagination. The need represents something much more, not just love but a kind of archetypal, “divine” love. Not just company, but the deep longing to be whole, to unite with “the beyond”. When we feel needy, or lonely, our Inner Child, according to the Jungians, is crying out. It doesn’t just want to complain.
Hillman says, “The intensity of the need reflects the immensity of the world beyond from which it comes.” The child can help us imagine–when we articulate the need, speak it out loud and feel deeply into the body the sensations that that need creates (where do you feel the need? Where do you feel loneliness?), we let it come up fully. We turn towards the child. We can then be specific about the need. What are we fantasizing will fill this loneliness? Who do I want with me? What would they say? What would they do? Are we riding horses in the sunset?
Allowing the images to come.
Allowing the needs to become wants. When we stay with the loneliness long enough, this voice crying to be satisfied, until it becomes a want, something interesting happens. The emptiness of the need, the lack that represents loneliness begins to become filled: with wanting, with desire. The writer DH Lawrence tells us that “Desire is holy”. It is hot, fiery, passionate. It fills us: “I am filled with desire”. It motivates us. It makes things happen. Desire connects us with the beyond. It moves us towards our purpose.
According to Hillman, a fear of desire stands in the way of finding one’s purpose.
We are afraid of the Inner Child: the weakness that being needy represents.
We feel shameful at our weakness, at our neediness. We deny the needs, or try to fill them some other way. Or we criticize ourselves, punishing the child, or ignoring the child.
But what if this deep, existential loneliness, this longing to be united with what “lies beyond” or what lies deeply in our soul is really the doorway to purpose, to fire, to passion, to an integrated and complete psyche.
What if this neediness is not asking to be filled by external factors: parties, social media likes, validation, but with this deeply felt sense of desire that fuels us in the direction of our dreams?
What is the loneliness asking of you?
When you let the loneliness cry out, when you allow it to provide you with images, and when you allow the loneliness to become a want, what does it drive you to do?
What does it fill you with?
What does it inspire you to do next?
10. Getting To Know Yourself. “If you’re lonely when you’re alone, you’re in bad company.”
— Jean-Paul Sartre. Through this series we’ve explored the concept of feeling alone while surrounded by other people, and feeling utterly content while in complete solitude. And, so loneliness isn’t so much about being physically isolated, but in our deeper inner feelings of connection. The Stoics and the Buddhists tell us that, when we feel lonely it’s because we’ve stepped out of the present moment.
We’ve turned our thoughts to what we lack; we’ve identified with our suffering.
And, according to James Hillman and many other thought leaders on the psyche, we’ve decided that the solution to our suffering is located “out there”, in the external world. But no, say the Buddhists, Stoics and other philosophers. The solution to our suffering is internal. It lies within. And so, they say, when you’re lonely, you need to spend even more time alone–getting to know yourself. When we know ourselves, we feel relaxed in our own company. When we know ourselves, we can share ourselves with others when we’re blessed with their company, thus feeling more connected to them and less alone. Perhaps loneliness isn’t being isolated from others—not all the time.
Loneliness is the feeling we have when we’re isolated from our true selves. So, how can we get to know ourselves? The Buddhists say, sit.
Pay attention to your thoughts, your emotions and your body sensations in the present moment.
James Hillman tell us to watch our pain turn into desire, which tells us what the soul deeply wants. This time of year is hard for a lot of us. Add on a global pandemic, and this year is looking like a challenging one for most. Can you spend some quiet time alone with yourself?
Can you watch the feelings of loneliness arise and fall in your body? Can you deliver yourself a little self-compassion? In those private moments of emptiness, say: “Loneliness is here”. “Everybody feels this way sometimes”. “May I be kind to myself”. And, can you say:
That feeling that you can’t settle. You can’t eat. You can’t relax. Your muscles are tense.
Not all is right with the world. Many people who live with chronic low-grade anxiety don’t even realize it’s there.
I see this all the time in my patients who experience panic attacks (when a couple of straws “break the camel’s back” so to speak, the “backs” being a nervous system that is already tightly wound up), or dissociation, even depression, or chronic exhaustion.
Chronic low-grade anxiety can occur if something happens to us that our nervous systems don’t yet understand. I was babysitting a dog for a few days and she and my dog got into a fight. It was nasty and it rattled my nervous system.
I found myself feeling wound up… needing to be soothed, to be settled, for someone to tell me that it wasn’t going to happen again. My response is to go into “information” mode, to poll people, to get an authority’s perspective.
But, of course, it’s impossible to have certainty in this world. And so, my nervous system was asking for something: either that the situation wouldn’t happen again, or that I would know how to handle it and make things alright if it did.
Those with a history of childhood trauma may live in a state of hypervigilence and chronic anxiety–for you it might be your default state, like oxygen, anxiety is always there, at the very baseline of your experience.
The experience of low-grade anxiety is terrible. You’re always vigilant. You’re obsessing, you can’t relax. Your startle reflex is completely uptight.
You have nightmares, you don’t feel hungry. And yet you suddenly feel light-headed and starving.
Everything feels like too much.
Symptoms of chronic low-grade anxiety:
brain fog
overwhelm
disrupted sleep
feeling jittery or shaky
nausea
lack of hunger
extreme hunger
tense, sore muscles
digestive issues, IBS, bloating, diarrhea
generalized sense of dread
shortness of breath, or difficulty getting a full breath
sweating
fatigue
and so on
How do you heal it? Well, it’s tough because ultimately the nervous system wants you to REASSURE it that the world is a SAFE PLACE.
And… it’s not.
Shit happens.
It’s a bumper sticker for a reason.
Shit happens and when it does we need resources.
These resources come in the form of physical nutrition: literally salt, glucose and water. They come from stable hormones (related to blood sugar, a properly functioning circadian rhythm), managed inflammation.
They come from restorative practices: exercise and rest, time where you feel into your body. And they come from understanding the situation: storying it.
In the case of the dogfight, it helped me to learn about dogs, to know how to keep them calm and happy, to understand their particular language and establish myself as the dog leader (also lots and lots of exercise and a bit of CBD oil).
Once they were calm I was calm too.
In the case of childhood trauma it might involve working with the story through the support of a trusted therapeutic relationship, and maybe after working on building resources and engaging in stabilizing practices that help you feel embodied.
Therapies to treat chronic low-grade anxiety:
nutritional practices focused on obtaining essential nutrients like fat and protein and stabilizing blood sugar
support circadian rhythms, sleep and cortisol responses in the body
support neurotransmitters and cell membranes
trauma-informed therapy, or Cognitive Behaviour Therapy
movement
meditation and self-compassion
breathwork
emotional regulation, self-soothing and other embodiment practices
time in nature
plenty of rest
regular routines and self-care-informed habits
plant medicines that can help access deeper seated trauma or regulate the nervous system, hormonal systems and brain chemistry.
And so on.
Our nervous systems are beautiful things. They’re trying to tell us something.
A nervous system on edge is telling us that all is not harmonious with the world: perhaps our internal world, or our external one.
One of the reasons I love dogs so much is that we share a fundamental understanding: walking is healing. I love walking. My body craves walking. I walk to strengthen my lower body, to stretch my psoas (hip flexors), to stabilize my core. I walk to self-soothe, to process emotions, to move anxiety. I walk to boost my circulation, to stimulate lymphatic flow, to lay down bone density. I walk to think, to dream, to create. I walk to roam. Our hunter gather ancestors walked 12-18 km per day (approximated from studies on the modern Hadza). Walking is probably the most therapeutic practice (besides sleeping) that there is. I start every day with a walk to prime my brain for cognitive and emotional work. In the winter it feels particularly therapeutic as it exposes me to cold, to fresh air and to sunlight. Exposing my body to cold helps to regulate my temperature, and prevent Seasonal Affective Disorder (not to mention the sun exposure, on a sunny day, which provides light therapy). I’ve been prescribing walking to many of my patients. To calm anxiety, to heal depression, to regulate the nervous system and to stimulate dopamine–our body’s “seeking” chemical. Many of us have noticed our worlds contract: we’re not travelling, we’re not roaming. Long walks help us feed the roaming instinct that we share with our canine companions. They fill our need to explore, to see people, to experience. Winter walks, while initially uncomfortable help our bodies transition to the colder climate. Cold exposure is also extremely anti-inflammatory, boosts our body’s natural antioxidants and stimulates feel-good chemicals in the brain that support our mood, cognitive function, and energy. I walk when I’m sad. I walk when I’m anxious. I walk when I’m bored. I walk when I’m restless. I walk in silence, with music, with a podcast, while recording voice audio to a friend. I walk alone. I walk with others. I walk with Coco. My body has begun to crave walks. Coco’s body never stopped craving a walk. I walk to reunite with my wild self.
She told me that lately, all the children she works with have a label. “Meredith can’t attend your online class because it’s her first day of school and she can’t handle more than two things because of her anxiety”, one mother wrote in an email as she backed out of a private class my friend had created by special request.
“Everyone is nervous on their first day of school”, my friend remarked, as she recounted the story to me.
“I need everyone’s microphones muted”, a 10-year old student exclaimed during an online class, “I have sensory overwhelm and attention deficit disorder and can’t handle background noise”.
My friend spent three years teaching in a rural school at the edge of a volcano in Guatemala. She worked in a private girls’ school in Colombia. And she taught grade 1 at an outdoor jungle school on the Pacific Coast of Mexico. “I’m not used to these North American kids”, she reflected.
“I wonder what diagnoses we’d have gotten in university?” I mused. I remember our Revolutionary Wall–pictures of Noam Chomsky, Victor Jara and Ghandi plastered on the wall that welcomed us into the entrance of our dirty apartment.
That year we’d worn our sweaters backward because it “felt right” to rest your chin on your hood, stopped washing our hair to “let the oils moisturize our roots”, and spent a week on a 1000-piece puzzle instead of going to class.
It was our last year. We were done.
My other friend was diagnosed with cancer, which would soon turn terminal. I was suffering from some sort of unacknowledged eating disorder–there were no body positivity Instagram feeds at the time. I could have used some.
It was a painful year.
For those and many more reasons, I’m sure, I was depressed.
I remember at some point during that year heading to a walk-in clinic because I was gaining weight, depressed, exhausted and completely shutdown. The walk-in clinic doctor told me “it wasn’t my thyroid” and to “eat less” so that I would lose weight.
I never got a diagnosis.
I was never offered an antidepressant.
I remember feeling hopeless. Desperate for an answer, but most of all, a solution.
If she had offered me an antidepressant, I’m certain I would have taken it. In fact, I did end up taking one about a year later for a brief period when living in Colombia (before the side effects made me stop).
I escaped a label.
My journey forked in the road and I took the one less traveled that led me towards naturopathic medicine.
Before that, though, I saw my own natural doctor who listened to me and put together the puzzle of my symptoms (who knew that skipping class to put together our 1000-piece puzzle would figuratively prepare me for my future career).
Rather than diagnose me, he listened to me and told me the underlying causes of my symptoms–not just what they were called.
And then, because we knew the cause, we also had a solution. And I soon felt better.
Of course, when I started naturopathic school, another 4-year full-time program with full days of classes (sometimes 10+ hours a day) and millions of exams and assignments, the underlying hormonal conditions that drove the original depressive episode I experienced at the end of my undergrad resurfaced.
I ended up seeing a fourth year naturopathic intern and she put me on something called adaptogens.
Adaptogens are class of plants. They support our Hypothalamic-Pituitary-Adrenal (HPA) response, which orchestrates the stress response. They are studied in rats who, when given adaptogens can perform longer on swim tests, producing less cortisol (our stress hormone) in the process.
These rats can tread water longer, without as much stress hormone and therefore, with less damage from stress. Depression is one of those side effects from the damage of psychosocial stress.
Stress leads to shutdown, inflammation and further hormonal imbalance, causing a wide variety of symptoms that seem disconnected but arise from the same source.
After all, isn’t depression, anxiety and burnout just us trying to keep our heads above water?
Oh man, did I ever wish I’d known about adaptogens in undergrad!
If I could have, I would have shouted about them from the rooftops, thrown bottles of them out of a plane, put them in the water supply.
I can’t do those things, but I can put many of my patients on them. Many of my patients suffering from depression and anxiety, caused by problems with their HPA axises, end up taking adaptogens.
I prescribe them when those I work with experience things like low mood, fatigue, sleep issues, inflammation (pain and swelling), hormone imbalances, particularly PMS or peri-menopause, sugar and salt cravings, delayed muscle recovery, tension, panic attacks and anxiety, dizziness and weakness, low motivation, and other oh-so-common symptoms often labelled as Major Depressive Disorder or other psychiatric illnesses.
Did I ever wish I’d known about adaptogens when I was in undergrad.
Instead I remember taking a crappy B vitamin complex from the local drugstore that a roommate’s mom gave me because I was on the birth control pill and “you need B vitamins on the birth control pill”. (Which is true: you need more vitamin B6 on the pill, but probably not one from a local drugstore multivitamin).
It didn’t do much.
I really really wish someone, a fairy godmother, the walk-in clinic physician, a man on the street, an article somewhere on the internet (like this one), had told me, “You have these symptoms because you are suffering from HPA axis dysfunction, as a result of significant psychosocial stress. This makes you suffer from the symptoms you’re dealing with, depression not being a condition of its own, but just another symptom of this condition.
“Adaptogenic herbs can help you get through this, as well as some important foundational lifestyle pieces that someone like a naturopathic doctor can help you with.
“There is a reason for your suffering. A context behind it. There is a cause we can identify.
“And, most importantly, there is a solution.”
But, I didn’t have anyone to tell me that.
I really wish someone had told me about adaptogens, but I haven’t ever wished that someone had diagnosed me with depression.
Now, a diagnosis can be extremely validating for some.
It can be lifesaving.
Medical intervention can also be really helpful for some people. But, like adaptogens (I should add), medications aren’t a one-size-fits-all solution.
We don’t know what causes depression and anxiety (likely many factors, HPA axis dysfunction being one of them), but we do know it’s not caused by a chemical brain imbalance.
And medications are designed to correct the brain imbalance that doesn’t exist, which is why they don’t work in everyone.
However, they do do something in some. Because, even though they don’t really solve the problem they’re supposed to (at least not in that simplistic way), they might be doing something else, which solves a problem in a few people.
The problem is, antidepressants make some people feel worse. In others they do nothing. And, in some of the people they do help, they don’t do enough. We’re still suffering.
And labels, while they can be helpful and lifesaving in some cases, can do damage in others.
Take my friend’s student with anxiety. What if her story of “I get stressed out on the first day of school because I have anxiety” turned into:
“I get stressed out on the first day of school because a lot of people do. It’s normal to feel nervous and anxious on the first day of school and want everything to go right.”
Now, of course, I don’t want to insinuate that anxiety isn’t a real thing. Of course it is!
There are many of us who suffer from anxiety disorders–a higher amount of anxiety than is common. Rather than first-day jitters, they might experience severe panic and complete dysfunction that make life miserable.
However, in the first example, the power is out of this student’s hands. It lies in her identity. In her dysfunction.
In her label.
In the second, it becomes a shared human experience, which she might be able to externalize and work with. Because it’s a common experience, she might find support, kinship, and understanding in those who experience the same.
Of course, I don’t know her case specifically. Maybe her diagnosis has helped her. Maybe her anxiety is well labelled and managed. Maybe she doesn’t need help. Maybe she is doing just fine.
All I know is, I wonder what I would have been diagnosed with, with my sweater on backwards, my hair full of grease, my body heavy like lead, a million puzzle pieces spewed all over the kitchen table in my dirty apartment with the revolutionary wall.
I have no idea what my diagnosis would have been, but I’m personally glad I never got one.
Instead, I wish I had had the permission to go through what I was going through.
I wish I’d had context for my suffering.
I wish I’d been given hope that things would get better.
I wish someone had empowered me through understanding the underlying causes of my symptoms and, of course,
