The first time I saw a naturopathic doctor was a few years before I contemplated becoming one myself. I had finished my undergrad degree and was bumming around for the summer, working on film sets, trying to get help for some underlying hormonal condition which I now know to be caused by burnout.
The doctor’s office was warm and carpeted. He had a shelf of books, although I don’t remember what they were or were about. I imagine some were medical textbooks. He performed a physical exam that seemed at the same time unnecessary and strangely medical. Still, I hoped would be injected with this particular kind of magic and systems thinking that I expected—that he would look at me and declare me to have too much phlegm or give me some insights into my general state and appearance that had been handwaved as “normal” by the blood tests and various other medical practitioners I’d been to.
I had tracked my food for a week. For breakfast, I had cereal (the healthy kind), skim milk, coffee, and fruit. He held this paper in front of him, and I awaited his thoughts.
“You should stop eating dairy,” he said, not looking up, “It’s not that good for us.” I assumed “us” meant “us humans.” He didn’t elaborate, stating it as if I were apparent.
I remember this 16 years later, although I’m sure he said more things in that appointment.
What does it mean to make these statements to patients? Sometimes, I find myself explaining things, elaborating, discussing how we might try a dairy elimination diet, and making connections between the properties of dairy or this client’s experience with dairy (bloating, inflammation, eruptions of cystic acne).
I was bloated and inflamed with cystic acne, but I don’t remember if I stopped putting milk in my cereal that day. I distinctly remember a year later indulging in a frothy milk latte in a café in Cartagena, Colombia, writing in my journal that I expected it would bloat me and combine poorly with the insufferable heat and humidity outside.
The other day, I was visiting with my friend and naturopathic colleague, playing with her baby on the floor and talking about practice, health, and medicine. I was speaking about the pressure I feel when working with a new patient to solve their problems in the first visit. Often, no one had even acknowledged their problems before, and here was my task to not only acknowledge but already know about and have a solution for these problems. I remember attributing this same magic to the naturopathic doctor I saw in 2008.
My friend nodded, “Many of our solutions are just band-aids. It takes years to shift our thinking and behaviours to make long-term changes to our health.” I remember eating Tiramisu years after this 2008 appointment, developing painful cysts the next day.
One thing was certain: I remembered his (perhaps offhand) remark and started making connections, even if they didn’t lead to long-term behavioural changes.
I still sometimes eat dairy. At this friend’s house, we each had a Greek salad with chicken and all the fixings, including feta cheese. It was delicious. The next day, my skin looked okay. All in all, I’m pretty good at avoiding cow’s milk.
I am more meticulous about avoiding gluten.
I don’t necessarily agree that dairy isn’t good for “us [humans].” I’m not even sure if it’s not good for me. Like most things, it’s nuanced and depends on the terrain (my stress levels, gut health), the type of dairy (organic, fermented) and the amount. So, maybe I’m not entirely convinced. Sometimes, it tastes so darn good, and I don’t care.
I suppose that hearing something is “not good for us” is insufficient for learning. Experiencing how something is not good for us, while better, is still probably not sufficient.
I suppose that sometimes we humans do things that aren’t good for us.
I suppose our lives, like healing, are works in progress.
It was a crappy week and I was chatting with a friend online. He said something that triggered me… it just hit some sort of nerve. I backed away from my computer, feeling heavy. I went to the kitchen to pour myself a glass of water and collapsed, elbows on the counter, head in my hands, my body shaking and wracking with deep, guttural sobs.
A few seconds later, I’m not sure how long exactly, I stood up. Tears and snot streaming down my face, I wiped them off with a tissue. I felt lighter, clearer. I was still heavy and sad, but there was a part of me that had opened. I went back to my computer and relayed some of this to my friend, “what you said triggered me, but it’s ok, it just hit a personal nerve. I’m ok now though, I know you didn’t mean any harm”. I typed to him.
Joan Rosenberg, PhD in her book 90 Seconds to a Life You Love, would have said that, in that moment, I had been open to feeling the moment-to-moment experience of my emotions and bodily sensations. I felt the waves of emotions run through my body, and let them flow for a total of up to 90 seconds. And, in so welcoming that experience and allowing it to happen rather than blocking it, fighting it, projecting it (onto my friend or others), I was able to release it and let it go.
For many of us, avoidance is our number one strategy when it comes to our emotions. We don’t like to feel uncomfortable. We don’t like unpleasant sensations, thoughts and feelings and, most of all, we don’t like feeling out of control. Emotions can be painful. In order to avoid these unpleasant experiences, we distract ourselves. We try to numb our bodies and minds to prevent these waves of emotion and bodily sensation from welling up inside of us. We cut ourselves off.
The problem, however is that we can’t just cut off one half of our emotional experience. When we cut off from the negative emotions, we dampen the positive ones as well.
This can result in something that Dr. Rosenberg titles, “soulful depression”, the result of being disconnected from your own personal experience, which includes your thoughts, emotions and body sensations.
Soulful depression is characterized by an internal numbness, or a feeling of emptiness. Over time it can transform into isolation, alienation and hopelessness–perhaps true depression.
Anxiety in many ways is a result of cutting ourselves off from emotional experience as well. It is a coping mechanism: a way that we distract ourselves from the unpleasant emotions we try to disconnect from.
When we worry or feel anxious our experience is often very mental. We might articulate that we are worried about a specific outcome. However, it’s not so much the outcome we are worried about but a fear and desire to avoid the unpleasant emotions that might result from the undesired outcome–the thing we are worrying about. In a sense, anxiety is a way that we distract from the experience of our emotions, and transmute them into more superficial thoughts or worries.
When you are feeling anxious, what are you really feeling?
Dr. Rosenberg writes that there are eight unpleasant feelings:
sadness
shame
helplessness
anger
embarrassment
disappointment
frustration
vulnerability
Often when we are feeling anxious we are actually feeling vulnerable, which is an awareness that we can get hurt (and often requires a willingness to put ourselves out there, despite this very real possibility).
When we are able to stay open to, identify and allow these emotions to come through us, Dr. Rosenberg assures us that we will be able to develop confidence, resilience, and a feeling of emotional strength. We will be more likely to speak to our truth, combat procrastination, and bypass negative self-talk.
She writes, “Your sense of feeling capable in the world is directly tied to your ability to experience and move through the eight difficult feelings”.
Like surfing a big wave, when we ride the waves of the eight difficult emotions we realize that we can handle anything, as the rivers of life are more able to flow through us and we feel more present to our experience: both negative and positive.
One of the important skills involved in “riding the waves” of difficult feelings is to learn to tolerate the body sensations that they produce. For many people, these sensations will feel very intense–especially if you haven’t practice turning towards them, but the important thing to remember is that they will eventually subside, in the majority of cases in under 90 seconds.
Therefore, the key is to stay open to the flow of the energy from these emotions and body sensations, breathe through them and watch them crescendo and dissipate.
This idea reminds me of the poem by Rumi, The Guest House:
This being human is a guest house. Every morning a new arrival.
A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all! Even if they’re a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably. He may be clearing you out for some new delight.
The dark thought, the shame, the malice, meet them at the door laughing, and invite them in.
Be grateful for whoever comes, because each has been sent as a guide from beyond.
One of the reasons I was so drawn to Dr. Rosenberg’s book is this idea of the emotional waves lasting no more than 90 seconds. We are so daunted by these waves because they require our surrender. It is very difficult however, if you suffer from anxiety to let go of control. To gives these emotional waves a timeframe can help us stick it out. 90 seconds is the length of a short song! We can tolerate almost anything for 90 seconds. I found this knowledge provided me with a sense of freedom.
The 90 seconds thing comes from Dr. Jill Bolt Taylor who wrote the famous book My Stroke of Insight (watch her amazing Ted Talk by the same name). When an emotion is triggered, she states, chemicals from the brain are released into the bloodstream and surge through the body, causing body sensations.
Much like a wave washing through us, the initial sensation is a rush of the chemicals that flood our tissues, followed by a flush as they leave. The rush can occur as blushing, heat, heaviness, tingling, is over within 90 seconds after which the chemicals have completely been flushed out of the bloodstream.
Dr. Rosenberg created a method she calls the “Rosenberg Reset”, which involves three steps:
Stay aware of your moment-to-moment experience. Fully feel your feelings, thoughts, bodily sensations. Choose to be aware of and not avoid your experience.
Experience and move through the eight difficult feelings when they occur. These are: sadness, shame, helplessness, anger, embarrassment, disappointment, frustration, vulnerability.
Ride one or more 90 second waves of bodily sensations that these emotions produce.
Many therapeutic techniques such as mindfulness, Dialectical Behaviour Therapy, somatic therapy, and so on utilize these principles. When we expand our window of tolerance and remain open to our physical and emotional experience we allow energy to move through us more gracefully. We move through our stuckness.
Oftentimes though, we can get stuck underwater, or hung up on the crest of a wave. Rumination and high levels of cortisol, our stress hormone can prolong the waves of unpleasant emotion. We may be more susceptible to this if we have a narrow window of tolerance due to trauma.
However, many of us can get stuck in the mind, and when we ruminate on an emotionally triggering memory over and over again, perhaps in an effort to solve it or to make sense of it, we continue to activate the chemicals in our body that produce the emotional sensation.
Therefore, it’s the mind that can keep us stuck, not the emotions themselves. Harsh self-criticism can also cause feelings to linger.
I have found that stories and memories, grief, terror and rage can become stuck in our bodies. Books like The Body Keeps the Score speak to this–when we block the waves, or when the waves are too big we can build up walls around them. We compartmentalize them, we shut them away and these little 90 second waves start to build up, creating energetic and emotional blockages.
In Vipassana they were referred to as sankharas, heaps of clinging from mental activity and formations that eventually solidify and get lodged in the physical body, but can be transformed and healed.
Perhaps this is why a lot of trauma work involves large emotional purges. Breathwork, plant medicines such as Ayahuasca, and other energetic healing modalities often encourage a type of purging to clear this “sludge” that tends to accumulate in our bodies.
My friend was commenting on the idea that her daughter, about two years old, rarely gets sick. “She’ll have random vomiting spells,” my friend remarked, “and then, when she’s finished, she recovers and plays again”.
“It reminds me of a mini Ayahuasca ceremony”, I remarked, jokingly, “maybe babies are always in some sort of Ayahuasca ceremony.”
This ability to cry, to purge, to excrete from the body is likely key to emotional healing. I was listening to a guest on the Aubrey Marcus podcast, Blu, describe this: when a story gets stuck in a person it often requires love and a permission to move it, so that it may be purged and released.
Fevers, food poisoning, deep fitful spells of sobbing may all be important for clearing up the backlog of old emotional baggage and sludge so that we can free up our bodies to ride these 90 second emotional waves in our moment-to-moment experience.
Grief is one of these primary sources of sludge in my opinion. Perhaps because we live in a culture that doesn’t quite know how to handle grief–that time-stamps it, limits it, compartmentalizes it, commercializes it, and medicates it–many of us suffer from an accumulation of suppressed grief sankharas that has become lodged in our bodies.
Frances Weller puts it this way,
“Depression isn’t depression, it’s oppression–the accumulated weight of decades of untouched losses that have turned into sediment, an oppressive weight on the soul. Processing loss is how the majority of therapies work, by touching sorrow upon sorry that was never honoured or given it’s rightful attention.”
Like a suppressed bowel movement, feelings can be covered up, distracted from. However, when we start to turn our attention to them we might find ourselves running to the nearest restroom. Perhaps in these moments it’s important to get in touch with someone to work with, a shaman of sorts, or a spiritual doula, someone who can help you process these large surges of energy that your body is asking you to purge.
However, it is possible to set our dial to physiological neutral to, with courage turn towards our experience, our emotions and body sensations. And to know that we can surf them, and even if we wipe out from time to time, we might end up coming out the other side, kicking out, as Rumi says, “laughing”.
The only way out is through.
As Jon Kabat Zinn says, “you can’t stop the waves, but you can learn to surf”.
“I don’t believe in diseases anymore, I treat stories.
“…No other medical system in the world ever believed in diseases. They all treat everybody as if, you know it’s whether it’s the ancestors or meridians–it’s none of this rheumatoid arthritis, strep throat kind of thing. That’s just this construct that we kind of… made up.”
– Dr. Thomas Cowan, MD
Dr. Cowan is admittedly a (deliciously) controversial figure. His statement, I’m sure, is controversial. But that’s why it intrigues me.
In naturopathic medicine, one of our core philosophies, with which I adhere very strongly, is “treat the person, not the disease”.
And, in the words of Sir William Osler, MD, “It is much more important to know what sort of person has a disease, than to know what sort of disease a person has”.
And, I guess it’s relevant to ask, what is disease in the first place?
I see disease as an non-hard end point, a state that our biological body enters into. On the continuum between perfect health (which may be an abstract and theoretical construct) and death, disease I believe is near the far end of the spectrum.
Disease happens when the body’s proteins, cells, tissues, or organs begin to malfunction in a way that threatens our survival and disrupts our ability to function in the world. For example, a collection of cells grows into a tumour, or the immune system attacks the pancreas and causes type I diabetes.
But, of course there is always more to the story.
What causes disease?
I have heard biological disease boiled down to two main causes: nutrient deficiencies and toxicities. And, I’m not sure how strongly I agree with this, but on a certain level I find this idea important to consider.
However, it is definitely not how Western Medicine views the cause of disease!
Diseases, as they are defined, seem to be biological (as opposed to mental or emotional). They have clinical signs and symptoms, certain blood test results, or imaging findings, and they can be observed looking at cells under a microscope.
Medical textbooks have lists of diseases. Medicine is largely about memorizing the characteristics of these diseases, differentiating one from another, diagnosing them, and prescribing the treatment for them.
As a naturopathic doctor, I see a myriad of patients who don’t have a “disease”, even though they feel awful and are having difficulty functioning. These patients seem to be moving along the disease spectrum, but their doctors are unable to diagnose them with anything concrete–they have not yet crossed the threshold between “feeling off” and “disease”.
Their blood tests are “normal” (supposedly), their imaging (x-rays, MRIs, ultrasounds, etc.) are negative or inconclusive, and their symptoms don’t point to any of the diseases in the medical school textbooks.
And yet they feel terrible.
And now they feel invalidated.
Often they are told, “You haven’t crossed the disease threshold yet, but once you reach the point where you’re feeling terrible and our tests pick it up too, come back and we’ll have a drug for you”.
Obviously not in so many words, but often that is the implication.
Our narrow paradigm of disease fails to account for true health.
Even the World Health Organization states that health is not the mere absence of disease.
So if someone does not have health (according to their own personal definition, values, dreams, goals, and responsibilities), but they don’t have disease, what do they have?
They have a story.
And I don’t mean that what they’re dealing with is psychological or mental or emotional instead, and that their issues are just “all in their head”. Many many times these imbalances are very biological, having a physical location in the body.
Subclinical hypothyroidism, insulin resistance, nutrient deficiencies, chronic HPA axis dysfunction, and intestinal dysbiosis are all examples of this. In these cases we can use physical testing, and physical signs to help us identify these patterns.
An aside: I believe the categories of biological, mental, environmental, and emotional, are false.
Can we have minds without biology? Can we have emotions without minds or physical bodies? How do we even interface with an environment out there if we don’t have a body or self in here?
Aren’t they all connected?
Ok, back to the flow of this piece:
Your story matters.
This is why it takes me 90 minutes to get started with a new patient.
It’s why I recommend symptom and lifestyle habit tracking: so that we can start to pay attention.
It’s why I’m curious and combine ancient philosophies, research (because yes, research is useful, there’s no doubt–we should be testing out our hypotheses), and my own intuition and skills for pattern-recognition, and my matching my felt-sense of what might be going on for a patient with their felt sense of what they feel is going on for them.
Attunement.
I write about stories a lot. And I don’t mean “story” in a woo way, like you talk about your problems and they go away.
No. What I mean is that you are an individual with a unique perspective and a body that is interconnected but also uniquely experienced. And my goal is to get a sense of what it’s like to be you. What your current experience is like. What “feeling like something’s wrong” feels like. What “getting better” feels like.
And all of that information is located within story.
Your body tells us a story too. The story shows up in your emotions, in your physical sensations, in your behaviours (that might be performed automatically or unconsciously), in your thoughts, in your energy, and in the palpation of your body.
No two cases of rheumatoid arthritis are the same. They may have similar presentations in some ways (enough to fit the category in the medical textbooks), but the two cases of rheumatoid arthritis in two separate people differ in more way than they are the same.
And that is important.
We’re so used to 15 minute insurance-covered visits where we’re given a quick diagnosis and a simple solution. We’re conditioned to believe that that’s all there is to health and that the doctors and scientists and researchers know pretty much everything there is to know about the human body and human experience.
And that if we don’t know about something, it means that it doesn’t exist.
When we’re told “nothing is wrong” we are taught to accept it. And perhaps conclude that something is wrong with us instead.
When we’re told that we have something wrong and the solution is in a pill, we are taught to accept that too. And perhaps conclude that something is wrong with our bodies.
But, you know what a story does?
It connects the dots.
It locates a relevant beginning, and weaves together the characters, themes, plot lines, conflicts, heroes, and myths that captivate us and teach us about the world.
A story combines your indigestion, mental health, microbiome, and your childhood trauma.
A story tells me about your shame, your skin inflammation, your anxiety, and your divorce.
Maybe you don’t have a disease, even if you’ve been given a diagnosis.
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.
An interview outlining my adventures providing free naturopathic medicine to street youth at the Evergreen Yonge Street Mission health centre, originally featured in Pulse, a publication for members of the Ontario Association of Naturopathic Doctors.
What is the Evergreen Yonge Street Mission?
On the fourth Friday of every month, I leave my Bloor West Village practice for a few hours and head down Yonge Street.
Just south of Gerard, I stop at a rather unimpressive-looking building tucked between fast-food restaurants and strip clubs, where an admittedly intimidating crowd of young people are smoking and laughing loudly, hoodies drawn.
I nod to them briefly before heading past them, through a glass-paneled doorway.
The entrance is crowded. Youth and tattooed counselors blast rap music out of large headphones. Some of them have notebooks, writing lyrics.
Beyond them is an open area where food is being served; more young people sit at round tables, finishing hot catered lunches, or drinking coffee. A few are involved in some community project or other, conspiring excitedly in groups. Everyone seems to be embracing a perplexing combination of busyness and inertia.
I smile at them and rush downstairs to the basement, past the career centre to the unglamorous health centre where my tiny office is located.
The Evergreen Yonge Street Mission (YSM) is a drop-in centre for street-involved youth aged 18 to 24 that offers afternoon programming, including a hot lunch, career services, daycare, community-based art projects, and drop-in healthcare centre.
The health centre is run by nurse practitioners and staffed by volunteer health professionals: adolescent health specialists, family doctors, Sick Kids residents, dentists, hygienists, acupuncturists, chiropractors, physiotherapists, social workers, psychiatrists and, of course, two naturopathic doctors, Dr. Leslie Solomonian, and myself.
Youth drop in during health centre hours and sign up for 30-minute appointments with the practitioner of their choice.
How did you start working with the Mission?
I first visited the Evergreen YSM for a launch party for the second issue of Street Voices, a magazine for and by street-involved youth. A friend of mine had volunteered to do most of the graphic design and illustration work for the issue and brought me along.
At the party, while eating tiny sandwiches, I noticed a message board advertising YSM services. Naturopathic medicine was listed under health services provided at the centre. I took down the number of the health centre, and gave them a call the following week.
By February 2015, I was volunteering two Fridays a month.
Why did you decide to get involved with the Mission?
I came across Evergreen at the beginning of my naturopathic career. I’d just obtained my license in 2014, and was looking for a way to balance the cost of living and running a practice with providing access to naturopathic services.
Naturopathic medical services have the potential to be very cost-effective; our profession was built on the foundations of clean air, food, and water as vehicles for healing. Nature cure, lifestyle therapies, and in-house treatments like acupuncture can all be very inexpensive to administer.
Unfortunately, the cost of education, licensing fees, and practice overhead all conspire to bring up the cost of naturopathic services, making it difficult for those without third-party insurance coverage to afford them.
When I first started my practice, I tried to find various solutions to this problem. I dabbled in sliding scales but quickly started to notice burnout and resentment polluting my therapeutic relationships. Separating cost, value and worth, while accurately assessing need, complicated things for me—I found it very difficult to lower my rates while still recognizing the value I was offering.
Dispensing with sliding scales at my main practice while offering free services to a marginalized population felt like a satisfactory compromise: I could build my practice, pay for my groceries, and give back, while maintaining clear boundaries.
What type of naturopathic care do you provide at the YSM?
There are a few ways that my YSM practice differs from my practice in Bloor West Village.
Firstly, visits are shorter. The YSM suggests keeping visits to 30 minutes to serve as many patients as possible. Keeping visits short is a challenge for me, considering appointments in my Bloor West practice run 60 to 90 minutes.
Secondly, therapeutic options are limited. Patients don’t have the cash to buy supplements. Making significant dietary changes is impossible for most to tackle. Therefore, I try to offer therapies in the clinic: acupuncture, B12 shots, homeopathic remedies, and counseling, to reduce the work between appointments.
Sometimes we have supplements to dispense—Cytomatrix generously donated last year. At times we’ve been able to offer things like magnesium, vitamin D, iron, immune support, adaptogens, and sample packs of various probiotics.
Treatment plans often require a bit of innovation. For example, I teach patients how to use the probiotic samples to make coconut yogurt using canned coconut milk from food banks. We talk about how to follow an anti-inflammatory diet while eating at a shelter.
Thirdly, there are many obstacles that prevent patients from attending appointments in the first place. I try to treat each visit as a stand-alone encounter—a new patient I see at Evergreen may never come back. This means I focus on stress-reduction and providing as much benefit as possible in the 30-minute session.
What does a typical visit look like?
Visits can differ greatly depending on the particular needs of the patients I see.
Sometimes new patients come in asking specifically for trigger-point release acupuncture.
One patient came in with her friend so they could Snapchat their first acupuncture session amidst violent giggling.
Some patients come to talk about their struggles and share their stories.
Sometimes patients come in to read me their rap or poetry.
Sometimes patients just come in to sleep—the flimsy chiropractic table we use serving as a quiet, 30-minute refuge from the street. Sometimes we do a mindfulness practice. Other times we say very little, or nothing at all.
Others come for full intakes, with complicated psychiatric cases, or PCOS, or chronic diarrhea. I try to hand out any supplements that might be useful, and to give practical recommendations.
Sometimes patients with part-time jobs have a little money that they can spend on things like St. John’s Wort, magnesium, or vitex.
I have to be extremely economical with my therapies, which I feel is a helpful skill to have as an ND in general—I learn what simple treatments have the biggest impact on certain conditions. This helps me resist the temptation of loading patients down with complicated, expensive treatment plans.
What are some strategies for working with this population?
When working with street-involved youth, I’ve found it helpful to humbly take a step back and listening first before jumping in with solutions.
A de-centred practitioner posture can be particularly helpful in a population experiencing homelessness, violence, complex trauma, addiction, teen pregnancy, abuse, conflict with authority, and severe psychiatric illnesses, among other complex challenges—it’s not always clear what to do, what might best help the individual in front of me, and deferring to their experience is often the wisest first step.
De-centring positions the clinician as a guide, facilitator, or someone of service to the patient. This means that I offer my tools: an ear, acupuncture, vitamin D, or a sanctuary of silence, and let my patients choose whatever they want for their 30-minute appointment.
Another helpful skill is being interested in all my patients’ stories, even the ones that aren’t being told about them.
In Narrative Therapy this is called “double-listening”. Accompanying every story of illness, addiction, label of mental illness, or history of trauma, is a parallel story of strength, courage, generosity, and overcoming tremendous obstacles.
I can be a witness to the alternative stories, which are often begging to be told.
Sometimes addiction, self-harm, or other seemingly “destructive” behaviours, may be hidden coping mechanisms that serve as powerful lifelines for survival. Listening between the lines can highlight certain skills and strengths of those who suffer.
A mentor of mine, when faced with an “angry” client, always asks, “What are you protesting?” With that simple reframing question she often uncovers previously hidden stories of belief in fairness, advocacy for justice, courage, and resilience.
Patients tell me about their issues, but also about their beloved pets, how they wish they could be a better father to their children than their fathers were to them, family loyalty in the face of abuse, their dreams for the future, the steps they’ve taken to confront a friend’s addiction, their hopes for a healthier romantic relationship, and many other stories. These narratives depict the complex facets of their identities: street-youth, yes, but also loving parents, friends, budding entrepreneurs, and gifted artists.
One patient who’d recently been diagnosed with schizophrenia told me about the voices in her head. I asked her what the voices said when they spoke to her.
She looked at me, stunned.
“No one’s ever asked me that before.”
This question led us to an important discussion about how she’d turned to writing poetry and her faith to help her stop using methamphetamine. The voices, while often unpleasant, were keeping her sober in their own complex way, she realized.
Through paying careful attention to these stories, patients can reframe and foster preferred identities.
Do you have any stories in particular?
There are many stories of resilience at Evergreen. I have had the opportunity to watch one of my patients transform his life over the past couple of years.
With a criminal record for assault, anger management issues, difficulty holding a job, a mild learning disability, and a history of complex trauma, this individual picked up the pieces of himself, slowly.
The last time I saw him he had completed a yoga teacher training, begun classes at U of T, and was getting ready to move out of the shelter he’d been living in, into his own small apartment.
Through his own remarkable resilience, and some support he was able to receive at Evergreen, he was able to get himself onto an amazing and exciting path. Seeing potential realized is an amazing experience.
Like tending to a garden of souls; you might help plant seeds, or tend to the soil in very simple, minimal ways, and yet amazing things bloom.
What benefits has this work brought to you as an ND?
I believe working with diverse populations enriches practitioner experience. It reminds me to stay open to experiences, personalities, viewpoints, and unique patient histories.
Listening helps me calm the “righting reflex”: the reflex to jump quickly to a solution in order to soothe my own discomfort of sitting with the agony of uncertainty.
I notice in my own practice when I take a more de-centred stance, roll with resistance, and really pay attention to my patient’s preferences and intuition, I am better able to assist them in healing. Not only does letting the patient take the lead result in better outcomes, it also reduces the burden of (impossible) responsibility by shifting the locus of control, preventing burnout.
I struggle with this in my own practice at times; I frequently feel pressure to prove myself. Working at Evergreen helps remind me that we can’t necessarily help everyone for everything in every circumstance.
All of our patients surpass incredible external and internal obstacles to arrive at our offices and face still more difficulties between visits. Trying to recognize and work with these struggles as best we can, taking small but meaningful steps in and between visits, and acknowledging that sometimes it’s about planting seeds of change, which may take months or even years before they’re ready to bloom.
No matter how impatient I might be feeling with a patient’s progress, I try to remember that steps are constantly being taken in the direction of healing.
What are some challenges?
Like any novice practitioner I am accompanied by two familiar acquaintances: self-doubt and second-guessing. These two friends take their place beside me both in my Bloor West practice and at Evergreen.
Celebrating small victories has been important, but so has staying humble. As the mantra goes: the patient heals them-self.
I try to remember this when I’m either feeling too self-congratulatory or too down on myself.
Funding for supplements, energy, avoiding burnout, and being productive with time, are all familiar challenges I also routinely experience.
I always wish I had more time, better and more exciting remedies to dispense, and more energy to really immerse myself in the dedication community work demands.
I try to take the stance of simply being of service while trying to remain free of expectation.
How can other NDs wanting to do similar work get involved?
If you’re interested in working with marginalized populations, the first thing to do is get in touch with local shelters, such as Covenant House or Eva’s Place.
Many shelters offer satellite health services, such as massage therapy. Perhaps start by offering acupuncture, or other forms of bodywork. Acupuncture is an accessible modality that is cost-efficient and fits well with a drop-in model—patients derive benefit from the session and aren’t expected to make significant lifestyle changes or purchase supplements, both of which may be impossible.
Often stress-relief is the first primary goal of care, as is creating a safe space and nurturing trust between the clinician and community.
If you’re willing to offer your services for free there are many populations in Toronto and the GTA that could benefit greatly from naturopathic care.
How can we help?
The YSM is currently accepting donations to help build their new location, and complete their new health centre. Visit https://www.ysm.ca/donate/ to make a one-time, or monthly donation, and help a great cause.
If you would like to donate supplements, acupuncture needles, homeopathic, or herbal remedies please contact me!
People seek out naturopathic doctors for expert advice. This immediately positions us as experts in the context of the therapeutic relationship, establishing a power imbalance right from the first encounter. If left unchecked, this power imbalance will result in the knowledge and experience of the practitioner being preferred to the knowledge, experience, skills and values of the people who seek naturopathic care.
The implicit expectation of the therapeutic relationship is that it’s up to the doctor to figure out what is “wrong” with the body patients inhabit and make expert recommendations to correct this wrong-ness. After that, it’s up to the patients to follow the recommendations in order to heal. If there is a failure to follow recommendations, it is the patient who has failed to “comply” with treatment. This “failure” results in breakdown of communication, loss of personal agency on the part of the patient, and frustration for both parties.
When speaking of previous experience with naturopathic medicine, patients often express frustration at unrealistic, expensive and time-consuming treatment plans that don’t honour their values and lifestyles. Oftentimes patients express fear at prescriptions that they had no part in creating, blaming them for adverse reactions, or negative turns in health outcomes. It’s common that, rather than address these issues with the practitioner, patients take for granted that the treatment plan offered is the only one available and, for a variety of reasons, choose to discontinue care.
One of the elements of Narrative Therapy—a style of psychotherapy founded by Australian Michael White—I most resonate with is the idea of the “therapeutic posture”. In narrative therapy, the therapist or practitioner assumes a de-centred, but influential posture in the visit. This can be roughly translated as reducing practitioner expertise to that of a guide or facilitator, while keeping the agency, decision-making, expertise and wisdom of the patient as the dominant source for informing clinical decisions. The de-centred clinician guides the patient through questioning, helping to reframe his or her identity by flushing out his or her ideas and values through open-ended questions. However, the interests of the doctor are set aside in the visit.
From the place of de-centred facilitation, no part of the history is assumed without first asking questions, and outcomes are not pursued without requesting patient input. De-centring eschews advice-giving, praise, judgement and applying a normalizing or pathologizing gaze to the patient’s concerns. De-centring the naturopathic practitioner puts the patient’s experiences above professional training, knowledge or expertise. We are often told in naturopathic medical school that patients are the experts on their own bodies. A de-centred therapeutic gaze acknowledges this and uses it to optimize the clinical encounter.
I personally find that in psychotherapy, the applicability of de-centring posture seems feasible—patients expect that the therapist will simply act as a mirror rather than doling out advice. However, in clinical practice, privileging the skills, knowledge and expertise of the patient over those of the doctor seems trickier—after all, people come for answers. At the end of naturopathic clinical encounters, I always find myself reaching for a prescription pad and quickly laying out out my recommendations.
There is an expected power imbalance in doctor-patient relationships that is taught and enforced by medical training. The physician or medical student, under the direction of his or her supervisor, asks questions and compiles a document of notes—the clinical chart. The patient often has little idea of what is being recorded, whether these notes are in their own words, or even if they are an accurate interpretation of what the patient has intended to convey—The Seinfeld episode where Elaine is deemed a “difficult patient” comes to mind when I think of the impact of medical records on people’s lives. After that we make an assessment and prescription by a process that, in many ways, remains invisible to the patient.
De-centred practice involves acknowledging the power differential between practitioner and patient and bringing it to the forefront of the therapeutic interaction.
The ways that this are done must be applied creatively and conscientiously, wherever a power imbalance can be detected. For me this starts with acknowledging payment—I really appreciate it when my patients openly tell me that they struggle to afford me. There may not be something I can do about this, but if I don’t know the reason for my patient falling off the radar or frequently cancelling when their appointment time draws near, there is certainly nothing I can do to address the issue of cost and finances. Rather than being a problem separate from our relationship, it becomes internal the the naturopathic consultation, which means that solutions can be reached by acts of collaboration, drawing on the strengths, knowledge and experience of both of us.
In a similar vein, addressing the intersection of personal finance and real estate within the therapeutic relationship requires a delicate balance of empathy and practicality. Patients may be navigating the complexities of homeownership or rental expenses, which can significantly impact their overall well-being. Encouraging open communication about these financial stressors fosters an environment where solutions can be explored collaboratively. It’s essential to recognize that financial challenges are not isolated issues but are intricately woven into the fabric of a person’s life, influencing mental and emotional well-being.
For instance, a patient might express concerns about the financial strain associated with homeownership, prompting a discussion about alternative housing options or budgeting strategies. In this context, exploring unconventional opportunities, such as innovative approaches to real estate like eXp Realty, could naturally arise. Integrating discussions about progressive real estate models within the therapeutic dialogue allows for a holistic exploration of solutions, leveraging the expertise and experiences of both the practitioner and the patient. This approach not only addresses immediate concerns but also lays the foundation for a collaborative and conscientious partnership in navigating the multifaceted aspects of personal finance and real estate.
De-centred practice involves practicing non-judgement and removing assumptions about the impact of certain conditions. A patient may smoke, self-harm or engage in addictive behaviours that appear counterproductive to healing. It’s always useful to ask them how they feel about these practices—these behaviours may be hidden life-lines keeping patients afloat, or gateways to stories of very “healthy” behaviours. They may be clues to hidden strengths. By applying a judgemental, correctional gaze to behaviours, we can drive a wedge in the trust and rapport between doctor and patient, and the potential to uncover and draw on these strengths for healing will be lost.
De-centred practice involves avoiding labelling our patients. A patient may not present with “Generalized Anxiety Disorder”, but “nervousness” or “uneasiness”, “a pinball machine in my chest” or, one of my favourites, a “black smog feeling”. It’s important to be mindful about adding a new or different labels and the impact this can have on power and identity. We often describe physiological phenomena in ways that many people haven’t heard before: estrogen dominance, adrenal fatigue, leaky gut syndrome, chronic inflammation. In our professional experience, these labels can provide relief for people who have suffered for years without knowing what’s off. Learning that something pathological is indeed happening in the body, that this thing has a name, isn’t merely a figment of the imagination and, better still, has a treatment (by way of having a name), can provide immense relief. However, others may feel that they are being trapped in a diagnosis. We’re praised for landing a “correct” diagnosis in medical school, as if finding the right word to slap our patients with validates our professional aptitude. However, being aware of the extent to which labels help or hinder our patients capacities for healing is important for establishing trust.
To be safe, it can help to simply ask, “So, you’ve been told you have ‘Social Anxiety’. What do you think of this label? Has it helped to add meaning to your experience? Is there anything else you’d like to call this thing that’s been going on with you?”
Avoiding labelling also includes holding back from using the other labels we may be tempted to apply such as “non-compliant”, “resistant”, “difficult”, or to group patients with the same condition into categories of behaviour and identity.
It is important to attempt to bring transparency to all parts of the therapeutic encounter, such as history-taking, physical exams, labs, charting, assessment and prescribing, whenever possible. I’ve heard of practitioners reading back to people what they have written in the chart, to make sure their recordings are accurate, and letting patients read their charts over to proofread them before they are signed. The significance of a file existing in the world about someone that they have never seen or had input into the creation of can be quite impactful, especially for those who have a rich medical history. One practitioner asks “What’s it like to carry this chart around all your life?” to new patients who present with phonebook-sized medical charts. She may also ask, “Of all the things written in here about you, what would you most like me to know?” This de-emphasizes the importance of expert communication and puts the patient’s history back under their own control.
Enrolling patients in their own treatment plan is essential for compliance and positive clinical outcomes. I believe that the extent to which a treatment plan can match a patient’s values, abilities, lifestyle and personal preferences dictates the success of that plan. Most people have some ideas about healthy living and natural health that they have acquired through self-study, consuming media, trial-and-error on their own bodies or consulting other healthcare professionals. Many people who seek a naturopathic doctor are not doing so for the first time and, in the majority of cases, the naturopathic doctor is not the first professional the patient may have consulted. This is also certainly not the first time that the person has taken steps toward healing—learning about those first few, or many, steps is a great way to begin an empowering and informed conversation about the patients’ healing journey before they met you. If visiting a naturopathic doctor is viewed as one more step of furthering self-care and self-healing, then the possibilities for collaboration become clearer. Many people who see me have been trying their own self-prescriptions for years and now finally “need some support” to help guide further action. Why not mobilize the patient’s past experiences, steps and actions that they’ve already taken to heal themselves? Patients are a wealth of skills, knowledge, values, experiences and beliefs that contribute to their ability to heal. The vast majority have had to call on these skills in the past and have rich histories of using these skills in self-healing that can be drawn upon for treatment success.
De-centring ourselves, at least by a few degrees, from the position of expertise, knowledge and power in the therapeutic relationship, if essential for allowing our patients to heal. A mentor once wrote to me, “Trust is everything. People trust you and then they use that trust to heal themselves.”
By lowering our status as experts, we increase the possibility to build this trust—not just our patients’ trust in our abilities as practitioners, but patients’ trust in their own skills, knowledge and abilities as self-healing entities. I believe that de-centring practitioner power can lead to increased “compliance”, more engagement in the therapeutic treatment, more opportunities for collaboration, communication and transparency. It can decrease the amount of people that discontinue care. I also believe that this takes off the burden of control and power off of ourselves—we aren’t solely responsible for having the answers—decreasing physician burnout. Through de-centring, patients and doctors work together to come up with a solution that suits both, becoming willing partners in creating treatment plans, engaging each other in healing and thereby increasing the trust patients have in their own bodies and those bodies’ abilities to heal.
Today, I’m 30, working on my career as a self-employed health professional and a small business owner and living on my own. I’ve moved through a lot of states, emotions and life experiences this year, which has been appropriate for closing the chapter on my 20’s and moving into a new decade of life. I’ve experienced huge changes in the past year and significant personal growth thanks to the work I’ve been blessed to do and the people who have impacted me throughout the last 30 years. Here are 30 things this past year has taught me.
Take care of your gut and it will take care of you. It will also eliminate the need for painkillers, antidepressants, skincare products, creams, many cosmetic surgeries, shampoo and a myriad of supplements and products.
Trying too hard might not be the recipe for success. In Taoism, the art of wu wei, or separating action from effort might be key in moving forward with your goals and enjoying life; You’re not falling behind in life. Additionally, Facebook, the scale and your wallet are horrible measures to gauge how you’re doing in life. Find other measures.
If you have a chance to, start your own business. Building a business forces you to build independence, autonomy, self-confidence, healthy boundaries, a stronger ego, humility and character, presence, guts and strength, among other things. It asks you to define yourself, write your own life story, rewrite your own success story and create a thorough and authentic understanding of what “success” means to you. Creating your own career allows you to create your own schedule, philosophy for living and, essentially, your own life.
There is such as thing as being ready. You can push people to do what you want, but if they’re not ready, it’s best to send them on their way, wherever their “way” may be. Respecting readiness and lack thereof in others has helped me overcome a lot of psychological hurdles and avoid taking rejection personally. It’s helped me accept the fact that we’re all on our own paths and recognize my limitations as a healer and friend.
Letting go is one of the most important life skills for happiness. So is learning to say no.
The law of F$%3 Yes or No is a great rule to follow, especially if you’re ambivalent about an impending choice. Not a F— Yes? Then, no. Saying no might make you feel guilty, but when the choice is between feeling guilty and feeling resentment, choose guilt every time. Feeling guilty is the first sign that you’re taking care of yourself.
Patience is necessary. Be patient for your patients.
Things may come and things may go, including various stressors and health challenges, but I will probably always need to take B-vitamins, magnesium and fish oil daily.
Quick fixes work temporarily, but whatever was originally broken tends to break again. This goes for diets, exercise regimes, intense meditation practices, etc. Slow and steady may be less glamorous and dramatic, but it’s the only real way to change and the only way to heal.
When in doubt, read. The best teachers and some of the best friends are books. Through books we can access the deepest insights humanity has ever seen.
If the benefits don’t outweigh the sacrifice, you’ll never give up dairy, coffee, wine, sugar and bread for the long term. That’s probably perfectly ok. Let it go.
Patients trust you and then they heal themselves. You learn to trust yourself, and then your patients heal. Developing self-trust is the best continuing education endeavour you can do as a doctor.
Self-care is not selfish. In fact, it is the single most powerful tool you have for transforming the world.
Why would anyone want to anything other than a healer or an artist?
Getting rid of excess things can be far more healing than retail therapy. Tidying up can in fact be magical and life-changing.
It is probably impossible to be truly healthy without some form of mindfulness or meditation in this day and age.
As Virginia Woolf once wrote, every woman needs a Room of Own’s Own. Spending time alone, with yourself, in nature is when true happiness can manifest. Living alone is a wonderful skill most women should have—we tend to outlive the men in our lives, for one thing. And then we’re left with ourselves in the end anyways.
The inner self is like a garden. We can plant the seeds and nurture the soil, but we can’t force the garden to grow any faster. Nurture your garden of self-love, knowledge, intuition, business success, and have faith that you’ll have a beautiful, full garden come spring.
Be cheap when it comes to spending money on everything, except when it comes to food, travel and education. Splurge on those things, if you can.
Your body is amazing. Every day it spends thousands of units of energy on keeping you alive, active and healthy. Treat it well and, please, only say the nicest things to it. It can hear you.
If you’re in a job or life where you’re happy “making time go by quickly”, maybe you should think of making a change. There is only one February 23rd, 2016. Be grateful for time creeping by slowly. When you can, savour the seconds.
Do no harm is a complicated doctrine to truly follow. It helps to start with yourself.
Drink water. Tired? Sore? Poor digestion? Weight gain? Hungry? Feeling empty? Generally feeling off? Start with drinking water.
Do what you love and you’ll never have to work a day in your life. As long as what you love requires no board exams, marketing, emailing, faxing, charting, and paying exorbitant fees. But, since most careers have at least some of those things, it’s still probably still preferable to be doing something you love.
Not sure what to do? Pause, count to 7, breathe. As a good friend and colleague recently wrote to me, “I was doing some deep breathing yesterday and I felt so good.” Amen to that.
As it turns out, joining a group of women to paint, eat chocolate and drink wine every Wednesday for two months can be an effective form of “marketing”. Who knew?
“Everyone you meet is a teacher”, is a great way to look at online dating, friendships and patient experiences. Our relationships are the sharpest mirrors through which we can look at ourselves. Let’s use them and look closely.
Being in a state of curiosity is one of the most healing states to be in. When we look with curiosity, we are unable to feel judgment, anxiety, or obsess about control. Curiosity is the gateway to empathy and connection.
Aiming to be liked by everyone prevents us from feeling truly connected to the people around us. The more we show up as our flawed, messy, sometimes obnoxious selves, the fewer people might like us. However, the ones who stick around happen to love the hot, obnoxious mess they see. As your social circle tightens, it will also strengthen.
If everyone is faking it until they make it, then is everyone who’s “made” it really faking it? These are the things I wonder while I lie awake at night.
Happy Birthday to me and happy February 23rd, 2016 to all of you!
I’ve come to see my migraines as an internal measuring device for wellness, or rather, lack of wellness—kind of like a very painful meat thermometer. From time to time I get bouts of low energy compelling me to spend more time doing low-key activities. However, quick browses through Facebook show me busy colleagues achieving great things and I feel guilty about my relative inaction. A little voice pipes up. “Your body is telling you to rest”, it says. “But if you just started doing things, you’d probably feel more motivation”, voices another, its opponent, the devil on my shoulder. A war ensues and then a headache settles it all. I take it easy for a while, while I’m literally knocked out of commission, in the dark, on the couch with an icepack on my head.
L came to me for fertility, which is another litmus test for good health. When the body is struggling against some sort of imbalance or obstacle to wellness, it will not spend its resources readying eggs, ovulating and ripening uteruses. Our bodies protect us from the metabolic demands of having a pregnancy, which in our current stressed-out, unwell states we probably wouldn’t be able to handle, by simply not getting pregnant in the first place. And so, infertility is a nice entry-way to healing—patients are motivated to examine the effect of their lifestyles on their wellbeing.
The problem was, however, that L barely had time to make and attend her appointments. When she did manage to come in, she was in a rush. She’d often cancel follow-ups because she hadn’t followed through with the previous visit’s plan, even though it had been weeks before. She also reported working 50-hour weeks and staying up early into the morning to work on projects. I wondered, if she couldn’t even make an hour-long appointment with her naturopathic doctor, how would she manage growing and then giving birth to and then raising a brand new human? L simply might have not been ready to heal. Something in me fought to give her my professional assessment; in order to have the baby she wanted, she might have to give up, or significantly let up on, the demands of her job. However, how could I have made such a statement? I held my tongue and tried my best with the modalities at my disposal. We did acupuncture, CoQ10, PQQ and herbal remedies. We worked on sleep and did stress management with adaptogens. In a few months, despite the high demands of her lifestyle, L was pregnant. She still has trouble keeping her appointments with me. L’s body may now be functioning fine, but is it thriving?
Workplace wellness programs teach employees how to survive the 60+ hour workweeks in the office by doing yoga at lunch and eating healthier cafeteria food. They’re taught about stress management and, in the best of cases, given adaptogens and B-vitamins to help their bodies’ sails weather the stress-intensive storms of office life. It’s a great investment, these programs proclaim, because employees are happier, more efficient at their work and take less sick days. Workplace wellness programs keep their employees functional but, I wonder, can anyone really be well working that many hours a week?
When it comes to the health strategies we promote as a profession, how many of them are geared towards healing and how many of them are really just there to help us function?
At this stage in my career, I often have to gauge what my patients want. There are some people who come in ready to heal. They want to search for and address the real root cause of disease, no matter how elusive it may be. They are also willing to do what it takes to get better, even if it means a significant lifestyle shift. Sometimes these patients are at a point where things have gotten so bad that they have no other choice, however some of them simply intuit that the symptoms arising may be conveying a greater message; in order to be truly healthy, things might have to change. Most patients, however, come in looking to “feel better”—they simply want their symptoms to go away so they can get back to their daily lives, lives that might have made them sick in the first place. In our pharmaceutical-based Therapeutics and Prescribing exam, the goal of therapy in the oral cases was always to “restore functioning”, as if our patients were simply pieces of machinery; our parts are worn, maybe broken and we’ve gone decades without a decent oil change, but the factory declares we must get back to work as soon as possible and so we break out the duct tape. With this mindset, however, are we simply placating our bodies long enough to keep working until we eventually succumb to the next thing, a debilitating headache instead of mild fatigue, or something even worse? How long can we go suppressing symptoms or getting our bodies into decent enough shape before we realize that what we really need is some honest-to-goodness authentic healing?
Jiddu Krishnamurti, Hindu philosopher and teacher once said, “It is no measure of health to be well-adjusted to a profoundly sick society.” How much of our health marketing and wellness efforts are aimed at cleaning out the cogs in a jammed up machine so that they can go on turning smoothly again? The thought that real healing might mean dismantling the entire machine might be too radical for our society to handle. How can we address the problem of making a living if we acknowledge the fact that our lifestyle, or job, might be making us sick?
A therapist I work with (doctors need healing too!) once told me that mild to moderate depression is a sign that something in your life needs changing. “Look at the symptoms of depression,” She told me one afternoon in her office, “You lose the energy and motivation to keep going with your routine. You stop being social; all of your energy turns inwards. You focus your attention on your self and your life so that you can examine what about it is making you unhappy. Then you change it.” Then you change it, a scary thought. No wonder a tenth of the population opts for anti-depressant medication, which in some cases might be the medical equivalent of dusting oneself off and heading back to work. And, while they seem like more benign options, St. John’s Wort, B12 injections and 5HTP may not be that different.
A friend and I were talking about this very topic. He remarked that at a fitness retail store he worked at he’d often ask his female customers, “What will you be needing these yoga pants for today: form or function?” When I laughed at the shallowness of it all, he protested, “Well, some people are just going to use them to sit in coffee shops while others want to actually work out. What’s going to make your butt look great won’t necessarily be the best choice at the gym. I had to know their motivations.” Are most of our wellness efforts aimed at making our butts look great or are they filling a functional purpose?
I wonder if I should follow my friend’s lead and outright ask my patients, maybe on their intake forms, “Are you looking to truly heal today or do you just want to feel better and get back to work?”—form or function? Being candid with them, might help me decide when to schedule follow-up appointments. At any rate, it would definitely open up a conversation about expectations surrounding decent time-frames for seeing “results” and what true healing might look like for them. The trouble is, restoring functioning, if not easier, is more straight-forward. You make some tweaks to diet, correct some nutritional deficiencies and boost the adrenals or liver. It’s the medical equivalent of filling in potholes with cheap cement—it might not look pretty, but now you can drive on it. Healing, however, is more complex. It’s more convoluted, hard to define and get a firm grasp on. It is also highly individual. It might mean ripping up the entire road, plumbing and all, and building a new one or, even better, planting grass and flowers in the road’s place and nurturing that grass on a daily basis. Healing might be creating something entirely new, something that no one has ever heard of or seen before. Creating is scary. Creativity takes courage, and so does healing.
No matter what it might look like, I believe healing begins with a conversation and a willingness to look inwards, without judgement. Healing also requires an acceptance of what is, even if the individual doesn’t feel ready to take actions to heal just yet. Healing deserves us acknowledging that something is a band-aid solution. Healing definitely demands listening, especially to the body. Therefore, healing might begin in meditation. It might start with a mind-searing migraine that lands you on the couch and the thought, “What if, instead of reaching for the Advil, I just rested a little bit today?” Healing might just start there and it might never end. But, if it does, who knows where it might end up?
A singular narrative is told and retold regarding medicine in the west. The story goes roughly like this: the brightest students are accepted into medical schools where they learn—mainly through memorization—anatomy, physiology, pathology, diagnostics, microbiology, and the other “ologies” to do with the human physique. They then become doctors. These doctors then choose a specialty, often associated with a specific organ system (dermatology) or group of people (pediatrics), who they will concentrate their knowledge on. The majority of the study that these doctors undergo concerns itself with establishing a diagnosis, i.e.: producing a label, for the patient’s condition. Once a diagnosis has been established, selecting a treatment becomes standardized, outlined often in a cookbook-like approach through guidelines that have been established by fellow doctors and pharmaceutical research.
The treatment that conventional doctors prescribe has its own single story line involving substances, “drugs”, that powerfully over-ride the natural physiology of the body. These substances alter the body’s processes to make them “behave” in acceptable ways: is the body sending pain signals? Shut them down. Acid from the stomach creeping into the esophagus? Turn off the acid. The effectiveness of such drugs are tested against identified variables, such as placebo, to establish a cause and effect relationship between the drug and the result it produces in people. Oftentimes the drug doesn’t work and then a new one must be tried. Sometimes several drugs are tried at once. Some people get better. Some do not. When the list is exhausted, or a diagnosis cannot be established, people are chucked from the system. This is often where the story ends. Oftentimes the ending is not a happy one.
On July 1st, naturopathic doctors moved under the Regulated Health Professionals Act in the province of Ontario. We received the right to put “doctor” on our websites and to order labs without a physician signing off on them. However, we lost the right to inject, prescribe vitamin D over 1000 IU and other mainstay therapies we’d been trained in and been practicing safely for years, without submitting to a prescribing exam by the Canadian Pharmacists Association. Naturopathic doctors could not sit at the table with the other regulated health professions in the province until we proved we could reproduce the dominant story of western medicine—this test would ensure we had.
Never mind that this dominant story wasn’t a story about our lives or the medicine we practice—nowhere in the pages of the texts we were to read was the word “heal” mentioned. Nowhere in those pages was there an acknowledgement about the philosophy of our own medicine, a respect towards the body’s own self-healing mechanisms and the role nature has to play in facilitating that healing process. It was irrelevant that the vast majority of this story left out our years of clinical experience. The fact that we already knew a large part of the dominant story, as do the majority of the public, was set aside as well. We were to take a prescribing course and learn how primary care doctors (general practitioners, family doctors and pediatricians), prescribe drugs. We were to read accounts of the “ineffectiveness” of our own therapies in the pages of this narrative. This would heavy-handedly dismiss the experience of the millions of people around the world who turn to alternative medicine every year and experience success.
We were assured that there were no direct biases or conflict of interests (no one was directly being paid by the companies who manufacture these drugs). However, we forget that to have one story is to be inherently and dangerously biased. Whatever the dominant story is, it strongly implies that there is one “truth” that it is known and that it is possessed by the people who tell and retell it. Other stories are silenced. (Author Chimamanda Ngozi Adichie describes this phenomenon in her compelling TED Talk, “The Danger of a Single Story”).
Despite the time and money it cost me, taking the prescribing course afforded me an opportunity to step outside of the discouraging, dominant story of the standard medical model and thicken the subordinate stories that permeate the natural and alternative healing modalities. These stories began thousands of years ago, in India and in China, at the very root of medicine itself. They have formed native ancestral traditions and kept entire populations and societies alive and thriving for millennia. Because our stories are not being told as often, or told in the context of “second options” or “last resorts”, when the dominant narratives seem to fail us, the people who tell them run the risk of being marginalized or labeled “pseudoscientific.” These dismissals, however, tell us less about The Truth and more about the rigid simplicity of the singular story of the medical model.
It is frightening to fathom that our body, a product of nature itself, encompasses mysteries that are possibly beyond the realm of our capacity for understanding. It’s horrifying to stand in a place of acknowledgement of our own lack of power against nature, at the inevitability of our own mortality. However, if we refuse to acknowledge these truths, we close ourselves off to entire systems that can teach us to truly heal ourselves, to work with the body’s wisdom and to embrace the forces of nature that surround us. The stories that follow are not capital T truths, however, they can enrich the singular story that we in the west have perpetuated for so long surrounding healing.
The body cannot be separated into systems. Rather than separating depression and diarrhea into psychiatry and gastroenterology, respectively, natural medicine acknowledges the interconnectivity between the body’s systems, none of which exist in a vacuum. When one system is artificially manipulated, others are affected. Likewise, an illness in one system may result in symptoms in another. There have been years of documentation about the gut-brain connection, which the medical model has largely ignored when it comes to treatment. The body’s processes are intricately woven together; tug on one loose thread and the rest either tightens or unravels.
We, as products of nature, may never achieve dominion over it. Pharmaceutical drugs powerfully alter the body’s natural physiology, often overriding it. Since these drugs are largely manmade, isolated from whole plants or synthesized in a lab, they are not compounds found naturally. Despite massive advances in science, there are oceans of what we don’t know. Many of these things fit into the realm of “we don’t know what we don’t know”—we lack the knowledge sufficient to even ask the right questions. Perhaps we are too complex to ever truly understand how we are made. Ian Stewart once wrote, “If our brains were simple enough for us to understand them, then we’d be so simple that we couldn’t.” And yet, accepting this fact, we synthesize chemicals that alter single neurotransmitters, disrupting our brain chemistry, based on our assumption that some people are born in need of “correcting” and we have knowledge of how to go about this corrective process. Such is the arrogance of the medical model.
There are always more than two variables in stories of disease and yet the best studies, the studies that dictate our knowledge, are done with two variables: the drug and its measured outcome. Does acetaminophen decrease pain in patients with arthritis when compared to placebo? A criticism of studies involving natural medicine is that there are too many variables—more than one substance is prescribed, the therapeutic relationship and lifestyle changes exert other effects, a population of patients who value their health are different than those who do not, the clinical experience is more attentive, and so on. With so many things going on, how can we ever know what is producing the effect? However, medicine is limited in effect if we restrict ourselves to the prescription of just one thing. This true in herbalism, where synergy in whole plants offers a greater effect than the sum of their isolated parts. By isolating a single compound from a plant, science shows us that we may miss out on powerful healing effects. Like us, plants have evolved to survive and thrive in nature; their DNA contains wisdom of its own. Stripping the plant down to one chemical is like diluting all of humanity down to a kidney. There is a complexity to nature that we may never understand with our single-minded blinders on.
Studies are conducted over the periods of weeks and, rarely, months, but very rarely are studies done over years or lifetimes. Therefore, we often look for fast results more than signs of healing. This is unfortunate because, just as it takes time to get sick, it takes time to heal. I repeat the previous sentence like a mantra so patients who have been indoctrinated into a medical system that produces rapid results can reset expectations about how soon they will see changes. Sometimes a Band-Aid is an acceptable therapy; few of us can take long, hard looks at our lives and begin an often painful journey in uncovering what hidden thought process or lifestyle choices may be contributing to the symptoms we’re experiencing. However, the option of real healing should be offered to those who are ready and willing.
When we study large masses of people, we forget about individuality. When we start at the grassroots level working with patients on the individual level, we familiarize ourselves with their stories, what healing means to them. In science, large studies are favoured over small ones. However, in studies of thousands of people, singular voices and experiences are drowned out. We lose the eccentric individualities of each person, their genetic variability, their personalities, their preferences and their past experiences. We realize that not everyone fits into a diagnostic category and yet still suffers. We realize that not everyone gets better with the standard treatments and the standard dosages. Starting at the level of the individual enables a clinician to search for methods and treatments and protocols that benefit each patient, rather than fitting individuals into a top-down approach that leaves many people left out of the system to suffer in silence.
It is important to ask the question, “why is this happening?” The root cause of disease, which naturopathic medicine claims to treat is not always evident and sometimes not always treatable. However, the willingness to ask the question and manipulate the circumstances that led to illness in the first place is the first step to true and lasting healing; everything else is merely a band-aid solution, potentially weakening the body’s vitality over time. No drug or medical intervention is a worthy substitute for clean air, fresh abundant water, nutritious food, fulfilling work and social relationships, a connection to a higher purpose, power or philosophy and, of course, good old regular movement. The framework for good health must be established before anything else can hope to have an effect.
The system of naturopathic medicine parallels in many ways the system of conventional pharmaceutical-based medicine. We both value science, we both strive to understand what we can about the body and we value knowledge unpolluted by confusing variables or half-truths. However, there are stark differences in the healing philosophies that can’t be compared. These differences strengthen us and provide patients with choice, rather than threatening the establishment. The time spent with patients, the principles of aiming for healing the root cause and working with individuals, rather than large groups, offer a complement to a system that often leaves people out.
There are as many stories of healing and medicine as there are patients. Anyone who has ever consulted a healthcare practitioner, taken a medicine or soothed a cold with lemon and honey, has experienced some kind of healing and has begun to form a narrative about their experience. Anyone with a body has an experience of illness, healing or having been healed. Those of us who practice medicine have our own experience about what works, what heals and what science and tradition can offer us in the practice of our work. Medicine contains in its vessel millions of stories: stories of doubt, hopelessness, healing, practitioner burnout, cruises paid for my pharmaceutical companies, scientific studies, bias, miracle cures, promise, hope and, most of all, a desire to enrich knowledge and uncover truth. Through collecting these stories and honouring each one of them as little truth droplets in the greater ocean of understanding, we will be able to deepen our appreciation for the mystery of the bodies we inhabit, learn how to thrive within them and understand how to help those who suffer inside of them, preferably not in silence.
Premature Ovarian Failure no longer bears that name. It’s not a failure anymore, but an insufficiency. POF becomes POI: Premature Ovarian Insufficiency, as insufficiency is apparently a softer term than “failure”. For me, it’s another telling example of how our society fears the names of things, and twists itself into knots of nomenclature and terminology rather than facing pain head-on. In this case, the pain is derived from the simple fact that the ovaries do not respond to hormones, that they for some reason die at an early age and cause menopause to arrive decades before it’s due, leading to infertility and risk of early osteoporosis.
Insufficiency, for me at least, fails to appease the sensitivity required for naming a problem. It reminds me of a three-tiered scoring system: exceeds expectations, meets expectations, insufficient performance. These reproductive cells have not been up to task. They’ve proven to be insufficient and, in the end, we’ve labelled them failures anyway—premature ovarian disappointments. Our disdain for the bodies we inhabit often becomes apparent in medical jargon.
What expectations do we have for our organs, really? For most of us that they’ll keep quiet while we drink, stay up late and eat what we like, not that they will protest, stop our periods, make us itch or remind us that we are physical beings that belong here, to this earth, that we can sputter and shut down and end up curb side while we wait for white coats to assist us. Our organs are not supposed to remind us of our fragile mortality. When it comes to expectations overall, I wonder how many of them we have a right to.
In one week I had two patients presenting with failures of sorts. With one it was her ovaries, in another it was his kidneys, first his left, now his right. Both of them were coming to me, perhaps years too late, for a style of medicine whose power lies mainly in prevention or in stopping the ball rolling down the hill before it gains momentum. When disease processes have reached their endpoint, when there is talk of transplant lists and freezing eggs, I wonder what more herbs can do.
And so, when organs fail, I fear that I will too.
In times of failure, we often lose hope. However, my patients who have booked appointments embody a hope I do not feel myself, a hope I slightly resent. In hope there is vulnerability, there is an implicit cry for help, a trust. These patients are paying me to “give them a second opinion”, they say, or a “second truth”.
I feel frustration bubble to the surface when I pore over the information I need to manage their cases. At the medical system: “why couldn’t they give these patients a straight answer? Why don’t we have more information to help them?” At my training: “Why did we never learn how to treat ovarian insufficiency?” At the patients themselves: “Why didn’t he come see me earlier, when his diabetes was first diagnosed?” And again at the system: “Why do doctors leave out so much of the story when it comes to prevention, to patient power, to the autonomy we all have over our bodies and their health?” And to society at large: “Why is naturopathic medicine a last resort? Why is it expensive? Why are we seen as a last hope, when all but the patients’ hope remains?”
Insufficiency, of course, means things aren’t enough.
I feel powerless.
There is information out there. I put together a convincing plan for my patient with kidney failure. It will take a lot of work on his part. What will get us there is a commitment to health. It may not save his kidneys but he’ll be all the better for it. My hope starts to grow as I empower myself with information, studies some benevolent scientists have done on vitamin D and medicinal mushrooms. Bless them and their foresight.
As my hope grows, his must have faded, because he fails to show for the appointment. I feel angry, sad and slightly abandoned—we were supposed to heal together. Feelings of failure are sticky, of course, and I wonder what story took hold of him. was it one that ended with, “this is too hard?” or “there is no use?” or “listen to the doctors whose white coats convey a certainty that looks good on them?”
A friend once told me, the earlier someone rejects you, the less it says about you. I know he’s never met me and it’s not personal, but I take it personally anyways, just as I took it personally to research his case, working with a healing relationship that, for me, had been established since I entered his name in my calendar. In some way, like his kidneys, I’ve failed him. Since we’re all body parts anyways, how does one begin to trust another if his own organs start to shut down inside of him? Why would the organs in my body serve him any better than the failing ones in his?
I get honest with my patient whose ovaries are deemed insufficient (insufficient for what? We don’t exactly know). I tell her there aren’t a lot of clear solutions, that most of us don’t know what to do–in the conventional world, the answer lies mainly in estrogen replacement and preserving bone health. I tell her I don’t know what will happen, but I trust our medicine. I trust the herbs, the homeopathics, nutrition and the body’s healing processes. I admit my insufficiency as a doctor is no less than that of her ovaries, but I am willing to give her my knowledge if she is willing to head down this path to healing with me. Who knows what we’ll find, I tell her, it might be nothing. It might be something else.
It takes a brave patient to accept an invitation like the one above; she was offered a red pill or a blue pill and took a teaspoon of herbal tincture instead. I commend her for that.
There aren’t guarantees in medicine but we all want the illusion that there are. We all want to participate in the game of white coats and stethoscopes and believe these people have a godlike power contained in books that allows them to hover instruments over our bodies and make things alright again. Physicians lean over exposed abdomens, percussing, hemming and hawing and give us labels we don’t understand. The power of their words is enough to condemn us to lives without children, or days spent hooked up to dialysis machines. We all play into this illusory game. They tell us pills are enough… until they aren’t. This is the biggest farce of all.
I can’t participate in this facade, but I don’t want to rob my patient of the opportunity for a miracle, either. We share a moment in the humility of my honesty and admission of uncertainty. I know my patients pay me to say, “I can fix it.” I can try, but to assert that without any degree of humility would be a lie. How can one possibly heal in the presence of inauthenticity? How can one attempt to work with bodies if they don’t respect the uncertain, the unknown and the mysterious truths they contain? In healing there is always a tension between grasping hope and giving in to trust and honestly confessing the vulnerability of, “I don’t know.”
For my patient I also request some testing—one thing about spending time on patients’ cases and being medically trained is that you get access to information and the language to understand it. I notice holes in the process that slapped her with this life-changing diagnosis.
When her labs come back, we find she might not have ovarian insufficiency after all. Doorways to hope open up and lead us to rooms full of questions. There are pieces of the story that don’t yet fit the lab results. I give her a list of more tests to get and she thanks me. I haven’t fixed her yet, but I’ve given her hope soil in which to flower. I’ve sent her on a path to more investigations, to more answers. And, thanks to more information in the tests, I’ve freed her and her ovaries from the label of “failure” and “insufficient” and realized that, as a doctor, I can free myself of those labels too. The trick is in admitting, as the lab results have done in their honest simplicity, what we don’t know.
For the moment, admitting insufficiency might prove to be sufficient in the end.
