“The right to determine what shall or shall not be done with one’s own body, and to be free from non-consensual medical treatment is a right deeply rooted in Canadian common law. The right underlines the doctrine of informed consent.
“With very limited exceptions (such emergency use or incapacity), every person’s body is considered inviolate and accordingly every competent adult has the right to be free from unwanted medical treatment.
“The fact that serious risks or consequences may result from a refusal of medical treatment does not vititate the right of medical self-determination.
“The doctrine of informed consent ensures the freedom of individuals to make choices about their medical care. It is the patient, not the physician (or others) who ultimately must decide if treatment–any treatment–is to be administered.” Justice Robbins of the Ontario Court of Appeal.
I deeply believe that the key to optimal health is taking full responsibility and accepting all personal power for one’s own health. This may involve doing research, educating oneself, or assembling a team of trusted health professionals, with you, the patient at the centre.
We have a busy and overloaded healthcare system and even well-meaning professionals can find themselves hurriedly having a conversation in which they are not properly informing patients of the risks and benefits, or alternatives to treatment that they are recommending. I have had patients hurriedly scheduling for surgeries they weren’t sure they wanted, or pressured into hysterectomies or long-term treatments whose risks they didn’t understand.
I have also had patients make perplexing choices in the name of their own care–choices I didn’t necessarily agree with, such as forgoing conventional cancer treatments or further testing or screening.
However, it is the duty of the healthcare provider to provide advice. And it is the right of every patient to accept or reject that advice.
In light of recent, disturbing events, I have started posting some facts on Canadian law and Informed Consent only to be met with surprise–many people are not aware of their rights to refuse medical treatment, to be informed of the risks, and to be allowed to make a choice free of pressure or coercion.
Despite it being deeply enshrined in Canadian law, many patients are not aware of their right to full bodily integrity, autonomy, and choice.
Since 1980, the Supreme Court of Canada made it the right of every patient to be given full informed consent before any medical procedure such as taking blood, giving an injection or vaccination, performing a physical examination, exposing the patient to radiation, and so on.
“The underlying principle is the right of a patient to decide what, if anything, should be done with his body.” Is quote from the famous Supreme Court case of Hopp v. Lepp.
Every health professional under the Regulated Health Professions Act, including naturopathic doctors has a duty to uphold informed consent. We are well versed in it. We are required to uphold it, document it, and maintain it with every patient we see.
Our naturopathic guidelines on consent state, “The ability to direct one’s own health care needs and treatment is vital to an individual’s personal dignity and autonomy. A key component of dignity and autonomy is choice. Regulated health professionals hold a position of trust and power with respect to their patients and can often exercise influence over a patient; however, decision-making power must always rest with the patient.”
In 1996 Ontario passed the Health Care Consent Act, a legal framework for documenting, communicating, establishing and maintaining informed consent in all healthcare settings.
Informed consent is required before all treatment can be administered. Treatment includes: “anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment or community treatment plan.”
Informed consent must be present in 4 key areas:
The consent must relate to the treatment.
The consent must be informed.
The consent must be given voluntarily, i.e.: made by the patient, and under no coercion, pressure, or duress.
The consent must not be obtained through misrepresentation or fraud.
In order to obtain your full informed consent, you must be given the following information:
The nature of the treatment.
The expected benefits of the treatment.
The material risks of the treatment, no matter how small, especially if one of the risks of side effects is death. The risks should not be minimized for the purpose of influencing your decision-making. The risks should be in relation to your health history. For example, if you suffer from cardiovascular disease, you should be made aware of the the risk of blood clots or myocarditis. It should also be disclosed if certain risks remain unknown.
The material side effects of the treatment. Again, these side effects should be explicitly stated, no matter how small, and if long-term side effects are unknown, that should be stated.
Alternative courses of action.
The likely consequences of not having the treatment. These consequences should not be exaggerated and must be related to the particular patient at hand. What is the actual risk of the patient not receiving the treatment?
Consent cannot be given in a state of duress or coercion. Healthcare providers must be aware that they hold a position of authority and may maintain a power imbalance. They must not misrepresent the benefits of the treatment, and they must disclose any conflict of interest.
Healthcare providers must ensure that patients are not acting under the pressures of someone else, such as an employer, government agency or family member, and are making this decision on their own.
Finally,
The Informed Consent Guide for Canadian Physicians states, “Patients must always be free to consent to or refuse treatment, and be free of any suggestion of duress or coercion. Consent obtained under any suggestion of compulsion either by the actions or words of the physician or others may be no consent at all and therefore may be successfully repudiated. In this context physicians must keep clearly in mind there may be circumstances when the initiative to consult a physician was not the patient’s but was rather that of a third party, a friend, an employer, or even a police officer.
“Under such circumstances, the physician may be well aware that the paitent is only very reluctantly following the course of action suggested or insisted upon by a third person. Then, physicians should be more than usually careful to assure themselves that patients are in full agreement with what has been suggested, that there has been no coercion and that the will of other persons has not been imposed on the patient”.
It is your body and it is your choice. You always have the right to do what’s best for you. True, empowered health cannot come from a place of coercion or pressure.
Know that you always have a choice–your doctor has a duty to inform you of your choice, as well as the information necessary for you to make the right choice for you, regardless of what is happening in the media or in politics.
I was sitting with my friend and her ex-partner. Their kids are soccer stars–one is headed towards a professional career and the younger one is not far behind.
My friends ex-partner, a fit soccer fan himself, lamented, “I’m getting old. I don’t recover like I used to. I’m not as fast as I used to be. I feel more sore after a game of soccer now in my 40s than when I was in my teens and 20s. Getting old sucks.”
“When you were younger you played soccer everyday,” my friend retorted. “Is it that you’re getting old or is that, as an adult, you have more obligations and responsibilities than you did when you were in your teens and yet expect yourself to be able to pick up the sport and play once a week as hard as when you were playing everyday?”
We blame old age on everything in our society.
I’m tired of “you’re getting older” being the main throwaway diagnosis of my friends, family, and patients’ sliding health and fitness. Kelly Slater is almost 50–he plans to keep surfing into his 70s. I’ll bet he can, too.
Coco is like 70 in dog years and climbs steep hills and races and chases and bites (with the 5 teeth he has left) like a puppy.
As adults, I think we need to take responsibility for our bodies and take our range of motion, flexibility and strength seriously if we’d like to retain the physical mobility of our youth. It’s not your age—it’s what your age means to your movement patterns that will dictate your injury susceptibility, your recovery, your progress in your sport of choice, and your overall fitness and health.
I’ve been thinking about this lately because I’ve been taking my surf training a bit more seriously this year.
Surfing is an incredibly difficult sport. Tiny increments in progression happen over years, not months. Going from a beginner (which I would classify myself as: an advanced beginner) to an intermediate surfer is a timeline of almost daily sessions for at least a couple of years.
I’ve been surfing for two years and still have massive leaps and bounds to go before I’d classify my skills as “intermediate”.
Because the lakes don’t offer as much consistency as the ocean, I figured I wasn’t going to make progress fast enough unless I started to do dry-land training, focusing on physical strength for paddling and speed pumping down the line, and flexibility and mobility to be able to put my body in the positions that the sport demands–this means core strength, glute strength, hip and ankle flexibility and upper body strength.
It also means balance and practicing upper and lower body coordination.
It means I need to practice certain movement patterns on dry land, and train on a surfskate. It means I need to make sure my body has the range of motion necessary to surf, and the joint and muscle health necessary to recover faster, and prevent injury. It’s not fun to get injured as an adult when you have a job to go to that pays the bills.
I dislocated my shoulder at age 20 while snowboarding and it affected my ability to study effectively at university. My shoulder still gives me trouble, particularly if I put it in “backstroke” position, internal rotation and overhead extension– I can feel it slide out, in danger of redislocating. I don’t want another injury in my 30s.
I’ve also been watching the Olympics and thinking of professional surfers like 19-year old Caroline Marks. Her prodigy-like talent comes from a combination of learning the sport early in order to instil proper motor patterns, a competitive spirit, familial encouragement, financial resources, body type (a strong lower body and lower centre of gravity), and amazing coaching.
According to William Finnegan it’s almost impossible to be “any good” at surfing if you start learning after the age of 14.
Damn.
However, learning new movements and teaching your body how to coordinate in new ways does wonders to stave off depression and dementia as well as keep your body strong and supple.
I find focusing on performance in a sport helps with my body image: I focus on how my body looks in its postures and positions while performing the sport vs. the shape of it in general.
I also find the dopamine hits and adrenaline highs are addictive and calming—If I go too long without surfing I feel a bit if ennui-like withdrawal.
I also find that surfing is an amazing way to connect me with a community, with nature, with the lakes and the ocean, and my breath and body.
And I find it satisfying to work towards goals.
As a kid I was fairly athletic but not particularly talented at any competitive sport. I did gymnastics for a second, and played soccer for a number of years. I was on the swim team in high school and taught and coached swimming myself. I am still a strong swimmer but was nothing more than an average racer.
I was on the triathlon team at Queen’s for a couple of years, and had a job as a snowboarding instructor throughout high school. I loved snowboarding during that time until going to school in a relative flat place and suffering an injury drastically reduced the amount of time I was able to spend on the hill.
I’ve been fascinated about the technical aspect of skills I’m interested in acquiring.
I love learning what the optimal stance is and how to position my body to mimic it. I’m interested in learning how to breathe right, which muscles need stretching and which ones need strengthening.
I love the video analyses and the tips from friends on how to improve. I enjoy the struggle and the frustration and the plateaus followed by random bursts of improvement that fill you with giddy excitement. That slam dunk, arms in the air feeling.
When taking a history, I always ask patients about their physical activity levels and their movement patterns.
Many are physically active in order to support their health: walking daily, going to the gym to lift weights or take exercise classes, doing yoga or pilates. But many will tell me that their activity comes mostly from playing sports–they play hockey or golf once a week.
And many of my surfing friends just surf.
That’s fine if you’re like my friend Steve who surfs or skateboards virtually everyday, but if you’re the type of athlete who only has the time or opportunity to engage in your sport once a week or less you’re most likely putting yourself at risk of injury without any dry-land functional training.
Functional movement helps our bodies stay optimally healthy and… well, functional. The functional movements include pushing, pulling, squatting, lunging, twisting, gait, and rotation. We need them to stay mobile and injury free. I read somewhere that most 50 year olds can’t stand in a lunge position.
I know that many people in their 30s can’t sit crosslegged on the floor, or squat. Our hip flexors are tight, our glutes are loose, and our ankles are immobile. We aren’t training our bodies for functional existence, like sitting on the floor and standing up out of a chair without using your hands.
It’s important to stretch daily to prevent muscle and joint injury. It’s important to keep certain muscles strong–like the upper body muscles for paddling. Our bodies weren’t meant to perform repetitive movements on demand after staying locked in a shed for weeks. They need to move regularly and need to stay tuned up to perform the sport of your choice, especially if you’re still interested in progressing at it.
Many sports are asymmetrical as well. This can leave us vulnerable to injury as certain flexors are tighter than their extensors, and so on, putting strain on joints.
Being able to move your body through space, not just linearly, in 2D, like in running or walking, but across all dimensions: front and back and side to side and twisting and jumping and crawling, is important for maintaining proprioception and body awareness.
Open hip flexors (can you do a squat? Can you sit cross-legged on the floor? What about Pigeon Pose?) are important for maintaining optimal back and digestive health.
The glutes are the most metabolically active muscles in the body and for most of us they just lie around flaccid all day as we sit in our chairs and work on our computers. This causes tightness and strain in other areas of the body such as the hip flexors, calves and hamstrings.
I noticed that my left calf was so tight it was impacting my ankle flexibility. I learned this through yoga–noticing that when I would try to get into skandasana (side lunge), my heel wasn’t able to touch the floor on the left side. This left ankle tightness is inevitably going to impact my surfing because my body cannot literally get into the posture necessary for certain maneuvers and therefore will limit my progress.
And so I’ve been focusing on more sport-specific dry land training for the sport of surfing–a challenging feat to take on as someone in her mid-30s who doesn’t live near an ocean–but also to maintain optimal health, body awareness, and functional movement.
Challenge you body and brain through finding a sport you love, or activities that you love that you’d like to get better at. Train for these activities, stretch daily and begin to explore your body in new ways: learn what muscles need loosening and what muscles need strengthening, Begin to expand the range of motion of your joints to prevent injury.
Strengthen your bone mass through applying repetitive stress to long bones (through walking, running, jumping and weight-lifting).
Explore fluidity of movement through swimming, dance, yoga, pilates, or other activities that require complex movements, coordination, grace, style, and flow.
Watch your body shape transform into something you are genuinely proud of: not so much because of what it looks like, but for what it is capable of, how it supports you, and what it can do.
Develop and hone your body awareness. Deepen your breath. Pay attention to pain and physical sensations, including the physiological sensations of hunger, thirst, and fatigue. Body awareness can help to heal injury, process trauma, and engage in self-care. It can help with emotional regulation, and interpersonal relationships.
And, most of all, stay active. Whatever you do, find joy in movement.
It’s mulberry season, which means while walking through my neighbourhood I can snack, picking food right off the trees growing behind fences or on people’s front lawns whenever I walk by a berry-stained sidewalk.
There’s something therapeutic about entering into the flow state of berry-eating from a tree (or a bush? they’re massive bushes. The act of eating becomes a ritual. It demands presence and attention. It becomes like a game, the objective is looking for rich colour, ripeness, size, and strategizing how to access the delicious, prized morsel you’ve laid your eyes on, then savouring the experience of having attained it, before beginning the process again.
It’s impossible to binge-eat this way.
I remember at my friend’s cottage last September it was blueberry season and we spent the weekend casually hanging out in the middle of blueberry patches. I would find an abundant bush, settle down in the midst of it and graze. I must have eaten 5 cups of blueberries each day and yet it took me the entire day to do it.
What better way to spend a day?
The best part of it was: I met my food.
I was listening to Paul Saladino of the Fundamental Health Podcast interview Daniel Vitalis from the Rewilding Podcast. The subject came up about foraging, and hunting and meeting your food.
“Some people have never seen a bass,” Daniel Vitalis commented.
“Maybe not in the wild, maybe not in a zoo. They don’t know how big it is, what colour it is, what kind of lakes it lives in, what it looks like.
“And, more importantly, even if someone fishes for bass or knows what they look like, if they eat bass in a restaurant or from a frozen filet they’ve bought at the grocery store, they most likely haven’t met that bass.
“There’s a massive disconnect in our society between us and the food we eat.”
In almost every other culture we would have shared an intimate relationship with food.
When I was eating blueberries I took the time to settle down in a patch of bushes and linger. The act of eating was immersed in a ritualistic past-time. I was connecting with the specific plant whose food I was borrowing. I was visiting her home–her environment.
When you fish for bass, or hunt a deer, you enter that animal’s setting. You meet it alive. You witness it living. You witness it dying.
The animal’s fate intertwines with yours.
Your survival and his become like a seesaw. Yesterday it was your turn. Today it’s mine.
I suppose the fish filet’s fate is also intertwined with yours: he may have been destined to end up in the freezer section of the local Costco, but somehow… it seems radically different, largely impersonal. Colder.
This is why we obsess over food sometimes: where was the bass made? Was it caught or farmed? Is it organic? Where was it processed? Eating animals is wrong—I’m going to go vegan. And so on.
I believe that this neurosis becomes our remedy for disconnect, for the disembodiment we experience. Eating becomes an intellectual task. We need to read labels, visit websites, and do research, rather than just experiencing our food first in its living form, before engaging in the eating of it.
Hunter gatherers don’t read labels. They don’t diet.
The Hadza from Tanzania don’t have food rules, restrictions ,or even mental, nutritional concepts about food. That’s a Western thing.
The Hadza, like many other cultures more connected to their food sources, simply possess the raw biological desire to eat whatever and however much they like that they can get, whenever they can get it. They are guided by taste and hunger.
Their lives revolve around hunting and gathering food. They simply immerse themselves in their food environments and eat.
We are also immersed in a food environment: the packaged, fried, doctored foodstuffs packed into grocery stores, fast food restaurants, gas stations, and convenience stores. These foods connect with our hunger cues and communicate with our tastebuds but offer none of the impact of “real” food on our physiology. They don’t nourish us.
They don’t connect us to the natural world. They don’t encourage ritualistic eating. What happened to that wheat sheaf or corn blade for it to become refined flour or hydrogenated oil? Could I participate in the making of it? Or do I lack the chemicals and technology to process this food to make these potato chips, bread, or cookies?
Our food environment encourages our disconnect and this encourages our neurosis around food and nutrition. In order to thrive in this environment we need to think about food. We need to read labels and make choices and abstain from certain foods, and make an effort to change our environment so that it becomes one more conducive to human nourishment.
We need to refuse foods served to us at events, or buy separate groceries, and make separate meals for our partners or children.
We create a food “island” for ourselves, in the midst of our community.
And this becomes impossible.
You are only as healthy as the group and environment you find yourself in.
So what can we do? Perhaps we can start with community. Where do the healthy people shop? Where do you feel most connected to your food? Is it in your garden? Is it visiting a farm? Hunting or buying meat from a hunter, or a farm? Can you meet your meat before you buy it? Can you develop a relationship with those who grow or process your food?
A hunting trip offers a deep connection to food, land, and tradition. It’s an opportunity to step into nature, understanding the balance that sustains both wildlife and people. For many, harvesting meat firsthand is the most ethical way to eat—knowing exactly where it came from, how it was taken, and the effort required to bring it home. A well-planned trip isn’t just about the hunt; it’s about immersing in the landscape, respecting the process, and ensuring nothing goes to waste.
Perhaps it means more at-home food preparation. Visiting more farmer’s markets. Talking with the people selling you your eggs. Perhaps it means developing a connection with a local farm where you source your food. Perhaps it means you pick your apples in season, or you grow your own herbs. Maybe you bake bread with your children, or can your own tomatoes.
Maybe you develop your own food and eating rituals and you practice them as a family or as a community.
Maybe you ask some questions about your food–what does this bass look like? How did this cow live?
Food has always been so central to human culture.
When we connect with the rituals of picking, hunting, growing, processing, and consuming our food, we learn what it is to be truly human.
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.
I talk with Dr. Kara and Dr. Dave of That Naturopathic Podcast, rated in the top 6 Canadian Medicine podcasts, about taming the tiger of anxiety. Click to learn about your HPA Axis, the stress response and how we can “tame the tiger” by providing our body and mind with the assurance that we’re safe. Listen on Spotify.
I talk to Taylor Morozova of the Weird Waves Podcast about how I became a naturopathic doctor, surfing, immunity, vitamin D, and how to stay safe in the age of Corona. Listen on Spotify.
In September of 2019, Jakobsen, Gluud and Kirsch published a review in the British Medical Journal: Evidence-Based Medicine entitled “Should antidepressants be used for major depressive disorder?” (1)
Their conclusion was this:
“Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.”
Now, before we move on with what drove them to make this seemingly radical conclusion, I want to be clear:
I am not stigmatizing medication.
All of those who take medication for depression have asked for help.
Asking for help is important.
Asking for help is brave.
And, whatever help works for you is the right kind of help.
But imagine this; imagine you are a pretty decent swimmer.
You’ve practiced swimming all your life. You’ve gotten lots of experience swimming in pools, lakes, and oceans. You know how to swim, just like you know how to cope with turmoil. But, despite your strength, one day you find yourself drowning.
“No, I’m not drowning,” you might say at first. “I can’t be drowning. I know how to swim! If I’m drowning, it means I’m a failure…
“What will everyone think?”
And so you continue to splash around a bit, until it becomes undeniable. You gasp some water-filled air. Your head submerges and you think, indeed, “I’m drowning.”
When you get your head above water you call for help.
This takes a lot.
It’s not easy to admit that you need help.
It’s not easy to overcome that little voice that tells you that asking for help is troubling other people, admitting defeat, showing weakness—and whatever else that darned little voice thinks it means.
“HELP!” You exclaim, louder this time—little voice be damned.
“HEEELP!”
And someone on shore sees you. They have a life-preserver in their hands and they throw it your way.
Your shame is peppered with relief—and gratitude: there’s an answer to all this suffering. You thrust your hand towards the life preserver, grasping it with a firm bravery.
Only, it starts to sink. It’s full of holes.
“What’s the matter?” The person waiting on the shore exclaims, as you continue to struggle, “Don’t you want help?”
The shame returns. Hopelessness joins it.
I advocate for mental health awareness. I advocate for perpetuating the message that it’s ok to talk about mental illness. It ok to admit you need help.
I believe the following:
Depression is not a a sign of weakness.
It’s not a sign that you are defective.
It’s not a sign that you haven’t learned proper coping skills, or that your coping skills are defective, or that you’re fragile.
It’s also not fixed by simple solutions like eating salad, running or putting “mind over matter”.
Depression happens to a lot of us.
It affects 300 million people globally. It is the leading cause of disability world-wide, with a lifetime prevalence of 10 to 20%. This means that 1 in 5 people will experience depression in their lifetimes.
We all know someone who suffers. Maybe you suffer.
And a lot of people ask for help. The National Health and Nutrition Examine Survey (NHANES) in 2017 found that 1 in 8 people over the age of 12 are taking an anti-depressant, a 65% increase over the last 15 years.
This means that 65% more of us are asking for help.
That’s a lot of life preservers.
So, just how effective is this help?
First, we need to understand how the efficacy of anti-depressants are measured.
The symptoms of depression are subjective. This means they are not observable. There is no imaging that shows if someone is depressed. There are no blood tests for depression. There are no physical exams.
Therefore, to assess the presence and severity of depression, clinicians use questionnaires. The most commonly used depression questionnaire is The Hamilton Depression and Rating Scale (HDRS), a 52-point checklist that assesses various symptoms of depression and rates them on a scale of no-depression to severe.
When patients with depression first see a family doctor or psychiatrist they are often issued the HDRS and given a score.
Let’s use Janet’s story as an example. Janet first came to see her psychiatrist two years ago. She wasn’t sleeping and yet felt sleepy all the time. She’d gained weight but had no appetite. Her entire body was sore, as if she had the flu. She’d lost interest in all of the activities that used to fire her up. She’d lost interest in everything.
After a few weeks of feeling progressively worse, Janet began to be plagued by thoughts of suicide. This scared her. She went to her family doctor, who referred her to a psychiatrist.
Janet’s HDRS score was 25. This meant she was moderately to severely depressed.
Janet was given an anti-depressant, a Selective Serotonin Re-uptake Inhibitor (SSRI). She was told it would correct her “brain imbalance”, and treat the cause of her symptoms. Janet was relieved that there was a solution.
If an anti-depressant can decrease the HDRS by 3 points, then the medication “works”. Or at least the results are statistically significant.
However, if Janet’s symptoms improve by 3 points, from a score of 25 to, say, a score of 22, how does she feel?
Not much different, it turns out.
To experience “minimal improvement”, a decrease in symptoms that someone with depression would notice, say an increase in energy, an improvement in sleep, or a change in mood, a patient’s HDRS score would need to decrease by at least 7 points.
This means the Janet would need to bring her HDRS down to 18 or lower before she starts to feel noticeably better.
Studies show that anti-depressants, on average, don’t do this.
Some randomized control trials do show that anti-depressants decrease the HDRS score by at least 3 points, which is still registered by patients as having no perceptible effect, but the results are mixed.
A large 2017 systematic review showed that anti-depressants only decreased patients’ HDRS by about 1.94 points (2) and another large study published in the Lancet (3) also failed to show that anti-depressants produce a statistically significant effect, let alone a clinically significant one.
In addition to the minimal changes in symptoms, anti-depressant research is also polluted with for-profit bias. Most studies are conducted or funded by the drug companies.
This makes a difference: an analysis showed a study was 22 times less likely to make negative statements about a drug if the scientists worked for the company that manufactured it (4).
Studies at high-risk of for-profit bias were also more likely to show positive effects of a drug (5).
Another limitation of anti-depressant trials is the lack of active placebo control. In Randomized Control Trials, participants are sorted into two groups: an active group, in which they receive the medication, and a placebo group, in which they receive an inert pill.
The goal of this process is to control for something called the “meaning response”, or “placebo effect” where our expectations and beliefs about a therapy have the potential to affect our response to it.
Remember that depression, as I mentioned before, is a condition made up of subjective symptoms.
If I asked you to rate your energy on a scale of 1 to 10, how would you rate it? What if I asked you tomorrow? What if I asked you after giving you a drink of something that tastes suspiciously like coffee?
Because of its subjective nature, and the subjective questionnaires, like the HDRS, that measure it, depression is very susceptible to the placebo response.
Therefore, it’s important to control for the placebo response in every trial assessing anti-depressants.
But it might not be enough to just take a sugar pill that looks like an anti-depressant.
SSRI medication produces obvious side effects: gastrointestinal issues, headaches, changes in energy, and sleep disturbances, to name a few.
When a patient taking a pill (either placebo or active treatment) starts to feel these side effects, they immediately know which group they have been randomized to, and they are no longer blinded.
This can be solved by giving an “active placebo”: a placebo that produces similar side effects to the active medication. Unfortunately anti-depressant trials that use active placebo are lacking.
But what about the people who DO benefit from anti-depressants?
Janet knew a few. She had a cousin who also suffered from depression. He took medication to manage his symptoms. He’d told her many times that he just wasn’t the same without it.
Perhaps you, reading this article have found benefit from an anti-depressant medication. Perhaps you know someone who has: a family member, or a friend. Maybe it was their lifeline. Maybe it’s yours.
According to Jakobson et al., there are indeed some people who benefit from anti-depressants. Anecdotally we know this to be true. However, the results of large studies show minimal to no benefit from medication, on average.
This means that some people might benefit; we know that some do. It also means that an equal number of people are harmed.
In order for the net effect of anti-depressant medication to be close to zero, an equal number of people experience negative effects that outweigh the positive effects seen in others.
So, while some may have already tried medication and benefited from it, those considering medication won’t know if they’ll be in the group who benefits, or the group who is harmed.
The side effects of anti-depressant medication are often underrepresented. In the Lancet study, adverse effects were neither recorded nor assessed (3).
The most common side effects include gastrointestinal problems, sleep disturbances, and sexual dysfunction. More serious side effects, like increased risk of suicide, are also possible. Some of these effects may persist even after the medication is stopped.
Anti-depressant trials are short-term. Most trials assess patients for 4 to 8 weeks, while most people take anti-depressants for 2 years or longer.
Anti-depressants also put people at risk of physiological dependence and withdrawal.
Withdrawal symptoms can occur a few days, or even weeks, after tapering anti-depressant medication. They sometimes last months.
Withdrawal symptoms are often mistaken for depressive relapse. This can make it difficult, or even impossible, for patients to come off medication. This is worrisome considering the lack of research on long-term medication use.
It is sometimes argued that anti-depressants are more effective, or even essential, for severe depression, however the evidence for this is lacking (4).
In their paper, Jakobson, Gluud and Kirsch conclude that, based on the evidence, anti-depressants show a high risk of harm with minimal benefit.
Before prescribing them, Jakobson et al recommend more non-biased, long-term studies that use active placebo, and honestly assess the negative effects of the medications.
They recommend that studies use improved quality of life and clinically meaningful symptom reduction, not just statistical significance, as standards for treatment success.
Despite these conclusions, SSRIs remain a first-line treatment for major depressive disorder. They are also prescribed for conditions like severe PMS, IBS, anxiety, grief, and fibromyalgia, or other pain conditions. 1 in 8 adults in North America are taking them.
As a clinician who focuses in mental health, I am not against medication.
I have seen patients benefit from SSRI or SNRI medications. Sometimes finding relief with medication when nothing else worked.
My clinical practice keeps me humble.
If a patient comes into my practice on medication, or considering medication, I listen. I ask how I can support them. I answer questions to the best of my ability. I trust my patients.
Patient experience trumps clinical papers.
However, for every patient who benefits from medication, just as many experience negative side effects, or no effect. I trust their experiences too.
I also trust the experiences of the patients who have been trying for months, or years, to wean off medications.
Let me repeat it again: depression is real. Asking for help is hard. And it’s important.
Depression is a multi-factorial condition.
This means that it stems from hundreds of complex causes. This is why it’s so difficult to treat. This is why so many people suffer.
Let me also repeat: depression is not easily fixed.
There is no one solution, and there are certainly no ONE-SIZE-FITS-ALL solutions.
So, if you or someone you care about is suffering from depression, what can you do?
First, get help. This is not something you can get through alone.
Second, seek lots of help: gather together a team of professionals, family and friends. You can start with one person: your family doctor or a naturopathic doctor, and then assemble your support network.
Choose people you trust: people who listen, provide you with options, and seek your full informed consent.
It is important to work with a healthcare team who take into account the factors that may be contributing to your symptoms: brain health, gut health, life stressors, nutrition, inflammation levels, presence of other health conditions, sleep hygiene, family history, contributing life circumstances, such as grief, trauma, or poverty, and who lay out various treatment options while filling you in on the risks, benefits and alternate therapies of each.
Medication may be part of this comprehensive treatment plan, or it may not.
It is brave to ask for help.
And I believe that bravery should be rewarded with the best standard of care—with the best help.
References:
Jakobsen JC, Gluud C, Kirsch IShould antidepressants be used for major depressive disorder?BMJ Evidence-Based Medicine Published Online First: 25 September 2019. doi: 10.1136/bmjebm-2019-111238
Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and trial sequential analysis. BMC Psychiatr2017;17:58
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet2018;391:1357–66
Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med2008;5:e45.doi:10.1371/journal.pmed.0050045
Ebrahim S, Bance S, Athale A, et al. Meta-Analyses with industry involvement are massively published and report no caveats for antidepressants. J Clin Epidemiol2016;70:155–63.doi:10.1016/j.jclinepi.2015.08.021
My friend Nelson (not his real name) was depressed.
Depression frequently came in and out of Nelson’s life, but this last bout was the worst.
Severe job stress compounded by issues with his relationship sent Nelson into a downward spiral, leaving him broken, sobbing and exhausted after engaging in the simplest of tasks.
Sadness and a feeling of doom rushed in to greet him at the end of each sleepless night. Nelson gained weight, despite never truly feeling hungry. His face appeared sunken and swollen. Despite sleeping 14 hours a day, dark circles hung under his eyes.
Since focusing and concentrating on work was impossible, he asked his psychiatrist to help him apply for mental health leave. Nelson was granted sick leave, as well as a prescription for Effexor, and a recommendation to get as much rest as possible.
After a year, Nelson felt worse. When rest and the medication weren’t working, he started exercising vigorously. He hired a nutritionist who cleaned up his diet, and he started taking fish oil and a B complex, among other supplements.
Even then, he still struggled. The hopelessness was still there. Returning to work at this point seemed impossible.
Nelson opened up to a friend about his struggles.
“I went through a similar thing a few years ago,” Nelson’s friend confessed. “And the thing that helped the most was micro-dosing.”
Micro-dosing, taking small doses of psychedelic substances, like LSD or psilocybin-containing “magic” mushrooms, entered the public consciousness in early 2015, after James Fadiman, PhD and author of The Psychedelic Explorer’s Guide, appeared on the Tim Ferris Podcast.
It involves taking a “sub-perceptual” dose of a hallucinogen, like LSD or Psilocybe cubensis “magic” mushrooms, that contain the hallucinogen psilocybin. A sub-perceptual dose means that, while these substances still exert effects, they don’t produce a noticeable hallucinogenic “high”.
According to Paul Austin at the The Third Wave, people micro-dose for two main reasons: to remove negative mood states, such as depression, anxiety, PTSD, addiction, and ADD; and to increase positive mood states such as flow, creativity, improved productivity and focus, and sociability.
Micro-dosing has been used experimentally in individuals trying to quit smoking and to heal depression.
After listening to the podcast and reading some of the articles his friend sent him, Nelson managed to obtain capsules containing 200 mg of dried psilocybin mushrooms. Procuring these substances is still illegal, but Nelson figured he had nothing to lose.
When I caught up with Nelson, he was already a few weeks into his micro-dosing regimen. I asked him how he was doing.
“I’m actually feeling better than I have in months,” he told me, smiling. “I’m not passing out on the couch anymore. I wake up at 7 every morning without an alarm. I feel optimistic for the first time in months. And it seems to be consistent!
“This week I’ve managed to attend three social events and I seem… more motivated. My workout game improved too. Also, I’m not sure I’m ready to go back to work just yet but I’ve noticed my motivation has picked up. So much so that I’ve started taking free programming courses online. I—I can’t really believe it.”
Research on Psychedelics for Depression
Unfortunately, we can’t draw any sound conclusions from Nelson’s experience; scientific data from randomized control studies is still lacking. However, the growing collection of anecdotes on the benefits of micro-dosing for mental health and well-being has caught the attention of researchers.
Thomas Anderson, a PhD candidate at the University of Toronto, polled almost one thousand participants on social media channels and message boards, like Reddit, to gather some initial data on the benefits and drawbacks of micro-dosing hallucinogens.
The micro-dosers that Anderson and his team polled reported higher levels of creativity, and improved mood and focus. They claimed to notice a reduction in depression and anxiety symptoms, increased motivation to eat right and exercise, cognitive enhancement, improved self-efficacy and heightened social functioning.
They reported that the main drawback they experienced was obtaining these substances, which are currently illegal in The US and Canada.
Although interesting, this self-reported data isn’t hard science. To increase objectivity, Anderson and his team presented the participants with tests of creativity (finding out how many uses they could find for common objects, for instance) and questionnaires that measured wisdom. The micro-dosers scored high on both these metrics. They also scored lower in tests that measured negative emotion.
Anderson and his colleagues plan to publish these preliminary findings in a series of papers. They are currently in the process of obtaining Health Canada approval for a controlled study.
Psychedelic research was terminated in the 1960’s, leaving a massive knowledge gap of their therapeutic potential. But now, with the publication of Fadiman’s Psychedelic Explorer’s Guide and Michael Pollen’s even more recent How to Change Your Mind, psychedelics are receiving a fresh surge of interest, particularly for their mental health benefits.
One of the prominent names in this new-wave research community is Robin Carhart-Harris, PhD, at Imperial College London, who is investigating psilocybin as a treatment for severe depression.
Published in a 2016 issue of Lancet Psychiatry, Carhart-Harris administered two doses (one small and one moderate) of psilocybin, spaced one week apart, to twelve patients with Major Depressive Disorder. The doses were administered in a controlled, therapeutic setting, and symptoms were rated immediately after therapy, and then again at one and three months.
The study results were remarkable. Five of the twelve patients dropped from “severe depression” to “no depression” immediately after receiving the second dose. All of the study participants experienced an overall reduction in symptoms with five of the study participants remaining depression-free after three months.
Roland Griffiths, Phd, at John Hopkins, is involved in a number of studies examining psilocybin’s ability to induce mystical experiences in terminally ill patients.
In a 2016 randomized, double-blind, placebo-controlled crossover trial published in the Journal of Psychopharmacology, he and his team found that administering high-dose psilocybin to terminally ill cancer patients increased mood, quality of life and optimism, and decreased death anxiety. These benefits were sustained at the six month follow-up. Over 80% of the study participants claimed to experience greater life satisfaction and feelings of well-being.
How Psychedelics Work to Boost Mood
LSD, psilocybin, and other psychedelics, work like serotonin in the brain by acting on serotonin receptors, specifically the 5HT2A serotonin receptors.
Like psychedelics, anti-depressant medications, like SSRI and SNRI medications (Selective Serotonin and Selective Serotonin and Norepinephrine Re-uptake Inhibitors), Cipralex and Effexor, respectively, also work on serotonin pathways. However, these medications’ effects are limited: some people improve on them, while others feel no different, or even worse.
SSRI and SNRI medications activate 5HT1A receptors. According to Carhart-Harris, this makes a difference. In his paper on the “Bipartite Model of Serotonin Signalling” he proposes that these receptor pathways help people cope differently.
5HT1A receptors, acted on by anti-depressants, help with “Passive Coping”. They help individuals with depression tolerate the stress in their lives, be it a toxic work environment or destructive relationship—nothing has changed about the situation, you can just deal with it better.
Psychedelic stimulation of 5HT2A receptors activate pathways involved in “Active Coping”: identifying and directly addressing sources of stress. Active coping might mean asserting boundaries at work or applying to new jobs. It might look like ending an unhealthy relationship.
In other words, 5HT2A receptors stimulate neural pathways that reveal previously elusive solutions to problems. They do this by increasing a chemical called Brain-Derived Neurotropic Factor, or BDNF.
BDNF promotes the growth of new brain cells and neural pathways in the brain. These processes, called “neurogenesis” and “neuroplasticity” , are essential for learning, creativity and memory. Research shows that increased neuronal plasticity benefits mood.
Psychedelics also work by disconnecting the brain’s Default Mode Network. The Default Mode Network, or DMN, connects frontal areas of the brain, such as the Medial Prefrontal Cortex, with lower brain areas like the Posterior Cingulate Cortex.
When we’re daydreaming, stuck in traffic, sitting in a waiting room, or otherwise not actively engaged in a mental task, our DMN lights up. In these quiet moments, we lapse into a state of reflection and self-referential thinking. In other words, our minds wander.
If we’re in a good mood, this mind-wandering creates narratives, daydreams and fantasies about the future. If we’re depressed, it leads to rumination, negative over-thinking, and self-criticism, which worsens mood.
Disrupting the DMN allows old thought patterns to fall away, opening up novel possibilities.
Activating Flow States
Shutting off the DMN can help us enter a state of Flow. Flow states occur when we are completely immersed in an activity so worthwhile that our sense of time and self cease. When in flow, we toe the limits of our talents, making these states incredibly rewarding and enriching. They are the antithesis to depressive and anxious mood states.
Psychedelic substances, along with other practices like meditation, help put us in a state of flow. These states are characterized by elevated levels of serotonin and dopamine and calming and focussing alpha brain wave oscillations. When in them, we become capable of incredible things.
In The Psychedelic Explorer’s Guide, James Fadiman writes about “Clifford”, a premed student. Clifford shares,
“I was taking a biology course to prepare for medical school, and we were studying the development of the chick embryo…I realized that in order to stay alert, a tiny dose of LSD could be useful.
“With that in mind, I licked a small, but very potent, tablet emblazoned with the peace sign before every class. This produced a barely noticeable brightening of colours and created a generalized fascination with the course and my professor, who was otherwise uninteresting to me.”
Due to some health issues, Clifford ends up missing the final exam. His professor agrees to a make-up. Before the exam, Clifford pops the rest of the now-tiny LSD tablet into his mouth.
The make-up exam consists of drawing the complete development of the chick from fertilization to hatching—the entire course.
“As I sat there despondently, I closed my eyes and was flooded with grief. Then I noticed that my inner visual field was undulating like a blanket that was being shaken at one end. I began to see a movie of fertilization!
“To my utter amazement, I was able to carefully and completely replicate the content of the entire course, drawing after drawing, like the frames of animation that I was seeing as a completed film!
“It took me an hour and a quarter drawing as fast as I could to reproduce the twenty-one-day miracle of chick formation. Clearly impressed, my now suddenly lovely professor smiled and said, ‘Well, I suppose you deserve an A!’ …the gentle wonder of life was everywhere.”
While impressive, Clifford’s account, like Nelson’s, is merely an anecdote. Far more research is warranted.
Micro-Dosing for Mood
Micro-dosing allows individuals to tap into the 5HT2A receptor-stimulating, BDNF-increasing, DMN-uncoupling, and flow state activating benefits of psychedelics, without the mind-stabilizing effects.
At a sub-perceptual doses there are no weird colours and visuals, alternate realities, or ego deaths. Micro-dosers report that the world merely appears brighter, or that they feel “sparklier”—they experience greater well-being. Otherwise, they can proceed with their lives normally.
Fadiman’s micro-dosing protocol consists of taking a tenth of a full dose, about 10 to 20 mcg of LSD, or 200 to 500 mg of dried-weight psilocybin mushrooms, every three days. This means that if the first dose is taken on Monday (Day 1), then the second dose is taken on Thursday (Day 4). According to Fadiman, spacing doses avoids tolerance, keeping the doses effective.
Participants are encouraged to engage in their daily activities: working, eating, sleeping and exercising normally.
Fadiman recommends participants keep a record of mood, cognition, motivation and productivity. People often report that they feel the best on Day 2, the day after taking a micro-dose.
Drawbacks to Micro-Dosing
In my role as a naturopathic doctor, I can’t recommend or counsel on the use of psychedelic substances for the treatment of any health condition. While the scientific interest in their use as therapeutic agents is growing, these substances are illegal to obtain and possess, and there is a lack of solid research on their safety and efficacy.
As of right now, the only way to legally access psychedelic therapies is through research. MAPS, the Multidisciplinary Association for Psychedelic Studies, often lists recruitment opportunities for ongoing studies. Thomas Anderson, at the University of Toronto, is in the stages of obtaining Health Canada approval for a randomized control trial on the benefits of micro-dosing in healthy volunteers.
Like all therapies, there are risks to taking these substances, even at low doses. While LSD and psilocybin confer a low risk for addiction and are ten times less harmful than alcohol (the harm scores of LSD and psilocybin are 7 and 5, respectively, compared to 72 for alcohol), they are not completely benign.
Psychedelics can aggravate schizophrenia, psychosis, dissociation, severe anxiety, and panic. They can also interact with medications and supplements that act on serotonin pathways. Their effects at high doses can be disorienting and oftentimes unpleasant: in the studies that showed positive benefit, they were administered under careful supervision, in a therapeutic set and setting.
Our society’s mental health is in crisis. As a clinician who focuses on mental health, I am always excited to learn of new therapies that have the potential to heal mood. With Canada’s 2018 legalization of cannabis, gateways are opening for future uses of psychedelics as medicine. Perhaps with more research and advocacy, we’ll one day see micro-dosing of psychedelic substances as a safe and effective mainstay therapy for promoting mental and emotional well-being.
When it comes to improving mood, most of us will do anything, including taking boatloads of pills.
One of the challenges I face as a naturopathic doctor is choosing which supplements to prescribe my patients; in the realm of natural medicine we have what seems like an infinite amount of options.
I can prescribe herbs for regulating the stress response, calming inflammation, or Zen-ing out the brain. I can prescribe amino acids, like 5HTP, which help regulate chemicals in the brain. I can recommend the hottest new products, like collagen, or a greens powder, or the newest Superfood. There are also a host of nutrients that the brain and body need for optimal functioning.
I try to keep my list of supplement recommendations to a maximum of 5, letting diet and lifestyle do the rest of the heavy-lifting. This means that I work in layers. When I see a new patient, I start by prescribing nutrients that fill in nutritional gaps. Perhaps my patients are showing signs of deficiency, based on their health histories, diet diaries or blood results; Or perhaps they just need a bit more nutrient support in the face of physical, mental, emotional and environmental stressors. After they start to notice improvement, we might move on to clearing more layers using herbs or therapies, like acupuncture or Mindfulness-Based Cognitive Therapy.
Naturopathic medicine does not believe in one-size-fits all treatment plans. If I see two patients with depression on the same day, both may receive entirely different plans. I base my recommendations on the person and her unique biography and biology, not the condition. However, because I try to keep my supplement suggestions to a minimum, when I work with patients with depression, I find these 5 nutrients continue to appear on my list.
1. Fish Oil
While most anti-depressant therapies target the brain, we know that depression isn’t simply a brain disorder. Depression is a complex condition impacted by our genes, physical health, social and physical environments, early childhood traumas, current stressors, nutrients status, and many other factors. Our minds and bodies are connected and therefore depression is as much a product of the health of our bodies and our environments, as it is of our brains.
Mounting evidence shows that inflammation in the body plays a major role in depression. Since the 90’s, scientist have found inflammatory cytokines (immune system molecules that cause inflammation), like IL-6 and TNF-a, elevated in depressed individuals.
When pro-inflammatory substances, like lipopolysaccharide (LPS) or interferon-a, traditionally used to treat hepatitis C, are injected into healthy individuals they cause symptoms of depression like lack of motivation and pleasure, and feelings of sadness.
Anti-inflammatory substances are effective anti-depressants. The omega-3 fatty acid eicosapentaenoic acid, or EPA, found in fatty fish like salmon and sardines, is a well-known anti-inflammatory nutrient. One study found that supplementing with EPA prevented depressive symptoms in individuals who were injected with interferon-a.
Fish oil contains the omega-3 fatty acids EPA and docosahexaenoic acid, or DHA. Both of these marine omegas are found in certain fatty fish, which can be remembered by the acronym SMASH: sardines, mackerel, anchovy, salmon and herring (also trout). Fish oil supplements combine EPA and DHA. DHA is a component of our brain mass. It is needed for developing the brain and nervous system of growing babies, and is indicated in pregnant and breastfeeding women. EPA confers the anti-inflammatory benefits.
A meta-analysis composed of 15 randomized control trials involving almost 1000 participants, found that fish oil was an effective therapy for treating depression as long as the fish oil contained over 60% EPA relative to DHA.
Another review of three studies, showed that omega-3 fish oil supplementation reduced depressive symptoms in children and adults by 50%.
When it comes to supplementing with fish oil for depression, it’s the EPA that counts, not the DHA. Also, more fish oil seems to be better than less. Studies that showed the best anti-depressant actions dosed participants with at least 1 gram of EPA per day. Some studies gave patients 2 grams of EPA or more per day. Supplements that showed the most benefit contained higher amounts of EPA relative to DHA.
A 100-gram serving of wild Atlantic salmon contains about 400 mg of EPA, while farmed Atlantic salmon, surprisingly contains more: 700 mg of EPA per 100 grams. While consuming fatty fish, like sardines, and pasture-raised, rather than grain-fed, animals can increase our dietary ratio of omega 3 to omega 6, which has general health benefits, supplementation with a high-EPA fish oil is probably necessary to supply the 1 to 2 grams of EPA per day that have been shown to reduce depression.
2. An Active B Complex
B vitamins are cofactors for thousands of reactions in the body. Cofactors are “helpers”. They help enzymes and cellular process work—without these helpers, important jobs just don’t get done. This can have major implications for our mental health.
For example, the vitamins B6 and folate are needed to convert the amino acids tryptophan and 5HTP to serotonin, the “happy hormone”. Serotonin is a neurotransmitter responsible for managing mood: soothing depression and anxiety; and regulating appetite, memory, and sexual desire. Serotonin is the main target of conventional anti-depressant therapies, SSRI (selective serotonin reuptake inhibitor) medications, which raise brain levels of this chemical.
Both B12, which is important for energy production and neuronal health, and folate, which is important for DNA repair, detoxification and reducing inflammation, have been found to be low in patients with depression. A B12 deficiency, resulting in fatigue, memory loss and low mood, can also mimic the symptoms of depression.
It’s important to supplement with an active form of the B vitamins. This means buying and consuming a B complex or multivitamin that contains B12 and folate in their active forms: methylcobalamin and methyl-folate (or 5-methyltetrahydrafolate, or 5-MTHF), respectively.
Individuals who have a genetic mutation that prevents them from efficiently converting folic acid (a synthetic vitamin found in cheap supplements and fortified grains, like wheat and rice) to active folate, are highly represented in the major depressive disorder population. This gene is called MTHFR C677T and is associated with lower blood levels of folate and an increased risk of depression. To learn more about folic acid and MTHFR mutations, read my article here.
B vitamins are also needed by the mitochondria, the “powerhouses” of our cells. By helping our mitochondria work properly, they help reduce inflammation, boost energy production and promote antioxidant synthesis.
We can find B vitamins in egg yolks and liver. The only dietary sources of B12 are found in animal foods, making it difficult for vegans and vegetarians to get without supplementing. Folate is abundant in leafy greens.
Physical, mental, emotional and environmental stressors create a higher demand for the B vitamins. The B vitamins are water soluble, excreted in the urine and not stored. Therefore, to support neurotransmitter synthesis and energy levels in my depressed patients, I often prescribe a good-quality B complex supplement to complement their diets.
3. Magnesium
Because my clinical focuses are mental health, hormones and digestion, I prescribe magnesium to virtually every patient I see—magnesium is an important nutrient for all of these conditions.
Like the B vitamins, magnesium is a cofactor. It’s involved in helping with over 800 chemical process in the body that simply won’t get done without it. We need magnesium to make cellular energy in the mitochondria, to produce neurotransmitters, like serotonin, and to repair DNA, among many other jobs.
Due to soil deficiency, low intake, stress and decreased absorption, it’s estimated that about 40 to 60% of North Americans are magnesium deficient. Only 1% of the magnesium in our bodies is present in blood. Blood levels don’t reflect the body’s magnesium stores, and so testing for deficiency is unreliable.
Magnesium is a potent muscle relaxer. Deficiencies show up wherever muscles are contracted, rather than relaxed: this can include constipation because of poor intestinal motility, muscle aches and pains, frequent urination due to contracted bladder muscles, menstrual cramps, and headaches and high blood pressure from constricted blood vessels. Insomnia, anxiety and sensitivity to loud noises can also all be signs of a magnesium deficiency. PMS, insulin resistance and sugar cravings are all further indications for magnesium supplementation.
Magnesium can be obtained from leafy greens like spinach and chard. However, most individuals need to supplement to stock up their magnesium levels, particularly if experiencing stress, fatigue, anxiety or depression. Like the B vitamins, magnesium is water soluble, excreted in the urine in response to stress.
A 2017 randomized control trial published in PloS One, found that 248 mg of magnesium chloride decreased the PHQ-9 score of those with mild-moderate depression by almost 5 points. This result compares to standard anti-depressant medications. Despite the relatively low dose and inferior form of magnesium, the effects were well-tolerated and benefits were seen in 2 weeks.
I prescribe magnesium glycinate, a much better-absorbed form, before bed to help patients sleep better. This means starting with 100 to 200 mg per night and increasing by that amount every 3 to 4 days or until patients are having a bowel movement on waking—this is called “prescribing to bowel tolerance”.
A side effect of taking too much magnesium is loose stools, or soft stools that fall apart in the toilet on flushing, which can be corrected by lowering the dose. I personally take about 900 mg of magnesium at night to manage my stress, mood, energy levels and muscle tension.
4. Vitamin D
About 70 to 90% of North Americans are deficient in vitamin D, which acts like a steroid hormone rather than an actual vitamin, and regulates over one thousand genes in the body. Our skin makes vitamin D when it comes into contact with UVB radiation from the sun. Those of us who live in northern climates with limited sun exposure don’t make enough vitamin D and need to supplement, especially during the Winter months.
Vitamin D is needed to regulate the gene Tryptophan Hydroxylase 2, which converts the amino acid tryptophan (a component of protein that can only be obtained from diet and is found in foods like turkey and pumpkin seeds) to serotonin in the brain.
Low vitamin D concentration has been associated with depression, however researchers aren’t sure if the relationship is causal: does low vitamin D status put someone at risk for developing depression? Or do depressed individuals have low vitamin levels in their bodies because of some other factor?
Studies have failed to show that taking vitamin D supplements impacts depression. I also haven’t found vitamin D to impact my patients’ moods as a solo therapy. It’s likely that nutrients like vitamin D acts as part of a network, in conjunction with other vitamins, like magnesium, which is responsible for converting supplemental vitamin D into the active form. Vitamin D is a fat-soluble vitamin, and taking it in chalky tablet form may not raise levels. I prescribe vitamin D3, the active form of the vitamin, in drop form. Vitamin D drops are suspended in fats like coconut or flax oil, which makes them easier for the body to absorb.
Whether a case of the chicken or the egg, when it comes to vitamin D and mood, we know that supporting vitamin D status is essential for achieving optimal health, managing immune function, reducing inflammation, reducing the risk of osteoporosis, and regulating mood, given vitamin D’s role in serotonin synthesis.
The Framingham study found that patients who had low levels of vitamin D had poorer mental functioning and reduced volume of a brain region called the hippocampus, which is responsible for memory formation and mood regulation. Reduced hippocampal volume is a risk factor for and consequence of major depression.
There is a “sweet spot” to optimal vitamin D levels; because it’s a fat-soluble vitamin and can be stored, too much vitamin D may be as bad as too little. Therefore, I like to measure my patients’ blood levels in the Fall to determine the right dose for supplementation. 4000 IU a day is a good, safe dose for most people during the Winter months.
5. Zinc
Zinc is the catalyst for hundreds of enzymes in the brain, including making serotonin, norepinephrine and dopamine, all of which are brain chemical targets of anti-depressant therapies.
There is a major concentration of zinc in the hippocampus, a brain region affected by depression. Studies show that zinc plays a role in supporting neurogenesis (the creation of new brain cells) by stimulating Brain Derived Neurotrophic Factor (BDNF). BDNF creates new brain cells and boosts mood. Anti-depressants may work by increasing brain levels of BNDF, protecting the brain against stress.
Plasma zinc concentrations are lower in major depressive disorder. Animal studies also show that depleting zinc can lead to major depression.
Zinc supplementation has been shown to boost mood. A study of 50 overweight or obese patients were assigned to receive either 30 mg of zinc or placebo. After 12 weeks, the group who received zinc experienced a greater reduction in the severity of their depression and an increase in the levels of BDNF in their brains.
Zinc is also an important nutrient for supporting the immune system and managing inflammation.
Besides depression, other signs of zinc deficiency include skin issues, like dry skin and acne, infertility, issues with gut membrane integrity (leaky gut), hair loss, low testosterone, poor immune function and fatigue.
Dietary sources of zinc are harder to come by for vegans and vegetarians, who are at a higher risk for developing a zinc deficiency. Zinc can be found in red meat, shellfish, lentils and pumpkin seeds.
I typically prescribe zinc the way I prescribe iron, in pulse doses: I recommend that patients work their way through a bottle of zinc (taking 30 to 100 mg per day), while we assess whether symptoms improve. Unlike iron (which we can measure more accurately by looking at its storage molecule ferritin), zinc can’t be accurately measured in blood. Like magnesium, zinc deficiency in the body’s tissues may be present long before low zinc levels show up in blood.
While this list can be a great tool for anyone interested in supporting their mood through boosting nutrient status, keep in mind that this information is not a substitute for medical advice.
I believe it’s essential to work with a naturopathic doctor, or a functional medical doctor, who can make the appropriate recommendations for your individual health needs. A personalized consultation that assesses your diet, blood work, health history and specific symptoms, can help you hone your list to come up with a dynamite nutrient plan that’s specifically tailored to you.
In The Myth of Sisyphus, Camus wrote that weariness awakens consciousness, that “Everything begins with consciousness. Nothing is worth anything except through it.”
In the last few months, I’d been weary—sleeping, eating, exercising, commuting, working, preparing for more work, sleeping, and repeat—but I didn’t feel any consciousness awakening, and I still felt like I was waiting for that “everything”, or at least something, to begin.
I wanted to immerse my bare hands in the soil of life—to feel the softness of joy, the moisture of awe, and the cool warmth of peace, between my fingers. I wanted to feel alive: for my soul to urgently thrust itself into each morning, as if the spinning world depended on it.
Instead, I was stuck in traffic.
In the world of natural health junkies, spiritual community dwellers, and backpacking hippies, a Ten-Day Vipassana Retreat is a right of passage. My friends, colleagues and fellow travellers all assured me that the experience changed them. They all reflected on their ten days spent in the woods in silence, sitting for excruciatingly long hours, as catalysts for growth. They’d burned off dead and stagnant parts of their egos, let go of their cravings, and emerged shiny, with a renewed zest for all their lives had to offer.
Listening to their stories, I imagined myself in their places: sitting mute and contemplative in the dark. Through eliminating all input, I expected the Universe (with a capital U, naturally) to reveal rich meaning beneath its monotonous surface. Plus, I heard the food was good.
So, I signed up. A few months later, with a backpack filled with drab clothes and a meditation cushion, I was driving to the Dhamma Torana Vipassana centre, located outside of Barrie, Ontario.
A sleepy hippie greeted me as a I pulled into a virtually empty, gravel parking lot at the entrance to the centre.
I got out of my car and smiled at him, “I’m here for the Vipassana retreat.”
“Yeah, man,” He replied with eyebrows raised, as if searching his brain for what I was referring to. “Hey, though, do you mind parking your car closer to that truck? There’s going to be a lot of us trying to fit in here.”
I looked around for evidence of this meditation-hungry crowd. Instead, there were a handful of cars parked, including a large black pick-up truck and my own.
“Sure,” I said, “Do you mind just watching my bag?”
I squeezed my car up against the truck. Now we were two cars huddled side-by-side in the large, empty lot. It looked ridiculous but, you know, we were a community now.
“I couldn’t lift the bag,” Said the hippie-turned-parking-attendant, half-apologetically. He’d left it on its side in the dirt. The bag contained two pairs of pants, two t-shirts, some shampoo, and meditation cushion. It probably weighed three pounds.
I smiled tightly at him, hoisted the bag onto my shoulder, and made my way to the registration house to get my room key. Then I headed over to the women’s side of the property to find my cabin.
The cabin was a tiny room containing two beds separated by a shower curtain. I was supposed to share with a roommate, but she hadn’t arrived yet.
How do you room with someone you can’t talk to or look at? I prayed that my roommate wouldn’t show up and that I’d get the room to myself.
I put my things away and headed to the dining hall for dinner.
We were told to hand over our electronics, writing materials, and other valuables. I handed over my car keys so that I wouldn’t be tempted to escape. As my things were being placed into bins, I felt like Austin Powers preparing to be cryogenically frozen.
In fact, the retreat centre, while beautiful, had prison-like undertones. Signs declaring “Course Boundary” stopped you from exploring—or going back to the parking lot. Days later I would stare at that sign longingly, dreaming of the freedom represented by my car. Men and women were segregated into completely separate areas of the property. We weren’t allowed to talk and make eye contact once the silence was imposed. We were also told not to bring flashy, tight or flamboyant clothes and so many of use looked like prisoners: heads down, attention turned inwards, clothes dark, loose and drab.
Dinner was vegan food. It was good. However, having been a recovering vegan in the past, I wondered if I’d finish the retreat like the parking volunteer, too weak to lift my own three-pound bag.
After dinner we were given a speech on the rules: no talking, texting, touching, making eye contact, gesturing, wearing tight clothing, doing yoga, running, writing, reading, sunbathing, killing (even mosquitos), sex, drugs, rock ‘n’ roll (or any other music, for that matter), alcohol, eating dinner (just some fruit for newbies), and so on. No Phone, no pets, no cigarettes. It was going to be a long ten days.
I couldn’t wait.
I wondered what amazing insights would emerge from these ten days of spacious silence.
It was time for the first meditation, after which we would observe the Nobel Silence. We settled onto our assigned cushions. I had brought my own meditation cushion and saw that others had brought their own supplies too. Many brought intricate contraptions for sitting: meditation benches, special blankets, chairs, back rests, and knee pads. Rather than preparing to sit for an hour, it looked like they were readying themselves to enter the Earth’s orbit.
The meditation started. The teacher of Ten-Day Vipassana retreats, S.N. Goenka, is dead and so instruction is delivered by a series of tapes he’d recorded, presumably, while still alive.
One of the two assistant teachers pressed play and Goenka’s chanting began. Goenka’s would be the only voice I’d really hear for ten entire days, and it had an alarming amount of vocal fry.
I fidgeted throughout the hour of our first meditation. My meditation practice up until that point consisted of daily thirty-minute sits. I don’t think I’d ever sat for an hour. In fact, after twenty minutes, I’d usually experience numbness in both legs that sent me crawling around on all fours painfully trying to restore blood flow. During this first hour I kept crossing and uncrossing my legs. It wasn’t just me; silence in the hall was punctuated by the cacophony of restless shuffling.
Five more minutes of chanting followed by a gong finally signalled the end of my antsy misery. I slowly and silently got up, keeping my eyes inoffensively cast in front of me, and shuffled, among the tribe of other zombies, out of the hall and back to my quarters. It was barely 9 pm, but I flopped exhausted onto my little bed and immediately fell asleep.
The next day, loud gonging heaved me into the pitch-dark early morning. It was 4:15 am. I dressed in the dark, shuffled to the bathroom to brush my teeth, and headed to the meditation hall for the first two-hour meditation of the First Day.
The schedule was terrifying. We were to wake at 4:15 in the morning to sit for the first meditation, two hours, at 4:30. A gong would then signal breakfast for 6:30 am, after which we’d sit for another hour of meditation. Then we were to return to the meditation hall or go to our rooms and sit for two more hours. Lunch was at 11:00 am, followed by another break. Then, four hours of meditation followed by a snack break, where new students were allowed to eat fruit and drink tea. There was no dinner.
After the snack break, was another hour-long meditation, then a discourse where we were to watch Goenka lecturing—the only entertainment of the day. Then more meditation—45 minutes. Bedtime was 9:30 pm. Lights were to be out by 10 pm. With the first wake-up gong sounding at 4:15 in the morning, and nothing to do in the evenings, I doubted that the early bedtime would be a problem.
The first thing I did was count: eleven hours of meditation. Each day I was to spend eleven hours sitting on a cushion, keeping my back straight, and watching my breath. Besides eating, and walking in the forest during breaks, that was to be my life for the next ten days. How was I going to handle this?
“I think you’ll make it to day seven and then decide you’ve had enough,” a skeptical friend had told me before I’d left. I’d been insulted. Now I doubted my own convictions. Day Seven seemed very far away.
Most of my friends had told me that they’d wanted to leave by Day Three.
By Day Two, however, I was done. My legs and back ached and, halfway through the second day, I decided that I couldn’t do another second of meditation. “I can’t do this anymore!” I exclaimed in my head. Besides Goenka’s, the Voice in My Head was the only voice I’d had access to for the last two days. And it happened to be mistaken. I kept on.
During my 32 years on the planet, I don’t believe I’d spent a day without communicating in some way, shape or form with another human being. Since I could put words together, I hadn’t spent a day in silence. Since I could read and write, there wasn’t a day in which I hadn’t engaged with some form of written text.
I missed it. While taking bathroom breaks, I stared intently at the sign outlining the shower rules. I fascinatedly read about using the hair catcher while showering. I read how we were to clean it out after and dump any hairs in the garbage. I studied the rules about drying and squigeeing the shower walls after use. “With Metta,” The notice signed off. With Metta. Withmettawithmettawithmetta. I read the words over and over again. Bathroom reading. It might as well have been War and Peace.
I expected the days to soak me in serene silence. I was wrong. As it turned out, my head was louder than an elementary school cafeteria during lunch hour. But, unlike the lunch break, there was no end to the noise.
“I eat brown food in the morning with brown tea and green food for lunch with green tea,” My inner monologue babbled gaily. It was true: breakfast was always oatmeal and prunes, which I accompanied with black tea. Lunch was a green salad and some soup or curry. I ate it with green tea. “Maybe I can be vegan,” The Voice in My Head chattered, optimistically, “The food here is so good. I could eat like this all the time. I don’t even miss dinner! Maybe I should start doing more intermittent fasting. I wonder if they sell a recipe book, oh, I can’t wait for breakfast tomorrow morning!”
And, “What colour pants am I going to wear tomorrow? The brown ones or the black ones? Brown or black? Black or brown? Should I wear the brown ones with the white shirt and the black ones with the blue shirt? Or the blue ones with the—” I’ll spare you the rest.
I had entire conversations with people in my head. I wrote, rewrote, and edited monologues, conversations and imaginary dramas. I crafted responses from the characters I was arguing with. I practiced my lines and honed them.
I humbly discovered that it was not a chaotic world, filled with sensory distractions, that stifled some creative genius locked somewhere within; the chaos was removed and no genius emerged. Instead, when left to its own devices, my mind became a shallow simpleton bouncing senselessly to topics like the clothes I was wearing, the things I was eating, and people I was dating. How disappointing.
During the eleven hours of meditation, my mind and body rebelled. Every itch, twitch and irritation, mental or physical, would send me crossing and uncrossing my legs, refolding my hands, opening my eyes, and stretching my neck—anything to avoid actually meditating.
My only reprieve was meal times. I would wait for them, like Pavlov’s dog, salivating in anticipation of the gong that would release me from the hell of sitting.
On Day Three, however, I noticed something different. I was sitting in meditation and I wanted to move: do something, like cross my legs a different way. I felt tension and frustration rise within as I resisted the urge. The resistance was like a boulder to push against. It had edges, viscosity. I couldn’t push anymore. I relaxed, softened. I opened.
And with that, the resistance popped. I felt immediate relief.
It was as if my mind and body were wrapped in a crumpled fabric. Each knot and wrinkle resembled an agitation, a restlessness, a mania that arose from within my physical and emotional self. Pushing up against these wrinkles would only tighten them, causing more agitation. But, when I began to breathe, to dissolve their solidity, they began to soften, and pop, like bubble wrap. The fabric began to iron out. I was calm.
I started to notice bigger knots: my relationship with uncertainty, for instance, that seemed too monstrous to pop, however the mini bubbles of impatience started to disappear as they arose, one by one.
Openness.
Openness provides relief from suffering.
Maybe I could survive this.
On Day Three Impatience and I got to know each other. Impatience has been a theme in my life, a low-level agitation that manifests in restlessness: my desire to connect on social media, to distract with technology and day-dreaming, to tweeze hairs and do dishes instead of doing work, and to lurch through life with my head pushed forward, oblivious to my surroundings.
I moved through life like I ate: inhaling a fresh spoonful before swallowing the first. I wasn’t tasting my food. I wasn’t tasting life.
During one particularly turbulent moment in meditation, when a wave of impatience hit, so did a series of images: family weddings, babies being born, pets passing away, family members passing: images of events that had not yet occurred, but almost certainly would. I was racing towards the future, which would bring me both wonderful experiences and inevitable pain. And, of course, at the end of it all would be the end of me. What was the rush?
I brought my attention back to my breath. Some more knots in my mind’s fabric opened.
On Day Four I recognized that, at the heart of this impatience was a craving for certainty. Underneath that craving: fear.
What I am afraid of? I asked the blackness.
Almost immediately, from some depths of my psyche, the answer surfaced.
I’m afraid to suffer.
Suffering, the Buddha’s first Nobel Truth. Life is suffering, or Dukkha. Like every other being who had ever lived, as long as I was alive I would suffer. If I craved certainty, then this was it.
We began to practice Vipassana on Day Four. For the past three days, my entire world had been reduced to the rim of my nostrils where my breath passed. The technique of focussing on the breath at the nostrils is called Anapana, and its goal is to sharpen and focus the mind.
Vipassana, or the development of equanimity regarding the impermanence of nature, and the truth of suffering, focusses on body sensations. We first began to scan the body from the tips of the toes to the top of the head (“Staaart from. the. topofthehead. Top of. Thehead,” Chirped Goenka’s voice on the recordings), a relatively simple technique in theory that proved to be excruciating in practice.
If the first few days had introduced me to the manifest agitations and disquiets in my body and mind, Day Four presented me with the full-on war raging within. For three hours a day we were to resist the urge to move. My body was on fire.
Demons in my head commanded me to move, get up, scream. Others shouted at me to stay still. Still others urged me to quit. Amidst their shouts was harrowing physical misery.
I felt like I was under the Cruciatus Curse. In fact, the whole retreat was starting to seem like a JK Rowling novel, or some other Hero’s Journey. I had set out to conquer evil only to find that all evil came from within, and was now being asked to face it bravely, conjuring up a Patronus of equanimity to protect me from being consumed by this hellish fire.
“The only difference between a Ten-Day Silent Vipassana Retreat and a Harry Potter novel is that ‘He Who Must Not Be Named’ is literally everything,” I thought, sardonically.
From Days Four to Five, I emerged from every sitting broken and exhausted. Being on Day Five was like reaching the middle of a claustrophobic tunnel. I was halfway through and still had just as far to go. I scanned the deadpan faces of the crowd during mealtimes to see if anyone else had spent the last hour being electrocuted.
Goenka said the sensations of fire and electricity were Sankaras, mental cravings that embed themselves in our physical bodies and cause suffering. An intense sensation was simply one of these Sankaras floating to the surface of the body. If we met it with “perfect equanimity”, it would be eradicated, and we would be cleared out for our next incarnation.
These body sensations—the sharp, twitching, numb, searing, blinding, and even pleasurable— were a representation of nature itself. Sensations arise in the body and pass away; they are impermanent, Anitya. Through first being aware of them, and then meeting them with openness, without clinging or aversion, we can be free from suffering.
“Maintain perrrrrrfect equanimity. Perrrrrrfect equanimity, with the understanding of Anitya.
“Anitya…. Anitya….” Goenka’s recordings crooned.
Sapiens author Yuval Noah Harari, also a long-time Vipassana practitioner, states, “Meditation is about getting to know the most ordinary, daily, natural patterns of the mind, body and emotions, to observe reality as it is. If you can observe, to some degree, reality as it is, without running away to stories and fictions, you will be a more peaceful and happy person.”
Well, I certainly wasn’t happy.
On Day Five I was being burned at the stake. Someone had lodged a red hot poker into my right flank, just to mess with me. “I will never be able to walk again,” My mind blabbered, “This is torture. I’m becoming permanently injured. I can feel the meniscus in my knees slowly tearing—“
Goenka’s chanting began, indicating we had five more minutes of this hell. I relaxed, even though we still had five more minutes of this hell. The mind is a ridiculous thing.
—Donnnnng….
Freed by the beautiful, beautiful music of the gong, I sprang up. I expected to hobble, in pain, clutching at my back, working out stiffness in my knees. I anticipated the inevitable sharp pain that would appear in my ankles as I took my first step.
Yet, as I walked out of the meditation hall to stand in the July sun, I noticed that there was not a twinge of pain, a tightness, nor an ache to be found. My body felt perfectly fine. On the contrary, I actually felt great: light and supple. It felt like I was floating.
Hm.
By the time Day Six arrived, I was greeting the pain like an old friend. I noticed that discomfort came, not from the sensations themselves, but from the mind’s anticipation of and resistance to them. If I expected an arising sensation to be painful, I would brace myself against it, creating tension. And, after the sensation had faded, my mind would still grip it, creating a story of aversion.
So, I stopped calling it pain. Instead, it was a series of sensations: numbness, vibration, tingling, spark, heat, radiation, burning, but not pain. I noticed the sensations that disappeared as soon as they materialized, like shooting stars across my back. Others were solid, like clumps of cement hanging out in my body for the entire hour. I now easily sat for an hour without moving, watching this orchestra of sensations transpire across my flesh.
The war was ending. I was winning.
I was free.
Four days to go.
Anitya.
Sometimes impermanence isn’t fast enough.
On Day Seven, I settled into meditation, welcoming it now. I dropped into my breath, and began practicing Vipassana, sweeping my attention over my body, observing the sensations that were present, just as Goenka instructed.
Curiously, the sensations dissolved. There was no sensation, there were no Sankaras, there was no body. I could still feel the line where my lips met, and where my hands came together in my lap. Other than these two black outlines drawn in space, I had dissolved into ether, the atoms of my body emitting a subtle vibration that merged with those that surrounded it.
It wasn’t surprising. For the last seven days I’d been eating oatmeal and meditating in the woods without speaking to anyone. Now my entire body was evaporating. Nothing was surprising anymore.
I later learned that this phenomenon was called a “Free Flow”. It results from absolute openness: from a mind that is both equanimous and subtle. Solidity dissolves, and what is left is the vibration of atoms, all transient, anitya. All impersonal, Anatta.
The Three Buddhist Marks: Anitya, Anatta, Dukkha.
Impermanence, Non-Self, Suffering.
Now that I was One with, whatever it was I was one with, I figured I might as well seek some spiritual answers. Or at least make a wish or something.
I thought of what I most wanted in the world. “I want connection,” I told the Universe, “I want deep, connected relationship.”
Amidst the vibrations, something answered. A simple, Why?
Hm. Why, indeed? I’d never entertained the question.
I want to be loved, emerged my answer, from I-didn’t-know-exactly-where, since I was currently nothing. It was like my heart was speaking instead of my head. The utterance arose out of space, before dissipating, like smoke rings from a caterpillar’s hookah. Then, there was silence.
The energy, or entity, or my Higher Self, whoever I was talking to, seemed amused at my naivety. I could feel her compassionate chuckle vibrating into the atoms that buzzed where my body had once sat.
You already are,
the amused response manifested from the darkness into which I was dispersed.
You already are.
And, at that moment, nothing seemed more true. Nothing can give us what is already in our basic nature.
