On Thursday, June 20th, the Ontario government passed Bill C-59, exempting psychotherapy sessions from HST.
This is excellent news! This means that from now on, HST does not need to be charged for therapy visits (it was removed from Naturopathic Medicine appointments several years ago).
This makes therapy a little cheaper, as savings are passed onto you.
As many of you know, I have been a registered psychotherapist (qualifying) since the Summer of 2023 and have been accepting new clients since April 2024.
Sessions are covered by extended health benefits and are conducted online for Ontario and Quebec residents.
To learn more about working with me, feel free to book a 20-minute free meet and greet at taliand.janeapp.com
Therapy discussions involve:
burnout and stress
self-care
self-esteem, self-worth, self-talk
work stress and imposter syndrome
relationships
values and narrative therapy
grief
trauma
family systems, parental and intergenerational patterns, relational dynamics
cognitive behavioural tools
somatic and mindfulness tools
mental health care: dealing with depression, anxiety, ADHD symptoms, etc.
And so on.
I am an eclectic therapist who loves cognitive, psychodynamic, and humanistic approaches and therapy styles. I offer tools from various therapeutic modalities that might best suit clients and their needs.
I prefer not to rigidly adhere to one approach–you may choose to talk, prefer body-based tools, or want homework exercises or practical solutions to your problems. In the end, all therapy styles can be effective, but it comes down to the preferences and needs of the individual.
Therapy differs from naturopathic medicine appointments, which are more directive and prescriptive and involve bloodwork, supplements, herbs, and lifestyle recommendations.
In therapy sessions, we focus on building a nonjudgmental and supportive therapeutic relationship as we work on helping you gain self-understanding and insights to help you live by your goals and values.
Therapy and naturopathic medicine can pair well with one another.
Therapy can help remove obstacles to lifestyle changes, like self-talk or associations that can keep us feeling stuck. We can compassionately and non-judgementally explore factors that lower motivation or prevent us from taking the specific actions that we want.
Naturopathic medicine can support therapy by identifying the physical root causes of mental health symptoms and supporting the body through gut health, hormonal balance, and optimizing organs like the liver, blood sugar, stress response, and sleep.
They complement one another very well, and I often work with the same individual in both practices.
What does “Qualifying” after my registered psychotherapist title mean?
Therapists licensed by the College of Registered Psychotherapists of Ontario (CRPO) must put “qualifying” after their names until they have completed all three requirements.
450 hours of client session
100 hours supervision
completion of a Registration Exam
While psychotherapists qualify, they are still licensed, have a licence number, have sessions covered under insurance, and receive regular (weekly) supervision with a licensed supervisor.
Qualifying registrants typically have lower fees than psychotherapists who have completed these requirements.
My last step will be to complete the registration exam in Spring 2025, in which I expect to remove my title’s “qualifying” aspect.
Let me know if you have any questions about the registration and licensing of psychotherapists in Ontario!
It was a crappy week and I was chatting with a friend online. He said something that triggered me… it just hit some sort of nerve. I backed away from my computer, feeling heavy. I went to the kitchen to pour myself a glass of water and collapsed, elbows on the counter, head in my hands, my body shaking and wracking with deep, guttural sobs.
A few seconds later, I’m not sure how long exactly, I stood up. Tears and snot streaming down my face, I wiped them off with a tissue. I felt lighter, clearer. I was still heavy and sad, but there was a part of me that had opened. I went back to my computer and relayed some of this to my friend, “what you said triggered me, but it’s ok, it just hit a personal nerve. I’m ok now though, I know you didn’t mean any harm”. I typed to him.
Joan Rosenberg, PhD in her book 90 Seconds to a Life You Love, would have said that, in that moment, I had been open to feeling the moment-to-moment experience of my emotions and bodily sensations. I felt the waves of emotions run through my body, and let them flow for a total of up to 90 seconds. And, in so welcoming that experience and allowing it to happen rather than blocking it, fighting it, projecting it (onto my friend or others), I was able to release it and let it go.
For many of us, avoidance is our number one strategy when it comes to our emotions. We don’t like to feel uncomfortable. We don’t like unpleasant sensations, thoughts and feelings and, most of all, we don’t like feeling out of control. Emotions can be painful. In order to avoid these unpleasant experiences, we distract ourselves. We try to numb our bodies and minds to prevent these waves of emotion and bodily sensation from welling up inside of us. We cut ourselves off.
The problem, however is that we can’t just cut off one half of our emotional experience. When we cut off from the negative emotions, we dampen the positive ones as well.
This can result in something that Dr. Rosenberg titles, “soulful depression”, the result of being disconnected from your own personal experience, which includes your thoughts, emotions and body sensations.
Soulful depression is characterized by an internal numbness, or a feeling of emptiness. Over time it can transform into isolation, alienation and hopelessness–perhaps true depression.
Anxiety in many ways is a result of cutting ourselves off from emotional experience as well. It is a coping mechanism: a way that we distract ourselves from the unpleasant emotions we try to disconnect from.
When we worry or feel anxious our experience is often very mental. We might articulate that we are worried about a specific outcome. However, it’s not so much the outcome we are worried about but a fear and desire to avoid the unpleasant emotions that might result from the undesired outcome–the thing we are worrying about. In a sense, anxiety is a way that we distract from the experience of our emotions, and transmute them into more superficial thoughts or worries.
When you are feeling anxious, what are you really feeling?
Dr. Rosenberg writes that there are eight unpleasant feelings:
sadness
shame
helplessness
anger
embarrassment
disappointment
frustration
vulnerability
Often when we are feeling anxious we are actually feeling vulnerable, which is an awareness that we can get hurt (and often requires a willingness to put ourselves out there, despite this very real possibility).
When we are able to stay open to, identify and allow these emotions to come through us, Dr. Rosenberg assures us that we will be able to develop confidence, resilience, and a feeling of emotional strength. We will be more likely to speak to our truth, combat procrastination, and bypass negative self-talk.
She writes, “Your sense of feeling capable in the world is directly tied to your ability to experience and move through the eight difficult feelings”.
Like surfing a big wave, when we ride the waves of the eight difficult emotions we realize that we can handle anything, as the rivers of life are more able to flow through us and we feel more present to our experience: both negative and positive.
One of the important skills involved in “riding the waves” of difficult feelings is to learn to tolerate the body sensations that they produce. For many people, these sensations will feel very intense–especially if you haven’t practice turning towards them, but the important thing to remember is that they will eventually subside, in the majority of cases in under 90 seconds.
Therefore, the key is to stay open to the flow of the energy from these emotions and body sensations, breathe through them and watch them crescendo and dissipate.
This idea reminds me of the poem by Rumi, The Guest House:
This being human is a guest house. Every morning a new arrival.
A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all! Even if they’re a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably. He may be clearing you out for some new delight.
The dark thought, the shame, the malice, meet them at the door laughing, and invite them in.
Be grateful for whoever comes, because each has been sent as a guide from beyond.
One of the reasons I was so drawn to Dr. Rosenberg’s book is this idea of the emotional waves lasting no more than 90 seconds. We are so daunted by these waves because they require our surrender. It is very difficult however, if you suffer from anxiety to let go of control. To gives these emotional waves a timeframe can help us stick it out. 90 seconds is the length of a short song! We can tolerate almost anything for 90 seconds. I found this knowledge provided me with a sense of freedom.
The 90 seconds thing comes from Dr. Jill Bolt Taylor who wrote the famous book My Stroke of Insight (watch her amazing Ted Talk by the same name). When an emotion is triggered, she states, chemicals from the brain are released into the bloodstream and surge through the body, causing body sensations.
Much like a wave washing through us, the initial sensation is a rush of the chemicals that flood our tissues, followed by a flush as they leave. The rush can occur as blushing, heat, heaviness, tingling, is over within 90 seconds after which the chemicals have completely been flushed out of the bloodstream.
Dr. Rosenberg created a method she calls the “Rosenberg Reset”, which involves three steps:
Stay aware of your moment-to-moment experience. Fully feel your feelings, thoughts, bodily sensations. Choose to be aware of and not avoid your experience.
Experience and move through the eight difficult feelings when they occur. These are: sadness, shame, helplessness, anger, embarrassment, disappointment, frustration, vulnerability.
Ride one or more 90 second waves of bodily sensations that these emotions produce.
Many therapeutic techniques such as mindfulness, Dialectical Behaviour Therapy, somatic therapy, and so on utilize these principles. When we expand our window of tolerance and remain open to our physical and emotional experience we allow energy to move through us more gracefully. We move through our stuckness.
Oftentimes though, we can get stuck underwater, or hung up on the crest of a wave. Rumination and high levels of cortisol, our stress hormone can prolong the waves of unpleasant emotion. We may be more susceptible to this if we have a narrow window of tolerance due to trauma.
However, many of us can get stuck in the mind, and when we ruminate on an emotionally triggering memory over and over again, perhaps in an effort to solve it or to make sense of it, we continue to activate the chemicals in our body that produce the emotional sensation.
Therefore, it’s the mind that can keep us stuck, not the emotions themselves. Harsh self-criticism can also cause feelings to linger.
I have found that stories and memories, grief, terror and rage can become stuck in our bodies. Books like The Body Keeps the Score speak to this–when we block the waves, or when the waves are too big we can build up walls around them. We compartmentalize them, we shut them away and these little 90 second waves start to build up, creating energetic and emotional blockages.
In Vipassana they were referred to as sankharas, heaps of clinging from mental activity and formations that eventually solidify and get lodged in the physical body, but can be transformed and healed.
Perhaps this is why a lot of trauma work involves large emotional purges. Breathwork, plant medicines such as Ayahuasca, and other energetic healing modalities often encourage a type of purging to clear this “sludge” that tends to accumulate in our bodies.
My friend was commenting on the idea that her daughter, about two years old, rarely gets sick. “She’ll have random vomiting spells,” my friend remarked, “and then, when she’s finished, she recovers and plays again”.
“It reminds me of a mini Ayahuasca ceremony”, I remarked, jokingly, “maybe babies are always in some sort of Ayahuasca ceremony.”
This ability to cry, to purge, to excrete from the body is likely key to emotional healing. I was listening to a guest on the Aubrey Marcus podcast, Blu, describe this: when a story gets stuck in a person it often requires love and a permission to move it, so that it may be purged and released.
Fevers, food poisoning, deep fitful spells of sobbing may all be important for clearing up the backlog of old emotional baggage and sludge so that we can free up our bodies to ride these 90 second emotional waves in our moment-to-moment experience.
Grief is one of these primary sources of sludge in my opinion. Perhaps because we live in a culture that doesn’t quite know how to handle grief–that time-stamps it, limits it, compartmentalizes it, commercializes it, and medicates it–many of us suffer from an accumulation of suppressed grief sankharas that has become lodged in our bodies.
Frances Weller puts it this way,
“Depression isn’t depression, it’s oppression–the accumulated weight of decades of untouched losses that have turned into sediment, an oppressive weight on the soul. Processing loss is how the majority of therapies work, by touching sorrow upon sorry that was never honoured or given it’s rightful attention.”
Like a suppressed bowel movement, feelings can be covered up, distracted from. However, when we start to turn our attention to them we might find ourselves running to the nearest restroom. Perhaps in these moments it’s important to get in touch with someone to work with, a shaman of sorts, or a spiritual doula, someone who can help you process these large surges of energy that your body is asking you to purge.
However, it is possible to set our dial to physiological neutral to, with courage turn towards our experience, our emotions and body sensations. And to know that we can surf them, and even if we wipe out from time to time, we might end up coming out the other side, kicking out, as Rumi says, “laughing”.
The only way out is through.
As Jon Kabat Zinn says, “you can’t stop the waves, but you can learn to surf”.
It’s day one of my period and I’ve been healing a broken foot for 6 weeks. The weather is overcast, thick, humid and rainy.
My body feels thick and heavy. Clothing leaves an imprint on my skin–socks leave deep indentations in my ankles. My face and foot is swollen. My tongue feels heavy. My mind feels dull, achey, and foggy. It’s hard to put coherent words together.
I feel cloudy and sleepy. Small frustrations magnify. It’s hard to maintain perspective.
My muscles ache. My joints throb slightly. They feel stiffer and creakier.
This feeling is transient. The first few days of the menstrual cycle are characterized by an increase in prostaglandins that stimulate menstrual flow and so many women experience an aggravation of inflammatory symptoms like depression, arthritis, or autoimmune conditions around this time. You might get. a cold sore outbreak, or a migraine headache around this time of month. The phenomenon can be exaggerated with heavy, humid weather, and chronic inflammation–such as the prolonged healing process of mending a broken bone.
Inflammation.
It’s our body’s beautiful healing response, bringing water, nutrients, and immune cells to an area of injury or attack. The area involved swells, heats up, becomes red, and might radiate pain. And then, within a matter of days, weeks, or months, the pathogen is neutralized, the wound heals and the inflammatory process turns off, like a switch.
However, inflammation can be low-grade and chronic. Many chronic health conditions such as diabetes, arthritis, PMS or PMDD, depression, anxiety, migraines, even bowel and digestive issues, have an inflammatory component.
In the quest to manage chronic inflammation, people often explore various avenues, including dietary supplements. One such natural option gaining attention is OrganicCBDNugs. Derived from the hemp plant, CBD, or cannabidiol, is believed to possess anti-inflammatory properties, potentially offering relief to those struggling with conditions like arthritis, anxiety, or migraines.
This organic supplement, with its purported ability to interact with the body’s endocannabinoid system, might provide a holistic approach to tackling inflammation-related issues. As we navigate the complexities of our bodies and the ebb and flow of inflammation, exploring natural remedies like Organic CBD could be a step toward finding equilibrium and promoting overall well-being.
As I telly my patients. Inflammation is “everything that makes you feel bad”. Therefore anti-inflammatory practices make you feel good.
Many of us don’t realize how good we can feel because low-grade inflammation is our norm.
We just know that things could be better: we could feel more energy, more lightness of being and body, more uplifted, optimistic mood, clearer thinking and cognitive functioning, better focus, less stiffness and less swelling.
Obesity and weight gain are likely inflammatory processes. Insulin resistance and metabolic syndrome are inflammatory in nature. It’s hard to distinguish between chronic swelling and water retention due to underlying low-grade chronic inflammation and actual fat gain, and the two can be closely intertwined.
It’s unfortunate then, that weight loss is often prescribed as a treatment plan for things like hormonal imbalances, or other conditions caused by metabolic imbalance. Not only has the individual probably already made several attempts to lose weight, the unwanted weight gain is most likely a symptom, rather than a cause, of their chronic health complaint. (Learn how to get to the root of this with my course You Weigh Less on the Moon).
Both the main complaint (the migraines, the PMS, the endometriosis, the depression, the arthritis, etc.) and the weight gain, are likely due to an inflammatory process occurring in the body.
To simply try to cut calories, or eat less, or exercise more (which can be helpful for inflammation or aggravate it, depending on the level of stress someone is under), can only exacerbate the process by creating more stress and inflammation and do nothing to relieve the root cause of the issues at hand.
Even anti-inflammatory over the counter medications like Advil, prescription ones like naproxen, or natural supplements like turmeric (curcumin) have limiting effects. They work wonderfully if the inflammation is self-limiting: a day or two of terrible period cramps, or a migraine headache. However, they do little to resolve chronic low-grade inflammation. If anything they only succeed at temporarily suppressing it only to have it come back with a vengeance.
The issue then, is to uncover the root of the inflammation, and if the specific root can’t be found (like the piece of glass in your foot causing foot pain), then applying a general anti-inflammatory lifestyle is key.
The first place to start is with the gut and nutrition.
Nutrition is at once a complex, confusing, contradictory science and a very simple endeavour. Nutrition was the simplest thing for hundreds of thousands of years: we simply ate what tasted good. We ate meat, fish and all the parts of animals. We ate ripe fruit and vegetables and other plant matter that could be broken down with minimal processing.
That’s it.
We didn’t eat red dye #3, and artificial sweeteners, and heavily modified grains sprayed with glyphosate, and heavily processed flours, and seed oils that require several steps of solvent extraction. We didn’t eat modified corn products, or high fructose corn syrup, or carbonated drinks that are artificially coloured and taste like chemicals.
We knew our food—we knew it intimately because it was grown, raised, or hunted by us or someone we knew—and we knew where it came from.
Now we have no clue. And this onslaught of random food stuffs can wreck havoc on our systems over time. Our bodies are resilient and you probably know someone who apparently thrives on a diet full of random edible food-like products, who’s never touched a vegetable and eats waffles for lunch.
However, our capacity to heal and live without optimal nutrition, regular meals that nourish us and heal us rather than impose another adversity to overcome, can diminish when we start adding in environmental chemicals and toxins, mental and emotional stress, a lack of sleep, and invasion of blue light at all hours of the day, bodies that are prevented from experiencing their full range of motion, and so on.
And so to reduce inflammation, we have to start living more naturally. We need to reduce the inflammation in our environments. We need to put ourselves against a natural backdrop–go for a soothing walk in nature at least once a week.
We need to eat natural foods. Eat meats, natural sustainably raised and regeneratively farmed animal products, fruits and vegetables. Cook your own grains and legumes (i.e.: process your food yourself). Avoid random ingredients (take a look at your oat and almond milk–what’s in the ingredients list? Can you pronounce all the ingredients in those foods? Can you guess what plant or animal each of those ingredients came from? Have you ever seen a carageenan tree?).
Moving to a more natural diet can be hard. Sometimes results are felt immediately. Sometimes our partners notice a change in us before we notice in ourselves (“Hon, every time you have gluten and sugar, don’t you notice you’re snappier the next day, or are more likely to have a meltdown?”).
It often takes making a plan–grocery shopping, making a list of foods you’re going to eat and maybe foods you’re not going to eat, coming up with some recipes, developing a few systems for rushed nights and take-out and snacks–and patience.
Often we don’t feel better right away–it takes inflammation a while to resolve and it takes the gut time to heal. I notice that a lot of my patients are addicted to certain chemicals or ingredients in processed foods and, particularly if they’re suffering from the pain of gut inflammation, it can tempting to go back to the chemicals before that helped numb the pain and delivered the dopamine hit of pleasure that comes from dealing with an addiction. It might help to remember your why. Stick it on the fridge beside your smoothie recipe.
We need to sleep, and experience darkness. If you can’t get your bedroom 100%-can’t see you hand in front of your face-dark, then use an eye mask when sleeping. Give your body enough time for sleep. Less than 7 hours isn’t enough.
We need to move in all sorts of ways. Dance. Walk. Swim. Move in 3D. Do yoga to experience the full range of motion of your joints. Practice a sport that requires your body and mind, that challenges your skills and coordination. Learn balance both in your body and in your mind.
We need to manage our emotional life. Feeling our emotions, paying attention to the body sensations that arise in our bodies—what does hunger feel like? What does the need for a bowel movement feel like? How does thirst arise in your body? Can you recognize those feelings? What about your emotions? What sensations does anger produce? Can you feel anxiety building? What do you do with these emotions once they arise? Are you afraid of them? Do you try to push them back down? Do you let them arise and “meet them at the door laughing” as Rumi says in his poem The Guest House?
Journalling, meditation, mindfulness, hypnosis, breath-work, art, therapy, etc. can all be helpful tools for understanding the emotional life and understanding the role chronic stress (and how it arises, builds, and falls in the body) and toxic thoughts play in perpetuating inflammation.
Detox. No, I don’t mean go on some weird cleanse or drinks teas that keep you on the toilet all day. What I mean is: remove the gunk and clutter from your physical, mental, spiritual, and emotional plumbing. This might look like taking a tech break. Or going off into the woods for a weekend. Eating animals and plants for a couple of months, cutting out alcohol, or coffee or processed foods for a time.
It might involve cleaning your house with vinegar and detergents that are mostly natural ingredients, dumping the fragrances from your cosmetics and cleaning products, storing food in steel and glass, rather than plastic. It might mean a beach clean-up. Or a purging of your closet–sometimes cleaning up the chaos in our living environments is the needed thing for reducing inflammation. It’s likely why Marie Kondo-ing and the Minimalist Movement gained so much popularity–our stuff can add extra gunk to our mental, emotional, and spiritual lives.
Detoxing isn’t just a trendy buzzword; it’s about fostering clarity and wellness in every aspect of our lives, including our living spaces. A clean, organized home can significantly contribute to a healthier mindset and emotional balance. That’s where Clean 4 You comes in, offering a fresh perspective on home cleaning that goes beyond mere tidiness.
They understand that clutter and grime can weigh heavily on our mental and emotional states, which is why they provide services tailored to create an environment that supports your detox journey. By enlisting the help of professionals, you can focus on nurturing yourself while they take care of transforming your space into a sanctuary.
If you’re seeking assistance specifically designed for individuals with unique needs, the NDIS Cleaner Perth service from Clean 4 You is here to help. This dedicated team is trained to cater to the requirements of those on the National Disability Insurance Scheme, ensuring that every client receives the support they need for a clean and safe living environment.
With a commitment to using eco-friendly products and methods, Clean 4 You allows you to detox your home in a way that aligns with your values, providing peace of mind as you embrace a healthier lifestyle. With their expertise, you can achieve a pristine space that not only looks good but feels good, allowing you to focus on your personal wellness journey.
Finally, connect with your community. Loneliness is inflammatory. And this past year and a half have been very difficult, particularly for those of you who live alone, who are in transition, who aren’t in the place you’d like to be, or with the person or people you’d like to be–your soul family.
It takes work to find a soul family. I think the first steps are to connect and attune to oneself, to truly understand who you are and move toward that and in that way people can slowly trickle in.
We often need to take care of ourselves first, thereby establishing the boundaries and self-awareness needed to call in the people who will respect and inspire us the most. It’s about self-worth. How do you treat yourself as someone worthy of love and belonging?
Perhaps it first comes with removing the sources of inflammation from our lives, so we can address the deeper layers of our feelings and body sensations and relieve the foggy heaviness and depression and toxic thoughts that might keep us feeling stuck.
Once we clear up our minds and bodies, and cool the fires of inflammation, we start to see better—the fog lifts. We start to think more clearly. We know who we are. Our cravings subside. We can begin to process our shame, anger and sadness.
We start to crave nourishing things: the walk in nature, the quiet afternoon writing poetry, the phone call with a friend, the stewed apples with cinnamon (real sweetness). We free up our dopamine receptors for wholesome endeavours. We start to move in the direction of our own authenticity. I think this process naturally attracts people to us. And naturally attracts us to the people who have the capacity to love and accept us the way we deserve.
Once we start to build community, especially an anti-inflammatory community—you know, a non-toxic, nourishing, wholesome group of people who make your soul sing, the path becomes easier.
You see, when you are surrounded by people who live life the way you do–with a respect for nature, of which our bodies are apart–who prioritize sleep, natural nutrition, mental health, movement, emotional expression, and self-exploration, it becomes more natural to do these things. It no longer becomes a program or a plan, or a process you’re in. It becomes a way of life–why would anyone do it any other way?
The best way to overcome the toxicity of a sick society is to create a parallel one.
When you’re surrounded by people who share your values. You no longer need to spend as much energy fighting cravings, going against the grain, or succumbing to self-sabotage, feeling isolated if your stray from the herb and eat vegetables and go to sleep early.
You are part of a culture now. A culture in which caring for yourself and living according to your nature is, well… normal and natural.
There’s nothing to push against or detox from. You can simply rest in healing, because healing is the most natural thing there is.
About a month ago I fractured my right 5th metatarsal (an avulsion fracture, aka “The Dancer’s Fracture” or a “Pseudo-Jones Fracture”).
As soon as I laid eyes on the x-ray and the ER doctor declared, “Ms. Marcheggiani,” (actually, it’s doctor, but ok) “you broke your foot!” things changed.
I have never broken anything before, but if you have you know what it’s like. In a matter of seconds I couldn’t drive. I could barely put weight on it. I was given an Aircast boot to hobble around in, and told to ice and use anti-inflammatories sparingly. My activities: surfing, skateboarding, yoga, even my daily walks, came to a startling halt.
I spent the first few days on the couch, my foot alternating between being elevated in the boot and immersed in an ice bath. I took a tincture with herbs like Solomon’s Seal, mullein, comfrey, and boneset to help heal the bone faster. I was adding about 6 tbs of collagen to oats in the morning. I was taking a bone supplement with microcrystalline hydroxyapatite, pellets of homeopathic symphytum, zinc, and vitamin D.
We call this “treatment stacking”: throwing everything but the kitchen sink at something to give the body as many resources as possible that it may use to heal.
My brother’s wedding came and went. I was the emcee, and the best man. I bedazzled my boot and hobbled around during set-up, photos, presentations, and even tried shaking and shimmying, one-legged on the dance floor. The next few days I sat on the couch with my leg up.
I watched the Olympics and skateboarding videos. I read The Master and the Margarita and Infinite Jest. I got back into painting and created some pen drawings, trying to keep my mind busy.
I slept long hours–an amount that I would have previously assumed to be incapable. The sleep felt necessary and healing. I was taking melatonin to deepen it further.
I closed down social media apps on my phone to deal with the immense FOMO and stop mindlessly scrolling. I journaled instead, turning my focus from the outside world to my inner one.
It was a painful process, and not necessarily physically.
I was confined to my immediate surroundings–not able to walk far or drive. I was at the mercy of friends and family to help me grocery shop. The last year and a half has made many of us grow accustomed to social isolation and a lot of my social routines from years prior had fallen by the wayside.
My world, like the worlds of many, had gotten smaller over the last 18 months. With a broken foot, my world shrunk even further.
The loneliness was excruciating.
It would come in waves.
One moment I would relish the time spent idle and unproductive. The next I would be left stranded by my dopamine receptors, aimless, sobbing, grieving something… anything… from my previous life. And perhaps not just the life I had enjoyed pre-broken foot, but maybe a life before society had “broken”, or even before my heart had.
I thought I would be more mentally productive and buckle down on work projects but it became painfully obvious that my mental health and general productivity are tightly linked to my activity levels. And so I spent a lot of the weeks letting my bone heal in a state of waiting energy.
My best friend left me a voicemail that said, “Yes… you’re in that waiting energy. But, you know, something will come out of it. Don’t be hard on yourself. Try to enjoy things… watch George Carlin…”
During the moments where I feel completely useless and unproductive, waiting for life to begin, I was reminded of this quote by Cheryl Strayed. This quote speaks to me through the blurry, grey haze of boredom and the existential urgency of wasting time.
It says,
“The useless days will add up to something. The shitty waitressing jobs. The hours writing in your journal. The long meandering walks. The hours reading poetry and story collections and novels and dead people’s diaries and wondering about sex and God and whether you should shave under your arms or not. These things are your becoming.”
These things are your becoming.
Something will come out of it.
When I did a 10-Day Vipassana (silent meditation) retreat in the summer of 2018, I learned about pain.
It was Day 3 or 4 and we had been instructed to sit for an entire hour without moving. The pain was excruciating. The resistance was intense. I was at war with myself and then, when the gong went off and there was nothing to push against, I noticed a complete relief of tension. I was fine.
The next time I sat to meditate (another hour after a 10 minute break), I observed the resistance and released it. It’s hard to describe exactly what I did. It was something like, letting the sensations of pain flow through me like leaves on a river, rather than trying to cup my hands around them, or understand or making meaning out of them.
The sensations ebbed and flowed. Some might have been called “unpleasant” but I wasn’t in a space to judge them while I was just a casual observer, watching them flow by. They just were.
And when I have intense feelings of loneliness, boredom or heart-break I try to remember the experience I had with pain and discomfort on my meditation cushion. I try to allow them.
“This too shall pass”.
When I have a craving to jump off my couch and surf, or an intense restlessness in the rest of my body, the parts that aren’t broken, I try to let those sensations move through me.
I notice how my foot feels. How while apparently still, beneath my external flesh my body is busy: it’s in a process. It’s becoming something different than it was before. It’s becoming more than a foot that is unbroken. It’s becoming callused and perhaps stronger.
Maybe my spirit is in such a process as well.
The antidote to boredom and loneliness very often is a process of letting them move through, of observing the sensations and stepped back, out of the river to watch them flow by. A patience. Letting go.
I can’t surf today. But, it is the nature of waves that there will always be more.
Pima Chodron in her book When Things Fall Apart also references physical pain and restless in meditation while speaking of loneliness.
She writes,
“Usually we regard loneliness as the enemy. Heartache is not something we choose to invite in. It’s restless and pregnant and hot with desire to escape and find something or someone to keep us company. When we can rest in the middle, we begin to have a nonthreatening relationship with loneliness, a relaxing and cooling loneliness that completely turns our usual fearful patterns upside down.”
She continues,
“When you wake up in the morning and out of nowhere comes the heartache of alienation and loneliness, could you use that as a golden opportunity? Rather than persecuting yourself or feeling that something terribly wrong is happening, right there in the moment of sadness and longing, could you relax and touch the limitless space of the human heart?
“The next time you get a chance, experiment with this.”
“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.
We all have thought spirals. You know, where your thoughts feel like they’re on an automatic playback loop? If you suffer from OCD, your thought spirals likely plague your existence.
Those with OCD have very strong and triple-thick rubber resistance band kinds of thought spirals. In OCD, the part of their brain that “gear shifts” (called the caudate nucleus, if you’re curious), unhooking the rubber band to start to play something else–a kind of “thank you, brain for sharing”–isn’t working. The thought loop plays and plays, intrusively, sometimes horrifyingly.
Even if you don’t have OCD and you can gear shift, you still probably know the rubber band thought loop I’m describing. I think that OCD is likely a spectrum and we all fall somewhere on the spectrum of our brain’s ability to shut off the caudate nucleus and gear shift out of a thought spiral.
Mental states such as fatigue, low blood sugar, dehydration, depression, anxiety, brain inflammation, and so on, make it more difficult to gear shift, because the brain requires a lot of energy to shut off the caudate nucleus.
The difference in those who have OCD is that the gear shift gets stuck way more frequently and the gears get lodged more strongly than those on the far other end of the spectrum.
On the far end of the spectrum may be those who hardly think about anything and let everything go and are super chillax and take nothing personally and all that (possibly some very experienced mediators can get there too).
So, back to the original question. Can you locate your thought loop?
That rubber band that fixates on whether your friends hate you because they took longer than 15 minutes to answer in the group text?
That rubber band that convinces you that the strange mole on your left thigh looks two shades darker than yesterday and you read on Google that that could mean that it’s cancerous, and your doctor looked at it (and then the doctor whose second opinion you sought) and said it was fine but that doctor might be a quack, what medical school could they even have gone to anyways, and now you’re planning your funeral?
Can you identify your thought spirals when they occur?
Thought rubber bands have a flavour. They sometimes speak in their own voice, or a particular tone. Or the way the thoughts jump from concept to concept is different from your normal, balanced and sober thoughts.
The thought spirals might produce a certain feeling in your body that is familiar (and often unpleasant): perhaps a sinking feeling in your stomach, or a 60-lb labrador retriever sitting on your chest. There may be a couple rubber band flavours: a mean one, a frenzied one, one that sounds like your mother, and so on.
Can you locate yours?
Does it have a name?
Sometimes people call it “OCD”–this is probably why people with OCD (especially “Harm OCD”, or thought loops that involve harming others, more on those later), often feel such relief at receiving the label. The label might help us (and our loved ones) recognize that we have a rubber band in the first place. That just because we have thoughts doesn’t necessarily mean anything. And this begins the process of something called Externalization.
Sometimes “OCD” isn’t the best name.
Some people call their thought loop “Herbert”.
I once heard a hilarious story where an individual named hers “Yes, Ma’am!”
Externalization.
Externalization is the act of locating the phenoma we have identified with as something outside of ourselves.
Oh my, imagine if you actually were Herbet (or OCD, or “Yes, Ma’am”). What if you actually believed them? Imagine believing OCD when she tells you that your best friend Glenda from 5th grade saw that funny look on your face that you let slip for a second when she revealed to you that she’s getting a divorce and you now think she thinks that you’re judging her and now she thinks you’re a horrible person or her feelings are hurt and that’s not the type of person you are you should have looked more supportive or asked more questions.
Ugh, that would be horrible.
Now you can think of OCD (or whatever your thought loop is called) as a person, or an entity separate from yourself that occupies your head from time to time. You can see it as a separate thing that might be helpful sometimes. Maybe you have the same values as your OCD sometimes (like the values of being a good and supportive friend and not making weird involuntary faces at Glenda).
Maybe the OCD stepped in quickly once to remind you to check your watch and you did and you actually did need to leave because more time had passed than you thought.
But, you can also think of OCD as a person who you are not 100% overlapped with. Maybe you’re really not friends with OCD if she’s the kind of person who keeps talking about you harming your dog, even though you love your dog (this is reference to certain versions of OCD, called Unwanted Thought Syndrome, or Harm OCD, where people have disturbing, often violent thoughts that are completely unaligned with their true selves. People might think about harming their dog or engaging in violent acts even thought they love their dog more than anything and haven’t squashed so much as a mosquito in their lives).
If you externalize these rubber band thought spirals, you are able to start the process of disconnecting from them. Then, you can start work with them. You can start to realize that they don’t mean anything.
Externalization helps us realize that thoughts of harming your dog aren’t your thoughts. And, more importantly, they don’t actually mean anything about you, your friend Glenda, or reality.
And, if you’re reading this and identify with any of the examples, let me just be your gear shift here and remind you that you are not these thoughts!
I’ll say it a different way: the fact that you’re upset by certain thoughts and think you’re a bad person for thinking them is more proof that you are not these thoughts.
In fact, for a moment I want you to think of a way in which you can’t possibly be that thought. Let’s just stop here for a second. I want you to think of a time you did something really nice for your dog. Did you get her a treat? Ok, then you’re not the type of person who would harm her!
(In an interview, Dr. Steven Phillipson says that he wouldn’t hesitate to let one of his patients with intrusive thoughts about pedophilia babysit his kids. “I’d be far more worried about you than them,” he assures his patients, highlighting that intrusive and unwanted thoughts don’t mean the thinker will act on them–but cause immense distress for the person thinking them).
Externalization helps us share our thoughts. This is why I believe the “Stop the Stigma” campaign is so important. It’s super hard to gear shift on your own. It’s especially hard to do it when you’re under-slept, or undernourished, or having a bad day. We need other people to be the gear shift for us sometimes, while we’re learning to grease the gears ourselves.
I call this “Outsourcing the Prefrontal Cortex”, running something by a friend who knows you and can reassure you that whatever horrific thought or idea is looping in your brain isn’t true or important or indication that you’re a bad person or need to call the police and go back and check if you ran someone over or text the person again.
There are times when I can get caught in thought spiral and I remember yanking at the gear (so there was a part that was able to externalize and even determine that the gear needed to be shifted, which already takes lots of practice). Despite my efforts, though I just wasn’t able to nudge it.
So I talked to a friend. And sometimes even saying it out loud helped—saying it out loud was a way to confront the thoughts. And she and I laughed and she reassured me. And I felt silly but it was what I needed to hear. And the gear moved. And I relaxed. And my brain could move on.
Sometimes seeking reassurance can be a compulsion, however. The difference lies in whether you can tolerate the thoughts and externalize them as thoughts, and Outsource your Prefrontal Cortex in order to unstick your gear shift.
There are three brain areas involved in OCD: the Orbitofrontal Cortex, the Anterior Cingulate Cortex and the Caudate Nucleus.
We are smart social creatures and our brains are geared so that we can learn from our mistakes. The orbitofrontal cortex sounds off an alarm when it thinks we’ve done something wrong. It is our error detection system. It’s the shock you feel when you realize, “Hey did I run over a speed bump back there or…”
The anterior cingulate cortex keeps us feeling uneasy and unsettled until the mistake is corrected. And the caudate nucleus, our “gear shifter” responds to error correction and turns off once we’ve done something correctly so we can move on.
In OCD all three areas are hyperactive. The main neurotransmitter of this brain circuit is glutamate, our excitatory neurotransmitter. This is why NAC (n-acetyl cysteine) can be such a helpful supplement for OCD, tourettes, tics, skin picking and hair-pulling, binge eating, and thought spirals and compulsions, as it “mops” up glutamate in the brain and can calm down the entire circuit. It’s also thought that the orbitofrontal cortex might be low in serotonin, why many people with OCD are prescribed Zoloft or another SSRI medications and can see some benefit from them–5HTP can be a helpful supplement for supporting serotonin synthesis in the brain but shouldn’t be mixed with SSRIs.
The gold standard treatment for OCD is Exposure and Response Prevention Therapy, or ERP.
ERP works by first viewing the thought loops as sticky, addictive substances while addressing our fears surrounding them by exposing us to the thoughts. If you’re afraid of snakes, exposure therapy engages a step by step process of getting you in front of a snake until the fear centre of your brain, the amygdala no longer associates friendly, non-poisonous snakes with danger. ERP is similar–when we face the intrusive thoughts head-on they start to lose their power over us.
ERP involves sitting with the thought loops and refraining from engaging in any compulsions until the brain stops caring about them, and the alarm stops sounding. OCD doesn’t necessarily involve compulsions–often the compulsions can be mental, such as constantly telling a friend (over-outsourcing the prefrontal cortex, let’s say).
It involves heading into the intrusive thoughts, and thought spirals, perhaps listening to recordings of yourself saying them, and sitting with the feelings of discomfort until you are used to them. You know when someone’s car alarm goes off in a parking lot and no one even turns to look? That’s how ERP wants you to engage with your intrusive thoughts.
Mindfulness and externalization are helpful tools to aid the process of ERP.
Often it’s necessary to explore why certain subject matter of the thoughts is so “hot”–perhaps looking under the hood at traumas and implicit memories that you may have experienced that may have led to an over-active alarm system. However, it’s probably necessary to start by building the skills of exposure and response prevention so that you can stay stabilized throughout your trauma therapy, by dampening the alarm system that kicks off the thought spirals.
One thing not to do, if you have OCD, is to go to a therapist who does more psychodynamic therapy, or who examines the “deeper” meaning of the thoughts. Your brain is already trying to do that (“What kind of person has these kind of thoughts?”) and it’s not helpful. Addressing trauma maybe be incredibly helpful at some point in your treatment plan, but analyzing and picking apart the thoughts is probably more damaging than useful.
Seeing the thoughts as just thoughts that show up in the mind and don’t mean anything important is a better attitude to take towards them.
You might not have OCD (again, I believe that it’s a spectrum), but you definitely have thought loops. You do have rubber band thoughts. And you do have a gear shifter.
When I get stuck in thought loops I try to gear shift by saying, “I’m enough”.
It’s not much, but it sometimes settles things down. Whatever I’m worrying about and obsessing about doesn’t matter as much–because I’m enough, just as I am.
It’s simple, and it’s been working.
If you suffer from OCD or you are having a hard time managing your intrusive thoughts, finding a therapist who focuses in ERP, or working with an ND who can help you strengthen your “gear shift” can be incredibly helpful places to get started.
In my last post on “I Treat Stories“, I talked about the spectrum between perfect “health” (perhaps better defined as “potential”) and disease, and death. The Disease Spectrum, perhaps we can call it.
And I also talked about the conflict many naturopathic patients experience when they are clearly not feeling well but are dismissed by the medical establishment because “there is nothing wrong”, i.e.: their signs and symptoms don’t fit into a disease classification.
I talk about functional conditions like insulin resistance and HPA axis dysfunction or estrogen dominance (or IBS, depression, anxiety) as these conditions in which functioning is impaired in someway, or the person doesn’t feel like themselves, and yet they are dismissed.
I want to correct this, however. I don’t believe that these conditions, even most diseases, per se, are the result of the body malfunctioning.
Instead, I think we should look at symptoms, and so-called pathologies and diseases, as the body adapting in a very functional way to circumstances that might be challenging, or malfunctioning.
Depression and anxiety are terrific examples of this.
In these conditions (which do fit a disease classification system, with which I very much do not agree–these classification systems rely only on symptoms, therefore they cannot possibly be viewed as true “diseases”), patients are told that they have an inborn malfunction–their brains don’t work properly. They might be told they have a chemical imbalance, or something to that nature, and that they require a lifetime of medication.
This can’t be farther from the truth.
Firstly, there has never been any evidence of these so-called brain imbalances. And there are no concrete physical signs of these “diseases” either. There are no universal changes to the brain, nothing that shows up on blood tests, and no issues with brain chemistry.
Even the therapies, usually SSRI medications, actually cause brain imbalances–there is no evidence that they solve them. There is also no evidence that they are safe and effective long-term (and limited evidence that they are safe and effective in the short-term).
What we do know is that animals in the wild become anxious when they are threatened.
And that animals in the wild become depressed when their anxiety response (their fight or flight survival response) is burnt out.
And that is the story I hear again and again in patients.
They have a history of anxiety–their nervous systems are wired “up”. This could be because of early childhood trauma. It could be attachment trauma, receiving insecure attachment or inadequate attunement from their caregivers. They might be contending with a great deal of conflict at the time of diagnosis. They may have psychological schemas about not being enough, leading to perfectionism and self-criticism, which their nervous system perceives as constant attack. They may have experienced anxious modelling from a parent or caregiver who suffers from anxiety (generational trauma, essentially).
They may be suffering from nutrient deficiencies, or a metabolic issue, giving their nervous system the input that there is a food shortage, one of our main historical stressors throughout human history.
And so on.
Ultimately, there is something happening in the environment in which their nervous system either lacks adequate safety signals or is receiving signals of danger or threat.
When patients present with depression they often describe a history of anxiety. Maybe they experienced it as “active” anxiety: feeling shaky and jittery, hyperactive, fearful, etc., or more “passive” or “mental” anxiety: worrying, ruminating, narrating, over-thinking, constant striving, self-criticism, thought loops, etc.
Not that anyone has ever asked them before reaching for the prescription pad, but when I talk to my patients presenting with depression they almost always report a baseline level of anxiety that has gone on for some time, followed by a period of acute stress, or shock, or loss, that led to this collapse of sorts.
At this point they experience extreme fatigue, low motivation, shut-down, paralysis, and intense self-criticism, even suicidal thoughts and intense feeling of hopelessness. The world starts to seem pointless. Their bodies and mind “shut down” in a sense.
And, of course they eventually seek solutions, firstly from the medical system (because we have been trained to medicalize the problemm–something has gone “off” with the machinery of the body. We locate the problem within ourselves, not with our situation.) and the response is pathologized, and most often medicated.
And then we talk about ending the stigma of mental illness (when in fact, many cases, if not most are not illnesses at all). What could be more stigmatizing or disempowering that the way we currently frame mental health?
Depression and anxiety are not sicknesses, or weaknesses. They are adaptations.
Depression is an inflammatory shutdown state that results from chronic overstimulation of the fear response in the nervous system. It is a symptom. It reflects the health of your very well-functioning brain and nervous system and their ability to adapt to adversity.
This adversity can be biological (infectious, a nutrient deficiency, metabolic issues, inflammation, etc.), mental, emotional, and environmental. It can (most often) be a confluence of one or more of these categories.
When a deer is trying to escape a predator and their fight or flight response fails to get them out of harms’ way, their nervous systems shut down. Their body releases opiates. They feel far away. Their limbs go limp. They can’t escape in body, so they escape in their minds and emotions. They despair. This is depression.
This is why the story is so important.
Without story, we can’t possibly understand what is going on for you specifically. We can’t possibly understand your situation. And, therefore, we can’t figure out what to do to help.
Is someone asking you about your story? Or are they just cataloguing your symptoms?
Are they asking about your family history, your history of trauma, the circumstances going on in your life? Are they talking to you about your thoughts, or your tendency to self-criticism and perfectionism? Are they asking you what you eat, how you move, how well you sleep, and how you recover from stress? Are they ruling out anemia, nutrient deficiencies, thyroid issues, fatty liver, insulin resistance, hormonal imbalances, and chronic inflammation, or gut issues?
Are they asking how content you are with your job? What your dreams are for the future? How fulfilled and loved you feel in your primary relationships? Are they asking you about poverty? Discrimination? Whether you feel safe in your neighbourhood? Whether you felt safe growing up as a kid?
Are they misdiagnosing your grief?
Does your healthcare practitioner get you? Can they connect the dots for you? Does talking to them give you a glimmer of hope, even in this hopeless time? Do you feel empowered and strong when you walk out of their office?
Or are they telling you you have a brain imbalance, or a in-born defect?
In reality, you are not defective. You are incredibly strong. Your body is adapting. It is resilient. And in its process of adaptation it is giving you these symptoms. Now, you don’t have to just tolerate these symptoms. There is so so much we can do. Perhaps pharmaceuticals are supportive for you while you start to compassionately look deeper.
But, there is so much more to the puzzle than just pharmaceuticals.
It’s worth asking,
What are you adapting to?
To learn more about nutrition and mental health, check out my course Feed Your Head.
“I don’t believe in diseases anymore, I treat stories.
“…No other medical system in the world ever believed in diseases. They all treat everybody as if, you know it’s whether it’s the ancestors or meridians–it’s none of this rheumatoid arthritis, strep throat kind of thing. That’s just this construct that we kind of… made up.”
– Dr. Thomas Cowan, MD
Dr. Cowan is admittedly a (deliciously) controversial figure. His statement, I’m sure, is controversial. But that’s why it intrigues me.
In naturopathic medicine, one of our core philosophies, with which I adhere very strongly, is “treat the person, not the disease”.
And, in the words of Sir William Osler, MD, “It is much more important to know what sort of person has a disease, than to know what sort of disease a person has”.
And, I guess it’s relevant to ask, what is disease in the first place?
I see disease as an non-hard end point, a state that our biological body enters into. On the continuum between perfect health (which may be an abstract and theoretical construct) and death, disease I believe is near the far end of the spectrum.
Disease happens when the body’s proteins, cells, tissues, or organs begin to malfunction in a way that threatens our survival and disrupts our ability to function in the world. For example, a collection of cells grows into a tumour, or the immune system attacks the pancreas and causes type I diabetes.
But, of course there is always more to the story.
What causes disease?
I have heard biological disease boiled down to two main causes: nutrient deficiencies and toxicities. And, I’m not sure how strongly I agree with this, but on a certain level I find this idea important to consider.
However, it is definitely not how Western Medicine views the cause of disease!
Diseases, as they are defined, seem to be biological (as opposed to mental or emotional). They have clinical signs and symptoms, certain blood test results, or imaging findings, and they can be observed looking at cells under a microscope.
Medical textbooks have lists of diseases. Medicine is largely about memorizing the characteristics of these diseases, differentiating one from another, diagnosing them, and prescribing the treatment for them.
As a naturopathic doctor, I see a myriad of patients who don’t have a “disease”, even though they feel awful and are having difficulty functioning. These patients seem to be moving along the disease spectrum, but their doctors are unable to diagnose them with anything concrete–they have not yet crossed the threshold between “feeling off” and “disease”.
Their blood tests are “normal” (supposedly), their imaging (x-rays, MRIs, ultrasounds, etc.) are negative or inconclusive, and their symptoms don’t point to any of the diseases in the medical school textbooks.
And yet they feel terrible.
And now they feel invalidated.
Often they are told, “You haven’t crossed the disease threshold yet, but once you reach the point where you’re feeling terrible and our tests pick it up too, come back and we’ll have a drug for you”.
Obviously not in so many words, but often that is the implication.
Our narrow paradigm of disease fails to account for true health.
Even the World Health Organization states that health is not the mere absence of disease.
So if someone does not have health (according to their own personal definition, values, dreams, goals, and responsibilities), but they don’t have disease, what do they have?
They have a story.
And I don’t mean that what they’re dealing with is psychological or mental or emotional instead, and that their issues are just “all in their head”. Many many times these imbalances are very biological, having a physical location in the body.
Subclinical hypothyroidism, insulin resistance, nutrient deficiencies, chronic HPA axis dysfunction, and intestinal dysbiosis are all examples of this. In these cases we can use physical testing, and physical signs to help us identify these patterns.
An aside: I believe the categories of biological, mental, environmental, and emotional, are false.
Can we have minds without biology? Can we have emotions without minds or physical bodies? How do we even interface with an environment out there if we don’t have a body or self in here?
Aren’t they all connected?
Ok, back to the flow of this piece:
Your story matters.
This is why it takes me 90 minutes to get started with a new patient.
It’s why I recommend symptom and lifestyle habit tracking: so that we can start to pay attention.
It’s why I’m curious and combine ancient philosophies, research (because yes, research is useful, there’s no doubt–we should be testing out our hypotheses), and my own intuition and skills for pattern-recognition, and my matching my felt-sense of what might be going on for a patient with their felt sense of what they feel is going on for them.
Attunement.
I write about stories a lot. And I don’t mean “story” in a woo way, like you talk about your problems and they go away.
No. What I mean is that you are an individual with a unique perspective and a body that is interconnected but also uniquely experienced. And my goal is to get a sense of what it’s like to be you. What your current experience is like. What “feeling like something’s wrong” feels like. What “getting better” feels like.
And all of that information is located within story.
Your body tells us a story too. The story shows up in your emotions, in your physical sensations, in your behaviours (that might be performed automatically or unconsciously), in your thoughts, in your energy, and in the palpation of your body.
No two cases of rheumatoid arthritis are the same. They may have similar presentations in some ways (enough to fit the category in the medical textbooks), but the two cases of rheumatoid arthritis in two separate people differ in more way than they are the same.
And that is important.
We’re so used to 15 minute insurance-covered visits where we’re given a quick diagnosis and a simple solution. We’re conditioned to believe that that’s all there is to health and that the doctors and scientists and researchers know pretty much everything there is to know about the human body and human experience.
And that if we don’t know about something, it means that it doesn’t exist.
When we’re told “nothing is wrong” we are taught to accept it. And perhaps conclude that something is wrong with us instead.
When we’re told that we have something wrong and the solution is in a pill, we are taught to accept that too. And perhaps conclude that something is wrong with our bodies.
But, you know what a story does?
It connects the dots.
It locates a relevant beginning, and weaves together the characters, themes, plot lines, conflicts, heroes, and myths that captivate us and teach us about the world.
A story combines your indigestion, mental health, microbiome, and your childhood trauma.
A story tells me about your shame, your skin inflammation, your anxiety, and your divorce.
Maybe you don’t have a disease, even if you’ve been given a diagnosis.
I’ve struggled with body image as much as the next woman. In certain influencer, nutrition and health circles I find “skinny” is confused for “healthy”. When we talk about health and wellness, people assume we mean “thinness”, or weight loss. And I want to confess something: I hate treating weight loss. I love love love when people notice positive side effects from their treatment plans: they’re sleeping better, more relaxed, have better skin and yes, have even noticed some weight loss, but when weight loss is our primary goal, something we’re aiming for at all costs, (and this is the key point) beyond the weight OUR BODY WANTS to be for health, then I’m often stumped. My goal is to support the healing process of the body, and to do no harm. Fat, while vilified in our society, is not a 4-letter word. (I also mean that literally… it’s… a 3-letter word). Our bodies love fat. Fat is stored energy. It’s your cushy bank account—resources saved for a rainy day. It’s mental, emotional, and physical protection. Our cushioning protects us against falls. It’s a storage reserve for reproductive needs (growing a baby’s brain and breast-feeding). It’s the rubber insulation of the electrical wiring of our nervous system and brain. It’s brain mass. It’s a layer of warmth. Stress, famine, lack of sleep, inflammation, and hormonal resistance, are some common signals that tell the body to store and maintain fat. Our bodies also have a set point range at which they feel most comfortable—and this set point, unfortunately for our Instagram followers, may be higher than society tells us it should be. I have found in my practice that if we treat the underlying causes of fat gain: the inflammation, poor sleep, chronic stress, insulin resistance, etc., we might notice weight loss as a happy side effect of improved metabolic functioning. Sometimes our bodies have experienced mental, emotional, physical or metabolic trauma and need to hold onto their protective layer a little while longer. Maybe your body thinks you need a little softness… I created a course: Intuitive + Mindful Eating, body image, metabolic health, hormones and more.
So, if another diet “failed”, trust me, that’s normal. It’s not your fault. Diets don’t work. In fact, in the long run they do the OPPOSITE of what their supposed to do: improve our metabolic health. Instead they DAMAGE our metabolic health, through cyclical restriction (which often leads to binging and weight gain). And this leads to guilt, shame, and a poor relationship with our body image and food. The solution is to work with your body where it’s at. – Understand how your metabolism works, and learn about your Set Point Weight. – Listen to your cravings and hunger cues and use them as tools for communicating with your body to heal your metabolism – Make peace with your body size through developing Body Neutrality (easier to achieve than body positivity for a lot of people) and becoming more “embodied”–feeling at home in your body vs. trying to change it. – Recognizing that you can feel at peace with your body where it’s at right now: and that losing weight (if it means working against your metabolism) won’t make you healthy. And it won’t make you happy. – Making peace with food through Intuitive and Mindful Eating. – Practicing gentle nutrition that honours hunger cues and cravings and keeps you fuelled throughout the day. – Self-compassion – Understanding how hormones play a role in body size and metabolism and how to nurture them to feel your best. I cover all of this in more in my course You Weigh Less on the Moon. Because it’s true, you do!
