Is anyone else feeling wet dog in a bathtub-level lonely? With this pandemic loneliness is on the rise. And we already lived in an epidemic of loneliness. Humans are social creatures with attachment needs–and many of us are alone or surrounded by people who make us feel more alone. Sometimes loneliness doesn’t make sense.
This is a time when loneliness has turned from epidemic to global pandemic.
As we physically distance, the emotional distance between each other becomes greater.
I don’t have a solution to loneliness, but the great minds of neuroscience, psychology, literature, philosophy, and spirituality have written on it a great deal, and so I’m going to examine some of it in the following paragraphs.
1. “Saying Hello Again” When I first announced this project, many people reached out to me and talked about their grief: the loss of a spouse, a beloved pet.
Many more of us are grieving relationships with those who haven’t died, but who we don’t get to interact with as much anymore. Grief is a tricky subject. In our society we don’t have established rituals for grieving. In the DSM if you’ve lost a loved one more than two weeks ago, and your grief coincides with the symptoms for Major Depressive Disorder, you’re considered mentally ill.
Imagine losing someone important to you and not feeling depressed for more than two weeks…
In many instances we NEVER “get over” the pain of losing someone. And yet, in many ways, grief that interferes with our productivity and way of being is pathologized. Narrative Therapy invites us to grieve in ways that I have always felt were the richest and most helpful. It does this through a series of “Remembering Conversations”. (For more, I’ve linked to the paper “Saying Hello Again” by David Denborough.) You can speak remembering conversations out loud with a friend or therapist. You can write them down, or walk in the woods and reminisce. Find a quiet space where you can think of your loved one. It could be someone real, currently alive but not present–a religious figure, or a famous person. A stuffed animal. A pet. An ex-lover. Or someone who has passed away. Call them into your memory, and consider the questions. – What did [your loved one] see when they looked at you through loving eyes? – How did they know these things about you? – If they could be with you today, what would they say to you about the efforts you are making in your life? What words of encouragement would they offer? – What difference would it make to your relationships with others if you carried this knowledge with you in your daily life?
2. Feeling Lonely vs. Being Alone. “You come home, make some tea, sit down in your armchair, and all around there’s silence. Everyone decides for themselves whether that’s loneliness or freedom.” Surely solitude and loneliness are related but not equivalents. My patients and friends who are married with children crave alone time. My single friends who live alone crave company. What most of us want, however, is the feeling of freedom that comes with being ourselves. And we all know that this feeling can arise alone in the comfort of our own company or in the presence of those who fully accept us. The Dalai Lama has repeatedly claimed that he never gets lonely.
When he was asked the question “Do you get lonely?” at a speaking forum, it took the translator a while to convey the concept to him before he was able to answer. According to him, loneliness is not a condition of solitude. It’s a condition of mindset.
He weighs in: “We often are alone without feeling lonely and feel lonely when we are not alone, as when we are in a crowd of strangers or at a party of people we do not know. “Clearly the psychological experience of loneliness is quite different from the physical experience of being alone. “We can feel joy when we are alone but not when we are lonely… Much depends on your attitude. If you are filled with negative judgement and anger, then you will feel separate from other people. You will feel lonely. “But if you have an open heart and are filled with trust and friendship, even if you are physically alone, even living a hermit’s life, you will never feel lonely.” The loneliest I’ve felt is when I was in a relationship with someone whose love I couldn’t feel. But, I’ve felt completely at home and accompanied while traveling with strangers. When do you feel you can truly be as you are?
3. On being socially awkward and telling ourselves stories. We were in the midst of … isolation and so my friends cancelled their baby shower. They asked for books (if we were compelled to send gifts) and something else, I don’t remember…(clothes?) So I hopped on Amazon and happily ordered a few books I remember loving as a kid: Amos the sheep who doesn’t want to give up his wool, Frances the badger who gets conned into giving up her porcelain tea set in lieu of a plastic one, and so on. My friend is a therapist and I was sure he’d appreciate the psychotherapeutic subtext of these stories: finding self-worth, developing boundaries, etc. Anyways, I sent the books off and forgot about it. Then, one lonely evening I sat on the couch alone and let my Default Mode Network run rampant. I started ruminating on the books–they must have arrived. I hadn’t heard from my friends. Maybe they were going to send out more formal thank you card.
Or maybe something was wrong. Then I realized that they were about to have a BABY, a mere fetus+1 day. And I realized in horror I had sent them a pile of children’s books–for 3-5 year olds.
I felt out of touch, self-absorbed–I felt ashamed. And then I felt ashamed at my shame–surely this wasn’t such a big deal? What was wrong with me? I tried to Cognitive Behaviour Therapy my way out of this thought trap–this story about being weird and disconnected. I couldn’t do it. I eventually reached out to another friend who has two kids. She played the role of my prefrontal cortex (using others for emotional regulation is extremely helpful). She assured me that babies can’t read anyways and so, whatever, any kind of book is fine. Duh… then I realized: this is the collateral of isolation.
If the gifts had been unwrapped in person, I might have realized they were slightly age inappropriate and would have made a joke. People would have laughed, we would have moved on. Instead, my mind was free to fill the silent void with stories. Eventually I confessed my neuroticism to my friends, embarrassed. They laughed and thanked me for the gift. We tell ourselves stories about how others see us all the time. About their judgements and prejudices, motivations, anger, hostility and failings.
What story are you telling yourself about the people in your life?
4. The Power of Art. Remember this scene from the movie Good Will Hunting? Sean : [during a therapy session, after coming from the job interview with the NSA] Do you feel like you’re alone, Will? Will : [laughs] What? Sean : Do you have a soul mate? Will : Define that. Sean : Somebody who challenges you. Will : I have Chuckie. Sean : You know Chuck; he’s family. He’d lie down in fuckin’ traffic for you. No, I’m talking about someone who opens up things for you – touches your soul. Will : I got – I got… Sean : Who? Will : …I got plenty. Sean : Well, name them. Will : Shakespeare, Nietzsche, Frost, O’Connor, Pope, Locke… Sean : That’s great. They’re all dead. Will : Not to me they’re not.
This exchange has always come to mind when I think about the loneliness of trying to find a soulmate–someone who knows the secrets and truths that lie deep in our hearts. Do our soulmates need to be living people who we share our lives with? People we can converse with on a daily basis? Ideally yes. However, many people in literature will speak of the phenomenon about feeling alone in a crowded room, with no one to share their private thoughts. When we read someone’s deep thoughts and feelings and relate it… makes us feel less alone, especially if what we’re reading speaks directly to our own hearts. You know that sensation, when you’re feeling something really deeply and then you read or hear someone else (maybe someone you know, maybe someone famous, or dead) describe that phenomenon in a way that is far more eloquent and articulate than you feel you ever could?
That feeling of being deeply validated and understood. Literary soulmates. People who have thought long and hard about this particular existential human experience you’re going through right now.
Not only have they lived it, but they’ve taken the trouble to put it into words, images, music. To remind you that you’re sharing a nervous system with 8 billion other living human beings . To remind you that you’re not alone.
5. Making Friends as an Adult aka Going After What Lights You Up. “You can’t make friends in your 30s”.
My friend’s brother is an investment banker in Manhattan and this was his claim a few years ago. My friend, a bonafide hippie (they are hilarious opposites) and I wondered if it was true. I’ve spent pockets of my adult life wishing I had more friends. I’ve had long conversations with patients who wish they had more friends, or are looking to date and having trouble meeting people. One of the things I was grieving during the last few months was loss of the spontaneity of meeting people.
No more picnics on the Island where a random group of people invite me to share their wine and then write letters to my Nonna.
No more “networking” events I decide at the last minute to drop in on, where I meet a friend who introduces me to someone who would soon be a best friend. No more of that randomness. A contraction of possibilities. The same friend wrote to me, in an email we sent to each other in our early 20s when we were out of school and trying to find our way. “I don’t even know what it is about making friends. It can just be so random the way you meet someone in passing you might really connect [with] or you might ignore each other after 5 minutes and never speak again.
“The philosophy is right — if you go after what lights you up you are bound to stumble upon someone else who is lit on that in their own way and for their own reasons so you are bound to connect on some level!” And, of course we’ve heard this so many times: go after what you’re passionate about and the people will trickle in, like a kind of osmotic current. And it’s easier said that done, finding out what lights you up. I suppose it starts with creating an open question and waiting for the answer to show itself. Lake surfing was one of the answers that manifested itself to me. It’s been a blessing for me in so many ways–from even finding out it existed, to randomly meeting people in the line-up to my regular surf buddies, to the photographers who celebrate us on social media, the sport, although technically a solo one, is all about connectivity. Water is sticky. so are we.
6. Self-Soothing. Will scientists and drug companies create a pill for loneliness? Hormones like oxytocin, endogenous opioids (our body’s own morphine) and allo-pregnenalone, a steroid hormone related to estrogen, progesterone, testosterone, and cortisol, are all common targets for “medicating” loneliness. We can medicate loneliness ourselves, however through self-soothing. Self-soothing behaviours include: – talking about your emotions with others – social and physical warmth (getting cozy and Hygge) – Touching, including self touch and self holds – Soothing music – Satiety through consuming high-calorie foods (chocolate, anyone?) – And even drugs, although engaging in the above self-soothing behaviours tends to protect against drug addiction in the research–if you’re able to reach for a cozy sweater and a puppy in order to self-soothe you’re probably less likely to turn to alcohol. Self-soothing behaviours increase oxytocin in the brain. They calm areas of the brain like the insula and amygdala that are associated with anxiety. Self-soothing boosts endogenous opioids (research shows that opioids like morphine help calm the sting of social rejection, which our brain perceives to be the same as physical pain), and serotonin and dopamine. Self-touch or self-holds is an excellent way to self-soothe. In my podcast on Polyvagal Theory with Dr. Steph Cordes, we talk about self-touch: things like putting a hand on your chest, wrapping your arms around yourself, child’s pose, or cupping your face in your hand. Sometimes speaking your own emotions can be helpful (“I feel sad right now” or “This is hard”). Also, particularly where these emotions pertain to loneliness, invoking a common humanity can he a helpful tool for feeling less alone and can help soothe and process hard feelings. “Everyone feels this way sometimes”, or “Suffering is a part of life”. In Mindful Self-Compassion, invoking a common humanity is an important step in taking the burden of our feelings off of ourselves and recognizing that we’re all interconnected in the emotional space. How do you self-soothe?
7. Attunement. “[Attuning with others] is at the heart of the important sense of “feeling felt” that emerges in close relationships. “Children need attunement to feel secure and to develop well, and throughout our lives we need attunement to feel close and connected.” – Dan Siegel, MD Attunement is the process of responding to another’s emotional cues. Infants first learn attunement from their parents. When a parent can read a baby’s expressions or hear her cries and respond appropriately: with comfort, food, warmth, a diaper change, it builds a sense of trust in the infant’s body. The baby feels seen and understood by the world. A lack of attunement can cause attachment insecurity: leading to feelings of anxiety, distrust, emotional avoidance, depression, and relationship dissatisfaction. It’s ultimately lack of attunement that results in mental health challenges in an adult’s life. Attuning to others can be hard if you didn’t receive the proper attunement from your parents. However, we can still learn to attune to ourselves and others as adults.
Here are some tips for learning how to be more attuned: – Attune to yourself first: starting by recognizing what you feel in your body: what thoughts, emotions and feelings are present? How are you breathing? – Practicing mindfulness can help you understand what is going on in your body and mind, as you learn to attune to yourself emotionally. – When trying to attune to another, limit distractions (turning off the TV, putting away cellphones, etc.) so that you can fully pay attention to the emotional space. – Make eye contact and mirror the others’ physical cues: mimic their postures, gestures and even tone of voice. Physical mirroring is a hallmark skill of attunement. – Listen carefully with compassionate curiosity: seek to understand before seeking to be understood (a useful cliche). Can you give the other person the benefit of the doubt? Can you try your best to relate to what they might be staying and hold them in what Carl Rogers called “Unconditional Positive Regard”? – Can you try to identify what emotions someone might be experiencing as you talk to or sit with them? What are you feeling in your own body?
8. Sharing the Things that Matter “Loneliness isn’t the physical absence of other people – it’s the sense that you’re not sharing anything that matters with anyone else.”
— Johann Hari, from his book Lost Connections. Johann also writes: “Be you. Be yourself… “We say it to encourage people when they are lost, or down. Even our shampoo bottles tell us—because you’re worth it. But what I was being taught is—if you want to stop being depressed, don’t be you. Don’t be yourself. Don’t fixate on how you’re worth it. It’s thinking about you, you, you that’s helped to make you feel so lousy. Don’t be you. “Be us. Be we. Be part of the group. Make the group worth it. “The real path to happiness, they were telling me, comes from dismantling our ego walls—from letting yourself flow into other people’s stories and letting their stories flow into yours; from pooling your identity, from realizing that you were never you—alone, heroic, sad—all along. “No, don’t be you. Be connected with everyone around you. Be part of the whole. Don’t strive to be the guy addressing the crowd. Strive to be the crowd. So part of overcoming our depression and anxiety—the first step, and one of the most crucial—is coming together.” And, “Now, when I feel myself starting to slide down, I don’t do something for myself—I try to do something for someone else. I go to see a friend and try to focus very hard on how they are feeling and making them feel better. “I try to do something for my network, or my group—or even try to help strangers who look distressed. “I learned something I wouldn’t have thought was possible at the start. Even if you are in pain, you can almost always make someone else feel a little bit better. Or I would try to channel it into more overt political actions, to make the society better. When I applied this technique, I realized that it often—though not always—stopped the slide downward. It worked much more effectively than trying to build myself up alone.” I think what Johann is saying is that a sense of meaning, purpose, belonging can’t coexist with loneliness.
Psychoanalyst Francis Weller says it another way,
“at some point we have to stop being the one looking for homecoming and be the one offering it.
“As long as I identify as the homeless child who didn’t get welcomed back I need to make a pivot and say ‘I can also, because of that wound find the medicine of welcome’.”
In what way does being of service help you feel more connected?
How have you learned to deliver what Francis calls “the medicine of welcome” to others?
9. Needs are the doorway to the Inner Child, Imagination, Desire and Purpose. James Hillman, the great Jungian psychoanalyst urges us to use our needs–loneliness being one–to explore the depths of our soul. Loneliness, according to Hillman is, like any other need, “a voice that demands to be satisfied”.
We believe that loneliness represents a void that can be filled by something external: a person’s physical presence, or the actions or words of another that fills the space inside. But a need is actually a doorway: to the Inner Child, who opens the door to the imagination. The need represents something much more, not just love but a kind of archetypal, “divine” love. Not just company, but the deep longing to be whole, to unite with “the beyond”. When we feel needy, or lonely, our Inner Child, according to the Jungians, is crying out. It doesn’t just want to complain.
Hillman says, “The intensity of the need reflects the immensity of the world beyond from which it comes.” The child can help us imagine–when we articulate the need, speak it out loud and feel deeply into the body the sensations that that need creates (where do you feel the need? Where do you feel loneliness?), we let it come up fully. We turn towards the child. We can then be specific about the need. What are we fantasizing will fill this loneliness? Who do I want with me? What would they say? What would they do? Are we riding horses in the sunset?
Allowing the images to come.
Allowing the needs to become wants. When we stay with the loneliness long enough, this voice crying to be satisfied, until it becomes a want, something interesting happens. The emptiness of the need, the lack that represents loneliness begins to become filled: with wanting, with desire. The writer DH Lawrence tells us that “Desire is holy”. It is hot, fiery, passionate. It fills us: “I am filled with desire”. It motivates us. It makes things happen. Desire connects us with the beyond. It moves us towards our purpose.
According to Hillman, a fear of desire stands in the way of finding one’s purpose.
We are afraid of the Inner Child: the weakness that being needy represents.
We feel shameful at our weakness, at our neediness. We deny the needs, or try to fill them some other way. Or we criticize ourselves, punishing the child, or ignoring the child.
But what if this deep, existential loneliness, this longing to be united with what “lies beyond” or what lies deeply in our soul is really the doorway to purpose, to fire, to passion, to an integrated and complete psyche.
What if this neediness is not asking to be filled by external factors: parties, social media likes, validation, but with this deeply felt sense of desire that fuels us in the direction of our dreams?
What is the loneliness asking of you?
When you let the loneliness cry out, when you allow it to provide you with images, and when you allow the loneliness to become a want, what does it drive you to do?
What does it fill you with?
What does it inspire you to do next?
10. Getting To Know Yourself. “If you’re lonely when you’re alone, you’re in bad company.”
— Jean-Paul Sartre. Through this series we’ve explored the concept of feeling alone while surrounded by other people, and feeling utterly content while in complete solitude. And, so loneliness isn’t so much about being physically isolated, but in our deeper inner feelings of connection. The Stoics and the Buddhists tell us that, when we feel lonely it’s because we’ve stepped out of the present moment.
We’ve turned our thoughts to what we lack; we’ve identified with our suffering.
And, according to James Hillman and many other thought leaders on the psyche, we’ve decided that the solution to our suffering is located “out there”, in the external world. But no, say the Buddhists, Stoics and other philosophers. The solution to our suffering is internal. It lies within. And so, they say, when you’re lonely, you need to spend even more time alone–getting to know yourself. When we know ourselves, we feel relaxed in our own company. When we know ourselves, we can share ourselves with others when we’re blessed with their company, thus feeling more connected to them and less alone. Perhaps loneliness isn’t being isolated from others—not all the time.
Loneliness is the feeling we have when we’re isolated from our true selves. So, how can we get to know ourselves? The Buddhists say, sit.
Pay attention to your thoughts, your emotions and your body sensations in the present moment.
James Hillman tell us to watch our pain turn into desire, which tells us what the soul deeply wants. This time of year is hard for a lot of us. Add on a global pandemic, and this year is looking like a challenging one for most. Can you spend some quiet time alone with yourself?
Can you watch the feelings of loneliness arise and fall in your body? Can you deliver yourself a little self-compassion? In those private moments of emptiness, say: “Loneliness is here”. “Everybody feels this way sometimes”. “May I be kind to myself”. And, can you say:
I appeared on the Rebel Talk Podcast with Dr. Michelle Peris, ND. Dr. Michelle writes,
“Not a week goes by that I do not discuss mental health with patients in my office. Rates of depression and anxiety are on the rise. So I really wanted to unpack this important topic for you, giving you relevant information and diving deep into interventions that can help optimize mental health. ⠀
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In this episode, Dr. Talia details how our brains work while suffering from depression, anxiety and stress. Her deep knowledge of neuroscience is combined with mindfulness practices and also with microdosing, an approach that consists in taking low doses of psychedelic drugs, such as LSD or psilocybin-containing “magic” mushrooms, in order to prevent and treat symptoms of depression. ⠀
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Dr. Talia talks about mental and physical barriers, that can holds us back from making the changes needed for a healthier and more balanced life. Listen to this podcast and be inspired by this out-of-the-box conversation about neuroscience, mental health and mindfulness.”
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.
Self-compassion is the act of treating yourself as you would any other loved one: treating yourself with kindness vs. Self-Judgment.
Self compassion is a modality that is being researched for treatments for mental health conditions, preventing burnout, improving motivation, body image, resilience, and in clinical settings for the helping professions.
The leading expert on self-compassion, Kristen Neff, PhD, defines self-compassion in three ways:
Mindfulness
Invoking a sense of common humanity
Self-acceptance vs. self-judgement
This 3 minute self compassion break can be done in a moment of difficulty, such as in the presence of strong emotions, physical sensations, self-criticizing thoughts, or in the face of failure. It can be done on a daily basis or when difficulty is present.
Step 1:
Adopt a posture that invokes a sense of self compassion. The posture to adopt is traditionally placing hands on the heart, but can also be hands placed on the neck, or a mudra. Touch releases oxytocin, our “love hormone” which releases feelings of calm, love and connection, even when it’s our own hands being placed on our own body.
Step 2:
Either to yourself, or out loud, say these three sentences.
This is a moment of suffering. This is mindfulness, acknowledging that suffering is present and turning towards, as opposed to turning away from difficulty.
Suffering is a part of life. Other alternatives to this are: other people feel this way. This is invoking the sense of common humanity, reminding yourself that you are not alone and other people on earth have felt or are currently feeling this way.
May I give myself the compassion I need. This is setting an intention to be kinder to oneself. Other alternatives are: may I be kind to myself, or may I try to accept myself as I am.
For more on Self-Compassion, to access more of Kirsten Neff’s research, and for free resources, visit selfcompassion.org
This is one of my favourite exercises from Mindfulness Based Cognitive Therapy, or MBCT, and just one exercise in an 8-week course directed at those who suffer from depression and anxiety.
This exercise helps us practice staying with difficult thoughts, emotions, and body sensations, teaching us to turn towards difficulty, rather than turning away.
It is better to do this exercise when difficulty is already present.
Try to use a 10 lb weight, not a 100 lb weight. However, in many situations, we don’t get to choose. If the practice is particularly intense, you can perhaps focus on the breath, or open your eyes and let go of the practice.
Note: this video is to support a mindfulness practice and to use in conjunction with help from a licensed mental health professional.
I often encourage my patients to write a letter to themselves on their birthdays for the following year using a website called FutureMe.org, where you can post-date emails to yourself to any date in the future. This exercise is great to do on any day, really. Tomorrow is my birthday. I’ll be 32. Here is my letter.
This is it.
This is your life.
As Cheryl Strayed wrote, “The f— is your life. Answer it.”
There are some things that you thought were temporary, mere stepping stones on your way to someplace better, that you now realize are familiar friends, ever present in their essence, but varying in their specific details.
For instance:
1) You will ride buses.
You will never escape the bus. For a while taking the bus was seen as a temporary stop on your way to something else (a car?). You took the bus as a pre-teen, excited to finally be allowed to venture to parts of town alone. As a student, you took the bus to the mall, laughing at the ridiculousness of Kingston, Ontario, once you’d left the protective bubble of the student community, completely inappropriately, yet affectionately (and ignorantly) called The Ghetto.
You will visit other ghettos, also by bus, that are far more deserving of their names. However these ghettos will instead have hopeful names such as El Paraiso, or La Preserverancia. Those who live there will persevere. So will you.
Buses will take you over the mountains of Guatemala, to visit student clients in Bogota, Columbia. To desirable areas of Cartagena. You’ll ride them through India. They will carry you through Asia, bringing you to trains and airports.
You’ll ride buses as a doctor. You’ll ride the bus to your clinic every day.
Sometimes, on long busy days in Toronto, it’ll seem like you’ll spend all day trapped in a bus.
The bus is not a temporary reality of your life. The bus is one of the “f—s” of your life. You’ll learn to answer it. You’ll learn to stop dissociating from the experience of “getting somewhere” and realize you are always somewhere. Life is happening right here, and sometimes “right here” is on the seat of a bus. Eventually you start to open up, to live there. You start to live in the understanding that the getting somewhere is just as important as (maybe more than) arriving.
We breathe to fill our empty lungs. Almost immediately after they’re full, the desire to empty them overwhelms. Similarly, you board a bus to get somewhere, while you’re on the bus, you start to understand.
You’re already here.
Maybe you’ll graduate some day, to a car.
But sooner or later, you’ll board a bus.
And ride it again.
2). You’ll experience negative emotion, no matter who you are or what your life circumstance.
Rejection, worthlessness, sadness, and heart break, are constant friends. Sometimes they’ll go on vacation. They’ll always visit again.
You will never reach the shores of certainty. You will never be “done”. You may take consolation in momentary pauses, where you note your confidence has found a rock to rest its head against. But you’ll grow bored of your rock (it is just a rock, lifeless, after all). You’ll then dive back into the deep waters of doubt, risk despair, and swim again.
Happiness isn’t a final destination. Instead, it’s a roadside Starbucks: a place to refuel, and maybe passing through is an encouragement you’re headed in the right direction.
3). The people in your life are like wisps of smoke.
They will come and go. Some of them will simply whiff towards you, visiting momentarily. Their names you’ll hardly remember. You’ll share ice cream and one deep, healing conversation about love that you’ll remember for years to come. You’ll reflect on this person’s words whenever you consider loving someone again.
You’ll remember the ice cream, the warm sea breeze, the thirst that came afterwards, the laughter. But it will be hard to remember his name… David? Daniel? You won’t keep in touch, but you’ll have been touched.
There will be others who come to seek your help. You might help them. You might not. They might come back regardless, or never return. Many times it will have nothing to do with the quality of your help. Or you.
Sometimes the smoke from the flame will thicken as you breathe oxygen into it. People will come closer, you’ll draw them in, inhale them.
Sometimes you’ll cough and blow others away.
You’ll wonder if that was a wise choice. You’ll think that it probably was.
Does a flame lament the ever-changing smoke it emits? Does the surrounding air try to grasp it? Do either personalize the dynamic undulations of smoke, that arise from the candle, dance in the fading light and dissipate?
Flames don’t own their smoke. They don’t seem to believe that the smoke blows away from them repelled by some inherent deficiency in them. Flames seem to accept the fact that smoke rises and disappears, doing as it’s always done.
4). Not everything is about you.
There will be times when failure lands in your lap. You’ll wonder if it’s because there is some nascent problem with you, that only others can see. These failures will tempt you to go searching for it.
You’ll find these faults. These deficiencies. In yourself, in others, in life itself.
You’ll wonder if it explains your failures. You’ll wonder why the failures had to happen to you.
You think that people can smell something on you, that your nose is no longer able to detect, like overwhelming perfume that your senses have grown used to, but that assaults the senses of others around you.
Failure and rejection, cause your heart to ache. Your heart aches, as all hearts do. The hearts of the virtuous, famous, heroic, and rich ache just as hard. The hearts of those who have committed evil deeds also split apart. (The only hearts that don’t may be the truly broken, the irredeemable. And those people are rare.)
You will experience joys. Your heart will mend and break, a thousands times.
And it has nothing to do with you.
5). Success is not a final destination.
There are no destinations. You will ride buses, you will feel happy, you will feel joy. You will try. You will succeed.
And you won’t.
You’ll pick up the pieces of your broken heart. You will mend them. You will flag down the next bus.
You will board it.
You will grasp—you can’t help it. Grasping will only push the wisps of smoke away, causing it to disappear in your hands. This will frustate you, but you’ll keep doing it.
Over and over.
And failing.
You’ll grasp some more and come up empty, thinking that it is because something is wrong with me. There is lots wrong with you.
There is lots right with you.
Most things have nothing to do with you. (That might be just as painful to accept
But healing as well.)
No one said healing didn’t hurt. Sometimes it f—ing hurts! But, as Cheryl Strayed wrote, “the f— is your life”.
Mindfulness philosophy tells us that our thoughts and emotions are simply phenomena that arise in our bodies and minds: they are not us.
Those of us who suffer from depression and anxiety tend to enter cycles of over-thinking. The mind wanders and engages in self-focused rumination that feeds negative emotions, worsening mood.
While ruminating, we think about the causes and consequences of our depression; we reflect on mistakes we’ve made in the past, we dwell on our perceived personal faults, and we speculate about how we’ll fare negatively in the future.
This kind of rumination becomes a scratch-itch cycle that causes us to feel worse.
However, learning to engage the contents of self-focussed mind-wandering as a non-judgmental observer may be the key to stopping this cycle.
Those who are able to step back and become aware of awareness or think about thoughts, as opposed to getting lost in them, tend to have better control over their thought processes as a whole, and thus their emotions. Mindfulness involves taking a non-judgmental, curious stance about the contents of the mind, as an impartial witness.
Studies show that mindfulness, or taking this non-judgmental, curious stance, can change brain areas associated with rumination, and emotional regulation.
This fall I took a course to obtain a facilitator certificate for Mindfulness-Based Cognitive Therapy (MBCT), an evidence-based 8-week program that aims to treat depression and anxiety through imparting mindfulness skills. Because of the growing evidence base on the benefits of mindfulness for stress and mental health, the facilitator program attracts many medical professionals.
One of the course participants, a psychiatrist, didn’t like me. I noticed her frowning in my direction every time I spoke. She deliberately avoided and ignored me, talking to everyone else in the course but me.
As the only naturopathic doctor in the group, the other participants showed some curiosity towards my field. When I answered their questions, the psychiatrist’s face seemed to twist into a subtle expression of disgust and disapproval.
She thought I was a quack, a hack; I didn’t have enough training. She assumed I wasn’t qualified enough to provide care to those who suffer from mental health concerns. I could feel her judging energy from across the room every time I lifted my hand to answer a question, or make a comment. Her deploring gaze scrutinized my every move.
I was a naturopathic doctor and she, a psychiatrist. We had emerged from different worlds, philosophies, and backgrounds—we were from incompatible ends of the mental health professional spectrum. Of course she didn’t approve of me: it was only to be expected.
We were spending all day meditating, and this is the story my mind had decided to write.
At the end of day 3 of the course, with days of evidence selectively compiled to support my story about this disapproving psychiatrist’s opinion of me, I left class to head for the bus stop. Waiting for the same bus was no one other than my nemesis.
Great, I thought. I smiled at her, stiffly.
She smiled at me.
“Talia, right?” She asked.
I nodded: yes, Talia.
“You’re the naturopath, right?” She inquired, brows kneaded together in a frown.
I nodded again, bracing myself. Are we really going to do this here?
But then, time-space cracked and split open, revealing an alternate universe to the one in my own head. Her face melted into a warm grin, “Oh, I love naturopaths!” She exclaimed warmly.
She went on to describe her wonderful encounters with the members of my profession who had attended to the various personal health concerns she’d faced.
“I’m so interested in holistic health for managing mental health concerns,” She said, before leaning in a bit, conspiratorially, and adding in hushed tones, “You know, psychiatry doesn’t work.”
I stood there, dumbfounded.
Her particular opinions about psychiatry aside: not only was the entire story I’d written and held onto for the past few days wrong, it was way wrong. I had fabricated an entire story in my head, corroborated by what I had been convinced was real evidence. The realization of how avidly I’d bought into this story, as if it were simple fact, was earth-shattering.
My story, had just been that: a story, conjured up by thoughts. These thoughts bore no relationship to reality at all, no matter how convincingly they had presented themselves.
It rare to have the opportunity to experience our mental constructs and biases topple so dramatically. The mind has a tendency to rationalize away any evidence contrary to our beliefs—”Well, I only passed because I got lucky”, or “The test was easy”, or “She said she liked my hair—liar”.
Very few of us entertain the idea that our thoughts and emotions don’t represent our ultimate reality.
According to Mindfulness Theory it helps to think of our minds as movie screens and our thoughts, emotions, and body sensations as contents of the movie. We can watch the action, identify with the characters, and follow the plot with invested interest. The movie can inspire thoughts and emotions within us, both positive and negative. The movie can grip us; we might lose ourselves in the drama, forgetting that we are mere witnesses to it.
It can help to remember that we are not the movie. Sometimes it’s helpful to remember that we’re not even acting in the movie.
No matter how deeply the film may move us, we can always take the stance of movie-going witness. We can take various perspectives in relation to the drama on screen. We can immerse ourselves in the drama, losing our sense of self completely. We can remember that we are audience members, enjoying a film. We can ignore the movie altogether and laugh to a friend sitting beside us. We can be aware of the contents of the movie theatre, the people sitting around and behind us, or the sticky floor under our feet. We can even leave the theatre, which we will certainly do once the credits roll—it’s just a movie after all, a distraction from the reality of our lives.
In the way that we approach the contents on a movie screen, we can take various stances towards the contents of our minds.
Meta-awareness is the act of remembering that we are movie watchers—the act of becoming aware of awareness itself. When we practice meta-awareness, we take a non-judgmental view of our thoughts and emotions, watching them arise in our bodies and minds like the drama in a movie arises onscreen.
We can easily identify with the tens of thousands of thoughts that appear on the movie screens of our lives. We may be convinced that we’re unloveable, that we’re failures, or that life is hopeless, simply because these particular thoughts have appeared in our mind’s screen. We can also identify with positive thoughts, such as the idea that we’re excellent swimmers, or good fathers.
Our thoughts may reflect reality—we may have the thought that if we step into a pool of water our feel will get wet—but simply having a thought does not create reality itself.
While taking the bus that day, I realized that I had unwittingly cast my psychiatric colleague as the guest-star of People Who Are Judging Me, an episode in Unloveable: The Series, which is a piece of entertaining fiction that my mind has written, directed, produced, and cast me as the lead in. I often forget that I’m simply an audience member watching the movie of my mind’s creation—this movie is not necessarily the truth about my life.
Research has identified a network in the brain called the Default Mode Network (DMN), that connects the lower brain areas, like the amygdala and hippocampus, with higher brain centres in the prefrontal cortex. The DMN is active when our minds are wandering and is particularly active when those with depression are ruminating and engaging in narrative self-referencing: or attributing one’s self as the cause of (negative) events in one’s life—for example, interpreting an expression on someone’s face to be a look of disgust and assuming it’s because they disapprove of your profession.
Meditation, particularly practicing meta-awareness, can produce shifts in the DMN that decrease rumination. Practicing meta-awareness allows us to rescue our identities from the tyranny of thought. We watch and detach from thought, watching them rise and fall in the mind without clinging to them. By becoming aware of our thoughts and emotions and taking a curious attitude towards them, we can break the cycle of rumination, thereby supporting our mental health. Observing thoughts, rather than becoming lost in their drama, allows us to feel and behave independently of them.
For example, simply having the thought, “I’ll always be alone,” doesn’t have to produce a negative emotion, if I recognize it as just a thought.
We might reframe the thought “She hates me” to be: “I just had a thought that this person hates me. It’s just a thought that I have no way of knowing for certain is true. I will smile warmly at her anyways. I might be completely wrong.”
Or, we can do nothing, waiting until the thought “She hates me” passes through the screen of our minds.
We can turn off this particular movie, and put on a new one. After all, we can’t stop the flow of thoughts: there will always be others to take their place.
Lesson learned: I am not my thoughts.
And: some psychiatrists are way more hippy than I am.
Humour me for a moment. Take a moment to imagine your “happy place”—the place you feel most at home. Where are you? What are you doing? Who is there with you?
What are the sights, sounds, smells, tastes, and sensations that fill the air and tickle your skin? What are the internal bodily sensations you notice when you find yourself here, in this place? What emotions do you feel?
I’ll venture some guesses: you feel calm, at peace, safe, energized, connected, and integrated. If you turn your attention to your breathing you probably notice that it’s slow, deep, restorative. That head cloud of frenzied thoughts and worries that you tend to spend your time in might have cleared. Your sense of “self” has probably moved out of your head and into your body.
Maybe, through doing this short exercise, you’ve come home to yourself, even just a little.
1) Understand what “self-care” means.
A friend recently shared a Collegehumor video with me depicting three women in a nail salon, bragging about what horrible things they’ve done, from eating 13 glazed donuts in a single sitting, to “enslaving the entire office”, in the name of their own self-care. Because, according to the video, “You can be terrible if you call it ‘Self-care’”.
Humorous? Perhaps. An accurate depiction of self-care? Well, no.
I asked followers of my Facebook page to tell me what the phrase “Self-Care” means to them. They enthusiastically replied:
“Silence. No social media, or anything electronic.”
“Floating in water—buoyant, effortless.”
“Being kind and gentle to myself.”
“Meditation and time to oneself.”
“Eating healthy foods.”
“Respecting your body.”
“Epsom salt baths.”
“Peace.”
“Rest.”
“Hygge.” (a Danish word that is roughly translated as “warm and cozy”)
“Yoga.”
“Commitment.”
“Masturbation.” (There’s one in every crowd.)
In essence, their responses boiled down to, “Self-care is feeling good, taking care of myself, and taking care of my body, by engaging in activities that feel nourishing while reducing external stress and overwhelm.”
Put even more simply, self-care is the act of practicing self-compassion, whatever that might look like to you.
2) Understand the impacts of stress.
The relationship between self-care and stress is important. According to The American Institute of Stress, about 75% of us have significant physical and psychological stress in our lives.
This stress takes a toll; it produces physical, mental and emotional symptoms, sending us into emergency rooms with panic attacks, and drugstores with prescriptions for pain, anxiety, or anti-hypertensive medications.
Stress lands us in doctor’s offices, pouring over junky magazines waiting to discuss our latest health complaint—digestive issues, mental health issues, fatigue, autoimmune disease, metabolic syndrome, chronic pain, weight gain, and so on.
Our bodies have a built-in stress response to save our lives when triggered by a life-threatening danger. Now, this fight-flight-freeze mechanism is chronically set off by the abundant stressors in our modern era—traffic, deadlines, relationship woes, artificial lighting, and in-laws.
When our body encounters a stressor, one of the hormones it releases is cortisol.
Cortisol affects every system in the body; it elevates blood sugar, heart rate, and blood pressure. It suppresses the immune system, redistributes fat, shrinks certain areas of our brain involved in learning and emotional regulation, causes painful muscle contraction, impairs digestion, and affects our sleep.
Managing stress involves two main goals: lowering external stressors, and managing internal perceived stress by boosting our physical, mental, and emotional resilience. Self-care is our armour against the internal and external stress we put up with daily.
3) Make a list of your nourishing and depleting daily activities.
Let’s try an exercise from Mindfulness-Based Cognitive Therapy. Write down a list of routine activities in your typical day: hauling yourself out of bed, brushing your teeth, eating breakfast, sitting in traffic, working, exercising, making dinner, and so on.
Decide if each activity is nourishing, depleting, or neutral. In other words, does this activity fill your cup or drain it?
For instance, I find that breakfast is nourishing, but less so when I scroll through Facebook feeds or answer emails while eating it. Coffee immediately feels nourishing to me but, hours later, caffeine-fuelled and wired, I often feel more depleted than if I had opted for an herbal tea, or hydrating water instead.
4) Find out what brings you pleasure or mastery.
To get a deeper understanding of your day, determine if the activities that nourish you provide you with pleasure, mastery, or both.
Pleasurable activities feel good in our bodies, and minds when we do them. They bring us positive emotions like safety, calm, peace, happiness, joy, excitement, gratitude, and awe. Sleeping, eating, laughing with friends, cuddling with my dog, and consuming art, are all activities that give me pleasure.
Activities of mastery give us a sense of accomplishment and achievement. We feel that we are developing ourselves and moving closer towards an important goal. When we engage in activities that give us a sense of mastery, we experience our lives to be rich in meaning. Checking things off a to-do list gives me a sense of accomplishment. So does making strides at work, and taking a course, or studying.
5) Make some changes to your list.
Oftentimes, patients recoil in horror when they realize that their lists contain only depleting and neutral activities. There are no activities in their day that nourish them: either through pleasure or self-development. I ask them:
Are there any depleting activities that you can stop doing?
Are there more nourishing activities that you can start doing?
How can you make a depleting activity feel more nourishing?
Self-care and self-compassion are the agents through which we answer these questions.
6) Set healthy boundaries.
Before we can reduce the invasion of depleting activities in our lives, we must learn to prioritize our needs. Many of us put others’ needs first. We ignore the advice of every flight attendant—we put on everyone else’s oxygen mask before our own. Before long, we run out of air.
In order to nourish ourselves, we need to learn to create healthy boundaries around our energy and time; we need to say “no.” Author Cheryl Strayed writes, “No is golden. No is the kind of power the good witch wields… [It involves] making an informed decision about an important event in your life in which you put yourself and your needs and your desires front and centre.” When we say no to the people, activities, commitments, and responsibilities that drain us, we say “yes” to ourselves.
Think of your list of depleting, nourishing and neutral activities. What activities, if you could just say “no” to them, would bring you immense relief? What would saying no to those activities allow you to say yes to instead?
7) Recognize perceived stress.
Whether or not external events elicit a stress response in our body depends on our perception. Stressful events are woven into how harmful and uncontrollable we perceive them to be, rather than their intrinsic capacity to cause us harm.
Our perception of stress can be influenced by biochemical factors, such as our levels of neurotransmitters, and hormones. It can also be influenced by our mindset, our capacity for resilience, and how far into burnout we’ve begun to drift.
Lowering our perception of stress requires that we practice the skill of mindfulness: being aware of how external situations affect our thoughts, emotions, body sensations, and behaviours. It also requires that we pay attention to our internal physiology: our hormones and circadian rhythms, and inflammation levels, to support our body’s physical capacity to deal with stress.
8) Practice Mindfulness.
A tarot reader friend of mine once said, “It is impossible to be healthy in this day and age without mindfulness.” She was probably right.
Mindfulness helps us lower our perception of stress. It is the act of bringing attention to the present moment, intentionally, without judgement. Through mindfulness we can be intentional about our behaviours: how often we exercise and what it feels like, what certain foods feel like in our bodies, and what activities we engage in.
Mindfulness also allow us to parse out our overwhelmed, worried, personalizing, catastrophizing, black-and-white, future-telling, and negative, thoughts from our body sensations and emotions. We realize that our thoughts are just that—thoughts. Thinking something doesn’t necessarily make it so.
Research shows that mindful meditation strengthens the connections between the rational brain and the emotional brain. It helps us develop awareness of our moment to moment experience. It connects us to our bodies and our emotional states.
There are many different mindfulness techniques. You can do sitting meditations, standing meditations, and walking meditations. You can do mindful yoga. You can wash the dishes mindfully.
However, the simplest way to begin a mindful practice is to sit or lie down in a comfortable position, with an relaxed and alert posture, and focus on the experience of breathing.
Focussing on the breath helps us practice bringing our awareness to the present moment. As we learn to ride the waves of our breathing, we eventually learn to ride the waves of stress that sometimes lap gently at our floating bodies, and other times rock us to our core.
With mindfulness we can begin to relax our resistance to the waves. As Jon Kabat Zinn says, “You can’t stop the waves, but you can learn to surf.” Mindfulness is the surfboard that carries you.
9) Practice self-soothing.
Self-soothing helps us regulate our emotions in the presence of external stressors. Dialectical Behaviour Therapy teaches self-soothing as a means of returning to the “Window of Tolerance”.
When we’re in the Window of Tolerance we’re not in fight, flight or freeze. We aren’t depleted, disconnected and dissociated. We feel relaxed and safe, but also alert and focussed. We are present, in control of our bodies. Self-soothing allows us to enter the window of tolerance by boosting the hormone oxytocin, which helps us feel calm, nurtured, and connected.
To boost oxytocin:
Lie or sit in a comfortable position, place your hands on your chest and breathe slowly and deeply.
Connect deeply with a trusted other: a person in your life, a pet, or an entity (God, your higher self, a deceased loved one, etc.).
Use body weights or heavy blankets on your body.
Recite believable affirmations of self-love.
Ask someone you trust for a hug.
Boost pleasure through engaging the senses: listen to soothing music, savour delicious food, look at beautiful images, touch soft fabrics, and use aromatherapy and calming essential oils, like lavender.
Poet Mary Oliver tells us, “You do not have to be good… You only have to let the soft animal of your body love what it loves.”
Self-soothing requires practicing mindful awareness to recognize if you’re slipping outside your Window of Tolerance. It also involves implementing nourishing rituals that “the soft animal of your body” loves, to release oxytocin, and return to feelings of calm.
10) Balance blood sugar to balance your mood.
Our blood sugar is complexly intertwined with our other hormones, like insulin and cortisol, but also our neurotransmitters, like serotonin, epinephrine and dopamine, which influence our mood.
More than 1 in 3 American adults has pre-diabetes. This indicates an impairment in our body’s ability to control blood sugar, which throws mood and hormones off balance.
One of the main life-saving actions of the body’s stress response is to regulate glucose in the blood. Fluctuations in blood sugar can trigger cortisol and stress hormone release. Stressful events can also wreak havoc on our body’s ability to control blood sugar. Regulating blood sugar, therefore becomes a priority for managing our body’s internal stress cues.
To balance blood sugar:
Eat a full 20 to 30 g serving of protein and healthy fat at each meal.
Eat a large, protein-rich breakfast that contains at least 200 calories’ worth of healthy fats: 1 avocado, a handful of nuts or seeds, coconut oil, full fat yogurt or kefir, 3 eggs, etc., within an hour of waking.
Eat snacks that contain 10-15 g of protein. A great snack for balancing blood sugar is a 1/4 cup of pepitas, or raw pumpkin seeds. Rich in protein, fibre and healthy fats, they also contain zinc and magnesium, two important minerals for balancing mood and supporting stress hormones.
Ensure that every meal contains gut-loving fibre: eat 2-3 cups of vegetables at every meal.
Avoid refined sugars and flours wherever possible.
Experiment with Time-Restricted Feeding, leaving at least 12 hours of the day open where you consume only water and herbal teas, to give the digestive system a rest. For example, if you have breakfast at 7am, finish your dinner by 7pm, to allow 12 hours of fasting every night.
11) Calm your stress response through healing your circadian rhythms.
The body’s stress response is tightly connected to our circadian rhythms. Cortisol, the stress hormone, follows a predictable daily pattern, rising within an hour of waking in the morning, and then falling throughout the day. Low cortisol levels at night coincide with the rise in melatonin, our sleep hormone.
Morning fatigue, afternoon crashes, and waking at night, all point to a flattened or altered stress response that has negatively impacted our body’s circadian rhythms. Sleep is also the greatest reset for the stress response. We build up our metabolic reserve and internal stress resilience every night when we rest.
To heal your circadian rhythms:
Expose yourself to bright, natural daylight soon after waking.
Eat a large, fat and protein-rich breakfast within an hour of waking.
Avoid exercising too close to bedtime.
Keep blood sugar stable.
Practice sleep hygiene: keep your bedroom dark and cool, and reserve your bed for sleep and sex.
Avoid blue light after 7 to 8 pm. Wear blue light-blocking glasses, use a blue light-blocking app on your devices, such as F.Lux, or simply avoid all electronics in the evening, switching to paper instead.
Try to get to bed before midnight, as the deepest sleep occurs around 2 am.
Talk to your naturopathic doctor or natural healthcare professional about melatonin supplementation or other natural remedies to help reset your sleep cycle.
12) Manage Inflammation and nurture your microbiome.
Cortisol, the stress hormone, is an important anti-inflammatory. High levels of inflammation have been associated with mental health conditions like depression and anxiety.
Keeping inflammation levels low not only reduces our need for stress-hormone-signalling, but keeps us healthy. Most chronic conditions, like cardiovascular disease and diabetes, are associated with inflammation.
To keep inflammation levels low:
Eat a variety of anti-inflammatory colourful fruits and vegetables.
Avoid processed oils like soy and corn oil, whose omega 6 fatty acids are known to contribute to inflammation.
Eat healthy fats from avocados, fish, coconut, olives, nuts, seeds and grass-fed animals.
Avoid processed foods and fried foods wherever possible.
Nurture your gut health by eating lots of fibre, and consuming fermented foods, like kefir and sauerkraut.
Our gut is the seat of the immune system. Keeping it healthy is a powerful preventive measure for keeping inflammation levels low. Our gut bacteria also play a role in our mood and stress-hormone regulation. Therefore, keeping them healthy and happy is essential for boosting our internal resilience against external stressors.
13) Recognize that balance doesn’t exist.
None of us are born cool and collected. Those of us who seem to “have it together” are simply quick to respond to life’s tendency to fall apart. Balance doesn’t exist; as soon as we feel like we have the details our lives lined up, a sharp gust of wind sends them tumbling in all directions. Therefore prioritizing self-care becomes an ever-evolving balancing act that we must commit ourselves to through nurturing our internal resilience.
A poem by Kelly Diels says it best, “when your love knocks you down or your weak ankles trip you up, stop worrying about balancing—‘cuz you’re not — and bounce.”
Prefrontal Cortex: …Right, so the deadline for the article is Monday. I can work on it tomorrow morning, but then I also need to schedule time for grocery shopping—what am I going to make for the week to eat? There’s a giant load of laundry in the bin too, which I should get to, maybe I can squeeze that in while I’m writing. Laundry is such an involved process sometimes… I also have that doctor’s appointment on Thursday, then I there’s that package I have to pick up at the post office, and I have to mail out my passport for—oh, right, we needed the bathroom—
Amygdala: Good God, NO!!!! OH IT’s THE END OF TIMES! THERE’S A THING there! A crawly, thing, so many legs, evil legs. We’re going to die!!!!!
PFC: It’s a centipede. Trapped in the bathtub.
A: What’s a centipede?! It looks like an alien. Those legs will crawl up our legs, into our mouths, eyes, under our skin—
PFC: Centipede’s don’t do crawl under your skin. I believe that’s…uh, scabies? Centipedes are relatively harmless. Besides, this one is extra harmless; it’s trapped in the tub. Look, see how he’s struggling to get out? He can’t. Poor guy… It reminds me of a time when I felt helpless…
A: It needs to die, we need to kill it, we can’t go on like this!!!
PFC: What, with a centipede in the tub?
A: It’s LEGS. They’re hideous, it crawls, it’s fast. Oh, God, I hate it. We need to call someone.
PFC: We can’t call someone. We’re a strong, independent 30-something woman. We’ve handled massive spiders as big as our heads in the Amazon, giant Caribbean cockroaches in our granola—
A: LOOK AT IT. It keeps moving… Oh god, I hate it.
PFC: It keeps moving because it’s trying to get out of the tub.
A: AND CRAWL ON OUR FACE. LOOK AT IT’S BILLIONS OF DISGUSTING LEGS!
PFC: Why discriminate against something that has many legs? Hindu gods have an extra set of arms and they’re divine. Remember all the times we wished we had another set of arms so we could hold grocery bags while looking for our keys and texting?
A: THAT’S DIFFERENT THIS… MONSTER—
PFC: —centipede.
A: CENTIPEDE… can’t text. It has nefarious plans for us once it gets out of its white, porcelain prison. WHAT ARE WE GOING TO DO?
PFC: Well, we could just leave it there… he doesn’t seem happy in the tub, though…
A: WE’LL NEVER BE ABLE TO BATHE AGAIN! WHAT IF IT CRAWLS OUT?
PFC: It can’t crawl out. Ok, you’re right, we can’t leave it there. The noble thing to do would be to scoop him out and put him in the garden.
A: NOOONONNONONNONONO GOD NO WE’RE NOT TOUCHING IT!
PFC: Why? It’s small, harmless. It’s trapped. We could use a water glass and a card, or book…
A: NO, NOT THE BOOKS, WE DON’T PLAY CARDS WE’RE NOT TOUCHING IT.
PFC: We could… kill. it.
A: OK OK OK!!! HOW?! How?
PFC: Well, we could squish it? Flush him down the drain? I feel like that goes against our moral principles. And, I’d also have to conclude that, quite frankly, it would be an act of cowardice, the ethically inept thing to do—
A: —which option requires the least amount of touching it and squishiness?!
PFC: Flushing. But it will also result in a slow, agonizing death for the poor creature, who we have decided to persecute for simply being in our tub, and for possessing many legs. I’m not sure of the extent to which a centipede feels pain and suffers, though. I mean, does it suffer like we do? Suffering, after all, is often in the stories we tell ourselves about our expectations and identities, our beliefs about what should be and what we deserve, rather than what is. I don’t know if centipedes have identities or expectations but, if we flush him, he’ll struggle, which means he is resisting what is, which is suffering. Causing suffering to another being is wrong. We can also clearly observe that he prefers to stay alive—
A: SHUT UP AND DO IT! FLUSH HIM!
PFC: It would be wrong. We’d feel bad about it. I would, you would. Let’s put him in the garden, please?
A: NO NO NO FLUSH PLEASE.
PFC: Let’s just leave him, pretend he’s not there and come back later.
A: What if he gets out? Crawls on our face while we’re sleeping?
PFC: I don’t think that’s likely. I think he’s trapped in there.
A: He’s going to die eventually let’s kill him, get rid of him!
PFC: Eventually, like you mean at the end of his lifespan? That’s true. I’m not sure how long centipedes live… It’s also cold outside, I don’t think putting him in the garden would do any good. He obviously came in to escape the cold. We’re seeing more centipedes inside now as the weather changes.
A: OH STOP REASONING and just do it!
PFC: …. ok.
….
PFC: Amygdala, it’s done. It was horrible, we’re horrible brain areas. Are you happy? You don’t have to worry about it anymore. I also made sure I let plenty of water flush down the drain so he can’t crawl back up, even though highly unlikely, I knew you might have something to say about that… Amygdala?
A: …
PFC: Amygdala? You’ve… gone quiet.
A: So how are you going to get your article written, laundry done, groceries bought AND cook something for the week? You also made plans with your friend this weekend and you need to shower in the centipede-infested bathroom, and CLEAN the bathroom, it’s filthy. You’ll never get it done… Fear, dread, overwhelm! IT’S THE END OF TIMES!
I talk about root causes of anxiety, the most common mental health condition, and what to do about it from a functional medicine perspective.
Hi, everybody, Dr. Talia Marcheggiani here. I’m a naturopathic doctor who practices in Bloor West Village, in Toronto and today I’m going to talk to you guys about the roots of anxiety.
Anxiety is the most common mental health condition. It affects about 18%of North Americans and it encompasses a wide range of different diagnoses including generalized anxiety disorder, panic disorder, OCD, phobias, PTSD and depression, and social anxiety. It’s a huge umbrella of different conditions. So the first thing I do when I meet my patients is try to understand how anxiety manifests for them. The word anxiety means very little to me. What I care about is how the symptoms are manifesting in my individual patient in front of me and how it affects their life. So, I’ll ask them what does it mean when you tell me that you have anxiety? Walk me through a situation when your anxiety gets triggered, tell me what it’s like to live inside your shoes, inside your head, what kind of things do you worry about? What goes on in your body? And, how do you know that you have anxiety? Did you decide that you had that diagnosis or did someone else give it to you and what do you feel or think about having that diagnosis? Do you agree with it? Do you disagree? Do you have any doubts? The symptoms of anxiety encompass the body because it affects our nervous system, every single bodily organ is affected, potentially, by anxiety and some people have some of the symptoms or all of them and sometimes very few, just the mental and emotional symptoms, and many of us don’t even identify with having chronic anxiety or anxiety disorders or anxiety symptoms.
First of all, we have the mental symptoms. People with anxiety will commonly experience worrisome thoughts, anticipatory anxiety, so, being worried about the immediate future or the distant future. They might feel irritable or excited, they may have depressed mood. A lot of the people I see with anxiety have this kind of “chilled out” demeanour because it’s very common for someone who’s got a high level of anxiety in their body to dissociate a little bit from those feelings and appear very calm. They kind of describe it as a duck on a pond. On the surface, you see this calm animal, just floating along, but when you look under the water you see the duck legs busily working away and so that’s how a lot of people will describe their mind. They say, on the surface I’m really calm, but once you look under the surface, you see that there’s a lot of mental activity and a lot of worry that’s happening.
There may be fears, such as specific fears, such as phobias, or just general fears, like in the case of generalized anxiety disorder, or fears may be triggered in certain situations like in the case of social anxiety. Insomnia is very common, an overactive and busy mind is very common, fatigue is another common symptom as well as difficulty concentrating, memory loss, brain fog. So all of these conditions that show that the person who’s experiencing anxiety and who is dealing with anxiety is distracted and focused on other things, rather than what’s right in front of them. So a lot of the time my patients will describe an inability to feel present and feel connected and enjoy the moment. Their mind is always on something else. Sometimes the anxiety is based around specific concerns and sometimes it’s just very general and it doesn’t really matter what’s going on in someone’s life, there’s this sense of impending doom that they’re dealing with on a daily basis. Anxiety and depression are very common, they’re comorbid mental health conditions, and it’s very difficult to tell the difference a lot of the time. There’s a hypothesis that they’re similar conditions, or the same condition, but one is a more extraverted, so that would be anxiety, version of depression, which is a more introverted and internalized manifestation of the same disease process. This is still a hypothesis, but it makes some sense and it resonates with a lot of people that I talk to.
Then we have the bodily symptoms of anxiety. A lot of people will experience muscle tension, aches and pains. This is typically in the shoulders where they carry their worries or they’ll find themselves tensing their muscles without being aware of it. They may experience twitching, and they experience pain from the tight muscles. There’s also sensory symptoms, such as ear ringing, hot and cold flushes, changes in vision, tingling, numbness, muscle cramps. It’s very common to have cardiovascular symptoms, such as a racing heart or heart palpitations and this often occurs in people who have panic attacks, which often sends them into the emergency room, because it can be difficulty breathing, racing heart, chest pains, sweating, all these kinds of autonomic symptoms that one might experience if they were having a cardiovascular event, can occur in someone with anxiety or panic disorder. It can be really frightening.
Then there’s gastrointestinal symptoms, so there’s definitely a connection between IBS and anxiety. And those of us who don’t necessarily suffer from anxiety but have experienced nervousness, which I’m sure we all have, will notice that our gut is definitely affected and we may have looser bowels, bloating, difficulty digesting, or we might not have an appetite or want to eat. And this all common in people who have chronic anxiety. Genitourinary symptoms, such as frequent urination, or frequent thirst, often leading people to think that they have diabetes. Also, there might be a delay in urination, so you feel like you have to go to the washroom, you go to the toilet and then there’s a moment where you can’t really go, and you’re trying to wrestle with yourself, which is really common. So urinary hesitancy, it’s called. And then we have the autonomic, so the symptoms that are related to the autonomic, or automatic, nervous system, such as a dry mouth, dilated pupils, sweating or flushing, and this also related to our GI symptoms.
So, these are just a few of the anxiety symptoms. And, as you can see, they affect pretty much every single system in the body. Our nervous system, which is what is affected in anxiety, consists of our brain, our spinal cord and all of our nerves. Nerves that go to and from different body organs and our nervous system is divided into the voluntary and the involuntary, or autonomic, nervous system and our autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. So our sympathetic nervous system is the “fight or flight” nervous system. This gets turned on when we sense an immediate danger and our body is primed to respond to that danger.
The parasympathetic nervous system is turned on when we’re sleeping and digesting, and when we’re a state of otherwise calm, when there is no danger around. You can think of these two systems as a seesaw. One gets turned on while the other gets turned off and our body should be able to toggle back and forth between these two arms of the autonomic nervous system easily and without getting stuck in either one and depending on the situation and what’s going on. So imagine that you’re walking through the forest, and you’re feeling calm, and you’re feeling at peace, and then you look down at what you think is a stick on the ground that starts to move, your autonomic nervous system is going to kick you into the sympathetic, fight or flight, response. In this response your body will be primed to either fight, flight, run away, or freeze. And these three responses are what will get us away from the danger or meet that impending danger and this is what our body will respond with in order to ensure our survival when there are dangerous situations that we’re faced with.
Once that danger’s gone, we’ve either fought, flown, or frozen and the danger has forgotten about us and left, we’ll return to the parasympathetic nervous system. We need the parasympathetic nervous system turned on when we’re eating and when we’re sleeping. If we have problems, so if we get stuck in that fight or flight response for too long, either because we perceive there to be danger, or our body simply can’t switch back into the parasympathetic state, we’re going to have problems with feeling relaxed, sleeping soundly, and digesting our food properly.
Those of us who are experiencing chronic stress, our nervous system is just taxed, and we’re in the sympathetic nervous response far longer than we should be, because we’re constantly facing deadlines, or we have a lot more responsibility and a lot less control, on our plate, we’re going to experience this feeling of chronic stress. This will exacerbate someone who’s already got a predisposition towards anxiety. There’s a hypothesis, or personality theorists hypothesize that some of us are just born with a higher level of neuroticism as part of our constitutional tendencies. So I see that a lot of anxiety will run in families, especially in female patients, many of them will have grown up with a mother who suffered from anxiety. So there’s definitely a nature component to the nature-nurture debate in terms of what causes anxiety. So, while we can’t really affect our nature, or our genetics, we can affect how those genes are expressed and we can look at the environmental factors that might trigger those genes to be expressed. So that’s what I’m here for. My goal as a naturopathic doctor is to take a full assessment, understand what someone’s symptoms of anxiety are, what the external factors, the environment of their life is like, and look for potential causes that might be exacerbating the anxiety, making it difficult for them to function and perform and live the life that they know they can live. Living a life that’s full of abundant health.
So, the first cause that I want to talk about is chronic stress. when we’re stressed out, like I described when we encounter that snake in the grass, our body will release hormones called norepinephrine and epinephrine. Those are our fight or flight hormones. Those are short-lived, and when those run out, our body starts to make cortisol. Cortisol is a more long-term stress hormone. However, when we’re stuck in that sympathetic state our body becomes, well a theory is that our body becomes unable to produce as much cortisol for long periods of time, that our adrenals get “fatigued”. Another theory is that our brain stops responding to cortisol and we develop a kind of cortisol resistance. And this we’ll see with a lot of brain fog, memory loss, difficulty concentrating, there’ll be a lot of weight gain, especially around the abdomen, and people will experience a lot of inflammatory symptoms, so that’s when we’ll see joint pain and muscle aches and, potentially, worsening of depression as cortisol can kind of motivate us and get us going, because, if you think about it, when we’re in a state of fight, flight or freeze, that’s an action-oriented state, once our body stops responding to that, we enter this kind of burnout and exhaustive phase.
What’s more, once our body stops responding to cortisol, in order to maintain that sympathetic tone, to stay in that fight or flight state, that for whatever reason our body is turned on to, we start to make those catecholamines, norepinephrine and epinephrine again and that contributes to those symptoms of anxiety. So essentially what anxiety is is a high cortisol, high norepinephrine state, where we have that racing heart, we have those tense muscles, we’re looking for danger and our body, for one reason or another, expects that there’s some kind of danger that it needs to defend itself against.
So, not all stress is bad stress. You think of a new mom, she’s full of love and all these feel-good hormones, but the lack of sleep, the added responsibility, all of the things that having a new baby might mean to her and her life, are going to contribute to more stress hormones going through her system. And so I’ll ask a lot of my patients if they’re stressed and, even though I’m kind of getting a sense of high stress from them in terms of their level of busyness, and their level of downtime and just the demands on them in their day-to-day life, a lot of them will say that they don’t feel stressed, that they love their job. So it’s not about whether you love your job, or whether or not you love the things that are, basically, getting piled onto your plate, it’s your body’s perception of those things. So, our body does well when it has enough down time, it has enough restful sleep, and it gets enough breaks. So that keeps that toggle from the sympathetic nervous system, to the parasympathetic nervous system, fluctuating in a healthy way, without getting in one or the other.
Another common cause of anxiety that I see, or definitely a factor that exacerbates anxiety symptoms, is blood sugar imbalance. So, when we wake up in the —a lot of us wake up in the morning and we have cereal, or we have those packaged oatmeals. So, in North America we eat high-carb, high-sugar breakfasts, or we skip breakfast, or we just eat a lot of carbs and sugar in general throughout the day. When you eat a food that’s high on the glycemic index, that contains a lot of easily digestible carbs or refined flours and sugar, we get this immediate spike in blood sugar, as those sugars are absorbed directly into our blood stream. When we get this high level of sugar, we might feel a lot of energy, we might feel really good, we get a lot of dopamine release, and it feels pretty awesome, we get a lot of immediate energy that our body can use. But then, because our body wants to maintain a certain level of blood sugar, what gets released next is a hormone called insulin. Insulin helps that glucose, that sugar, get inside of our cells, where we can use it for energy. If our blood sugar shoots up too high our body sends more insulin into the blood stream to lower that sugar. Sometimes it sends too much insulin and our blood sugar plummets, we get hypoglycaemia symptoms: dizziness, “hangry”, irritability, weakness, fatigue, you’d kill someone for a piece of toast kind of situation, and carb cravings, and we respond by eating more carbs and the cycle begins again. That can exacerbate anxiety because our energy levels are going to be rising really quickly and falling really quickly. Stress hormones are going to get triggered everytime we enter a hypoglycaemic state. And, because cortisol also releases sugar into the blood, so cortisol and insulin work together. Going through this eb and flow of blood sugar, basically riding the blood sugar rollercoaster, is going to exacerbate and mimic a lot of the anxiety symptoms that I described. So a lot of people I talk to, when they’re experiencing anxiety, oftentimes, during the day when they’re experiencing anxiety, it’s between meals, or it’s after a high carb, high sugar meal. And, so a big part of managing their anxiety, or at least creating a terrain where their mental health can function optimally, and their emotional wellness has a chance to function optimally, is to get their blood sugar nice and level. And this means adding protein and fat to every single meal, lowering those refined carbohydrates, beginning each day with a high-fat, and high-protein breakfast. Nutrient deficiency is another really big cause that I look for when it comes to anxiety. So, the happy hormone, serotonin, which is implicated in both depression and anxiety, that’s what the antidepressant and anti-anxiety drugs like cipralex or prozac act on, so those selective-serotonin re-uptake inhibitors. This is a hormone that gives us a feeling of satisfaction, it gives us a feeling of uplift, it’s often what tanks when we crave carbs, and so eating carbohydrates kind of perks our serotonin levels up. In order to make serotonin, we need an amino acid called tryptophan, which we get from protein, and we need the vitamins B6, magnesium, B12, and zinc, and iron. And those take tryptophan and turn it into another amino acid called 5HTP, which then gets turned into serotonin. And then, once we have enough serotonin, that gets turned into melatonin, which helps us sleep and regulates our circadian rhythms. So any break in either of those pathways is going to result is us having lower levels of serotonin and melatonin available to our nervous system for us to have proper mental and emotional regulation. When we’re stressed out, our demand for those nutrients goes up, because our adrenal glands are also sucking in a lot of those nutrients to make cortisol and the catecholamines. Protein is super important, not just for blood sugar regulation, but to give us the amino acids that we need to make the proper neurotransmitters. So, I mentioned serotonin, I also mentioned norepinephrine and epinephrine and other ones include dopamine, GABA, which is a nervous system calming neurotransmitter, glycine, another nervous system calming neurotransmitter, and a good source of glycine is collagen, or gelatin, which I’ve mentioned in other videos. See the “8 Foods for Mental Health”, and tyrosine, which makes dopamine and also makes the catecholamines. So we need tryptophan, which makes serotonin and melatonin, we need GABA, which makes GABA, and that calms our nervous system down, we need tyrosine, which makes dopamine, this is a feel-good hormone that helps us seek rewards and feel motivated, and energized, also tyrosine gets made into thyroid hormones, again, which helps us feel energized and keeps our energy levels stable and our metabolism revved up, and the catecholamines, norephinephrine and epinephrine, which we need for that fight or flight response and that we’re going to be burning through a lot more quickly when we’re in that fight or flight response. And then glycine, another nervous system-calming amino acid. And glycine also helps balance the nervous system. Typically we don’t suffer from protein deficiency in North America, but I see it more and more, especially low-quality sources of protein. So, chicken nuggets, yeah they have chicken in them, but they only have about 10 grams of protein and a ton of trans fats and a lot of processed carbohydrates. So, although we might be eating hamburgers and chicken fingers and omelettes on waffle, we’re not necessarily getting enough good sources of protein. So, ensuring protein from things like legumes, nuts and seeds, clean animal products, fish, like salmon, and white fish, are all really important and I often suggest people get 30 grams of protein per meal, so three times a day, but it depends on your weight, it depends on your energy demands and it depends on your lifestyle and how stressed out your are, because our demands for protein definitely go up during stress. It also depends on how level your blood sugar is and if you’re getting those hypoglycaemic symptoms, sometimes those people need to increase their protein, while decreasing some of the carbohydrates, especially those refined carbohydrates, and give their body more fibre-rich carbohydrates that the body has to work harder to extract and release into the bloodstream. Another really common cause, or contribution, or exacerbation to anxiety is iron deficiency. So I see this a lot in menstruating women. It’s not super common in young men to have iron deficiency, but women who are menstruating every month, especially women with heavy periods, and who are experiencing fatigue, definitely need to get their ferritin levels tested. So, ferritin, in our blood, will tell us what our iron stores are like. So, how much iron we have available to our tissues. Iron is useful for participating in lots of different chemical reactions in the body, as part of normal metabolism, but it’s also important for caring oxygen to our tissues and oxygen is what we need in a process called oxidative phosphorylation, which gives us energy. So, no oxygen, no energy. And what will happen is, if we lower levels of iron in our blood and lower levels of oxygen, our heart starts to beat faster in order to send more volumes of blood to our tissue. So, it figures, if, with each heartbeat, i’m not sending as much oxygen, if I just double up my heartbeats, I might send double the amount of oxygen and try to meet the demands of the tissues that I’m sending oxygen to. You can kind of figure out, then that quick heartbeat mimics those heart palpitation symptoms of anxiety and can trigger some anxiety symptoms. Iron’s also go this grounding affect. It gives us this nice, level energy. And there’s a very specific feeling to iron deficiency fatigue that a lot of women may have experienced. It’s not quite like a sleepiness, or a lethargy, it’s a very specific feeling of just depletion. So it’s important to get ferritin checked and then find a kind of iron that you can take every day to build your levels up, at least for a few months, and one that’s easily absorbed.
So, another reason why iron might be low is in the case of leaky gut, or malabsorption syndrome, so this can occur in somebody with inflammatory bowel disease, or celiac disease, where the intestinal cells are just not able to absorb as many nutrients, or somebody with IBS, so, just generally sluggish digestion, inefficient digestion, perhaps a lack of stomach acid, or a lack of those digestive enzymes that help us absorb our food. IBS and leaky gut are other common symptoms and causes of anxiety. So it’s kind of a chicken or an egg situation. Our gut bacteria produces serotonin, dopamine. We’ve got about 5 trillion in our gut, and that’s about 10x more cells than we have in our bodies. For the most part, when it comes to a cell-to-cell basis, we have 10x more gut bacteria than we have cells. So we’re more gut bacteria than us. Our gut bacteria, there’s good ones, there’s bad ones, we haven’t been able to isolate all of them, there’s very little, relatively, that we know about the microbiome, but a lot more research is coming out, especially in the area of mental health. We know that these gut bacteria can make their own neurotransmitters. They can even specifically ask for food, so a lot of people with sugar cravings have a dysbiosis going on where the gut bacteria need those refined carbohydrates and that sugar, in order for them to grow. And so they’re sending out ghrelin, or hunger-stimulating signals to try and get us to eat more sugary foods. Our gut bacteria also make most of the serotonin in the body and our gut cells also make most of the serotonin in the body. So if we have unhealthy gut cells, they’re not going to be able to regulate our nervous system. And if we have an imbalance in gut bacteria, again we won’t be able to regulate our nervous system, because we won’t be producing those neurotransmitters that we need to balance and to be able to toggle seamlessly between the parasympathetic and sympathetic nervous systems. The gut is also where a lot of our immunity lies. And our immune system is going to be the cause of low-levels of inflammation, especially if there’s a little bit of autoimmunity or food sensitivities, or allergies going on. Low levels of inflammation are going to affect our brain. So there is a hypothesis that depression is caused by low-grade inflammation in the brain. We don’t have pain receptors in our brains, so we ‘re not able to detect inflammation in the way you would with an inflamed knee. If you injured your knee or had arthritis in your knee, and you would notice that your knee was red, and swollen and it would hurt to touch and you wouldn’t be able to walk on it. We don’t get those symptoms in our brain because of the lack of pain receptors and so how brain inflammation might manifest is brain fog, difficulty concentrating, depression, anxiety, mental chatter, negative self-talk, negative thoughts, those symptoms that are really common, mental symptoms, in something like depression and anxiety.
There’s a lot more we need to research about this, but there’s something called LPS, lipopolysaccharide, that’s produced by some of the “bad” gut bacteria. When rats were injected with lipopolysaccharide, or when human volunteers were injected with lipopolysaccharide, we mimic the symptoms of depression. When those same patients and rats were given EPA, which is a very anti-inflammatory fatty acid that’s from fish, marine sources like salmon and sardines, the depression symptoms went away. There’s also some studies in depression with prednisone and corticosteroids, which lower inflammation really rapidly. They come with a host of side effects, so that they’re not that great of a remedy for depression, but they actually lowered depressive symptoms. There’s a lot of a connection, that we’re noticing, between inflammation and depression and anxiety and we’re just not sure to the extent that inflammation causes depression. I tend to think that, probably most cases of depression and anxiety have some kind of inflammation present, especially when we consider that just chronic, turned on, sympathetic nervous system and high levels of cortisol is going to contribute to a cortisol resistance in the brain and increase neuroinflammation, especially in the hypothalamus.
We also know, as I mentioned before that symptoms of anxiety and symptoms of IBS often go hand in hand. And so, a lot of the anxiety symptoms that people will get are looser bowels, bloating, loss of appetite, just difficulty digesting their food. And a lot of symptoms that people with IBS will get are anxiety. And one of the treatments for IBS are selective-serotonin re-uptake inhibitors, which, you guessed it, are also drugs that treat anxiety.
So another common cause that fits really well into my practice, my focus is on mental health and hormones, and these two areas overlap, probably more than they don’t overlap, it hormonal imbalance. So, especially in women, men have their own host of issues when it comes to hormonal imbalance, but women, because our hormones are cycling and going through different phases all month long, we’re more susceptible to problems with proper hormone regulation, especially in the face of female endocrine disorders such as PMS, PMDD, PCOS, all of the acronyms, endometriosis, fibrocystic breasts, and just dysmenorrhea, so painful and heavy menstruation, or irregular cycles. So all of these point to symptoms of hormonal imbalance. Estrogen and progesterone are the two female hormones and they do have effects, yes on the ovaries, and they control ovulation, they control building up of our uterine lining and shedding of the uterine lining, when those two hormones fall away, and that causes our period to occur, so they definitely control our fertility, but they also have affects on other tissues in the body. One of those tissues, one of those organs, is our brain, our nervous system, so estrogen can work a little bit like serotonin and, so what you might notice, right before your period when your estrogen levels drop, or women that are going through menopause and have a drop in estrogen levels, is you’ll get irritable, you’ll get depressed, and you’ll crave carbs like crazy. And a lot of women get something called premenstrual dysphoric disorder, where they have fluctuations in their estrogen levels. So, lowering of estrogen, or insufficient estrogen, may cause some of those more depressive anxiety symptoms, progesterone acts like a GABA agonist, which, I mentioned before, is a calming neurotransmitter. So, lower levels of progesterone, and I see this in a lot with women who have something called “estrogen dominance”, I have another video on this, and women with PCOS as well, and women who have high estrogen symptoms, or conditions such as endometriosis and fibroids, and fibrocystic breasts, and those kind of symptoms, or conditions where estrogen levels tend to be high, and progesterone levels tend to be low or deficient, they’ll often have anxiety with these symptoms. And lower levels of progesterone, especially premenstrually, often are related to low mood and anxiety, and cravings. So, looking at hormones, especially when the patient sitting across from me has a lot of menstrual issues, and irregular cycles and all of the other things I mentioned, I’ll definitely look into hormones and promote proper estrogen detoxification and building up of progesterone. A common cause of low progesterone is being in that fight or flight state. So, now I’m starting to reveal how this web interconnects, how everything is tangled together and how cortisol and blood sugar all relate to everything. So, cortisol, it uses the same precursor to make progesterone, and, when our body needs more cortisol, it will steal progesterone from the system to make cortisol. Because our body has to prioritize sometimes, and getting away from that snake in the grass, and saving our life is more important than making babies to our body in the short-term. So, we suffer in the long-term if that snake in the grass never goes away and we’re always kind of worried about juggling all the things in our lives. But a lot of women who are chronically stressed, or are in that sympathetic nervous state, will have lower levels of progesterone, so doing a lot of adrenal support is one of the ways that we help their bodies build up some progesterone.
And then, finally, I think I mentioned before, there’s a reason that we have anxiety, it’s not an irrational fear. A lot of the time when I sit across from patients, the things that they’re worried about are legit things to worry about. Maybe they’re out of work, or there’s financial worries, maybe there’s just so much on their plate that it’s difficult to find any time for themselves, or make ends meet, maybe they’re unhappy with their career, they’re relationship is in jeopardy. There’s all kinds of things that people deal with on a daily basis. And then, that being said, there’s also people who are just primed to be more neurotic than others, based on that spectrum of neuroticism in terms of personality and constitutional predisposition. And I think we know this, there’s some people who are just a little bit more anxious than others and that diversity in human personality probably helped us evolutionarily and so I think there was obviously an evolutionary advantage for someone who’s nervous system was a bit more responsive. Those people could get away from danger, they were expecting danger more often, and they probably ended up surviving and passing their genes on to their ancestors more readily than those who were way too laid back and didn’t think about danger and got themselves into risky situations.
So, those who are a little bit more neurotic may be predisposed to negative thinking, over-estimating the negative outcomes of certain events or maybe engaging in critical self-talk. Especially in the case of post-traumatic stress disorder, PTSD, there’s definitely a connection between early childhood trauma, or just trauma in adulthood, some of these experiences can teach us to turn our nervous system on, or to get triggered more easily as a way of surviving in the future. There’s different areas of psychotherapy that deal with these phenomena, and they term them different ways, but they can be called core beliefs, or certain mental schemas, so when our brain experiences very strong emotions, the amygdala wires those emotions down in implicit memories. They’re really tightly wired and those memories get triggered again whenever there’s a situation that reminds us of the situation that wired down those responses. It might be a certain smell, or a certain sound, or a certain song, something that activates those memories, that may not be conscious, because the amygdala is pre-verbal, will trigger those feelings of fear and prime our body to respond. And the problem is that we’re surrounded by potential stimuli all the time that can trigger that. And so, really understanding what triggers anxiety symptoms, where those triggers may have come from, and bringing those memories up to the cognitive, cerebral cortex and rational mind, so that we can help dissolve those memories, is a big part of psychotherapy and how we manage anxiety with psychotherapy. Especially if we think the cause of anxiety may be related back to some sort of childhood trauma or implicit memory that was consolidated.
Those are some root causes of anxiety that I would look for as a naturopathic doctor, among many others. What an intake will look like is a 90-minute conversation with the person in front of me where I get to know them, and understand the environment surrounding the phenomena of their symptoms, the symptoms themselves, and all of the other different factors that might be contributing to the anxiety that they’re displaying. So, I’ll ask about period health, I’ll ask about sleep, I’ll ask about their energy levels, I’ll ask about any other physical symptoms they might be experiencing, their digestion, what their stress levels are like. We’ll go through a review of systems, looking at every single organ system and trying to create a tabulation of how anxiety might be manifesting for them, and we may even explore what their core beliefs are, or implicit memories are in future visits. And we’ll talk about diet. And then I’ll make some recommendations as I begin to understand what those root causes of anxiety might be. So we’ll look at whether they may be experiencing nutrient deficiencies, leading to an imbalance in proper neuroendocrine production, if there might be some inflammation going on, if they may be experiencing some digestive issues, or some hormonal imbalances, or if there’s chronic stress going on in their life. And so what we’ll do is, once we find out the causes, we’ll engage in some psycho-education, so I really believe in empowering my patients to understand their bodies, to be able to notice when things are triggering them, to notice what exacerbates their anxiety, what makes it better, and to develop a self-care plan where we’re eating right, we’re thinking right, we’re exercising right and we’re getting enough rest, if possible.
So that’s the gist of it, that’s Root Causes of Anxiety, my name is Dr. Talia Marcheggiani, I work in Bloor West Village in Toronto.
