My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
“I’m hungry”, I say, according to her recollection of that moment and many others like it; she says that as a child I was always preoccupied with food. My constant yearning for something munch got to the point where every time she tried to cook dinner, I’d follow her to the kitchen, like a hungry dog, and persistently beg for food. I was insatiable, she claims. But, as an adult looking back I wonder, insatiable for what?
I remember that moment, but from the third person perspective. So I wonder if it’s as past events sometimes go, where the telling of a memory from an outsider’s perspective serves to reshape it in the imagination. I can feel the emotions, however, watching my 4-year old form tugging on my mother’s clothing, her body towering over me, her face far away. She stands at the stove. I remember feeling full of… what was that yearning? Was it for food? Was it hunger for physical sustenance or nutrition from some other source? I wonder if the constant, nagging hunger was an articulation, in 4-year old vocabulary, of the need for something else: attention, affection or reprieve from boredom. I remember being told at one point that my favourite show was on and felt some of the anxiety of missing what I was lacking dissipate: a clue.
As a child, adults occupy the gateway to food. As adults, the gateways take on another form. Perhaps it is anxiety about body shape or the guilt of knowing that eating too much of a certain kind of thing isn’t nutritious. Perhaps the barrier to sustenance is financial. However, when I stand now in the kitchen, bent over the fridge, arm slung over the open door, contemplating a snack, I know that I am making a choice. And, for myself, as for many others, it’s not always clear whether the call to eat is hunger and physiologically based.
In the west, we have an abundance problem. More and more adults are reaching obese proportions. Metabolic diseases of excess like diabetes and cardiovascular disease are increasing and more and more women are experiencing the hormonal dysregulation that can come from carrying more body fat.
While I don’t recommend aspiring to the emaciated standard that we see plastered on magazines, Pinterest ads or runways, I do think that, for many people, balancing energy intake with energy output could be beneficial for optimal health and hormonal signalling. Body fat is metabolically active. It also stores toxins and alters that way our body metabolizes and responds to hormones, insulin being just one example, estrogen being another. Therefore, conditions like PCOS, infertility, diabetes, PMS and dysmenorrhea, or certain inflammatory conditions might benefit from a certain amount of weight loss.
An addition here: this post is not about body-shame or even necessarily about weight loss per se. It’s about overcoming emotional eating patterns that might even derive from the same disordered patterns that manifest in anorexia or bulimia. The goal of this post is to bring more awareness to how we operate within the complex relationships many of have with food and with our own bodies.
There are many reasons why we eat and physiological hunger is only one of them. Tangled up in the cognitive understanding of “hunger” is a desire for pleasure, a desire to experiment, to taste, to experience a food, to share with family and friends, to enjoy life. There are also deeply emotional reasons for wanting food: to nurture oneself, as reward, to combat boredom and to smother one’s emotions like anxiety, depression, ennui, yearning for something else— we often eat to avoid feeling.
Health issues aside, I believe that Emotional Eating (as it’s so-called) is problematic because it dampens our experience of living. By stuffing down our emotions by stuffing our faces we prevent ourselves from feeling emotions that it might be beneficial for us to feel in order to move through live in ways that are more self-aware, mature, self-developed and meaningful. While some emotional reasons to eat might be legitimate (acknowledging your beloved grandmother’s hard work by having a few bites of her handmade gnocchi, for instance), many of the reasons we eat linger below the surface of our conscious mind, resulting in us suffering from the consequences of psychological mechanisms that we are unaware of. I believe in making choices from a place of conscious awareness, rather than a place of subconscious suffering.
In heading directly into the reasons I am tempted to emotionally eat, I’ve learned quite a lot about myself. I’ve ended up eating less, as I’ve become more aware of the non-hunger-related reasons that I reach for a snack, but that doesn’t have to be the end goal for everyone. I believe that just understanding ourselves through uncovering and analyzing the emotions that influence our everyday behaviours can have life-changing effects; it allows us to know ourselves better.
As I work through the process of understanding why I overeat, I’ve realized there are a few steps to address. I believe that there are layers to the reasons we enact unconscious behaviours and first, it is important to untangle the physiological from the emotional reasons for eating, understand what real hunger feels like, address the “logical” reasons for overeating and then, when ready, head straight into the emotions that might cause overeating to occur
Distinguishing between physiological hunger and emotional hunger:
The first step, of course, is to distinguish between physiological/physical hunger—the body’s cry for food, calories and nourishment—and emotional hunger. Typically, physiological hunger comes on slowly. It starts with a slow burn of the stomach, growling, a feeling of slight gnawing. It grows as the hours pass. For some it might feel like a drop in blood sugar (more on this later): feeling lower energy, dizzy and perhaps irritable. Physiological hunger occurs hours after the last meal, provided the last meal was sufficient. Usually, if one drinks water at this time, the physiological hunger subsides and then returns. Essentially, eating a meal or snack will result in the hunger vanishing and returning again still hours later.
Emotional hunger, however, is different. It starts with an upper body desire to eat. It might be triggered by commercials, social situations, or certain strong emotions. There might be cognitive reasons to eat (“I might be hungry later” or, “Oh! We’re passing by that taco place I like!”) that are not directly guided by the physical desire for sustenance. Emotional eating is often felt in the mouth, rather than the stomach. It might be brought on by the desire to taste or experience the food, rather than to fill oneself. The cravings might be specific, or for a certain food-source, such as cookies (this is not a hard and fast rule, however). Emotional hunger does not vanish from drinking water. Emotional hunger comes on suddenly, and is often not relieved by eating the prescribed amount of food (having a full meal); oftentimes we finish lunch only to find ourselves unable to get the cookies at the downstairs coffee shop out of our heads.
2. Settling hormonal reasons for overeating: serotonin, insulin, cortisol:
Not all physiological hunger, however, is experienced as the slow, gnawing, slightly burning, grumbling stomach sensation described above. Sometimes we experience the need to eat because our blood sugar has crashed, or our neurological needs for serotonin have gone up. We might eat because stress hormones have caused blood sugar to spike and then crash. We might also experience certain cravings for food because our physiological needs for macronutrients; like carbs, fat or protein; or micronutrients, like sodium or magnesium, have not been met.
Therefore, it becomes essential to address the hormonal imbalances and nutritional deficiencies that might be causing us to overeat. Oftentimes, getting off the blood sugar rollercoaster is the first step. This often involves a combination of substituting sugar and refined flours for whole grains, increasing fats and protein, and, of course, avoiding eating carbohydrate or sugar-rich foods on their own. It often involves having a protein-rich breakfast. I tend to address this step first whenever my patients come in and express feeling “hangry”: irritable and angry between mealtimes.
Often drops in brain-levels of serotonin cause us to crave carbohydrate-rich foods. This is very common for women experiencing PMS. In this case, balancing hormones, and perhaps supplementing with amino acids like l-glutamine, tryptophan and 5-HTP, can go a long way.
One of the questions I ask my patients who crave a snack at 2-3 pm (a mere 2-3 hours after their lunchtime meal), assuming their lunch contained adequate nutrients, is “Do you crave, sugar, caffeine, salt or a combination of the above?” Cravings for sugar or salt at this time might indicate a drop in cortisol and give us a clue, combined with the presence of other symptoms, that this person is in a state of chronic stress, burnout or adrenal fatigue. In this case, it is essential to support the adrenal glands with herbs, nutrients, rest, and consuming adequate protein during the afternoon crash.
Finally, when it comes to cravings for foods like chocolate, meat or nuts, or even specific vegetables (when living in South America I would experience over-whelming cravings for broccoli, funnily enough), I find it important to identify any nutrient deficiencies. It is common to experience a deficiency in something like magnesium, iron, selenium, zinc, and the fat-soluble vitamins A, D, E and K; and our bodies will do their best to beg us for the specific foods they’ve come to learn contain these nutrients. Either consciously eating more of these foods (like brazil nuts in order to obtain more selenium), preferably in their healthiest form (such as dark chocolate, as opposed to milk chocolate, to obtain magnesium), or directly supplementing (in the case of severe deficiency), often results in the cravings diminishing.
3. The Hunger Scale and food diaries:
One of the first things I have patients do is understand the Hunger Scale. There are a variety of these scales on the internet that help us cognitively understand the stages the body goes through on its quest to ask for food and it’s attempt to communicate fullness. Being able to point to certain levels of hunger and fullness and pinpoint those physiological feelings on the Hunger Scale allows us to further flush out the subtleties between a physical or emotional desire for food.
Food diaries, I find, can help bring more awareness to one’s daily habits. Oftentimes, keeping a food diary for a few weeks is enough for some patients to drop their unwanted eating behaviours altogether. Other times, it can help us detect food sensitivities and unhealthier eating patterns or food choices. It also helps me, as a practitioner, work off of a map that illustrates a patient’s diet and lifestyle routines in order to avoid imposing my own ideas in way that may not be sustainable or workable for that particular individual.
A word about diet diaries, however: when recording food for the purpose of uncovering emotional eating behaviours, I often stress that it is important to record every single food. Sometimes people will avoid writing in their diary after a binge, or outlining each food eating when they feel that they’ve lost control, writing instead “junk food”. Guilt can keep us from fully confronting certain behaviours we’d rather not have acted out. However, I want to emphasize that the diary is not a confession. It’s not, nor should it be, an account of perfect eating or evidence that we have healed. Keeping a diet diary is simply a tool to slow down our actions and examine them. It’s a means of finding out how things are, not immediately changing them into what we’d like them to be. This is an important reminder. The best place to start any investigation into being is from a place of curiosity. Remember that the point of this exercise is to observe and record, not necessarily to change, not yet; it is very difficult or even, I would argue, impossible to completely eradicate a behaviour if the reasons for engaging in that behaviour escape our conscious awareness.
Therefore, recording food allows us to begin to poke at the fortress that contains the subconscious mind. We start to slow down and uncouple the thoughts and emotions from the actions that they precede and, in doing so, develop some insights into how we work. It can also help to start jotting down other relevant points that might intersect with what was eaten. These pieces of information might include time of day, where you were, what thoughts were popping into your head, and how you felt before and after eating the food. As we observe, more information begins to enter our conscious experience, allowing us to better understand ourselves.
4. Pealing back the layers: Understanding the “practical” and logical reasons for overeating:
One of the things that I have noticed, through my own work with addressing emotional eating, is that there are often layers to the “reasons” one might overeat. Some of the first layers I encountered were cognitive, or seemingly “logical” reasons. For example, I noticed that before eating without hunger I might justify it by thinking “I need to finish the rest of these, I don’t want them to go to waste”, or “I’ll finish these in order to clean out the container”, or “I should eat something now so I won’t be hungry later”, or “I didn’t eat enough (insert type of food) today so I’ll just eat something now, for my health”, or “If I don’t have some (blank) at so and so’s house, she’ll be offended”.
When looking more closely into these justifications, I found them to be flawed. However, they were logical enough for me to eat for reasons other than to satisfy a legitimate, physiological yearning for nutrients. It’s interesting to see how the mind often tries to trick us into certain behaviours and how we comply with its logic without argument.
5. Addressing the practical reasons: Planning:
In order to address the first layer of rationale for eating when not hungry, I decided to do the following: I would plan my next meal and either have it ready in the fridge, or pack it with me to go, and then I would wait all day until I was hungry enough to eat it. I would repeatedly ask myself, every time I thought of reaching for my portions, “Am I hungry now?” And would answer that question with, “Is there a rumbling in my stomach? No? Then it’s not time to eat.”
I found it would often be a several hours later before my body would genuinely ask for the food. I also found that eating satisfied the physical hunger often much sooner than it took me to finish the food. I realized how I often eat much more food and much more often, than I genuinely need.
However, holding off eating until physical hunger arises takes a conscious effort that is often unsustainable. Few of us can move through our busy lives constantly asking ourselves how hungry we are and when, and then have food at the ready to satisfy that hunger with appropriate, healthy choices. Therefore, I used this practice as a mere stepping stone to move through the deeper layers of emotional eating. By addressing the rational and logical reasons for overeating, I was able to get in touch with the deeper, emotional (and, arguably, real) reasons for which I was eating without hunger.
6. Pealing back the layers: Understanding the deeper, emotional reasons for overeating:
For a while I would wake up, make myself a coffee, and then wait until I felt hungry. Sometimes the feeling would arise in a few minutes, sometimes it would take hours. Depending on what I’d eaten the previous day and what my activity levels were, I would often not get hungry until well into the afternoon. However, the thoughts of eating something would frequently persist. And when the thoughts came up, whereas before they would be satisfied by me having something to eat, I now resisted them. When I resisted the thoughts, their associated emotions would strengthen. I then decided to journal before reaching for food, especially when I wasn’t sure if I was actually hungry or not.
Journalling can help us pull up, process and make sense of some of our emotions. I would write about what I might be feeling—what I might be asking for that wasn’t food. Through doing this, emotional reasons for hunger began to surface. The more I held off eating, the stronger and more clear the emotions became. It was a deeply uncomfortable process. This is why we emotionally eat—removing the emotions is often far more pleasant than dealing with them.
Emotions that surfaced were anxiety, ennui, boredom, loneliness and sometimes even anger. However, boredom and a listless, almost nihilistic, sense of ennui were among the two most common emotions I realized that eating medicated for me. For me, eating was entertainment. It broke up the monotony of the day and gave my senses something to experience. It gave my body something to do: chewing, tasting and digestion. Not eating made that sense of boredom grow stronger.
7. Addressing the emotional reasons: Nurturing and preventing:
Knowing more about the root emotional causes for overeating allowed me to work more closely with the source of my behaviour. I find that the closer we get to the source, to the roots, the more effective we are at removing the weeds, or behaviours, from our lives. I knew now that if I didn’t want to overeat, I would have to prevent myself from getting bored. I would have to have checklists of things to do. I would stay active and engaged in life: in my work, my friendships, and the other non-food-related things that brought meaning to my life.
During this time, I did more yoga and meditated. I journaled and wrote. I also meditated on boredom. I traced it back to where I might have felt it in my life before and noticed themes of boredom in my childhood. I realized that the child tugging on her mother’s shirt and asking when dinner was ready was probably a child who needed something to do, a child who was bored.
8. Pealing back the layers further: Working directly with core emotions:
Going even further, we can begin to peal back the layers of the emotional reasons for overeating in order to avoid replacing one “addiction” with another—such as replacing overeating with over-busying oneself, distraction or overworking. I began to find other emotions that ran deeper than mere boredom. I also realized that whenever I had felt boredom in the past, there was a threshold, often filled with discomfort, that I would eventually surpass. Once surpassing this threshold, a well of creativity, or a plethora of interesting insights, would spring forth. I remember as a child I would create stories, or lie on my bed and stare that the ceiling of my bedroom, contemplating the nature of the universe. These beautiful moments had been made possible by boredom and my courage to not distract myself from it.
Working with a therapist, or doing some deep inner work, we can access the core beliefs and emotions that might cause these emotional reasons for overeating to exist. Oftentimes we encounter core beliefs whose effects spill out into other areas of our lives, preventing us from living fully and consciously. Working through these beliefs can be deeply satisfying and help us experience transformational self-growth.
9. Setbacks: Understanding Change Theory:
Finally, engaging in this process of self-discovery doesn’t follow the same pattern in every person. Some people may find that their reasons for overeating are dissolved as soon as they start recording the foods they eat (this is surprisingly common). Others might find that years of working with a therapist have resulted in a mere dent in their ability to eat in response to hunger and to stop unwanted eating behaviours. In most everyone progress is not linear.
Change Theory and the Stages of Change schema depicts the alteration of behaviours as cyclical, rather than linear. As we move through the stages, we enter a cycle of pre-contemplation, contemplation, planning, action and maintenance. Sometimes we fall out of the cycle and relapse. Many people working with behavioural changes and addictions prefer to rename relapse “prolapse”, claiming that prolapse is a necessary stage for continuing the cycle of change and that much is to be learned from failing at something. It is through observing how the world produces unexpected results, and then attempting to understand the unexpected while trying again, where learning takes place. We don’t really learn if we don’t fail.
Sometimes addictive behaviours, emotional eating included, worsen at a time when someone is on the verge of making a massive breakthrough. Sometimes poking at a new layer of the source of unwanted behaviour accompanies an exacerbation in the practice of that behaviour. Having curiosity and self-compassion throughout the process is essential. Savouring the increased self-awareness that comes with any effort to effect change in one’s life is part of the enjoyment of the experience.
Someone, I think it was Eckhart Tolle, once said that when it comes to mental illness, anxiety is about worry for the future, while depression is concerned with regret for the past. While, I’m not entirely (or even nearly) convinced that this is true, there is little doubt that those with both depression and anxiety can get caught in the paralysis of going over past events and regrets in their minds. Therefore, healing regret becomes important for reframing our past experiences and present identity and improving mood and self-esteem.
Regret is a sticky emotion. It reminds us of who we once were. It’s the cold hand on the shoulder and the voice that whispers “remember…” in our ear when we’re getting a little too confident, when we’re actually feeling happy with who we are now.
My patients will often tell me that when they find themselves in a spiral of low mood, their minds are often playing and replaying past events over and over. They mull over painful memories until they are distorted, painting themselves as the villain the more they rewind and press play. Remembering in this way smears grey over their entire sense of self, and discolours the possibilities they see for themselves in the future and, worse, their abilities to take meaningful action in the present. It leads to deep feelings of self-hate and worthlessness. It causes feelings of hopelessness. And so I tell them this:
Regret, while painful, is not always bad. It is a reflection, a comparison between two people: the person you are now and the person you used to be. When this comparison is particularly vast, when the you you used to be is particularly painful to remember, then know this; you have changed. Regret comes with looking back with pain, wishing we’d taken a different course of action than the ones taken. However, when we flip this concept over and examine its shinier underbelly, we realize that in order to feel regretful about past events we are acknowledging that we (present we) would not have performed the same action or made the same choice now. The flip side is not that we’re bad, it’s a reflection of our goodness. We have learned and evolved. We’re different.
Looking back is different from looking forward. Our lessons are what shape us. The fact that we regret is proof that we learn, we grow and we change into better, preferred versions of ourselves. If we sit in the experience of regret, we can feel proud that, if faced with the same situation today, we’d be better. Regret doesn’t mean that we are bad people, it’s proof that we’re good people. In order to regret the past we’ve had to have changed.
To transform mulling over painful life choices and past actions, I recommend a writing exercise, inspired by Narrative Therapy. In every story of regret and “badness” there is also a story of values, skills, preferred identity and goodness. The next time you find yourself cycling through feelings of regret grab a pen and paper and answer the following questions:
1) What happened? What were the events that transpired? What did you do? What did other people in the story do? What were the events leading up to the action you and others took? What was the context surrounding you at the time? What influenced your decision to act as you did?
2) Looking back, what would you have done differently? What parts are particularly painful to remember? What actions or events do you regret?
3) What might these regrets say about you now? What might it say about you to know that you would have acted differently if you were faced with the same situation? What values do you embody that enable you to recognize that what you did in the past was regretful for you?
4) Looking at these values, how have you shown you have this value in the past in other situations? Do you have a particular story you remember?
5) How has that value or skill made an impact on the lives of others? In the story that you remembered, what might the actions you took in #4 have meant to the people around you?
6) How do you embody this value in the present? Where does it show up in the actions you take today? How might you embody this value in the future? What actions might you take while remembering this value? What does remembering this value and the story from #4 make possible for the future?
Going through this writing exercise can help us look back with more compassion for the person we were, who was growing into the person we are now. It might make possible ways that we can rectify anyone or anything was impacted in the past, if it means an apology, paying forward a good act, taking different steps in a similar present situation or even moving on and letting go of our tendency to hold onto the memory.
“I was born with an imbalance in my brain,” my patient explains to me, “The medication corrects it—Since I started taking Cipralex, I wake up feeling like a normal person again.”
It is estimated that about 10% of adults in North America are taking a medication to help them cope with anxiety and depression. Many people swear by these substances, others claim that they worsen depression, cause uncomfortable side effects and fail to treat the root cause of symptoms, numbing us to the experience and cause of our emotional pain and physical symptoms. The reality is, however, that prescriptions for these medications is increasing.
What are anti-depressants?
Most anti-depressant medication falls into the pharmaceutical category of SSRI, or Selective-Serotonin Re-uptake Inhibitors, like Prozac or Cipralex. These medications prevent the body from mopping up the “happy hormone”, serotonin, in the brain, making its feel-good effects last longer. The result is thought to be more serotonin in the brain and, therefore, increased feelings of happiness and euphoria. Other drugs work on preventing the re-uptake of other neurotransmitters, brain chemicals dopamine and norepinephrine, which also cause feelings of happiness, pleasure and reward, and give us energy.
The Monoamine Theory of Depression:
The leading theory of depression for decades, the Monoamine Theory, states that in people who suffer from depression, there is an imbalance in serotonin production and signalling in the brain—a “serotonin deficiency”—which SSRI medication corrects. Because this is how anti-depressant medication works, this has taken over as the prevailing theory of depression. However, there has never been a published study that proves that people who suffer from depression or anxiety have issues with brain serotonin production or metabolism. It almost seems that pharmaceutical companies have “reasoned backwards” creating a theory in order to support anti-depressant use.
As patients, we want to believe that the medicine our doctors give us is just that, medicine—something that treats the root cause of disease and makes us healthier, rather than covering up our symptoms while the underlying problem continues to worsen. However, most medications don’t work that way. While Advil may alleviate a headache, we intuitively know that our headache was not caused by an Advil deficiency. Likewise, alcohol may calm down those plagued by social anxiety, but we know that alcohol isn’t a cure for social anxiety; it is a drug that can temporarily help symptoms and relying on it will only cause further health problems down the line. We know that for most health conditions, while a drug may help temporarily, something else is going on inside our bodies that warrants attention.
While the percentage of people who are medicated for depression has increased in recent years, the rate of disability from mental health conditions is steadily on the rise. This is perplexing, especially if these drugs are doing what they’re “supposed to”, which is curing a brain chemical imbalance. Shouldn’t medicating patients with depression result in a cure, or at least a declining rate of disability for mental health concerns? Clearly, something else is going on.
Harnessing the Placebo Effect:
Many patients report the fact that anti-depressant medications saved their lives, radically turning around serious and debilitating symptoms. I’ve heard quite a few stories from individuals who couldn’t get out of bed until they found the right SSRI for their body.
The data shows that SSRI medication has the ability to reduce depressive symptoms by 30% in individuals, a modest reduction at best, but still significant. But, do these medications work as well as the studies claim? A glance at the entire body of research casts doubt on the efficacy of anti-depressant medication:
Firstly, there is a large body of unpublished negative studies. This means that studies that show there is no difference in anti-depressant medication and placebo is left out of the body of literature, favouring a bias for positive publications, publications that find anti-depressants work. Medical research draws conclusions by producing studies over and over again. When the results of several studies are combined, doctors and researchers are able to draw conclusions about whether a medication works or not. When only positive research is published, without negative research to balance it out, it casts medications in a favourable light that they may not necessarily deserve. This is an unfortunate phenomenon in medical science as a whole, and often skews the evidence in favour of drugs that may not be as effective as we hope.
Secondly, the gold standard for evidence, the Randomized Control Trial (RCT) may have design flaws due to the nature of the medications being tested. In RCTs, patients are randomized into two groups. One group is given placebo and the other the active drug that is being tested. The subjects and the people evaluating them are both blinded—neither knows which group is given the drug and which is given the placebo. This reduces the possibility of bias in reporting and observing the effects of the medication. The idea is because an inert pill, or “placebo” may be able to exert the effects of a drug, providing about 30% benefit, according to some sources. However, when patients who are in the active group experience side effects of the medication: gastric symptoms, nausea, headaches, altered sleep and appetite, they quickly become alert to the that fact that they are in the medication group, leaving room for the placebo effect to occur. This is termed the “Active Placebo Effect”. When SSRIs are compared with active placebos—placebos that don’t act as medicine but produce the same side effects—we found their effects rapidly diminished, perhaps because the placebo effect was not taking effect anymore.
What about the people who SSRIs help?
To cast doubt on the efficacy of anti-depressants does not in any way invalidate those who have felt the medications helped them. Every body is different and I believe that it is not for us to say how someone should or shouldn’t be reacting to a medication or therapy. The mysteries of our bodies are vast and there is only so much that we’re aware of in the world of medicine and health. Furthermore, the placebo effect, while often being used to dismiss therapies (“oh, it’s probably just a placebo effect”) should really be viewed as an amazing miracle of medicine and evidence of how powerful our bodies and minds are. The placebo effect shows us that, according to our beliefs, we have the power to heal ourselves. We believe that we’re getting treatment, we believe the treatment will help us, and the very nature of those beliefs heals our physical bodies.
This does not mean that the people who were suffering before taking the medication were “faking it” or should have been able to just snap out of it—that’s not how the placebo effect works. The placebo effect is based on changing our beliefs, which, as you may know, is not something we can simply will ourselves to do. However, the fact that our beliefs hold this kind of healing power, I find, frankly, is amazing. The placebo effect shows us evidence of an almost magical ability of the mind-body connection to heal ourselves, without side effects, and I believe it is something that we should harness and celebrate.
What’s the problem, then?
While anti-depressants may be harnessing the placebo effect to help individuals heal, there are downsides to them as well.
Firstly, SSRI medications have a long list of side effects, from weight gain and fatigue to sexual dysfunction and vitamin deficiencies, being on these medications over the long-term can be unpleasant for some and seriously affect quality of life for others.
Secondly, anti-depressant medications are notoriously difficult to get off of. I have assisted many patients in getting off their medication, with the help of their medical team, but it’s never easy and must always be done slowly and responsibly. Getting off medication involves a slow wean over months with support of natural therapies, psychotherapy and lifestyle changes. Because these drugs force the brain to adapt, causing a very real chemical imbalance, oftentimes the withdrawal effects are so intolerable that patients are not able to come off.
Most patients who decide to try anti-depressant medications are not aware how difficult it will be to stop taking the medication, if they should eventually choose to do so. This is unfortunate, as I believe that full informed consent should be applied to patients so that they may make appropriate decisions about their health—patients should be made aware that they are expected to stay on the medication for life and that weaning will be very difficult and, in some cases, not possible.
Finally, there is a growing body of evidence showing that patients who do not receive medication, but other forms of help such as diet and lifestyle changes, psychotherapy and stress management, do better, have higher rates of remission and less relapse than those who are medicated. As we see with the studies that show that more medication is correlated with more disability from mental health concerns, it is possible that medicating depression is only worsening the problem for most people.
So, what causes anxiety and depression?
Scientists and clinicians are not sure what the cause of depression is. However, the Cytokine Theory of Depression and the Gut-Brain Connection are two areas that are gaining increasing interest from researchers. These theories state that depression may be a cause of inflammation in the body that affects the brain, and that imbalances in gut health, especially with gut bacteria may offset mental health, respectively. Naturopathic doctors also notice a clinical correlation between burnout or “adrenal fatigue” and mental health symptoms.
Healing the mind and body, however, starts with creating a therapeutic relationship with a professional that you trust. After that, I find that healing the gut, correcting inflammation and nutrient deficiencies while addressing harmful core beliefs and stress can have wonderful results for healing depression and anxiety.
Depression is a symptom:
Psychiatry would have us believe that depression and anxiety are conditions that we are born with. Conventional medicine states that perhaps we have a familiar tendency to develop these conditions, perhaps we’ve had them since childhood, but, and in this case it is clear, depression and anxiety are not things that you heal from; they are things you simply manage.
I disagree. I don’t believe that depression and anxiety stand on their own as diseases, but symptoms of a deeper imbalance. Like any symptom, I believe mental health concerns are trying to tell us something. Our bodies have no other way of communicating with us other than through the symptoms they produce: lack of motivation, sore muscles, bloating and diarrhea, headache, joint pain, brain fog, fatigue and so on. As naturopathic doctors, we are trained to listen, not just to our patients, but the messages their bodies are signalling to us through symptoms.
This means that, when I start seeing a patient with depression, whether they are on medication or not, we develop a full work-up, asking in-depth questions about sleep, diet, exercise, digestion, mental status, mood, energy, reproductive health and so on. I connect these symptoms together to find out what is going on beyond what may be immediately visible.
Depression and anxiety often have a root cause. The cause may be stress, childhood trauma, leaky gut, adrenal fatigue, inflammation or even medication and drug use itself. Through uncovering the root of the issue, we are able to treat it, helping the body restore itself to balance and health.
My philosophy of healing is that, sometimes, illness can be a gift, especially if it encourages us to delve deep into our lives and values and make the necessary changes for healing ourselves. Sometimes depression and mental health challenges can be the beginning of a grand and fulfilling journey where we learn to connect more deeply to our bodies, discover our life purpose and a greater sense of happiness and life satisfaction.
When a successful person is asked to share the secrets of his or her success, the unanimous response is that success requires “effort” and “hard work”. Other popular euphemisms are that success demands “sweat, blood and tears” or “1% inspiration, 99% perspiration”. In grade school we’re lectured on working harder and reprimanded for not trying hard enough. Put in the time and effort to get the grades that will land you the job that will require similar or increasing levels of time and effort. Olympic athletes are lauded as modern-day heroes for their early mornings, punishing workouts and restricted diets. Our society reveres those who put in 80-hour work weeks, despite their implausibility, as we all need to sleep, eat and defecate, which take up hours that are obviously not spent working. It’s a shame to some that we’re limited by these earthly, time-consuming bodies that have been the disdain of capitalism since it’s inception. I see more youth in my practice, who are already bearing the weight of society’s expectations. They are working hard, as instructed, and this “hard work” is taking a physical, mental and emotional toll on their lives. But what can they do? Success requires effort, goes the mantra of our times.
This effort shows up on faces and in bodies. Our minds exhaust us with chastising inner talk; teeth clench, jaws grind and shoulders hunch around ears, creating a new neck-less species, The Hard Worker, inhabiting the earth in increasing numbers.
70% of people today admit to being under stress. When I asked my patients if they feel “stressed”, many shrug, deny or tell me their stress is nothing that they can’t handle, and then proceed to rank their stress levels as 6 out of 10 or higher, 10 being a hair-pulling, crazy-eyed, stressed-out-of-their-wits state—I find it significant that being more than halfway to our limits still qualifies us as not being stressed.
It’s likely that admitting to stress and overwhelm is a weakness in our effort-driven society. If the bodies we inhabit fail to perform, we’ll be replaced by someone more able-bodied, or someone more able or willing to push their limits and sacrifice their health for short-term success—or maybe a machine. Machines don’t need paid vacation or sick leave. While the future seems bleak, it certainly helps with the healing business, as 75-90% of doctor’s visits are either directly or indirectly stress-related. We know that stress has the power to wreck havoc on the body, contributing to diseases, inflammation, decreased immunity, proliferation of cancer and premature aging. We know that stress is implicated in the rising incidence of mental health conditions. We know that things can’t go on as they are, the system is simply not working.
And so when modern society is failing us, it helps to turn to ancient ideas, before it all went wrong, such as Taoist philosophy, to look for answers. The Taoist principles of wu wei, or “effortless action”, tell us that action does not always originate from effort and stress. Effective actions, like creativity and good ideas, can occur spontaneously and of their own accord.
In a society where relentless growth and production are imperative for the survival of the economy, it’s hard to image any action in the absence of sheer effort. Incessant production can’t rely on the eb and flow cycles of natural inspiration and creativity to dictate when, how much or how hard we work. And yet, this perhaps says more about the societal necessities of the work available to us, and our enjoyment (or lack thereof) of such work, than it does about human inspiration. I’ve been planning this blogpost for a while and although it might have been written sooner if set to a deadline, I’ve eventually gotten around to it; here it is. It is a fact that when things need to get done, they will. The doing might happen later than we’d like it to, and yet it still happens, inspired by a genuine desire or necessity, rather than pressure-cooker of stress.
I’m often asked, as a doctor, to help support my patients’ bodies in periods of intense stress—”periods” that have gone on for years with no apparent end in sight. While there are several remedies that can help the body recuperate from the wear and tear of effort or help the adrenal glands secrete more cortisol to continue producing more and faster, there’s also only so much that can be squeezed out of tired organs. Oftentimes, as I’ve written before, the path to healing is paved with introspection and a serious reconsideration of lifestyle. Can we continue to produce and strive at our current rates and still expect to feel fit, healthy and energized? We can build faster computers and smarter phones but our bodies are very much limited to the tools nature has slowly evolved over time, including the natural medicines available to us. Perhaps our lifestyles, like the economy and the stress on the environment, are simply unsustainable. Perhaps it’s time to question how many of the activities in our lives are worth the effort.
While it may not be possible to quit our jobs, pack up and move to the Bahamas, perhaps there are small nooks in our routines where wu wei might fit and flourish. It may be possible to ease up on our own expectations of ourselves, or give up some of our conventional ideas of success. After all, is the journey to success worth slogging if we won’t be happy or healthy when we get there? Finding space in our lives to allow action to arise spontaneously may be crucial in doing the necessary, healing work of stress-management.
Applying wu wei might mean examining the intentions behind our actions and our current lifestyles. Here are some questions to ask yourself.
When is effort appropriate and when is it wasted?
Where am I trying to get to? What is my definition of success?
Is there a day/afternoon/hour in my week when I can “schedule” unscheduled time?
Are there tasks I can ease up on, laundry for instance, that I can trust will get done on their own time?
Can I agree to forgive myself when I fail to meet deadlines or choose to take a day off?
What would it feel like to stop paddling and let the current carry me for a while? Can I do this at work? At home?
In what area of my life could I allow myself a little more room to breathe?
What are my top ten values in life? What goals align with those values? What actions would help me move closer to those goals? How much does thinking of those actions excite or inspire me?
Today, I’m 30, working on my career as a self-employed health professional and a small business owner and living on my own. I’ve moved through a lot of states, emotions and life experiences this year, which has been appropriate for closing the chapter on my 20’s and moving into a new decade of life. I’ve experienced huge changes in the past year and significant personal growth thanks to the work I’ve been blessed to do and the people who have impacted me throughout the last 30 years. Here are 30 things this past year has taught me.
Take care of your gut and it will take care of you. It will also eliminate the need for painkillers, antidepressants, skincare products, creams, many cosmetic surgeries, shampoo and a myriad of supplements and products.
Trying too hard might not be the recipe for success. In Taoism, the art of wu wei, or separating action from effort might be key in moving forward with your goals and enjoying life; You’re not falling behind in life. Additionally, Facebook, the scale and your wallet are horrible measures to gauge how you’re doing in life. Find other measures.
If you have a chance to, start your own business. Building a business forces you to build independence, autonomy, self-confidence, healthy boundaries, a stronger ego, humility and character, presence, guts and strength, among other things. It asks you to define yourself, write your own life story, rewrite your own success story and create a thorough and authentic understanding of what “success” means to you. Creating your own career allows you to create your own schedule, philosophy for living and, essentially, your own life.
There is such as thing as being ready. You can push people to do what you want, but if they’re not ready, it’s best to send them on their way, wherever their “way” may be. Respecting readiness and lack thereof in others has helped me overcome a lot of psychological hurdles and avoid taking rejection personally. It’s helped me accept the fact that we’re all on our own paths and recognize my limitations as a healer and friend.
Letting go is one of the most important life skills for happiness. So is learning to say no.
The law of F$%3 Yes or No is a great rule to follow, especially if you’re ambivalent about an impending choice. Not a F— Yes? Then, no. Saying no might make you feel guilty, but when the choice is between feeling guilty and feeling resentment, choose guilt every time. Feeling guilty is the first sign that you’re taking care of yourself.
Patience is necessary. Be patient for your patients.
Things may come and things may go, including various stressors and health challenges, but I will probably always need to take B-vitamins, magnesium and fish oil daily.
Quick fixes work temporarily, but whatever was originally broken tends to break again. This goes for diets, exercise regimes, intense meditation practices, etc. Slow and steady may be less glamorous and dramatic, but it’s the only real way to change and the only way to heal.
When in doubt, read. The best teachers and some of the best friends are books. Through books we can access the deepest insights humanity has ever seen.
If the benefits don’t outweigh the sacrifice, you’ll never give up dairy, coffee, wine, sugar and bread for the long term. That’s probably perfectly ok. Let it go.
Patients trust you and then they heal themselves. You learn to trust yourself, and then your patients heal. Developing self-trust is the best continuing education endeavour you can do as a doctor.
Self-care is not selfish. In fact, it is the single most powerful tool you have for transforming the world.
Why would anyone want to anything other than a healer or an artist?
Getting rid of excess things can be far more healing than retail therapy. Tidying up can in fact be magical and life-changing.
It is probably impossible to be truly healthy without some form of mindfulness or meditation in this day and age.
As Virginia Woolf once wrote, every woman needs a Room of Own’s Own. Spending time alone, with yourself, in nature is when true happiness can manifest. Living alone is a wonderful skill most women should have—we tend to outlive the men in our lives, for one thing. And then we’re left with ourselves in the end anyways.
The inner self is like a garden. We can plant the seeds and nurture the soil, but we can’t force the garden to grow any faster. Nurture your garden of self-love, knowledge, intuition, business success, and have faith that you’ll have a beautiful, full garden come spring.
Be cheap when it comes to spending money on everything, except when it comes to food, travel and education. Splurge on those things, if you can.
Your body is amazing. Every day it spends thousands of units of energy on keeping you alive, active and healthy. Treat it well and, please, only say the nicest things to it. It can hear you.
If you’re in a job or life where you’re happy “making time go by quickly”, maybe you should think of making a change. There is only one February 23rd, 2016. Be grateful for time creeping by slowly. When you can, savour the seconds.
Do no harm is a complicated doctrine to truly follow. It helps to start with yourself.
Drink water. Tired? Sore? Poor digestion? Weight gain? Hungry? Feeling empty? Generally feeling off? Start with drinking water.
Do what you love and you’ll never have to work a day in your life. As long as what you love requires no board exams, marketing, emailing, faxing, charting, and paying exorbitant fees. But, since most careers have at least some of those things, it’s still probably still preferable to be doing something you love.
Not sure what to do? Pause, count to 7, breathe. As a good friend and colleague recently wrote to me, “I was doing some deep breathing yesterday and I felt so good.” Amen to that.
As it turns out, joining a group of women to paint, eat chocolate and drink wine every Wednesday for two months can be an effective form of “marketing”. Who knew?
“Everyone you meet is a teacher”, is a great way to look at online dating, friendships and patient experiences. Our relationships are the sharpest mirrors through which we can look at ourselves. Let’s use them and look closely.
Being in a state of curiosity is one of the most healing states to be in. When we look with curiosity, we are unable to feel judgment, anxiety, or obsess about control. Curiosity is the gateway to empathy and connection.
Aiming to be liked by everyone prevents us from feeling truly connected to the people around us. The more we show up as our flawed, messy, sometimes obnoxious selves, the fewer people might like us. However, the ones who stick around happen to love the hot, obnoxious mess they see. As your social circle tightens, it will also strengthen.
If everyone is faking it until they make it, then is everyone who’s “made” it really faking it? These are the things I wonder while I lie awake at night.
Happy Birthday to me and happy February 23rd, 2016 to all of you!
I’ve come to see my migraines as an internal measuring device for wellness, or rather, lack of wellness—kind of like a very painful meat thermometer. From time to time I get bouts of low energy compelling me to spend more time doing low-key activities. However, quick browses through Facebook show me busy colleagues achieving great things and I feel guilty about my relative inaction. A little voice pipes up. “Your body is telling you to rest”, it says. “But if you just started doing things, you’d probably feel more motivation”, voices another, its opponent, the devil on my shoulder. A war ensues and then a headache settles it all. I take it easy for a while, while I’m literally knocked out of commission, in the dark, on the couch with an icepack on my head.
L came to me for fertility, which is another litmus test for good health. When the body is struggling against some sort of imbalance or obstacle to wellness, it will not spend its resources readying eggs, ovulating and ripening uteruses. Our bodies protect us from the metabolic demands of having a pregnancy, which in our current stressed-out, unwell states we probably wouldn’t be able to handle, by simply not getting pregnant in the first place. And so, infertility is a nice entry-way to healing—patients are motivated to examine the effect of their lifestyles on their wellbeing.
The problem was, however, that L barely had time to make and attend her appointments. When she did manage to come in, she was in a rush. She’d often cancel follow-ups because she hadn’t followed through with the previous visit’s plan, even though it had been weeks before. She also reported working 50-hour weeks and staying up early into the morning to work on projects. I wondered, if she couldn’t even make an hour-long appointment with her naturopathic doctor, how would she manage growing and then giving birth to and then raising a brand new human? L simply might have not been ready to heal. Something in me fought to give her my professional assessment; in order to have the baby she wanted, she might have to give up, or significantly let up on, the demands of her job. However, how could I have made such a statement? I held my tongue and tried my best with the modalities at my disposal. We did acupuncture, CoQ10, PQQ and herbal remedies. We worked on sleep and did stress management with adaptogens. In a few months, despite the high demands of her lifestyle, L was pregnant. She still has trouble keeping her appointments with me. L’s body may now be functioning fine, but is it thriving?
Workplace wellness programs teach employees how to survive the 60+ hour workweeks in the office by doing yoga at lunch and eating healthier cafeteria food. They’re taught about stress management and, in the best of cases, given adaptogens and B-vitamins to help their bodies’ sails weather the stress-intensive storms of office life. It’s a great investment, these programs proclaim, because employees are happier, more efficient at their work and take less sick days. Workplace wellness programs keep their employees functional but, I wonder, can anyone really be well working that many hours a week?
When it comes to the health strategies we promote as a profession, how many of them are geared towards healing and how many of them are really just there to help us function?
At this stage in my career, I often have to gauge what my patients want. There are some people who come in ready to heal. They want to search for and address the real root cause of disease, no matter how elusive it may be. They are also willing to do what it takes to get better, even if it means a significant lifestyle shift. Sometimes these patients are at a point where things have gotten so bad that they have no other choice, however some of them simply intuit that the symptoms arising may be conveying a greater message; in order to be truly healthy, things might have to change. Most patients, however, come in looking to “feel better”—they simply want their symptoms to go away so they can get back to their daily lives, lives that might have made them sick in the first place. In our pharmaceutical-based Therapeutics and Prescribing exam, the goal of therapy in the oral cases was always to “restore functioning”, as if our patients were simply pieces of machinery; our parts are worn, maybe broken and we’ve gone decades without a decent oil change, but the factory declares we must get back to work as soon as possible and so we break out the duct tape. With this mindset, however, are we simply placating our bodies long enough to keep working until we eventually succumb to the next thing, a debilitating headache instead of mild fatigue, or something even worse? How long can we go suppressing symptoms or getting our bodies into decent enough shape before we realize that what we really need is some honest-to-goodness authentic healing?
Jiddu Krishnamurti, Hindu philosopher and teacher once said, “It is no measure of health to be well-adjusted to a profoundly sick society.” How much of our health marketing and wellness efforts are aimed at cleaning out the cogs in a jammed up machine so that they can go on turning smoothly again? The thought that real healing might mean dismantling the entire machine might be too radical for our society to handle. How can we address the problem of making a living if we acknowledge the fact that our lifestyle, or job, might be making us sick?
A therapist I work with (doctors need healing too!) once told me that mild to moderate depression is a sign that something in your life needs changing. “Look at the symptoms of depression,” She told me one afternoon in her office, “You lose the energy and motivation to keep going with your routine. You stop being social; all of your energy turns inwards. You focus your attention on your self and your life so that you can examine what about it is making you unhappy. Then you change it.” Then you change it, a scary thought. No wonder a tenth of the population opts for anti-depressant medication, which in some cases might be the medical equivalent of dusting oneself off and heading back to work. And, while they seem like more benign options, St. John’s Wort, B12 injections and 5HTP may not be that different.
A friend and I were talking about this very topic. He remarked that at a fitness retail store he worked at he’d often ask his female customers, “What will you be needing these yoga pants for today: form or function?” When I laughed at the shallowness of it all, he protested, “Well, some people are just going to use them to sit in coffee shops while others want to actually work out. What’s going to make your butt look great won’t necessarily be the best choice at the gym. I had to know their motivations.” Are most of our wellness efforts aimed at making our butts look great or are they filling a functional purpose?
I wonder if I should follow my friend’s lead and outright ask my patients, maybe on their intake forms, “Are you looking to truly heal today or do you just want to feel better and get back to work?”—form or function? Being candid with them, might help me decide when to schedule follow-up appointments. At any rate, it would definitely open up a conversation about expectations surrounding decent time-frames for seeing “results” and what true healing might look like for them. The trouble is, restoring functioning, if not easier, is more straight-forward. You make some tweaks to diet, correct some nutritional deficiencies and boost the adrenals or liver. It’s the medical equivalent of filling in potholes with cheap cement—it might not look pretty, but now you can drive on it. Healing, however, is more complex. It’s more convoluted, hard to define and get a firm grasp on. It is also highly individual. It might mean ripping up the entire road, plumbing and all, and building a new one or, even better, planting grass and flowers in the road’s place and nurturing that grass on a daily basis. Healing might be creating something entirely new, something that no one has ever heard of or seen before. Creating is scary. Creativity takes courage, and so does healing.
No matter what it might look like, I believe healing begins with a conversation and a willingness to look inwards, without judgement. Healing also requires an acceptance of what is, even if the individual doesn’t feel ready to take actions to heal just yet. Healing deserves us acknowledging that something is a band-aid solution. Healing definitely demands listening, especially to the body. Therefore, healing might begin in meditation. It might start with a mind-searing migraine that lands you on the couch and the thought, “What if, instead of reaching for the Advil, I just rested a little bit today?” Healing might just start there and it might never end. But, if it does, who knows where it might end up?
A singular narrative is told and retold regarding medicine in the west. The story goes roughly like this: the brightest students are accepted into medical schools where they learn—mainly through memorization—anatomy, physiology, pathology, diagnostics, microbiology, and the other “ologies” to do with the human physique. They then become doctors. These doctors then choose a specialty, often associated with a specific organ system (dermatology) or group of people (pediatrics), who they will concentrate their knowledge on. The majority of the study that these doctors undergo concerns itself with establishing a diagnosis, i.e.: producing a label, for the patient’s condition. Once a diagnosis has been established, selecting a treatment becomes standardized, outlined often in a cookbook-like approach through guidelines that have been established by fellow doctors and pharmaceutical research.
The treatment that conventional doctors prescribe has its own single story line involving substances, “drugs”, that powerfully over-ride the natural physiology of the body. These substances alter the body’s processes to make them “behave” in acceptable ways: is the body sending pain signals? Shut them down. Acid from the stomach creeping into the esophagus? Turn off the acid. The effectiveness of such drugs are tested against identified variables, such as placebo, to establish a cause and effect relationship between the drug and the result it produces in people. Oftentimes the drug doesn’t work and then a new one must be tried. Sometimes several drugs are tried at once. Some people get better. Some do not. When the list is exhausted, or a diagnosis cannot be established, people are chucked from the system. This is often where the story ends. Oftentimes the ending is not a happy one.
On July 1st, naturopathic doctors moved under the Regulated Health Professionals Act in the province of Ontario. We received the right to put “doctor” on our websites and to order labs without a physician signing off on them. However, we lost the right to inject, prescribe vitamin D over 1000 IU and other mainstay therapies we’d been trained in and been practicing safely for years, without submitting to a prescribing exam by the Canadian Pharmacists Association. Naturopathic doctors could not sit at the table with the other regulated health professions in the province until we proved we could reproduce the dominant story of western medicine—this test would ensure we had.
Never mind that this dominant story wasn’t a story about our lives or the medicine we practice—nowhere in the pages of the texts we were to read was the word “heal” mentioned. Nowhere in those pages was there an acknowledgement about the philosophy of our own medicine, a respect towards the body’s own self-healing mechanisms and the role nature has to play in facilitating that healing process. It was irrelevant that the vast majority of this story left out our years of clinical experience. The fact that we already knew a large part of the dominant story, as do the majority of the public, was set aside as well. We were to take a prescribing course and learn how primary care doctors (general practitioners, family doctors and pediatricians), prescribe drugs. We were to read accounts of the “ineffectiveness” of our own therapies in the pages of this narrative. This would heavy-handedly dismiss the experience of the millions of people around the world who turn to alternative medicine every year and experience success.
We were assured that there were no direct biases or conflict of interests (no one was directly being paid by the companies who manufacture these drugs). However, we forget that to have one story is to be inherently and dangerously biased. Whatever the dominant story is, it strongly implies that there is one “truth” that it is known and that it is possessed by the people who tell and retell it. Other stories are silenced. (Author Chimamanda Ngozi Adichie describes this phenomenon in her compelling TED Talk, “The Danger of a Single Story”).
Despite the time and money it cost me, taking the prescribing course afforded me an opportunity to step outside of the discouraging, dominant story of the standard medical model and thicken the subordinate stories that permeate the natural and alternative healing modalities. These stories began thousands of years ago, in India and in China, at the very root of medicine itself. They have formed native ancestral traditions and kept entire populations and societies alive and thriving for millennia. Because our stories are not being told as often, or told in the context of “second options” or “last resorts”, when the dominant narratives seem to fail us, the people who tell them run the risk of being marginalized or labeled “pseudoscientific.” These dismissals, however, tell us less about The Truth and more about the rigid simplicity of the singular story of the medical model.
It is frightening to fathom that our body, a product of nature itself, encompasses mysteries that are possibly beyond the realm of our capacity for understanding. It’s horrifying to stand in a place of acknowledgement of our own lack of power against nature, at the inevitability of our own mortality. However, if we refuse to acknowledge these truths, we close ourselves off to entire systems that can teach us to truly heal ourselves, to work with the body’s wisdom and to embrace the forces of nature that surround us. The stories that follow are not capital T truths, however, they can enrich the singular story that we in the west have perpetuated for so long surrounding healing.
The body cannot be separated into systems. Rather than separating depression and diarrhea into psychiatry and gastroenterology, respectively, natural medicine acknowledges the interconnectivity between the body’s systems, none of which exist in a vacuum. When one system is artificially manipulated, others are affected. Likewise, an illness in one system may result in symptoms in another. There have been years of documentation about the gut-brain connection, which the medical model has largely ignored when it comes to treatment. The body’s processes are intricately woven together; tug on one loose thread and the rest either tightens or unravels.
We, as products of nature, may never achieve dominion over it. Pharmaceutical drugs powerfully alter the body’s natural physiology, often overriding it. Since these drugs are largely manmade, isolated from whole plants or synthesized in a lab, they are not compounds found naturally. Despite massive advances in science, there are oceans of what we don’t know. Many of these things fit into the realm of “we don’t know what we don’t know”—we lack the knowledge sufficient to even ask the right questions. Perhaps we are too complex to ever truly understand how we are made. Ian Stewart once wrote, “If our brains were simple enough for us to understand them, then we’d be so simple that we couldn’t.” And yet, accepting this fact, we synthesize chemicals that alter single neurotransmitters, disrupting our brain chemistry, based on our assumption that some people are born in need of “correcting” and we have knowledge of how to go about this corrective process. Such is the arrogance of the medical model.
There are always more than two variables in stories of disease and yet the best studies, the studies that dictate our knowledge, are done with two variables: the drug and its measured outcome. Does acetaminophen decrease pain in patients with arthritis when compared to placebo? A criticism of studies involving natural medicine is that there are too many variables—more than one substance is prescribed, the therapeutic relationship and lifestyle changes exert other effects, a population of patients who value their health are different than those who do not, the clinical experience is more attentive, and so on. With so many things going on, how can we ever know what is producing the effect? However, medicine is limited in effect if we restrict ourselves to the prescription of just one thing. This true in herbalism, where synergy in whole plants offers a greater effect than the sum of their isolated parts. By isolating a single compound from a plant, science shows us that we may miss out on powerful healing effects. Like us, plants have evolved to survive and thrive in nature; their DNA contains wisdom of its own. Stripping the plant down to one chemical is like diluting all of humanity down to a kidney. There is a complexity to nature that we may never understand with our single-minded blinders on.
Studies are conducted over the periods of weeks and, rarely, months, but very rarely are studies done over years or lifetimes. Therefore, we often look for fast results more than signs of healing. This is unfortunate because, just as it takes time to get sick, it takes time to heal. I repeat the previous sentence like a mantra so patients who have been indoctrinated into a medical system that produces rapid results can reset expectations about how soon they will see changes. Sometimes a Band-Aid is an acceptable therapy; few of us can take long, hard looks at our lives and begin an often painful journey in uncovering what hidden thought process or lifestyle choices may be contributing to the symptoms we’re experiencing. However, the option of real healing should be offered to those who are ready and willing.
When we study large masses of people, we forget about individuality. When we start at the grassroots level working with patients on the individual level, we familiarize ourselves with their stories, what healing means to them. In science, large studies are favoured over small ones. However, in studies of thousands of people, singular voices and experiences are drowned out. We lose the eccentric individualities of each person, their genetic variability, their personalities, their preferences and their past experiences. We realize that not everyone fits into a diagnostic category and yet still suffers. We realize that not everyone gets better with the standard treatments and the standard dosages. Starting at the level of the individual enables a clinician to search for methods and treatments and protocols that benefit each patient, rather than fitting individuals into a top-down approach that leaves many people left out of the system to suffer in silence.
It is important to ask the question, “why is this happening?” The root cause of disease, which naturopathic medicine claims to treat is not always evident and sometimes not always treatable. However, the willingness to ask the question and manipulate the circumstances that led to illness in the first place is the first step to true and lasting healing; everything else is merely a band-aid solution, potentially weakening the body’s vitality over time. No drug or medical intervention is a worthy substitute for clean air, fresh abundant water, nutritious food, fulfilling work and social relationships, a connection to a higher purpose, power or philosophy and, of course, good old regular movement. The framework for good health must be established before anything else can hope to have an effect.
The system of naturopathic medicine parallels in many ways the system of conventional pharmaceutical-based medicine. We both value science, we both strive to understand what we can about the body and we value knowledge unpolluted by confusing variables or half-truths. However, there are stark differences in the healing philosophies that can’t be compared. These differences strengthen us and provide patients with choice, rather than threatening the establishment. The time spent with patients, the principles of aiming for healing the root cause and working with individuals, rather than large groups, offer a complement to a system that often leaves people out.
There are as many stories of healing and medicine as there are patients. Anyone who has ever consulted a healthcare practitioner, taken a medicine or soothed a cold with lemon and honey, has experienced some kind of healing and has begun to form a narrative about their experience. Anyone with a body has an experience of illness, healing or having been healed. Those of us who practice medicine have our own experience about what works, what heals and what science and tradition can offer us in the practice of our work. Medicine contains in its vessel millions of stories: stories of doubt, hopelessness, healing, practitioner burnout, cruises paid for my pharmaceutical companies, scientific studies, bias, miracle cures, promise, hope and, most of all, a desire to enrich knowledge and uncover truth. Through collecting these stories and honouring each one of them as little truth droplets in the greater ocean of understanding, we will be able to deepen our appreciation for the mystery of the bodies we inhabit, learn how to thrive within them and understand how to help those who suffer inside of them, preferably not in silence.
I was recently told that a benefactor would contact me about the work I’ve been doing for the Evergreen Yonge Street Mission in Toronto—I provide naturopathic services to street-involved youth twice a month in the drop-in health clinic. There is a natural health company that might be interested in sponsoring some of the naturopathic services. However, in order to understand where their money is going, they want to hear some success stories before they consider if and how much to donate. Are the services working? They want to know. Since I, more than anyone, appreciate the power of a story and, since I’m trying to raise some money to expand the services I provide myself, I thought I’d tell one. Names and details have been changed.
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A shift at the mission lasts a few hours. Youth sign up for the adolescent medicine specialist and her Sick Kid’s Hospital resident, dental work or me, the naturopath, represented under the heading “naturopathic medicine/acupuncture”. There is no money for supplements—and supplements can be expensive—and the youth I treat don’t have money to buy food let alone a bottle of melatonin. So I do acupuncture.
Eduardo was waiting when it I called him. He was lying face up on the bench in the waiting area, looking at a pamphlet on “dope addiction”. He was wearing sunglasses. When he came into the visit, he didn’t take them off, despite the low-level lighting of the treatment room I occupy. It felt strange to talk to someone’s dark glasses, not making eye contact with them as we spoke. I wondered vaguely if I should tell him to take off the glasses, and then left it alone—his comfort as the patient should take priority over mine. Why challenge his autonomy and further push the power imbalance by telling him to do something that was not fully necessary? I worked around the glasses, moving them aside slightly in order to needle the acupuncture point yin tang, located between the eyebrows. The glasses stayed on. So be it.
Eduardo and I spoke Spanish, as his English wasn’t strong. He spoke of feeling shaky, showing me his tremoring hand to prove it. When did the shakiness start? I inquired. When I overdosed on crack, he explained. Well, that would do it, I thought to myself, although you can imagine my clinical experience with crack overdose was limited—there aren’t that many crack overdoses in Bloor West Village.
As it turned out, Eduardo had a significant dependence on marijuana, smoking 7 grams a day while in his home country. When he bought pot on the streets in Toronto, however, he found one deal laced with crack. He ended up in the hospital after smoking it. Another time, his weed was laced with meth.
He held his hand up. I watched it shake. He told me his whole body felt shaky. This would be exacerbated further if he stopped smoking marijuana, he assured me. Had he ever stopped before? I asked. Yes, he said. Why did he stop? I asked him, taking a de-centred approach while staying curious about preferred ways of being. In this case I suspected he preferred to be sober—after all, something had made him stop.
The cost, he explained.
Ah, that, I thought. Well, it makes sense.
Eduardo’s experience highlights the complex relationship people have with substances, and the challenges they face when it comes to finding alternatives that suit their needs. For many, the search for a healthier, more manageable way to deal with stress or cravings can lead them down unexpected paths.
Any other reason? I asked him.
He explained that his family didn’t approve. I asked him why. What might they think of marijuana? What did they see him do when he was high that led to their disapproval. Eduardo couldn’t answer. He changed the subject and explained he’d gone back to weed after quitting it that time because it helped him sleep. Since the episode with the crack overdose, though, sleep was difficult. That’s why he was here: to get acupuncture to help with sleep.
Eduardo spoke in a low voice, often responding with a word or two. Despite the glasses shielding his eyes, he kept his gaze on the floor. When I had him lie on the treatment table, I encouraged him to close his eyes and rest while the acupuncture worked.
After a few minutes, I removed the needles. He thanked me shyly and left. Like many of the people I treat, I figured the odds were high I’d never see him again.
—
I was surprised, then, that a month later, I saw him in the waiting area again.
The visit went pretty much the same way as the first with one key difference. The second time he came in, Eduardo removed his glasses, meeting my eyes for the first time.
I was touched.
His sleep was still bad. His mood was still low. He hadn’t smoked crack for a while. He was living in a shelter; his family had kicked him out because of his addiction to marijuana. He implied great trauma in his home country, however he didn’t say much more about it. He mentioned regretting that his English was poor—it had been traumatic to come to Canada.
He told me he was applying for medical marijuana. It would be a safer way to smoke, he told me.
He was practicing harm reduction on himself. I asked him if he considered this “taking steps.” He nodded. I asked him about any other steps he’d been considering. He mentioned swimming. Swimming had been a passion of his in his home country. I got more details about his goals: how often did he want to swim? Where? He decided that 3-5 times a week at the local pool would be ideal. I asked him what he’d first have to do to make that happen. Check the pool times, he answered.
I asked him if he’d ever considered quitting marijuana. He said no, he needed it to sleep and to manage his anxiety. But, you know, it was expensive. And, of course, he repeated, his parents had an issue with it. That was a problem for him. I asked him why it was a problem.
It’s a problem… he repeated. He said nothing more.
We did more acupuncture. He went on his way.
—
Two weeks later, Eduardo came to see me again. He took his glasses off as soon as he saw me.
He reported his sleep was better. He had been swimming 3 times a week at the local pool. He hadn’t smoked crack in a month. He’d stopped marijuana the last time he saw me. He hadn’t smoked for two weeks. He showed me his hand. It wasn’t shaking.
Do you think these are positive developments? I asked him.
He shrugged nonchalantly but failed to disguise the smile that tugged at the corners of his mouth. He looked down.
I put in some acupuncture needles and asked him what his next steps might be. He answered that he thought he might call his old boss back and get back to work. Then he wanted to save money so he could move out of the shelter he was in.
He then started to talk a little bit about his brother who was killed in his home country and his friends who’d betrayed him to another gang resulting in him having to flee for his life. He talked about receiving premonitions in his dreams. This made sleep difficult, but it had also caused him to act and avoid harm—he’d learned from a dream that his friends were untrustworthy. We wondered together if this was more than a source of anxiety, but a special skill that kept him safe. Maybe he wouldn’t have to be vigilant if important warnings came to him in his dreams. I wondered if marijuana, along with helping hims sleep had hindered that gift. He thought about that for a while.
When he left he asked me how many more acupuncture treatments he might need. I told him to come in as often as he liked but 8-10 was a good starting point.
Ok, he said, it’s been 3 so far.
Right, I said. It’s been 3.
Ok, he said. See you in two weeks.
He put his glasses back on and walked out into the chaos of Yonge Street. There was a street festival going on.
—
At one point in my time spent with Eduardo, one of the staff at the mission inquired about his mental capacities. Apparently the psychiatrist he’d been working with was considering a diagnosis of mental retardation or severe learning disability–it was taking him so long to learn English and he was often slow to answer questions.
No disrespect to psychiatry: the more I work with mental health, the more respect I have for the utility, albeit limited, of psychiatric assessments and medications. For many people, and when applied delicately and sensitively, these things add powerful meaning and serve as important life savers. However, I want to emphasize the importance of lowering practitioner power, understanding the challenges another person may face in their life and respecting the autonomy, decision-making power and special skills of the individual who seeks health care. In addition, rather than looking for the problem in the person, what success stories are they bringing forth? What goals have been set and what steps have been taken already?
I often comment that the stories I hear and the conversations I have in the work I do are not the least bit depressing. Sure, the youth have dark, complicated, often horrific pasts. However, every individual is a collection of hopes, dreams, goals and personal strengths and abilities. Every person that comes to see me wants something more for themselves and has already exercised an ability to move closer to their preferred ways of being in the world, showing me the incredible capacity for human strength and endurance. The only difference, between the perspective I get to enjoy and the one seen by other health professionals, however, is that I look for stories of strength. Because strength is always there, waiting for a thoughtful question to bring it into the light.
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As a child, I was obsessed with stories. I wrote and digested stories from various genres and mediums. I created characters, illustrating them, giving them clothes and names and friends and lives. I threw them into narratives: long stories, short stories, hypothetical stories that never got written. Stories are about selecting certain events and connecting them in time and sequence to create meaning. In naturopathic medicine I found a career in which I could bear witness to people’s stories. In narrative therapy I have found a way to heal people through helping them write their life stories.
We humans create stories by editing. We edit out events that seem insignificant to the formation of our identity. We emphasize certain events or thoughts that seem more meaningful. Sometimes our stories have happy endings. Sometimes our stories form tragedies. The stories we create shape how we see ourselves and what we imagine to be our possibilities for the future. They influence the decisions we make and the actions we take.
We use stories to understand other people, to feel empathy for ourselves and for others. Is there empathy outside of stories?
I was seeing R, a patient of mine at the Yonge Street Mission. Like my other patients at the mission health clinic, R was a young male who was street involved. He had come to see me for acupuncture, to help him relax. When I asked him what brought him in to see me on this particular day, his answer surprised me in its clarity and self-reflection. “I have a lot of anger,” He said, keeping his sunglasses on in the visit, something I didn’t bother to challenge.
R spoke of an unstoppable rage that would appear in his interactions with other people. Very often it would result in him taking violent action. A lot of the time that action was against others. This anger, according to him, got him in trouble with the law. He was scared by it—he didn’t really want to hurt others, but this anger felt like something that was escaping his control.
We chatted for a bit and I put in some acupuncture needles to “calm the mind” (because, by implication, his mind was not currently calm). After the treatment, R left a little lighter with a mind that was supposedly a little calmer. The treatment worked. I attributed this to the fact that he’d been able to get some things off his chest and relax in a safe space free of judgment. I congratulated myself while at the same time lamented the sad fact that R was leaving my safe space and re-entering the street, where he’d no doubt go back to floundering in a sea of crime, poverty and social injustice. I sighed and shrugged, feeling powerless—this was a fact beyond my control, there wasn’t anything I could do about it.
The clinic manager, a nurse practitioner, once told me, “Of course they’re angry. These kids have a lot to be angry at.” I understood theoretically that social context mattered, but only in the sense that it posed an obstacle to proper healing. It is hard to treat stress, diabetes, anxiety and depression when the root causes or complicating factors are joblessness, homelessness and various traumatic experiences. A lot of the time I feel like I’m bailing water with a teaspoon to save a sinking ship; my efforts to help are fruitless. This is unfortunate because I believe in empowering my patients. How can I empower others if I myself feel powerless?
I took a Narrative Therapy intensive workshop last week. In this workshop we learn many techniques for empowering people and healing them via the formation of new identities through storytelling. In order to do this, narrative therapy extricates the problem from the person: the person is not the problem, the problem is the problem. Through separating problems from people, we are giving our patients the freedom to respond to or resolve their problems in ways that are empowering.
Naturopathic doctors approach conditions like diabetes from a life-style perspective; change your lifestyle and you can change your health! However, when we fail to separate the patient from the diabetes, we fail to examine the greater societal context that diabetes exists in. For one thing, our culture emphasizes stress, overwork and inactivity. The majority of food options we are given don’t nourish our health. Healthy foods cost more; we need to work more and experience more stress in order to afford them. We are often lied to when it comes to what is healthy and what is not—food marketing “healthwashes” the food choices we make. We do have some agency over our health in preventing conditions like diabetes, it’s true, but our health problems are often created within the context in which we live. Once we externalize diabetes from the person who experiences it, we can begin to distance our identities from the problem and work on it in creative and self-affirming ways.
Michael White, one of the founders of Narrative Therapy says,
If the person is the problem there is very little that can be done outside of taking action that is self-destructive.
Many people who seek healthcare believe that their health problems are a failure of their bodies to be healthy—they are in fact the problem. Naturopathic medicine, which aims to empower people by pointing out they can take action over their health, can further disempower people when we emphasize action and solutions that aim at treating the problems within our patients—we unwittingly perpetuate the idea that our solutions are fixing a “broken” person and, even worse, that we hold the answer to that fix. If we fail to separate our patients from their health conditions, our patients come to believe that their problems are internal to the self—that they or others are in fact, the problem. Failure to follow their doctor’s advice and heal then becomes a failure of the self. This belief only further buries them in the problems they are attempting to resolve. However, when health conditions are externalized, the condition ceases to represent the truth about the patient’s identity and options for healing suddenly show themselves.
While R got benefit from our visit, the benefit was temporary—R was still his problem. He left the visit still feeling like an angry and violent person. If I had succeeded in temporarily relieving R of his problem, it was only because I had acted. At best, R was dependent on me. At worst, I’d done nothing, or, even worse, had perpetuated the idea that there was something wrong with him and that he needed fixing.
These kids have a lot to be angry at,
my supervisor had said.
R was angry. But what was he angry at? Since I hadn’t really asked him, at this time I can only guess. The possibilities for imagining answers, however, are plentiful. R and his family had recently immigrated from Palestine, a land ravaged by war, occupation and racial tension. R was street-involved, living in poverty in an otherwise affluent country like Canada. I wasn’t sure of his specific relationship to poverty, because I hadn’t inquired, but throughout my time at the mission I’d been exposed to other narratives that may have intertwined with R’s personal storyline. These narratives included themes of addiction, abortion, hunger, violence, trauma and abandonment, among other tragic experiences. If his story in any way resembled those of the other youth who I see at the mission, it is fair to say that R had probably experienced a fair amount of injustice in his young life—he certainly had things to be angry at. I wonder if R’s anger wasn’t simply anger, but an act of resistance against injustice against him and others in his life: an act of protest.
“Why are you angry?” I could have asked him. Or, even better, “What are you protesting?”
That simple question might have opened our conversation up to stories of empowerment, personal agency, skills and knowledge. I might have learned of the things he held precious. We might have discussed themes of family, community and cultural narratives that could have developed into beautiful story-lines that were otherwise existing unnoticed.
Because our lives consist of an infinite number of events happening moment to moment, the potential for story creation is endless. However, it is an unfortunate reality that many of us tell the same single story of our lives. Oftentimes the dominant stories we make of our lives represent a problem we have. In my practice I hear many problem stories: stories of anxiety, depression, infertility, diabetes, weight gain, fatigue and so on. However, within these stories there exist clues to undeveloped stories, or subordinate stories, that can alter the way we see ourselves. The subordinate stories of our lives consist of values, skills, knowledge, strength and the things that we hold dear. When we thicken these stories, we can change how we see ourselves and others. We can open ourselves up to greater possibilities, greater personal agency and a preferred future in which we embrace preferred ways of being in the world.
I never asked R why the anger scared him, but asking might have provided clues to subordinate stories about what he held precious. Why did he not want to hurt others? What was important about keeping others safe? What other things was he living for? What things did he hope for in his own life and the lives of others? Enriching those stories might have changed the way he was currently seeing himself—an angry, violent youth with a temper problem—to a loving, caring individual who was protesting societal injustice. We might have talked about the times he’d felt anger but not acted violently (he’d briefly mentioned turning to soccer instead) or what his dreams were for the future. We might have talked about the values he’d been taught—why did he think that violence was wrong? Who taught him that? What would that person say to him right now, or during the times when his anger was threatening to take hold?
Our visit might have been powerful. It might have opened R up to a future of behaving in the way he preferred. It might have been life-changing.
It definitely would have been life-affirming.
Very often in the work we do, we unintentionally affirm people’s problems, rather than their lives.
One of the course participants during my week-long workshop summed up the definition of narrative therapy in one sentence,
Narrative therapy is therapy that is life-affirming.
And there is something very healing in a life affirmed.
In most service industries, there are certain guarantees. If you go to a restaurant, your soup is guaranteed. At the GAP, you will get a pair of chinos, guaranteed. In lots of instances, you get what you are paying for and in most cases, you get to see if before you hand over your credit card—a coffee, a massage. In many cases, if you’re not satisfied, you can get your money back—guaranteed.
This is not the case in medicine. We cannot legally guarantee results. There are no guarantees.
Everybody and every body is different. Contrary to what it might seem like in our age of paralyzing fear of uncertainty, no one has all, or even most, of the answers.
Dr. Google makes it seem like we do, though.
When I see a new patient who is worried about their health and their future, I want to be able to promise them. I want nothing more than to say, “these breathing exercises will eliminate your anxiety, just like you asked for: poof! gone.”
I want to guarantee things.
I want to tell someone that, if they follow my instructions, they’ll never have another hypertensive emergency again. I want to, but I can’t. No one can. And our job is not to guarantee. It is to serve.
A $10,000 bag of chemotherapy pumped into your arm will not guarantee that the cancer goes into remission no matter how many studies show it has an effect. I can’t promise you’ll get pregnant, even though I’m doing my best, you’re doing your best and science is doing its best.
That’s all I can guarantee: that I will try my very best.
I can be your researcher, teasing out the useful scientific information from a sea of garbage and false promises—false guarantees from those who have no business guaranteeing anything. I can provide my knowledge, culminated from years of study and practice and life. I can sit with you while you cry and hear you share your story. I can let you go through your bag of supplements, bought in a whirlwind of desperation, and tell you what is actually happening in your body—something that doctor didn’t have time to explain. I have time to spend with you. We can have a real conversation about health. I can also make recommendations based on my clinical experience, research and millenia of healing practices. These recommendations will certainly help—virtually everyone sees some kind of benefit—but I can’t guarantee that either.
I watched a webinar on probiotics recently. The webinar sent me into a spiral of existential probiotic nothingness. I’ve been prescribing probiotics for years. I’ve seen benefits from them with my own eyes. Patients have reported great things after taking them and I feel better when I take them: my stomach gets flatter, things feel smoother, my mood gets lighter. Probiotics are wonderful. However, according to the research that was being presented by this professional, which he’d meticulously collected and organized, many things we thought about probiotics aren’t true. I’d have to change my whole approach when it came to probiotics, prescribing certain strains for certain conditions where they’d seen benefit. I remember feeling hard-done by by the supplement companies and the education I’d gotten at my school. How could we be so off base on this basic and common prescription?
At the same time, some skeptics were harassing me on Twitter, telling me that I’d wasted 4 years, that naturopathic medicine is useless and doesn’t help people. Besides having helped numerous people and having been healed myself, their words got to me. What if everything I know is as off-base as my previous knowledge on probiotics was?
The very next day, I called a patient to follow up with her. She’d kind of fallen off the radar for a while. She was happy to hear from me. I asked her how she was feeling, if she’d like to rebook. “I don’t need to rebook,” She told me, excitedly, “I’m completely better!”
After one appointment.
I was astounded and intrigued. Of course, we expect people to get better, but it takes time to heal, and I rarely go gung-ho on the first appointment, there was still lots left in my treatment plan for her. She’d been experiencing over seven years of digestive pain, debilitating fatigue, life-changing and waist-expanding cravings for sugar. It takes a while to reverse seven years of symptoms. It takes longer than a couple of weeks. But her symptoms were gone. She felt energized, her mood was great and she’d lost a bit of weight already. She no longer had cravings.
And she’d just started on one remedy.
Which was, you guess it, probiotics.
Sure, you might think. Maybe it wasn’t the probiotics, maybe she would have just gotten better on her own. Possible, but unlikely. She’d been suffering for years.
Ok, then, you say, maybe it was a placebo effect. Maybe it wasn’t the actual probiotics. Again, it’s possible. She’d tried other therapies before, which hadn’t worked, however and she “believed” in them just as much as the probiotic. And the probiotic made her better.
The point is this: we don’t know. Science is magical. People are magical. Medicine, which combines science with people, is the most magical of all. There are no guarantees.
The point is that anything can make anyone feel better: a good cry, a $10,000 bag of chemotherapy, journalling for 12 weeks or popping a probiotic. Some things have more research behind them. Some things we’ve studied and so we know some of the mechanisms for why things work. But we still have a lot of why’s and we always will. Everybody and every body is different. No two people or two conditions should receive the exact same protocol or supplement or IV bag or journalling exercise or cry-fest. We have no guarantees what will work or what will make you feel better. Just some research papers, some experience, maybe the odd dash of intuition or interpersonal connection and a firm resolve to want our patients to get better. And that’s a guarantee.
My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
