I talk about 5 essential tools for caring for your mental and emotional health. These are powerful self-care practices that can help balance your mind and emotions.
Hello, everybody, my name is Dr. Talia Marcheggiani. I am a naturopathic doctor with a focus in mental health and hormonal health.
Despite the increasing amount of research into mental health conditions and psychiatric conditions, and the increase in interventions and early recognition and pharmaceutical therapies that come with mental health diagnoses, we’re actually seeing more debility in mental health outcomes: more debility, more morbidity. So we’re seeing worsening of outcomes even though we’re applying more interventions.
So, how could this be? You expect that the better the drugs that we’re developing, the less disease we should encounter, if those drugs are actually working to counteract the disease process. We’re not seeing that in the realm of mental health, especially when it comes to the common conditions such as depression and anxiety.
And when it comes to disease in the west, we’re not really winning the war against disease. So, things like cardiovascular disease, cancer, hormone imbalances such as diabetes, hypothyroidism, mental health conditions such as depression and anxiety, ADD and ADHD, infertility, neurological disease such as MS and Parkinson’s, autoimmune disease, such as, again, MS and things like Hashimoto’s Thryoiditis and myasthenia gravis, and immunodeficiencies such as HIV. All of these diseases are on the rise, all of these chronic, lifelong diseases. And so, despite these advances in research and drug development, we’re not seeing an improvement in our ability to manage these diseases or prevent them.
And there is obviously not one simple solution to this problem, but one thing I want to point our attention to is this increase in stress and this connection to stress and the diseases that I mentioned. Obviously it’s not just one cause, that would simplify the entire system to an almost ludicrous degree, but there is an estimation that 75-90% of hospital visits are either directly or indirectly related to stress.
And some of the symptoms of stress, so chronic stress or even acute stress, are an increased heart rate, elevated blood pressure, elevated blood sugar, decreased memory and cognition, disrupted levels of serotonin, leading to depression and anxiety, disrupted levels of the other hormones such as dopamine and norepinephrine, and addiction to stress, so a chance in the opioid receptors and the brain structure, altered hormone synthesis, increased inflammation, altered gut flora, etc., etc., and a change in the immune system. So, basically, every system of the body is affected by stress. And being in a prolonged, acute state of stress is lethal to the body.
So, we can look at the rise of cardiovascular disease and diabetes and the fact that stress increases our heart rate and increases our blood pressure and increases our blood sugar. And we can make some of those connections between the symptoms of stress and the diseases that are increasing in our society.
When it comes to mental health, we see how our neurotransmitters and our brain structure and our gut and our immune systems are affected by chronic stress and we can infer that some mental health conditions are either caused by or aggravated by this chronic stress situation. And, so, by not addressing stress and by not looking into stress and finding healthy ways to manage it, we’re doing ourselves a disservice in the management of these diseases and the prevention of them,
So, there’s a few theories that connect—there’s that Monoamine Hypothesis when it comes to mental health, that people with depression and anxiety have this inherent brain imbalance. So they don’t make enough serotonin, or their brains for some reason aren’t responding to serotonin. Again, it’s a very reductionistic model because it reduces all of the experience of depression and anxiety and conditions such as ADD and ADHD and bipolar down to one single neurotransmitter and it oversimplifies the entire system and the entire constellation of symptoms that people can experience and the life situations surrounding these conditions and the fact that they’re comorbid with things like stress and poverty and childhood trauma and those kinds of things.
But there’s some other theories that we can look at, and some other kind of pieces of the puzzle that we can add to create a more inclusive narrative. So there’s a theory called the Mind-Body Theory and this kind of arises as a counteraction, or a counter-philosophy to what Descartes discovered or decided that he discovered, which was that the mind and body are separate entities—this dualistic hypothesis. We know absolutely that that’s not true but our mind and body are completely connected and that our mind probably doesn’t reside only in our brain because our nervous system extends throughout the entire body and our minds are also inter-relational, so they’re a product our environments and our relationships with other people as well.
We know that the gut is the second brain, for the amount of neurons that it inhabits and the neurotransmitters that influence its function. Our gut health affects our mood depending on how healthy it is. And we call this connection, another word for it, a more scientific word, is “Psychoneuroimmunology”. This is the connection between the immune system, the nervous system, and our psychology, our mood: our thoughts and emotions. So, we know that everything in the body is interconnected and you can’t prescribe an antibiotic and not expect that there’ll be sequelae or consequences, or side effects that affect a different body system. And we see that all the time now, but we have to understand how tugging on one thread in this interconnected web is going to affect another piece of it further down the line.
There’s also this Energetic Model of mental health, and that’s that the emotions have their own energy. There’s this theory that the emotions can manifest as physical symptoms and we see this in the work of Gabor Mate, who writes extensively about stress and addictions and mental health, in his book “The Body Says No”. He talks about how the health of our thoughts and emotions impact our physical stress. And so it’s not just that our thoughts and emotions can impact our mental health, but also our physical health and might set the stage for us to get conditions like cancer, or autoimmune disease, and all of the other diseases that I mentioned.
So, when it comes to stress and our mental health and emotional wellbeing, we need to take a proactive approach. Just like we do with getting vaccinations, and preventing colds and flus, and getting proper nutrition, and exercise and all of that, we need to be strategic about how we manage our stress.
The World Health Organization defines mental health as “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” So, notice that this definition isn’t simply the absence of disease and it’s not necessarily a normalizing—being “happy” or not having a diagnosis. This definition is about realizing one’s potential and experiencing emotional “wellness”, for lack of a better word. So, an ability to cope with life’s stressors and to live a life of meaning and purpose.
So I want to talk about 5 tools that are really important for establishing a self-care and emotional wellness routine, for improving mental health. These strategies may not be sufficient enough for more serious psychiatric conditions, but I believe that they form the foundation of proper lifestyle strategies to help with increasing our emotional wellness and our ability to cope with life’s stressors.
So the first one I want to talk about is something called “Self-Care”, which is becoming kind of a buzzword in high-stress communities such as universities, and even some offices and corporations. So, one of the first things I want to talk about is the power of saying “No”. Sometimes saying No, especially for more agreeable individuals, and a lot of the time for women, saying no is a difficult thing for us to do.
When I give this presentation to a group I always ask them, “Why is it hard for you to say no? What would happen if you didn’t say no? Let’s say a friend invites you out and you’re just not feeling it, or you’re invited to a baby shower and it’s just more than you can handle and you wish you could say no, but you don’t.” And, one thing that everybody says is that they’d feel guilty, if they said no. This is sort of universal. And so I ask them, “What would happen if you didn’t say no? What would happen if you went along with it, even if you just didn’t have the energy to devote to this commitment?” And people say that they’d feel resentment. And so when it comes to deciding what things to take on and what things to discriminate against in terms of the tasks that we take on, the commitments that we make, we’re kind of stuck between this dichotomy between feeling guilt and resentment spectrum. One of my mentors, Gabor Mate, in his book “The Body Says No”, talks about when faced with this choice between guilt and resentment, especially when we’re more prone to guilt-avoidance by saying yes more often than maybe we should, he said “choose guilty every time”, because the feeling of guilt, and obviously this isn’t a hard or fast rule, but the feeling of guilt is more indicative that you’re taking care of yourself.
His theory as well is that resentment tends to build up in the body and contributes to the cause of more disease such as cancer and this cancer personality that he writes about is the woman that will say yes to things and is scared to say no out of guilt. So, resentment is far more damaging for the body and therefore, when trying to avoid guilt, maybe move towards guilt, especially when you know that you might be taking on more than you should. And also pay attention to the idea that when we say yes to things we’re saying no to other things. So, we’re always saying “no” and “yes”. We only have 24 hours in the day and so, by saying yes to that baby shower that you’d rather not go to, what are you saying no to? Are you saying no to doing a yoga class for you, or getting extra sleep, or saving your money for a family vacation? So, paying attention to those commitments that we make. There’s a great article online called “The Law of F- Yes! Or No.” And this law is, if you’re faced with a decision and you’re not feeling like this, “F- Yes!”, then say no and save that time and save those commitments for something else that you’re more enthusiastic about.
When it comes to self-care, there’s another great article that talks about the BACE method, so that’s BACE. And this stands for these 4 pillars of self-care. And the first one of body-care. So that’s making sure you have a healthy diet, that you’re supporting yourself nutritionally, that you’re getting movement in, that you’re sleeping enough. A is acceptance, just allowing the emotions, and that self-care, that self-love to come through. C is connection, so establishing those interpersonal relationships and prioritizing them, especially relationships that feel nurturing, where you can be your authentic self. And E is enjoyment, finding activities that are fun and cause a sense of enthusiasm and enjoyment in your life. And this is something that’s often a problem for a lot of adults with lots of responsibilities that, when I ask them to rate on a scale of 1 to 10 how much fun they have, or how satisfied they are with the amount of fun in their life, they often rate it pretty low.
A lecture that I attended, there was a woman who was talking about self-love and improving self-worth and recommends asking oneself this: “what would someone who loves themselves do? Or say?” and that can be pretty powerful for just examining how our internal dialogue is manifesting and how we’re talking to ourselves and treating ourselves. Would someone who loves themselves eat that? Or say that? Or do that activity or say yes to that commitment? And, you know, just sitting with that question can be really helpful for changing some behaviours, or adding perspective to our daily lives.
There’s also this, lastly in the realm of self-care, there’s this idea of Wu Wei, which is a Taoist idea, which is translated roughly into the art of “effortless action”. In our society we’re kind of educated to pair action with effort. So, we don’t feel like we deserve success unless our success was the result of a massive amount of effort that we’ve put in, and stress. And, according to wu wei, this idea that action is objective, we can measure it, but effort is subjective. So, you can see if you’re performing an action, but the perception of effort behind it is this kind of subjective and thought-based experience. So, we can do the laundry or DO the laundry. We can do laundry from a place of self-love and self-care, like “I want to care for my clothes, and to have nice clothes to wear tomorrow and I’m going to do this for myself and I’m going to be mindful as I do it”. And I’m going to do this out of necessity, but also out of a natural drive that’s coming from this place within. Or I can have laundry on my to-do list that’s causing me stress. So, sometimes even wu wei is about doing less and not feeling guilty for that.
The second tool for emotional wellness is journalling and writing. This is one of my favourites. So, journalling allows us to keep a record, to get creative, and to engage in self-expression. And when we write we engage both sides of our brains: the motor centres, the language centres, the centres that are involved in language perception and in language generation, also our visual centres. So, a lot of the brain is lit up in the act of writing and that can help integrate some of our deeper thought processes.
Writing down things leads to clarity and focus. We’re forced to deepen our thought processes and remove ourselves from some of the cognitive loops we might be engaged in. We can complete our thoughts and reach their inevitable, often ridiculous conclusions and this kind of comes from some core beliefs, or, we call them “automatic thoughts.” Like, “I’m a failure” or “I’m worthless”. Those kind of things that our brain generates based on past experiences that may not be relevant anymore to who we are now. Through writing we’re forced to look inside of ourselves, to causes and explanations for how we feel. We’re also able to express ourselves and rid the body of pent up emotions, such as anger and aggression and sadness, shame.
I often recommend that people write a letter. Especially if there’s someone in the past that’s done damage to them, or hurt them. Someone that they miss, sometimes remembering somebody through a letter: sometimes people wish that they could communicate with someone who’s passed away or is no longer in their life anymore and, through this letter-writing, you’re able to.
I also have people write letters to themselves from the perspective of their personality at age 80, and this can sometimes provide perspective for patients who are depressed and young, because it gives them an idea; it increases the perspective of their lives. And sometimes I have people personify and anthropomorphize their problems or addictions and write letters to that or write letters from that and through that process can learn a lot about the relationship between themselves and alcoholism, for example.
There’s another great activity I like called the “God Jar”, for people that have constant worries or wake themselves up at night and process things or who are anxious about the future—The God Jar or the Wish Jar. And so, you get a mason jar and little pieces of paper and you write things that you’re worried about or things that you’re anxious about or thinking about and you scrunch them up and throw them into this jar and, in essence, symbolically, you’re giving those problems to “God”, or to the universe or you’re just simply filing them away for later use. And this is sort of a subconscious, or conscious, dumping of your problems, especially if you don’t have immediate control over them. I mean, in the middle of the night you’re not going to be able to finish your taxes when you’re supposed to be sleeping, or solve a problem at work. And that can often worsen our problems, when we’re not getting enough sleep. Then I sometimes have people open up that jar 6 months later and take a look at some of the things they’ve written and that can also generate feelings of accomplishment and achievement and perspective when you find out that those things that you were so worried about 6 months ago are no longer even relevant and you barely remember them. So, it’s pretty powerful.
Another great exercise is something called a Gratitude Journal. And there’s a Ted Talk about this that, for 21 days, and I like to tell people to do this for a full month, 28 days. If you write 3 things that you’re grateful for at the end of the day for 21 days, it actually changes your brain structure and helps you see things in a more positive light and focus on the blessings, rather than the things that you lack. Our brains have a negative bias. So, they’re wired to pay attention to the things that we’re missing out on and that we’re lacking and when we focus on and acknowledge the things that are going right for us, it can sort of change our perspective. And, throughout the day, as you’re doing this exercise, you’re going to be paying attention to things that you’re going to have to write down later, so you’re paying attention to the things that went well, that you want to include in your gratitude journal. And this can have profound effects.
There’s some studies about journalling. And there was a study that showed that patients with HIV or AIDS, who wrote about their life for 30 minutes had an increased CD4 T cell count—and that’s the cells in the body that are affected by the HIV virus. So, by simply writing about their lives, something profound, it wasn’t just a grocery list. But writing something profound about their lives, such as sharing their life story, actually increased their immune system’s ability to function in the face of the HIV virus.
And then, similarly, there was another study in patient with rheumatoid arthritis—this is an autoimmune condition—they had these patients write for 20 minutes a day, for 3 days, and they found that their symptoms went down and their immunoreactivity went down. So we’re seeing these two studies, and we’re not exactly sure of the causal effect, these studies are a little bit correlative and very difficult to control for, because patients who are in the study, subjects know if they’re writing in their journal or not. But these studies were controlled against people who were just kind of mindlessly writing about grocery lists. So, it was writing about more profound concepts and sort of outlining a significant life event, or life story, or significant events that were happening in the day that had an emotional charge to them.
So, we find that engaging in journalling, even 20 or 30 minutes a day, can actually modulate the immune system. So, if you have a immunodeficiency issue, like HIV, it can increase immunoreactivity, and if you have an autoimmune disease like rheumatoid arthritis, or asthma, if can lower that immunoreactivity and inflammation. So there’s this evidence that journalling and our thoughts and emotions are directly impacting our immune system and our immune system’s ability to function and balance itself.
The third tool for mental and emotional wellness is interpersonal support. And, being a naturopathic doctor who does a lot of counselling in my practice, I tend to favour psychotherapy and counselling as a form of social support for people that don’t feel that they can be authentic or have that deep connection with people in their lives.
There’s evidence that loneliness is the new epidemic, especially in our society and, as social animals, connecting with others is part of our biology, part of who we are. Through therapy, what I really like about it, is it can help us reframe the past and our personal identity. We can start to identify some automatic thoughts and core beliefs, which are deep-seated beliefs that may not serve us anymore in the present and may actually be contributing to feelings of low mood or behaviours that are unwanted. It can also allow us to rewrite our life story, so, looking back on the past and reframing certain events, from the perspective of someone maybe with more resources and power. For example, someone with a history of trauma may have an idea of powerlessness and being victimized and, in every single story of trauma that I’ve encountered, people have always responded in some way. Either psychologically, mentally, emotionally, if not in action, and sometimes just recognizing these responses changes our whole perception of the event and our identities in the present, our ability to act in the present. So, there is evidence that stress is related to our perception of things that happen, not actually what happened. So, for example, imagine somebody that’s just broken up with their girlfriend and they were very in love. And you can image what their mental and emotional state would be like. Maybe the next day they don’t feel like getting out of bed, there’s clothes all over the floor, they haven’t brushed their teeth, they’re feeling extremely sad, and crying. And nothing has changed biologically in this person, but the situation surrounding their life has changed. Then imagine that this person wakes up the next day and they’re in this state of low mood and depression. And they get a phone call. And it’s their girlfriend saying, “you know, I’d like to get back together, I made a mistake, I’m in love with you and I don’t want to be broken up anymore.” So you can imagine that this person’s mood is going to change rapidly as the situation changes. And so, there is a change in their circumstances, but not in their physical biology.
And sometimes, in past events, there’s the story that our minds create around what happened, and then there’s the actual events that happened. So you might call your partner and they don’t pick up the phone, and we start to create a story about why that is. Maybe it’s because they don’t love us anymore, they want to break up with us, that we’re worthless, that no one’s ever loved us, that we’ll never find love, that we’ll always be alone. But, in actuality, we don’t know those things and the only thing that’s happening is they’re just not picking up the phone and there’s thousands of explanations for that.
We perceive situations based on our personal histories, our physical conditions, our state of minds, etc., and things that we’ve learned in the past and also our core beliefs. So, we filter our experiences through our perceptions and our identities and personalities and so, by understanding more about these things, we can understand why we pick out certain events and draw conclusions from the connection between those events rather than others. There’s some people that, when they fail a test, they just think, “Oh, it was a hard test, or maybe I didn’t study hard enough.” And there’s others that think “I’m a failure, I’ll never pass anything, there’s no point in trying, I’m dropping out of school.” And so it’s not just the event but our perception of the event that change our thoughts, mood and behaviours.
Another great thing that therapy and social support can do, is help us identify our passions and purpose in life. So there’s a psychological that I really like to listen to called Jordan Peterson that talks about how the purpose of life is not necessarily well-being and happiness, because happiness is a state that can be derived chemically, through doing things like cocaine, or substance abuse, and happiness might just be a disposition that certain people embody better than others and that life is suffering. And this is present in Buddhist philosophy that no matter how we live, we’re going to encounter events that are devastating for us, and that are hard for us to deal with. And so, in those situations, we’re not going to feel happy, so what’s going to drive us? What’s going to push us forward? What’s going to keep us going in those times and so his theory or idea is that we should look for what makes it worth it: what adds meaning to our life. What is our potential in life? What is our purpose? What gives us that sense of meaning such that, when we encounter these situations of suffering and hopelessness that we’re able to continue on. So, having a direction for our lives, and having a sense of identity and purpose that gets us up in the morning and makes us move forward, even when we’re not particularly feeling happy that day.
Therapy and social support are also great for just self-acceptance. So, having other people mirror back to us who we are and how we’re being in the world.
The 4th tool for emotional wellness is mindfulness and meditation, so very very powerful tools. It’s arguably very difficult to be healthy in this day and age without some form of mindfulness meditation, or meditation practice to combat the increase in stress that we encounter in our society. So, mindfulness is—there’s many different techniques, but the main tenant is just taking the perspective of the compassionate, detached observer to our thoughts, emotions and physical sensations. So, when we split our mind or watch our thoughts, we can get a better sense of awareness of how emotions and thoughts arise in our body, pass through our bodies, and how we’re not them—that there’s this observer role that we can also take, that we can watch ourselves from.
Mindfulness allows us to stay in the present and reframe certain situations and just slow time down so that we’re not victims to the whims of our biology, that we’re able to understand it a little bit more. And there’s a great resource on the internet called “Mindfulness-Based Stress Reduction” that’s a secular kind of meditation by a man in Massachusetts called Jon Kabat Zinn and you can download body scan meditations or take a course in MBSR in your town. I highly recommend them; they’re really great for developing mindfulness practice.
There’s also yoga, and qi gong and tai qi, and these kind of integrated, mindfulness-based and physical exercises that can help slow us down, bring us into the present and help us observe our minds and emotions a little bit better. And there’re amazing for managing stress. There’s good evidence building about them helping us deal with stress and manage our mental health conditions.
And the 5th tool for mental and emotional wellness is to look at that mind-body connection that I mentioned before. The mind-body theory sees our thoughts and emotions as energy that can impact our cellular biology, from that idea of psychoneuroimmunology. And there’s increasing evidence about this and how calming our thoughts down, doing some mindfulness meditation, can affect our heart-rate and can affect our blood pressure, and journalling can affect how our immune system responds.
There’s this idea that if our thoughts and emotions aren’t processed properly they can become trapped and stagnated in the body and contribute to disease. So, Gabor Mate mentioned that resentment can build up and lead to things like cancer. It’s one of his theories that he’s observed through working with patients.
We know that there’s this connection between physical manifestations of symptoms and physical conditions and certain emotional causes. In medicine we know this because every time a study is done, a randomized control trial, two groups need to be divided amongst the subjects. One is given a placebo, an inert pill. And this idea that someone who believes they’re taking medicine will notice a positive effect, is something that we just take for granted, but we build into every single study that we do, if it’s a good study. So, this idea that you can take a pill, believe it’s helping you, and actually physically notice a change in your body is really remarkable. And this just proves that there’s this connection between the mind and body, that we can further explore and exploit.
So, there’s things like herbal remedies that help our body increase our cells’ resilience to stress and help manage the stress hormone cortisol. And these are some herbs called adaptogens. So, they literally help us adapt to stress. And these are things like withania or ashwaghanda, rhodiola, ginseng, even nervine herbs like St. John’s Wort and skullcap can help balance our neurotransmitters and our stress hormones and lower inflammation in the body.
Doing self-care things like getting a massage, or getting acupuncture can help. And there’s a study that compares acupuncture to Prozac, so getting one acupuncture session a week for 6 weeks was actually comparable to Prozac for decreasing symptoms of depression and anxiety.
In my practice I always address diet and gut health and just make sure people are absorbing their nutrients, that they’re guts are producing the proper amounts of neurotransmitters, that there’s the proper bacterial balance, that there’s no inflammation being caused by a gut dysregulation. And we also want to remove those external stressors that can be contributing to an impaired digestive system. So, there is this saying that “we are what we eat,” but more accurately, we are what we absorb, because you can eat a lot of stuff, but, depending on how you’re digestion is functioning, we might not be absorbing all of it and incorporating it into our body, into our cells.
So, inflammation in the gut, caused by a bacterial imbalance, or food sensitivities can impact our health and we have some evidence that depression and anxiety can be caused by some latent levels of inflammation in the brain. And we know that there is an impact on gut health and increasing levels of inflammation and also stress. And really lowering that stress response, healing the gut, can have huge impacts on our mood. Establishing routine, and sleep are major pillars. So, I don’t think I’ve ever encountered a patient who felt mentally healthy when they had disrupted sleep. A lot of the time having a ritual around sleep and getting into a routine and waking up at the same time every day, really working on getting deep sleep—so avoiding electronic use before bedtime, trying to get as many hours before 12 am of sleep as possible, so preferably having a 10pm bedtime or winding down around 10 pm. Doing things like teas, or hot baths, or reading a book before bed or doing some yoga or stretches or meditation before bed to teach the body that it’s time to start relaxing is really important and has huge impacts on health, on our mood, on our emotional wellness, our ability to cope with stress, our ability to heal from stress, and our ability to balance inflammation and the immune system.
There’s evidence that exercise—I mean exercise is arguably the first-line therapy for someone with depression, especially someone under the age of 24. Instead of reaching for pharmaceutical interventions, such as selective-serotonin reuptake inhibitors, more psychiatrists are recommending exercise to young patients, which is wonderful. I’m so happy about that! And, so 30 minutes of a moderate to intense form of exercise such as weight training, or running or moving your body, can help release some of those trapped emotions, as well as boost those neurotransmitters and help our body increase its resilience against stress.
And then, finally, I just want to point out that making sure that we’re supporting our neurotransmitter synthesis through diet is really important. So, making sure that we’re getting enough magnesium, zinc and B vitamins, and proteins and amino acids, which are all helping us create the neurotransmitters like serotonin and dopamine that are going to impact our mood and mental health. So, we can journal, but we are physical beings, and we are a product of our biology. So, by supporting that biology through proper nutrition, we’re able to incorporate those nutrients and create the proper components of our body for proper mental and emotional wellness.
So, I also like to ask people this miracle question. So, this is the final thing that I’m just going to conclude on. The Miracle Question is from a modality called “Solution-Focused Therapy”. And this question is, “if you woke up tomorrow and all of your issues were completely gone, you woke up in an amazing 10 out of 10 state of energy and physical well-being and mental and emotional well-being, what would be possible for you? What would your day look like?” If you can stand in that place and sort of write down what you’re aiming at, what you’re aiming towards, it helps set the stage for taking the proper actions that preserve your mental and emotional wellness. And it also helps you stand in a new territory, one that’s not of disease or illness, but one of possibility.
And, finally, I was at this free meditation circle as we were talking about self-love, and we were talking about how difficult it can be to love oneself. Because, oftentimes we have these core beliefs that drive our psyches and oftentimes these core beliefs are negative. And so what was said was that it’s often hard to stand in a place of self-love when you’re intent on changing things and you’re not happy with where you are now. And so, he said, the person running the meditation said, “self-love is like a garden. So, you can nourish the soil and water the seeds, but you can’t actively force the garden to grow.” So what you can do is, you can take care of the things you love in yourself, all the things that you have in your right now, rather than trying to be somewhere that you’re not currently at. And this is kind of like when you have, for parents out there, if you have a child, you love your 4-year old child, and you don’t put expectations on them that you would a 25-year old. So, you’re loving your 4-year old at where they’re at, but also recognizing that this is somebody who is developing and so you’re loving their potential to develop, just as you’re loving their 4-year old incarnation, their 4-year old manifestation of their personalities. So you’re loving their potential to grow, just as you love the seeds that you’ve planted in your garden, but you’re also loving things where they’re at. And through that act of self-love and tending to the garden, or tending to your child, you’re encouraging that growth and development in the directions that you want.
My name is Dr. Talia Marcheggiani. I’m a naturopathic doctor and I work in Bloor West Village, in Toronto.
Certain amino acids, when taken therapeutically, can affect our body’s ability to produce neurotransmitters that can greatly impact our mental and emotional health. These therapies can help treat depression, food addictions, alcoholism, psychosis and anxiety, among other things.
Transcript:
Hello, everybody, my name is Dr. Talia Marcheggiani. I am a naturopathic doctor and I work in Toronto and I focus on mental health and hormones, especially women’s hormones.
Today I want to talk to you guys about amino acid therapy and amino acid supplementation in preventing cravings, particularly for substance addictions or sugar addiction, but also for improving our mood and mental health and for treating specific psychiatric conditions.
Amino acids are the building blocks of protein. If you think of a string of beads, amino acids are the individual beads that get connected in a string and then folded up into the proteins that make up our body. Our body is basically just a hunk of protein and water. And these proteins set the stage for all of the chemical reactions, as well as the structure of our body.
When it comes to addictions and mental health conditions, there’s a lot of debate around what sets the stage for someone to experience addiction, or struggle with addictions throughout their life. And one of the things that gets a lot of blame, that also fits the pharmaceutical model, especially when it comes to depression and the prescription of serotonin re-uptake inhibitors, is this idea that mental health and addiction is something innate, that we’re born with and that needs to be corrected chemically with something like a drug like an SSRI. And we know that there’s obviously a genetic component to addictions and mental health and it’s certainly not the fault or moral failing in the person that’s suffering from these kind of things, but we also know that our genes don’t write the entire story of our experience and that, for many people, there’s lifestyle changes that can really influence genetic predispositions.
So a study that was done in rats who had a built-in genetic predisposition to addiction, to cocaine addiction, particularly, because they had a deficiency in a hormone called “dopamine”, or issues with their dopamine synthesis, and cocaine is a really potent stimulator of dopamine, which is kind of like a pleasure and reward hormone, or neurotransmitter, in our brains. These kinds of rats that were treated with amino acids, they didn’t display addictive behaviours, so they were essentially cured and their genetics were no longer relevant in terms of how they were acting out, or their behaviour, which is really promising because it was just amino acid therapy.
So neurotransmitters are hormones that work in our brain; they’re produced and act in the brain. Well, we know now with more research, I mean that’s the traditional definition of neurotransmitter, but from more research we’ve found that there’s evidence for the gut producing certain neurotransmitters like serotonin. So you can watch another video where I talk about the gut and how important it is to have a healthy gut when it comes to managing mental health, especially in depression and anxiety.
There’s a few neurotransmitters that are really, that really influence our behaviour and our mental health status and so the first one I already mentioned is dopamine, which gives us that sense of reward and gives us a sense of pleasure. So, dopamine is active when you’re doing something that is really internally motivating. You’re engrossed in a task. In terms of addictions, it’s that seeking behaviour. So a lot of people will experience pleasure in seeking out their substance of choice or thinking about indulging in sugar when they get home from work. So, that’s dopamine, that’s sort of our—the pleasure that we get from acting in the world and it definitely runs part of the show when it comes to addictions.
To quote another study in rats, so dopamine is really prevalent in our hypothalamus and so, with rats, you can give them a lever where they can direct cocaine directly into that area, and so it gives them a giant hit of dopamine. And rats that are given that option, will choose that option over food and so they’ll just stimulate their brain until they die. They’ll drink some water here and there but most of the time all they do is stimulate their dopamine. So that’s how pleasurable it is. It’s pretty much the influence of how we behave in the world and what goals we set for ourselves in the world as well. It’s how we get our delayed gratification, it’s how we work towards pleasurable tasks and how we engage in things like study or work goals or things like that.
Another neurotransmitter, serotonin, which I’ve talked about before, and that’s what the SSRIs, so selective serotonin re-uptake inhibitors are working on. And those are the most widely prescribed psychiatric medications. And that’s the hypothesis that people with depression and anxiety have a deficiency in serotonin: just this kind of innate serotonin deficiency where they either don’t make enough or they’re metabolizing it more quickly than other people. So serotonin is kind of our happy hormone, that’s what gives us a sense of well-being and pleasure. And, there’s no evidence for this hypothesis, however know that through stimulating serotonin pathways, to an extent, we can get some favourable outcomes. We also know that SSRI medications deplete serotonin, and that there’s a connection between serotonin and sugar addictions, because eating sugar will increase serotonin. So a lot of women with sugar cravings during PMS. So a couple of weeks, sometimes up to two weeks before their periods, some women will get really intense cravings for sugar and carbs, and that’s indication of a fall in serotonin before their period, which is causing them to seek out these things to boost their serotonin levels. And that can be treated with amino acids.
And then a third is acetylcholine. So acetylcholine is involved in memory and cognition and sort of that feeling of being engrossed in a task. Not so much involved in pleasure, but in our ability to stay focussed and to concentrate.
A fourth neurotransmitter is called GABA. GABA suppresses our nervous system. So, this is relevant in people with anxiety and this is what the drug class benzodiazepines work on, is GABA receptors. So, in our limbic system, GABA kind of calms down that fight or flight, or that fear state in our body. And oftentimes people who have a heightened nervous system or stress response could use some GABA to calm them down.
So there’s a few amino acids that work on these neurotransmitters. So these neurotransmitters are built with an amino acid backbone. By giving these amino acids, we’re kind of like—if you think of all these neurotransmitters assembled on a factory line, the amino acid is the starting point. So if you’re giving a lot of the supplies, then you’re more likely to cause in increase in production of the thing that you’re increasing the supply for.
We also know that there can be deficiencies in amino acids and therefore, if there’s a shortage of supplies for the key ingredients for the things you’re producing in a factory, you’re not going to get the end result because there’s just not enough of the raw materials to make what you’re trying to make.
So, we can have things like serotonin deficiency not so much because there’s a genetic predisposition, or an issue with the brain’s ability to metabolize it or make it, but maybe that there’s a deficiency in the amino acids, or the vitamins and minerals that are needed to create serotonin.
When it comes to naturopathic medicine and functional medicine, we kind of look at this. We try and see how we can influence the body’s biochemical pathways to get more of what we’re noticing is lacking. And so one of the ways that we can find out which neurotransmitters are lacking is by running some functional tests. That’s not really a big part of my practice because of the cost involved in that, but we can tell a lot through symptoms. So we can tell a lot by asking, are people getting sugar cravings, what’s their drug of choice, are they heading towards cocaine or are they calming their nervous system down and stimulating their GABA pathways with alcohol. Are they trying to get that pleasure sensation with something like heroin? Are they going for stimulants or central nervous system depressants? So, based on what someone is addicted to, or looking at and really breaking down their addictive behaviours, we can find out more about which neurotransmitters might be off. And in a lot of cases there’s a deficiency in many of them.
One of the first things to recommend, just generally, is to increase more protein in the diet, because we know that these amino acids are contained in proteins. And, strangely enough, we don’t get a lot of high-quality protein in our diet in the Standard American Diet, so you think of a bacon and eggs breakfast and McDonald’s lunch and you’re like, ‘well, there’s protein in those foods…’ But, in something like eggs, we’re only getting about 6 grams of protein an egg, whereas I recommend more like 20 to 30 grams of protein in the morning for breakfast. And the reason for this is, of course, to just increase the amount of amino acids that your body can then use to make neurotransmitters, but also to keep blood sugar stable, because drops in blood sugar are going to cause stress hormones to be released and potentially for these neurotransmitters to be altered, worsening addictions, especially addictions to sugar and alcohol, which boost our blood sugar.
So the first thing, dopamine, that amino acid that creates dopamine is tyrosine. So, for some people, and tyrosine is a very stimulating amino acid, so people that kind of have that 2 pm slump, sometimes benefit with some tyrosine, or tyrosine in the morning when they’re feeling really low. And so these people kind of suffer from boredom, they really like stimulants, so they’ll do the caffeine, or they’ll use cocaine on the weekends, or they’re really involved in pleasure-seeking behaviour like, maybe they had a diagnosis of ADHD as a kid, or adult-onset ADHD, which is more involved in traumatic experiences and mental health and neurotransmitter imbalance than it is some genetic predisposition.
Sometimes with these people, supplementing with tyrosine can help, just give them that dopamine boost and keep their nervous system more stimulated so that they don’t need to stimulate it with substances.
For serotonin, the building block is l-tryptophan, which is then made into something called 5-HTP. So some naturopaths will prescribe l-tryptophan as a supplement, I tend to go more with 5-HTP because it passes a step so that your body has to do less work. 5-HTP is really great to help with sleep. It’s good to help with boosting mood, to a certain level, and it’s also really great for PMS sugar cravings, and alcohol cravings. I find myself, personally, so this Christmas I’m going sugar and alcohol free. I’ve been sugar and alcohol free for a few months, but I’m going to carry that on through the holidays, so I’ve had to turn to 5-HTP before my period because I realized how many sugar cravings I get before then. And, miraculously, just with a few hundred milligrams of 5-HTP, I’ve noticed a giant change in the foods that I was craving and in my ability to hold off on having sugar and alcohol. So, pretty powerful.
So, in order to make serotonin, 5-HTP also needs some B vitamins and magnesium. So, people that are deficient in things like B6 and B12 and folate, so I’m looking at vegetarians who often have B12 deficiencies, or vegans. And, actually I see a lot of B12 deficiency or suboptimal B12 in people that eat meat as well, so this isn’t necessarily something is only applicable to vegetarians.
But it’s important for a lot of people to supplement then with these other cofactors that help make serotonin, especially if they’re on an SSRI already. And I don’t advise just doing this on your own, it’s better to do this with a professional who can figure out what’s the underlying cause of a neurotransmitter imbalance and then help prescribe a comprehensive treatment plan that will get you to better neurotransmitter synthesis and treat your symptoms, or the underlying condition.
Something else that I find really helpful, and this is one of my favourite nutrients in psychiatry and in women’s health and something I take is something called N-acetyl cysteine, or NAC, “NAC”. And NAC is from the amino acid cysteine and it produces something called glutathione. So glutathione is the primary antioxidant in the body. This is what our body uses to neutralize all of the free radicals, that is kind of a buzzword—people will tell you to drink green tea, eat blueberries, to get antioxidants, well, the main antioxidant our body uses is something called glutathione, and NAC helps produce glutathione.
It helps our liver detoxify and, in hospitals medical professionals will give people intravenous NAC to treat Tylenol overdose, which we know is liver toxic, so it’s widely recognized that NAC can treat toxicity of the liver. It’s also a powerful antioxidant for the lungs so I prescribe it to patients who are smokers or recovering from smoking or aren’t really ready to quit smoking yet but are experiencing some of the bronchitis, the emphysema, or the increased phlegm or lung issues that go along with a chronic habit of smoking. So, it’s a powerful antioxidant and it has an affinity for the lungs and for excess mucus production. It also helps balance estrogen because of the liver detoxification, so it helps us detoxify estrogen through the liver, and is really helpful for a condition called polycystic ovarian syndrome, which is when the ovaries are producing testosterone and not responding to other hormones properly, so this is really helpful. It also helps with blood sugar balance. NAC’s the best. And so, there’s lots of research for NAC in things like bipolar disorder and schizophrenia and psychosis and OCD. So these more serious psychiatric conditions, NAC can really help balance. And we’re not sure exactly why but one of the hypothesis is that, because it creates glutathione, it helps lower inflammation, and we know that inflammation is implicated in mental health conditions and so that’s why NAC might be so useful. It doesn’t interact with psychiatric medications and so it’s a really big part of my practice.
New research has shown that NAC can help with addictions and cravings for things like nicotine, cannabis, food, so binge eating, cocaine and gambling, interestingly enough. And then there’s a new study that NAC can help treat porn addiction. So, it’s involved in helping lower that desire for, not necessarily substances, or food, but behavioural addictions as well, which is useful. And there’s studies in trichotillomania, so that’s like, compulsive hair plucking—so people will pluck their eyelashes or pluck their hair—or skin picking, and NAC can work pretty rapidly in bringing down those desires and stopping those behaviours.
GABA is something you also might have heard of. So, GABA was a neurotransmitter that I cited before, that calms the nervous system down. GABA, there’s debate about whether it crosses the blood brain barrier. So, our brain has this really tight wall that it prevents certain substances from crossing. That’s to protect our brain tissue from toxins and foreign objects, or foreign substances. So we’re not sure, necessarily, if GABA’s acting on the brain unless there’s a leaky brain situation happening, so kind of like leaky gut, we can also have that with our blood brain barrier. But there’s herbal combinations that help stimulate GABA, that I implement in my practice sometimes to help people that are experiencing panic attacks or anxiety, to get them to a level where they can then make the changes that are going to sustain them. So, things like valerian and hops, and passionflower and something that I prescribe a lot, kava, another herb called lemon balm. So, sometimes combinations of these, or just one of these things can help, especially before bed. And so, one of the indications for GABA deficiency is a craving for wine, especially at the end of the day, and particularly white wine. I guess it has more GABA-stimulating properties. I have a lot of patients, many of them female patients, that just really crave a glass of wine at the end of the day. And a few other patients that will have an after-work beer. So, just doing some GABA, or some GABA herbs, on the way home from work might be enough to decrease that need to reward and balance that nervous system, because the alcohol does have a GABA-stimulating effect and calms people down. It’s us looking for a way to self-medicate and trying to balance our neurotransmitters through the actions that we’re familiar with that don’t necessarily set us up for powerful health because they perpetuate further addictions, like turning to alcohol to calm ourselves back down, or as a reward and stress relief.
And the last neurotransmitter I’m going to talk about is something called l-glutamine. So, glutamine is a fuel for brain cells and for gut cells, as well as kidney cells. It’s another amino acid, it’s involved in creating the neurotransmitter glutamate, which is excitatory. So, this is something that increases our nervous system tone.
So, glutamine we prescribe as naturopaths a lot for leaky gut because it helps feed our enterocytes, or our gut cells, it can help repair them. So, somebody with celiac disease who’s experienced a lot of intestinal damage and has now taken out gluten, might need some glutamine, some l-glutamine to repair the gut cells that were damaged or increase that cell turnover so that they’re no longer experiencing symptoms.
L-glutamine has kind of got a sugary taste, but it doesn’t stimulate us like sugar does, and so one thing that people do when they’re experiencing sugar and alcohol cravings is to take some glutamine powder or open up a capsule of l-glutamine and let it dissolve under their tongue. And they experience a remarkable decrease in their sugar and alcohol cravings, those physiological cravings—the emotional cravings are another piece, obviously—but the physical cravings where our body is really asking for these foods, the l-glutamine can really help calm that down powerfully. So this is something that I’m going to experiment with myself and with some patients that I know could really benefit from this.
So I wanted to give this talk, just to give you guys some easy things to try over the holidays, especially when you’re experiencing some of those sugar or alcohol cravings or getting into a situation where your vices are playing out in excess. I know that this is going to be helpful for me, because of my commitment to no sugar or alcohol this holiday season, which is actually easier than it sounds. And one thing to note too, is that with amino acids, because we’re pushing pathways, they don’t work necessarily like drugs that can take, like an SSRI can take 4 to 6 weeks before it’s effect comes on. These work within days. So, when I was experiencing sugar cravings before my period last month, and I started to take 5-HTP, which remember stimulates serotonin, or helps us produce serotonin, and can help with sugar cravings, and carb cravings. When I started to take 5-HTP, I noticed this sense of well-being and uplifted mood within a few days and it was a noticeable effect, as well as deepened sleep. My sugar cravings immediately dissipated when I started taking it. So it took a few doses to eliminate my sugar cravings and then a few days to increase my mood, which I didn’t even realize was kind of falling, based on that serotonin deficiency before my period. So, these are really powerful therapies that you can try. I don’t advise doing it on your own, but seeking the help of a professional, but these are things that can really help balance brain chemistry during the holiday season and set you up for better mental health.
So, next talk I’m going to talk about leaky gut and leaky brain and how avoiding gluten can help with mental health conditions. So, have a great holiday, everyone and I’ll see you next time. My name is Dr. Talia Marcheggiani, and I’m a naturopathic doctor who practices in Toronto. If you have any questions give me a shout on my email at connect@taliand.com. Happy Holidays.
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.
I talk about how to manage stress and promote mental health and emotional wellness through assessing balance in the key areas of your life that promote a healthy mind and body.
Hello, everybody, my name is Dr. Talia Marcheggiani. I’m a mental health and hormone expert.
Stress is a big reason why a lot of people come to see me, for support in their lifestyle and optimization of their health, especially their mood and mental health.
And, one of the things that I’ve come to understand in working with people one on one is that stress in life is an inevitability, especially in our society.
Work is just one aspect of the stress that influences our lives, but things like loss of loved ones, and ending of relationships, pressure from work, monetary struggles. These things in society are inevitabilities. So, we’re sooner or later going to be faced with major stressors in our lives regardless of how well our life is happening right now.
One of the big things in terms of working with people is helping with their resilience to stress. That means building up resources. So, before I meet with a patient I have them fill out an online intake form. And this is sent to their email and one of the—the intake form goes over what their concerns are, what they’re coming in for, it goes through all the areas of their health, their physical health and mental health and one aspect as well, in the chart is something called The Wheel of Balance. And, what the Wheel of Balance does is, it looks at all the major pillars that make up somebody’s life. It asks the potential patient or the new patient, to assess, to rate on a scale of 1 to 10 how satisfied they are with that area of their life.
So, for example, one of the areas is health and so on a scale of 1 to 10 how you feel that your health is managed? How satisfied are you with your level of health? Are you in chronic pain? Do you feel unwell generally? Or do you feel like health is pretty well managed, despite the fact that you’re coming in with a health concern?
Another area is relationships. So, personal relationships. So, some people don’t have a significant other and, if that’s so, how do you feel about that? Or, if you do have a significant other, how satisfying is that relationship? How well do you feel that relationship supports you in your life?
There’s several reasons for this Wheel of Balance. One is to just get a general understanding of the life of the person I’m going to be working with, what the broad picture is in terms of their life.
And another reason is that we know a lot of these factors such as relationships, and health and career, and money and whether you have hobbies, whether you have something that fills you, something that gives you a sense of purpose, we know that these things are determinants of health. So, your socioeconomic status is one of these factors that determines your longevity or your resilience against disease, especially your resilience against stress. If I have somebody coming in with depression and anxiety who’s recently been laid off, no amount of herbs—well, the herbs can buffer the stress response and relax the physical body so that somebody can look for work, but on the high priority list is helping them find a job again, because no matter how calm you’re feeling physically, or much meditation you’re doing, the fact that you don’t have a way to pay your bills is a major stressor that won’t go away until it’s dealt with.
And, another reason as well for doing this Wheel of Balance, if we’re assessing this holistic scope of what someone’s life is, is the fact that these pillars, when they’re strengthened, they provide the basis for the resilience against onslaughts of stress that come in.
So, many of the people that come in and see me who are dealing with mental health issues, they’re often struggling with an onslaught of stress that’s hit them. So it could be that they’ve recently been laid or separated from a partner in a romantic relationship, or it could be a great loss or trauma or somethings are surfacing.
Organizing these pillars of resilience is really effective for helping somebody deal with the stress and survive a new wave of stress.
In naturopathic school we learned about something called the Stress Wall, so it’s sort of a similar idea. You’re building up these resilience factors, you’re strengthening relationships, you’re dedicating time and energy to creating a career that you love, you’re arming yourself with hobbies and interests and purpose and passion and, therefore, when a stress wave hits you, you’re able to withstand it, or you’re able to recover more quickly. It doesn’t throw you, it doesn’t send you into chaos, physically, mentally and emotionally.
And sometimes these waves of stress they test our stress wall, so sometimes people are doing all right and then a really stressful time at work will show them how well their stress wall’s been built.
So one thing you can do, right now, having said all this, is do a Wheel of Balance with me. So, all you need is a piece of paper, and you’re just going to draw a circle on it. And you’re going to divide the circle up into 8 sections. So, divide it in half, then in quarters, then divide those quarters into halves so that you have 8 sections on your wheel.
And then you’re going to label each pie slice with a title. So, the first one is career. The second one, money, because those are two separate things. Our career is not always tied to our money. Sometimes satisfaction with a career doesn’t necessarily mean monetary satisfaction. So we separate those two things, although they can be linked. The third is health. The fourth is relationships, and this is romantic relationships or significant other.
The fifth is family and friends, supporting relationships. If you don’t have a significant other, you can also rate your satisfaction with the fact that you don’t have a significant other, so if you’re single and feeling pretty good about it, pretty happy with your independence, or are you in the search of looking for a significant other, or are you recently single and upset about that. So this is something where you can evaluate your satisfaction because it is a piece of the puzzle and piece of the Wheel of Balance in terms of resilience, because one of the biggest sources of stress is from romantic partnership or lack thereof.
So the sixth pie slice is fun and hobbies. This is something meaningful that you pursue outside of your work, whether you have one or more things. In that section is sort of what you do to destress, so do you come home and flip on the TV and is that a fulfilling and stress-reducing activity for you? It can be for a lot of people, but bringing awareness and consciousness to that is very helpful.
The seventh is purpose and growth. So, are you everyday creating meaning in your life? Is there a clear meaning for your life and are you fulfilling that meaning and purpose? Do you feel like you’re growing and learning every day? That’s really important for a lot of people and I often find that people mark that pretty low especially when they’re dealing with a mental health condition or a high amount of stress in their lives.
And then the final thing is your physical environment. Physical environment is, are you happy with where you’re living? So how your living arrangement is, physically. Is it a comfortable space to live in? Do you like how it’s decorated? Do you like where you’re living? What city you’re in? What part of the city you’re in? Are you exposed to nature on a regular basis and, if not or if so, how important is that to you? So you’re evaluating what the state is of the physical surroundings that you’re in. So that’s why we clean our houses or why we care about where we’re living because a cluttered environment does affect our internal and mental state.
So, again, those categories are career, money, health, relationship, family and friends, fun and hobbies, purpose and growth, and physical environment. So, when you’re finished you’ll have a chart that looks like this. So it’s got eight different slices with different labels. And, on your own I want you to fill in the pie according to your level of satisfaction, so if you’re 100% satisfied in the area of your career then you colour in the entire pie slice. If you’re only 50% satisfied or one quarter than you fill the corresponding amount out. Then you look at the areas you’re not as satisfied in and the areas you might be over-compensating in. So you might be really dedicated to maintaining a healthy lifestyle but may be sacrificing in the area of fun and haven’t really invested in making sure you’re creating fun activities.
You also might not want these categories. There might be another category that’s more important to you. If you don’t care about one of these categories it might mean that you’re satisfied with it, or you don’t feel that it brings meaning to your life, and that’s totally cool.
But, it’s sort of an idea of these areas that we build our lives around. And so what I do with people, because a lot of the time when people are feeling a lot of stress, or have a mental/emotional issue that they’re coming in with, depression or anxiety, neurosis or anything like that, a lot of the time they’re missing a few areas, or their Wheel of Balance is skewed in one area or it’s just generally weak all over. And so what we have to do—that means these people are very susceptible and vulnerable and the first thing to do, instead of working on diet or giving herbs and that kind of thing, is to strengthen some of those areas to create a more robust Wheel of Balance. And so what we do is, if there’s an area that you’re weak in, is creating one concrete thing you can do, more or less immediately, so let’s say within the week, that would strengthen and kind of balance out your Wheel of Balance.
And so, an area that is often lacking for most adults and busy people is fun, so if you put 25% of satisfaction in the area of fun, then coming up with a strategy, one thing you can do this week that would increase your satisfaction, even a little bit, and start to build up that pie slice, in the Wheel of Balance. So, thinking of something you would do that you would classify as fun. In the area of family and friends, how can I reach out to somebody, or strengthen an existing friendship or look for a way that I could put myself in a position to meet new people. So we start working on these areas. So once you’ve developed resilience and strength, we’re better able to weather the new waves of stress that hit us because they will, inevitably. Some of us are blessed to not have as many stress waves, but eventually there is something that will affect us and will affect our state of balance and our mental health so the stronger our pillars of resistance and the more robust our Wheel of Balance is, the better able we are to weather these storms and maintain our mental and emotional health and our physical health, because we know they’re all connected.
My name is Dr. Talia Marcheggiani, thanks for listening and if you want to contact me, my email is connect@taliand.com. I practice in Bloor West Village in Toronto.
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.
It seems like the world is falling apart. These days more than ever.
Race wars, weapons, war, wealth concentrated into the hands of a few, and violence, Facebook is filled with videos that fill our heads and hearts with a complicated mixture of sadness, anger, anguish, confusion, frustration, enrage, injustice and a deep-felt sense of powerlessness. We struggle through these events to go on living—to go about our lives in a dignified fashion, to pay our rent, to engage our relationships, to find happiness and satisfaction in our lots in this world. It seems like the world is ending, and yet we still have our daily responsibilities. Our cynicism is engaged; our idealism is crumbling. Many of us feel hope leaving our bodies. Many of us feel frustration morphing into despair.
Stress is estimated to be the number one cause of disease. As a naturopathic doctor, my role often involves cleaning up the debris from chronic, long-term stress responses gone haywire. Oftentimes my patients don’t even perceive the stress they’re under. “I’m type A! I thrive under stress and pressure”, some will tell me. Other times the people I work with are so far in a state of overwhelm it’s all they can do to keep moving forward with their daily routines.
The World Health Organization estimates that 75-90% of doctor’s visits are attributed to by stress. I would estimate that 100% of the people I work with have on-going stress in their lives.
We doctors know that some people, the “Type B’s” in society, are more susceptible to stress. We know these people, we may even be one of them ourselves: the sensitive individuals, the intuitives, the feelers, the artists, empaths, activists and light-workers. We are individuals who are often drawn to artistic and healing professions, who care deeply about relationships, people, feelings and soft-ness in this world. We often find ourselves pushed up against hard edges, struggling to pay bills and cope with cruelty and injustice. We face daily struggles and the pain of living a disconnected, yet intricately interdependent life in modern-day society. Some natural doctors have terms us “parasympathetic dominants”—people whose nervous systems tend to get stuck in the parasympathetic (as opposed to stress-fuelled sympathetic) arm of the autonomic nervous system (the “automatic” nervous system).
We often feel overcome with a sense of overwhelm when faced with packed schedules, high stakes jobs that affect others, achievement-oriented striving and the prioritization of money and numbers over people. In this world of deadlines, assertion, aggression, fear, war and material wealth, we can often feel like we don’t fit in. We can suffer from burnout.
Burnout, “adrenal fatigue” or “parasympathetic dominance” happens when our stress response becomes depleted. It is characterized by naturopathic doctors as fatigue, excessive needs for sleep and quiet, lack of motivation, disrupted sleep schedules, difficulty losing weight, sluggish digestion, bloating and IBS, headaches and brain fog, poor memory, hormonal imbalance resulting in heavy or irregular periods, PMS, infertility and acne. Mental illness can begin to surface or worsen in this state, resulting in depression, anxiety, or even bipolar disorder and psychosis. The narrative of the mad, artistic genius, burdened by the weight and troubles of the world, surfaces to mind—the creative genius who is too sensitive for this world. We run the risk of becoming irritable, and losing some of our natural compassion as we drift off into exhausted survival mode.
Many of the people I work with are these sensitive individuals, myself included, and I’m proud to help this population. Through healing the sensitive feelers, we heal the world. The world needs a little more softness and more compassion. It needs people who can pick up on emotional nuances and care deeply about others. It needs people who listen, who feel, who create and share their versions of the human experience to teach others. Through the artists, we experience the depths of our own humanity. Through the artists, we see our pain and, through seeing our pain, we can begin to heal it. It is important that we can find fulfilling work and lives that nurture us, so that we may have the energy to extend our gifts to the world.
Healing parasympathetic dominance in my practice often manifests first as establishing a therapeutic relationship. We crave openness, time and space to explore emotional nuances and engage our natural sense of curiosity. We crave being deeply heard and felt. As a doctor, I do my best to listen, not just to the words, but the space between them, and the symptoms of the body. We look for root causes to issues so that we can establish lifestyle patterns that nurture us.
Creating a clean, nutritious diet: With lean protein, usually meats that stimulate metabolism and manage stress, healthy fats, anti-inflammatory nutrients and lots of fruits and vegetables, especially berries and leafy greens, we can begin to re-feed ourselves and heal inflammation.
Gentle, nurturing movement: I often suggest exercise that blends into the lifestyles of my patients, that works with them. Slow, meditative walking for an hour a day is a wonderful, scientifically proven method of bringing down stress hormone levels. It also creates space in the day for contemplation and integration.
Restful sleep: Through sleep hygiene and some strategically dosed supplements, improving sleep allows the body to repair itself and rest. Those suffering from burnout may need more sleep. Dealing with the guilt that can arise through sleeping in and saying no to non-essential activities to prioritize sleep is often a psychological hurdle in those who feel best when they are nurturing and giving to others, and not themselves.
Self-care: Journalling, meditation and engaging in creative pursuits are helpful armour in allowing one to integrate, express and stay open, energized and creative.
Nurturing mental health and emotions: Speaking to family and friends or a trained therapist or naturopathic doctor can allow us to dive more deeply into our own psyches. When we explore the corners of our mind we are able to heal mental-emotional obstacles to health and learn more about ourselves and others and alter the way we engage in the world. Opening ourselves up to deep-seated anger, fear and sadness is essential to clearing this repressed emotions and improving our experience in the world. My favourite forms of talk therapy are Narrative Therapy and Coherence Therapy. Both involve openly engaging the emotional and mental experience of the other to alter core beliefs and narratives and explore possibilities for living a preferred life experience.
Through the times we are facing, I urge us all to band together, embrace the healers and artists among us and engage in deep, nurturing self-care. Journal, spend time with friends and create. Take time from your activist pursuits and political readings to reflect, to meditate, to get some healing acupuncture and to cry or express anger. Feel the emotions that arise during this time. Take the time to listen to the narratives that emerge. Eat a diet filled with protein, try to keep to a sleep schedule, if possible. Nurture yourself and the complicated emotions that are arising within you and others.
We need you to help us through this time. It is people like you who can heal others, but only if you strive to heal yourself as well.
With 18% of the population suffering, anxiety is the most common mental health condition in North America. Through clinical practice, I’ve quickly come to learn that “anxiety” is a term that means many different things to different people. Its symptoms can range from a mild sense of unease to full-blown panic attacks and the burdensome weight of impending doom. Anxiety disorders are quite diverse. They include, according to the DSM-IV, specific phobias, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety, obsessive compulsive disorder (OCD) and even mixed anxiety and depression. Oftentimes the symptoms become crippling; they prevent the patients I see from living their optimal, authentic lives, instead living in a state of fear and self-loathing.
Symptoms
The symptoms of anxiety are holistic. They range from mental symptoms: excessive worry, insomnia, nervousness and anticipation, to name a few, to genitourinary symptoms like frequent urination, and gastrointestinal symptoms. There is a strong connection between anxiety and mental stress and irritable bowel syndrome (IBS), an elusive condition of the gut that results in unpredictable symptoms like bloating, diarrhea, constipation and stomach pain, which is often debilitating for those who suffer from it and very difficult to effectively treat. Other symptoms of anxiety include excessive sweating, muscle tension, rapid heart rate, changes in vision, hot and cold flushes and can be associated with suicidal ideation, self-harm and substance abuse disorders, when anxiety becomes severe.
Conventional Treatment
Unfortunately the conventional treatment for anxiety is limited. The first-line treatment is pharmaceutical and involves using a medication like citalopram, a selective-serotonin re-uptake inhibitor (SSRI), the same medication used to treat mild-moderate depression. This medication is prescribed based on the theory that anxiety is a extraverted version of depression, and that both involve disturbances in the production and signalling of serotonin, the “happy hormone”, in the brain. Benzodiazepines are another line of drugs used to treat anxiety symptoms, as they increase brain GABA levels, a calming brain chemical. However, “benzos” are best prescribed only in the short term (2-4 weeks) to manage serious symptoms. They are addictive in the long-term and can have serious side effects, such as being overly sedating, and depressing breathing, especially when mixed with other sedatives, such as alcohol.
Naturopathic Approach
When I first meet a patient who is suffering with anxiety, I begin by taking a complete case. I have never met two patients who have had identical anxiety symptoms—no two cases of anxiety are alike and therefore, no two cases should be approached in the same way. Therefore, it is important for me to get a complete case history, with details of how anxiety manifests in my patients’ lives: how it affects them, where it might have come from and what specific symptoms are faced on a daily basis. I also inquire about hormonal systems, digestive symptoms, sleep, diet and past medical history. It is important for me to treat the person, not the condition. This means that my patients and I spend time developing a relationship. I make an effort to get to know them during the first few visits, thereby getting to know how their condition uniquely occurs for them.
A large portion of the naturopathic diagnostic process is identifying the cause of anxiety. While conventional medicine points to dysfunctions in the brain, naturopathic medicine approaches anxiety holistically. We understand that because anxiety can affect nearly every body system, it can also manifest as a result of imbalances in a number of organ systems. In the first few visits, we spend time analyzing the web of our patients’ symptoms in order to untangle the clues that might lead us to the root cause.
The Root Causes of Anxiety
A holistic approach to anxiety aims to uncover the root cause of symptoms by investigating imbalances in a variety of body systems. In the body there is a balance between the sympathetic nervous system (fight or flight) and the parasympathetic nervous system (rest and digest). When one system is turned on, the other is turned off. A healthy body can oscillate between the two states easily, activating the fight and flight response during times of stress and activating the rest and digest response the rest of the time. Anxiety is present in the fight or flight, sympathetic nervous system state.
Cause: Stress
More than half of North American adults are experiencing some sort of mental, emotional or physical stress. Chronic stress relies on production of the hormone cortisol, which on its own can disrupt brain levels of happy hormones, like serotonin and dopamine. Chronic stress can also lead to burnout, or adrenal fatigue, which results in an inability of the body to respond to stress in a healthy manner. Instead of producing cortisol, the adrenal glands rely on epinephrine and norepinephrine (adrenaline and noradrenaline) to confront stressful situations. These hormones result in symptoms of anxiety like racing heart-rate, rapid respiration, muscle tension, mental worry, dry mouth and sweating palms. Being stuck in the fight or flight state, can cause anxiety or worsen existing symptoms.
2. Cause: Malnutrition and Hypoglycaemia
Protein, vitamins and minerals are the building blocks our bodies need to perform its millions of chemical reactions. Trying to heal anxiety without the proper ingredients for health is like trying to build a house without bricks, cement or nails. Neurotransmitters like serotonin and dopamine, and hormones like cortisol require the amino acids (protein) tryptophan and tyrosine for their synthesis, respectively. They also require cofactors, or “builders”, to make neurotransmitters, which include zinc, b-vitamins, magnesium and iron. Stress, because of it’s demands on cortisol production, can deplete these precious ingredients, increasing our dietary requirements. Decreasing vitamin and mineral content in food due to poor quality food production also means we’re not getting enough of these key nutrients and supplementation might be necessary to ensure our body is running optimally.
In addition, rising and falling blood sugar levels from a high-carb diet can cause hypoglycaemia. Hypoglycaemic symptoms can mimic anxiety symptoms, such as dizziness, racing heart, irritability, sweating and fatigue.
Iron deficiency is also a common finding in North Americans, especially menstruating women or vegetarians. Since iron is responsible for carrying oxygen in the blood, a decrease in oxygen carrying capacity results in rapid heart-rate and increased breathing rate, which can also be confused for symptoms of anxiety or panic attacks.
3. Cause: Digestive Issues
Although serotonin, the happy hormone, is primarily active in the brain, studies show that up to 90% of it is made in the intestinal tract. Therefore, a disruption in the health of digestive cells or the bacteria that coats the gut, can result in a disruption in mood as well as digestive symptoms like IBS. 40-60% of people have some sort of digestive issue in North America and there is a close connection between digestive issues and mood, termed the “gut-brain connection”.
Food sensitivities and issues with the health and integrity of intestinal cells can lead to wide-spread inflammation in the body, affecting the nervous system. Scientists have found that low levels of inflammation in the brain and an overactive immune system can contribute to depression and other mental health conditions as well as the breakdown of brain function, contributing to memory loss, headaches and difficulty concentrating and retaining information.
Furthermore, an inability to break down and absorb protein and micronutrients results in an inability for the body to make neurotransmitters like serotonin, which require protein and various vitamins and minerals for its production.
4. Cause: Hormonal Imbalance
Because of the high exposure to xeno-estrogens, or toxic estrogens, many women in North America suffer from a phenomenon called “estrogen dominance”, where there is either too much estrogen in the body or not enough progesterone to provide hormonal balance. Symptoms of estrogen dominance include, weight, gain, painful and heavy periods, irregular periods, fibroids, acne, PMS, infertility and an increased incidence of female cancers, such as breast and ovarian cancer. Estrogen and progesterone, in addition to being female hormones that control secondary sex characteristics like breast and hip development and fertility, also exert effects on the brain. Estrogen can cause irritability and anxiety symptoms, while progesterone has a stress-relieving and calming effect. Estrogen dominance, when not controlled, can worsen existing anxiety or be the cause.
5. Cause: Core Beliefs and Mental Schemas
Our brains are wired to retain the lessons we learn, especially if these lessons have been experienced alongside strong emotions, such as trauma. These emotional memories are often implicit and non-verbal, located in lower brain centres, below the level of our conscious thoughts. Once the memories are laid down, they can last a lifetime, influencing our thoughts, emotions and behavioural reactions to present day triggers. Anxiety and other mental health conditions can often be symptoms of these emotional memories, also called “core beliefs” or “mental schemas”. These beliefs dictate to us implicitly how the world works and, if left unexamined, can limit what is possible for us in our lives. When these beliefs get triggered, anxiety symptoms can result. Getting to the core of the symptoms and making the implicit memories verbal is the key to unlocking hidden psychological causes of mood disorders.
Holistic Solutions for Anxiety
Healing anxiety first involves identifying the specific symptoms that my patients present with and looking for potential causes among the common causes outlined above. In addition to a thorough history, I may order blood work to check the B12 and iron status of my patients. I may order a food sensitivity test or check for hormone levels like progesterone, estrogen and cortisol in the saliva and blood, depending on the symptoms a patient presents with.
When I work with patients, we often work together to develop a comprehensive strategy for coping with stress. Oftentimes this involves looking for ways to decrease stress in their lives, such as cutting back on work hours and setting healthy boundaries. Other times it involves looking for activities to incorporate into their lifestyles to manage stress, such as going for long walks (walking slowly for 1 hour can lower cortisol levels and help manage stress), engaging in meditation, yoga, nature exposure, journalling and other activities that have been proven to lower stress hormones.
Creating a nutritional plan is also important for managing anxiety. I work with the place my patients are at, rather than pushing a full dietary overhaul. Making minor adjustments to diet, such as adding more protein, especially in the morning, more fruits and vegetables and less refined carbs and sugars, can do wonders for decreasing anxiety symptoms. Reducing caffeine and alcohol consumption can also greatly benefit symptoms.
Depending on the specific symptoms and lifestyle of my patients, I might recommend nutritional supplementation to improve neurotransmitter synthesis. I also prescribe supplements to help my patients’ bodies through times of stress, depending on their stress levels and other symptoms they present with. Keeping supplements to a few key nutrients that treat the root cause of symptoms is preferable to taking handfuls of pills every day.
Improving gut health is important. This means supplementing with a good quality probiotic, identifying and removing food sensitivities, and eating a diet that is low in inflammatory fats and high in health-promoting omega 3 fatty acids. A digestive aid such as digestive enzymes or herbal bitters can also help with the body’s ability to absorb valuable nutrients from a healthy diet.
Balancing hormones by supporting liver function, adjusting birth control brand and dosage, and minimizing exposure to hormonal toxins such as BPA, fragrances or phthalates can help treat symptoms of estrogen dominance, if present.
Finally, counselling to identify core beliefs can also be beneficial for eradicating emotional memories that are no longer beneficial to patients and that can be contributing negatively to symptoms of anxiety and mood, is important. CBT, narrative therapy, mindfulness training and Coherence therapy are all processes through which patients can begin to identify and challenge the core beliefs that may be contributing to or causing their anxious symptoms.
For more information on a naturopathic approach to your anxiety, visit my contact page.
We all have a critic inside of our heads. Through talking to people, I’ve been able to form more complete pictures of what these critics look like. I’ve found them to be as varied as the heads they inhabit, with personalities and characteristics of their own.
Some critics speak in fragments, muttering key words in people’s ears: fat… failure… loser… always…be… alone. Some are quite articulate, forming complex arguments. All inner critics, however, are sharp in their cruelty and ingenious in the way they intrude into our thoughts and convince us of our lack of worth.
Our inner critics were born out of a need for protection. The inner critic’s job is to spare us shame and pain. If it criticizes us before we have the chance to say or do the “wrong” thing, it can help us avoid social humiliation, rejection and isolation. However, the disparaging, constant stream of criticism often leads to depression, low self-esteem and negative identity conclusions in many people–a strong critical voice has the power to convince the person it talks to that he or she is wrong. The critical voice in our heads has the power to poke holes in the social armour of our self-esteem, diminishing the good feelings we have about ourselves and destroying our sense of personal value, self-worth and resilience.
There are many ways to develop a healthy relationship with the critical inner voice and address issues of low self-worth and low self-esteem. One of these ways is to strengthen other, more positive voices, that serve to give us a balanced view of ourselves. Self-help books and feel-good memes emphasize the importance of positive affirmations.
“Write down ten things you love about yourself before you go to bed every night!”
“Recite ‘I am beautiful, healthy and happy’ five times each day!”
“Write ‘I love you!’ and ‘You’re awesome!’ in lipstick in the bathroom mirror and look at it every morning before you to go to work!”
“Paper your workspace with feel-good Post-it notes!”
The suggested ways of talking to ourselves are endless. A sample:
According to Guy Winch, PhD and author of Emotional First Aid, research shows that positive affirmations can be very effective at raising self-esteem. However, their efficacy only applies to a certain group of people (like Jessica here). Affirmations can boost the morale of those who already have high self-esteem and a high sense of self-worth. In people who struggle with strong critical voices, depression and feelings of self-loathing, positive affirmations only result in making them feel worse.
Science tells us that we accept statements and ideas when they fall into our current belief system. Therefore, people with healthy levels of self-worth, who already believe that they are loved, good at their jobs and successful, will reinforce those feelings through reciting positive affirmations about themselves. However, my patients struggling with issues of self-esteem will comment that when they feel unattractive, unloved or unworthy, reciting the opposite sentiments as affirmations (“I am beautiful, loved, worthy!”) only reinforces their current feelings of unworthiness and unattractiveness. When a positive affirmation doesn’t overlap with the beliefs we hold about ourselves, we will reject it, thereby failing to convince or persuade ourselves to feel otherwise. Trying to force oneself into feeling a positive emotion can often only serve to remind us of how unhappy we are actually feeling.
Dr. Winch offers an alternate 3-step exercise, which reminds me in many ways of Narrative Therapy as it aims to build on one’s preferred identity. The exercise is based on increasing the aspects of our identity we already believe of ourselves. It takes about 20 minutes and requires writing. Writing helps us process the information on both sides of the brain, properly integrating and enforcing these more balanced thoughts about ourselves. The exercise only works when you write your thoughts down.
Step 1: Choose a specific situation in which you feel bad or unworthy. Perhaps you have a test coming up and feel unprepared or convinced that you’ll fail. Perhaps there is a date you’re going to go on but you feel ugly and unworthy of someone’s time or attention. Maybe you feel unpopular and have come to the conclusion that you are a bad friend. Using context is important for creating an alternate voice to that our the critic.
Step 2: Once the context has been selected, write down a list of things—traits or behaviours you exhibit—that you have to offer that you believe are valuable to the situation. This list should be exhaustive. Perhaps you would make a good date because you are generous, always offering to pay. Perhaps you’re loyal or you care about others. Perhaps you remember important dates and make your partner feel special on his or her birthday. Perhaps you’re a good student because you get to class on time or study for an hour after class instead of watching movies. Perhaps you always take notes in class and often share them with others. Focussing on even the tiniest detail of what you have to offer the situation will help you in the creation of your list. If you can’t think of anything positive about yourself, pretend that you are writing it for a friend. What would your friend have to offer if he or she were faced with the same context and self-defeating thoughts as you?
Step 3: Choose one of the items on your list and write a short essay on why these traits or qualities are important to the context you are in. Why is being thoughtful (remembering birthdays, for instance) important for dating? How have you managed to manifest this trait in the past? How will you manifest this trait or behaviour in the future? Write about how this trait has been valued by others or might be of value to others in the context that you’re in. Focusing on specific details helps to flush out the narrative of how this trait has helped shaped your identity. Again, if you are unable to write about yourself, continue to write as if it were about a friend, sticking to more general ideas. Then put the paper aside, pick it up 24 hours later, and read it as if it were about you.
Writing a short, detailed essay about what we know we have to offer and why these offerings are worthwhile can help to build a more balanced view of ourselves and the qualities we bring to the world. Narrative exercises serve to strengthen what we already know about ourselves, thickening the preferred identity stories that either fail to get told or get drowned out by the dominant stories of negative labels and personal failings. The aim is not to shut up the inner critic, but to strengthen the voices that oppose it, balancing and creating a dynamic sense of self.
People seek out naturopathic doctors for expert advice. This immediately positions us as experts in the context of the therapeutic relationship, establishing a power imbalance right from the first encounter. If left unchecked, this power imbalance will result in the knowledge and experience of the practitioner being preferred to the knowledge, experience, skills and values of the people who seek naturopathic care.
The implicit expectation of the therapeutic relationship is that it’s up to the doctor to figure out what is “wrong” with the body patients inhabit and make expert recommendations to correct this wrong-ness. After that, it’s up to the patients to follow the recommendations in order to heal. If there is a failure to follow recommendations, it is the patient who has failed to “comply” with treatment. This “failure” results in breakdown of communication, loss of personal agency on the part of the patient, and frustration for both parties.
When speaking of previous experience with naturopathic medicine, patients often express frustration at unrealistic, expensive and time-consuming treatment plans that don’t honour their values and lifestyles. Oftentimes patients express fear at prescriptions that they had no part in creating, blaming them for adverse reactions, or negative turns in health outcomes. It’s common that, rather than address these issues with the practitioner, patients take for granted that the treatment plan offered is the only one available and, for a variety of reasons, choose to discontinue care.
One of the elements of Narrative Therapy—a style of psychotherapy founded by Australian Michael White—I most resonate with is the idea of the “therapeutic posture”. In narrative therapy, the therapist or practitioner assumes a de-centred, but influential posture in the visit. This can be roughly translated as reducing practitioner expertise to that of a guide or facilitator, while keeping the agency, decision-making, expertise and wisdom of the patient as the dominant source for informing clinical decisions. The de-centred clinician guides the patient through questioning, helping to reframe his or her identity by flushing out his or her ideas and values through open-ended questions. However, the interests of the doctor are set aside in the visit.
From the place of de-centred facilitation, no part of the history is assumed without first asking questions, and outcomes are not pursued without requesting patient input. De-centring eschews advice-giving, praise, judgement and applying a normalizing or pathologizing gaze to the patient’s concerns. De-centring the naturopathic practitioner puts the patient’s experiences above professional training, knowledge or expertise. We are often told in naturopathic medical school that patients are the experts on their own bodies. A de-centred therapeutic gaze acknowledges this and uses it to optimize the clinical encounter.
I personally find that in psychotherapy, the applicability of de-centring posture seems feasible—patients expect that the therapist will simply act as a mirror rather than doling out advice. However, in clinical practice, privileging the skills, knowledge and expertise of the patient over those of the doctor seems trickier—after all, people come for answers. At the end of naturopathic clinical encounters, I always find myself reaching for a prescription pad and quickly laying out out my recommendations.
There is an expected power imbalance in doctor-patient relationships that is taught and enforced by medical training. The physician or medical student, under the direction of his or her supervisor, asks questions and compiles a document of notes—the clinical chart. The patient often has little idea of what is being recorded, whether these notes are in their own words, or even if they are an accurate interpretation of what the patient has intended to convey—The Seinfeld episode where Elaine is deemed a “difficult patient” comes to mind when I think of the impact of medical records on people’s lives. After that we make an assessment and prescription by a process that, in many ways, remains invisible to the patient.
De-centred practice involves acknowledging the power differential between practitioner and patient and bringing it to the forefront of the therapeutic interaction.
The ways that this are done must be applied creatively and conscientiously, wherever a power imbalance can be detected. For me this starts with acknowledging payment—I really appreciate it when my patients openly tell me that they struggle to afford me. There may not be something I can do about this, but if I don’t know the reason for my patient falling off the radar or frequently cancelling when their appointment time draws near, there is certainly nothing I can do to address the issue of cost and finances. Rather than being a problem separate from our relationship, it becomes internal the the naturopathic consultation, which means that solutions can be reached by acts of collaboration, drawing on the strengths, knowledge and experience of both of us.
In a similar vein, addressing the intersection of personal finance and real estate within the therapeutic relationship requires a delicate balance of empathy and practicality. Patients may be navigating the complexities of homeownership or rental expenses, which can significantly impact their overall well-being. Encouraging open communication about these financial stressors fosters an environment where solutions can be explored collaboratively. It’s essential to recognize that financial challenges are not isolated issues but are intricately woven into the fabric of a person’s life, influencing mental and emotional well-being.
For instance, a patient might express concerns about the financial strain associated with homeownership, prompting a discussion about alternative housing options or budgeting strategies. In this context, exploring unconventional opportunities, such as innovative approaches to real estate like eXp Realty, could naturally arise. Integrating discussions about progressive real estate models within the therapeutic dialogue allows for a holistic exploration of solutions, leveraging the expertise and experiences of both the practitioner and the patient. This approach not only addresses immediate concerns but also lays the foundation for a collaborative and conscientious partnership in navigating the multifaceted aspects of personal finance and real estate.
De-centred practice involves practicing non-judgement and removing assumptions about the impact of certain conditions. A patient may smoke, self-harm or engage in addictive behaviours that appear counterproductive to healing. It’s always useful to ask them how they feel about these practices—these behaviours may be hidden life-lines keeping patients afloat, or gateways to stories of very “healthy” behaviours. They may be clues to hidden strengths. By applying a judgemental, correctional gaze to behaviours, we can drive a wedge in the trust and rapport between doctor and patient, and the potential to uncover and draw on these strengths for healing will be lost.
De-centred practice involves avoiding labelling our patients. A patient may not present with “Generalized Anxiety Disorder”, but “nervousness” or “uneasiness”, “a pinball machine in my chest” or, one of my favourites, a “black smog feeling”. It’s important to be mindful about adding a new or different labels and the impact this can have on power and identity. We often describe physiological phenomena in ways that many people haven’t heard before: estrogen dominance, adrenal fatigue, leaky gut syndrome, chronic inflammation. In our professional experience, these labels can provide relief for people who have suffered for years without knowing what’s off. Learning that something pathological is indeed happening in the body, that this thing has a name, isn’t merely a figment of the imagination and, better still, has a treatment (by way of having a name), can provide immense relief. However, others may feel that they are being trapped in a diagnosis. We’re praised for landing a “correct” diagnosis in medical school, as if finding the right word to slap our patients with validates our professional aptitude. However, being aware of the extent to which labels help or hinder our patients capacities for healing is important for establishing trust.
To be safe, it can help to simply ask, “So, you’ve been told you have ‘Social Anxiety’. What do you think of this label? Has it helped to add meaning to your experience? Is there anything else you’d like to call this thing that’s been going on with you?”
Avoiding labelling also includes holding back from using the other labels we may be tempted to apply such as “non-compliant”, “resistant”, “difficult”, or to group patients with the same condition into categories of behaviour and identity.
It is important to attempt to bring transparency to all parts of the therapeutic encounter, such as history-taking, physical exams, labs, charting, assessment and prescribing, whenever possible. I’ve heard of practitioners reading back to people what they have written in the chart, to make sure their recordings are accurate, and letting patients read their charts over to proofread them before they are signed. The significance of a file existing in the world about someone that they have never seen or had input into the creation of can be quite impactful, especially for those who have a rich medical history. One practitioner asks “What’s it like to carry this chart around all your life?” to new patients who present with phonebook-sized medical charts. She may also ask, “Of all the things written in here about you, what would you most like me to know?” This de-emphasizes the importance of expert communication and puts the patient’s history back under their own control.
Enrolling patients in their own treatment plan is essential for compliance and positive clinical outcomes. I believe that the extent to which a treatment plan can match a patient’s values, abilities, lifestyle and personal preferences dictates the success of that plan. Most people have some ideas about healthy living and natural health that they have acquired through self-study, consuming media, trial-and-error on their own bodies or consulting other healthcare professionals. Many people who seek a naturopathic doctor are not doing so for the first time and, in the majority of cases, the naturopathic doctor is not the first professional the patient may have consulted. This is also certainly not the first time that the person has taken steps toward healing—learning about those first few, or many, steps is a great way to begin an empowering and informed conversation about the patients’ healing journey before they met you. If visiting a naturopathic doctor is viewed as one more step of furthering self-care and self-healing, then the possibilities for collaboration become clearer. Many people who see me have been trying their own self-prescriptions for years and now finally “need some support” to help guide further action. Why not mobilize the patient’s past experiences, steps and actions that they’ve already taken to heal themselves? Patients are a wealth of skills, knowledge, values, experiences and beliefs that contribute to their ability to heal. The vast majority have had to call on these skills in the past and have rich histories of using these skills in self-healing that can be drawn upon for treatment success.
De-centring ourselves, at least by a few degrees, from the position of expertise, knowledge and power in the therapeutic relationship, if essential for allowing our patients to heal. A mentor once wrote to me, “Trust is everything. People trust you and then they use that trust to heal themselves.”
By lowering our status as experts, we increase the possibility to build this trust—not just our patients’ trust in our abilities as practitioners, but patients’ trust in their own skills, knowledge and abilities as self-healing entities. I believe that de-centring practitioner power can lead to increased “compliance”, more engagement in the therapeutic treatment, more opportunities for collaboration, communication and transparency. It can decrease the amount of people that discontinue care. I also believe that this takes off the burden of control and power off of ourselves—we aren’t solely responsible for having the answers—decreasing physician burnout. Through de-centring, patients and doctors work together to come up with a solution that suits both, becoming willing partners in creating treatment plans, engaging each other in healing and thereby increasing the trust patients have in their own bodies and those bodies’ abilities to heal.
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?
