WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


Uncertainty as a Measure of Spirituality

In physics, the Heisenberg Uncertainty Principle sets limits on knowledge. As a scientific law, its effects are seen only on the minute scale of subatomic particles. But I suspect it contains a deeper meaning that might help us relate to life in general.

The Uncertainty Principle states we can never accurately determine both the position and motion of a particle. The more we can say about an electron’s location, the less we can say about its velocity, and vice versa. As an analogy, imagine we’re tracking a red Ferrari in San Francisco. The Uncertainty Principle, if it had relevance at this scale, would say that if we know the car is currently in the middle of the Post and Hyde intersection, we can’t say how fast it’s going. It might be stopped; it might be racing at 110 mph. Or if we know it’s traveling exactly 62 mph, it could be anywhere in the city.

In ordinary life this species of uncertainty is negligible; the police can document where and how fast the Ferrari was moving when they pulled it over. But at atomic scales, the Uncertainty Principle limits our knowledge. This isn’t merely a problem of measurement failure; it’s a cosmic restriction on achievable precision. We can’t know details beyond a certain level of approximation. The consensus view is that electrons don’t move in a way that permits exact description. Matter exhibits fuzziness and randomness that cannot be resolved no matter how sophisticated our instrumentation.

In a reply to Dave’s comment on the last post, I stated:

More and more it seems to me that the path to higher consciousness demands we let go of certainty. No fixed beliefs can pass the gate… Yet something in the human mind insists on answers. Whether it’s belief in a God who listens or in a universe that doesn’t, we gravitate toward conclusions and feel uneasy when we can’t find them. But I suspect true mental presence requires that we give up our quest for certainty. We must rest in the not-knowing.

Not-knowing is a venerable practice in Eastern traditions. Ancient mystics understood there are questions that can never be answered. In this scientific era we’ve become accustomed to expecting truth to emerge upon investigation. We assume that if a phenomenon looks mysterious, time and research will eventually clarify the situation in causal and mechanistic terms. The conventional scientist understands that we don’t know everything, but he or she believes that everything is in principle knowable.

The Uncertainty Principle suggests otherwise. Even though it comes out of observations in cloud chambers and particle accelerators, I suspect it’s telling us something about the nature of ultimate reality: it’s beyond our ken. Not just in practical terms, but in absolute ones. Precise answers are not just difficult to find, they’re prohibited.

We should keep this in mind when we try to pin down spiritual truths. Maybe the reason the universe can look both sacred and heartless is that there is built-in paradox and obscuration. The more we identify with the material world the less we see of universal consciousness; the deeper we delve into meditative states, the more illusory the physical world appears. But the elusiveness of cosmic awareness and the haziness of matter are ever-present; they confront us when we push concepts too far in our search for final answers.

The point is: a universe that enforces uncertainty is a universe that promotes humility. The moment we become too sure of ourselves is the moment we risk disillusionment. Many people battle doubt by attaching ever more rigidly to convictions. Although faith plays a role in spiritual life, it can be misapplied to demand unquestioning belief of unprovable concepts. A better approach is to hold our views loosely. Since we are prohibited from finding ultimate truth, we might conclude the cosmos invites us to embrace not-knowing as the path to grace.

Imagine the discord that would simply dissolve if we all admitted we just can’t know.

>> Share on Facebook
>>





Recovery Model, Mindfulness, and the Value of Spirit

stonehenge

Today’s post is in response to the comment left by Lex Douvasa of the MHCD Research and Evaluation Team about my most recent post. In short, that essay talked about my (experientially if not actually) transcendent adventures as a mental health patient, about how my spiritual views have evolved since the resolution of my psychosis, and how spirituality and meditation help with mental health issues. Lex brings the Recovery Model into the conversation.

As I explore the internet communities interested in mental health, I am surprised at the intensity of the discord. The various factions differ so widely in their viewpoints that it is hard to see how any consensus could ever develop, at least not in the near term. That makes me wonder if I am being smart in diving into this controversy, especially since my attitudes are not yet fully formed, and I dislike extreme views and dogma. Then I think: maybe that will be my role, to comment without developing a strong allegiance to any side.

Even from that position, however, it is easy to embrace the Recovery paradigm in mental health. I have spent years in substance abuse recovery using the 12-step model. So I know that the approach can be effective. Anything that encourages people to be find deep sources of strength, to never stop pursuing improvement, and which provides hope of a better life, must be considered a good thing.

The spiritual dimension of the 12-steps can also be beneficial, though obviously it does not appeal to all. It appears that in the mental health context the spiritual aspect is not emphasized to the same extent as in, for instance, Alcoholics Anonymous. That is probably good, since people who run out the door won’t be helped.

I am glad there are people working to bring this way of seeking peace into the realm of mental wellness. Of course, even though the Recovery paradigm seems like it should be fairly harmless, and  has a vast potential, it is not immune to criticism. The Wikipedia discussion helped me see some points of contention that were new to me. Although probably written from a pro-Recovery viewpoint, it still gives a balanced perspective. Most of the criticisms seem to revolve around fear that abandoning the traditional structure might leave people stranded or feeling bad about themselves. It comes across as paternalism, a if people with mental conditions can’t tolerate being told they have the ability to help themselves. Despite the few voices of dissent, my impression is that the Recovery approach is headed toward the center stream. It already looks pretty well accepted as a valuable option in the arsenal of approaches to psychiatric ‘distress’ (here you could insert ‘illness’, ‘condition’, ‘abnormality’, ‘giftedness’, ‘diagnoses’, or whatever your preferred term is for the kind of entity the mental health system addresses). I applaud you for working to advance and document its effectiveness. Do you agree that it is gaining wide support? Or are you facing more resistance than I understand?

Since you inquired, my own treatment began as a rigidly traditional approach (I am using my hospitalization as my starting point here, though my first interactions with the ‘system’ started in childhood and adolescence). My psychiatrist (between 2000 and 2006) treated me with a powerful mix of medications that left my mind fuzzy, like a permanent hangover. In that state, it became easy to buy into her assessment that I should give up hope of ever again being productive. Since before then I had been an aggressive high achiever, this prognosis hit me very hard, and no doubt prolonged my severe depression.

Eventually, I made the intelligent decision (despite my chemically impaired cognition) to switch to a different system of care, which I found within the Kaiser HMO. In that setting they did not follow a Recovery Model explicitly, but did promote a sense of optimism and hope for improvement. They embraced a mind-body philosophy, for instance by teaching how important exercise can be.

(As for brain derived neurotrophic factor (BDNF) I listened to a good podcast on Dr. Ginger Campbell’sThe Brain Science Podcast‘ not long ago about exercise, the brain, and BDNF.)

Kaiser staff also introduced me to DBT (Dialectical Behavior Therapy), which you mention. I participated in part of the DBT series and benefitted from it, though the protocol struck me as unnecessarily complicated. Despite that reservation, DBT’s underpinnings of savoring bodily experience, not running away from feelings, and remaining in the present moment all make a big difference for me, when I abide by them.

In short, I believe that by turning to Kaiser I found a more modern model for my mental health care I entered a pretty enlightened system; it encouraged me to seek progress, rather than accept a static place of disability. (As a disclosure, I was a Kaiser physician before my neck degeneration ended my surgical career. I now have no connection–financial or otherwise–with Kaiser, except as a patient.)

In my opinion, a lot of mental illness results from feelings that spiritual traditions have historically tried to alleviate: hopelessness, futility, meaninglessness, loneliness, guilt, resentment, etc. That does not mean everyone with mental illness should be religious, or even do anything that harkens to a (possibly nonexistent) spiritual realm. But it is probably a good idea to encourage people to explore what they value in life, why they think it matters whether they treat people well or poorly, what helps give them a sense of purpose or meaning, and what they think makes a good person. That will give them some benchmarks for measuring their progress, milestones separate from society’s focus on material success and social popularity. It might also help them look more realistically at their failings, and recognize that they have the same human frailties as the remaining 7 billion people on the planet. If they take it a step further, and develop a sense of divine presence, or connection with a transcendent realm, then so much the better (and although I personally object to religions that are judgmental and fundamentalist, each person needs to choose their best path to wellness).

As I have emphasized in this nascent blog several times already, there is no one prescription that will work for everyone. Nevertheless, the Recovery Model in mental health, if it works anything like AA has in the addiction community, should have broad appeal and effectiveness. The mutual support, spirit of ongoing action, and belief in even seemingly hopeless cases can all be adapted from the addiction world to the benefit of those of us with psychiatric issues. Adding in encouragement for growth in the direction of finding meaning and purpose in life, or even exploring feelings of transcendent spirituality, would also be helpful to many people.

Thank you for bringing this paradigm to the forefront of my attention. I have read a little about it before, but it helped me to explore the topic further. Whether or not anyone reads all the way through this (typically for me) overlong post, the exercise helped me expand my understanding of available approaches to psychiatric conflicts.

>> Share on Facebook
>>





Archives