WillSpirit

Where Will meets Spirit
∞ A Blog Devoted to Balance, Peace, and Clarity ∞

A formerly depressed physician tells stories of trauma, grief and recovery, and offers suggestions for emerging from darkness, living with mood swings, and awakening to life.








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    • 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.




Satipatthana

trapped

The recent marriage between neuroscience and meditative traditions may hold the key to the future of human civilization. Few other modern trends hold any potential to derail humanity from its track of destruction. Many of Daniel Siegel’s writings demonstrate how a combination of internal (meditative) and external (scientific) explorations of the mind can relieve age-old sufferings of humankind. Rick Hanson’s book, Buddha’s Brain, distills this fertile and vast field into a roadmap for personal breakthrough to peace.

Living north of San Francisco, I am fortunate to be able to attend a weekly meditation event led by Dr. Hanson. Recently he guided a discussion about the fruits of practicing a venerable Buddhist meditation called Satipatthana. In the course of such work, one sequentially pays attention to body, to feelings, to mind, and to the obstacles and vehicles one encounters on the path toward awakening. Rick inquired about our personal takes on the benefits of this system of meditation. My thoughts cohered too slowly for me to participate in the discussion, but after returning home I wrote down what I believe Satipatthana is teaching me. I soon recognized a close connection between this meditation practice and what I’ve been saying on this site about the value of sorrow.

Back when I still suffered from chronic depression, my mind seemed like a monolithic psychic prison. With effort I could adopt a few moments of positive thinking, but all-too-quickly my internal world spiraled back into its baseline state of despair and negativity. It was as if my emotional habitat had been formed of poured concrete; it looked like a solid and monotonous block of cold gray stone. Changing my inner experience seemed about as likely as a prisoner breaking through the walls of a penitentiary with his fists.

Partly as a result of Satipatthana, I now understand that my mind is actually a fragmentary collection of mental activities that can be reshaped with the right kind of effort. The gray monolith turns out to be no more rigid and massive than the Styrofoam used to make stage props. By using this meditation practice to explore my body, feelings, and thoughts, I have learned that my mind is composed of many different parts. There is a module that directly monitors sensations; another evaluates what has been perceived; a slightly separate unit grasps or rejects the judged experiences. Further along the line, there is a component that suffers when desired experiences dissipate or undesired ones persist. Finally, there is an expansive region that remains detached and simply observes. While enjoying the steady peace of meditation, I can shift my focus and attend in turn to these distinct elements.

This helps me recognize the difference between the bodily and mental sensations that accompany sorrow, and the suffering that results. In the ordinary course of mental life the experience of grief and loss seems inseparable from the anguish that arises. In actual fact, there is a sequence: first comes identification of loss, then comes the sensation of grief (often felt as a hollow ache in the viscera), and finally comes the mental anguish.

Loss is inevitable. Grief is a natural and largely unavoidable reaction to major loss. But we can influence the depth of anguish and despair to which we descend. Before I started this work, the experience of grief almost always led to depression and a loss of all enjoyment of being alive. Meditation helps me embrace ongoing sadness while appreciating that life is a beautiful gift.

There is a difference between the sorrowful ache of mourning and the choking darkness of despair. The second does not necessarily follow the first. One can experience and even savor pangs of grief and remain grateful for every moment of human life.

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Sculpting Happiness

cortex2

Today I am filling in at the local Suicide Hot Line. Since this time of day tends to be slow, I’ll probably have time to complete a post. As I planned this essay, knowing where I’d be writing it, the topic of suicide naturally suggested itself to me. But after giving it more thought, I decided to write about something a little less depressing.

In the book Buddha’s Brain, Rick Hanson explains that dwelling on negative memories and feelings strengthens them. If we habitually focus on unhappy topics, and especially if we simultaneously harbor unpleasant emotions, then we increase the neural circuits that promote misery. The converse is also true: dwelling on happy topics and pleasant feelings leads to brain changes that foster contentment.

My goal these days is to improve my mental balance, and spend less time obsessed with depressing topics. Since my childhood was loaded with trauma and my adulthood has brought huge disappointments, negativity is already well entrenched in my brain. It will take the rest of my life to build in enough positive memory and feeling to counterbalance that burden of loss. Reliving my suicidal feelings and remembering the suicides of loved ones seem like counterproductive exercises. They can wait for some future day; no doubt depression will eventually descend despite my best efforts, and such subjects will be on my mind already.

Two readers have requested posts about neuroplasticity; since I’ve already introduced the idea by mentioning Hanson’s book, I might as well develop it further. Neuroplasticity has become a hot topic in neuroscience, but it is actually something we make use of every day. If we wanted to be less technical, we could replace the fancy jargon with the word learning without losing much meaning. Both terms refer to long-term changes in the brain.

One of the first and most striking demonstrations of neuroplasticity came from the research of V.S. Ramachandran. He showed that after an amputation, the brain regions that used to handle the sensory input from the lost limb do not simply go silent. Instead, adjacent functions spread into the unused area. So if an arm is amputated, the sensory system of the face expands into the area that once served the severed limb. As a result, people have odd phantom limb experiences, such as touch to the cheek causing ‘feeling’ in a hand that no longer exists. More elegant examples include the expansion of brain representation of fingers in musicians, or the larger memory modules of London taxi drivers, who have to memorize maps of the entire city.

The outer and most evolutionary recent part of the brain is the neocortex. In effect, it is a flat sheet of nerve tissue that has been folded and balled up to fit inside the skull. Although different parts of the cortex have somewhat different structural details, in every region the sheet is layered. In the visual cortex there are six layers, with some receiving input, some primarily performing internal processing, and some creating output to other regions. The number of layers and the specific appearance varies from place to place on the neocortical sheet, but one is struck by the overall uniformity. Regions that handle functions as diverse as vision, language, touch, movement, and judgment all look more or less the same, and areas with similar functions can appear identical. Thus, the sensory area serving the arm is indistinguishable in appearance from that serving the face.

This makes it easy for cortical regions to take up new functions. In people who are blinded, and especially those blinded from birth, hearing functions encroach on the visual cortex. This expands the processing space for auditory signals, and probably partly explains why people who are blind often hear better than those with sight. Enlarging the cortical space for fingers in musicians presumably increases manual dexterity.

These are large-scale changes that demonstrate the brain’s impressive ability to reorganize itself in response to need. Restructuring on that scale takes time, but smaller shifts in brain structure and function happen every instant. Every thought is accompanied by a ripple of neuronal activity that forms an organized ensemble and then dissipates. Every time a memory is created, new connections are established between nerve cells. The brain is changing all the time as we learn new skills, see new things, and think new thoughts. As we live we learn, and as we learn we change our brains. This is the essence of neuroplasticity.

We should feel both sobered and empowered by the fact that everything we think and do sculpts our neurons. Sobered, because every single thought leaves traces that accumulate; a lifetime of negative thinking strengthens the neural foundations of stress, fear, and sadness. If we clumsily allow our minds to obsess on whatever attracts attention, no matter how discouraging or counterproductive, we will develop brains prone to unhappiness. Empowerment comes from recognizing the opposite principle: fostering positive thoughts, memories, and feelings will gradually increase our ability to remain contented.

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Building a Peaceful Mind

ToolBox

About four years ago, the mental health providers who were helping me encouraged me to ramp up my meditation practice. I’d been pursuing silent worship and retreats as a quaker for twenty years by that point, and had taken my first mindfulness meditation class six years earlier. But I had slacked off in my efforts. Since that prompting to be more serious about meditating, I’ve found settling into the mind that lies beneath surface turmoil to be very helpful to my emotional balance. No doubt many readers will find what I write to be naive, which is unavoidable given that my intensive practice began so recently. Still, meditation helps my state of mind so much that I can’t resist commenting on a recent realization.

When I first began to practice mindfulness meditation on a regular basis, my instructors cautioned me to toss out the idea of emptying the mind of thought. They taught me to observe thoughts, sensations, and emotions without trying to influence them. Given the context of a psychiatry clinic, these instructions were all presented from a medical perspective; they followed the Jon Kabat-Zinn formulation. There are many other approaches to meditation, and some schools place more emphasis on achieving a mind free of domination by verbal thought streams. But that early teaching held, and for a long time I assumed that attaining silence in the mind would be difficult if not impossible.

Being a newcomer to this practice style, it’s no surprise that I’m finding my early understanding to be incomplete. More and more, I’m finding it easy to shut down verbal thought, and not only while formally meditating. It’s becoming a bit of a refuge, in fact. When I find myself starting to obsess, and especially when the thoughts take a negative turn (as they almost inevitably do), I find it easiest to just stop thinking. Cognitive Behavior Therapy taught me to challenge my assumptions, and recognize the distortions in my interpretations. To do so is still useful at times, but often the quicker route to relief is to simply shut down the thought apparatus. It takes a bit of effort, and it certainly requires that I remain conscious and alert, but it’s not as hard as I believed. If I were to dissect the experience, I would probably find a few echoing words deep in my awareness, but the loud and intrusive thinking is becoming relatively easy to turn off.

I sleep better as a result. It used to be that worries or even pleasant fantasies kept me awake; there was always something that seemed interesting to attend to. If I shut down the thinking apparatus, in contrast, then if my body is tired sleep soon comes. If sleep eludes me it usually means I’m not that tired, and I either get up for a while or I lay on my back and simply experience the peace in my mind. It’s another opportunity to meditate.

Once on my Twitter stream I wrote, “If you can’t think anything nice, don’t think anything at all.” Although I think this phrase was my own creation, it’s possible I heard it somewhere; it is a variation, in any event, on the old line: “Don’t believe everything you think.” Regardless of its origin, the statement was meant more as a joke than true advice, but now I’m taking it to heart. I’ve added the technique to my chest of tools for building peace and sanity.

Looking back, I realize it has taken a bit of discipline and practice to get to this point, and that my ability to achieve tranquility has gradually increased over time. Recognizing how my understanding has progressed makes me realize that meditation must have many surprises in store for me. The recent trend in mental health toward emphasis on mindfulness (seemingly the preferred label for meditation in clinical circles) appears to be well founded. Especially for someone like me, who once pursued favorable mind states so vigorously that I developed troubling relationships with intoxicants, the discovery of self-generated tranquility is profound. Anyone dedicated to improving mental health probably already knows the value of meditation, but if you have delayed putting that knowledge into practice, I highly recommend meditating regularly.

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First Love

Lovers2

After perusing a variety of texts about spiritual growth, I better understand the universality of my recent stirring mind states. This perspective helps, because it is easy to get carried away after numinous experiences. Hopefully, visitors will forgive my naïve enthusiasm and beginner’s ignorance.

It is no secret that profound experiences have blessed many people around the world and throughout human history. Those committed to spiritual paths devote their lives to seeking and exploring such epiphanies, and no doubt enjoy far greater understanding, equanimity, and wisdom than I ever will. My purpose here is only to describe my particular journey, and perhaps offer hope to others burdened with chronic depression. The most important fact of my ‘breakthrough’ is that it has swept away most of my misery. Even when I stumble and feel defeated for a few days, the memory of a better place remains, and the ease with which I exit the darkness astounds me. Six months ago my plan was to learn how to live a full life in spite of depression. That I would ever be completely free of it, even temporarily, seemed impossible. Before, in my best frames of mind, there remained patches of depression that threatened me with shade, like scattered clouds on an otherwise sunny day. Now I spend the majority of my time feeling light and balanced, with no ominous darkness on the horizon. And when depression does descend it doesn’t linger, it leaves behind no shadow, and while it lasts I appreciate its solemn beauty (most of the time, at least).

The Varieties of Religious Experience, by William James, is familiar to many western seekers of spiritual growth. The book describes the vast range of spiritual frames of mind, and the large variety of ways we reach them. Sometimes a person achieves transcendence after years of meditation, study, and intention. Spiritual awareness accumulates gradually as the result of such effort, with progress punctuated by moments of sudden growth. But a life of seeking is not required. Not infrequently, a person ‘awakens’ in the aftermath of catastrophic stress or after collapse into utter despair. Crisis and failure offer us the opportunity to give up the fight and drop all barriers. The reward can be a flood of clarity, acceptance, and universal love.

If I were to classify my current situation, it would fall between those extremes. Although I have certainly not devoted my life to a quest for meaning, I nonetheless have been studying and searching. And despite a decade of bad luck, nothing in the past year has been particularly awful, nor did my ego disintegrate in an acute moment of hopelessness.

The nature of my recent spiritual experiences also lies between extremes. Ten years ago a series of ‘visions’ transported me into a mood of wide-eyed ecstasy, a kaleidoscope of marvelous sensory experiences, and a conviction that I had seen and spoken with God. A more magnificent and soul-quaking episode would be hard to imagine. However, much of the mental content was unbalanced, irrational, or poorly grounded. Although the clarity and salience of recent weeks equaled those of the earlier episode, they were not accompanied by ecstasy or hallucinations. As I’ve discussed, strictly supernatural beliefs played no role. Instead, what I know to be true about how the world is structured and how my life has unfolded took on a new light. Every particle of my mind understood that the universe is both dispassionately random, and lovingly numinous. This sounds paradoxical when stated in words, but from a state of exquisite nonverbal awareness, it made perfect sense. This solidly sane sacred experience felt just as profound as the arguably insane ‘religious visions’ of a decade earlier. But it was a little less intense, and was free of ‘delusional’ and ‘hallucinatory’ content.

Looking at the other end of the spectrum, I’ve explored mindfulness meditation for some years, and the recent ‘awakenings’ felt akin to the state of wordless peace that comes with such practice. The way I felt intensely ‘alive’, for instance, mirrored the way mindfulness brings one in touch with one’s body and sensory surroundings without the intervening filter of the verbal mind. In fact, three days ago it was a combination of meditation and acupuncture that returned me (for a whole afternoon) to the frame of resonant clarity that began with my spiritual retreat in January, and which is becoming more and more familiar. But the psychic impact of my recent moments of understanding exceeded that of even the deepest meditative states I’d previously achieved.

Experienced practitioners probably read my descriptions with a bit of amusement. I must sound like an adolescent who has just discovered sensual romantic love, and thinks he or she has stumbled on something personal and exceptional, when in fact it is universal and expected. But even if everyone else already knows about such love, it’s new to the teenaged romantic, and soul-penetrating clarity is new to me. So I hope those further along this path will indulge my childlike wonder.

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Further Words on Sitting with Sorrow

meditation

A reader left this comment in response to a recent post about sitting still with depression:

I too struggle with despair and have done so all my remembered life. Sometimes it is just in the background, other times mind numbing. My T will ask what has triggered it and I never have an answer for her. I have never tried sitting with it. Something to think about and maybe even try if I can find the courage to do so. Thank you.

My policy is to answer every comment, even if with just a few words. From my own experience, I know leaving a comment on a blog and having it sit there ignored can be annoying. I much prefer to get some kind of response. Since my readership is by no means huge, and the number of comments never overwhelming, I always reply. After writing two responses to the above comment, and losing them both to computer glitches, I moved over to the word processor and wrote a more formal answer. It got quite long, and used up my blogging time for the day. Since what I wrote seems like it might interest more than just one person, I’m going to cheat and use it as my post for today. So here’s my response to this dear reader; I hope others can glean some useful words from the text:


Lostinamaze

Like you, I have been dogged by despair all my life. The death (probably suicide) of my mother when I was six, which followed years of repeated psychiatric hospitalizations, set the stage. But whatever the cause, depression has robbed me of many years of enjoyment, by making so much of my time on this planet feel like living in Hell.

The good news is, and I want to say this emphatically to you and anyone else who suffers, one can make progress against the darkness. In recent years, I have worked hard to get better, and have been blessed to find some guidance that has made growth possible. (I’ve spent much of my adulthood in therapy, but often I either was not trying hard, or was stuck with a therapist who lacked the kind of skill I needed.) My years of introspective therapy may have helped, but CBT and (more recently) ACT have been decisive. (Books to search out include ‘Mind Over Mood’ for CBT, and ‘Get Out of Your Mind and Into Your Life’ for ACT.)

My ACT therapist’s trick of making me sit still with depression is a spin-off from a pain management technique used in mindfulness meditation. I actually learned it years ago, but quit implementing it. The idea is to mentally move toward, rather than away from the sensations. To explore them like neighborhoods in a large, confusing city.

For physical pain one might ask: Does the hurt burn, stab, throb, or ache? Where in the body does it sit? Does it move around? Does it wax and wane, or is it steady? And so on…

With depression the steps are very similar: Is there pain in the chest, or stomach, or whole body? Is it an ache, a sinking feeling, or a sensation of deadness? Do I feel restless, or irritable, or lethargic? And so on…

By investigating, one gets distracted from snap value judgments, and begins to look more dispassionately at one’s sorrow. The panic, hatred and revulsion get replaced with grudging curiosity. It’s a bit like carrying on a conversation with a crotchety and snide relative at Thanksgiving, rather than storming into the next room and complaining about him.

It’s hard. And it does not lessen the pain (ACT insists that is not the goal) as much as reduce the aversion. But it helps.

I would also suggest Tom Wootton’s book ‘The Depression Advantage.’ In interest of full disclosure (since I’m plugging his book,) Tom is a friend of mine. He has been advancing the notion that ‘depression is beautiful.’ Believe me, I found it a very hard sell at first. But Tom does have a point, even if I won’t go as far as he does with it: there is a sense in which depression deepens experience. It helps one get in touch with life, humanity, and maybe even God (for those who believe.) If nothing else, I have come to realize, sorrow informs my writing. It helps to remember how many artists throughout history have mined their grief for inspiration.

I know this all sounds facile. And maybe you already know far more than I do about these things—I always worry that I will sound pedantic and give offense. I just want to spread the message that depression can be befriended, or at least tolerated.

By the way, I’d suggest gathering and practicing tools to combat negative thinking (i.e., CBT) either first or at the same time as starting this ‘sitting’ work. That way one approaches the project with a sense of at least some control over one’s mood states. This step may not be essential, but it made me feel a little safer to have some emotion-modulating skill before letting the sorrowful feelings flow through me without resistance.

I am not a psychiatrist or psychologist or any kind of mental health care worker. I am not recommending that anyone read just my blog and start practicing this technique. In fact, there is a danger of making things worse if one falls into feeding depression with negativity, rather than staying neutral in one’s exploration. Please do not overwhelm yourself. My point is only that in this third millennium of the current era, effective techniques exist for working with troublesome moods. Books abound, and well-trained therapists can be enlisted.

Good luck, and thank you for being such a consistent reader of my blog.

–Will


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