All of Life



Mindweather 101:Navigating Mental & Emotional DistressTABLE OF CONTENTSGETTING STARTEDClass Background2Class Introduction5MAKING SENSE OF THE PROBLEMLesson 1. The brain’s role in mental distress: One view8Lesson 2. What we believe about the brain matters. Part one11Lesson 3. The brain’s role in mental distress: Another view16Lesson 4. What we believe about the brain matters: Part two20Lesson 5. Just being there: Insights for family and friends25Lesson 6: Different ways of thinking about recovery32RESPONDING TO THE PROBLEMLesson 7. One way of responding to mental distress40Lesson 8. Can making it “go away” make it worse?44Lesson 9. Another way of responding to mental distress51Lesson 10. Surrounded with gentle acceptance: More for family and friends69Lesson 11. Can a gentle approach make a difference for mental and emotional pain?78WORKING WITH DIFFICULT THOUGHTSLesson 12. One way of thinking about thinking89Lesson 13. Re-thinking thinking96BROADENING THE CONVERSATIONLesson 14. Exploring the full range of contributors to mental/emotional distress112Lesson 15. Considering the full range of options119FINISHING UPClass Conclusion133GLOSSARYA – Z terms134CLASS BACKGROUND“As night follows day and day night, the mountain just sits, simply being itself . . . At times visited by violent storms, buffeted by snow and rain and winds of unthinkable magnitude, through it all the mountain sits. Spring comes, the birds sing in the trees once again...streams overflow with waters of melting snow. Through it all, the mountain continues to sit, unmoved by the weather, by what happens on the surface.”–Jon Kabat-Zinn, Wherever You Go, There You Are, 1994, 137–138Sometimes the weather is sunny. Sometimes the weather is stormy. And sometimes a tornado hits. It’s kind of the same in the mind and body. Depending on the day, and even the moment, different thoughts and feelings come and go like weather patterns in the sky. At certain points, the mind and heart can be pushed so far that extreme mental and emotional states arise: depression. . . panic . . . addiction . . . mania . . . bingeing . . . delusions . . . hallucinations.“I was so devoid of hope—so devoid of hope—and felt so alone . . . my world had become so small that I didn't see any light at the end of the tunnel.”–Woman reflecting on previous mental illnessAmishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “When you’re actually in these negative storms that can last months and even years, it’s very hard to think that it’s possible to step outside of it. It is your world.” Troubling thoughts and distressing emotions aren’t anything new, of course. But some research studies suggest that in the complexity of the modern world, the number of individuals facing mental and emotional disorder is increasing . . . and not just because we’re more aware of these problems. “When I was about 4 or 5 years old, my father began to molest me. When I was 16, I was raped by a boy I was dating. A year later, I was diagnosed with schizoaffective disorder.”–Ann Rider, CEO, Recovery Empowerment Network For any person who goes through something like this, it would be abnormal not to hurt so badly. When we go through really hard experiences, hurting this bad can actually mean we have a depth and sensitivity to us that is responding to the reality of a painful situation. In other cases, overwhelming mental or emotional pain can seem to hit us out of the blue, in ways that are not proportional to surrounding events. Whatever the reasons, severe mental and emotional pain can come to overwhelm any of us. Tom McConkie, Cofounder, All of Life: “It was just a disaster, I was a time bomb that went off at adolescence. And by the time I was 15–16, that’s when the problems were so pronounced that they were starting to manifest in upsetting ways. I first started seeing doctors and they diagnosed me with from depression, to anxiety disorder, to hyperactivity. I describe myself at that time in my life as a miserable human being.”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Right around age 30 I was teaching—I had been teaching in private schools—and you know, just sort of the typical profile of not making a lot of money, and having incredible schedules. It was an interesting phase for me, because the anorexia peaked and I got very, very thin. And also during that time, I began to experience anxiety and depression and a phase where I felt just out of control, like I didn't quite know how to get a grip on all that was going on, and I couldn't quite handle it.”Whoever it happens to hit, whatever exactly it is, and however it arises, the collective mental and emotional pain in the United States and across the world is enormous. Motivated by the possibility of reducing some of this mental and emotional pain, an enormous research effort composed of hundreds of scientists has taken place—and continues today. In the last twenty years alone, literally hundreds of thousands of studies have explored many contributors to these problems and how best to encourage healing and relief. To give you a sense of what we're talking about, our own search of a major medical database shows that from 1940 to 2012 there were over 100 thousand research and scholarly articles on depression alone, 99 thousand exploring anxiety disorders, 42 thousand on eating disorders, and 23 thousand looking at ADHD. With the sheer number of studies done, you might expect that the amount of mental and emotional burden around us is decreasing. Instead, the scope of these problems seems to be getting worse. Depression, for instance, has become the “leading cause of disability in the U.S. for ages 15–44,” and the fourth highest source of the “global disease burden." Research confirms higher levels of anxiety, and a literal eating disorder “epidemic." Ever-rising cases of attention problems also now plague both youth and adults. And in some areas of the world, even delusional problems have risen in recent decades. So what’s going on here? Answers to that question are not so simple and deserve some patience and careful consideration. Meanwhile, many who face mental and emotional pain remain stuck in a pattern of getting by day by day, with their problems not fully resolved and feeling only partially well.“My life really had shrunken to the point where I just saw myself as mostly this mentally ill person who would be dependent on psychiatrists and therapists to get through life. . . . I was told by one professional, ‘Maybe one day you'll get your life together enough that someone will marry you. . . . Maybe you'll have a job one day." –Woman reflecting on previous mental illnessHave you or one of your loved ones ever felt similar discouragement? This class was inspired by seeing way, way too much of this—including in our own family and friends—including in us.Do mental or emotional problems have to feel this hopeless?Do distressing thoughts and emotions have to control our lives?Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “For people that are really struggling, that are feeling a sense of real hopelessness, that the storm is overpowering: that they just leave the door open a little bit for the possibility that there’s something you can do.”Are you open to exploring some new possibilities? Tom McConkie, Cofounder, All of Life: “What I’m talking about is a kind of courage, and a kind of sincerity, where you look at your life and you’re willing to just see what’s there. And you realize in doing so, that where you are really losing your energy, what was really causing your suffering—what you didn’t realize was causing you to suffer—was all the energy you were spending on avoiding, all the energy you were spending on resisting. When you stop resisting, when you stop avoiding, and you look—you open your closet and look at that bogeyman, and you realize that you’re equal to that task, and that you can look at it and it won’t destroy you. It’s a willingness to hold your life--all of your life in awareness. It empowers you to take account and to start moving in a direction that feels right.”Are you ready to take a look at ALL of your life?CLASS INTRODUCTIONMindweather. What are we talking about? In this class we use the word ‘’mindweather” to capture the wide spectrum of mental and emotional experiences we face as human beings. This includes easy, comfortable moments and others that are hard, where turbulence can hit us out of the blue. “Hi everyone, my name is Vicki, and I'll be helping to teach the class that you've just signed up for. Welcome!” “And I'm Tom . . . also happy to be helping with this class.” “And I'm Jacob. I'll also be helping out with the class, giving Tom and Vicki a break once in awhile. Thanks for joining us.”With the help of nearly thirty-five other researchers and professionals, we’ve created this class because we know we’re not the only people who have hurt emotionally in intense ways. If you’re watching this video, chances are you have experience with emotional turbulence or mental distress either in your own life or in the life of a friend or family member.This class is actually for two groups of people: those facing some kind of painful mental or emotional distress, and those who are supporting them. Although the class discussions are definitely set up for adults, the ideas we will be exploring are relevant to people of different ages. So whether you, your child, or someone else you know is hurting, feel free to apply what you learned in whatever way makes sense to you.By the way, we’re going to be talking about lots of different kinds of mental and emotional distress: from depression and anxiety to ADHD, eating disorders, and even delusion. This is on purpose. Although many differences exist between the various kinds of mental disorders, there are also surprising commonalities, and some general principles and patterns that span conditions. Whatever it is you or your loved ones face, we’re sure you’ve already tried different things and learned plenty on your own. You've also probably experimented with different treatments or services and hopefully found some that are helpful. Our aim is certainly not telling you what to do or making specific recommendations about your situation necessarily. Those are questions only you can settle for sure, with your loved ones and any professionals you trust along the way. We trust you and respect your space to do that. We’re not here to lecture or to tell you what to think.Instead, our aim in this class is simply to help you think more carefully about some of the core questions and issues at the heart of mental and emotional disorder. By exploring this together, we’ll all come away learning something from the conversation. And trust us—there’s plenty to talk about!As you may already know, discoveries in neuroscience and genetics over the last twenty years are revolutionizing how we think about mental illness—questioning what we used to believe and introducing some new, exciting possibilities for anyone facing these problems. For example, have you heard that the brain can change over time? How about the new genetics research that shows gene expression turning on and off, depending on what we do? Or what about the research on mental health and nutrition, or exercise, or sunlight, or sleep, or media, meditation, or relationships? Interestingly enough, there’s very little public awareness about any of this. And that’s where we come in. What we’ll be doing in this class is opening a broader conversation about mental health conditions and what to do about them. In total, there will be fifteen separate discussions or lessons organized into these four sections. To be specific, then, our exploration will center around two key questions currently being asked by millions facing these problems: First, where are these problems coming from? Why am I, or my partner, or my son, brother, friend struggling so much? The first section of the class will explore these issues. Then we’ll move on to a second basic question: How can we best respond to, and attempt to work with these kinds of mental and emotional problems? What kind of help can I offer my friend, family member—or myself—to really start feeling better: and not just for a good week or two. The rest of the course covers this ground—in three additional sections. You may be tempted to skip ahead. Since the later lessons build on earlier ones, we recommend you take the class sessions in order. You may also wonder about trying to get through the whole class in one day. We don't recommend that, either. Think of your favorite television show. Did you ever try watching the whole season in one night? Probably not. In the same way, by taking the time to process each class, you’ll definitely get the most out of it.Although you'll be hearing from each of us—Tom, Jacob, and Vicki throughout—we've also interviewed nearly thirty-five others, including researchers who have studied these problems, practitioners who have worked with them, and individuals who have faced them. For each question we explore, then, you'll be hearing from a small panel of individuals with some great things to share.In order to make the class accessible to as many people as possible, we also do our best to avoid unnecessary jargon or scientific language and give it to you straight. We’ll provide a glossary for you when a new word or concept is introduced to help you keep track of the new ideas. At different points along the way, we’ll also be inviting you to share your own thoughts, insights, and experiences with us directly. We want to hear your story. And we also welcome your feedback and questions. In addition to using your input to improve the course, we’ll respond on the website to questions that come up and share insights from other class participants so we can all learn together. So thank you for joining us. What you’re about to see is the product of thousands of hours of effort, across hundreds of hours of interviews, and based on the hard work of twenty volunteers. We want to express our appreciation in particular to the 35 individuals who not only allowed us to interview them, but worked hard for decades to gather the wisdom and insights they so generously offered us. It’s thanks to all these contributions that we can now say this:Are you ready to dive in? In the first couple of lessons, we’ll start exploring some discoveries about the brain, breakthroughs that, surprisingly, very few people seem to know about. SECTION I. MAKING SENSE OF THE PROBLEMLESSON 1 THE BRAIN’S ROLE IN MENTAL DISTRESS: ONE VIEWUnderstanding mental and emotional distress and where it comes from is not always that easy. A good place to start is the role of the brain. Most people think that’s a settled question. Over the last two decades, however, our understanding of the brain has changed dramatically--as we’ll be discussing below. (Watch this video first to explore an especially common and dominant perspective on the brain.) “There is no cure. . . . His brain is wired in a way that his mental illness will be a monkey on his back the rest of his life.”– Mother of a child facing serious emotional distressA common experience for those facing severe mental disorder is being encouraged by well-meaning friends or family to just choose to feel differently: to be happier, to be less anxious, to pay attention, to just get over it. “Before I had my first depression, I believed that depression was a bunch of crap, you know, ‘pull yourself up . . . quit feeling sorry for yourself, go into a damn cancer ward for kids and you’ll see something to be depressed about . . . what the hell do you have to be depressed about?” – Male depression survivorA young woman facing anorexia spoke of someone telling her to ‘Just eat! You know how important it is to take care of your body, don't you?’ Another woman who had struggled with depression said, ‘It’s hard for family and friends to understand that you are really, really, really not doing this intentionally.’ It goes without saying that this kind of ‘help,’ though well-intentioned, can make things a lot worse.Over time, individuals who are struggling can start to internalize these subtle criticisms. “I would always say to myself, ‘I’m a smart guy, why can’t I control this? I’m an intelligent person . . . I take care of myself: Why can’t I handle this?’” – Man reflecting on past depression“I just lay there feeling terrible about myself and wondering, ‘What is my problem?’ You know, ‘why can’t I just make myself shape up and do something?’”– Woman facing depressionAmong other things, these kinds of 'if you would just shape up' attitudes reflect one reason why ongoing research into the biology of mental disorder is crucial. In recent decades, neuroscience researchers have begun to document how the body can arrive at a point where one's basic capacity to think, feel, or live well can be constrained and limited in profound ways. In other words, science is starting to show us that problems such as these are real and not simply a result of being lazy or just having a bad attitude. Mental and emotional pain is real, in all its forms, and the biological research is helping us understand that.Unfortunately, though, important details about the precise role of this biology are often overlooked. The result is that we end up having a black-and-white conversation with only two possibilities: Either a problem like ADHD is biological in nature, or not. Have you ever heard people debating nature versus nurture, or environment versus genes? That’s what we’re talking about. These splits, of course, are oversimplifications of the way things really are. The reality is that any human experience is biological in some way. Everything we do, we do in a body—whether that’s eating dinner, driving a car, watching television, or taking a nap—they all involve biological processes, from appetites and hormones, to chemical levels and neural pathways. For this reason, maybe we should consider talking about something more than whether or not various mental disorders are ‘biological’ or not. In place of this debate, what if we gave more attention to another question: How exactly is a condition like depression, or an eating disorder, or ADHD biological?By shifting attention to this other question, a whole new conversation begins. When you start looking at how exactly or in what ways a condition like depression is biological—the first thing you discover is that, surprisingly, there are very different ways of answering that question. We'll start with the view most common until the last 10–15 years. As recently as fifteen years ago, neuroscientists believed the mature, adult brain was set in place and static, meaning that it couldn’t change. We've always known, of course, that the brain changed rapidly during childhood and adolescence. The belief at the time, however, was that as individuals matured into their adult years, their brains became set in ways that were permanent for the rest of a person’s life. This idea goes back an entire century, to beliefs a few scientists proposed at the time based on limited evidence. “In adult [brains] the nerve paths are something fixed, ended, immutable . . . nothing may be regenerated.”– Neuroanatomist Ramon Cajal, 1913From chemical levels to neuronal networks, the function and structure of the brain was understood for most of the last century to be largely permanent and set in place. “Scientists used to believe that the brain developed all of its major functionality—that is, the ‘wiring’ of the brain . . . in early infancy. The ‘mature’ brain was thought to be unchangeable, like a computer with all its wires permanently soldered together.”– Michael Merzenich, PhD, Neuroscientist, University of California, San FranciscoThis idea hasn’t necessarily gone away.Jacob Hess, Cofounder, All of Life: “In one of my studies I interviewed a woman and I asked her, ‘How would you define depression?’ She responded, ‘It’s that little glitch in my brain that doesn’t produce the chemical that lets me be happy and content.’ That’s not an abnormal view of depression, that it’s a fixed, static, semi-permanent contribution to what you’re feeling.”Willa Casstevens, PhD, Department of Social Work, North Carolina State University: “Oftentimes, the message is that the brain’s got a permanent deficiency of some sort, biochemical, or what not.”Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “The old way of thinking within the neuroscience community was essentially that the brain develops, and that once it’s fully developed, it’s not very changeable. And then we thought, as a field, that we’re pretty much done, the brain is in a stable state, and what will happen after that is just neural death. And that process is just cognitive decline, on the way down. And that’s kind of the way we were as a field of neuroscience. We didn’t know that the brain is capable of changing.”So what does it mean for individuals and families facing serious mental and emotional problems when they understand the brain in this way? In the next class discussion, we’ll turn to that question. REVIEW: The brain plays an important role in mental and emotional distress. Historically, there have been very different ways of thinking about that role. One of them is that the adult brain is largely fixed and unchanging over time. What do you think it means for individuals facing serious mental and emotional problems when they understand the brain to be permanent and unchanging? Before you move on, check out the glossary link at the bottom of lesson 1 on the website. And please notice the resources, references and additional reading listed at the end of every class lesson. We’ll be sharing a few of our favorite websites and books relevant to each topic for those who want to explore more.LESSON 2 WHAT WE BELIEVE ABOUT THE BRAIN MATTERS: PART ONEWhat have you been told about the role of the body or brain in your own condition – or that of your loved one? Were you ever told by friends, family or professional help, that your brain or body were permanently disordered in some way?“You bring them home from the hospital, nurse them, and dream that they will be successful... But then they come down with a mental illness that is lifelong. Your hopes and dreams die away.” – Mother of a 16-year-old girlIn the first class session, we explored one way of thinking about the brain's role in mental and emotional challenges. For many years, scientists and the general public believed the adult brain was unchanging and permanent. What does it mean for individual patients and families, if they believe the brain can't change? “I live with mental illness every moment of every day. . . . It wasn’t always this way. I know how it feels to be happy and experience pure joy. I remember the anticipation and excitement of the new. . . . I don’t feel those things any more. . . . My brain doesn’t work properly. But it used to.”– Woman facing depression There are real burdens and challenges for anyone who faces serious mental or emotional disorder. When you add to those burdens the notion that your brain is also permanently dysfunctional, it's no surprise that many people feel overwhelmed, and even a bit helpless. “My brain is broken. I’ve got broken thoughts. I’ve been dreaming broken dreams. . . . I hate my broken brain.”– Woman facing depressionElisha Goldstein, PhD, Clinical Psychologist: “Our brain really runs us in a lot of ways. And if something’s defective about it and we can’t change it, that would make it difficult for someone to feel a lot of hope.” Tom McConkie, Cofounder, All of Life: “We think that’s a definitive statement about our body or our brain, and we tend to identify with that. And that can create kind of this claustrophobic feeling of, ‘I can only do so much about it because that’s what I am.’”Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “I think that if someone didn’t understand that the brain is capable of changing, it could leave you to be in a very suffocating, constrained feeling. It’s a hopeless feeling.” Elisha Goldstein, PhD, Clinical Psychologist: “And the thought is, ‘I’m not okay. And I’m never going to be okay. And no one’s going to be able to help me, and I’m not going to be able to help myself.’ It’s a deeply hopeless place.” Jacob Hess, Cofounder, All of Life: “People who face serious mental and emotional challenge often feel that they are somehow messed up inside. And we take that for granted. Obviously, there must be something wrong inside of that person.”Rick Hanson, PhD, Neuropsychologist: “They feel often tainted or broken or damaged deep down inside, which is often the deepest wound of all; much deeper than the surface symptoms of a mood disorder or anxiety and so on.” Ann Rider, CEO, Recovery Empowerment Network: “The people who come to our programs are smart, they’re creative, they're resilient, they're survivors, they're just amazing human beings. And yet they've been told they're broken—and they believe that. And so we have this huge population of really amazing, creative, smart people who have just been written off, and that's a tragedy. What are the consequences of believing in brain permanence?When individuals see their own body as somehow permanently deficient, it can dramatically affect how they come to think about recovery itself. Woman: “Is there a getting better from this or not? I mean, they told me in the beginning there wasn’t. But I’m hoping that I can make improvements that are permanent . . . I am getting better than I was, certainly. I don’t know how much better, you know? I’m not sure if I can ever be what I used to.” Interviewer: “Who told you that you likely won’t get better?” Woman: “Well, my initial diagnosis, they said, ‘This is something permanent.’ They told me, ‘This isn’t something that you’ll ever not have.’” – Jacob Hess, 2009 dissertation research Catherine Penney, RN: “Because I had the diagnosis of schizophrenia, I was told that I had a mental disorder that people never get well from.” “The diagnosis I was given at the time was bipolar disorder. The doctors all through, had all said that this was something that was chronic, it was something that was debilitating. It was something that as I got older, it would get worse.”– Woman reflecting on past mental distressThis is not an uncommon view, as you can see in these comments from parents we’ve interviewed speaking about their children who face mental or emotional struggles: “She will have issues all her life. . . . This is a lifelong battle for people with emotional issues.”“I have come to believe that there are mental illnesses that are nearly impossible to treat.”“I don’t know how solvable the problem really is.”“I don’t think there’s going to be a time that she’s going to be well. We’re going to have to stay on it, stay on it, stay on it forever.”For some, this kind of feeling about the future sets in after years of grinding struggle. When asked if she thought recovery was possible, one woman said, “No, not really. I mean, I just don’t know. I’ve fought with it so long that I just don’t know that that’ll ever happen.”For others, this same kind of belief in a permanent problem appears linked closely to their view of a permanent brain. “He needs to learn to live with it the best he can. I’m expecting him to regress. . . . His brain is wired in a way that his mental illness will be a monkey on his back the rest of his life.”– Mother of a child facing serious emotional distressTom McConkie, Cofounder, All of Life: “When I was about 16 years old, I remember the first conversation I had with a psychiatrist about my brain and how my brain influenced my mental illness and its role in my mental illness. He told me my brain was like a car engine without oil. And therefore, over time it would break down. It wasn’t able to do what it wanted to do because it didn't have all the proper components there. I was a bit crushed when suddenly, at age 16, listening to a medical doctor, I was disposed to believe him, that my brain was like a car engine that didn't have oil in it. Which brings up this natural question, ‘Where do I get oil? And how much does this oil cost? And where can I get a reliable supply, because the last thing I want is to break down.’ And all of these fearful thoughts come up, and your life transforms like that [snaps]. You go from having this brain to having this busted up jalopy of a car that's going to break down at any moment. And I remember that was a sad day and I really carried that with me.” “I was like . . . ‘this is something that’s going to be with me for good. . . it’s not a cold that’s just going to go away. This is me,’ you know—and that’s sad. You feel like you lose yourself, almost . . .This is not who I was supposed to be.”– Woman facing serious emotional challengesAre you seeing how all of this connects? ‘If my brain has a permanent problem, then maybe this is who I am. If this is who I am, then this is probably going to be my life. If this is going to be my life, then so much for hoping for any deep or really complete recovery.’Nikki Preece, Clinical Director, Alpine Academy: “So I’ve been doing this for over ten years. I have worked with hundreds of adolescent girls and young adult women. Those that come to me and have this story in their head, or this narrative, the way they see their brain as fixed and unchangeable or just stuck, and that this is the way it will always be—tend to make the least amount of changes. I will see a small shift, and typically those shifts will be about getting some more coping skills or enduring things a little better, but typically it’s about getting back to the status quo, not really getting to a place of sustained peace or contentment in life.”By the way, it's important to be clear about one question: medication. We don't have a lot to say about psychiatric drugs in this curriculum; in part, because we believe that kind of education is a doctor's job, not ours. Every once in awhile, pills will come up or be alluded to in a quote—sometimes in good ways, other times raising a question. But let's be very clear: many people have experienced help with medication. And we respect that, for sure. We believe people should have space to make their own decisions about that. So we leave that up to people and their doctors. Let's get back to our main point here: The personal impact of hearing that your brain is permanently deficient. Tom McConkie, Cofounder, All of Life: “I remember feeling dismayed—and maybe I'm putting that too mildly. I remember feeling a little bit crushed that all of a sudden this brain that had made such a good companion to me for sixteen years of my tender life, that it was deficient, that it was kind of broken, that there was something we needed to prop it up with to make it kind of work. Immediately, this new framework—this framing of symptoms that were coming up in my life—it wasn't a tough go at it, it wasn’t just this season of challenge and unrest. It was, 'this is your brain kid—this is how things are going to be.’ And I was upset; I felt deeply saddened by that prospect.”Catherine Penney, RN: “When you are already feeling hopeless and in despair, and like, you'll never get out of the hell you're in—to have someone tell you that what you have is a condition that you're going to have to live with the rest of your life, it makes you feel even more hopeless, more in despair, and more worthless, and like, 'why even try? Why even try? This pain is going to last forever.'” The personal consequences of this kind of hopelessness can be tragic. Jacob Hess, Cofounder, All of Life: “I recently interviewed a young woman who told me that her suicidal thoughts started the same day the doctor told her that her depression would likely be a lifelong condition. People who are already in a really tough position and feeling weighed down, being told by a person they trust—a person in authority—that 'after all, this condition that you're facing is probably lifelong.’ So we're taking this group of people that is already so vulnerable. And we're saddling them with this story that as far as I can tell is not true, is not scientific.”This is serious stuff. For anyone facing the pain of severe emotional problems, the message that there is little or no hope for full recovery can simply be devastating. One individual, who is now a board-certified psychiatrist, was told he couldn’t recover after his own diagnosis with schizophrenia years earlier. In an interview, he reflected: “This view that if one becomes mentally ill one will always be sick not only interferes with emotional recovery but also prevents one from identifying as a contributing member of society, striving to return to work, or establishing long-term relationships, which are essential aspects of recovery.The bottom line is this: How exactly we think about the brain matters. For those who see their brain as permanently deficient, or somehow defective, that can mean some real consequences for their experience of recovery.We finish with a few words from a woman also diagnosed with depression and schizophrenia, who was also given little hope for recovery from those around her, who also went on to recover in a very deep way. “This doctor told my family that I would never be able to live independently again. . . . Even though I have made progress over the last 4 or 5 years, there’s still always that seed of doubt that was planted, you know, ‘Can I really take care of myself?’ . . . But it was said by the doctor, so it had so much power and so much influence. And you know, if you went back and asked him, he probably wouldn’t even remember having said that and yet it’s had all these ripples for the last several years. One of the things that I’ve learned since then is that you can never predict the recovery of another person.”– Woman who faced schizophrenia REVIEW: The brain matters. What we believe about the brain matters too. Believing the brain is permanently deficient can make some people feel even more hopeless.What have you been told about the role of the body or brain in your own condition, or that of your loved one? Were you ever told by friends, family or professional help, that your brain or body were permanently disordered in some way? In medical science today, there is a lot of discussion about the power of expectation, belief, and the “placebo effect.” Essentially, what we’ve just reviewed above is a kind of reverse placebo effect -- tracing the power of negative expectation and despairing belief as it plays out in the lives and experiences of those facing serious mental and emotional problems. There is a growing scientific literature that explores the power of belief and expectation in the progression of healing and recovery. In the future, we will be making available some of these key studies for those who are interested in deeper exploration. LESSON 3THE BRAIN’S ROLE IN MENTAL DISTRESS: ANOTHER VIEWSo scientists used to believe the adult brain was permanent and fixed in place. What do they believe now? Time to explore a second view of the brain -- less commonly held among the general population, but very common among neuroscientists today. “We’re talking about the most important change in our understanding of the brain in four hundred years.”– Dr. Norman Doidge, The Brain that Changes Itself, 2007We've been talking about how scientists believed for a long time that the brain was static, fixed in place, and permanent once we became adults. In a remarkable way, this has all changed in recent years, at least among researchers. Over the last two decades, neuroscientists have discovered the surprising degree to which the mature, adult brain continues to re-wire and change over time—a process called, neuroplasticity. Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “We know that the brain is able to grow new neurons, a process called neurogenesis, the birth of new neurons. We know that this happens in kids. But what happened about 15 years ago or so is that we came to understand that new neurons can be born in adults, that neurogenesis is possible throughout our lives. And that was a very, very exciting possibility. And knowing that is a game-changer, because it says, okay, if new neurons can grow, maybe we can figure out how to make more of them grow.” “The brain is constantly revising itself. Physical brain change occurs every time we learn something new. We refer to this capacity for continuous physical, chemical, and functional brain change as ‘brain plasticity’ or ‘neuroplasticity.’" – Michael Merzenich, PhD, Neuroscientist, University of California, San FranciscoAmishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “Neuroplasticity is--let’s just break it down into its parts. ‘Neuro’ and ‘plasticity.’ Plasticity is a term we can use for many different systems, systems that are changing over time or that are able to be changed over time are plastic systems. You can think of it like something you might store your macaroni in. You can move it around, it’s able to be morphed in different ways. Neuroplasticity is just saying the brain has a very similar capacity. The concept of neuroplasticity is just that if you make the brain behave in a certain way for a long enough period of time, it’s going to have its structure reflect that type of process.”"Brain plasticity refers to the capacity of the nervous system to change its structure and its function over a lifetime, in reaction to environmental diversity.” – Brian Kolb, et al., Factors Underlying Cerebral Plasticity, 2010Jonathan Grindlinger, MD, Psychiatrist: “Physical changes occur in the brain according to what happens in the environment. The mind isn’t static, the mind is constantly changing and responding to environment, input from the outside, inside. It’s a dynamic, complex structure that processes information from the bottom up and top down, and interacts and changes with everything.”David Cohen, PhD, University of California, Los Angeles: “We are constantly impacted by experience, within the body and outside the body. From radiation, to chemicals, to food, to poisons. And the brain--it probably changes all the time, it probably moves and shakes every second, in some very subtle way, of course, but even in some gross ways. It’s constantly reacting and adapting to what comes in, to the evidence of the senses. It’s first and foremost vulnerable to what we hear and what we see. The first thing we’re vulnerable to is what we're told, and what we believe because of what we’re told . . . so that's plasticity right there.”“The brain never stops changing and adjusting. . . . Neuroplasticity is the lifelong ability of the brain to reorganize neural pathways based on new experiences.” – Erin Hoiland?& Eric Chudler, University of WashingtonThe earliest hints of brain changeability came as early as the experiments of Italian anatomist Michele Vicenzo Malacarne in 1793, with a formal proposal of the theory made in 1890 by William James in The Principles of Psychology. Experiments on rhesus monkeys by Karl Lashley in 1923 also demonstrated changes in neuronal pathways. The idea that human brains could change, however, still remained largely ignored. Canadian psychologist Donald Hebb in 1949 once again hypothesized that learning was “based on the strengthening of synapses” that occurs when two neurons are “simultaneously active”—in other words, “cells that fire together, wire together.” Evidence began to pick up more in the 1960s, with key studies of Paul Bach-y-Rita, Michael Merzenich, Jon Kaas, and others. Beginning in the 1970s, the neuroscience community finally began to admit the evidence no longer supported the view that the brain and nervous system were fixed throughout adulthood. Stefan Malecek, PhD, Certified Drug and Alcohol Counselor: "Do you have the same brain now that you were born with? Of course not—your brain has changed, evolved, etc., well, hopefully evolved (laughs)—sometimes you wonder when you walk around looking at humanity.”“Contrary to the notion that the brain has fully matured by the age of eight or twelve . . . it turns out the brain is an ongoing construction site. . . . The neurons that pack our brain at the moment of birth continue to weave themselves into circuits throughout our lives.”– Dr. Jeffrey Schwartz, UCLA School of MedicineAmy Saltzman, MD, Founder, Still Quiet Place: “There’s hard scientific data, fMRI data—which means we’re scanning the brain and looking at what’s happening in the brain as it’s happening—that demonstrates that adults’ brains can change, depending on how we live our lives, what types of habits we practice, where we put our attention.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “If you do a particular activity for some period of time, over and over again, the parts of the brain that are needed for that activity are going to get stronger, are going to get healthier. In the same way that if I were a body builder, and I work out my upper body, my upper body is going to be much stronger, but my legs might not change at all. So it’s the activity that we engage in that changes those targeted areas. Same thing for the brain.”Steven D. Hickman, PsyD, Department of Psychiatry, University of California: “Our brains are not as fixed as we used to believe. There is some flexibility and some ability to cultivate new pathways, to come out of well-worn grooves over time if we continue to practice. The brain is like a muscle, too. We can exercise it in these various ways.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “This is actually a revolutionary idea even within neuroscience. When I was in graduate school, it was not a very popular idea. It wasn’t something that everyone just knew. The idea that you were born with a certain brain structure and you’re pretty much stuck with it after it’s fully developed was probably the norm in our thinking. But it ends up that that is wrong, and that there are new brain cells being born, new connections being made in different brain cells all the time, on a daily basis.”“The brain is capable of impressive feats of experience-driven reorganization. The structure of the brain is exquisitely sensitive to experience . . . so supple that it can refine and retune itself every day of our lives.” – Gary Marcus, Birth of the Mind, 2004“The bottom line is the brain is wired to adapt. . . . There’s no question that rewiring goes on all the time.” – Steve Yantis, PhD, Neuroscientist,?Johns Hopkins UniversityBrain changes happen with good experiences and bad—something like abuse, for instance, has been shown to impact the brain. Scientists have now discovered these same kinds of changeable brain networks playing a role in clinical depression, general fear and anxiety, obsessive-compulsive disorder, attention problems, and delusional/schizophrenic challenges. One research team in the Harvard Review of Psychiatry suggested that the "neural network model for behavior . . . has produced a paradigm shift for modern psychiatry.” The consequences of this paradigm shift are only now being explored in medicine, psychology, and other fields. While the ultimate potential of the brain and the limits of its changeability remain an exciting mystery, one thing is clear: what we used to believe about the brain isn’t what we believe now. Tom McConkie, Cofounder, All of Life: “I think that of all the things we could do help people in this arena—people who have mental health challenges—we've got to come up with a better set of metaphors. My life experience has shown me that my brain is not like a car engine that needs oil. My life experience has shown me my brain is like a brain. And we don't know exactly what that is, and so we should be sparing with our metaphors about it, and when we use metaphors, we should know that we're using a metaphor. Because years later, having seen that season come and go in my life, and having had opportunities in life open up to me, having met people and formed relationships, and done work and traveled, and fallen in and out of love, and raised a beautiful house full of plants. All these things that I could have never imagined would come my way that had nothing to do with my brain being like a motor without oil in it. I think we would do well to just submit on some level to the mystery of the brain, and to acknowledge there are a lot of things we don’t understand about it, and therefore what’s possible, we literally can’t even imagine.” We've been talking to this point about neuroplasticity, and the new way of thinking about the brain it represents. In the next class discussion, we’ll ask the same question we did earlier: What does this other understanding of the brain mean for individuals and families facing serious mental and emotional problems? REVIEW: The brain is super-important. Scientists used to believe it was permanent when we became adult. Now they don’t.LESSON 4 WHAT WE BELIEVE ABOUT THE BRAIN MATTERS: PART TWOFor years, the scientific community believed the adult brain was largely permanent and unchanging--now they don’t. What does this shift mean for those facing serious mental or emotional problems? “As long as you’re breathing, there is more right than wrong with you—no matter what you are facing.”– Jon Kabat-Zinn, University of Massachusetts In earlier lessons, we looked into the view that the brain was unchanging and static—exploring what that meant for people's actual lives. We’ll now examine the opposite question here: What does it means for individuals facing serious mental and emotional problems when they understand that the brain can change? Elisha Goldstein, PhD, Clinical Psychologist: “It does give people a lot of hope to see a lot of the research coming out, more recently, that says we can grow certain areas of the brain, there’s this idea of neuroplasticity, the idea that we can actually grow important areas of our brain throughout the lifespan now, towards a healthier brain.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “What that tells us is, that there’s hope—that essentially, you can grow the brain no matter what age you are. And if you can grow the brain, you might be able to have those new neurons connect to existing neurons, so that there’s stronger functioning in different parts of the brain. And that gives a lot of hope.”Nikki Preece, Clinical Director, Alpine Academy: “Those girls that I’ve worked with who see their brain as changeable, as pliable, as plastic, as something that’s moldable, they tend to have the vision that that’s their life. That they are the artist in this painting of life. They find incredible hope in their future; they don’t see it as an ending point to things. They see it as a continual progression.”Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “If you do a particular activity for some period of time, over and over again, the parts of the brain that are needed for that activity are going to get stronger, are going to get healthier. In the same way that if I were a bodybuilder. If I’m going to work out my upper body, my upper body’s going to be much stronger but my legs might not change at all. So it’s the activity that we engage in that changes those targeted areas. Same thing for the brain.”If the brain can be exercised, then what do these exercises look like? Well, for starters, studies show the brain changing with psychotherapy, with meditation, and with learning a language. All these mental exercises have been documented to re-wire and develop new pathways, or neural pathways, in the brain. While we think of other areas of our lives as something we can shape and develop, this isn't usually how we think about the brain.Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “It wouldn’t surprise anybody to find that if you took somebody that wasn’t very physically fit and took them to the gym . . . And every day they go to the gym for two months and do a 30-minute workout. It wouldn’t surprise anybody to find that after that two-month period, the person’s more fit, right? They look better, they feel better, their body mass index might have gone down, their weight might have gone down. They have all the signs of being a healthier person, especially if they were not active before. The mind is no different. Just as the brain is fragile and can be damaged, it can actually also be strengthened through active exercise in the same way the body can.”Rick Hanson, PhD, Neuropsychologist: “The brain is constantly changing in structure, based on our experiences. If people do the work, if they keep working the muscle, as it were, of the brain, it will gradually change for the better over time.”"Our physical brain alone does not shape our destiny. How can it, when the experiences we undergo, the choices we make, and the acts we undertake inscribe a diary on the living matter of our cortex? . . . The life we lead, in other words, leaves its mark in the form of enduring changes in the complex circuitry of the brain—footprints of the experiences we have and the actions we have taken. . . . It is the life we lead that creates the brain we have.” – Dr. Jeffrey Schwartz, UCLA Dept. of Psychiatry The implications of these findings can be both startling and refreshing. When one woman facing mental disorder first learned about neuroplasticity, she responded, “Wow—that means I can do something personally to get feeling better.” Rick Hanson, PhD, Neuropsychologist: “Many people, particularly the general public, doesn’t really appreciate the ways in which mental activity alone—what we think, what we feel, how we guide attention, what we rest it upon and then what we do with what we’re paying attention to—they don’t appreciate the ways in which that literally sculpts neural structure.”Can acknowledging brain changeability make a real-life difference? Elisha Goldstein, PhD, Clinical Psychologist: “So, if someone does have, let’s say, an area of their brain that’s causing obsessions and compulsions, a looping in that area, the idea that they can use their mind to learn how to relate to it differently and therefore actually change the neural pathways that things are going down, is really helpful and promising.” Nikki Preece, Clinical Director, Alpine Academy: “Another girl I was working with . . . struggled significantly with anxiety and especially OCD, obsessive compulsive disorder, and she would have these intense obsessive thoughts, and her compulsion would be to self harm. And she did incredible self harm to herself in order to manage her anxiety. And when I began working with her, she had been in multiple hospitals, multiple treatment centers, seen multiple therapists. As I began to ask her about her history, she said, ‘I am OCD.’ I remember sitting with her and explaining neuroplasticity and this idea that the brain could change itself. And it was amazing to see, as light would come into her eyes and—I remember, and it gets me a little emotional—and I remember the first time when she said, ‘Do you think that I could change like that, do think that I could have those drastic changes?’”“The brain is . . . a talented learning machine. Nothing is completely fixed. Biology powerfully affects but does not lock in our reality.”– Dr. Louann Brizendine, The Female Brain, 2006Nothing is completely fixed. **************In the final part of Lesson 4, we’ll be exploring what brain changeability means for how we understand mental/emotional problems and the people who face them. In at least three different areas, the consequences may surprise you. What would happen if more people knew about these discoveries regarding the changing brain? When our view of the brain changes, exciting things start to shift. To end this lesson, let's consider three examples. This was the focus of Jacob’s dissertation research, so we’ll be hearing from him.The first shift that can happen is with our sense of identity. As we begin to see the brain in a new light, individuals facing these problems may come to see themselves differently as well. Jacob Hess, PhD, Cofounder, All of Life: “If you count on your fingers right now ten people you know who struggle in some way with emotional or mental challenge--ask yourself, are these people individuals who have obvious deficiency in who they are? Is it obvious that these are really defective people? When I do that, when I look at all the people in my family, my friends, who struggle emotionally, they are some of the deepest, most sensitive, most intense individuals that I know. People who can sit with you—and really connect. And they struggle with depression, or panic attacks, or hearing voices. And so there is something there that doesn’t add up. There's some research out there that suggests that people who struggle with serious mental or emotional problems do so, in part, because they have a depth of emotion to them—a sensitivity of thought and heart--that is unusual. You have to have emotional capacity in order to hurt emotionally. You have to have mental sensitivity in order to be tormented by thought. A simple way of saying it is, Homer Simpson doesn't get depressed!”(laughs)The idea that the brain can change, then, can influence how individuals facing these challenges think about themselves—opening up the possibility that they aren't fundamentally broken inside. A second consequence of brain changeability involves how we understand the origin of mental and emotional problems. We can even ask the question: If not just from internal dysfunction, then where do these problems come from?Jacob Hess, PhD, Cofounder, All of Life: “My sister struggles with anorexia/bulimia, and depression. And she is one of the most sensitive, most spiritual, most loving individuals I’ve ever known. So all of this just begs the question: If someone isn't messed up who struggles, if it's not someone’s inherent pathology, then what's going on? There are researchers at Clark University and University of Washington who have argued that we are living currently in a 'depressogenic society'—a society that is giving birth to depression, like a little petri dish where you get the conditions just right to get us to a place where we are just sitting ducks for something like depression.”Among other things, then, this new view of the brain can also impact how we approach emotional and mental disorders. Rather than focusing exclusively on searching for internal flaws or deficits behind emotional pain, what about also looking more broadly for explanations and answers in the world around us? Jacob Hess, PhD, Cofounder, All of Life: “If we think about mental and emotional problems as rooted inside of us, then it's natural that we're going to intervene to try to correct and fix individuals. But if we think about mental and emotional challenges as connected to the world around us, then our interventions are going to end up looking more like public health interventions. Where we figured out in the nineteenth century that if we clean up the water, and give people food to eat, and vaccinate, and do these preventative things, all of a sudden, we're eradicating diseases. We're having huge lifesaving benefits. Where are the public health interventions for depression? Where are the public health interventions to do a society-level educational campaign for eating disorders? There is a lot of potential if we re-think where these problems are coming from, it’s going to lead us to a whole other set of solutions—a whole other approach to intervention that we really haven’t tried very extensively. And it's exciting! It's like—What could happen?”Finally, let’s consider what these brain discoveries mean for recovery itself. One researcher concluded, “the belief that one can recover from mental illness is well established as an important aspect of the healing experience.” He continues, “Over and over again, we heard [in our interviews with distressed individuals], ‘I needed someone to believe in me’.” “The important thing is that I know that it won’t last forever. Before, I had no hope. I couldn’t see a light at the end of the tunnel.”– Depression survivor “Having some hope is crucial to recovery; none of us would keep trying if we believed it a futile effort.”– Former patient This researcher continues: “The most important finding in our research is that people who have shown significant or complete recovery from severe mental illness . . . have cited hope as an extraordinarily important component in their recovery. Part of the recovery was being around people who saw their condition as not permanent, a condition from which they could take increasing control of their life and reestablish a place in society.” (Medscape, 2005).Obviously many questions remain. For example, what exactly does recovery look like? In a later chapter, we’ll look at that together. For now, we can reiterate one point with certainty: The way we talk about the brain can have vivid, real-life consequences for actual lives—including how and whether people feel hope for a future that looks better—really better—than today.REVIEW: What we believe about the brain matters. This belief can make a difference for how we see ourselves. And it can even determine whether recovery seems possible at all.As a reminder, if you’d like to communicate more directly about what you’re learning so far, send us a note at coach@. In these first four lessons on the brain, we’ve tried to lay out a simple, clear exploration of competing brain portrayals--and what they might mean for people’s actual experience of mental illness and recovery. (For more in-depth information, please see the links at the bottom of Lesson 4 on the website.)LESSON 5 JUST BEING THERE: INSIGHTS FOR FAMILY AND FRIENDSLet’s examine a much more basic question that comes up--especially among family and friends of someone who is hurting: Is there anything I can do to help? “I’m not a therapist; I’m just a mom.” –Parent of a struggling teenWe’ve just discussed how crucial hope is in the recovery process. While professionals have an important place in reaffirming this hope, families and friends can play a huge role as well. Unfortunately, we often forget this for a variety of reasons. Paula Caplan, PhD, Women and Public Policy Program, Harvard University: “You’ll hear somebody say, ‘Well, her boyfriend broke up with her and she's really upset, but I didn't talk with her because I'm not a therapist’—and I want to say, we used to call it friendship; we used to call it human connection; we used to call it community support and community welcoming."Fifteen years ago, Dr. John McKnight, a researcher from Northwestern University, proposed that natural support systems like friends, families, and neighbors were beginning to forget their own capacity to help each other (McKnight, 1995). In part, out of a growing belief that only professionals could truly help and understand those who are hurting. This attitude can obviously contribute to isolating those who are hurting in our society. And those facing these problems may also come to assume that others just can’t get it. “You begin to feel just completely disconnected from your own life and from the people around you . . . I felt like I was in a place that no one else could reach . . . you know, they don’t know how I feel . . . they can’t possibly understand.”– Survivor of depression This same kind of isolation can sometimes happen out of a desire to not burden your own loved ones. “I just learned how to read the people that wanted to help me, and . . . how I could spend as little time as possible with them. . . . How to make it go away for their sake. . . . The thing is, that when you love people . . . you come to them at first, and you’re like: ‘This is where I’m at and I can’t do anything, please help.’ And you see them working and trying to do what they can, but you’re not feeling better (and you might even be getting worse) . . . And you just see that look of frustration, or, like, they don’t know what else to do, and it’s not that they’re mad at you. It’s just, ‘gosh, I’ve done everything,’ you know, ‘We’ve worked on this for so long, why isn’t it changing?’ You just start feeling so awful and you don’t want them to feel that, you know? So instead of both of you feeling that . . . eventually I was . . . like, “no, I’m fine”. . . so at least one of us isn’t hurting, you know?”– Young woman who faced depression So is all this isolation a good idea? Do we really want to conclude that family and friends are just not competent enough to support? What if surrounding family and friends felt a little more empowered to help? What if they decided that, even if they weren’t professionals, ‘no one loves this person more than we do, and we can make a difference.’ What would that look like? Robert Whitaker, Author, Anatomy of an Epidemic: “When you go back into the history of the treatment of the mentally ill, one of the surprises is….that one of the times in our history when the mentally ill were best cared for was in the early 1800s. That's when there was a form of care, pioneered by Quakers, called moral therapy. Moral therapy had this principle: we don't know what happened to these people, but we (a) believe they have a God-given capacity to hopefully recover, that nature can heal; (b) our job is to assist nature in helping people heal; and (c) these people are our brethren — they’re us. There's an extraordinary sense of humanity at the heart of this—not stigmatizing, not making them 'the other.' And the idea was to build a community, to build a retreat, an asylum in the best sense of the world, a refuge from the stresses of life. And in this asylum, this refuge, we'll make sure they have three square meals a day, we'll bring in entertainment in the evening, we'll set up reading rooms, we’ll help them garden, help them exercise, and there is a sense of being a part of the community that will help people get well and go out and do well. And people who have studied their long-term outcomes found that people going into those asylums got better with some great regularity and a high percentage never came back. So we have in history a very powerful story and evidence of how community can help many, many people heal.”Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “I conducted a research study with a Hutterite colony in South Dakota, and it’s a closed society, a little like the Amish community. They don’t have radio or television or contact with the outside world. And I sat down with these people who don't even have a word for depression. The closest thing they have to it is Aushtung—it's German—the idea is a depressive state. But rather than pathologize it, what the community does is they surround the person with love and affection. They take over their work duties. Their friends and neighbors come and visit them daily, they bring them meals. They sit with them, and talk with them. And it's that community response that helps the person to emerge from their, whatever dark night of the soul that they're going through. And then at some point, they can do it for someone else. And that, to me, is sanity. That is what we should all look like. Our society should aspire to rally around people who are suffering and say, 'How can we be with you?'”While that kind of approach has worked in other cultures and at earlier times, it's easy to wonder: aren’t things different today? Who has time for that now? Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “It's easy to think that the way of life that we observed in the Hutterite colony, for example, that sense of community, is quaint and a nice idea conceptually, but we can't recreate that in the real world. But the truth is that we can recreate it in the real world. We have technology that allows us to create it in the real world, we have neighborhoods that allow us to create it, we have faith-based communities. We can create it and start relying on those little, tiny changes between people that make the difference. It's what happens between two people, what Buber would call, the I–Thou relationship. That's where things happen.” Chris McKenna, Executive Director, The Mind Body Awareness Project: “We can talk about interventions and what the research says and what curriculum we’re using. But at the end of the day, do they have people that are really connecting with them on a heart level and taking a deep interest in who they are as humans? Because that kind of connectivity, that kind of being able to sit with someone and have that presence, that’s the first gift. And there’s just not enough of that right now.”While there are unique challenges in our time, the potential power and benefits of authentic community remain as real as ever. Ann Rider, CEO, Recovery Empowerment Network: “I pretty much gave up on my life until I stumbled across a therapist who actually listened to my story. This counselor said ‘tell me your story’ which is how they all start, but they don't usually listen to it as a true story. They listen to it as cues to a diagnosis. So this individual listened to it as a true story—and she looked me in the eye. I was so used to telling the story, I was like, ‘Yeah, yeah, this is what happened’—no emotion—but she looked me in the eye, she put her hand on mine, and said, ‘I'm so sorry that happened to you. You did not deserve to have that happen. I think your history is important here, and not just something that's gone wrong in your brain.’ I completely burst into tears and felt like, ‘I'm not broken—It wasn't my fault.’ And that was the beginning for me, of really starting to think—I’m getting choked up about it—that I might have a life—that I could do something with my life.”Elisha Goldstein, PhD, Clinical Psychologist: “We all want to feel understood and loved in this world. That’s at the heart of being human: to feel like we belong. Mother Teresa said that the greatest disease of today isn’t tuberculosis or leprosy. It’s a feeling of not belonging.” Paula Caplan, PhD, Women and Public Policy Program, Harvard University: “When somebody in the community offers you a hand or says, ‘if you want to talk, I will listen for as long as you want me to.’ That's a gift, that there's no motivation behind it, there’s no suspicious agenda, they're just offering to listen. And I've had people weep because nobody's ever listened to them before.”Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “We tend to be uncomfortable with people who cry. We tend to give people a limited time period in which to be sad, even when they’ve experienced the loss of a beloved. They’re allowed from this time to this time to be sad. And then the sadness should end. What we don’t allow people to do is to feel what they feel for as long as they need to feel it in whatever way they need to feel it.”Willa J. Casstevens, PhD, Department of Social Work, North Carolina State University: “I started listening more to my clients. . . . In many cases my clients were in their 40s or even 50s and would tell me, ‘I've never shared that with anyone.’ Abuse histories of one sort or another. And again, these had been secrets for many, many years. And once this was out and their stories were told and this was processed, people were able to let that go at some level, reengage with friends, reengage with family, and start doing activities in the community that they'd withdrawn from for years and years.” As you can see, some of the most significant benefits can come from the simplest of acts. Just having someone there for you when the world seems to be crumbling all around can be huge. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “During my anxiety/panic disorder days, I could call my mom any time of the day. I could call her whenever I felt like I needed grounding. One of the things I always felt with anxiety and panic disorder was that I was going to drop into a big black hole and die. There was nothing that could ground me—nothing that could help. And it's an awful feeling. But to have someone there, not even physically, but just hear their voice-- 'I'm here' --I knew I could call her and she would be there. She would listen. And that presence—even if we're not experiencing it ourselves—but we know someone who is--to be really present for that person, ‘I'm here. I might not be there with you,’—maybe it’s over the phone, maybe it’s Skyping, who knows the method. But if you can reach out to that person and say, 'I’m here. I love you, no matter what's going on for you, I'm here for you.’ To hear that and to give that is profound. It’s really profound.”**************When someone we love is really hurting, it makes sense that we want to do something--anything--to help. That’s often just what someone needs. Other times, however, this can be exactly what they don’t need. Have you ever been around someone who couldn’t stop trying to figure out how to solve your problems or help you change? Sometimes, it seems like some loved ones don’t know any other way to be. What if they could learn another way? We now turn more careful attention to what this other way looks like -- and how we can start to try it out in our own relationships. Pamela J. Birrell, PhD, Psychology Department, University of Oregon: “I define recovery as reconnection—connection with oneself, connection with important relationships, and connection with the community. I think we should call it mental alienation, and try to pull these people who have been so disconnected, stigmatized, diagnosed—back into the human community.”“I didn’t really choose to talk about it a lot with friends . . . because I know . . . depression is a depressing subject. The first skill I acquired was how to keep people from asking a lot of questions . . . just a little misdirection: ‘Oh, I’m sick today, uh, I got a cold today, Oh man I didn’t sleep at all last night.’”– Depression survivorJudith E. Pentz, MD, Psychiatrist: “Knowing that there is another person next to you can be very grounding and very helpful to know that you can turn around and see that that person is still there. That is so, so important in terms of the shift that one needs as a child, but it’s also true for an adult. Is that person going to be there no matter what? That piece is really critical in helping a person to not fly away into their field of delusions, psychoses, whatever it is.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I realized through that connection with her that she was helping me get my mind off that anxious spiraling that was on this trajectory of, ‘this is going to get worse, and you’re going to have a panic attack, and you’re going to be exhausted after, and this is the cycle.’ But when you can reach back to people who can understand you, if there are people that you feel safe with, people who’ll say, ‘It’s okay, I’ve got you, I’ve seen you through so much and I’m here and I’ve got you today. It’s all going to be okay.’ That’s such a gift.” Virgil Stucker, Executive Director, CooperRiis Healing Communities: “Every day, whether or not you have a mental health challenge, you need to awaken into a world that you know needs you. You need to be able to finish that day knowing that you have contributed. So no matter how ill, or how stuck, or how dis-eased you are, you need to get up, knowing you can help. So part of our program, we operate a farm: organic gardens, woodshop, farming with animals . . . you go off and do community service, you also help in the kitchen: you're contributing to the life that you're a part of. And no matter what age we are, we need to do that in order to have a fulfilled life.”When this kind of human connection is embraced as central to mental and emotional well-being, it can begin to change how we look at problems in an interesting way. Pamela J. Birrell, PhD, Psychology Department, University of Oregon: “I have become really interested in the effects of trauma on the psyche. Not only physical trauma, but primarily what we're now calling betrayal—people who have been betrayed by people who are supposed to take care of them. When people have been traumatized by sexual abuse, or even parental abandonment, they get disconnected from themselves, they get disconnected from others, so they don't feel safe in a relationship. So many of the things that we see as symptoms are really just what one school of thought calls ‘strategies of disconnection.’”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “A lot of times we think we are alone. And one of the most lovely things I’ve found on my path is that there are many of us out there. People who suffer just as we do from anxiety, from depression, from eating disorders. But to find friends out there who say, ‘Hey, you’re not alone.’ And to find the help that you need, the people who can help you work through that process. We can’t do it alone.” [*We can't do it alone. People can't do it alone. And you're not alone. People who suffer from anxiety--from depression, from eating disorders that are really not healthy--but to find friends out there and to realize, 'really not alone.' Places we can go that can help you--many resources out there. It's not A or B--there are many options. And it's really up to us to research those options, or find people who can help us research those options.] Some health professionals have started to experiment with what constant companionship alone can mean for struggling individuals. Judith E. Pentz, MD, Psychiatrist: “When a kid is in crisis, they're basically in what we call a shadow program, meaning that there is an adult with them all the time, including when they are sleeping in the evening. They are kept in a communal setting and not placed in a bedroom. No matter where the child is going throughout the day, be it at lunch, breakfast, school, activities, there’s literally a staff person next to them all the time. The idea would be the same in a home setting that you, in essence, work on making sure the child is never left alone and knows that they’re being taken care of all the time.”“Sometimes...that’s all you need, like during a humongous panic attack when you feel like it’s all going to end. If you can think—just for one second—‘I’m okay because this person loves me,’ sometimes that keeps you around.” – Depression survivorJudith E. Pentz, MD, Psychiatrist: “I have a young man right now who is being maintained at home…clearly looking at some borderline features of schizophreniform/schizophrenic-type picture. But the mom has been able to take time off of work, is making sure he’s sleeping enough, is making sure he gets adequate meals and is just staying with him. She is making a huge difference for him.”Joe Klein, LPC, Mindfulness Teacher: “There's nothing more therapeutic than that—being seen and being heard, having that sense of connection and belonging with each other. Dan Siegel talks about the attunement circuitry, the resonance circuitry in the brain. Part of the attachment relationship between a parent and a child happens because they spend significant time being with each other—giving each other really clear attention. So that develops parts of the brain—it develops a certain set of skills.” Chris McKenna, Program Director, Mindful Schools: “There’s this sense that we’re always being driven by some kind of subtle agenda on some level. We either want someone to do something or we want them not to do something. And this is particularly true with youth. We either have checked-out parents or we have helicopter parents, but it’s either--there’s always some sense of, ‘What are you doing now, is it productive,’ this regimentation of the way we actually have human relationships. Can you just put that all down for a period of time—let's just say every day—it doesn't have to be for two hours—and just really see what else happens.”Joe Klein, LPC, Mindfulness Teacher: “‘Let's go take a walk together. Let's go play a game of monopoly together. Let's do something different. The point is that we're going to be together with each other--and we're going to be attuning with each other.’”Chris McKenna, Program Director, Mindful Schools: “It can just be sitting on the couch. You get a short moment of awareness, you’re both looking at something beautiful, he says something about school, there’s a pause, you just appreciate him or her. You don’t add anything extra in, you’re just completely there, completely yourself, completely available to connect with your child. It sounds simple, but how many of us are doing that?”Joe Klein, LPC, Mindfulness Teacher: “Being with them, whatever’s happening, they’re going to see, ‘Oh. I’m being tuned in to, I’m being seen, I’m being heard, and I’m being listened to. I’m liking this. I’m going to show up for this.’”Judith E. Pentz, MD, Psychiatrist: “They understand that there will always be someone there no matter what is going on, and they begin to trust that that person, a human being, will be there for them.”A variety of health professionals, of course, can be an important part of the support picture. The take-home message of this lesson, again, is that these kinds of powerful and healing connections are also something any family can cultivate. As illustrated by this final story, the impact of even one heartfelt connection, with one friend or family member, can be surprising: “My coach noticed. My parents knew, but tried to deny. My brother was scared. . . . His begging for me to eat became a daily routine. He would stand by my locker with his teammates yelling down the hall for him, and beg me to eat. When I hit my lowest weight ever in the beginning of sophomore year, I was sent to the hospital. I was lying in my hospital bed bawling as they tried to stick the IV in my arm. I turned to look at my family so I could beg them to take me home. I opened my eyes, and in between my stone-cold parents stood my brother, Tom, big man on campus, with tears streaming down his cheeks. I made a silent vow that I would get better. . . . It took four hospitalizations and hundreds of therapy sessions, but I got well. Looking back, I think, the only thing that kept me eating was Tom's late night phone calls from his dorm room at college. I needed to get well for him.” So maybe friends and family can offer something after all. For those who need help in their own circle of friends and family, there is so much that you and others can offer. So give it a try. Let us know how it goes.In the next session, we’ll take another look at recovery itself—exploring what exactly that means, after all.REVIEW: Professionals can be very helpful. So can family and friends...but that can be easy to forget.In either case, there is surprising power in dropping the agenda--and fully being with someone.LESSON 6 DIFFERENT WAYS OF THINKING ABOUT RECOVERY“Is there a getting better from this?” –Woman facing depressionSo far, we've explored two different ways of thinking about the brain—one static, and one changing—and traced out what each of them means for facing serious mental or emotional challenges. Depending on how someone thinks about the brain, it can mean a whole lot about a variety of things, including whether someone sees recovery as a possibility at all. There’s one important question we haven't addressed, though. What exactly does recovery mean, anyway? Especially with the latest brain research, most people would agree that recovery from mental disorder is possible, at least to some extent. But agreeing on what exactly that recovery looks like is a different story. Let's begin talking about the most dominant view of recovery. In the United States, it’s common to see recovery as mostly about helping people learn to better manage, function, and cope with a problem. In this sense, as one researcher said, recovery is about regaining “function despite still having the permanent impairment and limitations of mental illness.” The comparison here is a catastrophic injury like damage to the spinal cord, where individuals have a permanent impairment but can return to a good quality of life with adequate support and assistance. “Like people who have had an amputation, those with a serious mental illness learn tricks about how to cope with their particular disability.” –Kate Mulligan, Psychiatric News, 2003Jacob Hess, PhD, Cofounder, All of Life: “Many people in mental health circles have come to the point where they believe recovery is a kind of long-term rehabilitation—a long-term coping with symptoms and helping somebody to function. And that's what people are being told: ‘There's hope because there's treatment.’ And that's great—to have some help with symptom management and functioning, that's a fine goal. If that's the only goal, however, and if people are not given any hope that long-term they can develop to another place where they're less vulnerable, and long-term their brain can re-wire to a place where it's less vulnerable, then we're still...consigning people to a lifelong condition. Lifelong!” Virgil Stucker, Executive Director, CooperRiis Healing Communities: “Recovery—if one limits it to what you generally think about as rehabilitation, you limit it to only functional and objective aspects. Recovery goes beyond that. It really involves fulfillment. Not just learning how to function better.”So let's be very clear here: better coping, managing, can be hugely important goals, especially at first. That’s not the question here. It’s when these things become the final goal, the only goal—the ultimate aspiration—that we may unintentionally leave individuals with little or no hope that deeper levels of recovery are even possible. If this was just the nature of serious mental illness, or how the brain worked, then that would all be understandable. If the only people who recovered were those with mild symptoms, then it would also make sense to just accept that lifelong impairment had to be a reality for some people. But is that true?Daniel Dorman, MD: “Catherine so clearly met the criteria of poor-prognosis schizophrenia. In the beginning, she barely spoke: usually 1 or 2 words or 1 or 2 sentences. During the first year all she would do would be to come in and sit down and bend her head down on her chest, and scrunch her hands together in an expression of what could only be agony. I'd ask her what she was thinking about and all she would say was: 'I hear voices.' She sat in a chair in the day room with her head on her chest and she didn't even swallow her own saliva; she would drool off her chin onto the front of her dress, down on to her hem, and the spittle would gather in a puddle on the floor in front of her.”Catherine Penney, RN: “For almost a year, I didn't even speak—I just sat in a fetal position, rocking back and forth. Because for me, I needed to keep my internal psychotic environment. I needed to control it myself because I didn't have trust or faith that anybody else could. I felt I was the only one who needed to get control of it—because nobody else seemed to care.”Daniel Dorman, MD: “Once I said to Catherine in a period of silence that ‘no wonder’ she was silent 'with all the horror that was going on.' So it was a process of trying to understand who this person is—which is unusual in the sense that that's not the way we tend to look at psychosis or schizophrenia anymore. We tend to look at it as an illness, immediately to be wiped out. And I was insistent that I at least try to understand where this went.”Catherine Penney, RN: “At first, it was a little irritating as well. But then he made a comment at one of the sessions: ‘I bet you feel safe where you are.’—and here I was, in a fetal position—‘The world can be a scary place, can't it?’ And it was like this antenna went up: ‘How does he know?’ Because my previous experiences were, ‘I’ve got schizophrenia, it’s a pathological condition, delusions have no meaning, symptoms have no meaning.’ But here was someone who saw beyond the exterior and the symptom, that saw the person underneath who was suffering. And so when Dr. Dorman kept seeing me and made that comment, a little seed of trust began to develop. And it was trust that didn't happen overnight—it was watered each time, each session with Dr. Dorman. And in time, as that trust grew, I opened up more and more.”Daniel Dorman, MD: “I was labeled nuts for being, for sitting with her. In fact, my fellow residents would say: ‘this guy, Dorman, he thinks he can talk to schizophrenics. He's as crazy as they are!’ In other words, in order to sit down and try to understand and treat people as human beings, and as unique human beings, you're regarded as nuts, which is curious, at the very minimum. At the end of the third year I was finishing my residency, and frankly, I was despairing. I thought that she would likely end up in a state mental hospital. One day I was sitting with her, and this happened: she brought her head up and did this [opens eyes wide]. And I was amazed—this was the first time, in close to two years, that she had opened her eyes. What she told me was, she thought it was time to ‘see the world.’”Catherine Penney, RN: “When I first started to get well, after I stopped hearing voices, I still kind of walked funny, and I looked funny—and people would laugh at me, and that kind of would make me want to go backwards. But I always remember Dr. Dorman saying, 'you have a well part in you Catherine, and it's a beautiful part—never forget that.' So whenever I started to feel bad when people laughed at me, I would think of that, and then I would just see that, and I would visualize that.”Daniel Dorman, MD: "After that, she began to explore cooking. So she had help from the nurses in the hospital. Catherine moved out of the hospital after six months into an apartment. She did start to date some, she went to school, she obtained a psychiatric technician license, and eventually started nursing school. Today, Catherine, right now, as we speak, Catherine has been a professional psychiatric nurse for 32 years. She has been in charge of an indigent population out in Palm Springs, California. Catherine then retired, and now is a clinical instructor at a nursing school.”Catherine Penney, RN: “I haven't heard voices since 1973. The last time I heard voices was—actually, I remember it very well—because we talked about it, Dr. Dorman and I. And it was a time where I was trying to go back to school after having been psychotic for so long. And I took two classes the first summer after I was discharged, psychology and sociology, thinking my mind would understand, like I could before. When I took those courses, it was like I could read the words...but I couldn't relate it to the meaning. And I got very, very depressed because I thought it meant, 'Oh my God, I have no choice—my brain is damaged. Why did I get well just to face failure again?' When I saw Dr. Dorman I told him what I was feeling about the voices. And he explained to me, 'Think about a house that has not been lived in for many years, and it gathers a lot of cobwebs and dust. Then all of a sudden a new family comes in and wipes away all the cobwebs and all the dust and cleans it up, and it starts to get its old function back again.’ He told me, 'Catherine, you will get back the faculties you had before you became ill. You will. Give yourself time.’ And I held onto that, like a lifeboat. It was like—because at that point I was feeling suicidal, like, 'Why even bother any more?' And so, even though I flunked those classes, I gave myself a break. I didn't take classes in the fall, and I went back to junior college in the spring, re-took those classes and got B’s in them.”Stories like this one are easy to write off as an exception—a unique situation where someone got lucky—but certainly not something that most people facing serious mental illness can expect. Daniel Dorman, MD: “It's often said that this is just a unique case—an unusual example. Well, first off, I would say that every case is unique and should be considered unique. Addressing the other side of that, I've been in practice for forty years and I’ve seen many, many people struggle with all levels of what we call psychosis, or borderline psychosis, and with an attempt to understand the nature of their struggles, many, many get better. “You have a well part in you . . . and it’s a beautiful part. Never forget that.”Is there anything coming up for you so far? We seriously wish we could be sitting there with you--hearing your thoughts, feelings or questions. In lieu of this, feel free to reach out to Jacob (Jacob@) or our coach (coach@) at any point as you go along in the class. **************Part 2: Another view of recovery: One award-winning journalist decided recently to review any study of mental illness he could find about recovery, and particularly, long-term recovery. The patterns he found were not what he had expected. Robert Whitaker, Author, Anatomy of an Epidemic: “The understanding is that people who have a first episode of psychosis or a diagnosis of schizophrenia, that's a chronic deteriorating disease, and basically, you're screwed. It's just going to be a bad long-term course. Well, the first thing you discover, that's really surprising, is the chronicity story really isn't warranted. So if you look back from 1945–55—the decade before Thorazine comes in—and you look at first-episode schizophrenia patients, these people are hospitalized. If you follow first-episode cohorts, 70% would be out in about 12–18 months. And five years later, somewhere between 65 and 75% would be living independently in the community; they would be working. Many of them would be married. Even at this disorder that we say is the most severe, we actually see a lot of people recovering. “Now, you might say, ‘Oh, listen, that's the old days, they diagnosed schizophrenia differently then, that's not a group so ill.’ Well, we have one modern study that followed schizophrenia patients for at least 15–20 years starting in 1980 and there, of the people who got off their medication (which was a fair number, almost half of schizophrenia patients)—over half were working by the end of five years and stayed working for the next ten years. Over 70% were just not psychotic anymore long term. There were about 25–30% who remained actively psychotic. So even with this disorder that we say is so difficult, we actually see a lot of recovery in what we might call the natural course of outcomes.” “We who have recovered from mental illness know from our personal experience that recovery is real. We know that recovery is more than remission with a brooding disease hidden in our hearts. We have experienced healing and we are whole where we were broken. Yet we are frequently confronted by unconvinced professionals who ask, ‘How can you have recovered from such a hopeless situation?’ When we present them with our testimonies they say that we are exceptions. . . .They say that our experience does not relate to that of their seriously, biologically ill, inpatients.”–Daniel Fisher, National Empowerment Center, 2010 Robert Whitaker, Author, Anatomy of an Epidemic: “So think about that. More than half working, two-thirds in relationships—that's a vision of ‘psychosis/schizophrenia’ we've totally lost! Now that's schizophrenia. How about affective disorders, how about depression, how about manic-depressive illness which we call ‘bipolar’ today? Well, you go back and here's what you read in 1965: ‘Depression will get better; it's self-limiting; we need to use the drugs to help speed that up. But you're going to get better’—that's #1. And how about its long-term course? ‘Depression is an episodic illness and very few people become chronic.’ It's seen as episodic. It’s seen as something that hits you for a time then generally goes away. After 4 months, after 6 months, after 8 months it's gone, and you’re back to what’s called euthymia, which is an absence of those symptoms, and you go on with your life. If you look at first-episode depressed patients hospitalized for depression--out of that first episode cohort, maybe 20% would end up chronically ill. The other 80% would have an episode, and maybe three years later they would have another episode, but it was an episodic illness. “Manic depressive illness, same thing—seen as an episodic illness. And in 1969, the leading manic depressive expert in the country said, ‘Listen, the one thing we can tell parents is it's not likely to be chronic, whether it’s depression or mania.’ Now we say, 'Your kid is screwed. It's going to be chronic.' Well, if we go back and try to discover the natural course of outcomes, we see that psychiatric disorders, even severe ones, by and large, are episodic. In other words, they do get better from whatever the psychiatric distress is, including--you’ll see people getting better from psychosis, mania, depression, whatever it might be. It might take them longer, but you see people getting better with great regularity; you actually see a lot of them staying well with great regularity. And maybe it's that they actually learned something, they went through a process, and they came out the other side a little bit stronger, who knows? I think actually that's one of the possibilities.”Daniel Dorman, MD: “The message is that your client—your patient, the person you're sitting with—is not to be underestimated. Growth and development are possible. There is no such thing as permanently stunted growth. The person sitting, drooling, catatonic, hearing voices, diagnosed as schizophrenic is struggling in a human way, just as anybody else—albeit more severe—but nevertheless, the struggle is very basic to us all. And the capacity to grow and develop is present in everyone.”Toby Tyler Watson, PsyD, Clinical Psychologist: “I know people who have been diagnosed schizophrenic, I know people who have been diagnosed bipolar, severely depressed and suicidal—and people who have recovered. And they’ve gone on to lead happy lives. That's not that uncommon for people to do that, if they do the work, but it's hard work. It doesn't happen in twelve sessions with your HMO. It can potentially take a year, two years, it could take three or five years. But if I told you, in three or five years you're not going to have strained reasoning any more, or hallucinations, or hear voices—but you're going to be functioning like the rest of America for the most part—and you're going to be happy for the next fifty years of your life, you'd probably sign up for it.” So what can we take away from all of this? To review, in addition to the discoveries in brain science mentioned earlier, major clinical research findings over the last forty years have provided increasing cause for hope in the possibility of recovery. Summarizing these studies, one Surgeon General report stated:“Long-term outcome studies . . . uncover[ed] a more positive course for a significant number of patients with severe mental illness in populations from virtually every continent, including landmark cross national studies by the World Health Organization from the 1970s and 1990s, showing unexpectedly high rates of complete or partial recovery.” –Mental Health: A report of the Surgeon General, 1999Biological and clinical findings, one researcher concluded, have converged to increasingly confirm that recovery and empowerment are ‘not the privilege of a few but a process that is possible for everyone to embark on and find help with’ (NEC). In the United States, one White House report on mental health begins with this statement: ’We envision a future when everyone with a mental illness will recover.’ In referencing this kind of a statement, let’s be careful of one thing. For someone who has hurt for a long time, naive promises of quick turnaround and sudden recovery can be painful and confusing. “Everybody makes that promise, ‘it’ll get better.’ And when it’s not getting better, you know, and . . . you’ve been hurting alone for so long, that promise really . . . holds no weight. . . . Because you’re like ‘No, I’ve been dealing with this for, you know, ten years by myself, and hurting that long for that bad, you think you can turn it around in a few months?’” –Young woman facing depression In its deepest sense, recovery usually takes time. One research team writes, “Recovery is not linear; recovery takes place as a series of small steps.” (Anthony, Cohen, Farkas & Gagne, 2002) “Recovery is . . . based on continual growth, occasional setbacks, and learning from experience.” –Consensus statement by the U.S. Department of Health and Human Services, 2006“At times our course is erratic and we falter, slide back, regroup and start again.” –Woman reflecting on her own recoveryAn eating disorder research team points out that successful recovery doesn't reflect absolute, unwavering resolution, as much as a "determination that ebbs and flows like the tides of the ocean, as it gradually rises." In other words, over time, people are capable of recovery, even in the midst of the changes and challenges of real life—a messiness that sometimes includes stumbles and heart-breaking setbacks. As with eating disorders, this is also true for depression, for delusions, for anxiety, for addictions, and many other challenges.“In our experience, it is more realistic, at least initially, to think in terms of moments of anti-anorexia/ bulimia clarity rather than a once-and-for-all realization . . . and subsequent unwavering rejection of it.”–Richard Maisel, et al., Inspiring Resistance to Anorexia/Bulimia, 2004These researchers go on to speak of a “back-and-forth rhythm of recovery” that comes in waves. Another separate research team has actually developed an approach known as the Tidal Model that has now been put into practice across several countries (Barker, 2008). Based on years of research into what people need, this approach focuses on encouraging families to create together the "next step" for recovery—with “the helper and the person working together to construct an appreciation of what needs to be done ‘now’.” (Barker & Buchanan-Barker, 2005).Okay, so recovery doesn’t happen overnight. But the evidence is encouraging and suggests that real recovery can happen, even in tough cases. Sounds exciting, right? Well, surprisingly enough, for a variety of reasons, there is remarkably little public awareness of any of this.“There’s a lot of people that don’t understand that you can recover.”–Young woman reflecting on her recoveryJacob Hess, PhD, Cofounder, All of Life: “What strikes me—what is so strange, honestly—is how few individuals have ever heard of the changeability of their brain—or that gene expression can turn on and off depending on what we do. Or that long-term recovery is possible. Most every person I speak with who struggles with mental or emotional disorder has heard from someone or somewhere--that their condition is lifelong. It's really remarkable.” “Even though the weight of personal testimony and epidemiological studies [suggest otherwise], most people in this country still believe that when a person has been labeled with mental illness they can never fully recover . . . that mental illness is a permanent condition.” –Daniel Fisher & Laurie Ahern, National Empowerment Center, 2010Virgil Stucker, Executive Director, CooperRiis Healing Communities: “Someone told me recently that recovery is an ‘outmoded, old-fashioned concept. I thought about that, and I became angrier and angrier and I said, 'How in the world could you withhold from someone the possibility that no matter how sick they are that they couldn't recover to their highest level possible. I'm not wanting to say that the challenges of serious mental illness aren’t significant. But I have never met someone with serious mental illness that I did not see some flicker of hope in—and that is all you need—some flicker in order to help someone move forward and strive for pared to the view of recovery we discussed earlier, this view is different. Rather than focusing on merely coping and managing, this view of recovery aims, as one psychiatrist puts it, at “regaining membership in society” with “meaningful roles” and a “sense of being a whole-person.” This kind of a deep and genuine recovery means, he continued, that the person is “not considered sick by others around them.” “I define recovery as creating a life of meaning and purpose, however big or small. But having something to work towards that gives you a sense of purpose—that makes you feel like you belong to the human race.”–Woman who previously faced mental illnessAnn Rider, CEO, Recovery Empowerment Network: “I now define recovery for myself as really, recovered. I have a life like everybody else's; I have a job that I love; I got the education I desired; I own a home. I have the respect and love of my neighbors, friends, and family. I'm just a human being like everybody else—not different. Every person has challenges.” “To me, knowing when you’ve gotten better is when you’re able to really laugh—and not only laugh on the outside but on the inside, too.”–Woman who faced depression in the pastVirgil Stucker, Executive Director, CooperRiis Healing Communities: “Who of us isn't broken in some way? Who of us doesn't need to learn how to live life, despite our challenges? Recovery is that restoration of relationship, restoration of basically the natural state of being. We are all meant to be in community—being fulfilled, not just living, but really articulating our dreams, developing it into a narrative, and moving forward with it. Catherine Penney, RN: “Recovery is just that journey where you become more and more aware of who you are, and how much you have within you that is strong and beautiful. It was like a re-birth. It was like being reborn again.”Jacob Hess, PhD, Cofounder, All of Life: “I have no problem with calling these conditions mental illnesses. It illustrates that there is something really happening in the body--it illustrates that it's not just something you can snap out of it and just choose your way out of it spontaneously. My confusion and what I don't understand is why, when we talk about mental illness, we have to use a metaphor of physical illness that never goes away. There are hundreds, perhaps thousands, of illnesses in the physical world that we can heal from and get better from--including cancer. I've had family members who have overcome cancer, and it's in remission. But when we talk about mental illness, typically we compare it with Type 1 diabetes where you have a long-term need for insulin. Why? Let's use the labels, but let’s use the labels thoughtfully. Let’s use them carefully, and in a way that doesn't put people in boxes, but that helps them move along. Robert Whitaker, Author, Anatomy of an Epidemic: “I think the message for families and those going through this is, a) don't accept the pessimistic story that if you have this crisis this is going to be you forever. Really what history and science are telling us is that many people can have a psychiatric event. It may be extended and it may be very difficult. But what history and science are telling us is there is actually an extraordinary resilience in people, and if you make environmental changes, people can generally come out of the psychiatric distress. That's the optimistic message.” For whatever reason, that optimistic message is something most people facing mental illness simply have not heard. If that doesn’t seem quite right to you, it didn’t to us, either. Especially when you consider what knowing this could mean for those facing these kinds of problems. So how about spreading the word. First, research shows the brain is changeable. Second, research shows people recovering long term, depending on how exactly they approach the problem. Any questions?This concludes our first section of the class—all centered around the question: How do we make sense of these problems? In the next section, we will turn our attention to that other question we just mentioned: So how should we approach and respond to these problems? What should we do about them? To recap this last class, and introduce the next, we’d like to finish with one final word: Robert Whitaker, Author, Anatomy of an Epidemic: “There's this beautiful quote by Samuel Bachoven, head of Boston Psychopathic Hospital, from 1940 to the 1970s. And he says this, 'My experience has taught me that most mental disorders—especially the most severe—are largely self-limiting in nature, unless we do something to turn them chronic.' So that’s the perception of this doctor, and I think that is really the one line that we need to rediscover: ‘largely self-limiting . . . unless we do something to turn them chronic.’ Unfortunately, we’re doing a lot to turn them chronic today.”REVIEW:There are very different ways of thinking about recovery. Many believe full recovery is not possible--seeing long-term symptom management as their best hope. Others believe full recovery is indeed possible...because they have lived it. SECTION II: RESPONDING TO THE PROBLEMLESSON 7 ONE WAY OF RESPONDING TO MENTAL DISTRESS“Today, me will live in the moment, unless it’s unpleasant -- in which case I will eat a cookie.” --Cookie Monster If it’s true that avoidance doesn’t actually get to the bottom of our problems and may sometimes complicate things, why do we keep going back to ways to avoid or distract from our pain?Let’s first talk about how we normally deal with pain of any kind. For most of us, it’s common to find some way, even just a distraction, to not feel the pain quite so much. Elisha Goldstein, PhD, Clinical Psychologist: “It’s so easy to get pulled into so many other things to avoid what’s actually really here. Especially when it comes to the difficult moments in life.” Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “I work with families who have experienced the death of an infant or a child, or a homicide or a suicide, and these are really traumatic experiences. I think in general, we as a society, in general don't know how to cope with others’ suffering, and even our own suffering. I think we try to circumvent it. We use whatever we can to distract ourselves from being able to tolerate our own painful, human emotions.”Susan Kaiser Greenland, The Mindful Child: “We’re really trained to turn away from these things. Distraction’s a handy technique. But as a way of life, distraction isn’t necessarily the most skillful way of doing things.”Tom McConkie, Cofounder, All of Life: “If avoidance is all we have, then we're setting ourselves up for great failure down the road. Because not only have we avoided this source of suffering, we haven’t looked at it, we haven’t addressed it, we haven’t done any work on it. Not only that, but we've also created a new addiction in our life -- every time I feel this, every time I sense this suffering present, I go and do this. We go watch a movie with a friend, or maybe we have a drink, or maybe we have several drinks, or maybe we go out and look for a sexual partner that we have no business being with. But it’s anything is better than being in this situation with this suffering.”Judith E. Pentz, MD, psychiatrist: “I can think of one person who basically wanted to sleep about 12–15 hours a day, get up, go to work, and then go back to sleep. Basically she wanted medication to a threshold that she would know that she could sleep 12–15 hours and then just get up and go to work and come home again. So I asked her about why she was doing that. Basically, it was to avoid her life, because it was too painful for her. I said, ‘It’s uncomfortable for me having to write these prescriptions for you to avoid your life. Let’s talk about what’s going on and why you’re wanting to do that.’ And she said, ‘I don’t want to.’”Whether escaping through alcohol, television, shopping, sleeping, binge eating, pornography, prescription drug abuse, or some other way, the overall aim of these approaches is to decrease pain soon, immediately if possible. While each of these things may offer some kind of short-term relief, it can be easy to sense that on a deeper level things are still not quite right. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “To everyone else, I looked happy, looked like I was coping, doing a great job, progressing in my career, all that great stuff. But below the surface, there was this stuff that was just churning. And I knew I wasn't coping.”Amy Saltzman, MD: “For people who have distressing thoughts and feelings, they probably already know that whatever they have been doing hasn’t been working . . . trying to escape by overworking, or using recreational substances, or spending a lot of time online or shopping.”Steve Alper, Mindfulness-based Stress Reduction Teacher: “Most of the options to escape, all of the options to escape, actually, that I’ve ever encountered, have pretty dramatically bad side effects. Ultimately, they cause suffering. You get it and you think, is this it?”David Antonuccio, PhD, Department of Psychiatry and Behavioral Sciences, University of Nevada: “From a psychological perspective, if you’re doing it to avoid the feelings that you're confronted with, all it does is postpone the problem, prolong the problem. It doesn't solve the problem, it doesn’t fix the problem—and anybody who's developed an alcohol problem knows that to be the case. So avoidance, while it may offer temporary relief, it does not solve the problem over the long haul.”If it’s true that avoidance doesn’t actually get to the bottom of our problems and may sometimes complicate things, why do we keep going back to ways to avoid or distract from our pain? As you start the second section of the class, one more reminder: If you’d like to communicate more directly about what you’re learning so far, send us a note at coach@. Part 2: If it’s not getting at the roots of our problem, why do we keep going back, again and again, to these same ways of checking out and numbing out?Elisha Goldstein, PhD, Clinical Psychologist: “In our culture right now we feel like uncomfortable emotions are something that we need to get away from. Our brain is telling us this is something really to be scared of or to get away from. We need to move towards what’s pleasant, and anything uncomfortable, anything that kind of puts you out for a little while, is something we need to stay away from.”Tom McConkie, Cofounder, All of Life: “As individuals, we usually have preferences in terms of what emotions are okay, or what’s welcome. And it's often negative emotion that we have such a problem with, like we're judgmental with ourselves for being angry, or we’re judgmental with ourselves for being judgmental. Or there are feelings coming up in the body we can't make room for.”“I battle with my brain when it gets out of line.”“Combatting my own thoughts, struggling against myself for my own sanity, is something I hate having to do.”“I am always battling my emotions, trying to manage them or figure them out. Day in and day out it takes a lot of energy and focus. I still need to work on this every single day.”–Individuals facing mental distressWhen infants and toddlers get hurt, they naturally turn to people they love and communicate their emotions without any inhibition. When we become adults, though, we learn something different: Somehow we get a message that it's not okay to feel certain things—and certainly not to share them. We’ve got to suck it up—keep emotions to ourselves, control ourselves, not fall apart, and literally, not be a baby. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Feeling like we have to get rid of what we’re experiencing because it's unpleasant. There's a real fear of really feeling what we're feeling. Being able to look at whatever it is and say 'this is what it is—this is fear, this is sadness, this is me wanting to go have a drink when I know I shouldn't, this is me driving myself into exhaustion—and I just want to get rid of those feelings, it's too uncomfortable. If I could just cut off my feelings, if I could just not be so friendly, so sensitive, then it would be easier.”However we can, then, we look for ways to mask the painful thoughts or feelings—never really questioning one deeply held belief, namely, that the most important thing we can do is make the pain go away. Now.“Things had gotten so bad for me that I said, “I’ll do anything. . . . I will do anything if you tell me that it will make me feel better. If you told me the problem lived in my finger and I had to cut it off, I would have done it. . . . I would have done anything to make that go away.”–Woman reflecting on her depressionAmy Saltzman, MD: “In our culture we’re taught that if we have a distressing thought or feeling, we’re supposed to do something about it. Usually the implication is to make it go away and then we’ll feel better.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “Our natural tendency is to push away the depression. ‘Of course I want to get rid of it, I want to think about something else.’”Steve Alper, Mindfulness-based Stress Reduction Teacher: “When someone’s hurting, we want to make the hurt go away.”“When depression starts to pull us down, we often react, for very understandable reasons, by trying to get rid of our feelings by suppressing them or by trying to think our way out of them. In the process we dredge up past regrets and conjure up future worries. In our heads, we try out this solution and that solution and it doesn’t take long for us to start feeling bad for failing to come up with a way to alleviate the painful emotions we’re feeling.” –Mark Williams, et at., The Mindful Way Through DepressionAnd of course, who can blame someone for wanting to make the pain go away? Seeking relief from pain is what we all do. The issue we’re exploring here is not whether to seek relief—but how exactly to go about that skillfully, in a way that leads to real, lasting reprieve, relief, and healing. We've spent this section paying attention to one common, fairly aggressive approach. In the next class, we’ll explore what this approach means for people’s actual experiences and how well it seems to work over the long term. REVIEW:One way to respond to emotional pain is to distract, avoid & numb out. This is something we all do sometimes. While it might provide some relief in the moment, over the long-term this approach may not get to the bottom of our problems. LESSON 8 CAN MAKING IT “GO AWAY” MAKE IT WORSE?“Our biggest problems arise from avoidance of the smaller ones.” –Jeremy CaulfieldWe just finished looking at one particular way of alleviating the pain of mental and emotional disorder—that is, direct attempts to make the pain go away. As we emphasized there, we’re all given to wanting the pain to go away. In fact, many of these responses can be necessary—especially over the short term. Over the long term, however, other questions arise: How well do these attempts to make pain go away do over time . . . especially lots of time? Like before, the place to start with this question is the brain. Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “If there’s something in our physical space that we don’t want around, we push it away. The problem is that within our brains, it works just the opposite. That the more that we engage with something, even in pushing it away, the more we bring it in. It’s a bit like the old example: If I tell you not to think about a pink elephant, you can’t help but think about the pink elephant, and the more that you try not to, the more you’re not able to, basically because of the way our brain works. For us to reference something that we don’t want to think about we actually have to access it, which means it brings it into our awareness. So we set up a situation where the one thing we’re most trying to get rid of is the one thing we’re actually inadvertently bringing in.”More work to make challenging emotions stop may have surprising, even contradictory effects. Sometimes even well intentioned efforts to promote positive emotion can seem to complicate things. Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, U. of Southern California: “People around a depressed person will often say ‘Well just snap out of it, what’s wrong with you? There’s nothing going on in your life that’s bad.’"Jacob Hess, PhD, Cofounder, All of Life: “I had a buddy who was engaged to be married and he was anxious about it. He was having anxious thoughts come to him about ‘is this the right person for me? I'm not sure I feel enough.’ He was saying, ‘I'm memorizing these positive thoughts, and I’m doing all these exercises to make sure the thoughts go away’ and I just said, ‘Stop. Stop. Hold on. This could be making it worse. All this work to make your thoughts go away, and to control them and to force them, is going to have a rebound effect.’” "You cannot force the mind. And if you try to, you won’t like what comes of it.”–Mark Williams, et al., The Mindful Way Through Depression, 2007Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, U. of Southern California: “If you take somebody who’s depressed and say ‘Oh, just think happy thoughts,' inevitably they fail. That just gives them more ammunition to beat up on themselves and say ‘Oh, what a failure I am, I can’t even think happy thoughts all the time.' You can see how that can spiral down and backfire by setting up an expectation that’s not attainable. We can’t think happy thoughts all the time. We can’t think sad thoughts all the time. Trying to control thoughts is doomed to failure.”When we try to pressure emotions in one direction—even a positive direction—the subtle message can sometimes be “It’s not okay to feel what you’re feeling!” "When we try to suppress thoughts like this, what we resist persists: our attempts to force the mind can rebound in exactly the opposite direction from the one we want. This can work for a little while—but at a huge cost; those who put more effort into keeping negatives out of mind end up being more depressed than those who do not.” –Mark Williams, et al., The Mindful Way Through Depression, 2007 Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “When we realize—when we feel a mood and we try to fix it—we're also saying about ourselves ‘Something is wrong with me, something is not complete about me.’ It's our reaction to it. And our sense that we have to go in and fix it and wrestle it to the ground. And we get ourselves into more trouble. That's been my experience.”Tom McConkie, Cofounder, All of Life: “We're kind of wired to focus on problems—there can be so many things right with me, and yet my awareness darts back to that little cough, and that tickle in my throat a thousand times a day. And because my awareness is flowing in that direction, it creates this experience of feeling like things are not okay. All I experience today is just, ‘I'm getting sick, I’m getting the flu.’ I think with mental health, there is a very similar analogy in mental health, where we tend to identify with the mess; we tend to become absorbed by the mess.”Interestingly enough, then, our brain is actually set up to detect problems, and that’s a good thing. Think of parents who don’t watch out for problems that might happen to their children. Not good, right? In the same way, maybe we can stop hammering ourselves so much when we notice, feel, or think about things that may be wrong. Maybe we can apply some gentle curiosity to what, if anything, those feelings mean, and whether they offer any lesson or suggest ways to respond. When it comes to how this applies to depression or anxiety, there’s more to say, though. So let’s get back to Tom.Tom McConkie, Cofounder, All of Life: “We've got these amazing brains that are beautiful at mapping the terrain around us and detecting danger. And when something's going wrong in ourselves, maybe emotional problems, maybe mental problems, our brains naturally go to that. It’s not just a mental or emotional problem that your brain detects, it might be that you're bleeding or in mortal danger and your brain is telling you that. We tend to focus in on these problems, and that's not a bad thing. But if we focus on them so reflexively, and so automatically, that our experience is that after being awake all day and at the time we’re ready to go to bed we had 50,000 thoughts, and 45,000 of those thoughts were flowing in the direction of, ‘I just feel depressed, I can hardly breathe I’m so depressed, it feels like I’m suffocating, I don't like my job, I don’t really have any close friends who understand me.’ “It's not even inherently a problem that that’s where your thoughts are going. But if we don’t learn to access this deeper part of us that is aware of that thinking, and aware of that emotional activity, if we don't have some kind of time or space set aside in our day where we can appreciate that inherent restful quality of awareness itself, where we can be aware that there are problems coming up, that the emotional pain is profound, that the mental problems are excruciating, but that there is something that is aware of that. And that there’s something that’s aware of all that, that holds all of that. It is untainted, the deepest part of ourselves that can hold all of life and all awareness.” Have you ever noticed things getting worse after some kind of attempt to make pain or distress go away? Part 2: Tom McConkie, Cofounder, All of Life: “You catch yourself getting into these ruts of attention—the way that rain would fall on a mountain and wear grooves into a hill, and flow down in streams to the point where other raindrops find those same spots where the water is flowing the most easily—our brains work the same way, our awareness works the same way. We get in these habits of thinking about certain problems, and we create these grooves. Neurologists, neuroscientists have this cute saying: neurons that fire together, wire together. The more we think about problems, the more we tend to experience them and we're ready to experience them and we have these neuronal pathways that help us experience them.”As we notice the way the brain works, it’s hard to not start to wonder, when did we decide that forcing, controlling, and micromanaging our thoughts and emotions was our best option? Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I think we all have this sense that we should be absolutely okay. We should be these perfect models of human beings who are well adjusted, who don’t get cross, who aren’t undone by certain events in our lives; we should be able to hold it together and be perfectly fit. And we hold ourselves to such high standards. Can we just back up and be where we are? It's so filled with shame, with judgment, with this idea that says 'I’m not good enough. Where I am is not good enough.' Because I’m measuring myself against all these cultural expectations. That’s really a tough place to be for all of us. It’s a really tough place to be.”Steve Alper, Mindfulness-based Stress Reduction Teacher: “I’ve had experiences with patients, frequently, who think, ‘Well, I’m unhappy, so there must be something wrong.’ Now, of course, there may be something wrong if they’re chronically unhappy, but part of what’s wrong is the feeling that ‘I’m chronically unhappy, there must be something wrong.’ When people can accept unhappiness as a normal part of life, then they’re less likely to elaborate further unhappiness in their efforts to keep unhappiness at bay.”Susan Kaiser Greenland, The Mindful Child: “The message of fixing and controlling is that there’s something broken—that there’s something wrong with you. And so that’s why we have to be careful with that.”The idea we’ve been exploring here is that we can actually make problems worse by over-aggressive efforts to make them better. But why? Isn’t working and trying harder always a good thing? It can be difficult to understand why all the forcing and controlling can backfire. Jacob Hess, PhD, Cofounder, All of Life: “I used to struggle with insomnia, I used to struggle to get to sleep. And I remember lying in bed, and my natural tendency, even last night, is to try to get to sleep—to work at it. And as anyone knows, who struggles with insomnia, working harder at getting to sleep is the worst way to get to sleep. In a similar way, there is new research suggesting that our hard-fought efforts to make a feeling or thought go away can rebound and can actually provoke the very thing we're trying to escape from. It's a fascinating idea that our best efforts—the very efforts that we're putting into being free—can be sinking us further.”“Thoughts go round and round as you try to find a deeper meaning, to understand once and for all why you feel so bad. . . . If you can’t come up with a satisfactory answer, you might feel even more empty and desperate. Ultimately, you may become convinced that there is something fundamentally wrong with you. But what if there is nothing ‘wrong’ with you at all? What if, like virtually everybody else who suffers repeatedly from depression, you have become a victim of your own very sensible, even heroic, efforts to free yourself—like someone pulled even deeper into quicksand by the struggling intended to get you out.” –Mark Williams, et al., The Mindful Way Through Depression, 2007 Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “If you’ve ever seen one of these Chinese finger puzzles, it’s a little woven tube that you get when you’re a kid. You put your fingers in at each end and you try to escape by pulling your fingers out and it grabs your fingers tighter. That’s how I like to think of the process of trying to get rid of depression, to get rid of a bad feeling or an uncomfortable thought. The more we try to get rid of it, the tighter we get ensnared.”Steve Alper, Mindfulness-based Stress Reduction Teacher: “If I have back pain, which I had this week—and it’s a good metaphor for emotional pain—if I’m bracing against the pain, then all of the musculature around the area of my back that is injured tightens up, and guess what happens? The pain intensifies, and I’m crawling on the floor to the bathroom, I can’t even stand up straight. The same thing happens with grief, or with anger. If we try to get rid of it and don’t accept it, it intensifies it.”Elisha Goldstein, PhD, Clinical Psychologist: “If we have some deep wound or difficult feeling that’s there, and we say, ‘I’m not going to feel you,’ when we’re holding it, we’re not only not escaping it, we’re really—it takes energy to hold that emotion down, so, we’re becoming depleted. We can hold onto our pain and say ‘I’m not going to feel you’ and allow our fist to hold onto it, almost, like within ourselves. We can choose to hold it like that [closed fist], or we can choose to hold it like this [open fingers]. When the pain comes and we’re able to be with it, then it passes away. But the more we hold onto it like this [clenches fist] the longer it sticks around. And it gets more intense.”This is an important point. Namely, that our very efforts to make problems go away may yield only temporary and superficial results in the end. Jonathan Grindlinger, MD, Psychiatrist: “This notion that health is feeling good all the time is completely ridiculous. I mean there's always cost to things. Are you going to pay up front when it's cheap, or are you going to pay high interest later by avoiding it? You can't escape reality—your body is going to respond to bad things going on in your life, whether you like it or not. Pain is a normal part of life. We can minimize it, but when we try to avoid it, it comes back with a vengeance.”Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “Human suffering is part of the human experience. We are going to suffer. The more we try to self-protect, the more we put ourselves into the fear-stress cycle. Sir Henry Maudsley said "Sorrow which doesn't find vent in tears, will soon make other organs weep." Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I think a lot of what happened with the eating disorders was truly a masking, in the end a very ineffective way of masking my own feelings, uncomfortable emotions, things that I hadn't really come to terms with or resolved. And I think it's not unlike other addictions—drinking, drug addictions, eating or not eating, controlling things—these might cover something up, they might give us some short-term sense of ease or satisfaction. But I think if we're honest with ourselves, we recognize it has very long-term, damaging effects. And it's hard to come to terms with that.”Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “I had a woman come to me 16 years after the death of her baby. And she had been on psychotropic medications for 13 of those 16 years. She had hidden her pain for so long—she had unnamed it, masked it, and suppressed it for so long—that it stole from her ability to feel joy. When we constrict our dark experiences, our dark emotions, when we don't allow ourselves the full range of human expression, then we also restrict our ability to feel joy and unbelievable, transcendent joy and meaning in life.”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “What feels right and balanced and good for me will be different for you, and different for someone else. But I think when we talk about depression or anxiety, or just periods of imbalance, we know where we don’t want to be. I think we know when we reach a point where we say to ourselves, ‘this is no longer working, this is no longer a way of life, something that I can sustain.”Chris McKenna, Executive Director, The Mind Body Awareness Project: “As human beings and particularly as teenagers in this culture, we’re subjected to these really strong impulses. They run through us. Our society moves at a very, very fast rate. So we don’t always get the tools we need in order to really feel and discharge these impulses, particularly at-risk youth. They’ve got a bunch of strong feelings and emotions and almost no tools that they’re taught on a practical level to deal with them.” As we near the end of this discussion, let's summarize: For individuals hurting deeply, getting rid of pain now is an understandable and sensible thing to want. While it may be helpful in the moment, this approach can often lead to problems down the road—especially if this becomes our main source of relief. And when that happens, there is a chance we may simply never get to the roots of our real problem. The immediate problem, in this sense, is how we approach the pain, rather than just the pain itself. In an interesting way, then, the exact way we approach pain can makes things worse. Rather than just panicking, for instance, we panic about our panic. Instead of just getting angry, we get angry at ourselves for being angry. We’ll have lots more to say about what all this means in the next couple of class sessions. For now, let’s end with a bit more exploration of this very point.Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Having that kind of low thought, or sad thought, or joyful thought—whatever kind of thought it is, or whatever kind of emotion it is, I don't see that as the problem. Where we get into the problem is our reaction to that. We want to fix what isn’t comfortable for us and doesn't feel good.” Joanne Cacciatore, PhD, School of Social Work, ASU: “When we limit our ability to tolerate the dark emotions, what we do, in a sense, is we also limit our capacity to experience the positive emotions in life. So our life becomes very small so that we can manage this constricted emotional state.”Tom McConkie, Cofounder, All of Life: “We all have pain and we all suffer, and some more than others. We assume that we suffer because of a something—a certain something is making us suffer. And when we look more closely, we realize that assumption is not borne out. We actually suffer because of a relationship we came into with that something. It's not the condition itself that causes so much suffering, it's our relationship to the condition. On some level—sometimes it’s very apparent and sometimes much more subtle—we realize on some level that there is some fundamental resistance to what is. We have resistance to 'This is happening to me, and I don't want it to be happening, I want it to go away.’ So we push against it, or we run from it, we distract; we invite harmful influences in our lives. It might be drug abuse, it might be compulsive gambling. We do these things to deny the very conditions that are present in our lives.”Jacob Hess, PhD, Cofounder, All of Life: “Instead of trying to avoid the pain and do whatever we can to try and make the pain go away, there is a new school of thought in psychology that says, yes—keep trying. Put effort into it, but do it in a different way.”Elisha Goldstein, PhD, Clinical Psychologist: “The idea isn’t to eradicate stress and pain. Stress and pain are actually good, to a point. The idea is how do we learn how to relate to it differently.” Tom McConkie, Cofounder, All of Life: “We assume that pain and suffering are the same thing. As you look closely, you realize that some things are painful, and some things are inherently pleasurable. And there’s always pain and pleasure in our lives. But what creates this suffering is this thought that 'I don't want that pain. I want it to go away. In fact, I would do anything to make it go away.' It's not just pain that’s the culprit. With pleasure we have this perverse relationship with it where we want more of it in our lives. ‘One piece of chocolate cake is not enough. One lover that I had that it’s not working out with, and I want to swap this one out for another one. This job doesn't glorify me properly. I want to change careers and get a new one.’ It's always, we want more and more pleasure. And we resist what is. We're not letting flow what is flowing in our lives. “I’m talking about a new relationship with experience, all the things that are coming up in your life moment to moment. I’m talking about really looking at those things closely and having the courage and honesty to let it be what it is; if it's painful, then give yourself to that, let it be painful. And if it's pleasurable, then let it be pleasurable for as long as it wants to be. But this grasping, this sense of 'Things aren't okay, we need to change conditions, we’ve got to manipulate more in order to get things just so.’ Even if by heroic efforts we're able to tend to conditions in a way that we get things just how we want them for a moment, they'll change again. They'll change on us again. I had my living room set up so lovely, until this film crew came and started disturbing furniture. I was so happy just breathing in how my space felt, and now it’s disturbed. And if I pin my happiness to that—my house looks pretty good, my car is pretty shiny—it changes. All these things that we tend to identify with, if we can just let them be as they are, and not ask for more or less.”We’ve highlighted in this discussion some of the consequences of trying to fight against what’s happening in our heads. For one, this probably won’t make the problem go away. What’s worse, fighting our thoughts or feelings can also give problems more power and potentially make the situation worse. In the end, the need to avoid pain can become a festering problem in itself. In the next class, we’ll begin to explore another approach.REVIEW: Trying to make pain go away immediately may have some effects in the short-term.Over the long-term, however, two problems often arise: (a) Deeper problems are not fully resolved. (b) Problems can get worse, as the consequences of short-term efforts pile up. Any reactions you had to the lesson? If you listen deeply in this moment, can you detect anything in your life that you might have been resisting? LESSON 9 ANOTHER WAY OF RESPONDING TO MENTAL DISTRESSNow it’s time to consider a second approach to serious mental and emotional distress. Since this one is much less known than the other one just explored, we’ll spend a bit more time on it.“Nothing is so strong as gentleness.” –Ralph W. SockmanTrying to make distressing thoughts or feelings go away, then, can potentially make things worse—especially over time. If not resisting, fighting, forcing, controlling, or running away from painful thoughts and feelings, what else can we do? Tom McConkie, Cofounder, All of Life: “I think about this turning point. It started in that moment where I just stopped, I calmed, and I just looked at what was going on. And I realized that my house—the house that is me—was in total shambles. And that was hard to look at. I couldn't believe how profound and extensive the damage was. And yet, I was seeing it. For the first time, I was actually seeing it without censoring it, without trying to avoid it, or distract myself, because I knew deep down how bad things were. I just looked at it.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Rarely do we take time out of our busyness to step off that treadmill and check in. And just say, ‘Hey, what am I feeling?’ I ask people all day 'How are you doing?' and people say, ‘Great, great, great.’ It’s a patent answer. But how are you really doing? Rarely do we have a chance to really sit down with a friend and say, ‘This is how I’m really feeling.’ What if we could do that for ourselves, what if we could step out of that busyness and ask myself, ‘What’s going on in my body, what am I feeling?’ But this chance to step out of the busyness into the present moment and say 'Hey, what's going on? And come to this place where you say, 'Look, this is me right now—this is how I'm feeling, this is what I’m feeling. This is what I need. This is what I need.’” As simple as it sounds, stopping can actually feel uncomfortable at first, especially because our habits are often just the opposite: not stopping. Instead, doing more, and more and more, or reacting, and reacting some more. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We are doing, and we’re just reacting, we’re on this automatic-pilot kind of place, all day long, just boom boom boom boom. And it's really the exception, the radical act when someone steps out of that and says, ‘What's going on for me?'” Tom McConkie, Cofounder, All of Life: “I remember the first time that I really decided to just sit still and take a look at what was going on in my life. I think we all come to those moments where we just say, 'I'm exhausted, it’s not working, I need to be still, throw on the brakes and take account of what’s going on.’ When I did that for the first time, I was a freshman in college, and I didn’t know what I was doing in terms of someone had taught me to do this, I just threw on the brakes, just looked, and I was just really stunned by what I saw.” What makes this approach of “stopping” unique is the willingness to do something that seems a little counter-intuitive at first: staying with the distress. Susan Kaiser Greenland, Author, The Mindful Child: “What do we do with challenging feelings, is we just bring awareness to them. A gentle, curious, friendly awareness, and without fear and with a bit of a sense of humor--but that’s kind of counterintuitive, because we’re really trained to turn away from these things--instead of turning away from a difficult feeling, turning into it--in little bits. Bit by bit by bit.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “In ancient times, when people made maps before they knew the world was round, they would map out to wherever it is that they knew, and then out on the edges they had these little warnings that said, “beyond there be dragons,” and so nobody ever went there. So that belief that there were dragons out there kept people to some degree where they actually were. The only way that we ever found out that there weren’t actually dragons out there was to feel our way out, and to go out and to seek what was actually there, and not to let our minds or other people tell us what was there, but to experience it, to actually feel our way into it.” Amy Saltzman, M.D.: “Just simply meeting it, without needing to change it, or fix it, or make it bigger or smaller. Again, as you practice this, you develop the capacity for meeting and even befriending difficult thoughts and feelings so that they don’t run your life.”What do you notice when you stop and observe what’s going on inside? Does it ever feel like certain thoughts or feelings are “running your life”?Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “To try to just react to it, clamp down on it, and fix it just gets us into more trouble. But if we were to just acknowledge what is for us, without so much judgment, that in itself is a very powerful place to start. One teacher that I adore, Pema Chodron, says, ‘We all have to start where we are. You start where you are, and I’ll start where I am, and we’ll just go step by step, moment by moment. Yes, we have a plan, but we begin to develop some emotional and cognitive flexibility in how we get to what we think is wellness.’” Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “Sometimes, we just need to cry. Sometimes, we just need to be with it. Even though it hurts, oftentimes I'll--people will tell me they had a crying marathon. And I'll say, ‘How did it feel?’ And they'll say, ‘Awful, awful, awful..and amazingly healing.’ It's that paradox that something can both hurt and be good for us.” This can mean different things for different people. For some, it can mean temporarily allowing themselves to be in a bit more pain, more openly than they normally would. Joanne Cacciatore, PhD, School of Social Work, Arizona State University: I experienced the death of a daughter in 1994 and went into my own dark night of the soul. I was unprepared; I was 26 years old and she died for unknown reasons. And I lost a lot of weight--I weighed about 89 pounds, and almost died myself. And they sent me to mental health professionals who seemed to exacerbate my already frail emotional state...I would tell the mental health professionals, "I'm not letting you medicate me, because her life was worth every tear I shed. You're not taking that away from me.”Decisions for how to handle pain are clearly personal and individual. For some, as we said before, medication can be a crucial help to alleviate the pain for a time. The point, of course, isn't about medical support per se; it is that any support--whether medical or otherwise--should think carefully about when it's necessary to take away pain, and when a person may need to feel something in order to fully heal. Either way, the insights that can come from stopping—if only for a moment—just to take a look at what is actually there, can be surprising. Part 2:As we’ve been exploring so far, this kind of gentle, nonreactive response can lead to new possibilities for our lives that arise precisely because we’re not getting carried away by the pain, or in the pain. Elisha Goldstein, Ph.D., Clinical Psychologist: “So no longer are you being enslaved by what’s difficult--your mind, your brain reacting with a sense of aversion, a sense of ’I need to get away from this.’ Now you’re saying, ‘Well actually, let me look at this for a moment.’” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “To be with, to actually see it for what it is, and then to make a choice about how one is going to work with it, that you don’t have when you are ensnared in that, trying to get away.” Randye Semple, Ph.D., Department of Psychiatry & Behavioral Sciences, University of Southern California: “To say, ‘I shouldn’t be depressed right now’ is a pushing away of the fact that the individual is depressed right now. And the shoulds are the opposite of is. So to recognize, ‘Oh, there’s a depressed mood there, and it’s going to affect me physically, my appetite may change, my sleep may change, it’s going to affect me emotionally with sadness or irritability. It’s going to affect me cognitively--thinking shifts in depression. Oh yeah, there’s all that negative thinking again, the negativity about the self, the world, and the future--it’s all just a big global negative.’ But they are still just thoughts. Yep, this is what’s happening right now, there’s a lot of negative thoughts going on. Now what would I like to do today?” Amy Saltzman, M.D.: “So there’s this way of having our feelings, meeting them, acknowledging that they’re there, not pushing them away, not making them bigger than they are, but just knowing that they are there, meeting them with kindness, and then choosing.” Notice that when we stop and watch, we’re not simply succumbing or giving in to whatever our thoughts and emotions are doing. We are more like an observer on the banks of a river, watching the current go by. As we get better and better at not getting pulled into the current, we develop more and more patience and compassion for what’s coming up, even if it’s really challenging to look at. Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “When you’re depressed, you feel bound up, straight-jacketed, without options, sort of poured in cement, maybe even. And even the slightest possibility that there’s some other way of relating to this, that you can feel a little wiggle of movement, is help. And you can build on that. When we can bring close attention to things, we start to see that there are options, that there’s wiggle room, that there’s a little bit of movement where we thought there was none. Paying attention, even when something feels really uncomfortable and difficult, can open up options that you’ve never seen before.” “If you have a wound and just cover it up, it's not going to heal. You need to open it up, disinfect and clean it, and then wrap it up. It's the same thing with emotional issues. We need to open up the wound, see what is there, what is infected, and then we need to clean it up.” --Diana Gonzales Elisha Goldstein, PhD, Clinical Psychologist: “The 13th century Sufi poet, Rumi, said, ‘Don’t look away from the bandaged place, that’s where the light enters.’"Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “It's in that darkness, really, where we grow. Rollo May said 'One does not become fully human, painlessly. By allowing ourselves to go into the darkness, to experience the dark emotions, we not only learn to tolerate our dark emotions, but we learn to grow and transcend our place in the world. Elizabeth Kubler-Ross said, the people who have experienced loss, the people who have experienced trauma, the people who have experienced suffering--those are the most beautiful people in the world. She says beautiful people don’t just happen.”Tom McConkie, Cofounder, All of Life: “I just stopped, and just sat still, kind of like I'm doing right now, and I just closed my eyes. I wasn't looking for anything in particular. My focus was not taking more stuff in, not seeking more stimulation—but to just really, be in my own experience. When I did that, I was stunned at how immediately I was able to see into something that felt much more primary to me than my feelings, than my thoughts, than my beliefs, than my experience, than my memory. It was this…essence that I felt that I was really contacting and steeping in. It was an awareness beneath the din of thought and feeling. On one pole, there was total disaster, total chaos. I was as broken and beat up as I felt, emotionally, mentally. Things were a wreck. And yet, simultaneously, in that same moment, I observed this deep stillness, this profound calm, this restful quality of being okay, being sustained and supported in the moment.” Ultimately, as reflected in these experiences, there are times when pain, especially when handled carefully and skillfully, can offer meaningful lessons and move us in a direction of deeper healing. Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “Everyone’s experience is going to vary, and I can’t tell you what you would necessarily experience, but I do know that as you engage in the practice, and notice what comes up and watch everything, including depression and depressing thoughts and sadness and sensations in the body that are uncomfortable associated with depression--that as you view them in the light of awareness, they change. There’s flexibility, there’s movement, and the relationship begins to shift. This is not an overnight thing. Often years leading up to that depression has sort of hardened that position, but if there can be a little movement, then, you can work with it.” [*It suddenly opens up perspective and options where you never knew you had options.] Amy Saltzman, MD: “Often when we meet those thoughts and feelings with kindness and compassion, they do kind of diminish in their intensity or their forcefulness or their demand to be acted upon.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “This power of coming to the present moment to just accept what is, without feeding it and making it larger, and just resting with that, helps to give us slowly, it’s a practice, access to everything else that is--beyond the illness, beyond the chronic pain, beyond the depression.” [*...right? Our perspective changes. Our awareness widens. And I feel it is compassion: “I’m suffering. I'm not feeling well" that's this, but there's so much more. It’s difficult to put into words. Is that clear enough? ]Tom McConkie, Mindfulness Teacher: “This narrative around mental illness in our culture has everything to do with what we lack. And we’re very interested in pointing people back in an intuitive way to what’s inherently whole in themselves. Once they can connect with that wholeness and that sense of being okay just as things are, even when things are a mess, ESPECIALLY when things are a mess. To just acknowledge that they're still breathing. And they're still alive. And there's so much potential; every moment is full of this—it’s just brimming with potential to move in a new direction. We want to open them up to that moment of intuition and awareness where they can move in a direction that they might not have explored, that they might not have thought to explore.” Most refreshing, then, is the idea that we can be in pain--emotionally, mentally or physically-- without being entirely consumed and overwhelmed and driven and defined by that pain. In this space we may begin to spot hints of health and healing starting to come up. Steve Alper, Mindfulness-based Stress Reduction Teacher: “How one deals with the effects of those illnesses can really alter the course of the illness, and if we can teach people to be with the discomfort in a certain way, it lessens the likelihood of blowing up into a full-fledged incident.” Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “I had kidney stones when I first came to California, quite an experience, very painful as you can imagine. And then what happened after I got over that, whenever I have kind of twinges, I think, ‘Oh my gosh, I’m going to get kidney stones.’ When people have had depression and then they have a thought or a body sensation, that they think, ‘Oh my gosh, I’m going to go back into that depth of despair again, I just know it.’ They’re absolutely fine one day but then, maybe just a little something, body sensation, that just has this cascade of thoughts that come with it…’Oh my gosh, this is going to be awful, I’m gonna end up in the hospital, or depression, I’m going to have a relapse, I’m going to curl up in my bed, put the covers over my head, I can’t cope.’" This kind of panic ironically invites the very thing we dread--making a spiral towards something like depression more likely...Even so, after many years of this kind of fearful reaction, it can be very hard to resist. Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “It has almost this pathway that’s been so set, like people walking over the grass to a parked car. They do it every day, so you’ve got this kind of neuronal pathway that’s been set.”Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “We do have those well-worn grooves that we slip into, that we sort of see everything in the same way for a while. And there are no possibilities when you’re in the groove, in the well-worn ruts of the road.” Like Steve just said, some habits for reacting to pain have been so over-used, for so long, that the brain has grown accustomed to them. Remember, though ...if the brain can change in one direction, it can change in another. Interestingly enough, it may not take something dramatic to get this process started. The message here is that something as simple as just stopping can ironically spark some positive movement in our life, and our brain. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “When we step into the present moment, we’re fully here with what is, and we’re not trying to make what is into something else. There’s this sense of compassionate awareness, of acceptance, or at least if not acceptance, acknowledgement, full acknowledgement of what’s going on—'here I am, I feel completely bummed out. Can I just fully acknowledge that? Can I not try to do anything about it right now? Can I just feel into that a little bit?” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “To bring a certain degree of kindness and compassion and patience to our own experience, and to let go of judging an experience as bad or good, but allowing the experience to be what it is, without the judgment.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “Acceptance is not passivity; it’s not a resignation. Acceptance leads to wanting to make changes in the present, compassionate choices in the present, so as to maximize the possibility of the future emerging the way you would like it to be.” Elisha Goldstein, Ph.D., Clinical Psychologist: “In this space of awareness, what do I need to do that’s going to be helpful for me right now? Maybe I need to take care of myself in this moment because I’m feeling so uncomfortable right now. Maybe I need to take a walk with my dog, maybe I need to go take a bath, maybe I need to just go lie down, maybe I need to call a friend. These are all actions that happen. When you pop into that space of awareness and make a choice, all of a sudden you’re an active participant in your own health and well-being. You’re no longer enslaved to what your mind is telling you.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “Our day, every day, is literally packed with choice points. Points where we can choose left or right, chocolate or vanilla, this person or that person, say yes, say no, turn off here or don’t turn off. Most of those choice points we miss because we’re on autopilot. And most of the time that’s okay. But then sometimes when we start to tell ourselves there are no options, we have no choices, we forget that there were all of these options and choices that were before us that we just missed because we just went on autopilot. So when we stop and pay attention, suddenly the whole world opens up, there’s all kinds of options and alternatives of dealing with any particular thing when we can see things as they are, rather than how our brain tells us they are.” So let's review for a minute: As simple as it sounds, being more present to our current experience can open up a new sense of possibility and freedom. “If you move into [calm] awareness in the midst of pain, even for the tiniest moment, your relationship with your pain is going to shift right in that very moment…It is impossible for it not to change because the gesture of holding it in awareness, even if sustained for only a second or two, already reveals a larger [view]. And that shift in your relationship with the experience gives you more degrees of freedom in your attitude and in your actions in a given situation, whatever it is...even if you don’t know what to do.” --Jon Kabat-Zinn, 2005, Coming to Our SensesElisha Goldstein, PhD, Clinical Psychologist: “Victor Frankel, who was a holocaust survivor and a neurologist and psychiatrist, has this wonderful quote attributed to him which says, ‘In between stimulus and response there’s a space. In that space lies our power to choose our response, and in our response lies our growth and our freedom.’ So our work is to let people know that that space, that space of awareness between stimulus and response is a choice point. So sometimes I tell people to be on the lookout for these choice points, these moments of awareness that you have throughout the day.”Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “We do have those well-worn grooves that we slip into that we sort of see everything in the same way for a while. And there are no possibilities when you’re in the groove, in the well-worn ruts of the road. But if you notice that they’re there and bring yourself up out of them, even for a little while, then you see that there’s possibility.” [repeat and elaboration from earlier]Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “And so it’s being able to move..and not always have that as a default. In the end, being able to actually say, ‘Oh, and this, too.’ That it doesn’t have to be that….of going down that same road of depressive symptoms, you don’t have to go down that path, you don’t have to go down that road anymore. There’s this other possibility. Hmm, okay, maybe I’ll try that path.’" This kind of awareness exercise isn’t some new fad in psychology. People have been benefiting from practices like the one we’re describing for hundreds and hundred of years. And as we’ve said, it doesn’t need to take a lifetime to see the benefits, either. Tom McConkie, Cofounder, All of Life: “I was really heartened by the fact that it didn't take a lifetime of training on the misty mountain tops of China to see this stuff. It was as simple as sitting in a chair and being willing to look at what was really going on. And I realized that aside from all the problems, aside from all the agitation—or maybe you could even say beneath all the problems and agitation, there was a sense that I was just aware. I was just aware of awareness. I was aware that I was aware. And there was something so calming about that to me—there was something so pristine about it—it was prior to any problem that I could ever experience. Even though I got pulled back into problems a thousand more times, a million more times, I knew that beneath that din, beneath that activity of problems coming up in my life, there was just something in awareness holding it.” The more we stop, the more we come to find ourselves with an ability to accept whatever we’re facing at the time--a deep okayness, regardless of circumstance. Tom McConkie, Mindfulness Teacher: [*We tend to identify with the mess; we tend to be absorbed by the mess—and everything that’s happening. And yet, for myself, the real discovery was I happened to be identifying with this, my awareness happened to be moving in that direction, but if I just stop for a moment, and redirect it I realize all these things going right.] “And I'm not suggesting here this kind of rosy view of reality, where we just ‘buck up’ and have an optimistic view. It’s not about optimism. It's about realism, it’s about really training awareness to look at All of Life--everything that's happening moment to moment, and you'll be surprised. Whereas you've been focusing on this mess, all the things going wrong. You'll actually see that outside of that wrongness, outside of that area arising as a problem, you'll realize all the things that are going right and you'll realize that represents that totality of your experience….When I think about positive thinking and this new age movement of manifestation, 'just think about what you want, see it in your mind’s eye and it will manifest'--I don't criticize that point of view, although I don't particularly identify with it. What I'm talking about is a kind of courage, and a kind of sincerity, where you look at your life and you're willing to just see what's there, and you realize in doing so that where you're really losing your energy, what was really causing your suffering, when you didn't realize it was causing you to suffer, was all the energy you were spending on avoiding, all the energy you were spending on resisting. When you stopped resisting, when you stopped avoiding, and you open your closet and look at that bogeyman. You realize, ‘Oh, the bogeyman was actually my avoiding the bogeyman.’ It was being terrified to look under the bed or in the closet, and you look at it and you realize you're equal to that task. You can look at it and it won't destroy you. And it’s the willingness to just hold your life, all of your life, in awareness that empowers you to take account, and start moving in a direction that feels right.” When we practice this kind of grounding in calm awareness, we also start to realize how much energy we were previously wasting on avoiding and resisting the things we don’t like. Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “Part of the human experience is experiencing the full range of human potential--both in what we would call the negative emotions, and what we would call the positive emotions. The struggle with it is what causes us suffering. It’s when we struggle with it, when we push away from it, when we can’t tolerate it. It's kind of like--I'm a surfer--so what they teach us when you first learn to surf is if you get sucked in by a rip-tide, that you have to relax into it. If you don't relax into it, you're going to drown. Because you can't struggle against it; it will take you under, and you will drown. So you relax into it, and you go with it--and it carries you; the riptide will carry you a mile down the shore and spit you out, and you will swim to a different shore. But you've made it. And it's a little like that with our suffering. Struggling with the suffering merely prolongs it.” As we learn to stop resisting so much, we may find ourselves having much more energy to meet the challenges of life more effectively. So what’s your situation like? What do you notice when you stop and observe what is going on inside? Part 3:As we’ve been exploring so far, this kind of gentle, nonreactive response can lead to new possibilities for our lives that arise precisely because we are not getting carried away by the pain, or in the pain.Elisha Goldstein, PhD, Clinical Psychologist: “... and he said, ‘Why don’t you look at this orange as if for the very first time ...to peel it as if this were the very first time you’ve ever noticed this orange…’ And I said ‘That’s ridiculous, why would I do that? I want this orange, I’m going to eat this orange’ and he said, ‘just humor me for a minute.’ This was a moment in my life where I was really struggling. I was very confused, I was worrying about my future, I had a lot of shame built up about my recent past in that time...And so I looked at this orange as if for the first time, and I saw all these dimples around the orange and I saw the color of the orange, and that’s not something I usually pay attention to. And as I opened the orange I notice this mist pop up from the orange, like effervescently, a mist pop up, and like a little kind of tickle ran up me. I thought, that was interesting, I don’t usually experience that. And so, as I was opening the orange I saw the membranes of the orange and...started to peel the orange apart…I started looking at it, holding it up to the light and I saw that it had some kind of translucence…and now this was kind of fun… And I put it on my tongue and I started tasting the orange as I bit into it. I ate it slightly slower than I normally would think to. And the flavor of the orange filled my mouth, so much so that it felt like I was experiencing an intense moment of joy.” As we have more and more of these moments, over time we cultivate what’s called mindful awareness. What does mindfulness look like? Appreciating a sunset. Drinking a glass of water. Brushing your teeth. Literally any moment of any day offers a chance to practice mindfulness or being present. Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “The thing about this mindfulness is that it’s not a skill. It’s not...a foreign thing that one has to learn. It’s really…The practice of learning mindfulness is a practice of reconnecting to something that we already know experientially, because we’re born with the ability to be mindful....I called home and my son at the time was two and a half, three years old, and I was just excited to talk to him ‘cause it had been a few days since I’d seen him and I said, ‘Hey, Ben, what are you doing?’ And he said, ‘Dad, I’m talkin’ to you on the phone.’ And it was that moment of, ‘Oh, yeah, he gets it. He’s doing it, he’s mindful, he’s right there with me, and I’m…what you were just doing, what you’re about to do, all this other stuff going on.’ And I think there’s something about that innate ability that we all have that kids are a little closer to because they haven’t lost it like some of us have gotten along a little further in age, we’ve gotten a little farther off track, a little more conditioned and stressed out and everything else, so there’s something that’s accessible about this to everyone.” While this approach makes good sense when we’re talking about positive experiences, like being more attentive to a delicious meal, or being more aware during a conversation with a good friend, we’re still left with a difficult question: How does it make sense to be more present and attentive of painful experiences? This can feel a bit counter-intuitive. After all, won’t that just make it hurt more?Jacob Hess, PhD, Cofounder, All of Life: "’Are you crazy? You're asking me to be more present to my emotional pain? You're asking me to sit with it and actually be here more? That makes good sense if you're talking about walking through the tulips, being more present to...the love of your family, etc. But how would it ever apply--it makes less sense how being present would matter for depression or for anxiety? It's distracting myself, it’s numbing out to it, and avoiding it that helps me survive it.’ I've heard that from a lot of people.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “There are a lot of options to escape. So why would you want to open to...pain?”...[*Why would anyone be crazy enough to want to feel their depression or anxiety?] In future classes at All of Life, we’ll have a lot more to say about this. For now, we would just suggest that this kind of awareness practice may help us begin to respond to distress in healthier ways.Vicki Overfelt, M.A., Mindfulness-based Stress Reduction Teacher: “If we can be with what is arising for us, and not add to it with judgment, or ‘Well, I used to do it this way, or I used to solve this that way, or I heard somebody else did it this way’--can we just rest with what is, feel it in the body. And then maybe some other little piece of information may arise about how I could approach that, or how I might reach out in order to help myself.” Elisha Goldstein, PhD, Clinical Psychologist: “I’ve worked with people who’ve had eating disorders, binge eating disorders, panic disorders, people who have lost people recently, who have had to deal with deep grief. What I teach people is to find moments throughout the day where you can connect to just your experience. So this is the idea--just stop--take a breath, take a few deep breaths. What that does is pop us out of the autopilot of the moment. Observe your experience. Observe your body. Observe how you’re feeling emotionally. All that is, is kind of naming it. It isn’t any big mystical enlightenment experience or anything like that. How am I feeling emotionally? Is my mind busy, scattered, or am I able to be present right now?” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “If we're truly present, we're not projecting into the future or ruminating about the past. We’re present for what is arising for us. So that practice, if you can imagine that, if you’re in the middle of a depressive, you’re feeling a depressive emotion, 'I'm depressed.' Our tendency to want to fix that, to not have it present, to not feel it, suddenly we’re tossing ourselves out into the future, or we’re ruminating about how we might have solved it in the past--and we are not focused on what is. The power of dealing with something as it is, and not trying to make it otherwise--this is really key. To me it’s such an important thing to really try to experience and have a taste of.” Tom McConkie, Cofounder, All of Life: “In our own way, we all avoid taking inventory and avoid looking at the mess that's in our house, that's in ourselves. And I was blown away--I don't know by what grace I was able to take a look at it--that bogeyman that I was afraid of looking at my whole life. But once I did, I was not only dismayed by how things were so messy, but equally by this profound sense of okayness that reassured me that I can hold both of those things. That it's not only okay to be messy, but that's part of our human condition. It's that okayness, that sense of profound peace we all have access to, that makes that mess okay.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: [*Our lives are so full. And the thing--the ray of hope that comes up for me is...we can feel, in this compassionate awareness…] “Awareness, I see as this vessel of loving kindness--in ourselves--that says, "I can have depressive thoughts, I can have anxious thoughts—I can have all kinds of emotions, physical sensations, but I'm much more than just that. I'm much more than just that.” Rather than only being able to tolerate certain emotions or states of mind, we begin to use all the experience that’s present in life, not just the stuff we like, but also the stuff we’d rather not have to deal with. And as we do that over time, we start to realize there’s almost no experience we can’t work with in a way that leaves us feeling stronger and more whole. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “What I know to be true is that when we can learn, even in small bites, to look at ourselves, to look at what is present for us, even if it’s troubling, even if it’s something we don’t like, and just take small little snippets of it, and relate to it and say, ‘Gosh, that’s me right now--can I just look at that? And then can I just let it go?’ This process of learning to relate to what comes up for us, it’s a practice, and it can be scary, but time after time I am reassured that there is nothing scary about it. It’s empowering, it does exactly the opposite.” Tom McConkie, Cofounder, All of Life: “It's always a tricky business talking about suffering, and talking about the way out of suffering, because we all suffer, and some of us quite a bit more profoundly than others. And when I think about the people who suffer the most—imagine people who are in so much physical pain, or mental/emotional pain, that they fantasize about ending their lives--that suffering is so real. I would say that in any moment, moment to moment, life is delivering us an opportunity to open up to what’s there. Regardless of the conditions, we can have courage, and honesty, and openness to just see what's happening. My experience is when we do that, when we really look at things openly and honestly, we realize that what we thought was more powerful than us, what we thought could completely swallow us or destroy us--we realize that just the act of courage to look at it, and be honest with the fact that this is here, this is what's upon me in my life in this moment. I found countless examples of friends, students, you name it—who had that moment of an encounter, even a confrontation with their suffering, who realize all of a sudden, that suffering that was driving them, driving their behavior, driving their thought process towards ‘I just want it to end’--they muster up that little droplet of courage, that courage to stop running and to turn around and to face. They realize that so much of that suffering, so much of that desire to make it all go away, let it all end right now, they realize that it was their very resistance, it was their very avoidance of what's present that was charging that situation so much. It's not to say that pain will go away. For reasons I can’t explain, some people deal with a lot more pain in this life. But we all have resistance. And if we can drop that resistance just a little bit, and be honest about the pain that’s present, I think we'll always be surprised at how equal we are to the task of meeting our pain.” So how does this sound to you? We’re interested to hear what you think. We’ve also got plenty more to talk about together. For now, let’s close this class with one summary statement from someone who knows the brain better than just about anybody: Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “I’d want to say to the people that are experiencing a lot of very serious difficulty in their lives--for people that are really struggling, that are feeling a sense of real hopelessness, that the storm is overpowering--that they just leave the door open a little bit for the possibility that there’s something you can do, something very simple, that can take just a few minutes of your day, that might actually allow you to feel better, to move toward feeling just a little bit better.” REVIEW: It’s possible to approach emotional pain in a more gentle way. As we fight less against our pain, we notice that we suffer less. By making room for whatever is coming up in our lives, a new sense of possibility and freedom can arise.So what is this mindfulness stuff anyway? Can someone give me a definition? If you’d like to learn more, in the final supplemental video we dive more directly into what exactly mindfulness is. SUPPLEMENTAL VIDEO: MINDFULNESSRandye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “We live in a world where we multi-task, we do things on what we call “automatic pilot” without full awareness of what we’re doing. If you’re driving, say, and daydreaming about what you’re going to have for dinner or a conversation you had with somebody, all kinds of things will go on around you that you’ll be completely unaware of. We can eat breakfast and watch t.v. at the same time and be totally oblivious to the taste of the food that we’re eating. So, mindfulness is the opposite of that. It’s a conscious, intentional choice to be present.”Jon Kabat-Zinn (2006) defines mindfulness as “paying attention, in the present moment, on purpose, non-judgmentally, as if your life depended on it.” A second, more compact definition attributed to the writer Jiddu Krishnamurti is “conscious affectionate awareness of the moment.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “The short definition, if you want to give it a definition, is moment-to-moment, non-judgmental awareness. The opposite--mindlessness--it's the to-do list where we run through our busy lives without really engaging in our lives. There’s this quality that's kind of absent. You get done with your day and think, 'Gosh, I did a lot of things, but how aware of all the things I did was I during my day?’ Mindfulness, to me, is this quality of attention I bring to my life--a quality that underlies every single thing I do. I take a shower, I notice the shower. I notice the temperature of the water...the smell of shampoo. The opposite of that experience would be hopping in the shower and planning the meeting you’re about to go to—so you don't feel the water, you don’t smell the shampoo, you don’t notice you might need to scrub your leg...all those details fall away; they go unnoticed.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “You can look at the carpet, the carpet in this room is a tan color. And you can say it’s a tan color carpet. Well, if you don’t really look very closely that’s true. If you actually get down there and look at the fibers, it’s made up of all of these multi-colored fibers. And, it’s all kinds of colors, from blue to grey to black to white, and together, when not really examined, they look tan. So we’re talking about bringing attention to the experiences of our lives with that same level of clarity, to see what’s actually there.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “Jon Kabat-Zinn says, ‘The little things, the ordinary things, they’re not little...practice, for example, mindfully taking the trash out...slicing a tomato, bringing your attention to what you’re doing in that moment. Have one dinner where everyone mindfully eats what’s on their plate. Smelling, tasting, experiencing the relationship between the movement of their body and the food. Mindfully brushing your teeth in the morning. Anything can be done with mindful attention. It’s a conscious choice to bring the mind and the body into the same place at the same time.’” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “There’s formal mindfulness or meditation practices, and there are informal ones. You happen on a beautiful sunset, and you pause--stop moving, which is so hard for us. Maybe just take a breath, feel the breath in the body and tune into the sunset. Notice if you start saying, 'oh, what a beautiful sunset--I remember last year...' Can you just be with that sunset--that moment? And then move on?” “To allow ourselves to be truly in touch with where we already are, no matter where that is, we have got to pause in our experience long enough to let the present moment sink in; long enough to actually feel the present moment, to see it in its fullness, to hold it in awareness and thereby come to know and understand it better.” --Jon Kabat-Zinn, 2005Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “All these details that have the potential to show us so much more of our lives, the fullness, the qualitative beauty of our lives. Much of that just is wasted on us because we’re so busy...thinking about what we need to do or didn't do. I can still get done everything I need to do. In a meeting--am I engaged with others...or am I thinking about what I need to do after I leave the meeting? How engaged am I in the moment?” [*And so when we begin to experience our lives in this way, we can ask ourselves, ‘What’s the quality difference when I just speed through vs. when I speed through, but I’m mindful.’ Maybe it’s not moment to moment—maybe we wander away. But through this practice, we can bring ourselves back to the present. When we go on a walk, are you focused on the air—or are you thinking about your oil change. We can still plan—but we don’t stand the danger of usurping the quality of our life with all the planning. Step into and open up to all the fullness of our lives. That’s what mindfulness is to me.]Megan Cowan, Mindful Schools: “Mindfulness is just bringing our awareness to whatever our experience is in a really simple, fundamental way. Just noticing how our feet feel on the ground, and how our body feels in the chair, and what it feels like to take a deep breath, let our shoulders relax. And how it feels when I’m looking at you, and how I respond to the things that you say, and how I respond internally, if there’s contraction, or if there’s ease or comfort. Mindfulness is noticing the emotions that come up, like anger or fear or frustration, or sadness or grief or happiness and excitement and calm and contentment. Noticing those things in a way where we are really embracing all of our experience and not being overly reactive to it, and from embracing it and just noticing it, actually we have a richer experience of it and more influence on what that emotion and what those thoughts and what those experiences are doing to us.” "Mindfulness is the aware, balanced acceptance?of the present experience. It isn't more complicated than that. It is opening to or receiving the present moment, pleasant or unpleasant, just as it is, without either clinging to it or rejecting it." --Sylvia BoorsteinSteven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “While it sounds a bit cliché, moments are all we have. This moment right here is the only one in which we can do anything, accomplish anything, plan anything, remember anything, is in this moment. But we often find ourselves off in other moments.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: [*We work with what we call choice points...moment by moment, we’re...making micro-choices, little tiny choices] “Choices can only occur in the present moment. The only time we ever have to make a choice is right now. And if our mind is wandering off into the past and into the future because we have limited attention, we may be missing a lot of the choices that are actually right there in the present, missing being able to see them.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “When we have the inner wisdom to know what to do and we can actually see the situation without predetermined ideas about how things are, without stereotypes, but in actuality of experience, we have options, possibilities, that we wouldn’t have seen if we were just on autopilot, we wouldn’t see that we have options because our brain just tells us, ‘Go this way, do this.’ And we do.” Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “So it’s always just coming back to any moment, you just kind of keep dropping in, and dropping in again. We’re building that mindfulness muscle of the brain, and it can be done whenever you have the realization that you’ve disappeared.”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Our minds are habituated to wander away, but through this practice we can bring ourselves back to the present. You go on a walk, are you noticing the sounds, the colors, the air? Or are you focused on the fact that you need to get your oil changed and as soon as you get home you make sure you get in the car and get that done. We can still plan—but we don’t stand the danger of usurping the quality of our life with that planning.”Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “The mind wanders off, that’s what the mind does. To wake up at the moment that you become aware that the thoughts have drifted off and choose to bring your attention back, gently, with kindness, like a puppy that you’re trying to train to heel--and it’s bouncy and exuberant. And if you are harsh with the puppy, the puppy doesn’t learn.”Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “You can always, always come back to the moment, however mindless you may have been, maybe for days. And it may be that the moment you come back to is way down the line, but when you come back, it’s like ‘Oh, here I am.’” “Are you able to come to a stop in your life, even for one moment? What would happen if you did? Take a few moments to [step out of] the rush of time: just watch this moment, without trying to change it at all. What is happening? What do you feel? What do you see? What do you hear?” --Jon Kabat-ZinnVicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We are doing, and we’re just reacting. We’re on this automatic pilot-kind of place. All day long, just boom boom boom boom boom. And it's really the exception, the radical act when someone steps out of that and says, ‘What's going on for me?' And when we answer that question for ourselves, how do we answer it? Do we answer it with, 'You're such a shlup….you shouldn't be having these feelings.' Maybe there's another little bird on that other shoulder saying, 'I hear you--it's okay, it’s good you're just checking in and feeling that. Is there some help you need? Do you need to call a friend? Do you need to see a doctor? Do you need to go on a run? Do you need some water? Do you need to eat something?’ It could be as simple as that, right? These little feelings of imbalance. How often do we check in? And when we do, how do we check in? Is there any self-compassion there, or it full of judgment?”Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “It’s a process, a life-long process, just being day to day, being here, your whole life is a whole practice, and how you learn to respond to the stuff that’s thrown at you. And so you’ve got opportunities to be mindful every moment of the day.”Good luck with your moments! If you’d like some help and support practicing this approach to experience, check out the mindfulness resources below this lesson. (end of lesson 9) ******Quotes that were NOT in Lesson 9 videos: Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “The solution to the finger puzzle is to actually do what’s completely paradoxical...just the opposite of what one would think. You have to actually move in to escape.”Jacob Hess, PhD, Cofounder, All of Life: “One of my friends recently told me that she and her husband were experimenting with a new way of approaching conflict in their marriage. Instead of avoiding hard topics and avoiding conflict, when they had a problem they were trying to approach the problem--to actually come together and focus more on it, in a compassionate and loving way. And as they've tried that, they've found that--it's been an intense process. It's a different kind of work. But it's freed them from some of the conflict that otherwise would have kind have been low-level, still there....so it's actually an exciting new idea--that like my friend, this couple--instead of avoiding and pushing conflict down, 'We're not going to talk about this'...let's take the conflict--in this case, the emotional pain or the mental anguish--and let's approach it, let's approach it in a compassionate way.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “In the process of healing, it's important to recognize the role we play. And listening--this role of mindfulness helps us tune into ourselves, physically, emotionally, cognitively--to understand what it is that is going on for us and where we might begin to seek help. It's an interesting thing that for some people, it's like 'I could listen to myself? And that that voice is valuable…This gift of mindfulness is this systematic way of tuning into the heart, body and mind and to know what's going on for us, so we can then bring that information outward and give it voice--then seek help that corresponds with our needs.” Laura Delano, Mental Health Peer Specialist: “I know for me--I have a different relationship with my emotions today--and rather than viewing certain emotions as things that are acceptable to feel, or things that are weak or bad or negative--I view every feeling as something to grow from and so, I see recovery as a healthy relationship to emotions that is based in embracing everything that I feel. And if I experience intense suffering, rather than trying to tamp down, and avoid or suppress it--I try to view it as a gift, because hands-down, the biggest growth spiritually, emotionally, have taken place after experiencing intense suffering.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “So another way to deal with the hurt is simply to learn how to be present with it. Learn how to experience it in the moment.” “Healing is a coming to terms with things as they are, rather than struggling to force them to be as they once were, or as we would like them to be, to feel secure or to have what we sometimes think of as our ‘own way.’” –Jon Kabat-Zinn, 2005, Coming to Our SensesSara Edmonds, PhD, Clinical Psychologist: “I now define recovery...as connecting with myself--in a way, holding myself compassionately. Even when I'm..thinking things or feeling things I don't like, or wishing would go away--to try to feel that it's okay--that I'm still okay.”“It takes a huge amount of fortitude and motivation to accept what is—especially when you don’t like it—and then work mindfully as best you possibly can with the circumstances you find yourself in, and with the resources at your disposal to be in wise relationship to what is, which may mean at some point acting to mitigate, heal, redirect, or change what can be changed.” –Jon Kabat-Zinn, 2005, Coming to Our Senses“Mindful awareness and learning to be with unpleasant feelings are not about striving for some ideal of happiness in the face of the difficult . . rather, it is as if we are bathing the difficult situation, and even our aversion to it, in an open, compassionate, and accepting awareness, just like a mother embracing a suffering child.” --Jon Kabat-ZinnRandye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “By shifting attention away from the past-oriented, depressive ruminative thoughts, or the future-oriented catastrophic , what-if-ing anxiety thoughts, it tends to bring the anxiety down and the mood up. We’re not feeding into those thoughts, we’re not building on it by repeating them over and over again.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “The thinking mind has this danger of having us focus on just that--and all this potential for beauty eludes us somehow. I'm much more than my anxiety. I'm much more than this depressive mood that feels like a black cloud. There’s so much more than me. And this power to come to the present moment to just accept what is, without feeding it and make it larger, it helps us give us access to everything else that is--beyond the illness, beyond the chronic pain, beyond the depression, right? Our perspective changes. Our awareness widens. And I feel it is compassion: ‘I’m suffering. I'm not feeling well,’ that's this, but there's so much more. It’s difficult to put into words. Is that clear enough?” Tom McConkie, Cofounder, All of Life: “...and just really rest in my fundamental okayness in this moment, without having to earn it, without having do anything beyond what's right here.” When can all this happen? While the recovery process takes time, this realization--like any realization--doesn't have to wait for months or years. "The only time you ever have in which to learn anything or see anything or feel anything, or express any feeling or emotion, or respond to an event, or grow, or heal, is this moment, because this is the only moment any of us ever gets….This is it."? –Jon Kabat-Zinn“This becomes the work and the adventure of a life-time, not being trapped in either our past or our ideas and to reclaim the only moment we ever have—and that is: this one. And taking care of this one can have a remarkable influence on the next moment—and so, on the future.” –Jon Kabat-ZinnRandye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: "Oh, I have a choice. If I get up and go socialize with friends, I’ll feel better. If I get up and get some physical activity, I’ll feel better. I can let the depression weigh me down so much that I get sunk into buying into the thoughts again, buying into the storyline, believing our own movie, or, I can keep reminding myself, ‘Oh, this is just a thought, I have a choice, I can get up and do something today that will eventually relieve my depression.’” “I am not speaking of some distant future in which, after years of striving, you would finally attain something, taste the timeless beauty of meditative awareness and all it offers, and ultimately lead a more effective and satisfying and peaceful life. I am speaking of accessing…this very moment--because it is always right under our noses, so to speak--and in so doing, to gain access to those dimensions of possibility that are presently hidden from us because we refuse to be present, because we are seduced, entrained, mesmerized, or frightened into the future and the past, carried along in the stream of events and the weather patterns of our own reactions and numbness, attending to, if not obsessing about what we often unthinkingly dub ‘urgent,’ while losing touch at the same time with what is actually important, supremely important.” --Jon Kabat-Zinn, 2005, Coming To Our Senses, p. 22“It is so easy to look without seeing, listen without hearing, eat without tasting…even to touch others without knowing the feelings we are transmitting and receiving. In fact, we refer to these ever-so-common instances of missing what is here to be sensed…whether involving our eyes, our ears, or our other senses, as being out of touch.” –Jon Kabat-Zinn, 2005, Coming to Our SensesMegan Cowan, Mindful Schools: “Our culture has lost all of the natural ways to encourage, stopping, integration, digestion, presence. We used to ride our bikes for hours after school or even if we live in a town there was a field somewhere, you know that you could go explore in. I think now a lot of kids, several things after school whether it’s tutoring, or sports or music and it’s kind of like one way after the other and that you could rush home and rush dinner, rush homework..and then ,you know, exhaust them into bed or over activated and can’t fall asleep.”“When you are taking a shower, check and see if you are in the shower. You may already be in a meeting at work. Maybe the whole meeting is in the shower with you.” –Jon Kabat-Zinn, 2005, Coming to Our Senses Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “To sit, yeah, to sit with one’s suffering, I think is a tall order for a lot of people…. a bit of an oxymoron. Why would you want to do that?”Megan Cowan, Mindful Schools: “Right, I mean in a way mindful is more critical now because the other more natural things that were in place maybe a generation ago or so to induce the same kind of understanding are those things aren’t in place. So mindfulness is giving us the capacity of self-awareness because the rest of the world and the way it is operating isn’t really informing us of that it is not giving us the instruction of self-awareness and it is not giving us the inclination toward stillness.”“Awareness may not diminish the enormity of our pain in all circumstances. It does provide a bigger basket for tenderly holding and intimately knowing our suffering in any and all circumstances, and that, it turns out, is transformative—and healing.” –Jon Kabat-Zinn, 2005, Coming to Our SensesAmishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “So if you can actually...start using it to build these muscles of your attentional control, eventually those muscles might be strong enough where you can start thinking how it’s going to be able to deal with this storm.”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I have a lot. I have a lot of faith that this works--there is a way beyond the X, Y, Z..the sense that things aren't right--points to a longing. It doesn't point to what's wrong in us. It points to what we want to discover in ourselves that we've just lost touch with. Our capacity. Our capacity to live a balanced life, but we're off kilter. It's not a permanent picture. There are ways to work with what is.” LESSON 10SURROUNDED WITH GENTLE ACCEPTANCE:More for Family and Friends The gentle approach we’re talking about can also be helpful for when we’re reaching out to someone around us -- family, friend, co-worker or even a stranger. “Oh! That gentleness! How far more potent is it than force!” --Charlotte Bronte, 1847, Jane EyreIn the previous class, we explored a more gentle and accepting approach to emotional and mental distress. While our tendency--anyone's tendency--is to try and make a problem go away, directly, aggressively, now...we’ve started to make a case for stopping and looking calmly at what's happening--not assuming all is lost and all is broken. Once we've been able to do this, we can then try to relate to whatever painful situation we find ourselves in, with a bit more wisdom, gentleness and kindness. It's not just individuals who can benefit from this approach. Surrounding family and friends can be just as anxious to make a problem go away as those who are suffering. After all, they are often suffering with the person. Jacob Hess, PhD, Cofounder, All of Life: “I see families getting so consumed and obsessed with doing something: ‘I've got to find some way to make this stop.’ They're almost in a fight or flight mode - where they're in battle mode.” Joanne Cacciatore, Ph.D., School of Social Work, Arizona State University: “We tend to be uncomfortable with people who cry. We tend to give people a limited time period in which to be sad, even when they’ve experienced the loss of a beloved. They’re allowed from this time to this time to be sad and then the sadness should end. And what we don’t allow people to do is feel what they feel for as long as they need to feel it in whatever way they need to feel it.”It’s especially easy to get impatient when a child is struggling.Stefanie Goldstein, PhD, Clinical Psychologist: “I think what happens when you have a situation in a family where a child is struggling with anxiety or depression is they become the identified patient. Everyone in the family focuses on them, and siblings feel slighted because their attention is going to this child, and the child not only is having all these difficult emotions and experiences but now they have all of this attention on them and everyone’s trying to fix them and they already don’t know what’s going on with them and feel bad that there is something going on with them and now everyone’s, ‘Okay, we have to fix you.’”Jacob Hess, PhD, Cofounder, All of Life: “One man I interviewed said that his mother was so consumed with finding an answer, she said ‘We've got to do something. We just have to find something.’ Now, that could be a heroic parent, or it could be someone making the problem worse.”“Any time it looked like something was going a little wrong with my daughter, I found myself holding my breath and expecting the worst. ‘What do we do? What do we do?’”- Mother of daughter facing serious mental disorderStefanie Goldstein, PhD, Clinical Psychologist: “I think often with parents who have children that are struggling with either a mood disorder--or maybe they haven't been to the doctor yet and they don’t know what’s going on--but this child is exhibiting some anxious behaviors like needing to check things, or nail biting, or having some school anxiety, or depression, where they’re wanting to avoid their friends or not wanting to go to school, or not being interested in activities they used to find pleasurable. Initially what I think can come up for parents is this huge weight of how do I fix my child? What do I do? And everyone you meet has a very strong opinion whether they’ve had their own experience or they have a neighbor who has or they read a book or they watched an Oprah episode - something in which they know the way to do it. And it can become profoundly overwhelming and in addition to that, parents are often feeling so much self blame of what did I do? Does this run in my family, is it my fault? Or is it because I didn’t do this? Or I was a working mom or, they’re not getting enough attention or we had a divorce and this is why. And so it can just feel like you’re drowning.”No matter how well-intentioned, then, this kind of panic, this kind of obsessing, this kind of advice and suggestions and “make it go away” pressure... can cause problems. These problems are as evident in relationships as they are in our own mind.Stefanie Goldstein, PhD, Clinical Psychologist: “Where I think the control gets out of control is where we have this clinginess, this attachment to how things, we think, need to be, ought to be, should be, and we sort of live in these invisible rules that we all have in our head-- ‘our child should be doing this, and by age two they should be reading and jumping and doing all these things and speaking perfectly,’ and when your child maybe isn’t quite, then this idea of, well, what do we need to do about it? We need to fix it, or we don’t need to fix it, or you are fixing it? You’re freaking out or you’re not fixing it? You’re not attending to your child. And all of these messages get so overwhelming and we really start to cling to this perfect idea of what it is to be a child and what it is to be a parent, rather than stopping for a moment...and pausing and checking in with who we are and who our children are, and what is true for our family and for this child and for myself.”Rick Hanson, PhD, Neuropsychologist: “Motivation is one of the absolutely fundamental factors of healing, of personal growth, everyday well-being. So how do we cultivate that in people? It doesn’t work to cultivate it top-down, outside-in through exhortations or finger-wagging, sort of guilt-tripping. It doesn’t work. They can’t just snap out of it. If they could snap out of it they would've snapped out of it. So we have to honor the force, the momentum, the inertia of the causes that drive a mental disorder or dysfunction much as we would respect the forces, the currents, the powers that drive a business problem or a raging river.” Willa J. Casstevens, PhD, Department of Social Work, North Carolina State University: “With my clients who hear voices, one of the real important things is to encourage them to talk about the voices without the fear that they're going to be, say, locked up. And in many instances, they've had that experience, so they're very concerned about that angle. When people are able to explore these experiences, often the anxiety and fear and depression that can be associated with those voices will decrease in a very significant way--and once that anxiety and depression decreases, even though the voices still may be there, the person is then freed up to go out and do the things they want to do. [*..to engage with life again....and the long-term upshot has actually often been to decrease or reduce voices, or in some cases, they do disappear.] Tom McConkie, Cofounder, All of Life: “In terms of family relationships, we all have families; we all come from some family, and like it or not, those relationships define us in really important ways. I would say to those families who are struggling to relate to one another, and perhaps there is someone who is quite ill or who is facing severe mental/emotional challenges. I would just suggest that there is a real power in reserving some time, day by day, for not doing anything. Not fixing anything. Not fixating on these problems coming up. We fall into these ruts so quickly, where 'This person is depressed, we need to make them not depressed.’ Maybe we'll blame them for being depressed because they were always the lazy one...It's so important to let that relationship breathe and give it space to be what it is. It could be depression, or an eating disorder, or could be schizophrenia; it could be very severe. But, can we reserve, or rather, can we defer the impulse to judge it, and to need it to be something else? Can we just make space for it, to allow it to be as it is. In my experience, when people came into my life and were able to just let me show up as I was, all of a sudden I was resisting my own experience less and less, I was more and more okay with that. And that gave my experience an opportunity to just have its voice, and have its life. Once you give something space, it’s a matter of time before it expands, expands, expands and then contracts, contracts, and then before you know it, it's a fond memory.” [*When you are backpacking in the wilderness,] “The first rule in any crisis is: ‘Don’t panic.’ The greatest danger is losing one’s head. Panic disorganizes thinking, and leads to self-defeating behavior. . . When we panic, we act hastily, make mistakes and get ourselves in even worse trouble. We can work our way out of the woods if we think carefully, talk calmly and work together…”--Mary Pipher (1996) The Shelter of Each Other (p. 252)Stefanie Goldstein, PhD, Clinical Psychologist: “You don’t always have to fix your kid’s experiences. Sometimes he just needs to be mad....it will pass. I think as parents...it’s this intense--we feel like it’s a need--but this intense desire to fix it, to change it, to make it stop, ‘cause it’s hard, it’s overwhelming. And yet, knowing from my own self, I need to experience my emotions sometimes. If I’m really angry, or really frustrated or really sad, I just need space to feel that. And at some point, giving myself that space will then allow it to not have as much power, and I see that for the same in my kids.” Rather than trying to simply make the problem go away, what if family and friends of those who are suffering tried the approach we just described: stopping, making some space, and just being there. If we all tried that, maybe we would discover what kind of healing is possible when we’re not forcing it. Rick Hanson, PhD, Neuropsychologist: “We can look at our child or our family member who’s also caught and carried away by something and realize that deep down inside that being is still someone who knows that this is not true; who longs for health and wellness. We never lose faith. We never give up on that being behind the eyes.”Toby Tyler Watson, PsyD Clinical Psychologist: “There's been some sort of injury to their humanity. The only thing that's going to restore that injury to their humanity--is more humanity: love, empathy, compassion, play, laughter, [*spirituality, the arts], the creative side of ourselves--all those things are curative to ourselves by themselves, and those are the things that we need to try to restore with people when there has been this injury, and kind of develop a new sense of identity with this new experience they've had--which is very scary.” [*And they should really be seen as quite resilient, rather than pathological.] Part 2: Some friends or family may worry that taking a more gentle approach might mean giving up their influence. As it turns out, many people find the opposite to be true: that a more gentle approach allows those who are suffering to heal in the only way they can--in their own way, at their own pace.Judith E. Pentz, MD, psychiatrist: “When a person is in crisis, one of the things to consider is to speak to them in a soothing, supportive manner. This can be very calming for them and calming for those around them who are concerned for the individual.”Catherine Penney, RN: “I remember saying, 'You know, I want to die--I just want to die.' I will never forget, he said--it was his voice, how he said it, ‘Cathy, why do you want to die? Why do you want to die?’ Like he really cared (emotional) that I wanted to die.” Daniel Dorman, MD: [I was told once by a patient why she got better.] “And she said, ‘What got me better was that you were authentic--which allowed me to become authentic.’ So underneath her struggles, that she cut herself, that she was in agony, there was another person under there, who could exist, actually, because we were in a room where I...existed in an authentic way--which allowed her the freedom to show that she could exist in an authentic way.” [*...that she could authentically struggle with who she was and why she had done to herself what she did.] Judith E. Pentz, MD, psychiatrist: “Many times the type of emotional problem or mental disturbance that’s present is an attempt to avoid the present. So, when you work with that person to help them be present with you, you’re working on allowing them to know they are safe so that they don’t seek these alternative states to escape the reality that’s around them.” A part of this kind of deeper acceptance and listening may be hearing someone enough to actually see and understand what their pain might mean to them. The story of Dr. Dorman’s work with Catherine is a good example of this. Daniel Dorman, MD: “Catherine's silence clearly had meanings--it meant that she was trying to shut herself down to avoid pain. Her hallucinations were not just symptoms, they voiced some sense of--they had meaning behind it. A search for meaning is absolutely necessary if we are going to find the person in there, and not just regard the person as a bundle of symptoms.” Catherine Penney, RN: “Here's someone who saw beyond the exterior of the symptom and saw the person underneath that was suffering, who just didn't look at it as, 'oh, that's not based in reality--that's not real.' We talked about it. [*...and we dealt with what was. Having someone be there and try to understand the meaning of what I was going through, made all the difference.] And what happened, as I started developing trust, I started hearing voices to kill Dr. Dorman….and I remember telling him, ‘Why am I hearing voices to kill you when you're trying to help me?’ Now he didn't say, ‘Oh dear, that is pathological...oh no, your symptoms are getting worse.’ No, he kind of expressed what he felt was behind the voices and hitting the heart of the feelings that were deep down in there...which, people do have feelings that hear voices and are delusional--believe it or not!” [*And so, that kind of started the process.] Deep listening and empathy require us to be okay with the fact that pain is present...and patient with things exactly as they are (at least for now). In turn, the person who is suffering may sense the acceptance that we’re offering, and suddenly see their situation in a new light. In this way, just your presence can help someone gain confidence in being with the pain, just as it is.Catherine Penney, RN: “I think the most important thing is not to get all worried and upset about seeing improvement right away. I know there is a tendency to want that, because you don't want to see your loved one suffer...But if you can only believe that there is a part of every human being that has that wellness in them, if you can just believe in that--even though the outside says the opposite. If you can just believe in that...that should help you get through.” [*...just to have this hope out there that it doesn't have to be this way--that it's not a dead end. There can be a way out.] Rick Hanson, PhD, Neuropsychologist: “When I’m faced with tough situations in my own family....I think about a traditional metaphor I once heard that if you want some fruit you can go to the nursery and you can get a little sapling, you can plant it in a good place, give it lots of fertilizer, you can then water it over time, pluck the bugs off, you can prune it and you can take really, really good care of it but you cannot make it give you an apple. In other words, all you can do is tend to the causes, but you cannot control the results. And it’s quite peaceful to appreciate that, you know? After that, we can step back, but paradoxically, that lack of persuasiveness, or pushiness or threatening...actually makes it easier for the other person to receive it, which we can recall ourselves when people have treated us in that kind of a respectful way.”Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “We treat suffering as if it's a pathological state. And the truth is, what we need to be doing is surrounding people in community...and creating a safety net for them. When we do that, at some point, when they are able to tolerate their dark emotions, then they can reach out to another person, and provide a safety net for that person. At some point, they take those emotional states of darkness, and they are able to transform those, and to integrate that grief into their life... and then reach out to another person [*so that, they're not immobilized, wallowing, forever]. That's the healing, that’s the magic right there--when we're able to take those painful states of our own suffering, and then we see the suffering of others and our hearts turn outward and our range of compassion for others just broadens and broadens and broadens--and we see the world in a totally different way.”Stefanie Goldstein, PhD, Clinical Psychologist: “Aikido has always been a really powerful metaphor for me, which is a spiritual form of martial art, and the way that it’s taught is rather than force meets force, it’s really, as force comes at you, you join with that forceful energy and begin to redirect it and transform it. And I think if we can really treat all of our relationships, and all of our life experiences that come at us with force--and having a child that has special needs, whether that’s developmental disabilities, or emotional needs or whatever it is--as a force that comes at us, really connecting with them and coming to that place of joining rather than coming at them and needing to fix them. We live in a world where we are constantly being met with forces that feel greater than us, that feel so strong that we want to fight against, they don’t feel good, we don’t want in our lives. And that’s our initial reaction. So, one example is, if your child is having school anxiety, say, and you’re feeling you have other kids you need to get to school, and you need to get to work, and so there’s all this anxiety, maybe the initial reaction is to just drag the kid and put him in the car and drive him to school--is to begin to slow that down and move with that energy of checking in with your child of, ‘what’s going on,’ and taking an extra 5 minutes, and maybe everybody’s a little late, and...there’s feelings about that, and yet, the relationship in that moment, just that 5 minutes of checking in, could possibly transform everyone’s day in a way that you’re not going to work frustrated and then you get into a fight with a colleague, and your children are going to school frustrated and they get in trouble by a teacher, and they don’t do well on a test, and it sort of set the tone for the day--but to slow down and move with that energy and really just investigate it and be curious about it together, it can naturally transform on its own.” Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “You know, being with suffering is a hard thing--being with our own suffering, and being with the suffering of others. And yet, if we don't learn to be with suffering, then we miss all the gifts that come from that suffering. And these are some pretty important things.” Can this kind of a stance really make a difference? Because this can be a major shift to make for any family, we’ll end this class session with two helpful illustrations. One family we interviewed had a daughter who got so sick that the state government was going to commit her for life to a long-term mental illness facility. The mother described what made the difference in her daughter becoming a productive member of society. “At the time, it was just terrifying…she was like a real crazy person. Her crazed eyes and unkempt appearance showed a mind out of control. I grieved the death of my daughter for quite a long time. She was just gone and there wasn’t much left. The professionals told us, ‘we’ve done everything we can do--she’s not going to fit into normal society’ -- and encouraged us to give up custody and send her to a long-term facility.” [They were ready to throw her aside; they felt they had done everything they could do.]“We refused. When we brought her home, that’s when the acceptance came. We had been through so many things trying to fix it, and so then we just accepted, ‘This is just the way she is going to be’ and brought her home. ”I’d like to say that we did [big] things, but we didn’t do that much. We would just talk with her gently. What we did was accept her--taking whatever information we could get and not probing with questions. [You don’t probe with questions—that sets her off. It gets to her, and upsets her easily. We take whatever information we can get. A lot of it is validation . . . I’ve adopted an attitude of ‘that’s just Megan’] Just letting her be, and making sure she knew she was loved. “It took a long time, it was very gradual, but things started to turn around. She’s doing light-years better, and has been holding a job for over a year. After being suicidal for three years straight, she’s had no reoccurrence of that. The state was ready to commit her to a long-term facility for life. She’s gone from that to being a pretty productive member of society. [She’s not the person she used to be.] Doctors said that her situation was one of the darkest they’d seen and they couldn’t believe she was doing better. They were totally shocked.” --Mother of a happy daughterThe power of complete, total acceptance could perhaps surprise each of us in our own families. As a final illustration, we conclude with an interview with popular author, Parker Palmer, where he describes how others responded to his bout with severe depression: I had folks coming to me who wanted to be helpful, and, sadly, many of them weren't. These were the people who would say, 'Gosh, Parker, why are you sitting in here being depressed? It's a beautiful day outside. Go, you know, feel the sunshine and smell the flowers.’ And that, of course, leaves a depressed person even more depressed because, while you know intellectually that it's sunny out and that the flowers are lovely and fragrant, you can't really feel any of that in your body, which is dead in a sensory way. And so you're left more depressed by this "good advice" to get out and enjoy the day. And then other people would come and say something along the lines of, 'Gosh, Parker, why are you depressed? You're such a good person. You've helped so many people, you've written'… Interviewer: “You're so successful.”Palmer: 'You're so successful, and you've written so well.' And that would leave me feeling more depressed because I would feel, 'I've just defrauded another person who, if they really knew what a schmuck I was, would cast me into the darkness where I already am.’There was this one friend who came to me, after asking permission to do so, every afternoon about four o'clock, sat me down in a chair in the living room, took off my shoes and socks and massaged my feet. He hardly ever said anything. He was a Quaker elder. And yet out of his intuitive sense, from time to time would say a very brief word like, “I can feel your struggle today,” or farther down the road, “I feel that you're a little stronger at this moment, and I'm glad for that.” But beyond that, he would say hardly anything. He would give no advice. He would simply report from time to time what he was sort of intuiting about my condition. Somehow he found the one place in my body, namely the soles of my feet, where I could experience some sort of connection to another human being. And the act of massaging just, you know, in a way that I really don't have words for, kept me connected with the human race. What he mainly did for me, of course, was to be willing to be present to me in my suffering. He just hung in with me in this very quiet, very simple, very tactile way. And I've never really been able to find the words to fully express my gratitude for that, but I know it made a huge difference. And it became for me a metaphor of the kind of community we need to extend to people who are suffering in this way, which is a community that is neither invasive of the mystery nor evasive of the suffering but is willing to hold people in a space, a sacred space of relationship, where somehow this person who is on the dark side of the moon can get a little confidence that they can come around to the other side (Tippett, 2009).Rubbing someone’s feet is only one of a thousand ways to support someone in a gentle way. Your own way as a family, or as friends will be different. But you can find it. (end of Part 2 video) REVIEW: With good intentions, sometimes we try to do something to make the pain of our loved ones go away. This can sometimes make things worse for our friends or family. By being gentle and accepting with someone--no matter where they are--we invite them to be gentle with themselves. *****QUOTES NOT IN THE LESSON 10 VIDEOS: Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “You can only be present with someone if you’re fully in your body…it’s just kind of doing that check in. Where am I?...So you can, as I say, really listen with your whole body, it’s not just with your ears. I don’t want to make that sound airy-fairy, but it’s the only way I can describe it, it’s a full-body listening.” Stefanie Goldstein, PhD, Clinical Psychologist: “Giving them the support of, ‘This is how you’re feeling and that’s okay, and let’s try and find a way to help support you so that you can get the skills so that you can feel better’...really connecting with them and coming to that place of joining, rather than coming at them and needing to fix them.” Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “If they are very depressed and are suicidal…being able to sit with your own fears about, ‘Oh my gosh, they’re…they could take their lives’…to really sit with it, and honor that part in them that’s very real, that…sense of hopelessness…To be able to recognize that, ‘Yeah, there is hopelessness there, and that’s what’s going on…right now.’" This kind of listening can do more than simply increase the power of a relationship. It can also help empower them in working with professionals. Stefanie Goldstein, PhD, Clinical Psychologist: “We listen to all of these messages and we live in a society where there’s an expert and we read these books by experts and they tell us what to do and how to do it and I certainly have read many of them so by no means am I saying they’re not helpful or informative but I think we defer our own internal wisdom and judgment for what the expert is saying and not really checking in with, does this fit for me? Does this fit for my child? Does this fit for my family? Because maybe it does and maybe it doesn’t. And I think we need more permission as, really as a community and as families to do that.” Stefanie Goldstein, PhD, Clinical Psychologist: “And I think again it goes back to checking in with yourself and if you have a partner or spouse checking in with them, and what is true for the two of you and what are your values and how do you see your child and what do you see that they need and obviously being a psychologist I’m a proponent of therapy and therapeutic interventions but for not every child. Maybe for them it’s really going horseback riding or it’s connecting to a creative outlet in which they have a way to express themselves. Maybe it’s a combination of both, just allowing there to be some space...and I think really it’s beginning to slow things down because we get so anxious and we want to help our kids and we want to do best and the quote of ‘The road to hell is paved with good intentions.’ And I think that often comes true in that parents are so well-intended and overwhelmed and so the most important thing is to really slow things down and creating space, not only for yourself, but for your child and for your family to be able to make a choice that fits for you and what feels best, and by also being educated in what your options are.”Pamela J. Birrell, PhD, Psychology Department, University of Oregon. “I worked with someone once who did a lot of delicate self-cutting around her eyes--and the previous therapist said, 'That's a bad thing--you need to go to the hospital.'...I said, 'Ow, it sounds like that hurts...I wonder why you're doing it?' And as we talked about it, we considered the reason she was cutting around her eyes was that she couldn't cry. And as soon as we came up with that, she never cut again--and began to see the cutting before that as a cry for help--a way to say something that was too awful for her to say.” LESSON 11 CAN A GENTLE APPROACH MAKE A DIFFERENCE FOR MENTAL AND EMOTIONAL PAIN? So what does this approach mean for mental and emotional pain? In the last two class sessions, we have discussed another, more gentle and patient approach to mental and emotional discomfort. Whether in relation to another person or to our own thoughts and feelings, the suggestion is to reconsider and perhaps question the need to aggressively get rid of our mental or emotional pain...instead, beginning to explore an approach that goes beyond resisting, fighting, controlling, forcing or running from this pain. What would it mean to approach this same pain--whether in ourselves or in a loved one--with more acceptance, compassion, and generosity? This brings us back to a really important question: What difference does this approach really make? It sounds nice and all…gentleness, compassion...But in the case of painful thoughts or emotions, how is that even relevant--let alone helpful? Does it have any real documented, concrete effects? Let’s start by hearing from the real experts--those who have faced painful emotional and mental problems in their own lives. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I was working at a great school in San Francisco [but knew I was coming to an end of my teaching--but knew I couldn't sustain that output and coming to some balance.] And I had gone to a retreat, a weekend retreat. The instruction and meditation is, as the mind wanders, you bring the mind gently back to the feeling of the breath in the body, it’s a very basic awareness of breath meditation, always working with the mind, the wandering mind....We were learning to relate to our thoughts differently…Then after that weekend...I had to drive home, and I have a little thing about heights and about bridges....when you travel to the Golden Gate Bridge there is a point where you can’t turn around...you’ve got to go over the bridge...I was experiencing panic attacks regularly, and the dissociative effect of that was very scary. This anticipatory thing set upon me,and I had this moment where everything stopped, and I just felt that emotion, felt the anxiety swell, and I just watched it as it passed away. It’s almost like I didn’t try--I had been training, training, training--and just as I was about to have what I was very used to--this feeling that an anxiety/panic attack is coming--the hyperventilation, the intensity, the sweating, the dissociative feeling like nothing fits together, and I'm going over a bridge—my gosh. It was all coming. And it came--but it was if I could just watch it and not be a part of it. I just watched it go. I had that peak of emotion--and it didn’t kill me! I could go through it. And the whole difference was I didn't have to get involved. I didn’t get on that wave and ride it. I let it come, and I let it go. I didn't add to it. I remember saying to myself, “THIS is what they're talking about! This is IT!”--and I GOT it. [My heart got it.] And I thought, 'this is the work...this is the work I have to do.' And that was a pivotal, a pivotal time for me.” [*Why was I surprised? We're habituated to think this is how it always has to be…here I was having that peak of emotion and it didn't kill me--I could go through it. I could not have that physical and emotional fall-out and it surprised me. But I think that's what I needed to feel to have the faith to feel if I worked on this path of learning to related to emotions and thoughts in a way that says, 'We can relate to everything'--there's nothing we can't experience...and here I was experiencing it. And it surprised me.]Tom McConkie, Cofounder, All of Life: “In my experience, it's been the willingness to just be really open and honest about what's coming up, and to allow them to come up--it doesn't mean to act on them, doesn’t mean to act the anger out, but just acknowledging that this is happening in our body. That is our experience here in this moment. There is such a power in welcoming that. If we can just let that activate, let it well up, get really big, and listen to what they are saying. We find over time that these emotions after welling up they just kind of dissipate. They die down. And before we know it, we're back to this calm.”When practiced consistently, this new stance toward pain, discomfort and darkness can lead to some surprising discoveries....especially this one: depending on how we approach painful emotions, they can actually come, then go, like the weather we mentioned earlier. [we can learn to help painful emotions actually pass--without all the usual suffering.] This deserves some more explanation. Tom McConkie, Cofounder, All of Life: “Emotions feel like really solid things. Some emotions, perhaps, have been with us for a long time and they tend to characterize our experience in life. We find that when we look really closely at them, they are changing all the time. What seemed really solid and opaque, it’s actually maybe misty, but in constant change. The awareness, the willingness to be present with an emotion, it actually softens it, gives it a kind of permission to activate and do whatever it wants to do--whether it's anger showing up in the body, whether it’s sadness showing up in the body. How often do we take a close look at the activity of emotion in the body and give it permission to just do what it’s doing? After all, our only other option is to deny it permission and push it down into the cellar where we keep all those unwanted emotions, only to manifest in our dream world, or in an inopportune time, and inappropriate place, with a certain person we wish we hadn't said that to. I mean, if we don't face these things, if we don't make room for them, do we really think it goes away?” “When we stop trying to force pleasant feelings, they are freer to emerge on their own. When we stop trying to resist unpleasant feelings, we may find that they can drift away by themselves.” --Williams and colleagues, The Mindful Way Through Depression, 2007, p. 109Tom McConkie, Cofounder, All of Life: “So I've just found this practice of letting emotional activity well up, and expand, and grow, and just show up in me in whatever way it wants to, to be so empowering. Because every time, if I'm willing to stick with it, if I’m willing to stick with the movement quality of the emotion, then eventually, at some point, like all things, it exhausts itself, it burns out, it uses up its life force. However you want to describe it. It was there one moment ago, getting bigger and bigger, and now it’s getting smaller. Now it's--where did it go? [*And I started to spot the crests and troughs, the depressive crests and the happy troughs.] And we can ride those waves. We can come into a relation with our emotions in a way that we're not making problems of the negative emotions, and we’re not clinging onto the positive emotions and wanting more—but we’re just vitalized, again and again continually by the emotional activity of the body. And that’s some satisfying emotional wave riding.” To review, then, this kind of gentle, self-compassionate awareness can have a significant, tangible impact on emotional pain. Some more examples may be helpful:Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “As the mom of two young kids...and a high-pressure academic job...it came to a point where I had lost feeling in my teeth from grinding....I could actually not give a lecture because I couldn’t actually feel my front teeth... to the point where I just wanted to quit all of it. I said, "I’ll just go do something else, I don’t care, because this is not working for me. And I’m not a happy person." So, before I just quit my job entirely, there were little whispers of the idea of neuroplasticity in my own mind, that you can actually change the brain--even if you don’t change anything about the circumstances of your life, there may be some way to change the way you think about your life. If that’s true, I’ve gotta give it a try. I’m a brain scientist, I spent my entire life studying the brain; if this is a central understanding my entire field has come to, before I abandon it altogether, let’s give it a shot. So, I promised myself that as the semester ended and I had summer break coming up, I would devote three months to giving it a shot. And if I didn’t feel any better, I would just, I would probably try to quit.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “Sure, there’s neuroplasticity, sure the brain’s capable of changing, but you’ve got to follow some kind of exercise or therapy or something. So at that point I decided to try meditation. And bought a little book called meditation for beginners with a CD in it and I thought, okay, this is easy enough, it’s a small book, I just read it and there are CD’s, and I follow it. I just committed to doing one of the exercises every day. And about a month and a half into this, I realized I did not have any numbing and tingling in my teeth any more, that I could speak, that I was showing up and noticing my child more, having better conversations with my husband, and I felt categorically different.”This kind of a gentle approach can also help in less dramatic ways...like when an old problem seems to be coming back: Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “So when you do notice something coming up--hmm, what is that? Going back to -- oh, actually that’s just butterflies in my tummy--that doesn’t necessarily mean I’m going to be depressed, it’s just butterflies in my tummy. So really being very clear about teasing this whole--if it’ depression--teasing it apart into little manageable components. So you do have that, ‘Oh yeah, grumbling in my stomach, chest...breathing…’ and the thoughts that go with it--obviously, often they all come simultaneously, so it’s very hard to tease it apart, but as long as you can keep tracking your experience there’s more chance of being less overwhelmed by it. So just being fully present with whatever is going on for you, just helps you to kind of keep pace with it, and realize that, again, it isn’t all that there is--it’s ‘Oh, and this too.’” Elisha Goldstein, PhD, Clinical Psychologist: “Now you’re saying, ‘Well, actually, let me look at this for a moment, let me look at this difficult emotion that’s here.’ Now it takes a lot of courage to go like this because our brain is telling us this is something we need to be scared of, and need to get away from. But let me look at this for a moment and investigate it, be curious about it, with a beginner’s mind, this idea of noticing this feeling as if for the first time, and watch it as it ripples and resonates throughout my body, notice the thoughts that come with it. What we start to understand is that there is a temporariness to this feeling that’s here.” Susan Kaiser Greenland, Author, The Mindful Child: “Just being confident in your own presence, and confident that if you hold the attention calmly, that things will naturally settle.” Elisha Goldstein, PhD, Clinical Psychologist: “In learning how to wrap that feeling in a sense of kindness and compassion, in a sense of just being aware, being curious about it, and noticing how it comes in peaks and goes away.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “It’s not so much that things pass, it’s...I want to be clear, I don’t mean things pass, that moments pass. We only live one moment at a time, and moments pass. And just because the experience in a particular moment, in this moment, is painful, it doesn’t mean it will be painful in the next moment.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “That takes real courage, and a certain degree of faith, at first, to be willing to do that. But there is this possibility that when you are able to stay with it, as opposed to doing habitually what you’ve done, which is to run away from it, or argue back from it, or try to control it in some way, and realizing that the trying to control is actually the problem, then this opening up happens.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “If we are willing to experience the moment however it is, we’re much more likely to experience the next moment skillfully, which is open-heartedly. If I have back pain, which I had this week, if the pain is a little bit less in the next moment than it is in this moment right now, and if I’m just clenched and trying to miss out on the pain, I miss out on the relief of the slightly waning intensity of the pain in the next moment, because I’m not paying any attention. So there is a relief in just letting it be.” As we discussed earlier in the class, just the hope, the possibility of something being different in the future--one day--that alone can be decisive in whether someone keeps trying. Nikki Preece, Clinical Director, Alpine Academy: “Another girl I was working with--she struggled significantly with anxiety and especially in OCD --- obsessive compulsive disorder--and she would have these intense obsessive thoughts, and her compulsion would be to self harm. [*And She did incredible self harm to herself in order to manage her anxiety. And when I began working with her, she had been in multiple hospitals, multiple treatment centers, multiple therapists. As I began to ask her about her history, she said I am OCD....I remember sitting with her and explaining neuroplasticity and this idea that the brain could change itself. And it was amazing to see as light would come to her eyes and I remember. And it gets me a little emotional and I remember the first time when she said, do you think that I could change like that, do you think that I can have those drastic changes.]“And as we began working together, what she found was this kind of resistance in the moment, of ‘How do I stay with this anxiety? I wanna pill to quickly fix it or I’m gonna have to hurt myself because it’s really intense.’ So we began a lot of mindful practices to stay present in one’s body, to feel the emotion but to allow it to go through us [*and we added some coping skills. We practiced moments when life is hard you just have to kinda endure and those kind of survival moments where we just get through and finding the good parts of life. She made incredible success and make lasting change.] She went over eight months without another incident with self harm and symptom free of the compulsions. She found that she would still have the obsessions, and they would still be there, but she learned to talk about them differently as mind clutter or mind chatter, as this bad storm that is going through, and if she would just calm herself, her mind would calm.” Chris McKenna, Executive Director, The Mind Body Awareness Project: “That chain reaction of reactivity, of impulse, of what it means to move from an uncomfortable reaction or emotion into some kind of destructive behavior, we actually believe that that’s where the education needs to happen--to get people to slow down, to use breathing, to use sensation, to redirect attention. These are very simple skills, but even after one or two weeks, we’ve had youth that…they will come back and report…’I was gonna swing on ’em, and then I just felt my feet on the ground. I felt a breath. My eyes kind of opened wider, I saw the lights, I saw the other youth, I took a short moment of awareness. I was still pissed, but I didn’t do it.’ [*...Any moment that they get, any moment of awareness that they’re able to take in the stream of what has often been a very traumatized life, just in that moment is the potential for enormous change and we’ve seen it so many times. Just given one moment of real insight into why they do something or, how they’re responding to a situation can really transform how they see the world.] Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: [*I don’t think we don't have to get to the bottom to learn...hard youth--sense of invincibility. I can do whatever I want. As an older person, 'that's not so true' I can see I don't have to reach the depths--maintain more of a middle way…] “As I am in-tune with my life I can catch myself much sooner. I don't have to experience these crazy highs and crazy lows. That's not what brings passion and intimacy into life--the crazy highs and crazy lows. Being present for everything--sort of a middle way, I have experienced a fullness in my life that I never thought possible. [*...that I would have never have achieved all the crazy things. The grace. Everything I went through so I could get here. Right now I definitely feel the most balanced and happy I've ever been in my life.]Chris McKenna, Executive Director, The Mind Body Awareness Project: “Any moment that they get, any moment of awareness that they are able to take in the stream of what has often been a very traumatized life, just in that moment is the potential for enormous change and we’ve seen it so many times. Just given one moment of real insight into why they do something, or, how they’re responding to a situation, can really transform how they see the world.” Tom McConkie, Cofounder, All of Life: “I started breathing, started sitting still, about 30 minutes a day. It was really hard--it felt like the hardest work I'd ever done, just sitting still and assess the damage. And see what was going on in my mind and my body. After about 6 months I noticed a really profound shift that I wasn’t expecting, I couldn’t have expected. It was this feeling of my breath dropping...down in my belly, and this kind of electrical current surging through my body, for perhaps all of adolescence, perhaps all of childhood, and I didn't really notice it was there, and I felt like the world was inherently an agitating place. It wasn't until my freshman year of college that I started sitting still, that I realized it was my body--it was me that was agitated. When I started to breathe and drop the breath, the kind of buzzing started to cool off. And I was starting to walk the earth as a new person--subtly, but significantly different from that person who started those exercises six months prior. I started to feel this really “chill” quality about my life that was totally foreign to me up to that point. [*I started sleeping through the night--started a positive chain of events that continues to this day.]Thoughts so far? How does this all feel to you so far? These are pretty new ideas to most people -- so take whatever time you need to let things sink in. Part 2:Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “I realized it was how I was paying attention to everything I was experiencing. That changed everything...it was such a profound understanding in my own mind that doing that was the reason I was feeling better. I was still engaged in research, I wasn’t teaching classes any more, but everything else was moving along. It was that I’d added this to my life. I was really curious about what actually changed. What was so different about, what was different about me in doing these exercises?” That’s a good question, Amishi. What exactly is it with this kind of gentle practice that can make such a difference? “Rather than seeing uncomfortable experiences as ‘bad and threatening’...we begin to see them for what they are: passing mental events -- bundles of bodily sensations, feelings and thoughts.” --Mark Williams and colleagues, The Mindful Way Through Depression, 2007, p. 150Elisha Goldstein, PhD, Clinical Psychologist: “I worked with one woman who ...used to go into a….walk by a café or a bakery, and she would get a cake and bring it home. She would do this multiple times a week, and she would eat the whole cake. And she did that out of a state of auto-pilot...of feeling stressed, feeling anticipation, feeling really uncomfortable, and the cake would solve that for her. This is actually the same with alcohol, any kind of addictive behavior of any kind. “We worked with her on bringing her in front of the bakery and seeing what was it like, what was this feeling that was there, that was so intolerable that she had to get away from it. And learning how to wrap that feeling in a sense of kindness and compassion and a sense of just being aware, being curious about it, and noticing how it comes, it peaks, and goes away. We could do the same with any kind of stress and pain that’s there in our life.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We can relate to everything. There’s nothing that we can’t feel, hear, hold--that we do have that capacity.” Chris McKenna, Executive Director, The Mind Body Awareness Project: “One [man] in particular, people had been giving him new concepts of how to behave, trying to change him from the outside with new ideas about what he should be doing. But there was still in him this unmet pain, this inability to be with his own suffering, and to work through it in his kind of own aloneness. So the idea of the practice of mindfulness, the fundamental idea of being able to witness and embody and be with all of these really strong impulses--it shifted things for him in a way that no other kind of intervention or modality had.” What the mindfulness view is saying, is that just the witnessing of the negative pattern, the idea of being rooted down in awareness and witnessing anger or some afflictive emotional state and not acting it out, but just saying ‘that’s what’s coming up right now, I’m not really in control of it, it’s been coming up for years,’ but that seeing, itself, effects significant change over time in how you relate to that negative emotional state. Because you really see that that emotion or behavior is not fundamentally who you really are, and over time does not have the ability to control your behavior. This doesn’t mean life is suddenly easy and perfect, of course. The messiness of life doesn’t go away after realizing these things. In fact, we may actually see it even more clearly than before. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Every moment, for me, is mixed with so much. Life is messy. It’s beautiful, and it’s messy. At the same time it’s bitter and it’s sweet, all mixed in together. So instead of us wanting it to be a certain way, can we be with our lives just as they are--messy.“ Tom McConkie, Cofounder, All of Life: “The fact of the matter is, take the healthiest, happiest human being, they are still going to have profound moments of anger, profound moments of jealousy, profound moments of sadness. And I think what makes the truly happy individual different than us, is all the guests are welcome. They have this relationship with the flow of emotional energy in the body. They recognize what's coming up, they’re mindful of what’s coming up—and they’re even joyful about that fact that there is emotional activity at all.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: [*The thing that occurs to me—my life from then till now hasn’t changed--I still have stress in my lives--we all have stress in our lives. But what I feel I have now is an intact way of relating to the stress that is present to me. Moment by moment.] “I know if I freak out or I feel distracted, or irritable, impatient--that I have a place to come where I can kind of step back. And I can relate to it from a place of non-reaction, I can say, ‘I feel the irritability, I feel the sadness--but I don't have to do anything about it. I'm just going to step back and notice, without judgment.” [*And I can always come back to my body, my breath, to the trees, the sun on my face, and start again.]While the messiness of life, then, doesn’t go away suddenly--or ever--what this does suggest is that this messiness--and anything that comes as a part of it--can be worked through. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Every day it’s like a constant check-point, a constant checking in, of where I can feel a surge of anxiety, or irritability, or whatever it might be, and I feel like I know what to do. I can back up, I can take a breath, I can view it in a much larger container, and I can relate with it. I’m not going to run from it, suppress it, I’m going to relate with it. I can deal with what comes up. And it is a moment to moment thing. If I freak out, I freak out. But I know I can start again. And every moment I can start over.”Research studies are confirming profound and long-lasting effects from this kind of an approach. There is even some evidence that a mindfulness approach decreases the likelihood of falling back into depression. We've included some of those studies in the resource section at the end. For now, we finish this lesson up by making a connection back to the beginning of the class. Namely, over time, this kind of awareness practice can help shift and change things in the brain.Rick Hanson, PhD, Neuropsychologist: “The primary way to change your brain for the better is through mindful attention to various things, because neuroplasticity is intensified for whatever we pay attention to. It’s the primary way to suck things into your brain for better or worse. Attention is like a combination spotlight and vacuum cleaner: it illuminates what it rests upon, and it sucks it into your brain.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “With this practice of mindfulness, what I’ve definitely felt is there is another muscle being formed--a muscle that is realizing, ‘Oh, there’s the trigger, I've always gone that way, but I'm going to do something differently, and instead of going down this reactive pattern, I will choose another response, something a little more skillful that won't get me in trouble, down the anxious path, down the depressive path. [*I mean, there are many paths that are damaging to us--even benign paths...but there are other options.] And they've shown scientifically that we can forge a new path.” [*…a neural pathway in the brain that is healthier. So that we create another habit…in the brain. And the research is compelling.]“Directed, willed mental activity can clearly and systematically alter brain function; the exertion of willful effort generates a physical force, has the power to change how the brain works and even its physical structure” (p. 18)[... a refocusing that will, in turn, sculpt anew the ever-changing brain.”] --Jeffrey Schwartz & Sharon Begley, 2002 Elisha Goldstein, PhD, Clinical Psychologist: “When we intentionally pay attention to something in this present moment, in a particular way over time…that changes the architecture of the brain in positive ways. That’s what science is finding right now. And that gives people a tremendous amount of hope.” [*That science is finding throughout the lifespan.] Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “A variety of activities are likely to change the brain....But it ends up that not all activities are the same. And if you look at studies on aging, and see what kinds of activities are actually allowing the brain to stay healthier, successfully, for longer, it’s those activities that require active engagement. So, if you’re, for example, learning a new language, but you’re just learning about the cultural aspects of what it means to learn a new language, you’re not actually learning the new language, for example, what cultures that speak Spanish are like. You’re not going to get as much of a benefit in brain changes as you would if you were instead, actually practicing it. Same thing go with things like photography, or knitting, versus taking a history class.”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “It's one thing to read it. But when the body feels it, then you think, 'I got it—I’m forging a new path. I’m forging a new kind of memory in my body.’ I did a lot of cross country skiing and if you've been the one to go out first, it's a little harder to get through the snow. Everyone behind you has an easier time because it’s a well-worn path. I always think about that as an analogy of what goes on in the brain. The well-worn path is easy to get on--but the new one is harder, and because it's harder, we’ll give up. And this is where the effort, and the practice, day after day, moment by moment, is really important.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: [*I realized it was how I was paying attention to everything I was experiencing....] “Something as simple as paying attention to your breath can lead to a whole cascade of positive things happening in one’s life.” [*Starting out with something as innocuous as paying attention to your breath, it takes the pressure off trying to combat the storm and just puts it into something very close that you know you’re doing. You know you’re breathing. You know you’re alive.]There you have it. From individual experience to the brain itself, the consequences of learning this other approach to painful emotions and thoughts are real. This is no snake oil. We’re talking about something with hard data and good evidence showing it works. In the next class we’ll consider what this approach means for something like thinking itself. REVIEW: A more gentle and accepting approach to our emotional pain can have some surprising results. For instance, we can begin to notice pain passing and changing on its own. As we practice being more gentle, we get better and better at working with whatever comes up in our lives--no matter what it is. Over time, this approach helps the brain change in positive directions. *****QUOTES NOT IN LESSON 11: Stefanie Goldstein, PhD, Clinical Psychologist: “I think the easiest way to slow down is the breath...Because you’re breathing right now, you have to breathe. You’re always breathing, and it’s something that you’re often not even aware of, and yet the more we can connect to our breath, even one long, slow, deep breath before you respond to your child, it can take 10 seconds, which I know we all have 10 seconds. We don’t have half an hour to meditate or, ya know, life is crazy, and trust me, as the parent of two small children and working psychologist, but 10 seconds we have. And if we can, the moment we begin to notice in our bodies that we feel activated or our voice rises or our posture rises and then we start to react to just take a moment, take that deep breath and move from that place, and everything changes.”“[The goal is to] stabilize and deepen our capacity for paying attention . . . to train the mind to be less scattered and more ‘present’ . . . so we are not perpetually at the mercy of the mind’s ingrained habits of reactivity” (p. 73). _________“Usually, we see what we want to see, not what is actually before our eyes. We look, but we may not apprehend or comprehend. We may have to tune our seeing, much as we would tune a musical instrument, to increase its accuracy, its sensitivity, its range. The intention would be to see things as they actually are, not as we would like them to be or fear them to be, or only what we are socially conditioned to see or feel.” –Jon Kabat-Zinn, 2005, Coming to Our Senses“As with any instrument, you have to actually calibrate [the mind] and stabilize the platform on which it sits so that you can get reliable readings. . . . If trying to look at the moon and put the telescope on a waterbed, every time you find the moon, every time you shifted your posture every little bit, you’d lose the moon in the telescope. It’s the same with the mind. Meditation is about learning the rudiments of stabilizing the mind enough so that it can actually do the work of paying attention and being aware of what’s actually going on beneath the surface of our own mind’s activities (which is often what thwarts us). “Bringing unpleasant feelings into awareness weakens their influence over our mind and enables us to respond to them in ways that do not evoke or perpetuate aversion and make spiraling into depression more likely . . . [In this way, we can ultimately] transform a cascade of reactions into a series of choice points.” --Williams and colleagues, The Mindful Way Through Depression, 2007, p. 121 “We already have the capacity to experience peace and happiness deep within ourselves. We do not have to earn enough points to deserve it or hunt for it someplace else. We simply have to learn how to skillfully get out of our own way.” --Williams and colleagues, The Mindful Way Through Depression, 2007Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Every moment is mixed with so much. In this moment, this is happening--but life is full…If we fixate on the pain, chances are pain is this large, burdensome theme. But if we can work to relate to this pain coming up, and to let it be as it is, maybe we can make this fixed thing, a little more flexible and we can begin to tease out things we can do to tease out things to make it less painful. Maybe within all of that, we notice the sunset; we notice our child's laughter.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I’m not a doctor, but I know we each come to our lives with certain propensities that predispose and other triggering...days or weeks or months trigger old anxiety. The difference now is episodes are less intense, they’re brief now. It’s almost as if they pop up as reminders. And I have—strangely…every once in a while as a teacher. I relate to my anxiety as a messenger--as a teacher If I feel anxious, I check in, ’What’s going on that’s triggering this?’ It could be something as simple as eating. Maybe it’s a conversation I should have had with my husband. Maybe we could sit down and resolve that. It's always coming around; it's always here...what's different is how I react to it. This has been a path of learning; a path with people who offer me help--friends, family, teachers. I don't think it's this linear, clear trajectory--within 30 days, you will be well. Unrealistic. Life is messy. Bitter and sweet, all mixed together. So instead of us wanting it to be a certain way, can we be with our lives just as they are? Messy. Not the model--okay, I'm me. Great. Let's start with that...and work from there.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “It’s not hard to do, it’s hard to remember to do, but with practice, we get better at it, like everything else.”Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “It's fascinating the more I read about it, the more I understand our capacity to develop underdeveloped areas in the brain--compassion, better decision making these are things we can work on through the practice of mindfulness and other health practices. It's very encouraging.” “The willful focusing of attention is not only a psychological intervention. It is also a biological one. Through changes in the way we focus attention, we have the capacity to make choices about what mental direction we will take; more than that, we also change, in scientifically demonstrable ways, the systematic functioning of neural circuitry” (Schwartz & Begley, 2002, pp. 368).SECTION III: WORKING WITH DIFFICULT THOUGHTS"I wish I could shut off these crazy thoughts!"PAYING ATTENTION TO THINKING:In many kinds of mental distress and disorder, thoughts play a central role. Thoughts can be troubling and dark, anxiety-filled and threatening…even destructive. Lots of attention, then, has gone towards how to remedy this kind of thinking—including explorations of different things to try to perhaps ‘make those thoughts go away.’ So how does the discussion we just had about different ways of responding to pain generally, apply to thoughts and thinking, specifically? Well, it turns out that most of us can be so engrossed and distracted by our thoughts, that we hardly know there's another way to approach them. And so we can be carried about and driven by whatever thoughts arise, moment by moment, without knowing there is any other option. Is there? Like in our discussions about the brain and responding to pain generally, there are actually major differences in how we can think about thinking. And you guessed it…in the two upcoming lessons, we’ll be exploring two different ways of approaching thoughts. LESSON 12 ONE WAY OF THINKING ABOUT THINKINGWe’ve been talking about two different approaches to mental and emotional distress generally. In the next two lessons, we’ll be focusing in on one particular aspect of distressing experience: painful, unusual thinking. For many people, unrelenting or troubling thoughts can come to feel almost torturous. When this happens, of course, our natural response is to simply try to make them go away or distract ourselves--as we discussed in Lesson 7. What would it mean to take a more gentle approach to these ‘crazy thoughts’ -- and begin to investigate them with more careful curiosity? What would we find? Part 1: Taking thoughts seriously and literally: “We are addicted to our thoughts.” --Santosh KalwarSusan Kaiser Greenland, Author, The Mindful Child: “Thinking. Well, let’s put it this way, thinking is not always your friend. And in the world that we’re in now, thinking is really prized. Thinking is king. But actually, thinking can get in your way sometimes.” So how do we usually think about thinking? Most commonly, we identify with thoughts and feelings automatically, even taking them to be a direct reflection of who we are, and our reality. Steve Alper, Mindfulness-based Stress Reduction Teacher: “It’s interesting how we usually think about thinking in Western culture. We usually take thinking for granted, and assume that thoughts have some direct correlation with some external reality.”…[*somehow anchored to an external reality.]Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: [*There’s a bumper sticker that says, don’t believe everything you think]....”We tend to believe the things that our mind issues up as actual facts.”Jacob Hess, PhD, Cofounder, All of Life: “It's common to believe that thought that comes is somehow a reflection of ourself, or of our reality. So a thought comes, a feeling comes--and that says something about me, you know: ‘You are what you think.’ [*Or ‘Our attitude determines our altitude.’...along the lines of ‘whatever you think is a reflection of who you are.’ We take that for granted.] “As a rule, we are very attached to our thoughts and feelings, whatever they are, and simply relate to their content unquestioningly, as if it were the truth.” –Jon Kabat-Zinn, 2005, Coming to Our SensesWhen we relate to thinking in this way, the consequences for something like depression couldn't be bigger. Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “When you’re actually in these negative storms that can last months and even years, it’s very hard to think that it’s possible to step outside of it. It is your world.”Steve Alper, Mindfulness-based Stress Reduction Teacher: “A woman I’ve worked with for a while, who is bright and accomplished, and extremely self-critical, and has had serious problems with depression. She is aware of this constant barrage of self-criticism and self-judgment which she used to believe without question. If she had a thought about how horrible she was, then she must be horrible.”“Before treatment, I just thought that whatever I thought was true.” --Depression survivor As we approach thoughts in this particular way, it becomes easy--frighteningly easy--to be swept away by whatever content is arising in the mind, especially when we're not paying attention. “The patterns of the mind that get us stuck in unhappiness and depression...get pulled up from memory and take control when we’re not fully awake and present. We’ve passed the reins over to the automatic pilot in the mind.” --Williams and colleagues, The Mindful Way Through Depression, 2007, p. 61When we “momentarily lose touch with ourselves,” one teacher observes, we can “fall into a robot-like way of seeing and thinking and doing.” It’s in these moments that we can find ourselves, in a sense, "taken hostage and carried away by the thought stream.” In times like these, our lives can be run almost entirely by our thinking, and we often don’t even realize it! “When we lose ourselves in thought...it can sweep our mind and carry it away, and in a very short time, we can be carried far indeed…We hop a train of association, not knowing that we have hopped on, and certainly not knowing the destination. Somewhere down the line, we may wake up and realize that we have been taken for a ride. And when we step down from the train, it may be in a very different mental environment from where we jumped aboard.” --Mark Williams et al.,m 2007, The Mindful Way through Depression; Jon Kabat-Zinn, 2006, Mindfulness for BeginnersThis process described above “can wind up...imprisoning us, causing great suffering.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “So if you look carefully at what it feels like for a depressed person...In many ways the systems of attention are being hijacked by certain kinds of mental content. So the thought just--no matter what you’re trying--the thought is what you’re paying attention to. No matter what else is happening in your life, the attention is latched onto that thought in this kind of focused attention way.”Tom McConkie, Cofounder, All of Life: “Thoughts in and of themselves are fine--they’re innocuous, they’re just thoughts. But when all you have is thoughts, when your whole experience is characterized by this unbroken stream of thoughts, they just start to beat in on you.”“My brain is constantly chattering away. Damn thing does not know when to take a break.” --Individual facing mental distress Chris McKenna, Executive Director, The Mind Body Awareness Project: “We kind of taking it for granted that people are thinking all the time, and kind of in this rodent-hamster wheel in their head, and it’s as if reality is just this constant stream of thinking that we’re identified with, and that we kind of contract around but we don’t really have any choice, and life is just kind of like that...”Ever felt like you had a hamster wheel in your head? “...and that noise externally is reflected in here--(points to head)--they’ve got a whole symphony of voices talking junk to them all day.” Anyone else ever had a whole symphony of junk playing in their head all day? Me too. Have you ever felt hijacked or controlled by uncomfortable thoughts? Feels pretty helpless sometimes, right? We’ll be talking about what to do about that next lesson. For now, we’re pointing to something more simple. As we approach thoughts as reality, it becomes easy--frighteningly easy--to be swept away by whatever thoughts come up. Like leaving a car on autopilot for too long, as long as we leave our mind on autopilot, we can set ourselves up for problems--veering in directions we don’t (really) want to go. In part 2 we’ll continue our exploration of this challenge in our heads. Part 2: Rumination & Over-thinkingIf we’re living inside our heads, that usually means we’re not aware that we’re living inside our heads. Instead, all we’re typically aware of is that life is hard, and we’re hurting. More often than not, that means we focus our attention on figuring out what’s causing the pain and how to make it stop. We tell ourselves that as long as we analyze hard enough, and long enough, eventually we’ll get to the bottom of things. Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “We tend to be able to solve our problems, many of our problems through thinking, and through problem-solving and thinking abstractly and all these sorts of things, and as humans, those are qualities we value; they’re what make us human.” [*We think that we can just study it because that’s how we’ve learned many other things.]Tom McConkie, Cofounder, All of Life: [*When things go wrong as human beings, we tend to think about them.] “We're endowed with this incredible capacity to form thought, and to plan complex operations and solve complex problems, so I think there’s something instinctive about us, when things are going wrong -- [*namely, in my case 'I feel depressed...oppressively sad--almost like I was suffocating'] -- my intuitive response was trying to think myself out of that hole.” And so we think and we think and we think, and there’s no end to the thinking. Often, over time, this can wear us down and become a huge source of suffering. This phenomenon is called “rumination” and it’s a serious contributor to depression, anxiety, and other mental illness. RUMINATION: “A compulsive, repetitive focusing on everything that is wrong in life.” Tom McConkie, Cofounder, All of Life: “I was given to thinking, and I thought I could kind of think my way out of my emotional problems. It wasn't until later that I realized how much anxiety the thought process itself was generating.”Dr. Seuss described this same habit in his classic psychological tome, “How the Grinch Stole Christmas:” “And the Grinch... stood puzzling and puzzling, how could it be so?....And he puzzled and puzzled 'till his puzzler was sore."?Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We are able to think our way out of a lot of our problems. But much of these things, I think, are deeper for us--emotional, psychological suffering--we often can't think our way out of.” Tom McConkie, Cofounder, All of Life: “The term rumination refers to this process by which we interpret, and reinterpret, and analyze, and reanalyze, and overanalyze--it’s the point at which the thought process, our ability to think, becomes pathological. In other words, it becomes the problem itself. Whatever the content was, whatever got us thinking in the first place, whatever problem we were responding to, that's...still there. But what's really problematic is the fact that we cannot see past our negative thoughts, and these negative thoughts are starting to call up emotion, trigger emotion in our body like battery acid, wearing through us. If we can't work with the thought process itself, if we can’t become aware of the fact that we’re ruminating, that we’re over-thinking our problems, then we're actually creating a bigger problem than the one that started this problem.” “The desperate attempts to talk our hearts and bodies out of feeling the way they do--all are mental gyrations that lead nowhere but farther down. Anyone who has tossed and turned night after sleepless night or been distracted from everything else in life by endless brooding knows well how fruitless these efforts are. Yet we also know how easy it is to get trapped in these habits of the mind.” --Mark Williams, 2007, The Mindful Way Through Depression Tom McConkie, Cofounder, All of Life: [*It comes back to making things go away.] “We don't realize that rumination--this process of thinking, thinking, thinking about our problems--it’s actually a form of resistance to the problem itself. We're afraid to engage with the actual problem, just open up to it and see what’s going on with it--so we put up this barrier, we build this wall of defense--and that thinking becomes a problem in and of itself. Whatever your primary problem was, that is now side-lined, and what’s taking up the majority of your moment to moment experience is a lot of thinking itself. We're primarily involved now in our thought process, and we’re not engaged with what was initially painful, what was initially causing the problem.” While thinking can help a situation, then, it can also sometimes make things worse. Over time, we can literally sculpt and shape our brains into a corresponding physical funk. Tom McConkie, Cofounder, All of Life: “As we think about the same thing over and over, we start to wear these grooves into our minds. The brain actually gets better at thinking a certain way because we do it so often.”Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “When we move into a place, say depressive rumination, the cycling, I call it a squirrel wheel, where the mind is just going over and over and over the same thing, it’s like...grooving a record. The needle is going deeper and deeper and deeper. And it sets up a habit, a conditioned response, so that if somebody says “A,” the person responds with that habituated, conditioned, automatic pilot kind of response.” [*Even if it’s not appropriate to whatever’s going on.]Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We have habitual ways of reacting to stress. If you think about all the ways you react, it’s habitual…and the more we do it, the more it becomes a deeper groove in the brain. So when something like anxiety, for example, is triggered, it's much easier to go down that well-worn, reactive path than to do something differently that wouldn’t necessarily be that maladaptive coping strategy, the path you’ve always walked down.” Any problem grooves or pathways in your own brain? When these brain habits control us, life can get especially painful... Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Sometimes with anxiety I would think, my brain, things feel scrambled, like I can't make sense of things because I’m just so worked up, so anxious.”When we get into this kind of brain funk [and mental pattern], something interesting happens. All of Life--the full extent of experience--becomes reduced to something else: Namely, just what we're thinking about. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We focus too narrowly on our approach--we focus just on 'how can I think my way out of this problem.' And in that process, a lot of times, we wake up old habitual cycles and then we start to project about, you know, what we can do about it in the future and we're completely out of the moment.” [*And just we've just reduced it to the cognitive process—just a thinking process. And we know that’s just a part of our conscious capacity, right?] Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “One of the qualities of mood disorders, anxiety and depression, are that attention becomes distorted. It’s one of the symptoms of the diagnosis, is impaired concentration or attention. And in depression, attention tends to be backward focused, it’s past-oriented...thinking all the things they should’ve done...a lot of guilt, self-blame, replaying of past experiences, and in anxiety it’s very future-oriented... what-if-ing, and catastrophizing: ‘What if this happens, what if that happens,’ and it creates a lot of anxiety in the present.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Our problem solving skill is significantly narrowed when we just look at it from a 'I've just got to think my way out of this. I’ve got to fix it.’ What we're leaving out of it is how our intuition, our hearts, our body can also inform us and help us to seek the kind of help we need. [*...so our potential for learning is much larger.] Even if you look at a mood, say, you’re walking along and you know how a mood comes over you and you feel up, your focus just narrows on that mood. Meanwhile, it's a lovely fall day and you don't see the colors, you don’t feel the air on your skin, you don’t even notice the birds, or your neighbor who tried to wave at you. But you were too caught up in your problem.”Wouldn’t it be nice to learn how to step away from that cycle, and even find some peace? The message of this lesson is that analyzing and over-analyzing may not be the best strategy to get there. The message of the next lesson is, simply...there's another way. REVIEW: When we get caught up in our thoughts, life becomes distorted. This can cause a lot of suffering. We can learn to relax, step back from thinking, and start to feel more content.QUOTES NOT IN LESSON 12 VIDEO: Isn’t it true that we’ve gotten so good at thinking that we don’t experience thoughts as thought anymore? Isn’t it true that we tend to experience our ideas, opinions and thoughts as facts, as the absolute reality of things? --Jon Kabat-Zinn Woman #6: “Once I felt depressed, I took it for granted that I was depressed. . . . that was my foregone conclusion.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “We all kind of live in our own movie worlds inside our heads...the star of our own movie. We’re not aware, we’re not awake when our thoughts carry us off.”“When depression starts to pull us down, we often react, for very understandable reasons, by trying to get rid of our feelings by suppressing them or by trying to think our way out of them. In the process we dredge up past regrets and conjure up future worries. In our heads, we try out this solution and that solution, and it doesn’t take long for us to start feeling bad for failing to come up with a way to alleviate the painful emotions we’re feeling. . . “ _____________ pp. 2“Trying to get rid of depression in the usual problem-solving way, trying to “fix what’s wrong” with us, just digs us in deeper. The 3:00 A.M. obsessing over the state of our lives . . . the self-criticism for our “weakness” when we feel ourselves slipping into sadness . . . the desperate attempts to talk our hearts and bodies out of feeling the way they do—all are mental gyrations that lead nowhere but farther down. Anyone who has tossed and turned night after sleepless night or been distracted from everything else in life by endless brooding knows well how fruitless these efforts are. Yet we also know how easy it is to get trapped in these habits of the mind.” --Mark Williams, 2007, The Mindful Way Through Depression LESSON 13 RE-THINKING THINKINGWelcome to our next lesson, where it’s time to introduce a second, very different way of relating to our thoughts. You might remember our earlier discussion about stepping back and starting to watch things in our life more carefully. This time, we’re talking about stepping back and watching what’s going on in our head. When we do this, we start to discover things about our thoughts we may not have noticed before. Elisha Goldstein, PhD, Clinical Psychologist: [*We’re having a difficult emotion and we notice our mind kind of spinning with “what if” scenarios, catastrophizing--all these terrible things are going to happen in the future and we realize, “God, that’s just my mind making up these stories”...that moment in time where we get in touch with a space of clarity... in that moment, you’ve stepped outside of it....]“The moment we can stop and pause and look at our thoughts, is the moment we realize we are not our thoughts, and that thoughts aren’t facts.” [*You’ve stepped into a space of awareness and in that space of awareness you have a choice. ‘Do I want to believe this story?’] “Thoughts are mental events that seem to come and go, like dissipating clouds in the sky.”Chris McKenna, Executive Director, The Mind Body Awareness Project: “It’s directing attention to some place deeper than thinking...the notion that you don’t have to believe and go along with every thought that you have. That it’s not somehow mandated that--involvement is not mandated. Who even knows where half the stuff in our brain comes from? When you’re a teenager it can feel…it can be so much pressure to conform to certain thought patterns, and that’s precisely why, at that point, you need to give people tools to question it, or else it becomes kind of like a torture chamber.” Tom McConkie, Cofounder, All of Life: “I think it’s really important to talk about the thought process, because as adults in Western culture we tend to be very thought-centric. For most adults, if they’re honest, they’ll admit that their central experience is related to the thought process. They can also have emotional experience, but for the most part, certainly my experience has been that the thought process tends to dominate.” Rather than reflecting the true reality of our lives and who we are, thoughts may therefore be seen as something quite different. Like weather patterns or clouds passing in the sky, for instance, thoughts or feelings can change, even moment-by-moment. Jacob Hess, PhD, Cofounder, All of Life: “Mindweather is the idea that our thoughts and feelings can sometimes hit us and be stormy, like the weather outside, some days can just be stormy, while other days can be easy, and sunny, and fair. We’ve all experienced the fluctuation between feelings, it just happens. And other days can just be torrential and really tough, and almost tsunami-like in their hitting us. I was at work one day...and I was just hit with memories and thoughts of past situations. I was...doing what I was supposed to do, and it just hit me.” Rick Hanson, PhD, Neuropsychologist: “Those coalitions of neurons that support the conscious experience of something, let’s say anxiety on the one hand, or depression, or joy or self-confidence on the other--that particular collection of synapses lasts no longer than a few seconds. It’s very fleeting. Coalitions form in a fraction of a second, they persist like eddies in a stream in the river swirling by. It’s a flotsam and jetsam that correspond to that particular thought or feeling or desire or memory or reaction and then, shhhhhwhwwwwoott, as little kids say, ‘all gone.’ It disperses. And then sometimes, it’s regenerated again if they’re persistent patterns, like a standing wave in a river, crossing over a boulder. Yes, there’s some stability in that pattern. And yet if we look closely at it, both psychologically and neurologically, it’s extremely dynamic. It’s transient; it’s fleeting; it’s impermanent, in other words.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “Everything is constantly changing, including thoughts and emotions. If you really understand that from inside-out because you’ve had that experience before, then it feels safe to let yourself be in pain because it’s like the weather in Kansas--just wait ten minutes and it will change. It’s the same thing with our emotions and our thoughts--just wait, it’ll be okay.” “Thoughts arise and pass away….without our effort, without our intention, just like waves on the ocean rise up for a moment, and then fall back into the ocean itself.” --Jon Kabat-Zinn, 2005, Coming To Our Senses, pp. 279-280Stepping back from thoughts doesn’t mean we ignore them. Sometimes you may decide to let a thought pass, or turn away from it. Other times, a thought may offer important teaching. The important thing from this vantage point, once again, is that it’s your choice to make. Jacob Hess, PhD, Cofounder, All of Life: “This is not to say that thoughts and feelings are just arbitrary and just kind of happen willy-nilly and they don’t mean anything, they don’t connect to anything. No. Certainly feelings and thoughts are often meaningfully connected to what we do, how we treat people, what we eat, whether we practice certain things that are meaningful to us like meditation or spiritual practices, etc. Feelings and thoughts can be meaningfully connected to many things. What this means is they are not necessarily connected to anything meaningful.” [*Let me give you an example. My friend who called me the other day and said..."I'm worthless; there's no good in my life." He's having thoughts of suicide. Are those thoughts something he needs to figure out where they're coming from--what they mean about his life?...when he is ready, he may need to understand these deep issues of well-being that he needs to resolve. But for the time-being, I think it's especially helpful to just say, ‘Matt, these are just thoughts.’ The thoughts telling you to jump in front of a bus? ...I've had the same thought once in awhile, during a really, really bad time. We all get hit with them.] Once we see thoughts as possibilities rather than facts, then we have space to relate to them differently. Some thoughts we can identify with and act on, while others we can just let pass.Tom McConkie, Cofounder, All of Life: “When you start to really scrutinize your thinking, when you really start to look at ‘what are the thoughts coming up in my brain day by day, and how do those lend to the beliefs I have, and the way I show up in the world?’ If you can just push back from that thought--and anybody can do this, they can become aware of this recurring thought--they can push back from that and they can decide how much they want that belief to define their life.” [*So whatever the diagnosis, whatever the predicament, in absolutely every case, we have the opportunity to at least be aware of the predicament we've interpreted--we can bring that to awareness, the way we've interpreted the problem and how we choose to act on it.] Steve Alper, Mindfulness-based Stress Reduction Teacher: “Back off, and watch the thoughts go by, like a river. It’s just so much more relaxing, and it gives you so much relief to do that.” Jacob Hess, PhD, Cofounder, All of Life: “It’s an idea that we don’t have to take literally any thought or feeling that comes. We can watch them, we can observe them, and we can sense--is there meaning in this for me? Is this something that is connected to my life?” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “If you could see that, that’s all that’s necessary. You don’t have to dispute it, you don’t have to change it, you don’t have to make it go away. You can just continue to watch it, and as you continue to watch it you can see it evolve and change and shift, and suddenly there’s movement, and a little movement leads to more movement, and the more movement becomes more space, more space becomes more ease. Over time, with consistent practice, you can begin to sort of shake loose that hardened thought that was really, in your mind, a fact. And this is that process of beginning to see thinking as something you don’t have to believe, you can just notice it happening.” Among other things, this introduces new options and new freedom in choosing how to relate to these thoughts and feelings. Amy Saltzman, MD: “So learning these skills of watching thoughts and feelings, and being able to choose our behavior is crucial. I think it’s not a choice, I think it’s multiple choices, and it’s multiple choices a minute, or a day. The choice is, first, am I going to choose to be consumed by my thinking, or observe my thinking? One of the things I tell my students is, you want to have your thinking or feeling, without your thinking or feeling having you.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “These are brain secretions--thoughts. If we can begin to notice that they are just that--they are something that the brain has offered up--that we can consider, that we can take or not take--that we can consider and investigate and then choose whether or not to believe them. Just to be able to know that you actually have a relationship with your brain is immense--what it issues up may seem very valuable and it may not be, but the point of the matter is not that your brain is right or wrong, but that it’s offering something up for your consideration and you get to choose. Then we have some options, we aren’t at the mercy of this brain that does what it does--sometimes with very logical reasons, and sometimes not.” Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “The way that I think about it is that the brain has a thought pump....it’s kind of pumping out these thoughts…And these thoughts can either pass by, or we might attach to them and actually grow the thought in some way, or elaborate on the thought in some way. And that's where I think our attention becomes critical. We might not have any control of the thought-pump pumping out these thoughts, but what we do after the thought exists in our awareness is within our control. Are we going to grow that thought...if it’s a negative thought or a depressing thought, are we going to give it a lot of attention and actually have the thought grow? Are we going to elaborate on that thought with rumination for hours? Or are we actually going to notice the thought happen and let it go on its way?”Tom McConkie, Cofounder, All of Life: “From the moment of that recognition, it was a lot of practice learning to just push back from the thought process, and really see them for what they were, rather than getting absorbed in the content of the thought, rather than assuming that the thought is important and that it has meaning, and that I need to interpret it, which, of course, only leads to more thinking. I would just learn to push back a little bit, and start to observe the flow of thought, the movement of thought.” Rick Hanson, PhD, Neuropsychologist: “We can either be swept away by this stream, identify with it, or caught up in the movie of it, as it were, believing it as real. Or, we can have a capacity to step back from it and have a sort of a bird’s eye view perspective.” [*... to dis-identify from our negative reactions to things.... to step back, disengage, not get so caught up in that stream of thought, not get so caught up in that looping, rumination, and see the whole picture.] These ideas can be fresh and exciting for some--and a bit unsettling and confusing for others. Take whatever time you need with them--there is no rush! If you’d like to ask questions about any of this, send us a note at coach@ Part 2:“We can cultivate a new and very different relationship to thoughts, allowing thoughts simply to be here instead of analyzing them, trying to work out where they came from, or trying to get rid of them in any way…” --Mark Williams,et al., 2007, The Mindful Way Through Depression While this approach can be a huge relief, it’s no simple change of perspective. It takes practice and effort, for sure. Tom McConkie, Cofounder, All of Life: “As far as this new relationship we can develop with the thought process, it seems challenging, maybe even impossible to some people, to become aware of the thought process. After all, we’re so identified with our thoughts, many of us have a deep belief that we are our thoughts, we are what we think. Think about Descarte and his declaration, “I think, therefore I am.” In our culture I think we believe that to a certain extent. It takes a little doing, takes a little practice, and it takes a willingness to experiment, but I find that any adult, or even reasonably mature child, can take up the practice of backing off from the thought process a little bit, rather than following every single thought and wondering what every thought means, and interpreting that thought, which leads to more thoughts, which are interpretations, and we all know where that road leads. If we just take a step back a little bit and just notice that there are thoughts there, that there is activity there, that it’s moving, that it’s flowing--we notice that we are not automatically caught into thought. We realize almost immediately that there is an awareness that can be aware of thinking. And we also notice just how calming it is to be aware of thought, as opposed to being thought. Being thought can be like being on a bucking bronco, right? And we’re getting tossed all over the place, and that’s all we are with the bronco, we’re this thinking mind. But it’s a lot nicer to be in the bullpen, behind those cages where the bull is bucking that poor cowboy around and say, ‘Wow, I’d hate to be that guy right now.’ And we can take that stance with the thinking process. And what’s amazing about it is, it doesn’t take much, just a simple willingness to watch your thoughts, and you certainly get better at it over time, practicing it, but there’s an incentive built into the process, it feels so good to be able to take a break, take a little vacation from thought. I find that a lot of adults, when I talk with them about this concept, they’re intrinsically motivated to do it because they know just how helpful it is for their mental health, their physical health, sometimes for their sanity.” Although challenging, this approach is totally doable for those willing to practice and learn. Amy Saltzman, MD: “So learning to observe your thoughts, without taking them personally, and without believing them, and without having to act on them, is a skill--and it’s a very learnable skill.” [*And that’s a very powerful thing because for most people, not just teenagers but all of us who have those thoughts in our heads, we think they’re true and we take them at face value and then we live our lives out of them. And it’s just a thought. And you’re much more than your thoughts.] Tom McConkie, Cofounder, All of Life: “If I look back on my own practice and process of relating to thought in a different way so I'm not a slave, but rather it's master, I think of this steady, gradual process of pushing back from thought...and then getting pulled back in, because we always get pulled into our thoughts, we always get pulled into the drama of our lives...the same way you go to a gym and you work dumbbells...I felt like I was training the muscles of awareness by pushing back and getting pulled back in. This force of gravity you can liken it to--we're so interested in our thoughts, we’re so interested in the content, we’re so convinced that the content is what’s important--we get pulled back--and we might wake up 5 seconds later, 5 minutes later, 5 years later, and realize 'That was just a thought, and I’ve been acting it out, assuming that was my life and it was the only way.’ You realize just how limiting thoughts can be in your perception of who you are and what your life can be.” As you can see, this new relationship to thought is very, very good news. Over time, as individuals practice, they can come to directly experience a new relationship with their own mind. And in this new relationship, rather than being permanent fixtures in our lives, challenging emotions and thoughts have the space to come and go, without all the drama. Chris McKenna, Executive Director, The Mind Body Awareness Project: “The broken records that have been playing in your head for however many years. You don’t even know where you got half of this information. And it’s just playing and running you, and surprisingly, there’s an option to actually take a rest from that for a second and to see what’s actually happening in your life and just around you right now without that stream of incessant thought. And most human beings, just by virtue of the fact that they want relief from that, when they are given the invitation to do that, even if they can’t do it for 45 minutes, even if they can’t hold it, they get a glimpse of that, and the honest response is, ‘That feels a lot better, that feels a lot clearer.’” This new relationship with our thoughts can almost immediately begin to change our experience of mental and emotional distress. Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “If you notice where your mind is, if you can pay attention to where your mind is, you might start to get a sense that there’s something separate from the thoughts that are arising, and that these negative things that are coming up are just kind of what the mind does, but you don’t have to take them so personally, in a sense...which kind of frees you up to think, ‘Okay, the negative thought is not me. It’s the thought, and it will pass.’"Rather than being the final truth, then, a thought can also just be a thought. And a feeling?… Well, that can also just be a feeling. Not reality. Not the world. Not you. [Instead, a thought...a feeling.] Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I can have depressive thoughts, I can have anxious thoughts, I can have all kinds of emotions, physical sensations--but I’m much more than just that. I’m much more than just that.” Adrienne Beattie, Mindfulness-based Stress Reduction Teacher: “You’re not your thoughts. You’re not those emotions. They’re certainly a huge influence on you, but that’s not who you really are. That’s the peace that offers the hope.” Amy Saltzman, MD: “When I work with teens a lot, they can learn that they can, by resting in a still, quiet place, they can observe those thoughts without believing them, without taking them personally, without having to act on them, and that’s a very powerful thing because for most people, not just teenagers, but all of us who have those thoughts in our heads, we think they are true, we take them at face value, and then we live our lives out of them--it’s just a thought, and you’re much more than your thoughts.” Jacob Hess, PhD, Cofounder, All of Life: “If you have a thought, if you have a feeling that hits you, it may just be a thought. It may just be a feeling. It may say nothing about you. It may have no significance or meaning for your reality. So for my friend who's being hit with thoughts that he's a total failure, not worth even living and not wanting to live--it could be really liberating if he could start to watch those as thoughts.”In other words, while the emotions and thoughts coming up may reflect on something useful, something productive, something healing--they may not. In fact, some thoughts or feelings may not tell us anything useful about our lives at all. That's up to us to decide. But it sure is nice to have a choice. Tom McConkie, Cofounder, All of Life: “I would just learn to push back a little bit and just observe the flow of thought, the movement of thought, and as I did so I realized there was an awareness deeper than the thought process itself. And that was probably one of the most shocking discoveries I ever made, to really connect with that first-hand--this experience of seeing my thought process as I observed it, becoming aware of awareness itself, and that gave me a lot of freedom. What was previously experienced as this kind of torture, being enslaved by the thought process, I was able to push back from that and just notice it as something a lot more innocuous, kind of like lying down on the bank of a river, just watching the stream float by.” Rick Hanson, PhD, Neuropsychologist: “It’s that fundamental capacity to be mindfully aware of what we’re experiencing... to observe it, to perceive it, to get off the movie as it were, of our upset, and our reactions to things and pop back twenty rows, you know, eating popcorn, looking at the screen going, Wow, what a bummer!’ you know, ‘how hard for that person.’ I don’t mean this sarcastically, I mean it in a very genuine way, a sympathetic way, but with some disengagement--that this is an experience that arises due to causes, it will pass away due to causes, and it’s not our identity....We don’t have to claim it or possess it.” Amy Saltzman, MD: “I think it’s a relief to know that you’re more than your thinking and feeling. It’s like I have this whole other capacity to watch my thoughts and feelings that’s really kind of untouched by these feelings. And it’s not overwhelmed by them, it doesn’t have to suppress them, it can simply watch them. And that’s a very empowering thing for somebody to learn.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “A woman I’ve worked with for a while--if she had a thought about how horrible she was, then she must be horrible. She’s aware of this constant barrage of self-criticism. One day, she suddenly realized that this was just thinking...and she started to laugh. In that moment, she dis-identified from that thought stream, from that narrative. It was no longer defining her. It was just, ‘Look at that. There’s an interesting thought stream, and I’m gonna sing it’..and she started singing these self-judgmental thoughts to the tune of 76 trombones. And it wasn’t, who I am, it was this thing--and she was free--in that moment, she was free.” Relating to thoughts in this way can be especially helpful for those facing serious mental distress. Chris McKenna, Executive Director, The Mind Body Awareness Project: “For people that have never been introduced to the idea that they are not the voice in their head and that they can actually take a break from that for a second, just by redirecting attention...particularly with people that are highly traumatized and have been suffering a lot, you do get some insights pretty quickly. It’s like, ‘Oh, wow! It’s almost like I feel better and I don’t know why.’" Susan Kaiser Greenland, Author, The Mindful Child: “It’s really the moment that we recognize that thoughts are just thoughts, and that they come, and they go, and they change, is incredibly liberating. That is really the key to psychological freedom.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: [*To be able to experience your thoughts as just thoughts can be very liberating.] “We’re no longer subject to the tyranny of our own minds. My favorite quote from one of the children, said ‘Mindfulness is not letting thoughts get in the way of living your life.’ Wisdom from a 12-year-old.” [*To let go of the attachment to believing that our thoughts are who we are is a freeing, opening, liberating kind of experience.] Rick Hanson, PhD, Neuropsychologist: “Probably 50% of mental health, really, boils down to one thing--the experience and the intellectual understanding and the felt recognition again and again and again that I have my problem, but I am not my problem. I think to paraphrase Maya Angela, she says, ‘I am certainly affected by the challenges I have faced in life but I refuse to be defined by them.’” Part 3: Stepping back from Thought: Examples Rather than attempting to solve every troubling thought or feeling that arises, in this way we can learn to step back and watch the storm pass. And that can go a long way in helping us get back into our groove. Susan Kaiser Greenland, Author, The Mindful Child: “The fact that these thoughts that we have--’He doesn’t like me”--may not be real, and that these thoughts that we have change--they come, they go, they change--is unbelievably liberating. It doesn’t mean you don’t have one of those thoughts and feel really rotten. That doesn’t necessarily go away all the time. But when you can catch it and say, ‘Ah, it’s just a thought; yeah, I really feel lousy right now, but it’s just a thought--hold on, it’s going to pass.’ When we can catch it--it’s freedom.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “If you could see a particularly depressing thought like, ‘I’m worthless’--if you could for a moment just see that arise in awareness as just a thought--then suddenly there’s just a little space around it. And if you see that there’s a little space, then there’s some wiggle room. And that wiggle room is hope, and options. And over time, with consistent practice, you can begin to shake loose that hardened thought that was really, in your mind, a fact.”And this raises an important question. This watching and allowing thoughts to pass sounds nice -- especially for normal, everyday experience. But what about when our thoughts are really going crazy? Elisha Goldstein, PhD, Clinical Psychologist: “I was working with one guy in a group. In that group, right in front of me, he was starting to have a panic attack. I asked him, ‘Can you take a few deep breaths?’ So he took a few deep breaths. He was popping out of this and listening to me for a moment. ‘Can you, for a moment, notice your body? Can you...notice how your body is sitting, notice where the feeling is in your body, and what emotion is there right now?’ ‘It’s anxiety, I feel a lot of anxiety.’ ‘Is your mind busy or is it calm right now?’ ‘It’s busy.’ As he started doing this, as he witnessed his experience, he started noticing that his anxiety actually started coming down.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “When you’re coming at, whatever it is you face in your life, from a stance of mindfulness, from being fully present, all of those things in your life appear different. They become just what they are--not what they tell you they are, or what your experience says they used to be. I was playing golf, by myself...it was about 100% humidity and 100 degrees, and I was by myself...I hit my ball into the woods and decided to go looking for it...I turned around and heard rustling in the bushes behind me, and I thought, ‘That’s an animal; what kind of animals do they have in Florida?’ All I could think of was alligators. So my heart starts to race, I’m already sweating, and I move towards the fairway, and it sounds like it’s coming towards me. And then I’m starting to picture everything--mountain lions, bears, whatever...it’s still coming towards me, my heart’s beating louder, I’m moving faster, and I finally get myself out onto the fairway...and I just had the presence of mind in a moment to turn and look--and a little bunny rabbit comes hopping out of the bushes. In that moment it was like, ‘Okay, so there was a beast behind me, and I took a moment to look and see what it was.’ And everything else was a story--everything else was a creation about the actuality of the experience. When you actually are willing to turn and look and encounter it, as it is, not as how your brain tells you it is, or how your experience suggests it ought to be, but just actually what is the actuality of that experience, you bring it down to what it actually is. And quite often that also creates some space around it that allows for movement, and shifts, and changes.” The more we practice stepping back from the content of the thinking mind and the emotions of the body, thoughts and feelings that seemed like big problems before become much less threatening--like a rainstorm in the desert--the sky darkens suddenly, the thunder claps, the rain falls, and soon enough, the sun is shining again. Elisha Goldstein, PhD, Clinical Psychologist: “If someone’s feeling really anxious, or stressed in that moment, what’s happening is they’re having a physical reaction in that moment. Their body’s starting to tense; their heart rate’s going up; they’re starting to breathe faster; they’re getting into this fight-or-flight response…if they kinda continue…if they allow that to continue they might continue to catastrophize, thinking that something terrible is going to happen in the future which then signals down to their body about having to fight or flight some more. Anxiety rises, that freaks out their mind, their mind starts racing even more and the cycle ensues. If they say, ‘Well, hold on a minute. I’m gonna…this is a physical reaction I’m having right now, based on interpretation of some kind...that my mind kind of created... thoughts aren’t facts, thoughts are just interpretations that happen, so I’m going to take some space from this…I’m gonna give this body 30 minutes,’ so they’re kind of stepping out of it for a minute. ‘I’m gonna give this body 30 minutes to see if it kind of cools down. I’m not going to entertain these thoughts anymore.’ What happens? Well, they’ve taken a key piece out of this stress-cycle reaction...and the anxiety starts to cool down. It’s very interesting.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “As soon as there’s that little bit of room, then there’s hope. It doesn’t have to be much, and it might close right back up again because it’s new, it’s foreign, it’s uncomfortable, it’s awkward--you start to think about what it means, and that’s where you get back into thinking, and facts...so the opportunity is to practice and look for the little shifts.” Elisha Goldstein, PhD, Clinical Psychologist: “It might be the moment that we’re having a difficult emotion and we notice our mind spinning with ‘what if’ scenarios, catastrophizing, all these terrible things are going to happen in the future, and then we realize ‘That’s just my mind making up these stories.’ You’ve stepped into this space of awareness, and in that space of awareness you have a choice--’Do I want to believe this story that’s happening right now?’” Chris McKenna, Executive Director, The Mind Body Awareness Project: “And what I would suggest to people is that, you can take those gaps, you can begin to focus on those gaps, just for a second, I’m not talking about a marathon of attention here. You feel your breath, just give yourself to that experience for a second, just for a moment, really let yourself relax, and focus, and ground, and see the truth of your primary experience, outside of all of these stories that you’re telling yourself about life--just see what it feels like in that moment to be human, without the story.”Elisha Goldstein, PhD, Clinical Psychologist: “Go ahead and try this out for yourself....The next time you’re feeling anxious, see if you can locate where it is in your body and suspend belief about your thoughts. See if you can say to yourself, ‘That’s just a thought. I’m going to pay attention to my body, so I’m going to stop entertaining my thoughts. Thoughts aren’t facts. I’m going to pay attention to my body right now…feel what’s here and see if this passes. If my body cools down in the next 30 minutes, great. If it’s still activated in the next 30 minutes then I’m going to continue worrying. Then I’ll go entertain my thoughts again. But for now, I’m just going to pay attention to my body, take a few deep breaths, and see if this passes.’ And it’s very interesting; most, if not all the time, it actually passes.” This kind of a steady, calm thought-watching stands in sharp contrast to how we usually try to fight back against certain thoughts. Elisha Goldstein, PhD, Clinical Psychologist: “We don’t want to force ourselves to think differently. Some people believe in that approach. And, for me, I believe more in kind of taking a step back from our thoughts. And seeing them for what they are – these kind of mental events that seem to pop in and out of our minds and are influenced by our moods, or influenced by our histories.”Chris McKenna, Executive Director, The Mind Body Awareness Project: “We pretend like everyone’s in control of their negativity and can change it on a dime, but most people who investigate their lives find this not to be true. Most people [who] begin to practice mindfulness find these patterns just keep coming up, and it’s like they’re not really doing it. It’s the past, it’s what happened to them, it’s what their life has collectively taught them, and it has this unbelievable momentum to it.” The mind seems to have a mind of its own…Elisha Goldstein, PhD, Clinical Psychologist: “The moment we’re perceiving anything in the present moment, our brain reaches back into those experiences to see and to make sense of what’s happening here and spits out perceptions, spits out an instant snap judgment that comes out about any particular experience: ‘This is bad, this is good, this is right, this is wrong. She’s being mean to me. I’m a victim.’ Whatever it is.” [*...we have to understand that thoughts are mental events that seem to come and go like dissipating clouds in the sky....we don’t need to believe everything we think.]Amishi Jha, PhD, cognitive neuroscientist, University of Miami: “You realize how much our mind is constantly wanting to hold onto things. Whether it’s a sensation like, ‘Oh, I feel a little tightness in my back,’ or it’s a thought, ‘I can’t wait till I’m done with this so I can go do, whatever it is.’ Or a negative thought, or a negative feeling. And, the practice is to actually never fully grasp onto that. Instead, to notice that it’s occurred and to, like a cloud passing in this vast open sky, just, let it go.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “There’s all kinds of options and alternatives of dealing with any particular thing when we can see things as they are rather than how our brain tells us they are. Your brain will tell you, ‘Well, this happened to me before so it’s going to happen to me again’....But thoughts aren’t facts. It’s as simple as that. We forget that constantly, and we tend to sort of operate on whatever it is our brain serves up for us, we just swallow it whole. And a lot of times that works very nicely because we don’t want to have to think about, how do I order a sandwich in the restaurant. You have a script for that. Your brain will just kind of take care of that so that you don’t have to think...So, it serves us well, but then sometimes when it serves up stuff that isn’t true--that’s just speculation, or it’s just based upon other experiences you’ve had, but isn’t actual fact and you swallow that whole, then you tend to live in that map. We’re talking about actually finding out directly from our experience, not letting our brain rule our experience. Let it inform our experience, but actually let our experience be the experience.” Since we’re not used to approaching thoughts in this way, there are little things we can do that can help steady us enough to do it. Chris McKenna, Executive Director, The Mind Body Awareness Project: “The reason in most mindfulness practices they put such a kind of premium on breathing or feeling something or paying attention to the senses is that it’s really trying to bring attention into our sensate experience, and out of the thinking stream for a second.”Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “I think by starting out with something as innocuous as paying attention to your breath, it takes the pressure off of trying to combat the storm, and just puts it into something very close that you know you’re doing--you know you’re breathing, you know you’re alive--so if you can actually just focus on something that is out of the realm of what you’re tackling, and start using it to build these muscles of your attentional control, eventually those muscles might be strong enough where you can start thinking about how it’s going to be able to deal with this storm.” Amy Saltzman, MD: [*Learning to observe your thoughts without taking them personally, and without believing them, and without having to act on them is a skill, and is a very learnable skill.] “So you can have people rest in a still, quiet place, rest their attention on the breath, and then simply begin to observe their thoughts.” Steve Alper, Mindfulness-based Stress Reduction Teacher: “There are many ways to step out of the thought stream. The more one understands and really appreciates deep down inside that this is only…this is a construction of our minds. This is just a product of our minds, these thoughts, then, you simply respond in the moment and you can make use of almost anything to help people to take a step back.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: [*There’s a lot of imagery about describing what goes on in the head.] “Thoughts are wild monkeys swinging from tree to tree. Just all over the place. They can be like leaves falling off a tree. Just floating around all over the place. They can be like a ping pong ball bouncing around or a pinball machine. They can be like a puppy that you’re trying to train to heel.” Amy Saltzman, MD: “Sometimes I talk about watching a thought parade, so you imagine yourself anchored in the breath, standing on a sidewalk, and you watch your thoughts walk by….you watch them come and go without marching with them, and when you notice that you’re marching with them, which sometimes happens, then you come back to the breath and you stand on the sidewalk and you watch them come and go. And that’s the thing that someone can practice.” Jacob Hess, PhD, Cofounder, All of Life: “The next time you get hit with a feeling of terror and darkness, the next time you get hit with a thought that's tormenting you--watch it. Experiment with just watching it, and observing it--even if it's just for 10 minutes that you practice watching your thoughts and observing them--rather than being your thoughts. That alone will make a big difference--like practicing the piano 10 minutes a day. Just try it for 10 minutes. If you can't do it for 10 minutes, try it for 1 minute. If you can't do this for 1 minute--even 1 moment of stepping off the treadmill in your mind and watching it--watching the thoughts come, watching the feelings. Even one moment breaks and short-circuits that pathway in the brain that's getting ground and ground and ground. It short-circuits it and starts to forge another pathway in your brain.” Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “So we blaze a little new path for how we contend with this thought that says ‘I’m no good, or I won’t amount to anything.’ We find a different way to work with it and then as we continue down that same pathway, we would begin to wear it down, so to speak, in the sort of literal sense on earth, and in the neural sense in our brain.” This kind of practice can do more than alter emotional and mental patterns alone. Amishi Jha, PhD, Cognitive Neuroscientist, University of Miami: “If you do a particular activity for some period of time, over and over again, the parts of the brain that are needed for that activity are going to get stronger, okay, are going to get healthier. In the same way that if I were a bodybuilder, right? And I’m going to work out my upper body, my upper body’s going to be much stronger but my legs might not change at all. So it’s the activity that we engage in that changes those targeted areas. Same thing for the brain.” [Quote repeated from earlier]Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “As you continue to do this, as you continue to be present, pathways in the brain open up, and movement happens and possibilities become realities. There is some flexibility and some ability to cultivate new pathways, to come out of well-worn grooves over time if we continue to practice.” Rick Hanson, PhD, Neuropsychologist: “The general public doesn’t really appreciate the ways in which mental activity alone--what we think, what we feel, how we guide attention, what we rest it upon, and then what we do with what we’re paying attention to--they don’t appreciate the ways in which that literally sculpts neural structure. The breaking news is not that neuroplasticity occurs, in other words, the plastic capacity of the brain to change itself, but rather how, and how extensively a mental activity is changing neural structure. It’s an interesting thing where the science is actually probably 10 to 20 years ahead of the culture itself in terms of realizing the real possibilities here of gradually changing your brain for the better. The sky’s the limit, really, in terms of the current research on how mental activity can change the brain.” In summary, we’re not doomed to our dark, negative and destructive thoughts. There is life beyond. Although it can be challenging to apply and practice, the benefits for learning this skill are well worth it. For those interested in exploring and practicing this approach, there are many resources available. We've listed some of our favorites here at the end. As you explore this for yourself, have some fun, and good luck!! REVIEW: The mind offers up thoughts for us to consider. We can practice choosing which thoughts we want to “grow” and attend to. As we get better at this, we feel happier and freer. ***QUOTES NOT FOUND IN THE AUDIOS FOR LESSON 13: In the previous class session, we discussed one especially common way of thinking about thinking—namely, seeing thoughts as a direct reflection of our reality and who we really are. We also considered some potential consequences of this way of thinking, including an increased tendency of being swept away by whatever thoughts arise. And when that happens, of course, we are also more likely to over-think and ruminate to get to the bottom of everything. If all that thinking left us in a wonderful place, of course, we wouldn't have anything to talk about. But most everyone already knows, too much thinking can often leave us more confused than when we started--and even feeling worse. So is there another option? Apart from checking out or distracting ourselves in one of a million ways, is there something else we can do? Is there a way to not be so bullied, so driven and so consumed by our thoughts? Jacob Hess, PhD, Cofounder, All of Life: “You could think of it as 'thought-spam.'...Our e-mail boxes get spammed all the time, right?...Our minds sometimes just get spammed. Do we have to figure out where every spam e-mail came from, and why they got sent, and what are the motives of these people sending them? And why am I so vulnerable to these messages, and what does it mean that I'm getting all these messages in my in-box? No! Heavens no. Just build a better filter! Make sure--figure out a way so they don't keep spamming you. Protect yourself. But don't take them--don't read too much into the spam. That's the message here.”Jacob Hess, PhD, Cofounder, All of Life: “We are not our thoughts. We don't have to be our thoughts. We don't have to identify with our thoughts. When you get spammed with messages about yourself or about a family member that are cruel and harsh or degrading and hopeless--it can be liberating to just say: ‘Well, phh, got through my filter.’ And you know--’How do I need to take care of myself now so I'm not as vulnerable?’”Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “Seeing your thoughts as just thoughts--of being able to recognize, ‘Oh yeah, this is just the radio or movie in my mind that’s playing away without my conscious intention to direct it in any way shape or form. And it may or may not have any relationship to what’s actually going on around me at the time’...To be able to step aside from our own thoughts. Not to push them away...accept that they’re there, to stop judging them, to recognize, ‘Oh yeah, this is just a thought...it’s just a thought.’"“When we don't even know thoughts as thoughts, when there is no awareness of the stream of thought itself and the individual bubbles and currents and whirlpools of thought within the stream, that we have no way to work to free ourselves from their incredibly powerful and persistent but often deluded energies.” -- Jon Kabat-Zinn, 2005, Coming To Our Senses, p. 280Jacob Hess, PhD, Cofounder, All of Life: “As long as we are being every thought. As long as every thought is a script…’This is the script of my life, this is the plot-line, the story-line, I'm just going to live it out.’ As long as we never question that, we're in a vulnerable place, mentally and emotionally speaking. But to the extent you can step out of your story-line and watch it from the side, and say, ‘What the--where did this come from? Who decided that this is how it had to be?’ If we watch our story-line, we can edit it--’I really don't think that's who I want to be.’” Steve Alper, Mindfulness-based Stress Reduction Teacher: “Observing thought as an event and...not getting caught up in the storyline but actually seeing the story unfold...just like you might experience a tingle in your body, and then you can look at it and realize it’s just a phenomenon and it may or may not have any correlation to what’s going on externally, or internally. Especially the kinds of thoughts that come unbidden into our minds...the thoughts that just rise up from who knows where.” “You can, if you care to, intentionally and specifically feature the thinking process itself in the field of awareness, watching your thoughts as discrete events arising and passing away like clouds in the sky. This can be a great spectator sport...by observing the very process of thought itself, you get to see how such tiny and transitory ‘secretions’ of the mind, which have no substantial existence and which are often completely illusory or highly inaccurate or irrelevant, can nevertheless be so consequential, how they can dramatically affect our states of mind and body, influence our decisions with potentially devastating downstream consequences for ourselves and others, and in any event, prevent us from being present with things as they actually are in any given moment. The practice of watching your thoughts from moment to moment can be profoundly illuminating and liberating.” --Jon Kabat-Zinn, 2005, Coming To Our Senses, p. 278“Just give yourself over to watching and sensing the arising of individual thoughts, as if they were bubbles coming off the bottom of a pot of water as it comes to boiling, or the gurglings of a mountain stream passing over and around rocks in a streambed.” --Jon Kabat-Zinn, 2005, Coming To Our Senses, p. 278-279“Feelings come and go like clouds in a windy sky.” - Thich Nhat Hanh“Remember, you are not your thoughts or opinions, your likes or dislikes. They are more like weather patterns in your mind that you can be aware of – like clouds moving across the sky. We might look upon some of the changes we are observing in our mind and body as internal ‘weather’...that we can remain stable and balanced in the face of the storms of our own minds and bodies.” –Jon Kabat-Zinn, Full Catastrophe Living, p. 127“It is important to acknowledge the difficulty of this practice; we are so used to living inside our thoughts rather than attending to them that it can be extraordinarily challenging to maintain a mindful relationship to thinking for any length of time.” --Williams and colleagues, The Mindful Way Through Depression, 2007, p. 165Elisha Goldstein, PhD, Clinical Psychologist: “Now you’re saying, actually, ‘Let me look at this for a moment....let me look at this difficult emotion that’s here.’ [*second time used] ... It takes a lot of courage to go like this ‘cause our brain is telling us this is something really to be scared of or to get away from....But let me look at this for a moment and investigate it, be curious about it, with a beginner’s mind….noticing this feeling as if for the first time. And watch it as it ripples and resonates throughout my body. Notice the thoughts that come with it. And what we start to understand is that, there’s a temporariness to this feeling...It naturally comes and goes.” Susan Kaiser Greenland, Author, The Mindful Child: “Just being confident in your own presence and confident that if you hold the attention calmly, that things will naturally settle.” Elisha Goldstein, PhD, Clinical Psychologist: “Learning how to wrap that feeling in a sense of kindness and compassion and a sense of just being aware, being curious about it and noticing how it comes, it peaks, it goes away.” [*Used a second time]“Sometimes the stream of thoughts is a mere trickle. At other times, it is a roaring torrent, a cascading waterfall. The challenge is always the same...to see the individual thoughts as thoughts, and not get caught by the content of them...to see individual thoughts as occurrences within the larger stream, as discrete events in the field of awareness, knowing them as thoughts as they arise, as they linger, and as they fade away, usually into the next one.” --Jon Kabat-Zinn, 2005, Coming To Our Senses, p. 279“If we find ourselves taken hostage and carried away by the thought stream, it makes sense to steady and gather the mind by focusing on the breath.” --Williams and colleagues, The Mindful Way Through Depression, 2007, p. 169“As far as thoughts themselves are concerned...we can cultivate a new and very different relationship to them, allowing thoughts simply to be here instead of analyzing them, trying to work out where they came from, or trying to get rid of them in any way. . . . in this way, it becomes much clearer which thoughts are helpful and which are merely the endless ‘propaganda’ of depression.” --Williams and colleagues, The Mindful Way Through Depression, 2007, pp. 164-165Steven D. Hickman, PsyD, University of California, San Diego Department of Psychiatry: “When we can see things as they are, rather than how our brain tells us they are....It’s a practice that can be quite liberating and freeing.” “In the daily conduct of our lives...it is extremely helpful to know that we are not our thoughts...and that they are not necessarily true, or only true to a degree, and often not so helpful anyway.” -- Jon Kabat-Zinn, 2005, Coming To Our Senses, p. 280Jacob Hess, PhD, Cofounder, All of Life: “There's a liberating message in this--it's a message of 'Your thoughts and feelings can change, they can ebb and flow’--just because that's the nature of thought and feeling, not because of something you have to go and figure out, and lay in bed at night and ruminate on ‘Why did I feel so bad today, and why was it such a hard day.’...Well, maybe you just got hit with some mindweather. Perhaps it was connected to something. We should always be open to our feelings and thoughts may be indicating something. But the idea here is that it's not necessarily the case....It could just be a thought, a feeling that's hitting us. And that's a hopeful message in a world where we're hit sometimes with stuff.” “When unattended, our thinking runs our lives without our even knowing it. … mindfulness practice can lead to being less caught up in and at the mercy of destructive emotions….[offering] a chance not only to know ourselves better, and see what is on our minds, but also to hold our thoughts differently, with greater wisdom, so they no longer rule our lives.” –Jon Kabat-Zinn, 2005, Coming to Our Senses, p. 375“Moment by moment we have opportunities to step out of that storyline of thinking and getting hijacked by our emotions and our ideas and opinions, our likes and dislikes and be with the actuality; to rest in the awareness that is our partner, our ally, our birthright.” (JKZ) Jacob Hess, PhD, Cofounder, All of Life: “Beneath the thought and beneath the feeling, there is still wholeness, still something of worth and value. And if you can start to inhabit that deeper place from which you can watch thought and feeling, there is...a radical new freedom that can emerge.” Randye Semple, PhD, Department of Psychiatry & Behavioral Sciences, University of Southern California: “If you can say, ‘Well, this is what’s going on with me right now and I’m not going to be at 100% and I can watch these thoughts and recognize them as thoughts’--it can stop the spiral. It’s more likely to pass by when you stop feeding the depression.” SECTION IV: BROADENING THE CONVERSATION ABOUT MENTAL HEALTHWe started the course exploring how to make sense of mental and emotional distress—exploring two ways of understanding the brain’s role. For those people who see the brain as permanently deficient, there will naturally be limits to what they come to hope for in terms of recovery. (After all, even if there are other things that can be done to support recovery, the fact remains: the brain still has a permanent deficiency). But what happens when that’s not a fact anymore? As the public becomes aware of brain changeability, at least two things start to change: First, all of a sudden, new hope begins to emerge for deep and lasting recovery from mental disorder as a possibility for literally anyone--not just those who don't have it very bad. And secondly, the wide range of social, cultural, relational and environmental contributors to mental disorder become relevant again. Welcome back…to All of Life. LESSON 14 EXPLORING THE BROAD RANGE OF CONTRIBUTORS TO MENTAL DISORDER “The truth is rarely pure, and never simple.” --Oscar Wilde To understand mental and emotional distress, to really get at the roots of these kinds of challenges, we need to look beyond the biology and chemistry of individuals alone and start looking at the full range of life--all of life--surveying the variety of factors that can contribute to or subtract from our mental health. The environment we live in is an important place to start. Toby Tyler Watson, PsyD Clinical Psychologist. “We're starting to come back to recognizing that when people suffer, they are a sign that something is not right in our environment, something’s not right in our organization--there’s been some sort of injury to their humanity.” Jacob Hess, PhD, Cofounder, All of Life: “Everyone wants to know what’s causing depression, what’s causing ADD. The problem with that question is it presumes there’s this one thing we need to find, this one genetic configuration, or some state in the brain. People can keep searching for that as long as they want, but the reality of the scientific literature is that we already know there are many, many different contributors to depression, and there is no single one ‘That’s it! for everyone’ factor. Over the last year we have done our own review of the risk factor literature--the literature that looks at anything that's been shown to contribute to depression, anxiety or ADHD. There are thousands of powerful studies that look at all kinds of contributors, and the take home message is this: There's a lot of different things that contribute to any given condition. It’s not a single thing. There’s no single thing that is the cause. There’s lots of different things. There’s a smorgasbord of contributors, just like there’s a smorgasbord of options.” In addition to trauma, there are a variety of lifestyle factors that may contribute to mental and emotional distress. When babies are grumpy and struggling, for instance, we naturally assume they need sleep. But how often do we do the same as sleep-deprived adults? It's easy to overlook the role of lifestyle patterns in our own situation. Judith E. Pentz, MD, psychiatrist: [*When we make choices that are not supportive for the body that is what I would call crimes against the wisdom of the body, mind and spirit--an example would be, very simple, how much caffeine does someone consume in a given day.] “We tend to burn the candle at both ends; not go to bed on time and get up really early, and then think that caffeine can help us through the day. It ends up really creating a vicious cycle for the person; not enough sleep, maybe caffeine plus sugar, and the end result being really jangled nerves.” [That really has a negative impact on their ability to manage their anxiety. Our body has a certain amount of wisdom that if we listen to, will speak to us.]Tom McConkie, Cofounder, All of Life: “In hindsight, it was kind of my sleep pattern falling apart that created this vicious cycle, where if I wasn’t sleeping well, then my body wasn’t resting properly, and then I would manifest physical symptoms of illness, things like that. I just had a hard time getting a good night’s sleep, and the more those physical symptoms started to manifest, the harder it was to go to sleep at night. It really dawned on me how profound my sleep disorder was... “I remember staying up into the early hours of the morning listening to a Dire Straits album just for something to distract my thinking mind. I think about--you hear about chinese torture of dripping water—it’s not so bad the first day. But after 5 years of that, someone can start to go crazy. I think the insomnia was a manifestation of the general anxiety that was in my life. I think the insomnia was a symptom of something even deeper than that, and it manifested as a sleep disturbance.” [*I think that the thought process can be similar. Insomnia like that, where thoughts in and of themselves are fine--they're innocuous. But when all you have is thoughts, when your experience is characterized by this unbroken stream of thoughts. I felt like I was going crazy from a young age. And I think the insomnia was a reaction to the anxiety in my life...manifesting as sleep-disturbance.] On a broader level, the impact of social and cultural influences may also be playing a role. Referring to the “non-stop interactivity” in our current media environment, a neuroscientist at the University of California, San Francisco, recently warned that the societal shift in this direction over the last several decades is “one of the most significant shifts ever in the human environment. We are exposing our brains to an environment and asking them to do things we weren’t necessarily intended to do. We know already there are consequences.” (Adam Gazzaley, as cited in Connely, 2010). Megan Cowan, Executive Director, Mindful Schools: “Not that technology is innately bad, but that we’re not really viewing it as something that we utilize--it’s kind of driving us, instead of us deciding what aspects of our life that it’s helpful for. And I think having some recognition of the effect that it’s having on us is important so that we can mediate it a little bit.” Another neuroscientist similarly cautioned that our brains are being “massively remodeled by our ever-intensifying use of the Web and related media.” (Michael Merzenich, Carr, 2010)“Today, the Internet grants us easy access to unprecedented amounts of information. But a growing body of scientific evidence suggests that the Net, with its constant distractions and interruptions, is also turning us into scattered and superficial thinkers.” --Nicholas Carr, 2001, Into the Shallows: What the Internet is Doing to Our Brains.Megan Cowan, Executive Director, Mindful Schools: “There’s a book called ‘The Shallows,’ about the effects of the internet on our brain, and it talks about how our attention span has really changed and that it’s harder to read a book, for example. So I got this book, ‘The Shallows,’ that is about this, and I’m on like page 30 after four months, and I can’t read the book. It’s kind of a joke...that we can’t read any more.”“The picture emerging from the research is deeply troubling, at least to anyone who values the depth, rather than just the velocity, of human thought.” --Nicholas Carr, 2011, Into the Shallows: What the Internet is Doing to Our Brains.Megan Cowan, Executive Director, Mindful Schools: “So the information overload, the way that it’s coming in, and and the speed that it’s coming in at, and the volume that it’s coming in at, isn’t actually digestible, or we can’t hold it all. I’ll look at headlines...but there’s something about the speed of things and the level of information that I just can’t take any more in at the end of the day.” “The richness of our thoughts, our memories, and even our personalities hinges on our ability to focus the mind and sustain concentration…When we’re constantly distracted and interrupted, as we tend to be online, our brains are unable to forge the strong and expansive neural connections that give depth and distinctiveness to our thinking.” --Nicholas Carr, 2011, Into the Shallows: What the Internet is Doing to Our Brains.Susan Kaiser Greenland, Author, The Mindful Child: “If I were to say the thing that I see that is the most worrisome when I’m working with parents and families in school is just how exhausted everybody is. Everybody is just stretched to the max, and when you’re so stretched, it’s easy to just snap. There’s a whole group of kids where the parents are up really, really early, they’re making breakfast for their kids, they’re taking them to school, their kids are being bussed to after-school, the parents come and pick them up from after-school around 5:30, 6 o’clock and then they have to rush home and make dinner and help with homework and they haven’t got a minute to sit down until their children are in bed at about 9:30, and I meet parent after parent after parent who’s doing that. Some of them are working two jobs, they’re doing the best they can and they are just going on all cylinders all the time. It’s mind-boggling.” [*It’s good to have wonderful intentions, but when you’re so stretched, it’s really easy to just snap. So it goes back to the need for us ...to have balance in our own life, and to really take care of ourselves too.]Megan Cowan, Executive Director, Mindful Schools: “One of the other things that we are up against in our culture is that, the rest of our culture is in ‘go mode.’ And we’re being influenced by the expectations of our society and the people around us, and sometimes it’s really hard to make choices that are going against that, and trust that they are a healthier choice for us.” Judith E. Pentz, MD, psychiatrist: “Our body actually has a certain amount of wisdom that, if we will listen, will speak to us.” “If I go without sleep and start partying a lot and get overextended and stressed, yeah, I’ll hit depression….I know the recipe for madness: I lose my sleep; drink too much...and get involved in too many things: that’s the recipe for madness for me.” --Man who faced depressionVicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Part of this work really has to be the work of self-compassion. We may not be in the place that we want to be, but can we take a step back and thoroughly understand where we are? With compassion. ‘Here’s what I’m feeling. Here’s what happens to me during the day or during the night. Here’s how I act out. Here’s the maladaptive coping habits that I have now, that I know are not doing me any good, but I don’t know where to turn.’ That kind of self-informed picture can help me seek out the help that I need, that’s appropriate for me as a person.”Part 2: Take a guess at the top 10 most popular grocery store foods in the U.S….ready? Top 10 most popular grocery store foods: 1. Coke Classic2. Diet Coke3. Pepsi4. Dr. Pepper5. Mountain Dew6. Diet Pepsi7. Sprite8. Philadelphia cream cheese 9. Potato chips (Lays)10. Oreo cookies (Nabisco)Don’t worry…no one’s claiming Oreo cookies are ‘the cause’ of mental or emotional distress. Nutrition is only one of many factors that may contribute to a complex picture of influence—a panoramic picture that we rarely spend serious time looking at. Jacob Hess, PhD, Cofounder, All of Life: “In my depression classes, most people are not aware of the full range of contributors. That alone is an optimistic and hopeful message for individuals and families facing these problems. It’s exciting.” [*...because it invites people to say, 'what is your risk profile? What are your vulnerabilities? And what are your real areas of strength, where you're not vulnerable? Is your relationship with your partner really strong? Well then that's not a vulnerability for you--but maybe your diet is crap. Maybe your diet is poor--and maybe you're just running yourself ragged with work.'] Judith E. Pentz, MD, psychiatrist: “Part of the challenge in our culture is that we are very crisis oriented and often aren’t focused on the weeks or the months leading up to the crisis, and what were the warning signs along the way--What are all the different reasons a person could be having depression, having rage problems, attention problems?” [*We want to medicate symptoms but we’re not necessarily looking at what the problem is underneath. When I’m working with people, I really ask that they look at their food choices, lifestyle choices, and how they might be having an adverse impact on their emotional state. Are you getting enough sleep at night?] Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “It might sound strange, but I relate to my anxiety, and to a few other things, but my anxiety as a messenger, as a teacher. If I feel anxious...I check in, I’m really feeling this--what’s going on that that might be triggering this? And is there something that I just need to back up and take care of? It could be something as simple as eating...the blood sugar gets low and it causes a little anxiety--it might be that. Maybe it’s a conversation I didn’t have with my husband last night that I should have had...maybe I’ll go back and sit down and have a chat with him and see if I can resolve some of that. So I know that it’s always coming around, it’s always here--what’s different is how I react to it. And I know that this has been a path for me--of learning.” Scott Shannon, MD, University of Colorado, Department of Psychiatry: “The approach that I take when I evaluate kids is what I call an ecological approach. I am really looking very broadly at...all the different ecosystems in the child's life. So that will include nutrition, family life, their education, their social life, their exercise, their sleep, their spirituality, their internal belief systems. All of these have a significant impact on the children and their mental health: things like media...the amount of screen time they have, the amount of aggression and violence in their lives, we try to take that all in context and then also looking at their genetics, their family history. I do thorough blood work, looking at all different biological factors that can impact a child's life. I try to always assess what is going on at school...then I step back, try to put this all together in a comprehensive picture...and talk to them about which areas in that ecosystem are most out of balance.” [*...and where we need to make the interventions.] Rather than focusing on individual challenges alone, what would it mean to begin carefully considering our surrounding environment--including our daily atmospheres at home, school or work? Toby Tyler Watson, PsyD Clinical Psychologist. “There's always, always a reason why a child is suffering or acting out--if they're struggling in some way and they’ve developed a sensitivity to feeling small, inferior, depressed, inadequate, maybe poor concentration, and they’re not sure why...there's a reason why it's happening. It might need to be explored for whatever the reason. It's not bad parenting. It could be just that the child has an emotional antenna that just starts to grow a little bit more, because maybe somebody commented to them on something that they wore; or some bad grade that they have, or they feel slighted by their sister or brother. When they have that sensitivity, we may not always pick it up as parents...we always miss stuff. I'm a parent--I miss stuff all the time.”“We can even respond to those facing extreme environments with more thoughtfulness and compassion…” Paula Caplan, PhD, Women and Public Policy Program, Harvard University: “I'm urging every civilian to listen to a veteran's story, and I tell them, don't say a word...just listen--except for one thing: the one thing I want you to say is, ‘If I had been through what you went through, I would be feeling the way you are.’” [*That's an understandable human reaction...this is not a weird reaction and there's nothing wrong with you.]Of course, you don’t need to have fought in a war, or have suffered severe abuse to hurt emotionally; all human beings experience trauma of some kind, in some way. Maybe, then, we can also admit that emotional and mental pain may not be as abnormal as we often make it out to be. Joanne Cacciatore, PhD, School of Social Work, Arizona State University: “I work with families whose children have died or are dying. That's known across cultures as being one of life's greatest suffering. So they’re not sleeping, they’re having trouble eating. They might be hallucinating--they might be hearing phantom voices or phantom kicking if the family had a baby who died. They may be experiencing these symptoms, but they are all normal responses to an abnormal event. Their emotional reactions--their biological and behavioral and social reactions--are actually congruent with the unnaturalness of the circumstance.”Paula Caplan, PhD, Women and Public Policy Program, Harvard University: “One of the things I find myself saying over and over...when people who come to see me and say, ‘Hi, I'm Mary--I'm borderline..or I'm bipolar’...I so often end up saying, ‘Your feelings are absolutely understandable human reactions--this is not a weird reaction, and there's nothing wrong with you.’ And that is the thing that people have told me, over and over, is the most helpful to them.”So there you have it: the world around us seems to be playing a role in what we're feeling and thinking. Not too surprising, right? By paying attention to all these contributors to mental and emotional distress, who knows? Maybe that will even change how we respond to them. On to the final class lesson! REVIEW: There is likely no single “cause” of mental/emotional distress. Current research, instead, confirms lots of diverse contributors. That’s actually pretty good news!***QUOTES NOT IN LESSON 14 VIDEOS: “The growing number of depressed people can be attributed to a ‘depressogenic society,’ a society that places many of its members at risk for developing depression. . . . You may be living in a society that makes you more prone to depression on a number of levels.” -- Drs. Addis and Martell (2004) from Clark University and the University of Washington Stefan Malecek, PhD Certified Drug and Alcohol Counselor: “We live in a society that is addiction-ogenic and trauma-tagenic--that promotes addiction and trauma--so that everyone to some realistic extent, is on some spectrum of mental illness, from the mild to the severe.”Jacob Hess, PhD, Cofounder, All of Life: “There are hundreds of reasons why an individual, or for that matter generations of individuals from a family, may have susceptibilities to . . . depression. They might be genetic [reasons], they might be susceptibilities, they might be allergens, or abuse issues. There are so many issues; it’s not one thing. It’s not like diabetes.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We’re a culture that loves the quick fixes—we want the quick diet, we want the couple of advils, no more headache--and if we don't get it, we get really impatient. And we give up--sort of all or nothing. And it's important for us to sort of step back and ask, is this the case? And ask am I willing to work on this piece by piece and ask myself really critical questions along the way--is this helping me work toward a life of balance? Is this helping me understand what's going on with me? And if not, maybe I need to drop that and try something else. But really understanding that this process of wellness is a lifetime pursuit.” Stefan Malecek, PhD Certified Drug and Alcohol Counselor: “I have struggled with depression**....and have gone back, back, back to the roots of it--which was tremendous abuse in my childhood--I shut down when I was 5--that was it, I was done--and I endured...I was first suicidal when I was 8 years old, because I just didn't want to live (emotional)....and I think that is a direct result of trauma.”Paula Caplan, PhD, Women and Public Policy Program, Harvard University: “Nowadays, we have increasing numbers of war veterans coming back...I have listened to the stories of veterans from 1942 to the present wars, and you know what's happening to them? They go to war, and here's what they say...'I grew up playing with toy soldiers and saw my brothers and father go to war, and went off to basic training and military preparations, and then I arrived in Crete or Fallujah and there was the real war, and every veteran has said, 'nothing prepares you for what war really is'.”Stefan Malecek, PhD Certified Drug and Alcohol Counselor: “I'm also a Vietnam vet...Trauma impacts the body and completely changes the neurology of the brain....I have a list of symptoms probably 2 feet long, of symptoms that result from being traumatized--including shortness of breath, nausea, dyspepsia--amazing amount of physiological changes that happen when you're traumatized...so that if these traumatic events happen to your body--changes in your neuropeptides, incredible things…”Paula Caplan, PhD, Women and Public Policy Program, Harvard University: “Then all of a sudden they're home: the rules, the goals, the approaches could not be more different--and they're devastated. Now what's the whole country doing? 'That's post-traumatic stress disorder--that's a mental illness. We should send them to therapists' offices...' I went to the Pentagon, and I went there thinking, ‘They're going to be critical of me.’ I went there to say, 'We should not be saying that to be devastated by war is a mental illness--what is a healthy human reaction, if that's a mental illness?' And they said, 'We couldn't agree more with you.'”*********The majority of mental health questionnaires focus on symptoms--the observable, behavioral manifestations of how someone is currently feeling. While this is an important aspect of any experience to consider, we typically end up paying far less attention to the root risk factors of what is going on. We decided to create questionnaires looking at the variety of root contributors to mental and emotional distress. We went to PubMed and searched for “depression and risk factor,” “ADHD and risk factor” and so on. We were surprised to find thousands and tens of thousands of studies. We have distilled down and summarized what we learned in several questionnaires--child and adult inventories getting at the roots of anything known to contribute to depression, anxiety, ADHD, etc. (You can check them out via the links on the web page for Lesson 14 Resources at the bottom of the page.) Feel free to share them with anyone who might be interested. Let us know what you think!LESSON 15 CONSIDERING THE FULL RANGE OF OPTIONS “I dwell in possibility.” --Emily DickinsonWe just finished exploring the range of contributors to mental and emotional disorder. To some, that may sound like bad news. “Wow, look at all the things that could be messing with us.” The reality, though, is that this is actually great news. If it’s true that a wide range of contributors to these problems exists, then that also means there’s plenty we can do to start getting at the roots of these problems, and start feeling better.Jacob Hess, PhD, Cofounder, All of Life: “At the beginning of my class, we give a self-survey where they look at anything that could contribute to their depression. And one woman came up to me at the end of this class, after she had done this survey--and she said, ‘Guess what? I have NINE risk factors for depression.’ It included sleep, which was a real issue for her, and exercise and sunlight. And her diet was totally messed up, etc. And she was excited that she had nine risk factors. Now I ask myself, why would anybody be excited to find out that they had 9 risk factors for depression? My answer is...perhaps for one of the first times, she realized how many things were leading in to her struggles with mood, and how much she could do.” Somewhere along the line, we seem to have forgotten there were a large range of options available. Jacob Hess, PhD, Cofounder, All of Life: “I was at a conference on ADHD....the psychiatrist who was presenting was somewhat critical of some of the ADHD medications on the market. At the end of the presentation, someone at the back raised their hand during the question and answer and said, ‘If we're not going to give these kids medications, then what are we going to do to help them with their ADD?’ And the psychiatrist turned to this man in the back, with almost a look of disbelief, and he said, ‘ALL OF LIFE! Sunlight, and exercise, and relationships, and silence, and nutritional supports, and good sleep, and reading.’ And his point was, ‘Have we lost an imagination of the range of possible supports that are available?’” Many of us have lost this vision of everything at our disposal. Medications, as we’ve pointed out, have been helpful for many. There is a growing awareness, however, that they shouldn’t be over-emphasized—especially if other options are pushed to the side. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “We know that there are many resources out there, it’s not A or B--there are many options. And it really is up to us to fully research those options, or find people who can help us research those options.”As we learn more and more about the range of risk factors and contributors to these problems, doctors, therapists and patients are beginning to explore more seriously all the many life adjustments that can promote mental health. This, of course, is no different than a heart patient who is encouraged to start exercising and eating differently as part of his treatment. Judith E. Pentz, MD, psychiatrist: “Last week I met with a professional woman, and she’s really been struggling with a lot of challenges. She’s very, very high energy...and I asked her if she was actually able to nurture herself. She looked at me and didn’t quite understand what I meant by that statement, and we discussed it. It turns out that the concept of nurturing is very foreign to her.” [*For her, it was more about being out there and giving to the world rather than working on taking care of herself....They don’t often take care of themselves and then wonder why their body isn’t responding in the way that it once did...It was a huge shift for her to say, ‘I need to start taking care of myself.’]Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “It’s important for us to sort of step back and think, ‘Am I willing to really work on this piece by piece?’ and ask myself really critical questions along the way: ‘Is this helping me work toward a life of balance?’ ‘Is this helping me understand what’s been going on for me?’ If not, maybe I need to drop that and try something else, but really giving it time, and understanding that this process of wellness is a lifetime pursuit.” Toby Tyler Watson, PsyD, Clinical Psychologist: “We’re starting to come back to recognizing that when people suffer, something is not right in our environment, something’s not right in our organization--we shouldn't squash it--we should actually listen to it and amplify it--and try to accommodate and make changes.” Judith E. Pentz, MD, psychiatrist: “It can be as simple as going to bed one hour earlier [*or staying at home and sharing a meal with the family and cooking it together], and that can be a form of nurturing one’s self.” Willa J. Casstevens, PhD, Department of Social Work, North Carolina State University: “That doesn't mean you give up all of what you were doing, or all of what you wanted to do, but it does mean you have to let go of some of it, re-evaluate some of it, maybe make some different choices for yourself. And hopefully your family can do that with you, hand in hand.” Families can be a critically important environmental factor. In a perfect world, families would look to one hurting individual as a sign or message of something they all need to work on. We don't live in a perfect world, though. “I just remember saying, ‘I don’t need to be here; my parents are the ones [with] problems; they need to be in therapy, not me….I definitely needed to be in therapy, but they did as well. We all did.”--Young woman reflecting on past residential treatmentOf course, many parents do whatever they can, making whatever changes are necessary, to help their struggling child. “It is easy for parents to say, ‘She screwed up; my [son or] daughter needs to change’...but you have to look at your part in the situation: each parent individually. That was the key: loving your child enough that you change...We were motivated to change ourselves so we could [better] help our daughter.” --Father of a struggling girlToby Tyler Watson, PsyD, Clinical Psychologist: “The key is to accommodate and to meet the child at their needs, to say, ‘Oh, I see what’s happening, how can I accommodate, how can we adjust, how can we change to accommodate the child’s needs?’”Judith E. Pentz, MD, psychiatrist: “A lot of times people really need to make some major changes when they are in crisis, but prefer not to. They want to kind of just keep going in the same direction. They don’t see that it’s been a train wreck that’s happening in slow motion, so to speak, and that there’s other parts of their life that might be falling apart…”[*yet they just want that one medication to make a difference so they can get along with their family better despite the chaos that might be there, or make choices that might be difficult…]Even though life adjustments can make a big difference for any of us, even smaller changes are sometimes so easy to resist. Judith E. Pentz, MD, psychiatrist: “I think it goes back to our culture being in a place of “Fix things quickly and let me get on with my life,” and “I don’t want to look any deeper than I need to.” There’s a perception that you can go on with your life and life doesn’t need to change, you don’t need to look at any threshold that might have triggered the crisis to begin with. There’s really no need for self-reflection. You can pretend like all is well. Unfortunately, if you aren’t digging deeper and making sure that some layers aren’t taken care of, it’s kind of like putting a finger in the dike, so to speak, where things are crumbling but that one pill is really helping to kind of secure things momentarily, but then things can come crumbling down, down the road potentially.” There are perhaps times in all our lives where mental and emotional pain can act as an alarm or warning that these bigger changes in our life or family are needed. Laura Delano, Mental Health Peer Specialist: “I decided to give sobriety a shot, because at that time I saw alcohol as the only medication that worked for me. The only time I didn’t care that I was miserable was when I was drinking. I had really become very reliant on it. So when I put the drink down, I was faced with the reality of my life, and it was really hard, but in a matter of weeks I just started to feel different...my life just started to clear up a little bit. I was still really unhappy, but I no longer felt totally controlled by my emotions...all of a sudden I felt this sense of hope. [*...and I had been hopeless for so many years.... my world had become so small that I didn't see any light at the end of the tunnel--and all of a sudden, as I started getting sober from alcohol and getting off these medications, I just started to feel a little bit of emotional energy--and hope... I'm no longer in any therapy of any kind.] Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “In a very low point in my life…” [*coincided with a period of drinking and drug abuse, and coincided with bulimia/anorexia, and in consequence, depression and anxiety—there’s no way to get away from it when you’re taxing your system as much as that.] “And I remember one evening... I was all alone and it was just me, with myself, with what I had done, and what I was doing….and something inside me...roared, ‘You’ve got to do something about this, this is not what you want to do long-term.’ It's hard to reach low-points in our lives, but instead of being ashamed of them--it's such a turn of perspective to regard these episodes as teachers, as opportunities--I can learn something from this, I don’t have to be ashamed of it. I can acknowledge it and can look for help. I can start right here, right here in the depths and work my way out. There is a way out.” [*But you have to take the first step.]Part 2: Judith E. Pentz, MD, psychiatrist: “When you start making changes, your whole inside of your world can really go tumbling, and you have to start asking questions about why you’ve made some of the decisions that have led to where you are today. And that can be really, really uncomfortable for people. [*So, I would say fear of change can be a concern.] People can get very stuck, and it’s safer in their stuckness than trying to make changes.” [*I can think of one person who basically wanted to sleep about 12-15 hours a day, get up go to work and then go back to sleep. Basically she wanted medication to a threshold that she would know that she could sleep 12-15 hours and then get up and go to work and come home again. So I asked her why...and it was basically to avoid her life because it was too painful for her. I said, 'it’s uncomfortable...having to write these prescriptions for you to avoid your life, let’s talk about what’s going on'... She’s like 'I don’t want to, I choose not to.’]In the face of such resistance, supportive helpers can offer nice encouragement in helping us make key decisions. Scott Shannon, MD, University of Colorado, Department of Psychiatry: “I’m really looking very broadly at the perspective in their lives that looks at all the different ecosystems in the child’s life. I have them come back about 2 weeks later, try to put this all together in a comprehensive picture, and come back and talk to them about which areas in that ecosystem are most out of balance: Is it a biological side? A psychological side? Mental issues? is it more social? Or more spiritual? Is it environmental? Are there toxins in their environment? Are there other things that are going on? I go over this talking about the different ecosystems in the child's life and where we need to make the interventions [and a plan].”While good professional help can be invaluable, our own sense of what is best should not be ignored.Stefanie Goldstein, Ph.D., Clinical Psychologist: “We live in a society where there’s an expert, and we read these books by experts, and they tell us what to do, and how to do, and I certainly have read many of them, so by no means am I saying they’re not helpful or informative, but I think we defer our own internal wisdom and judgment for what the expert is saying, and not really checking in with ‘Does this fit for me, and does this fit for my child, does this fit for my family?’ Because maybe it does and maybe it doesn’t, and I think we need more permission as a community and as families to do that. I think, again, it goes back to checking in with yourself, and if you have a partner or a spouse, checking in with them, and what is true for the two of you, and what are your values, and how do you see your child, and what do you see that they need? Obviously, being a psychologist, I am a proponent of therapy and therapeutic interventions, but not for every child. Maybe for them it’s going horseback riding, or it’s connecting to a creative outlet in which they have a way to express themselves. Maybe it’s a combination of both, but just allowing there to be some space. I think, really, beginning to slow things down because we get so anxious, we want to help our kids, and we want to do best, and parents are so well-intended, and overwhelmed. So the most important thing is to really slow things down, and creating space not only for yourself but for your child and your family, to be able to make a choice that fits for you, and what feels best...by being educated and knowing what your options are.” Jacob Hess, PhD, Cofounder, All of Life: “So the beginning point of some of these other approaches is stopping and saying, ‘Okay, I'm not going to freak out here...I'm going to consider all my options and settle on a plan--make a plan that is going to pay off long-term.” [*...a wellness plan that's going to get me where I want long-term.] While people understandably want relief as soon as possible, this does not necessarily mean they aren’t willing to work toward meaningful, long-term recovery. Jacob Hess, PhD, Cofounder, All of Life: “People like to say that Americans are after a quick fix. I used to believe the same thing, until I started interviewing Americans in these research studies. I have never, not in a hundred and ninety-five interviews with people, with individuals and families struggling with depression, met a single individual who just wants a quick fix, that is just looking for their problem to be papered over--and superficially managed. The message I hear is that we do want real solutions--we do want the pain at the center of our heart...we do want the aching pain to be resolved. We do want the condition tormenting our child to be resolved. We don't really just want a quick fix. We really want answers!”Whether big or small, life adjustments can lead individuals gradually, over time, to a better place. Tom McConkie, Cofounder, All of Life: “So it started with awareness, and as soon as I was aware of all the mental and emotional content that was like sludge in my body and mind, I started to be more choosy about what I watched on TV, what kind of books I read, who I hung out with because I had a really clear sense of how it was affecting me. And my relationships changed, and my relationship with literature changed, and the way I interacted with media, internet, things like that changed a lot. And that influenced my sleeping cycle. And I started to rest more; and I realized I felt really good when I exercised. And I realized that as I was more comfortable in my body...I noticed what foods made me feel good and what foods made me feel sick. And so I talk about my story in terms of this domino effect that started with this tiny bit of awareness, that started with being still and taking account what was going on. This awareness then shone into different parts of my life, and I just knew what needed to be changed. It's not that I didn't benefit from friends and mentors and doctors--they were instrumental in my own process. But what was surprising was how intuitively I could assess what was happening--’I’m going to really focus on nutrition now; I just know that's really out of whack. I'm going to focus on getting my sleep patterns down; from now on, phone is off at 10 and I'm going to be in bed, reserving time for the practice of sleeping in my life.’ And so what starts with this tiny bit of awareness, this intention to be healthy and whole, it just starts to expand and permeate all the different aspects of life. That's what I would communicate to people who are thinking they're in a hopeless situation and it couldn't get much worse and how could it possibly get better. Not to belittle that suffering, not to explain it away and say ‘It gets better kid.’ It's awful, and life can be so hard, and it's hard to be a human being. It's hard to take on the challenges that just come up in our awareness that characterize the human life cycle. Those things are so real. Yet equally real is our intuition to move towards wholeness, and to move towards health, and it starts with that single intention, to just take a look at what’s going on, and start to move in the direction you want to move in.” As people follow their own intuition, they can sense in their own situation, from their own body, what is best. That, as we’ve said, can mean any variety of things. Professionals are beginning to look at this same range of options. In Great Britain, for instance, they are beginning to prescribe exercise as a treatment for depression. Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “For my body, for me, movement is very important. I love hiking with my dogs. Being in nature is for me is like an elixir. It's like drinking in health. I need it. All seasons--I'll bundle up in the winter and go in the mountains. We just get out. We see people. We see nature. I think nature is a great equalizer--helps us return to a place of well-being. And it's everywhere we look.” [*I also love yoga. Yoga helps me feel strong. It's a practice that is done with a lot of compassion. We relate to the body through movement. And that could mean a lot of different things for so many people--contemplative practice, coming back to the present, coming back to the moment. We're not going off to dinner--we're staying present, through movement. And that I love.] What kind of things have you found help lift your own mood? How much do you ‘get out’ into the natural world? How much movement do you get in an average day? Part 3: If movement is important, then so also is not moving and resting. Quality sleep and rest is also becoming more acknowledged by health professionals as crucial to our mental well-being. “You’re not gonna be able to let yourself get sleep deprived your whole life...You’ve gotta kinda watch this and not think that you can go without sleep just because it feels like you could…You can’t do that to your brain for years on end. You also can’t not feed yourself...You’ve got to take care of your body because your body takes care of your brain.” --Man who faced depressionVicki Overfelt, Mindfulness-based Stress Reduction Teacher: “For me, something as basic as sleep is crucial. I’m very sensitive to sleep deprivation, of not having enough sleep--it makes me anxious. So over the years I’ve come to know what my triggers are, and those things that make that propensity, that tendency in me worse, or much more sensitive. Lack of sleep is definitely one of those. So I always try to get as much sleep as I can, or get the sleep that I need.” [*I have a daily regime of meditation—a sitting practice of meditation, which is the absolute core foundation, helps me relate to everything that happens in my body and heart with healthy regard.] Tom McConkie, Cofounder, All of Life: “It was in hindsight that I realized how significant sleep was in holding all my physical and mental health together. I didn’t appreciate until years later the way that the mind digests imagery, and the way that it works with experience. We're all pretty sensitive to the way we eat food and how we feel after a meal--reasonably--if you have a big meal of, say, fried fast food, you’re probably going to feel a bit of a slump in energy and kind of a listless quality about you. I don't think we have the same sensitivity for what goes on with the mind, what goes on in our psyche. And what I mean by that, is I realized, as I was really addressing my insomnia head on, I realized what kind of content I was absorbing throughout the day. And whether they were challenging emotional relationships or negative imagery streaming into my mind, that was kind of sitting in my gut, like the proverbial 6 pounds of undigested red meat that they say you can accumulate after a lifetime of meat-eating. I realized just how much gunk was there. And I was taking that to bed, and I was dreaming about it and waking up with the emotional residue of that content. Perhaps the most significant shift I made as I was addressing the insomnia was to just pay attention to my intake--what was my mental, psychic diet, and how much time was I dedicating to digesting that intake, what I was ingesting. Once I really tended to that, I might do some calming exercises before bedtime, maybe 20 minutes of breathing, working through that undigested material, so that my body was actually going into rest--a deeper rest than I had known before...that created this virtuous cycle of getting a good night’s sleep, I would wake up feeling not even good by a normal person’s standards, but good for me, moving in the right direction. I could feel it. That was significant to me. Over time...really paying attention to the content I was taking in in my life. That allowed me to sleep better, and that kind of cascaded into other fortunate turnarounds.” Megan Cowan, Mindful Schools: “The fact that we don’t have the time to see the natural ebb and flow means that things are happening throughout the day, just take one day. Things are happening throughout the day. We have a discussion with someone that’s challenging..that we don’t have time to actually integrate or think about, we have to immediately go back to the computer, or to the next meeting, or to the next assignment or whatever it is..And then, you have a number of those things throughout the day that you didn’t actually take time to feel on your nervous system and let it pass through. So you end up at the end of the day, not really having digested our experience of the day. And then you add days upon days, upon weeks, upon months, upon years of not taking time to stop and let things integrate, and I think that, to me, is the definition of mental illness; or rather, that mental health is the kind of stability or continuity and frequency of stopping, letting our experience digest and integrate.”Pace of life, then, can be closely related to a range of issues. Megan Cowan, Mindful Schools: “The speed of life these days--I think at no other time in history have we been so busy, all the time. And in ‘go’ mode all the time. And not just as personally but as what we are surrounded by. So then that just feeds the kind of going-mentality and the doing-mentality. And there’s something literally insane about it. That if you look at other times in history or other cultures now, even, or just at nature, that there is a natural ebb and flow of energy and awareness and awakeness and presence, that if you were just left to that natural ebb and flow, we would see it more clearly, but we don’t have--we don’t take moments of stopping to really notice what the energy is actually doing--I have a lot of it, I don’t have a lot of it, I’m tired, I’m eager, I want to do, I want to just be--We don’t have a lot in place in terms of systems and culture and support to notice those moments.” Tom McConkie, Cofounder, All of Life: “The emphasis shifted from acquiring, accumulating, to being. There was a shift from doing to being. And that played a huge role in cooling off that overstimulated nervous system that was manifesting as an anxiety disorder and chronic insomnia.” Megan Cowan, Mindful Schools: “I was in a high school class a few months ago, and the teacher in the classroom taught his students mindfulness meditation. And when I was visiting he said, ‘Megan, I taught them how to do this, and now they come in every day asking for it, and as a teacher, I feel like, ‘Oh, they’re just asking for this because they don’t want to do the lesson.’” And he told me this in front of them. And then I asked them, ‘What, why are you asking for it? Why are you guys coming in and asking for mindfulness?’ And many of them raised their hands and they said very similar things, but one of the kind of consistent things was, ‘It’s the only time in the day where I get to stop.’” Susan Kaiser Greenland, Author, The Mindful Child: “One of my earliest experiences which was really, really eye-opening for me was when I was sitting at that boys and girls club with a bunch of kids, and I was in there kind of late in the day and my class ended, it was an informal class, but it ended around 5...and we were in a very hectic and loud club--but sometimes around that time we would still be sitting there and we would have work together and spent some time together and we would get ourselves to a calm, centered place....And more often than not, you’d look up and in would come something that looked like a tornado coming in, whirling into the room and the whole energy of the room shifted, and who was that? It was somebody’s parents. And, you’re sitting there with the children and you’re looking at the parents and you can understand why the children are thinking, who is this crazy person coming in, but at the same time, you can look at the parent and realize, this parent has been up since 6 or 6:30 this morning, going from taking the kids to school and getting them breakfast to working a full day to now picking them up and has to look ahead, homework, dinner, and getting the children to bed before they can sit down and have a glass of tea.” To encourage people to re-think their chosen pace of life in a speedy U.S. culture, several public health campaigns have sprung up--including a “slow movement” (Honore, 2004) encouraging people to slow down eating and relationship time, a movement against over-scheduling children (Doherty & Carlson, 2002), and finally, a “silence” movement (Prochnik, 2010) inviting people to opt out of living in the random “noise” of the culture--instead, looking to make room for more quiet time as a way to cultivate deeper mental health (Williams, Teasdale, Segal & Kabat-Zinn, 2007). Tom McConkie, Cofounder, All of Life: “We're taught to strive, we’re trying to improve the self, get more education, earn more money, have more relationships with important, beautiful people--as I started to make stillness a feature of my life, as I started to come back to it more and more, it wasn't that I stopped striving. In fact, I think I had more energy than ever to strive and to accomplish goals I set for myself. But there was this place of rest that I could come back to, and there was this fundamental okayness with where I was—and that took the driven quality out of my goal setting, and it made accomplishing goals and going places and doing things fun, because I got to choose. And I knew if I wasn't doing something, I could be doing nothing. I realized that accomplishing goals and being somebody was something that I got to do, something that I got to do because it was joyful, not because I had to, not because I wasn’t going to be worth anything if I didn’t.” [*That was something lost on me before--I thought I had to be something.] Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I have a daily regime of meditation, a sitting practice of meditation, which is the absolute core foundation practice for me. It helps me relate to what arises in my mind, and in my heart and my body, with a healthy regard.” Judith E. Pentz, MD, psychiatrist: [*One’s own mental health and mental well-being is connected to one’s physical well-being. They go hand in hand and there are times when you actually are remedying your physical challenges that your mental challenges may be remedied as well....thyroid issues, people that have gluten insensitivities, individuals who may have problems with overgrowth with bacteria or yeast]. “Using a form of meditation or a mind/body integration like Tai Chi or yoga can be really helpful in modulating stress in one’s life.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Yoga helps me feel strong. It’s a practice that is done with a lot of compassion; we relate to the body through movement. As you move, you are coming back to the present, coming back to the movement, so we are not letting the mind go off and visit friends, or prepare dinner, we are staying present for whatever is arising, through movement, and it’s wonderful.” Megan Cowan, Mindful Schools: “There was an article recently in the New York Times called ‘Rest is not idle’ or ‘Rest is not idleness,’ and it was describing how periods of resting, not sleep resting, but just resting-stopping, that kind of stopping that we’re talking about, are critical for the integration of experience and mental health and overall well being.” Over time, this kind of a plan involving personal adjustments and changes in lifestyle can lead individuals to a very different place. Judith E. Pentz, MD, psychiatrist: [*if you don’t have enough B-vitamins it can also cause a lot of problems in different ways]....”So, as simple as modifying your diet may lend towards a better health for you physically, but you may be surprised at how it may have impacted your brain chemistry as well.” David Antonuccio, PhD, Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine: “When you exercise, you're doing something to your body, medically, biologically. When you eat something, you're having an impact on your body. In fact, some people might argue that these psychological treatments I’m speaking of are actually biological treatments--they have an impact on the brain and every organ in your body, quite honestly.” Jacob Hess, PhD, Cofounder, All of Life: “I got out of the habit of exercising recently. And for me, when I get up to go running in the morning after I haven't done it for a while, my body screams at me, ‘No! No! I do not want to do this.’ But if I keep doing it--going to the gym, playing basketball--after a certain amount of time, my body starts to shape with it, shape to it. It starts to mold to my efforts. All the research now on what exercise does to the brain--the brain, and the hormones, and the physiological system--starts to mold to what I’m doing.” Wherever you direct your energies, it’s important to remember that the body doesn’t change easily. Deep, lasting recovery takes time. Rick Hanson, PhD, Neuropsychologist: “People generally appreciate that the stream of causes, the factors, the forces that determine whether a business is successful or not, or guide a river in a certain direction...they understand that if you’re going to change the direction of that river you’ve got to do some serious work. The brain, and therefore the mind, is much the same way. Very powerful forces are in play inside the brain, which really means they're in play in the nervous system all together, and they’re in play in other systems in the body. The immune system is very involved in mood disorders and anxiety. Cardiovascular system gets involved. Gastrointestinal system gets involved. Musculoskeletal system gets involved. Hormonal systems really get involved as well. These are very powerful tributaries, if you will, of streams flowing into the mighty river of someone’s, let’s say, eating disorder, or clinical depression, or OCD, or other kinds of anxiety disorders, or serious addiction to drugs or alcohol. It’s na?ve to think we’re going to change those rivers, if you will, or that particular river of causes that’s leading to that illness, or that cluster of symptoms, to be sure, without making serious effort.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “Sometimes we go six steps backward, then we go four forward, and we have a chance to do things over, we have a chance to learn and then to keep moving, and the path is the goal. Because sometimes we can try as hard as we possibly can, and despite our efforts, things don’t seem to go our way. But in the background, as we do this work, progress is being made—even though it might not be obvious. And as we tune in a little more, the subtle progressions become more obvious. We don't bite off the whole thing at once, we take it one step at a time, one moment at a time, one breathe at a time.” Tom McConkie, Cofounder, All of Life: [*Life conditions naturally changed for me, as I got out of high school, moved to college, moved away from home—I really discovered the joy of learning when I moved away from home, finally moved away from the treacherous path of adolescence.] “Life just naturally presented new conditions to me that didn’t seem to fit anywhere with my concept of what it means to be a depressed person, or an anxious person. I was starting to feel a lot of happiness come into my life, I was starting to feel a lot of freedom, and a lot of focus. It wasn't this kind of awakening to ‘I'm not depressed any more,’ and ‘my attention is fine,’ and ‘I’m not as anxious as I used to be’--it was more day by day, just incrementally changing, moving in the direction of my life that was calling to me, and waking up to more of who I was.” And there you have it, All of Life! You made it to the end. Now all you have left is your own life ahead of you....Oh yes, and there's some concluding words from us. Check out the “Finishing Up” section for some concluding thoughts! REVIEW: If lots of things contribute to mental/emotional distress, then maybe there are also lots of things to do about it! Whatever the problem, then, there are likely a range of ways to respond. Small changes can turn out to be BIG! The End? ...or the Beginning? QUOTES NOT FOUND IN THE LESSON 15 VIDEOS: Willa J. Casstevens, PhD, Department of Social Work, North Carolina State University: “I worked...in community mental health settings with folks who had been given…severe and persistently mentally ill diagnoses....In many cases, after the first or second breakdown, the family wants to get back to business as usual. And the understanding that business as usual was not working is not there--but it needs to be.” Judith E. Pentz, MD, psychiatrist: [*There needs to be some desire within them to make a change given what’s going on for them].... “I had a person in crisis in my office yesterday who said, just give me a pill, I don’t want to change anything else....there are certain lifestyle changes she’s refusing to make choices about, including simply taking a walk every day. That she refuses to do.” Nikki Preece, Clinical Director, Alpine Academy: “So with one young woman that I am working with...She had significant clinical depression and anxiety that was manifesting in ways that she had a strong addiction to pornography and really looking at graphic and really disturbing pornography. She is playing with 50 hours a week of video games. She has really little social life and connecting with other people. Her parents are really worried...It is really evident that the way she saw her brain or the way that she could change was really minimal and very limited. So I started to share stories with her about neuroplasticity and about these people who can do radical change. She began to lighten up and say, ‘Really?’ And at one point, I feel as if I do all the talking. I want to hear from you. No I wanna hear more of this...At one point she asked, ‘So Nicky, do you think I can change like that. Do you think I could make that?’...And then we really had a serious discussion about the things that she had already been engaging in was changing her brain. This intensive addiction to pornography is actually rewiring her sexual drive and redoing how she is feeling sexual stimulation and attraction from other people. The intensive video gaming is rewiring her brain and pleasure system. In fact, she finds little pleasure in sitting and being. So we talked about neuroplasticity is in both ends. And if we engage these certain behaviors and patterns that we will in fact wire our brain in a certain way...If you are doing behavior that is destructive or maladaptive or harmful or dangerous that become such habitual parts of your mode of operation. Then could we change that. As we compare and contrast that, she got really animated, and yes we could. And we talked about what would that bring to your life if we could change these things and what would that mean? It was such a fun exciting thing to be with her. She is encountering this new way of thinking, at looking at the brain, and looking at life. That night, she left our session and I got an email from her mom that started with thank you. The girl came home and was so excited and showed her mom what we talked about. And her mom said it was the first time she had seen her so hopeful and see her brightness – of moving forward. And it was exciting for me to be a part of that.”Even when we sense it might be best, a deeper change can be challenging to make. Mark Foster, D.O., Family Physician: “I'm a family physician...if someone's coming to me in distress and I want to help them--what's the best thing I can do to help them?...Fortunately, there are a lot of things to offer them... spending another 5 minutes to help them start an exercise program--and following up with them in a couple of weeks....it's been studied...it's safe, it's effective, it has so many other benefits beyond your mental health--for your physical health...nutrition--we eat so poorly in this country and it takes a toll on our mental health. Those aren't easy fixes...but if you can help someone make that change, they're going to be so much better. and encouraging them...saying 'this is something that is within your realm of influence.'...”Even with good support, this kind of change can be easier said than done. Interestingly enough, these deeper answers sometimes involve a series of smaller steps. More often, there are many smaller adjustments that can also move someone to a better place. Woman #3: “This has been a process...of learning what happened to me, what did I need to get out of, what was lacking...and what is healthy or not healthy.” Man #2: “I have found from my own experience that a little bit of everything helps--a little bit of nutrition, a little bit of spiritual practice...meditation, you know, spiritual practice--whatever that turns out to be, it's a little different for everybody--I don't have just one thing that I do, it's very dynamic--a little bit of everything besides what we're being told is needed--and that has done very well for me.”Laura Delano, Mental Health Peer Specialist: “I didn't have any respect for myself--and I had a really hard time thinking I deserved to take care of myself....diet, nutrition, exercise, sleep...to know I can shape the way I feel based on what I eat and exercise and how much sleep I get... that's very empowering to me.” Marcia Lee, Educational Trainer: “If you stand up--just do that, one kind of motion--you will literally switch on 10-15% more of your brain. You're going to get more oxygen, more blood-flow to your brain, and it will become more activated--children naturally want to move. They use movement to create growth and balance. So the basic neuroscience behind this is, we need oxygen, blood-flow and glucose to keep our brain (especially for a child) as active as possible. So the natural thing is that a child is going to want to move...when they move, they're going to use that movement to balance their body naturally.... They need that...they need the movement. In Norway, they spend 45 minutes--this is every child--on instruction. And 15 minutes, on moving. They use physical movement--they get those kids moving. And they've got some of the highest test scores in the world. It's such a natural, simple kind of thing.”Megan Cowan, Mindful Schools: “If you have a lot of kids whose nervous systems are really revved up either from stress or worry, worried that they won’t do well in school, or they feel like they can’t pay attention or they just came in from recess and everybody’s kind of crazy, if you have these nervous systems that are really revved up, it’s going to be really hard to put more information in their system....But if you can do mindfulness and just let everybody’s nervous system relax, get everybody back into their body, let everything settled in, then there’s a learning environment where you can start to add more...And there’s different ways that kids can be taught to regulate. And some of that is natural, like I said, if we are outside playing for a few hours each day. There’s a regulation that’s inspired by nature just by being outside in the elements, and with trees. And there is something kind of grounding about that can be very regulating for our nervous system.” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “I had another spike in anxiety...new life, changing homes, getting married, a lot of change—and I had another spike. So the situation got big and more stressors than used to, I flipped my lid a little bit, but knew where to go—I knew I needed to make some deep changes…look at my job, how we're leading life with our daughter, what could be balanced more?” “It is revealing and distressing to compare the cognitive effects of the Internet with those of an earlier information technology, the printed book. Whereas the Internet scatters our attention, the book focuses it. Unlike the screen, the page promotes contemplativeness. Reading a long sequence of pages helps us develop a rare kind of mental discipline. . . .We have to forge or strengthen the neural links needed to counter our instinctive distractedness, thereby gaining greater control over our attention and our mind.” --(Carr)Judith E. Pentz, MD, psychiatrist: “There was another patient of mine that was really struggling...She came in basically saying 'Fix me, give me the answers and tell me where I need to go and what needs to happen.' [*Tell me what to do now!] I said, 'I can’t do that for you.'”... [*I said I could make suggestions to her, that she could make changes, and she still was very resistant and did decide to go home]...”I couldn’t fix her, her therapist couldn’t fix her, her mother couldn’t fix her, she had to make a choice about getting better…” [*I said, 'There were many things that we talked about that you needed to do to change, it’s your decision about what you want to do.']...“She came back a couple weeks later and she sat there with a lot of exasperation...I asked her what was going on; this was about two weeks later. She said, ‘I reduced my smoking, I switched to the patch, I’m making better food choices and I started walking, I am going to bed on time. I am not over-eating.' I said, ‘You sound upset about this--what’s the problem?’ And she said, ‘I’m feeling better! I made choices to not make the food choices I was making, and to stop smoking, and really was quite amazed at how much better I felt. That was so surprising for me.’” Vicki Overfelt, Mindfulness-based Stress Reduction Teacher: “There's so much potential, and I know that's a shift in perspective, and I know it’s hard to come to that when you're feeling depressed or anxious. I think there's maybe a difference between intention and goal—a goal to me feels cut and dried, that if I don’t achieve the goal exactly...whereas, thinking of things as a path—where you are taking a step, as you step you learn...every day, set intention to the best of our ability to become well. So wellness is a moving target, it changes day to day, but we know the general direction we’re moving in.” “In our lives…we experience constantly the changing nature of mind and body and of the outer world. We experience periods of light and dark, vivid color and drab dullness. We experience storms of varying intensity and violence, in the outer world and in our own lives and minds. Buffeted by high winds, by cold and rain, we endure periods of darkness and pain as well as savoring moments of joy and uplift. Even our appearance changes constantly, just like the mountain’s… Invite yourself to become a breathing mountain, unwavering in your stillness, completely what you are—beyond words and thought, a centered, rooted, unmoving presence.” --Jon Kabat-Zinn, Wherever You Go, There You Are, 1994, p. 137When the anxiety, the sadness, the crazy thoughts hit you—how do you usually feel? How do you typically respond? *****We've said a lot in this class about problems with trying to make things go away. It's very important we are very clear about something else: Sometimes we need to just do whatever we need to do to be okay and hold on now. We are not opposed to people doing whatever they need to make the pain go away for awhile. This includes taking medication. We respect their space and need to do that--and encourage people to work with their doctors in making decisions. When things let up, we can remember the deeper and more enduring change we seek. *****CLASS CONCLUSION: If it’s true that many things contribute to mental and emotional distress, then the good news is there’s lots of things we can start to look at adjusting that might make a difference. In the previous Lesson 14, we referred you to several vulnerability questionnaires we’ve developed for depression and ADHD that help someone explore the particular risk factors in their situation. Other inventories are in development for Postpartum Depression, Anxiety, Bipolar Disorder, and Schizophrenia. Once we pay attention to the variety of contributors to mental and emotional distress, we can begin to create our own “wellness action plan” -- a unique and comprehensive plan specific to our personal or family (or child’s) situation that includes any adjustment that feels important for us to consider. If you’re interested in doing that, here are some basic steps to consider: (1) Review and inventory anything that might be contributing to you or your child’s current mental or emotional state. This can include hunches you’ve had, as well as issues that other professionals or family members may have brought up. If you’re facing depression or ADHD, one of our vulnerability inventories mentioned in the last lesson may be helpful. (2) Once you have a list of all the potential contributors in your situation, it’s time to lay out a plan. Take out two pieces of paper, labeling one “Short-term plan” and the other “Long-term plan.” For your short-term plan, sketch out anything that feels important to do in the next three months. Just like you would do if you had the flu, your short-term plan should include any special self-care that needs to happen immediately. If not chicken noodle soup and lots of rest, what is the equivalent for mental and emotional distress--is there anything you or your loved one needs NOW that could really help decrease the stress of this experience and begin to stimulate healing? Trust your gut on these plans. Write items that come to you -- and put them in the place that feels right (short or long-term). Keep these papers close to you in case other ideas come to you, or if others you trust have good suggestions. In these suggestions, we thank Mary Ellen Copeland for her pioneering work in developing what she calls “Wellness Recovery Action Plans.” For the long-term plan, then list actions that feel important to put into place later on--but not necessarily over the next couple of months. This longer-term plan is about achieving a sustainable and stable wellness over time. (3) As you begin to put your plans into place, be willing to improve and upgrade them over time -- even as you “stick with” what feels important to practice and change. Get others you love and trust involved -- including family members, and professionals who are supporting you. Let us know how it goes! We’d love to hear about your experience. If you’ve enjoyed what you’ve learned here, we would appreciate your considering a donation to our non-profit. GLOSSARYAcceptance: This term comes up several times in the last half of the class. For our purposes here, acceptance is a gentle, self-compassionate, non-judgmental stance on our experience -- whatever it is, even if it’s painful. This is not the same as resignation to these experiences, but instead, a genuine opening and welcoming to what is coming up. Awareness: A fundamental state underlying thought, emotion and experience -- from which thought, emotion and experience can be observed. Jon Kabat-Zinn calls awareness our “birthright” -- and yet something most of us forget we even possess. In mindfulness practice, we cultivate our awareness of awareness and begin to connect with and inhabit it more fully and more consciously. Awareness of breath meditation: The breath is a common anchor for many kinds of meditation. Among the many types of meditation, this particular type invites people to practice focusing attention on the breath itself. When attention becomes distracted by other things -- thoughts, sounds, memories -- the invitation is to gently escort attention back to the breath. Chronicity: Chronicity refers to the duration or length of any experience -- in this case, the duration of mental or emotional distress. It has become more common to see serious mental or emotional illness as lasting for the duration of someone’s life -- rather than for a bounded time period (see “episodic illness”). Depressogenic: “Gen” refers to something that produces, stimulates the production of, or induces -- as in a “carcinogen” being something that contributes to cancer. In the same sense, something “depressogenic” is incubating or contributing to the formation of depressive mood or depression itself. Addis and Martel argue that the entire American society has become “depressogenic” -- incubating across many elements of the larger culture, painful mental and emotional distress. Ecological approach: A basic premise of the ecological approach is that no single factor is responsible for the complex phenomena of the natural world. In psychology, ecological systems theory was elaborated by Urie Bronfenbrenner -- calling for attention to multiple, interacting levels underlying any given experience. Episodic illness: Compared with illness that is permanent or life-long, an episodic illness is one which last only for a bounded time-period. In other words, the people with the illness get better. First-episode patients: Someone who experiences an illness for the first time is called a “first-episode” case -- in contrast to someone “chronic” who has faced the recurring illness for a period of time. Meditation: Meditation is a practice of concentrated focus upon a sound, object, visualization, the breath, movement, or attention itself in order to increase awareness of the present moment, reduce stress, promote relaxation, and enhance personal growth. Mindfulness: Mindfulness could be thought of as the gentle effort to be continuously present with experience. Moral therapy: Moral treatment developed in the context of the Enlightenment and its focus on social welfare and individual rights. At the start of the 18th century, the “insane” were typically viewed as wild animals who had lost their reason. They were not held morally responsible but were subject to scorn and ridicule by the public, sometimes kept in madhouses in appalling conditions, often in chains and neglected for years, or subjected to numerous tortuous “treatments” including whipping, beating, bloodletting, shocking, starvation, irritant chemicals, and isolation. By contrast, founders of moral treatment called for bans on the use of chains and the minimization of the use of physical restraints. In the late 18th century and early 19th century, Philippe Pinel in France, William Tuke in England, and Dorthea Dix in the U.S. began advocating for giving patients more freedom,in sunny, well-ventilated rooms -- with regular schedules and gentle attention from kind attendants. The moral treatment movement is widely seen as influencing psychiatric practice up to the present day, including specifically therapeutic communities, occupational therapy, and Soteria houses. The recovery movement today also reflects themes of moral treatment. Neuronal networks: Individual brain cells are called neurons. Like most humans, neurons don’t like to live alone -- so they interlink and glom together in a vast, complex network that allows them to communicate with each other and guide the processes in our body. When the brain changes, it is neural networks that are shifting, expanding and growing. Neuroplasticity: “Neuro” = brain. “Plasticity” = changeable. This fancy word captures the major discovery of the last two decades in brain research -- and one of the most exciting discoveries in any science -- namely, that the adult brain continues changing throughout the lifespan! This means its limits and its consequences are the exciting questions being answered right now by researchers and society as a whole. Neuroscientists: “Neuro” = brain. “Scientists” = smart folks. They deal with the anatomy, physiology, biochemistry, or molecular biology of nerves and nervous tissue and especially with their relation to behavior and learning. Want to have some serious fun on a weekend? Find a neuroscientist and have him/her tell you about the work they do. Fab! Okayness: A state of deep well-being that can be found even in the middle of profound emotional or physical pain. A reflection of the underlying wholeness that awareness itself is appreciated as having. Research cohort: This refers to a group of people who participate in a study. Resilient: Describing someone with the ability to become strong, healthy, or successful again after something bad or traumatic happens, or after a period of illness. Resistance: The refusal to accept something new or different -- or an effort made to stop or to fight against someone or something. Rumination: Ruminating is like a record that’s stuck and keeps repeating the same lyrics. It’s replaying an argument with a friend in your mind. It’s retracing past mistakes. When people ruminate, they over-think or obsess about situations or life events, such as work or relationships. Research has shown that rumination is associated with a variety of negative consequences, including depression, anxiety, post-traumatic stress disorder, binge-drinking and binge-eating. Still quiet place: This is a term Dr. Amy Saltzman uses to refer to the still awareness deeper than emotion or thought -- a place underlying all of experience. Stimulus and response: A stimulus is something that incites, arouses, or quickens action, feeling or thought. A response is the actual reaction taken to that stimulating force. Thinking stream: Once we come to see our thoughts as discrete (distinct or separate) mental events, we can pay attention to the succession of events -- one after another. The naturally changing stream of thoughts is sometimes compared to a river or a stream. Thorazine: Considered a breakthrough medication, Thorazine (chlorpromazine) secured FDA approval on March 26, 1954 as the first psychiatric medication. By 1964, about 50 million people worldwide had taken it. Its commercial success stimulated the development of other psychotropic drugs (drugs capable of affecting the mind, emotions, and behavior). In this way, Thorazine was instrumental in the development of neuropsychopharmacology, a new discipline dedicated to the study of mental pathology with the employment of centrally acting drugs. Voice hearing: This refers to hearing voices that do not correspond to anything in the surrounding, objective world. There is growing awareness and evidence that this experience is natural and workable. ................
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