Given these times, navigating chaos is now more important than ever…

Like the rest of the natural world, embodied BEing as opposed to disembodied DOing, requires a delicate balance of chaos and order.  When BEing authentic, we lack self-consciousness (the insecurity that fuels incongruent displays), enabling inspired doing to flow from abundance.  We know we are in this abundant BEing state when the reward overshadows the effort.  Many refer to this BEing state as natural flow. This is us as human BEings. 

Relating to resiliency, with deeper personal roots, we feel secure, trusting that our environmental and relational contexts are adequate to navigate passing challenges.  Because we are securely planted, we have a strong sense of place in the world.  We interweave with others, giving in times of abundance and receiving in times of need. We have an abundance of fruits and foliage to navigate the external conditions and more than enough to happily contribute to those with fewer resources.  

Too much order happens when we predominantly act out of the left side of the brain.  From here, we fall into frustrated perfectionism, losing our power to a set of idealistic rules that we feel beholden to.  From this state of disconnected attachment to external conditions, we fixate on DOing. When we prioritize the opinions of others over our needs and values, we lack creativity, adaptability, and heartfelt meaning.  As a result of this growing incongruence, we carry shame, causing a chronic form of stress that fuels ‘freezing’ and ‘fleeing.’ From this place of fear and scarcity growth is limited, and we become prone to stagnation. 

Too much chaos happens when we predominantly act out of the right side of the brain.  From here, we lose control as we frantically and fearfully move from one moment to the next, lost in a state of unconscious reacting to the fires of the moment.  The space we need to drop into the inner world to stay grounded is chewed up by a barrage of distracting external stimuli.  When in extreme chaos, we lose the felt sense of our grounding and security in the world, causing the nervous system to divert our energy to ‘fight’ for our life.  From this place of fear and scarcity, growth is very limited (if not impossible), and we become prone to emotional and nervous system breakdown. 

Living in complexity, a natural state of flow, happens when we find our unique balance of order and chaos.  BEing human requires a certain degree of security in one’s inner and outer resources, which enables us to trust in the various interacting parts of life, all synchronizing in an ordered fashion.  It requires a trust in the natural order that unfolds when we act congruently in the world.  We develop this trust by practicing authentic self-expression in relationships that can provide compassionate witnessing (unconditional positive regard).  In this state of complexity, how we feel and what is important to us manifests in the world through this authentic expression.  Because we are not self-conscious or tending to incongruent display we think others need from us, our days roll by relatively effortlessly, fuelled with heartfelt meaning and connection.  From this place of abundance, growth is maximized as we naturally synchronize with our environment.

Depending on our nature and the nervous system’s window of tolerance for uncertainty, we all have varying preferences.  Some prefer living on the edge of chaos, leaning into the inspiration that flows from this freer way of being.  Others prefer living with more order, finding pleasure in consistent routines that provide frequent grounding opportunities and clearer direction.  We find our place on the order-chaos spectrum by paying attention to the expansion and contractions of the body.  When we are out of balance, the body gets activated, which acts as our internal alert system.    This is our cue!  When alerted, we have an opportunity to get curious.  When we engage curiosity, we become an objective observer because the very thing we are observer is now a distinct ‘other.’ With this space between the observer and the felt sense, the intense threat lessens, enabling the root motion to be felt and tended to.  

One felt moment at a time, one compassionate act at a time, we find our way back to balance. 

“If you don’t like something, change it. If you can’t change it, change your attitude” (Maya Angelou). 

When we operate with a higher sense of coherence we are feeling into our agency (confidence in who we are and what we have), making us more able to optimistically re-orient ourselves, so we can navigate challenges from an inspired, creative, and embodied state of being.  Those that tend to this empowered form of optimism have significantly less stress than those who do not (Troy, 2015).   When we strategically use optimism to reframe our situation, we reduce our stress levels and lower our risk of developing a host of chronic health conditions (Aldao, et al., 2010). People who are more optimistic tend to live 11 to 15% longer than those who aren’t (Lee et al., 2019).   

Strategic optimism is not helpful if it causes us to accept painful circumstances that are in our power to change or if we use it to avoid feeling difficult emotions.  In fact, if we use optimism in this way, we may miss opportunities to tend to a wound that needs healing or to make changes that would benefit ourselves and others.   Using the R.A.I.N acronym (Brach, 2013), recognizing, allowing, investigating, and nurturing difficult emotions is the first step. Recognizing our emotions and perception(s) of the situation allows us to gain awareness of our reaction. Allowance engages the self-compassion required to make a space to feel (because we are worthy of such expression!).  From this compassionate space, we lean in with curiosity, eager to investigate, to learn more. Part of investigating is determining what we can change and control.  After tending to necessary emotions, it is then most helpful to take a significant action, which acts as the release port, relieving us of the suffering that flows from feeling incongruence.   By doing the significant thing, we build trust with ourselves as our spirit tends to the signals of the body, demonstrating to ourselves that we are worthy of such a significant effort.  In this way, we are prioritizing our wants and needs over those prescribed onto us by others.  Eventually, as we continue to do the significant thing, we deepen into secure attachment, which promotes a greater sense of coherence and congruence. If we cannot make a change to reduce our suffering, this is the time to accept, grieve the loss and optimistically resource and re-orient ourselves to the situation.  

The significant thing is different for every person and dependant on the situation and the unresolved wounds that it intertwines with.  Awareness of the significant thing comes from an embodied way of knowing (intuition), rather than the ‘figuring it out’ mind. It is the thing that takes the most self-compassion and courage, which requires the meaning of the significant action to overshadow the fear of taking it.  While we may fear doing to do the significant thing, often desperately trying to compensate by doing several other things in its place, ultimately, we will continue to feel out of tune until we act.  Finally, the significant thing if often subtle and may not directly involve others at all. It may involve writing a letter and then burning it.  It may mean making a phone call to make something right, enabling us to tune back into our sense of self-integrity after a violation (to self or others) occurs. 

The Significant Thing & Common Attachment Antidotes 

For those who tend toward avoidance as a reactionary (not intentional) coping strategy, the antidote to clear the incongruent feeling, typically manifesting as anxiety, is often a ‘reaching out.’ For those who tend toward anxious attachment to others as a coping strategy, the antidote often involves ‘reaching in.’ 

Working with our Negative Bias  

Optimism does not happen by merely thinking positive thoughts.  For it to be effective, we must intentionally immerse in a positive emotional state that enables us to shift our trajectory.  Once we embody a more positive state of being, we interrupt the fear and powerlessness associated with the stress response, which enables us to keep things in a more optimistic perspective.   

Most humans tend toward a negative bias, which means that when negative things happen, they have a greater impact on us and linger longer in our memory than positive ones (Gollan et al., 2016). While negative bias may help us when we are in danger, it is not so helpful when faced with day to day challenges.  To manage and even counter our tendency toward the negative, we need to consciously cultivate a more optimistic orientation.  To develop optimism, it requires a conscious effort to recognize when positive events happen and to take the time to immerse ourselves in the felt sense of them.  In time and with some effort, we can retrain our brains to automatically take notice of positive happenings in our day, balancing out our tendency toward the negative.    

“When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us” (Helen Keller, 1929). 

One moment at a time, one significant thing at a time, this is how we heal… 

By S.Dames and K.Hunter

They came upon the Cedar tree. It showed them the breadth of their centre and the strength and limitations of their shallow root systems.  While their resources span widely on the surface, when the drought and winds come, they feel fragile, wondering if they’re enough, if they have what it takes to survive the elements.

They came upon the Arbutus tree. It showed them their whimsical nature and the power of their magic.  Sprouting up like a fairy amid a forest of sameness. This is how they learned to embrace their uniqueness.  That a sprinkle of magic is exactly the medicine to transform their grief and shame.

They came upon the Maple tree. The fairy of the forest swayed before them, its tentacles reach joyfully to the sky, wrapped in an elegant moss jacket and bursting with foliage. This is how they learned to embrace their lightness, enabling them to dance with the fluidity of life. 

They came upon the Fir tree.  It struck them with its plainness. Its long thin trunk moving efficiently to the sky, wasting no time expanding on the surface.  This is a being that knows who it is, deeply rooted and resilient with nothing to prove.

They came upon the oak tree, all gnarled and alone, sending out seeds on the wind, trusting that only by falling to the darkness below could they sprout and live anew. 

They came upon the fallen tree, decaying and covered in moss, reverent at being the source from which new life will come.

And so they’ve come to learn that they too can feel messy, magic, stable, powerful, complex, basic and boring, carved out and teaming with life. That when embraced, they are the compost encouraging deeper roots and the seed from which new life springs…

I’m on this path. I’ve experienced this bliss. I know it’s possible…

When adversities from the past are emotionally unresolved, they remain with us, emerging as what we now call ‘trauma.’ When we heal these wounds, we remove the emotional charge from the associated people and events.  Without the emotional charge, the experience is simply a learning opportunity that cultivates depth, insight, and wisdom.  

Like a storm encourages deeper tree roots, when on a healing path, so too do past adversities encourage a more resilient constitution on the other side. Healing is the redemptive path, the re-writing of an old (and often painful) story from a place of genuine abundance.
 
Those of us who have spent a lifetime carrying around heavy emotional loads (trauma) experience great bliss when we develop the choice to lay it down (a product of healing).  This bliss carries us through the minor annoyances of life. It is the gift awaiting those who’ve spent a lifetime carrying a heavy load. This experience is so powerful that without any efforting at all, it accelerates the healing of others who continue to suffer beneath the weight of past adversities, and to a more conscious and compassionate human race. 
 
Let’s help each other put the loads down.  It serves everyone and it’s well worth the journey.

This mental health crisis is real and the stakes are higher than ever. By the age of 40, half of us resonate with a mental health diagnosis. Only 20% of those suffering from mental distress see any meaningful improvement with traditional biomedical treatment methods. 80% continue to suffer. It’s time to heed the evidence and shift beyond the outdated belief systems that keep us mired in ineffective mental health treatment methods. Dr. Crosbie Watler, a thought leader with decades of experience as a psychiatrist and mental health advocate, issues a call to action!

The Failed Promise of Modern Psychiatry

by Dr. Crosbie Watler, MD, FRCPC

The last decade of the twentieth century was a heady time for modern psychiatry.  Fluoxetine was released in the in the mid 80’s and many other so-called anti-depressants followed on its heels.  Though never proven, we touted the neurotransmitter deficit model for depression and truly believed that we were on the threshold of a major breakthrough in psychiatry and neuroscience.  In our collective excitement, we dubbed the 1990’s “The Decade of the Brain.” 

Fast forward to present day.  Despite widespread and often indiscriminate prescribing, on a per capita basis, there are far more persons off work on disability for anxiety and depressive related disorders than ever before.  The increase continues and is exponential.

There are two myths at play that serve to perpetuate the status quo.  First, is the myth of diagnosis in psychiatry.  In other areas of medicine, a diagnosis is a discrete, objectively verifiable condition.  There remain many symptom clusters that fail to meet this standard.  Lacking objective tests—much less treatments—the rest of medicine classifies these conditions as syndromes. 

Examples of common syndromes include Chronic Fatigue Syndrome and Irritable Bowel Syndrome.  In a desperate attempt to enhance the prestige of psychiatry—and as a requirement for billing the HMO’s in the US—the APA’s Diagnostic and Statistical Manual incorporates more diagnoses with each edition.  The belief that psychiatric diagnoses are defined constructs, on par with other areas of medicine, is the myth at the core of modern psychiatric practice.  Simply calling something a disorder, does not make it real (Joel Paris).

The image of a group of endocrinologists debating whether Type 1 diabetes should be a legitimate diagnosis is laughable, yet this is precisely how psychiatric “diagnoses” are minted.  If something is objectively real, we don’t debate its existence, and what was truth does not simply become untruth with the next edition of DSM.  The DSM committee meetings provide forums for so-called experts to lobby for their pet “diagnoses”, ones they feel comfortable treating and ones that will enhance their credibility and prestige. 

Further, if these diagnoses were real and credible, then why do psychiatrists so commonly disagree among themselves?  It is common to hear reference made to a psychiatrist’s particular “style.”  One psychiatrist’s Borderline Personality Disorder is another’s Bipolar Type 2, with entirely different treatment protocols. 

Lacking consensus on diagnosis, it is no surprise that the trajectory of psychiatric patient care is highly variable, depending on the bias of the treating psychiatrist.  Highly variable production systems operate at the expense of quality.  And who bears the cost of a highly variable system of care?  Certainly not the treating physician.  Most physicians are paid for face time, not for outcome.  This is akin to a contractor coming to your home and being paid for simply showing up. 

If strike one—so to speak—is that our diagnoses are syndromes, then strike two is that our medical treatments lack efficacy.  Given that we truly have no idea what we are treating in the first place, this should not come as a surprise!   An embarrassing and rarely mentioned statistic, is that our so-called antidepressants barely separate from placebo.  Further, we’ve since learned that many negative studies were simply mothballed (Lancet, 2012). 

What is truly incredible is that these medicines are still being marketed as anti anything.  If our antidepressants and antipsychotics lived up to their lofty promise, most psychiatrists would be out of work and the “treatment resistant” patients clogging our inpatient and tertiary care units would be promptly discharged.  This, of course, is not the case.  

Unfortunately, the public continues to drink from the punch bowl still being served by mainstream psychiatry.  How many times have you heard a friend recounting a visit to the doctor?

“The doctor says I have a brain disease called Major Depressive Disorder.  There is not enough serotonin in my brain, apparently.  He started me on Cipralex.”

Two months later you ask how she’s doing.

“Oh that medication didn’t work very well, I’m still off work.  My doctor added a second medication, Wellbutrin to ‘boost’ the first one, plus I’m on something to help me sleep…insomnia is a side effect of Wellbutrin.”

Two months later your friend stops by for a visit.

“My doctor thinks the reason my medications aren’t working is that I might have Bipolar Disorder.  He says there’s a ‘soft’ type that’s increasingly diagnosed these days.  He added a mood stabilizer.  I’m on four meds now and still off work.  I’m starting to lose hope.”

The above is played out countless times, day in and day out.  As a boomer psychiatrist, trained in the era of “biological psychiatry,” I soon realized that we were not healing patients in any substantive way with our medications.  We are creating life-long mental health care consumers.

We prescribe mediocre treatments for phantom conditions.  We cling desperately to the cloak of expertise and knowingness.  We have become less interested in the complex personal stories that might explain a patient’s suffering and inform non-pharmaceutical approaches.  We are quick to identify “disorder”, when the patient’s challenge might be a natural and logical downstream manifestation of upstream and primary causes.  This, to be fair, is a criticism that applies to other areas of medicine.

The conventional medical paradigm is rooted in the principle of specificity—a specific treatment for each discrete disease.  In common parlance, a pill for every ill. We are in an era of increasingly specialized medicine, where the physician puts his or her organ of choice on a pedestal, often treating the downstream symptoms as the primary condition.  When this fails—as it commonly does—psychiatrists often resort to desperate and toxic poly-pharmacy. 

Such prescribing is often the result of therapeutic despair on the part of the treating physician.  When a patient does not respond to treatment—and with physician’s ego on the chopping block—the doctor is desperate to do something, anything.  It seems that uninformed action is deemed somehow better than inaction. 

This demonstrates an all too familiar behavioural pattern and one not unique to the trades: when the only tool one has is a hammer, everything looks like a nail.  The hammer in this case is the prescription pad.  After many failed medication trials, the treating psychiatrist concludes that the problem lies with the patient, who is deemed treatment resistant.  The blame for treatment failure is projected onto the patient—they are treatment resistant. 

What of the possibility that we are simply using the wrong treatments?  Am we missing something?  Rarely are these questions at the table.  Curiosity and humility are simply thrown under the bus.  Above all, do no harm?  Also under the bus.  Despite all the claims for evidence-based and patient-centred care, the unavoidable and tragic conclusion is that the status quo works very well for the industry of care.  For the patients?  Not so much.

Much of what we do in clinical practice is simply “chasing smoke.”  We view the downstream symptoms as the primary condition.  Any first year medical student understands that fever is not a disease or disorder, it is a sign that there is something else amiss, something quite remote from the fever itself.  In medicine—and particularly in psychiatry—we often chase smoke. 

The majority of those labeled as depressed, are in fact distressed by the events in their lives and the stories they tell themselves about who they are.  Predictably, they fail to respond to our pharmacopeia.  Lost in the rush to increasingly specialized medicine, is the appreciation for the human organism as a whole.   We are the sum of our complex and interfacing systems, where symptoms in any one area might be secondary to remote upstream mediators.   The overarching clinical question then becomes, “Is this symptom the chicken or the egg?”

In our search for a better paradigm we might look to the wisdom of our ancient ancestors, from the Greeks, traditional Chinese, and yogi masters from thousands of years ago in India.  These teachings share the view that there is far more to us than meets the eye.  Am I my thoughts?  Is it as simple as, “I think, therefore I am?”  Who am I, really?  This question reflects our timeless quest for connection, identity, meaning and purpose. 

Connection with ourselves and with the world around us forms the bedrock of spritual health.  This new spirituality transcends specific religious affiliation and has spawned the phrase “spiritual but not religious.”  A holistic paradigm recognizes the importance of connectedness and is central to the Constitution of the WHO, wherein: “Health is a state of complete, physical, mental and social well-being and not merely the absence of disease or infirmity.”  Social well-being flows from a sense that we are connected with ourselves and with the world around us. 

The truth is, we were never evolved to live as we are.  We evolved to live in clans, with myriad connections to others, with each member having a purpose that supported the whole.  The price we’ve paid for the modern lifestyle, with all its conveniences and trappings of success, is profound disconnection.  There is a pandemic of distress and existential despair.  The boomers have chased happiness for decades.  Yet here we are.  Bigger cars, monster homes, extravagant vacations, on line shopping, cosmetic surgery… something, anything to make us happy. 

When our happiness remains elusive, we go to our doctor.  We are then given a simple checklist that confirms we are depressed.  Never mind that we really have no idea what depression is and its interface with normalcy.  Recognizing this dilemma, the ancient Greeks created a boundary between angst and melancholia.  Angst was a response to some life challenge and was inherent to normal human experience.  Melancholia was a distinct, profound and continuous depressive state that seemed independent of life circumstance. 

Until the 1980’s, a patient’s depressive complaints were classified as being either reactive or endogenous.  This parallels the ancient boundary between angst and melancholia.  Reactive depressive symptoms were much less likely to respond to medication and were referred for psychotherapy.  This important distinction was dropped from DSM 3 (1980).  We are entering the fifth decade of an ever-expanded and over-inclusive concept of mental disorders.  That this coincides with the introduction and aggressive marketing of novel “anti” depressants, is no coincidence.  We are in an era of medicalising distress, where most patients prescribed medications will fail to benefit (BMJ, 2013).  They will instead, exhaust themselves going down rabbit holes that are proven and guaranteed to fail.

Elements of a holistic model

We tend to see only what we are trained to see or are comfortable managing.  The decade of the brain has got us no closer to curing mental illness.  Over the past decade there has been a dramatic decrease in the release of new psychotropic medications.  It seems that even the pharmaceutical industry is throwing in the towel.  Tweaking brain receptors, split off from the organism as a whole, is simply barking up the wrong tree.  There is a better way. 

The body:

The benefit of movement and exercise for our mental and physical well-being is widely recognized.  We’re all familiar with the saying, “healthy body—healthy mind.”  A truly healthy body goes beyond the facade of one’s appearance or BMI.  Vital health is from the inside out. Central to this, is the mind-gut connection.  While the serotonin produced in the gut does not cross the blood-brain barrier, inflammatory cytokines certainly do, where they severely compromise serotonin turnover.  What triggers this inflammatory process?  We need look no further than the modern first-World lifestyle.  The standard American diet (SAD diet) is inflammatory.  The stress response is inflammatory. 

Food as medicine is not a new concept.  Hippocrates, considered by many to be the father of modern medicine, implored his patients: “Let food be thy medicine and medicine thy food.”  Beyond passing familiarity with our national food guides, which are obsolete even as revised versions are published, today’s doctors get little or no training in nutritional health.

How many psychiatrists do a food diary with their patients?  How many are aware that inflammation might be a significant perpetuating factor for a patient’s depressive symptoms, much less test for it?   How many are able to prescribe a specific nutrition plan that would support recovery and vital health?  Beyond being passive recipients of care, how many psychiatrists call on their patients to be active partners in their holistic recovery plan? My patients are consistently amazed that a psychiatrist is asking them what they eat and at being sent on their way with a lab requisition and a nutrition remediation plan.

The mind

If our brains can be compromised by processes external to the blood-brain barrier, is the reverse also true?  How do our thoughts and emotions impact our bodies?  Living in the first world, we are often in a state of heightened sympathetic tone—a state of fight, flight, or freeze.  This adaptation is deeply wired into our brains and served us well for most of our evolutionary history, where imminent threats to life or limb were not uncommon.  The threat would present itself, but once the threat was over—and if we survived—our nervous system would return to the restful state required for the body to heal and repair.

Fast forward to present day.  The threat is no longer the discrete and tangible tiger or rival tribesman.  Today’s threat comes from having the luxury to sit and think, or more accurately ruminate, about all the potential calamities that might come our way.  There is no such thing as stress, there is only the stress response to an external challenge.  Life is challenging, it does not have to be stressful—stress is a possibility. 

Stress is a reflexive protective response at the level of our limbic brain—more specifically, the amygdala.  In the absence of an objective threat to life or limb, the stress response is commonly triggered by the stories we tell ourselves—the so-called amygdala hijack (Goleman,1996).  While we might not completely eliminate the amygdala hijack, we can certainly influence what happens next.  Rather than simply being along for the ride, we can learn to pause, witness and reflect:  Am I using my brain, or is my brain using me (Tanzi & Chopra)?   We can redirect from thoughts that are not serving us, recognizing that there is no such thing as stress in the external world, there is only the stress we create in response to life’s daily challenges.

The stress response depletes the body in so many ways.  As is the case with the SAD diet, stress is inflammatory.  Chronic inflammation is an essential component of chronic diseases (Liu et al, 2017).   Beyond its potential negative impact on mood, high levels of inflammation are commonly seen with PTSD, along with a host of medical conditions including coronary heart disease, diabetes, cancer and dementia.  Stress compromises our immune response and in combination with our nutrient poor SAD diets, heightens our susceptibility to disease.   Even when not afflicted by a diagnosable illness, we feel depleted, lacking vital health. 

A common presenting complaint is the patient claiming to have anxiety, or beyond that, an anxiety disorder.  Generalized Anxiety Disorder is the diagnosis commonly applied.  Rather than invoking yet another disorder, we might explore whether the anxiety response is a natural and logical consequence of dwelling on contexts beyond our immediate control.  We don’t classify tennis elbow as a disease.  Tennis elbow is an overuse injury.  Anxiety could be reframed as an overuse injury—overuse of the mind.

If I have my hand on a hot element, I can take Tylenol for the pain, or I can take my hand off the element.  If I have anxiety, I can take Lorazepam, or I can learn Mindfulness Based Stress Reduction.  I can learn to meditate.  I can evolve, giving up patterns that no longer serve me.  I can take my power back, redirecting from worrying about outcomes I cannot directly control.  I can learn to quiet the mind, to think only when it serves me.  I can experience the healing that comes from alert thoughtlessness (Eckhart Tolle). 

The spirit:

Spirit—herein defined as connection—is identifying with something beyond the material world, the world of form of form (Deepak Chopra).  This connection has two poles—connection within (the intrapersonal) and without (the interpersonal).  We tend to be distracted by the noise around us, the external relationships.  We feel hurt or rebuffed when we perceive some narcissistic injury.  Brooding about about how others treat us, we fail to recognize that we are our own harshest critics.  We’ve incorporated so many messages, subtle and explicit.  We can’t even remember where the story came from, yet we keep telling it:

“I am not enough.”

“I am a failure.”

“If others really knew me, they wouldn’t like me.”

“I feel so guilty for my mistakes.”

“I hate myself.”

How is healing possible in such a toxic intrapersonal space?  It is not.  Without self-compassion, nothing else can take hold and flourish.  Not CBT, not the next antidepressant trial, not even the whole foods organic diet.  After almost three decades of psychiatric practice, I continue to be amazed by the prevalence of self-loathing.  In clinical practice, this is often the elephant in the room, akin to “Don’t ask, don’t tell.”  The patient is certainly not going to volunteer, “By the way doctor, I think you ought to know that I really hate myself.”  Conversely, the psychiatrist is unlikely to ask, “How do you feel about yourself.”  Lacking their own self-awareness, the psychiatrist would be very uncomfortable knowing how to respond in any helpful way to a patient’s intrapersonal despair.  

Fundamentally, most of us have no idea who we are.  How can we have compassion for something we don’t know?  Self-awareness is the foundation for self-compassion.  Our sense of self is highly conditioned.  We identify with our roles, relationships, successes and failures.  “I am a psychiatrist.”  No, I am not that.  Psychiatrist is a temporary role I play in the movie of My Life.  Who am I when I am not in that role?  Whatever handle we identify with, does it capture the essence of who we are, or is it something that can change?  If “I am a success,” then who am I when I fail? 

We have become so identified with the doing, that we’ve lost awareness of the being that is at our essence.  On the day of our birth we cannot avoid awareness of being.  There is no inner dialogue or story telling us who we are, or where we might me going.   Undistracted by the thought stream, we are immersed in the silent witnessing that is our essential nature.  This silent witnessing is central to the practice of meditation.  From the stillness of no mind, we are content and whole. We are freed from the insatiable quest for something to make us happy. 

Putting it all together

Radical change requires radical action.  Radical action is far-reaching and thorough—no stone is left unturned.  Our treatments fail not because our patients are treatment resistant.  Our treatments fail because they are not sufficiently radical.  We are a complex interface of biological, psychological, social, and spiritual components.  A radical intervention dictates treating all the components of health assertively and simultaneously.  In this context, a model reliant on simple symptom checklists as evidence for any primary disorder, is doomed to fail.  How could it be otherwise?

Dr. Crosbie Watler completed his MA at Lakehead University and worked in Atikokan and the Challenge Club in Kenora before going to Medical School at McMaster in 1988. He then proceeded to do his residency in psychiatry at Dalhousie University. Upon completion he then returned to Kenora from 1995 – 2001 and worked at Lake of the Woods District Hospital as Chief of Psychiatry. In 2001 Dr. Walter relocated to Duncan BC with his wife and their three children where he acted as the Medical Director for Island’s Health MHSU and the Dept. Head for Psychiatry. His medical practice required clinical expertise in multiple settings including, tertiary, inpatient, outpatient and ACT. Dr. Watler’s current interests focuses on incorporating the best of modern medicine with holistic/integrative health. Dr. Watler is an executive member of the Roots Program, forging new pathways to alleviate suffering related to mental distress.

Somatic intelligence refers to our degree of awareness and ability to interpret and respond to the sensations of the body (De Silva, 2017).  There are over 100 different bodily sensations, which are categorized as emotions, cognitive processes, or somatic and homeostatic states (Nummenmaa, Hari, Hietanen, & Glerean, 2018).  A core factor that differentiates humans from animals is an expanded consciousness, providing an awareness of the body, separate from the spirit that inhabits it.  Awareness of these sensations, coupled with the desire and confidence to respond, correlates with our somatic intelligence.

Nummenmaa et al. (2018) researched over 1000 participants to map out where the typical sensations are felt in the body. The illustration below is an excellent way to gain awareness and an ability to interpret and respond to the varying bodily signals.

When the spirit and body are securely attached (as described in the previous blog post),  we become inherently conscious and motivated to listen and tend to the sensations, desires, and concerns of the body.  This secure attachment is imperative to feel into our bodily sensations and navigate the stress response.  If we are not securely attached, and our ability to be aware of or respond to the body is hampered, we will continue to experience stress until we tend to the body’s concern.

Somatic intelligence refers to our degree of awareness and ability to interpret and respond to the sensations of the body (De Silva, 2017).  When the spirit and body are securely attached,  we Somatic intelligence refers to our degree of awareness and ability to interpret and respond to the sensations of the body (De Silva, 2017).  There are over 100 different bodily sensations, which are categorized as emotions, cognitive processes, or somatic and homeostatic states (Nummenmaa, Hari, Hietanen, & Glerean, 2018).  A core factor that differentiates humans from animals is an expanded consciousness, providing an awareness of the body, separate from the spirit that inhabits it.

When the spirit and body are securely attached,  we become inherently conscious and motivated to listen and tend to the desires and concerns of the body.  This secure attachment between the body and the spirit is imperative to navigate the stress response.  If we are not securely attached, and our ability to be aware of or respond to the body is hampered, we will continue to experience stress until we tend to the bodily concern.

To manage stress and the ripple effects it has on the body, we must first attain a degree of non-attachment. Non-attachment happens when we step back from the uncomfortable and often threatening sensations of the body, dis-identifying with them, so we can tend to them from a more objective and compassionate place. To do this, it is immensely helpful to develop the habit of talking to the body with unconditional positive regard, much like we would a dear friend. 

For the body to securely attach to the spirit it must believe it is unconditionally positively regarded. The ONLY way to come to believe it is regarded in this way is to test the relational container by being honest, showing up and speaking up authentically. When we do this with others and people respond by treating us as though we are inherently worthy, even if they do not agree with the opinions and behaviours that emerge on the surface, we gain trust and security in the relationship.

Much like testing the containers of our relationships with others is essential to believing we are unconditionally positively regarded by them, when emotional messengers present, the body is testing the relational container of the spirit. If we avoid, ignore, and will them to go away or BE something different, we continue to erode trust between the spirit and body and the messages persist, resulting in chronic anxiety, depression, and all sorts of unwanted behavioural projections.  The most unfortunate consequence of ignoring these felt senses is that we continue to promote a fracture between the body and spirit.  Conversely, when we respond with unconditional positive regard, receiving the emotional message like we would a welcome guest, the sensations don’t feel personal or threatening. Rather, it’s like sitting across the table with a dear friend, making space for them to share what’s on their heart, and providing the compassionate space for them to BE, FEEL, and soothe whatever arises in that moment.

When talking to a dear friend, we are clearly separate from them, they are an ‘other,’ which enables us to step back (non-attach). From this orientation, we don’t over identify with them, which prevents their experience from feeling threatening to us. Now, imagine your body and felt senses within are this dear friend. While they are welcome guests, they are ‘others,’ not essential to the spirit of who you are. As allies, they bring important information, feeling into and reporting on the subtle energies, premonitions, and incongruences that swirl within and around us. 

Each time we listen to the body, tending to the sensations and emotions that cue us, we promote secure attachment between the spirit and the body, healing the fracture that lies beneath our suffering. When you stop, notice, lean in and tend to your sensations and feelings you are expanding your awareness and practicing self-compassion, building trust with the body. In time and with practice, the body comes to believe it is unconditionally positively regarded by the spirit. When the body deeply believes it, secure attachment happens. When securely attached, the body and spirit reach homeostasis, awakening us to a new way of BEing, providing the equanimity and resulting peace that enable us to thrive.

Pause to Practice: Talking to your Body
When the body sends you a message, experienced as sensations and emotions, stop. Take a moment to notice what is happening, just notice. Lean in to really get a sense of it.  You might even ask your body what it needs and wants or what it is afraid of. Name what you are feeling. How would you describe it?

Notice how it feels when you put a name to what you are feeling. Is it a good fit? Does it need some adjustments?  Getting curious like this helps you step back (non-attach), keeping you from over identifying with the feeling. From this more objective orientation, you can hold space for the feeling, just like you would hold space for a friend who is sharing something important with you. 

Remember, for us to sustain any new beneficial practice, the felt reward must overshadow the felt effort (at least in general). How might you incorporate this new orientation in your day to day life?

This same orientation can help when conflict with others is activating the stress response.  If we can’t step back, we are likely to react with a harmful projection (directed inwardly or outwardly).  Next time you are in conflict and are feeling lost inside the stress response, how might you discuss the needs and wants of your body (and associated emotions, sensations) in a way that promotes non-attachment and self-compassion?

Interested in learning more and investing in your ability to securely attach? We partnered with Ladysmith Family and Friends to provide (FREE) virtual circles that promote unconditional positive regard and resiliency. Register by emailing Kate at: LaFFkateW@shaw.ca

Like trees, our roots intertwine amid a forest of others, enabling an opportunity to collectively resource, taking what we need in times of need and giving what we can in times of plenty. This pandemic represents an opportunity for humans around the world to come together to navigate a common challenge, mitigating this global threat before it becomes a chronic stressor.

Each of us has varying degrees of personal resiliency, reflected in the depth of our ‘roots’ systems. As a result, transient ‘weather’ systems will feel more threatening (stressful) to some than others. The ‘weather’ is the events, thoughts, and emotions that circle us, taking many forms, individually and globally.

In these rapidly changing and often chaotic situations, a common form of ‘weather’ is ambiguity. When ambiguity is high, it causes many of us to spiral into fear states that fester amid a sea of potentially threatening scenarios. Adding to the ambiguity, collective actions taken to navigate the potential threat can cause additional insecurity, and especially for those whose primary needs (food, shelter) are at risk. As a result, stress levels are high, which can lead to either chronic anxiety (sympathetic nervous system stuck on) or freeze, leaving us feeling disconnected and depressed (parasympathetic nervous system stuck on). By grounding collectively, as opposed to isolating individually, we are more likely to manage these common human challenges before they evolve into chronic stressors.

So…what does this look like?

On a practical level, at the risk of overcomplicating a complex topic, there are three evidence-informed qualities we can cultivate to promote personal and collective resilience in these collectively uncertain times:

1. According to Polyvagal theory (Porges, 2011), we are more likely to regulate our stress and confidently manage challenges when we feel securely connected to others. For instance, in a pandemic scenario, while physical distance may be a requirement, social distancing is not. In this age of technology, we can stay connected to others, despite our physical limitations.
2. To bolster sense of coherence (Antonovsky, 1979), we can expand our awareness of the plethora of inner and outer resources at our disposal. We can ground ourselves by taking an inventory of the structures (family, work, hobbies), assets (a safe place to live, food, warmth), activities (exercise, breathing, hobbies that bring joy), and relationships (those you feel safe to be authentic with) that help you feel resourced and secure amid the felt chaos. When we feel out of control, lost in a sea of insecurity, reminding ourselves of our resources is imperative. It is our resources that help us interrupt the stress response and that boost our confidence so that we can creatively navigate challenges that arise before they turn into chronic stressors.
3. To keep us connected, preventing states of intense fight, flight, or freeze, we can use these uncomfortable emotions to cultivate habits that promote self-compassion (Rogers, 1959), or a greater ability to self-regulate and self-soothe when discomfort comes our way. We do this by showing up authentically, acknowledging and normalizing our suffering. When we pay attention to what is arising, we have an opportunity to provide the loving-kindness necessary to feel and tend to past and present wounds. This process begins with noticing when difficult thoughts and emotions arise, stepping back to recognize these stimuli as transient messengers, rather than overly identifying with them. With this stepping back (non-attachment), we are more able to provide loving-kindness to ourselves, much like we would a dear friend.

While urgencies and emergencies often feel threatening, they are excellent opportunities to brush off our resources, strengthen our sense of belonging in a larger community, and cultivate greater personal and collective resilience.

Perhaps it’s time we reclaim our spirituality

The body is a vessel of the spirit BEing, providing a spiritual container to actualize and connect, contributing to a grand and greater whole. When tuned in, the spirit is indomitable and abundant, fully aware of and aligned with a power greater than the vessel for which it inhabits. We are all this glorious combination of spirit and body.

The biology and conditioning of our nervous system develops within a blueprint of scarcity and fear. When we default to this fear, our thoughts, emotions and resulting behaviours emerge as projections of the old belief systems connected to our unhealed wounds. Our spiritual self is the conduit that connect us to a power greater than our physical selves, reminding us of our wholeness and enabling genuine and compassionate connection to each other and to the planet that hosts us.

Without spirit, the efforts of the body lack inspiration. Without buy-in from the body, the spirit becomes trapped, unable to actualize in the physical world

When immersed in a world fixated on adornments and the appraisal of others, our orientation to spirit shifts. The spontaneous, spirit-filled self feels incongruent with what the external world demands. As a result, the spirit becomes a threat to the body’s felt need to gain the approval of the conditioned world. As the spirit grows dimmer with each layer of conditioning, the defensive nervous system becomes our primary concern. Spiritual distress signals become a source of anxiety to the body, reminding us we have forgotten who we are. As a result, the relentless need to DO lacks spiritual inspiration, eroding our emotional energy stores, and causing dis-ease. When separated, out of tune with spirit, the body cannot navigate the world objectively. This separation leads to spiritual distress until we come back into tune. Tuning in is the process of re-learning what it means to be a human BEing.

Addressing spiritual distress begins with stepping into a new blueprint, moving from fear to abundance. We do this by finding containers that promote spiritual expression, enabling us to feel safe to BE authentic. In time, we regain the trust necessary to enable the body to come into right relationship with the spirit. With this trust, the conditioning falls away, and the spirit grows brighter. We reach a tipping point, the resistance of the body dissipates, enabling us to see the conditioning for what it is. We set our BEing free from the illusive conditions of the physical world, and our orientation shifts from fear to abundance. From this space, the spirit informs the DOing of the body, providing the ease, confidence, direction, and inspiration to live abundantly.

Attachment reflects how securely rooted we are in our ‘real’ selves (congruence) and how confident we are to navigate life’s challenges (sense of coherence).

I’ve been exploring the concept of attachment for some time now and just recently developed a felt sense of secure attachment, perhaps for the first time.  Neither I nor my parents experienced secure attachment as children, evident in part by how we overcompensate, fixating on DOing instead of BEing, fuelled by a fear of not being good enough. After minding this area for some time now, I’ve begun attaching to my inner child and mirroring this same attachment with my children. This more secure form of attachment emerges from a place of abundance instead of fear and the ripple effects are astounding. 

As it turns out, learning to securely attach to myself and others is breaking a generational cycle of trauma born from the disconnection and insecurity I felt in my developmental years.  Investing in this ability to securely attach deepens my roots, providing the groundedness necessary to move more confidently in the world, which is enabling me to pass this same gift to my offspring.   

Before I get too far, I want to be clear that very few people securely attach all the time.  Most of us struggle with attachment and the process to gain more security is often slow and subtle.  When we get stressed, the vast majority of humans will tend toward anxious or avoidant behaviours – this is normal!

In childhood, our ability to attach to a primary parent or guardian forms the basis of our adult attachment style (Bowlby, 2012). Our ability to connect to a primary caregiver as children impacts our ability to forge healthy connections to others as adults.  If we felt rejected by our caregiver’s inability to emotionally connect, we tend to cling (anxiously) to others.  If we felt smothered because they relied on us to meet their emotional needs, we tend to retreat (avoid) from others.  Our attachment develops in stages ranging from immature dependent security, completely dependent on others for security, to mature dependant security, where we can give and receive in our connection to others from a secure sense of self (Blatz, 1967). For example, those who are closer to the dependant side of the spectrum tend to come from a glass half empty approach, yearning to be filled by others.  Those closer to mature dependant security tend to come from a glass half full perspective, connecting from a more grounded and optimistic place. People able to progress through the stages and come to mature dependent security will form mutually interdependent relationships in their adulthood (Blatz, 1967).  Interdependence is a balance of recognizing our dependence on others and honouring our independence as a unique individual. 

Because of our progression through the attachment stages, in adulthood we will gravitate to one of three broad attachment categories;

• avoiding attachment,
• secure attachment (springing from perceived unconditional positive regard as a child),
• anxious attachment.

The latter two (avoidant and anxious attachment) spring from perceived conditional regard and rejection as a child (Bretherton & Munholland, 1999). Children with repetitive and/or unresolved trauma may also develop avoidant attachment styles even when experiencing unconditional positive regard (Morina, Schnyder, Schick, Nickerson, & Bryant, 2016). Unfortunately, most of us fall along the edges of the attachment spectrum, either avoiding intimacy or anxiously attaching to others, with those who easily form secure attachments in the minority. The good news is that attachment styles are not fixed traits. Like most of our inner workings when we come to recognize our attachment style and the patterns (either negative or positive) that spring from it, we have a new opportunity to heal the old wounds at the roots.  In time and with mindful practice, we can re-orient ourselves and our relationship.

When insecurities present, those on the more anxious end of the spectrum tend to feverishly seek others to anchor to, fixating on relationships from a blueprint of scarcity, which often fuels anxiety and co-dependent relations.  When those on the avoidant end feel insecure, they are far more likely to lean back, disconnecting from external relationships, feeling too unsafe to expose their felt sense of vulnerability.  In between these two tendencies, in the middle of the attachment spectrum, is secure attachment.

What does secure attachment look and feel like?  Ideally, as children we can fall into a felt sense of safety, where we feel unconditionally positively regarded (UPR) by someone we trust and look up to.  This felt UPR makes us feel inherently worthy, separate from our ability to perform and achieve.   When we believe we are inherently worthy, we become self-compassionate, mirroring this same UPR inwardly.  By feeling safe enough to securely attach to another trusted human, we also learn attach to our inner world, promoting a greater ability to self-soothe when we experience challenges.   

When securely attached to self and others, the calamities of life are less threatening. They may be noisy and distracting, but they are distinct from the signal of who we are.  From this place, because we know who we are and the wealth of resources within us, we can confidently manage challenges (the noise). When we lack this attachment to self, we are prone to over-identify with the noise that presents, confusing who we are with unpredictable events and opinions that are largely out of our control.  From this insecure place, we often fixate on DOing to compensate for the dis-ease we feel inside.  Our actions emerge from a fear of not adding up, afraid we will not be good enough if we stop DOing.  From this fearful place, we grasp onto substances, events, and busyness to soothe us.  How we relate to others from this place of fear emerges in avoidant (emotionally disconnected) or anxious (emotionally clinging to others) attachment tendencies.

What are your attachment tendencies?

Using the following lists of characteristics, adapted from Wei, Russell, Mallinckrodt and Vogel’s Experiences in Close Relationship Scale (2007), notice which category you most resonate with. Consider your experience of past relationships and currents ones. Remember, our attachment tendencies are not fixed and we can move either direction on the spectrum, based on past adversities, our sense of coherence, and our degree of congruence.

Those closer to the anxious attachment end of the spectrum are more likely to resonate with these characteristics:

• I need a lot of reassurance that I am loved by my partner.
• I find that my partner/friends don’t want to get as close as I would like.
• My desire to be very close sometimes scares people away.
• I often worry about being abandoned.
• I worry that romantic partners won’t care about me as much as I care about them.
• I get frustrated if romantic partners are not available when I need them.
• When it comes to goodbyes, and many other transitions, I draw it out, afraid to let go.

Tips to soften anxious tendencies:

You are more likely to focus on external stimuli than internal stimuli. As a result, subtle feelings often go unnoticed until they build and compound, until they feel intense and overwhelming. Stress/anxiety emerges from a fear of not getting our basic need for love and acceptance met. Taking a step back from the intensity of the emotion enables you to keep the feeling in perspective, investigate it with a sense of curiosity, and with mindfulness practice and time, to re-orient yourself. If you cannot gain perspective (objectivity through non-attachment), talking to an objective other, such as a friend or counsellor, can be helpful.  As Fred Rogers once said, “anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.”

Practice attending to what is happening internally simultaneously with what is happening with the other person. Holding both experiences (the inner and the outer) connects you to your inner world, enabling it to ground you as you navigate the external.  Notice any tendencies to take the blame for conflict in relationships. When you take responsibility for something, take a step back, get curious, and see if you can come at the situation from a self-compassionate and impartial perspective.

Besides strengthening your connection to the inner world, take stock of your external resources and relationships. Try relationally diversifying yourself, which prevents you from putting all of your relational eggs/needs in one basket/person.

Those who tend to avoid attachment are more likely to resonate with these characteristics:

• I rarely turn to my romantic partner in times of need.
• I want to get close to my partner, but I keep pulling back.
• I don’t often turn to my partner for things, including comfort and reassurance.
• I try to avoid getting too close to my partner.
• I don’t often discuss my problems and concerns with my partner.
• I often feel nervous when partners get too close to me.
• I dislike saying goodbye, and many other lingering transitions, I’d much rather avoid the emotions associated.

Tips to soften avoidant tendencies:

You are more likely to retreat inwardly, keeping emotions to yourself, and to ruminate on fears (worry) when uncertainty presents. Practice interrupting this pattern by talking about your emotions to another person or if more comfortable, talk to the emotion.  Talking about or to the emotion creates a space between the emotion and the essence of who you are, enabling you to notice when ruminating, to question the veracity of the thoughts behind the emotion and to stop over identifying with it.  If you cannot gain objectivity (unable to step back) from strong emotions and negative thoughts, try interrupting the stress response by reaching out to connect with someone, or shake it off with a bout of intense exercise, or bathe in nature, or any activity that sparks desire and promotes relaxation.  Working with your biology and exploring tools that mitigate stress improves your sense of coherence (confidence to manage external events) and practicing vulnerability and self-expression promotes congruence (confidence to tap into inner resources). 

Starting out slow is important, ensuring that you don’t suffer from a vulnerability hangover, which can make matters more challenging by activating the stress response.  Small steps keep you moving forward, practicing in ways that feel safe and that enable you to remain objective, or at least to maintain windows of objectivity.  If you take too large of a step, you may find your felt need to retreat (stress response) overrides your efforts. If you retreat, that’s okay, it’s part of the learning process; this is how we learn to titrate the process, moving only as fast as we feel safe to do so.

Trust takes time and part of gaining trust is learning to trust yourself and the pace in which you feel safe moving. Experiment with different techniques, with getting close to others. Try leaning on people in small ways, investigate how it feels. If feelings get intense, practice self-compassion and self-kindness by allowing yourself to take a step back. Taking a break, even stepping back, is not necessarily retreating (although without awareness it can be), rather it can be an opportunity to create space between the event and the emotions activated by the event. The desire to retreat/emotionally dissociate comes from fear. We can catch ourselves before we retreat by noticing when it is happening (catch the felt anxiety or sense of panic emerging) and acting (stepping back) before we react.

To process, digest, and heal the wounds beneath our avoidant tendencies, it helps to identify a ritual such as a stress mitigation tool, hobby you enjoy, time in nature, or a person (or animal) that provides a sense of emotional safety for you. To clarify, we use rituals in these moments to connect and empower, not to distract us from acknowledging and tending to emotional wounds. Rituals cue us, enabling us to find order in moments that feel chaotic. We all need a certain degree of order, grounding us in times of chaos (a component of sense of coherence). These safe spaces, cued and created by ritual, provide an environment where we feel safe to be vulnerable. It takes vulnerability to feel our emotions. We must feel our emotions to walk through grievance and suffering. On the other side of many of the uncomfortable feelings that arise in us is healing is from the suffering associated with old wounds.

Finally, when the intense feelings emerge, take notice. Once you notice, create space by engaging in a comforting ritual or talking to a trusted friend/loved one. When we create safe spaces and cultivate a sense of curiosity, we are more likely to observe and even welcome the experience as it is (rather than resisting it as it is or avoiding it altogether).

Whatever your tendencies, remember to tune in and take your time.  Moving too fast will slow you down.  Moving slow and steady promotes a sense of safety, keeping us connected to our bodies and to our inner resources.  If you find yourself activated, take a step back, reground, reconnect, and celebrate how far you’ve come.  From this optimistic and gracious place, you’ll be ready to step back into the flow.