Find your edge

In battle for survival, existential contemplation tends to make an appearance in a person's story. Sometimes this happens in the beginning as a recent life conflict is seen as in terms of existential concerns. Sometimes they make an appearance during remembrance of a time past. And at other times they present themselves as a source of strength.

The benefits of yoga on mood and anxiety states are immense. There are many hypotheses about what exactly helps in alleviation of symptoms. Instead of singling out one factor and replicating it in its isolation, an approach which is embracing multiple thoughts seems most beneficial. Having said that however, disentangling threads of mysteries to help our comprehension is an endeavor as old as humanity. There are many reasons advanced for why Yoga is so helpful. For example it might be increase in self awareness, physiological benefit of exercise, psychological benefit of achieving mastery, an interpersonal benefit of increasing social involvement, the nature of the postures, the somatic energy manipulation etc. Regardless, when I received the following, I was struck by the way this benefit of yoga was worded. Yoga in this letter is woven into a self defining story for an individual. Such stories, have power since they pass over from reality into something of mythical proportions.

"During our conversation, I was skeptical when you mentioned Yoga. You said that Yoga can be helpful in depression. At that time, I was depressed. Life did not make sense. Everything was out of control. I did not have the energy to do Yoga. A friend of mine urged me into it. So we decided to give it a shot, for three sessions. The first session was great. I remember when I was a child, I used to do these "tricks" with my cousins, like somersaults or cart wheels. I was happy then.

My instructor, Pam is great. She said that building core strength is important because it can give energy to us. The energy required to live our daily life. My core strength is pretty bad. I love pizzas! However Pam encouraged me to "find my edge" in my postures. I never understood her fully, till much later. She said that when my body told my mind that it was at the edge of exhaustion, my mind either agreed with that or did not. Mostly my mind agreed with my body and I would relax my posture. Pam encouraged me to try the other option, where my mind would reject what my body was telling it. She said focus on your breath. I did.

One day in a half moon pose, I reached my edge. My leg was cramped and my mind was focused on my leg. At that time, I put the thought of my leg out of my mind and started thinking and working on my inhalation. An exhalation followed automatically and I realized that all I had to do was to inhale. I then realized the funny feeling I was getting in my nose, as I inhaled. I wondered what that was. "Dryness? Let's see how I feel with another inhale". And suddenly I realized, I was in the posture and my leg was still hurting me, but instead of shouting out it's pain, my body was talking to me about it. I dropped my pose. I felt great. I felt on top of the world. Later on when I thought about it I realized that I felt great because I had not given up as I coasted past my limitations.

Over a period of time, I realized what Pam, meant about the core energy required for life. I started practicing breathing during the painful moments of my life, when my mind said that it could not take it anymore. My life had a lot of painful moments and I had to breathe a lot. As my yoga practice improved, my breathing practice improved, my resiliency practice improved and my practice at living life in painful moments improved. I started sleeping through the night knowing, that I could get through tomorrow. I knew I could hear my mind whisper suicidal suggestions to me and get through it. Practice makes difficult things easier. I have been practicing at life.

It is not yoga only that has helped me survive but it has been instrumental. I am still not free of dark moments, dark days or dark weeks. But I am free of dark months. And I have learned how to keep a light with me in dark times. And not hate myself for it. My next project is to become a Yoga instructor. Sincerely yours"

Healing spontaneity

 Healing spontaneity

 Spontaneity is a voluntary or undetermined action. It is frequently observed that in difficult times, spontaneity disappears. A state akin to freezing up happens. Security is desired. Predictability is desired.  Spontaneous decisions tend to be a trade off for more predictable decisions. Both have their role in helping us adapt to everyday life. If our response to stressful situations in life are causing us difficulties then, there is high probability that that we have our predictability/spontaneity balance wrong.

If difficulties are faced with withdrawing into a shell, "playing it safe", isolation results. Anxiety about things cause us to start planning things in a way that they are predictable, hence under our control. Infact almost all freezing up or danger of freezing up is because of lack of spontaneity.
I will give the example of this common scenario by introducing to you Sarah.

Sarah went through a bitter divorce. As a result she stopped trusting people for a while. She felt that people were out to take advantage of her. She started withdrawing from her friends. She did not want to go to work, because it was exhausting to put on a face in front of everyone. She did not want to talk to her relatives because those five minutes in which she was talking to her relatives seemed an eternity. She would sit and watch TV all day. She would spend her time thinking how she could arrange things so that they would not overwhelm her. Social encounters, projects, sleep, appetite all needed to be planned. In her fragile state, something unpredictable carried a huge risk of ruining her entire day. 

We learn spontaneity in childhood. One of the first thing we practice is play. Play is impossible if one does not take risks or experiments. The delight of play is usually accompanied by delight in oneself, a confidence in one's abilities and the ability to act authentically in accordance to one's genuine beliefs. Every play is unique to that individual and serves as an affirmation of their personality. It is only with spontaneity that one can make a statement to the universe, "I am who I am and I love who I am".

Sarah worked hard in therapy. She recognized the fact, that she lived in her mind, more than she lived in the world. She started engaging in little acts that seemed dangerous to her. She went to a completely new grocery store, at the other end of town and spent time discovering things that made it different from the one that she used to get grocery at. She started smiling at babies or children that she came across. In the office, she started wishing a good morning to five people everyday. She had a script of three opening sentences and three topics, with which she would carry a conversation, and she found out that she did not have to use a second topic in the conversations that she started. Gradually she stopped preparing for conversations. She reconnected with positive people in her life. She picked up biking again. That had healing effects which originated from her childhood. 

During re(dis)covery, one of the most important things is to rediscover the play in oneself. Rediscovering this quality in the uncontaminated nature of childhood can be a life saver (literally). A buildup of confidence is paramount in preparation for this rediscovery but the best part is that it is a positive cycle that reinforces itself to multiply. People who are successful in their risk to be spontaneous, usually get an amazing sense of relief and rekindling of hope. This makes them try being more spontaneous. And so the one act multiplies.

Discovering potential areas in which to practice spontaneity is something that happens in therapy. Discovering protective boundaries in which spontaneity can be nurtured without being overwhelmed is something that happens in therapy. Discovery of habits, things or people who aid our spontaneity are all things that happen in therapy. "A loosening up", "go with the flow", "it's ok to smile", "it's ok to take risks on people and circumstances", "i can deal with it regardless of what might come my way", are all positive affirmations that happen in therapy. Usually when all this happens, one can see the multiplication of spontaneity in a person's life and then re(dis)covery.

Caution in use of antidepressants

In thinking about this article, I saw an interesting link which I thought I would share with you.

Dr Gutafson has always posited that there is an internal and an external world which is controlled by various phenomenon. A balance between the two worlds being the key to protect the inner child from the “harsh world” (Self Delight in a Harsh World, Gustafson).

In the modern megalomanic world where the laws of increased pack drive us, human beings become mere part of a machinery. The machinery of culture, the machinery of capitalism, the machinery of religion. Every thing is a machine in our current state of existing collective consciousness (Jung collective consciousness).

With that being the state, in the external world exist representations of our inner feelings. Language is mated with the non verbal (Balint The Basic Fault). Expressions from inside are morphed in to what influences us from outside and vice versa. Hence the definition of happiness or depression is very easily influenced by current trends. The current trend being the machine state that we talked about us, similarly defines the definition of happiness and depression. A person who is not productive enough to survive the machine state of things tends to drop out and hence is depressed (Basic dynamics of Psychiatry, Gustafson).

It is true, that depression also comes in many shapes and sizes depending on innumerable factors. In certain cases the sense of negative introspection prevails and one wonders about thanatos. In other cases the role of depression as an adaptive trait is very protective, though maybe anguished.

The change in a system should only come after great deliberation as is often pointed out. There is a lot of energy conversion that goes in to changing the static to the dynamic. Changing depression which is static to something dynamic is desirable in many cases but can be fatal in some. A classic example of lethality is what so many manic people inflict on themselves and others.

Do drugs switch people's moods. There is a debate about that in the scientific world with arguments on both sides. Can an SSRI be given safely to every person. Experience with general population though, would indicate otherwise. There are places where an antidepressant is helpful, there are places in which it is not helpful. There are studies which indicate adverse effects in some people. Activation or switching being one of the side effects. Every case of switching is unique and tends to express itself uniquely. It is sometimes really difficult to catch these cases until and unless they become really severe and consequences are “more” disastorous. In children parents usually notice earlier and take them off the medications. In adults though, things can become complicated, if social support structures are not there.

So is an SSRI the best thing out there for depression? Yes, it might be, to be able to give the boon of “functioning as a cog in the machinery”. And sometimes that is the answer that a psychiatrist should give. But sometimes it is not and it is equally useful to use a host of other treatments, that mental health professionals should be trained in.

The contracture and expansion of ideas

In the older days, in some unknown time, an unknown person infected by the same germ of static curiosity that infects me today, thought about a hypothesis which made a lot of sense at that time. The reason why women recovering from childbirth died more often than other women was because they had their vitality drained from them during childbirth. They gave a part of their soul to the child and that resulted in deficient "soul material". As a result they could not resist the evil influence of "death spirits" going around in the world. The "death spirits" preyed on weakened souls. Given the line of thinking and multiple simple experiments, however ill designed, people decided to contract the world around the post partum woman to save her life. Gradually other statically or dynamically curious beings restricted the world more and more around the woman. Another person posed that after the birth of a child the woman had her bones in a dilated position which gave the cold, a chance to get to "get in". As a result they could get catch a chest cold.

It is an interesting debate whether the idea propagated by itself as an independent entity or events acted as a catalyst on the right substrate to give a chemical reaction. Whatever the case, the idea that began at some point expanded and took a life of its own. It mutated and as a result of this idea the world contracted for the post partum woman. Some people would justify that this expansion of the idea and the contraction of world for the new mother is probably there to protect the mother. It would seem an evolutionary requirement for the idea to expand so that the new mother is saved to reproduce again.

If we observe the mechanics of the expansion of idea, we will observe that generalization is the main mechanism that makes ideas expand. Once one etiology gains credence the other etiology like it also seems more plausible. The idea grows thus. The witches burnt at the stakes is an excellent example of the idea generalizing like wild fire.

The same fundamental expansion on one scale and a contraction on another works whether we consider medical myths, jungian archetypes, religious thoughts on the larger scale or we consider the dynamics of paranoia, guilt or anxiety on the smaller scale.

Prigogine: The end of certainty

In his book, the end of certainty, Prigogine talks about irreversibility as a possibility. This is something that people have neglected when putting forward laws that describe how nature operates. He calls many laws deterministic in nature, in that, they can be bidirectional with respect to time. He however says that this bidirectional time is a very narrow minded view. It only takes into consideration the isolated experimental subjects and considers them free of the multiple other factors that are impacting on them.

I was involved with a functional behavioral analysis of a child with disruptive behaviors. In a functional behavioral analysis one tries to determine the antecedents that cause the behaviors and the consequences that either enforce or extinguish the behaviors. A hypothesis of the whole situation is made and that hypothesis is tested out. The parents are then given strategies to manage the behaviors from the hypotheses. The proof that those strategies work has been shown to the parents during the testing phase. Hypothesis like "the child can go to a non preferred activity if he knows that it is time limited and if it is followed by a preferred activity", is an example.

This kind of analysis of behaviors is fine if a behavior is only considered to be present and influenced by a limited number of antecedents and consequences. But the truth of the matter is that the true antecedents to a behavior are multiple and have a propensity to be unknown. Freud believed the majority of the decisions that a person was making were unconscious. When dealing with these many possibilities of environmental and psychological variability, it is essential not to "over simplify" or "over complicate"things to the point that incredulous demands be made of patients in "treatment".

Prigogine talks about phase space which would be very applicable to the scenario of the disruptive child. All the different possible behaviors of the child are represented in that phase space. Prigogine also talks about stable (determinism) and unstable (chaotic) equilibrium and details characteristics of those systems.

A beautiful example he uses is of Poincare who proved that dynamical systems are non integrable. An integrable system would be a static deterministic world without the possibility of freedom. Non integrability results from existence of resonances between degrees of freedom. What we have done with behavioral analysis is to put on deterministic glasses and translated the multi factorial world into a lesser dimension. The city of Oz was not really green.

Prigogine also talks about prevalent energies in a system. How potential energy is maximum in a state of equilibrium and free energy is at minimum in a state of equilibrium. Increasing energy in a system also increased the areas of randomness in it. He describes creativity as an irreversible phenomenon which has been associated with complexity. Any system in non equilibrium can spontaneously evolve in to increased complexity and any system in non equilibrium can lead to irreversible phenomenon, hence creation.

With this he comes full circle to creation as an irreversible process which creates a system of equilibrium for itself till of course it is pushed into non equilibrium again. It will get pushed into non equilibrium.

From this we glimpse a view of a world which is constantly oscillating in between equilibrium and non equilibrium. A world which is constantly changing due to chaos, organizing and disorganizing itself. And caught in the center is man who attempts to act like the universe, organizing and then disorganizing whatever it comes across. Creating and then uncreating. Cooking and then digesting. Being born and then dying.

Walking in the Doorway

The door which was a window
to a busy corridor.
Painting of moving people
typewritten and then
erased so!
For an instance they walked in the open,
with the walk they walked behind walls.
A brief interval
Walk in and then walk out.
And between the in and the out
Lay their entire life.
Naked so!
And despite all their walls,
the left and right
was longing to be heard.

Time for compassion

Today I was speaking to a friend who is working in internal medicine in an ER. While I was talking to him, he got a phone call asking him to consult on a lady who had arrived in the ER and refusing to leave and wanting to be admitted. He is still in residency training and I asked him what he was going to do. He said that it was simple. He would order the basic blood tests and then tell the lady that she can certainly stay in the hospital if she was willing to pay a $1000, because no insurance would cover her medical bill without a valid indication. And I asked him what will happen then. He laughed and said, "the same thing that always happens, she will leave."
By now I was extremely interested and asked him whether he would have solved the problem she came to the ER with. He replied that she had no problem. The blood work will have indicated no problem. There was no reason why she needed to be in the hospital. She was healthy. She would be taking the bed of a person who genuinely needed to be admitted.
I persisted, saying there is a reason why she wants to come in to the hospital. He agreed and said "That is not my concern. I am not a psychiatrist."
By now I was playing the devil's advocate. "What if she feels unsafe in her home and is coming to seek help but is not telling the real truth because she is frightened of the psychiatric ward." He replied, "It still is her problem, not mine. If I started conducting these voodoo hunts for crazies, there would be people who would die of heart attacks."
He had to go and attend to the patient. I let him go.
I was later thinking about our conversation. There are many things that would have been different in an ideal world. Money would not come in to play when basic human rights were concerned. I believe access to reasonable health care a basic human right. Mental health problems would be as important as physical ailments. A person would have the luxury of time to discharge his or her's professional duties. Work would be a joy rather than a burden.
Doctors even though adhere to a high code of ethics have been trampled by an unknown fear. The fear of lack of time, the fear of lack of sleep, the fear of lack of performance, the fear of lack of money, the fear of seeing themselves as a failure who never could amount to anything despite their brains and hard work that they put in to becoming a doctor while their class fellows enjoyed themselves and dallied their time away.
When you reach the top of the pyramid, you are not the same man. The journey changes you.
One of the basic things that comes with experience is the ability to be patient with a patient (who is called a patient for a reason). Since one never knows what life can throw out, it is of the utmost importance to be well grounded in the present and not let fears get in the way. When a day is started, there is every potential that I might be jumping off a plane by night fall with a parachute strapped on my back and there is every potential that I might be dead by night. Regardless of the potentials, one thing is certain that I have control over. I can enjoy and accept every minute of life as a gift.