Louis Cozolino, my favorite psychology writer, hosted a full day lecture on ‘Neurofluency' or the ability for a psychotherapist to assess, plan, and treat based on the latest brain science. Central to Cozolino’s theory of psychotherapy is attachment theory – or how our early childhood relationships with our parents influence our adult personalities. From this perspective, psychotherapy is a process of re-parenting and learning to utilize relationships to heal repressed or hidden traumas and feelings. Cozolino’s 40 years of clinical treatment of adults and children along with his research into evolutionary psychology and brain development results in an impressive understanding of the human mind.
Evolutionary Psychology and Early Childhood Development
Millions of years of evolutionary trials have given us our big brains, but not without a cost. Most newborn animals move independently within a few hours after birth, ensuring that they aren't slow-moving targets for predators. Human infants are an anomaly– unable to walk until 12 months and fully dependent on caregivers for years. Compared to the rest of the animal kingdom, human infants are born about three months too early so that our proportionally enormous heads can safely pass through the birth canal. This physiological reality is no accident- evolution gave us our bulky brains. We aren't the biggest or most resilient animal in the kingdom, but we are exceptional in our sociability and abstract thinking – characteristics made possible by our brains' size and complexity. Our premature birth, deep dependency on others, and nuanced ability to communicate are evidence of our evolutionary strategy of collectivism.
Our lifetime of relationships with others is initiated in the dependency we all experience during infancy. Like the foundation of a house, our early years are instrumental to our adult personality. As our brains are doubling in size over the first year and reaching 80% of adult size by the age of three.
Especially important to our development are moments when we experience fear or stress as children. From a primordial survival standpoint, these are moments when our safety is threatened. The natural inclination of our deeply collective species is to seek the support of mom or dad during these occasions. Watch a tearful toddler on the playground seek its parent to see this principle in action. Childhood is full of experiences like these – increasing in complexity as we age. A well-regulated and available parent temporarily soothes a child while also shaping their child's expectations on how to handle the inevitable stresses of their future adulthood. We learn to ask for help when we are in pain be it physical, emotional, or existential. Conversely, a dis-regulated parent, that is unavailable or angry about our distress teaches us that our pain is to be kept hidden from others. These lessons from childhood form the backbone of our adult experience, determining whether we live a life of connectivity and vitality or one of solitude and shame.
Yes, the resilient, quick-breeding vermin have been instrumental in proving the correlation between early childhood stress and future quality-of-life. Humans and rats share similar brain structures as well as social dispositions. Rats are attentive and nurturing mothers that display a variety of attachment behaviors with their pups including licking, grooming, and vocalizations. To test theories of developmental psychology, scientists (sadly) disrupt these behaviors. However, these studies provide research showing that as maternal care-taking increases, so does the future adult well-being of rat pups. These studies provide quantifiable data for intuitive sense obvious to any adult caretaker.
s For example, neurons in the brain of well-mothered rats show longer dendrites (the connective arms of neurons) and more synapses (the connectors between neurons) than deprived pups. Healthy rat pups also experience an increase in brain-derived neurotrophic factor (BDNF), a hormone essential in encouraging neuronal growth. Having an attentive and available rat mother correlates with a bigger and more complex brain structure.
Increased rat mothering also correlates with increased GABA neurotransmitter receptors in the brain. Anyone who drinks alcohol or takes Xanax or Klonopin (drugs that increase GABA) knows the powerfully calming effect of GABA. Well-mothered rats have more GABA receptors, consequently making them more relaxed in adulthood than their poorly mothered brethren.
Also, rats' immune systems and stress responses are profoundly shaped by their early mothering experiences. The class of hormones known as glucocorticoids is essential to regulating the hypothalamic-pituitary-adrenal axis a.k.a. our fight-or-flight system. The more glucocorticoid receptors present in the brain, the greater the ability to effectively manage stress and disease. Rat pups deprived of mothers had few glucocorticoid receptors and were consequently unable to tolerate mild stress. They were also likely to develop chronic illnesses later in life.
Future adult rat behavior was also shaped by early pup experiences. Decreased maternal availability was correlated with decreased exploration and novelty seeking in adult rats. Pups with poor mothering were less likely to search their surroundings and less likely to seek novel forms of stimulation as adults. They remained stuck in solvable mazes or engaged in repetitive self-soothing behaviors. Lastly, early childhood mothering was directly influential on future mothering behavior. If rats had absent mothers as pups they were likely to demonstrate poor attachment and care of their own pups later in life.
Number of neuronal cells effected by mother-pup separation. The white column shows the amount of neurons present in normal, non-deprived rats while the orange and blue columns represent neurons in rats deprived of maternal contact from post-natal day 3 or day 10, respectively. Evidence that separation from mothers at a young age is detrimental and the earlier the separation the worse the outcome.
"I'm not a rat!" It's true, your comprehension of this article up to this point verifies you are not a rat. But you have a brain like a rat and that's enough to lead Cozolino and other researchers to believe that having a good mother (or parental figure) that shows obvious signs of affection and attachment correlates with future mental and immunological health.
Adverse Childhood Experiences
Bolstering this argument are the Adverse Childhood Experiences (ACE) studies conducted by Kaiser-Permanente. Beginning in 1995, about 17,000 adults in the San Diego area were recruited into a study seeking to measure negative childhood experiences against adulthood issues with mental, physical, and relational health. The researchers were hoping to gather quantifiable data to back-up the assertions of the ‘soft-science’ of psychologists and psychotherapists. To answer the question: does your childhood really determine the quality of your adulthood? Amongst other questions, adults were assessed for their childhood exposure to neglect (emotional or physical), abuse (verbal, physical, sexual), and household challenges (poverty, hunger, homelessness, divorce, death, addiction, etc.). The higher the number of negative experiences, the higher the ACE score.
Findings of the ACE studies. Some have criticized the ACE study for lack of diversity and inclusion as all of the participants surveyed were insured through Kaiser-Permanente. One can imagine that those without health insurance probably have higher ACE scores than those with insurance. Meaning the trends reflected in the ACE studies are probably healthier than the general population.
In a remarkably direct fashion, higher Adverse Childhood Experiences scores have translated into higher rates of depression, anxiety and suicide attempts during adulthood. There is also a direct relationship with higher rates of smoking, obesity, coronary and liver disease. And those with high ACE scores are more likely to have unexplained negative medical symptoms and more likely to have trouble getting and keeping work.
Essentially, negative early childhood experiences result in negative adult experiences. These studies are correlative not causative – meaning the findings imply a difficult childhood probably contributes to having a difficult adulthood rather is the cause of it. Because of the sheer size and high-quality of the study, the ACE studies stand as a landmark in the field of mental health and epidemiology.
Since 95, there has been continual research into ACE and their prevalence amongst different populations. Not surprisingly, those from lower socioeconomic classes and non-white communities are disproportionately effected by adverse experiences. The ACE studies will continue to be an important reminder of the far-reaching effects of poverty, racism, and trauma on the lives of individual children.
Cozolino's analysis of the ACE studies translated early childhood negative experiences to later physical and psychological problems for adults. Continuing with this theme, Cozolino described core shame – a negative psychological feature of many adults that begins in childhood. Cozolino describes core shame as "a fundamental sense of being defective as a person, accompanied by fear of exposure and self-protective rage." Those that live with core shame typically suffer from depression, anxiety, addiction, or other mental health issues. The physiological and behavioral components of core shame are:
“Rapid and dramatic shift from sympathetic to parasympathetic dominance (emergency shutdown) and behavioral shift from escalating energy, approach, and connection to deflation, submission, and withdrawal.”
Cycles of Violence and Poverty. Billy Bragg's 'Levi Stubb's Tears' tells the story of a young woman fleeing from a broken home only to end up in an abusive relationship.
"Sympathetic and parasympathetic dominance" refers to the two branches of our autonomic nervous system, the mostly unconscious part of our peripheral nervous system that regulates our heart rate, arousal, digestion, and the fight-or-flight response. A healthy nervous system has an equal balance of both branches: the sympathetic branch allowing us to exert ourselves and handle daily stress; and, the parasympathetic branch allowing us to relax and connect with other people. A healthy life may be thought of like the daily balancing of activation with relaxation – sympathetic with parasympathetic. Core shame develops when our body's ability to deal with transitory stress is continually triggered and overburdened.
Our short term strategy for stress begins with the sympathetic branch. When a dramatic and perceived life-threatening challenge occurs, our sympathetic system spikes our heart rates, elevates our blood pressure, tenses our muscles to fight the problem or run away from it a.ka. fight-or-flight. If we can neither flee or bully our way to safety, our last defense lies with the parasympathetic branch and its "emergency shutdown" or freeze response to which Cozolino links to core shame. Limbs go limb, blood pressure and heart rate drop, and the mind dissociates or goes blank. We play possum. Many predators are only interested in live prey, so feigning death may have thwarted enough attacks of our ancestors to be included in our body's repertoire of survival strategies.
Deploying this 'freeze' strategy once or twice in our lifetime may ensure our survival, but it becomes problematic when freeze and collapse becomes a regular part of our life. Cozolino posits that the parasympathetic freeze response turns to core shame when it is repeatedly triggered by our early relationships and environment. As small, needy beings we are extraordinarily sensitive to the quality of our relationship with our parents. A threat to those relationships is a threat to our survival. Being shamed a handful of times in the heat-of-the-moment may not be particularly damaging, but a parenting style that is built on anger, intimidation, or punishment inclines us to frequently fall into collapse. The mind is adaptive and predictive, it predicts future conditions based on past experiences. So if our childhood was full of shame-inducing experiences we would expect to feel depressed, deflated, and withdrawn from life as an adult a.k.a. core shame.
Cozolino highlights the importance of our early childhood relationships in our developing sense of self-worth. That we develop a shameful or compassionate relationship with ourselves through our early family system is also bolstered by the research with rat families. Cozolino takes this exploration a bit deeper by looking at how the nuclear family system is part of the larger system of a society-as-a whole and its effect on shame.
Chimpanzees, our closest animal relatives, have complex and patriarchal social systems with a few male alpha chimps leading bands of 15-150 beta chimps. Alpha chimps use intimidation and physical violence to maintain their position in the frequently shifting social order. Due to disputes over mates or foraging territory, Cozolino posits that beta chimps display all the signs of shame/parasympathetic collapse when they are dominated/corrected by alpha chimps: submission, social withdrawal, lowered eye gaze, and a physical deflation or hunkering. While we can never ask a beta chimp if they believe they are ‘just the worst chimp ever,' we can imagine that the behavior markers and social consequences of their transgressions induce something like shame within them. Cozolino's observation is that this sense of shame is essential to maintaining chimp social order and survival. Shame is an acknowledgment of hierarchy and power.
As humans, our social hierarchies are vastly more complex than chimps, from families to communities to cities to states to global-alliances. Our experience of shame depends on the group of individuals and values in which we find ourselves rather than on how many mates are available or mango trees in our foraging territory. A person raised strictly evangelical may believe their homosexual flashes of desire are an abomination. Meanwhile, a young man in Chelsea, Manhattan celebrates his gay sexuality in the streets on June 20th of every year. In either of these communities, there is an agreed upon set of behaviors and beliefs that are either shameful or not – an intersubjective reality. That is, an agreed upon 'truth' that only exists because people agree it exists. For example, money is only valuable because we all agree that it is valuable. It has no intrinsic worth other than as a fire starter or as a sheet for scribbling. Shame is no different. While it was once disgraceful to divorce, it is now more common than staying married. Our society's values have changed over time and consequently, our families' sense of shame has morphed from the time we were children.
Unfortunately, for those with core shame, it's not just a matter of deciding one day to stop feeling bad about ourselves. Our core shame is usually an unconscious part of our personality – not a value by which we choose to live. Oftentimes, it is such a prominent feature of our existence that we have no awareness that there's an alternative way-of-being. This problem speaks to the deep roots of childhood shame and the largely unconscious nature of our minds. Also, to the importance of the mental and emotional health of the architects of our minds – our parents.
Healing core shame is a long and arduous task – the repeated making conscious of the unconscious. To link present-day symptoms like anxiety and depression, to distant memories or feelings. In essence, psychotherapy is re-parenting and the allowing of emotion to be expressed that was, long ago, made to be hidden. Because we learned during childhood that those closest to us also most deeply wound us – therapy is a lesson in learning to trust and in utilizing relationships to heal.
Michael Pollan’s latest book ‘How to Change Your Mind’ explores the history, usage, and potentialities of psychedelics as treatments for mental health. Pollan’s own enthusiasm for the topic is contagious and has inspired me to re-analyze my own experiences with psychedelics as well excite me for the legalization of psychedelic psychotherapy.
A few years ago, a friend clued me into the psychedelic ayahuasca. Ayahuasca is a brew made from the combination of two tropical plants, one containing the psychedelic compound Di-Methyl-Tryptamine (DMT) and the other containing an MAO Inhibitor which temporarily blocks the brain’s mechanism for metabolizing DMT. Like LSD or psilocybin, DMT typically causes powerful hallucinations for those who consume it. For centuries, this brew has been ceremonially used by indigenous cultures and shamans in the Amazon for spiritual and psychological well-being. Since a 2006 Supreme Court decision, ayahuasca consumption is legal in the US within the context of the South American traditions that utilize it.
I was both terrified and captivated by my friend’s description of his ingestion of ayahuasca with a shamanic group. He hallucinated an enormous serpent entering the crowded and dark ceremony space. The constrictor curled itself around his torso and squeezed him until light erupted from the crown of his head. Being the product of hippie-parents – these visions attracted me. And more captivating than the visions, was the clear emotional change present in my friend. As we worked together on a creative project, his enthusiasm and humor flowed freely. He easily translated his visions into metaphors for the struggles of his daily life. Fear and pain transformed into acceptance and healing.
At the time, I felt stuck in life. Some of my closest relationships were frozen in conflict. My job as an audio-engineer was at a dead-end. My sense of enthusiasm about anything diminished. I had yet to discover the power of traditional talk-psychotherapy, so the prospect of transforming my mind and life by simply ingesting a drug seemed worth the risk. After some thorough vetting by the organization, the ayahuasca facilitators offered me a spot in their next weekend of ceremonies with their shaman.
Before flying to Northern California for the ceremony, I read others’ online accounts of drinking ayahuasca. Most talked of the positive personal transformation following nightmarish battles with their own demons. Like my friend’s visions, much of the symbolism and imagery centered around the flora and fauna of the rainforest. Nets of vines, rainbow jaguars, and mischievous elven-humanoids. Almost everyone spoke of the nausea they experienced after ingestion. Many vomited during the course of a ceremony, though this purging was generally cathartic and meaningful. Symbolic of negative energy leaving the body. My internal cynic, normally quick to hack down anything resembling New Age Spiritualism, was tempered by my internalized protestant. It seemed appropriate that I needed to suffer to be happy.
After driving deep into bucolic countryside, we arrived at the large converted ranch-home that was the ceremony space. Nestled within a grove of redwoods, I nervously chatted with the ~40 other participants before the ceremony commenced at about 9 PM. The dark room was smoky with incense and totally quiet as I drank 2 or 3 ounces of the disgustingly bitter ayahuasca. As the shaman began to sing and play a jaw harp, I felt no difference for an hour or so. So when a second round of the brew was offered, I drank even more. Gradually, I noticed a subtle sense of pleasure pervading my body and perception. Even as the climate in the room grew restless, I noticed feeling giggly and playful. Someone suddenly stood up, hurriedly ran to the door while vomiting into a plastic bucket. “Unlike that guy, maybe my night with ayahuasca will just be fun?!,” I naively hoped to myself.
Wanting to hold onto my good vibes, I stepped outside to the cool and quiet yard abutting the redwoods. As I stood looking up at the stars and yawned, I noticed a disturbing distortion in the sound of my own breath. As if my bodily process had been poorly burned to a CD and was being played back to me. Then my jaw began to feel unhinged – like an egg-eating snake’s mouth. The stars above me trembled. Standing next to a rosemary bush, I was bewildered at these sudden changes. I had just a moment of confusion until ayahuasca hit me with the force of a punch to the gut. My legs gave out and I dropped to the soft grass, mere steps from the front door of the ceremony space. I laid in that spot for the next 3 or 4 hours.
Because of LSD’s association with the counter culture movement of the 60’s, the FDA banned research for 30 years into the therapeutic use of psychedelics. After promising gains made in the 40’s, 50’s and, early 60’s, the field went dark. Some very dedicated and impassioned scientists kept the flame alive and have finally managed, in the past 20 years, to again research the mental health potentialities of psychedelics.
Scientists now generally agree that the active compounds in psychedelics are acting upon the brain’s neurotransmitter serotonin. Serotonin became a household word in the late 80’s when a new class of anti-depressants Selective-Serotonin Re-uptake Inhibitors (SSRI’s) hit the market with the promise of alleviating human misery. 30 years of mixed results with SSRI’s has shown that we don’t understand the complexity of the serotonin system, including how exactly psychedelics or SSRI’s are inducing their effects.
Thankfully, recent developments in the technology of Functional Magnetic Resonance Images (FMRI’s) have allowed scientists a real-time glimpse into the tripping-brain.
Scientists were surprised that many parts of the tripping brain were less active than in daily-life. Specifically, there was diminished activity in a set of linked brain structures known as the Default Mode Network (DMN), a hub connecting an executive center of the brain (pre-frontal cortex) to the less-evolved brain parts involving emotion and memory. The DMN is most active when we are in self-reflection or meta-cognition – thinking about how we are thinking or feeling. In plain speak, the DMN is active when we are thinking about ourself. A sense of self or ego may be emergent from the DMN’s processing. This network takes the conflicting inputs from our visual, spatial, and other brain regions and determines what warrants attention by the ‘self’. The DMN’s primary task is to down regulate – to cull irrelevant bits of data from our awareness. Without the DMN and its ability to prioritize, our brain would be a discordant symphony without any self conducting. We are able to coherently move through the world because of the Default Mode Network.
However, an over-active DMN may also be the source of depression, anxiety, and other mental illnesses associated with a distorted sense of self. As Pollan illuminates “The achievement of an individual self, a being with a unique past and a trajectory into the future, is one of the glories of human evolution, but it is not without its drawbacks and potential disorders. The price of the sense of individual identity is a sense of separation from others and nature. Self-reflection can lead to great intellectual and artistic achievement but also to destructive forms of self-regard and many types of unhappiness (pg. 304).”
When researchers looked at the brains of participants who had ingested psychedelics they found a clear relationship between reported ‘ego-dissolution’ and diminished Default Mode Network activity. A reduction in depressive symptoms also followed. “‘I existed only as an idea or concept’ one volunteer reported. Recalled another, ‘I didn’t know where I ended and my surroundings began (p. 304).’” Research into the DMN and psychedelics attracted the attention of researchers analyzing the brain states of long-term meditators- those with thousands of hours of practice. These meditators also had abnormally diminished activity in the DMN, especially when in deep meditation where they reported transcendence of self – a dissolution of duality or no separation from subject and object. The brain states of experienced meditators looked remarkably similar to tripping brains.
After dropping to the yard mere feet from the ceremony space, my mind lost control of the reality it had, up to that point, known. Seconds, minutes, or hours later a new awareness emerged with dramatically different perceptions than my waking-self. I was unable to move my body or focus my eyes, but my hearing was unnaturally acute. I could make out the whispers of other participants in distant parts of the large yard and became aware of the orchestra of the Redwood forest near my prostrate body.
My ears were a gateway into another world and there was no separation between hearing and feeling. The wind bending the tops of the sentinel Redwoods and the cool, damp coastal air soaking into the forest floor. The tiny frogs in a nearby, unseen pond answering the elemental forces with a celebratory chorus. It was all inextricably linked. A feeling of reverence washed through me with each new gust of wind and chirp of frog.
Yet another part of me was profoundly disturbed by my new state of awareness. It needed to control something – anything. It wouldn’t allow me to sink into the forest-web for too long before it demanded attention. When it successfully wrested control it demanded action. “Sit-up and do something,” it mandated without a clear vision. As I fought to assume a seated position, I became aware of how utterly terrible and insane I felt. Nausea and vertigo rolled through me as panic and despair filled my thoughts.
I was convinced that I had done something wrong and needed to contact the authorities. They needed to imprison me for the crime of losing my mind. And my family needed to know how lost I had become. So far from home – so alone. [goya]
My mind unearthed a relic from my subconscious: my distant, long-dead grandmother on her death bed. Demonic and alive imagery electrified her memory. Isolated, terrified, skeletal. There was no separation between her state and mine. Our collective existence was horror.
It all reached a sickening crescendo and I vomited into the grass next to me, falling back to the earth in catharsis and sinking back into the grove of life. This cycle repeated several times over the course of the evening, though my sense of time was dramatically altered as I toggled between realities. The here-and-now was both a concrete reality and part of a terrifying, stretching-to-infinity continuum.
In early 2017, researchers in both the US and UK were given permission by their governing bodies to study the effect of psychedelics on treatment-resistant depression – depression non-respondent to several different kinds of interventions (medication, talk-therapy, etc.). Globally, incidences of depression have been rising, so the remarkable results of the study were a pleasing surprise. A week after the study, every single volunteer experienced a reduction in their symptoms and 66% of volunteers were completely depression-free. 33% of volunteers remained in remission for 6 months.
These results may sound modest, but compared to other forms of treatment they are stellar.
They hint that unlike daily medication, psychedelics may only need administering once every few weeks and have none of the unpleasant side-effects of anti-depressants like weight gain or diminished sexual interest. None of the respondents reported an adverse psychedelic experience, like suicidal ideation or increased agitation as can happen with medication. And unlike the weeks or months sometimes necessary for talk-therapy and medication to show improvement, clients showed nearly instantaneous improvement after their trip (p. 376-377).
While the quantitative data of the study showed statistical promise, the qualitative information proved to be just as rich. Through interviews with patients, researchers found that psychedelics broke the cycle of negative thinking and rumination characteristic of depression. Patients felt they had been freed from their mental prisons and had re-discovered connection with people, nature, and the world-at-large. Patients also discovered a broader spectrum of emotion – both good and bad – which gave them greater contentment and vitality.
In the pre-screening process, patients were encouraged to face whatever difficult emotions or thoughts came up during their trips. Instead of trying to make bad feelings or thoughts go away, to face them and understand where they come from and what they’re about. The results of such coaching were dramatic. One patient who suffered from years of depression reported ‘You don’t cherry-pick happiness and enjoyment, the so-called good emotions; it was okay to have negative thoughts. That’s life. For me, trying to resist emotions just amplified them (p. 380).’ Clients re-experienced traumatic memories yet were newly able tolerate the emotions associated with them. Their trips seemed to help integrate disparate parts of themselves and encourage a brave and compassionate view of the self and others.
Though the treatment shows much promise, it is not perfect. Most patients saw their depression return after 6 months, so psychedelics may represent an ongoing treatment rather than a one-time intervention. Though every form of mental health treatment (talk therapy, meditation, or electro-shock therapy) requires some amount of ongoing regimen. The brain is perpetually changing and growing, so like a garden it is reasonable to expect some ongoing maintenance and care of it.
Pollan also notes that new treatments, including SSRI’s, usually show greater promise at the beginning of their introduction than once established. The power of placebo is real and psychedelics may be no different – only time will tell. However, if psychedelics continue to show promise in depression, addiction, anxiety, and PTSD, they may show that the myriad diagnoses actually share an underlying faulty mechanism in the mind. Different variations of the same illness. Pollan exposits the work of former FDA head David Kessler and his term ‘capture’ to describe the unifying component of the mind involved mental illnesses “...All these disorders involve learned habits of negative thinking and behavior that hijack our attention and trap us in loops of self-reflection (p. 383-384).”
By decreasing activity in certain brain structures and connecting previously disparate parts, psychedelics may offer the brain a chance to forge new pathways – even after years of negative habits. This premise dovetails nicely with new wave theories of mind correlating mental flexibility with happiness. Psychedelics distortion of time, place, and self may be viewed as a key to unlocking the prisons-of-self characteristic of mental suffering. Pollan eloquently states, “When the ego dissolves, so does a bounded conception not only of our self but of our self-interest. What emerges in its place is invariably a broader; more open hearted and altruistic that is, more spiritual idea of what matters in life. One in which a new sense of connection, or love, however defined, seems to figure prominently (390).”
After 3 or 4 hours caught between my ego and the web of life around me, ayahuasca’s effects diminished enough for me to stand up and walk back into the ceremony space. As heavy rain began to fall outside, I tumbled to my sleeping mat between my friends. As the shaman continued to sing and dance, my body began to shake – discharging the energy from my struggle. My friend wordlessly covered me with a blanket and I slept.
Chuckling now as I remember my ayahuasca night -my view informed by years of psychological education and training - my egoic struggle seems like the wet-dream of a psychoanalyst. It is also so commonplace as to be cliché, but that does not diminish its importance. Immediately after the ceremony, I needed no intellectual or scientific understanding of my trip to feel the benefits. For a few months, life felt shiny and bright. I explored parts of my city and interests of mine that had been in plain sight, yet I had been too morose to explore. The challenges faced in daily life were now small in comparison to the challenge I faced during my night of ayahuasca. Life seemed effortless and my playful side returned with my friends and family. My new self-confidence also emboldened me to express to others what I had been containing for months or years. Fights happened, but they felt necessary and in the service of deepening the relationships rather than withdrawing from them.
Over the course of a few months, my new perspective gradually diminished as the various difficulties of life swept me up and away. Though the insights I gathered have been reinvigorated by Pollan’s exploration in ‘How to Change Your Mind’ and given me two ways to perceive my trip. First, the scientific explanation that would see my trip as the product of DMT drastically altering my neural pathways. My Default Mode Network was temporarily disengaged by the DMT molecules binding to my serotonin receptors while the MAO-Inhibitor prevented the DMT from being metabolized by my body – thus prolonging my experience for a few hours. For seconds or minutes at a time, my DMN was disengaged so that new neural pathways were being stimulated by the cornucopia of sensory data present in the vibrant forest. Temporarily, I had the brain of a toddler that had never experienced the sights, sounds, and textures of a redwood forest. Yet, there was enormous internal resistance to pulling my DMN offline – a testament to the brain’s robust neural pathways that were bolstered by every single moment of my life I had identified with my ‘self’. The vomiting and other gastro-intestinal effects induced by ayahuasca might also be seen as a typical side effect of serotonin-based drugs.
And now for the psychotherapeutic/spiritual/metaphoric interpretation. I was mildly depressed before this experience because I had over-identified with my ego or self. I was trapped in my mind’s projection of me in the future – one that had little hope or joy in my job or relationships. I saw little point in exploring the people or world around me because my self was convinced that they would offer no reward. Ayahuasca offered me a hyper-distilled version of my depression. A version that was not intellectual, but unavoidably felt. Like the ghost of Christmas Future for Ebenezer Scrooge (or Bill Murray), I was shown what life could be like if I continued down this path towards a lonely existence like my grandmother’s.
I was also presented an alternative to this path –the natural world full of dazzling complexity and richness. The struggle between choosing either path, more than world’s themselves, was the most meaningful aspect of this experience. For it was symbolic of a choice I face in everyday life. How much to identify with the story of my self?
For the past 6 years, my close friends and I have taken a 5-day backpacking trip in some wild part of the world. What started as a one-time adventure through Teton National Park has now become a tradition of endurance and bonding.
We walk 6-12 hours everyday carrying 35-40 lbs. packs above the tree lines of snowy mountains and alpine passes. When it’s time to camp, we pitch our tents, inflate our sleeping mats, filter water, and go through the long sequence of preparing our meals then cleaning up so as not to attract bears. Our shoulders, backs and knees groan as we crawl into our sleeping bags and hope rain or snow doesn’t fall too hard in the night. We repeat this sequence for 5 days.
Why choose to exert so much effort and experience so much discomfort? Aside from the staggering scenic beauty, because there is a deep sense of accomplishment from being self-sufficient in a harsh environment, if only for a few days. Because the suffering in close proximity with my friends shows me my limitations and areas for improvement. And because sleeping, eating, and…. pooping (not necessarily in that order) with my friends gives me an ability to laugh with them at anything resembling a joke (thanks Mt. Niblet and Nub Peak).
Usually the first few days of the experience feel like the relationships of my day-to-day life. I mostly regulate my emotions and myself and look out for my own well-being. As the group encounters both collective and individual hardship I see that others could use my help and I could use theirs. My friends’ mood soured on the second day when a rainstorm soaked their tent and sleeping bags. Some of us wanted a faster pace that day so we took the extra step of taking their sopping gear with us to dry in the sun. On the third day, I developed a monstrous blister on my heel and my girlfriend and friend carried much of my gear for the remaining 2 days. On an intellectual level, I agree that helping others feels good, but I often lose touch with this golden rule in my day-to-day life. Backpacking provides a plethora of opportunities to ask for help and to give it. Like the insights gathered in meditation, the only lessons I really learn are the ones I actually experience.
While the physical actions of helping others are clear and obvious to me: fill their water, give them a Tylenol, and share my stash of nuts.com snacks. The psychological, emotional, and power dynamics are more obfuscated and have required me to engage in some deeper introspection.
I like control. My day-to-day routine takes the guesswork out of what I should be doing at any moment. Because of the consistency, it is easy for me to anticipate and solve problems and knock out my responsibilities. To borrow some language from author Michael Pollan, the reason this strategy is effective is because there are no surprises. And the reason this strategy isn’t effective is because there are no surprises. At times, life takes on a monotonous or droll feel because I’m not open to the connections or spontaneity around me. This tendency manifests itself in a more stark way on our backpacking trips.
Typically, I plan the hikes for our group. This satisfies my need for control, but has also prohibited me from sinking into playful moments with friends because my mind is in ‘tasking mode.’ Much of the time, I feel executive responsibility for the trip even when no executive is necessary. In 2017, my partner and I quibbled because it was obvious that instead of enjoying Mt. Hood and my friends I was incessantly checking the map or time-to-sunset. I felt disconnected and alone. My chums clearly had the ability to read a map or track the sun, but I had difficulty trusting them.
In the world of psychotherapy, there’s a lot of travel metaphors like ‘finding your compass’ or ‘walking your own path’ or ‘asking a guide’, so I appreciated the concrete symbolism of literally handing over the map of our route to my close friend at the start of our hike this year. Before we ventured into Banff National Park, he playfully informed me that I wasn’t allowed to answer questions about the details of our route. I had to defer to him. In a welcome power play, he established his role and mine. “Safety word is ‘Quasimodo’, Dave.”
Losing control was (and still is) often difficult. At times, I disagreed with the consensus or felt lost in the crowd of 7. Occasionally, I became frustrated with my friends’ attitudes or their perceived lack of foresight (even in the face of my own). Sometimes I was moody or irritable because of pain in my feet or the unrelenting cold and wetness of the Canadian Rockies. Or those god damned thieving chipmunks! There was nowhere to hide my mood or my emotions. We ate, walked, and slept within feet of each other, 24/7 for 5 days. Thankfully, each new challenge while backpacking provided not just a potential for argument, but also a potential for repair and bonding. We could grumble, disagree and still laugh at each other’s horrendous ‘trail stink’ or share our last drop of water (but you can pry my cacao goji energy-squares from my cold dead hands).
The whole endeavor of backpacking reminds me of what I’ve read of encounter groups of the 60’s and 70’s and what I’ve experienced in limited doses at group psychotherapy conferences. The precursor to modern interpersonal process groups, encounter groups were short (3-4 days) but intense in their nature. Members often spent 12-15 hours per day together or even slept in the same room with one another. The format differed widely from group-to-group, but generally there was emphasis on: here-and-now feelings towards one another; honesty; and confrontation. Some were muscularly guided by leaders, while the leadership of others was more as an egalitarian. The thrust of encounter-group theory was that spending sustained and intense amounts of time with others whittles down ‘defenses’ and allows complexes or disorders to manifest more quickly than in once-per-week therapy sessions. In other words, it pisses you off. The surfacing of these emotions allows members to make quick gains at the cost of being very uncomfortable for a few days. Unfortunately, research showed that while encounter groups could produce significant and occasionally dramatic change, it could be negative or positive in its direction. Pressure creates diamonds, it also breaks pipes and causes earthquakes. Many groups had high casualty rates (~30%) and actually harmed the long-term well-being of some of its members. This fact was especially true of groups that emphasized anger and confrontation or were guided by authoritarian or rigid leaders.
According to esteemed process-group leader and author Irvin Yalom, M.D., a few important lessons on personal change in the context of relationships can be gleaned from these encounter groups.
1. Don’t just let it all hang-out, let more of it hang-out than usual if you are willing to analyze yourself
2. Getting out anger is helpful, but leaving it out is not
3. Individual learning and positive change correlates with group cohesion, group climate and role flexibility
4. High risk encounter groups produce high casualty rates – not higher gains
5. Don’t wait for understanding later, seek understanding now
Yalom’s third point on cohesion is the most relevant to my experience backpacking. As the group spent more time with one another and collective challenges were faced, cohesion grew and my own willingness to look at my quirks increased. After hiking through 8 hours of snow and sub-freezing temperatures our 4th day, I felt closer than ever to my friends the following day. And collective decision-making became easier. While our morale occasionally dipped, I credit my friends’ individual ability to tolerate and even laugh at our own discomfort.
Experiencing pain alone is miserable, facing it together was fun. Once again, I learned that sharing outside my comfort zone is a process of acceptance rather than rejection. The ability for me to toggle between occasional leader, follower, and member most-in-need-of-help gave me empathy for my friends whenever they switched into one of those roles. I took no offense when someone asserted we slow down and found it easy to lend my last pair of dry socks because I had lived the emotions intrinsic to those experiences.
While backpacking through the mountains is not feasible for many because of money, physical ability, or various other factors, I believe the lessons extrapolated can be found elsewhere in life. In the world of psychotherapy, participation in some kind of relational counseling (couples or group therapy) can bring profound understanding to individuals. My deepest relationships say a lot about my own fears and boundaries and illuminate new areas for growth. The challenge of trusting others and myself especially around my extremes of anger, suffering, and love, is a continual point of work that surfaces in my own coupledom and my membership in a process group. Our yearly hikes serve as yardsticks to measure my own progress (or regress), but any commitment to self-inquiry could potentially serve the same purpose whether its meditation, yoga, or a creative pursuit. Backpacking has the added benefit of a scenic external setting to a powerful internal experience…and plenty of opportunities for snacking.
The ideas shared in this blog are mostly taken from: Harari, Y. N. (2017). The Right to Happiness. In Homo Deus: A Brief History of Tomorrow (pp. 30-43).
Author Yuval Noah Harari has two bestseller books over the past 5 years, ‘Sapiens’ and ‘Homo Deus’ both of which I’ve immensely enjoyed during the past few weeks. Harari’s PhD in History from Oxford, professorship at the Hebrew University in Israel, and deep commitment to Vipassana meditation lend him the moxy to answer big historical and future-oriented questions.
Harari is also partly responsible for my interest in Vipassana meditation because of the benefit which he ascribes to his annual 30 or 60 day silent retreats. I assume that his clarity of ideas is a result of his Herculean efforts of concentration on retreat and in daily practice.
In ‘Sapiens’, he explains the rise and success of humanity from the savannas of East Africa to modern Wall Street through the development of writing, money, and capitalism. He offers interpretations on the costs and benefits of major developments in human history such as how the creation and valuation of money and capital has created a global standard allowing worldwide transmission of ideas and services while simultaneously creating the greed and apathy necessary for the Atlantic slave trade and global warming.
In ‘Homo Deus’, Harari’s 2nd book, he muses about the future of humanity and the great existential challenges we will face. Since the agricultural revolution 12,000 years ago, humanity has mostly occupied itself with preventing and or dealing with plague, famine, and war. For the last half century, the world has been mostly peaceful, mostly without widespread starvation, and mostly without catastrophic epidemics. There are, of course, horrendous exceptions to these rules which any person finds intolerable (Syria, Central American gang violence, US border detentions of immigrants, AIDS, Ebola, Rwanda). Harari contextualizes these episodes without dismissing their import, compared with all known history, we are currently in the most peaceful, well-fed, and healthy time ever.
If the trend continues and we avert ecological collapse or nuclear holocaust (two enormous ifs), Harari would argue that humanity will use its newly freed resources to improve levels of happiness. The marker for national success will shift from per capita income and Gross Domestic Product (G.D.P) to G.D.H. – Gross Domestic Happiness. As evidence for the shifting trend from productivity to happiness, Harari highlights the discrepancy between Singapore and Costa Rica. Singapore’s $90k per capita GDP eclipses Costa Rica’s $17k per capita GDP, yet Costa Rica continually scores higher on measures of citizens’ well-being. Clearly money correlates with happiness, but Harari suggests that there are diminishing returns after a certain point and there are factors other than money to consider when seeking happiness. More money and more productivity does not always translate to more fulfillment (p. 32).
Instead of continually rising GDP and per capita income, citizens will demand their governments improve their levels of happiness. The quasi-socialized governments of Scandinavia provide models for the future: healthcare for almost all, access to good education, less wealth disparity. The state assumes a bigger role in its citizens’ well-being. Our inalienable rights may be life, liberty, and (the pursuit of) happiness. Harari predicts this will increasingly be the expectation for governments (p. 32).
However, there are some troubling statistics that are not easy reconciled with the idea of ever increasing happiness by way of state provision as Harari notes. In Peru, the Philippines, Guatemala, and Albania the suicide rate is roughly 1 per 100,000 citizens per year while far wealthier and socialized Switzerland, France, Japan, and New Zealand have a rate of 25 per 100,00 citizens per year. In 1985, South Korea was a whisper of the regional power it is today. Its citizens are wealthier, better educated, and living under a far less authoritarian government. Why then has the suicide rate tripled in 30 years? (p. 33)
Since the 1940’s the US GDP grew 500% and per capita income doubled. Women, African Americans, non-heterosexuals and other minority groups increased their share of rights. A deluge of cheap goods from the recently globalized marketplace equipped almost every home with a TV, AC unit, computer, and other gadgets (p.34). Why then has subjective well-being stayed mostly the same or even decreased over that time? Statisticians and epidemiologists would find many correlations for this phenomena: rising income inequality, 24/7 work expectations, a decreasing sense of community. Harari’s Buddhist philosophy shines through as he explains this phenomena is a basic tendency of the human mind as much as it is a sociological problem.
As our access to goods and services increases, so do our expectations. We don’t feel content or grateful that we no longer have to use an outhouse or scythe our grains, instead we see it as normal and look for a new source of happiness. Harari further illuminates,‘It took just a piece of bread to make a starving medieval peasant joyful. How do you bring joy to a bored, overpaid and overweight engineer?' (p. 34)
Our mind has evolved over millions of years to ceaselessly seek pleasurable experiences. A wild ape that experiences everlasting bliss from eating a single mango would have no motivation to do anything else with its life, including sex or seeking more food. Baby chimps would never birthe and that line of genetic material would orgasmically howl to a stop. Part of our success as a species results from our endless need for stimulation (p. 37).
Our modern rewards are no longer as simple as food to survive and mates for procreation. Instead they are a job promotion, a better looking partner, or a more exotic vacation. While the tangible prizes have dramatically shifted over the past 12,000 years, our internal biochemistry and mindset has not (p. 38). No matter the means, pleasant sensations and thoughts never last and today’s excitement becomes tomorrow’s humdrum.
Harari and the Buddha might say that there is (and has been) a fork in the road for humankind. One path attempts to perpetuate the stream of pleasant sensations so that we never experience boredom, frustration, or sadness, while the other seeks to circumvent the whole system and see sensations for what they are – ephemeral and unworthy of pursuit or avoidance.
Harari believes humanity has mostly chosen to increase access to pleasant sensations as evidenced by our consumer culture that encourages us to do more, be more, and consume more in the name of happiness. He also cites the increasing usage of psychiatric drugs for less ‘serious’ psychiatric conditions especially in already well-off industrialized countries (p. 39). Of course, psychiatric drugs and services are essential to many, but the thrust of Harari’s point is that our consumer culture assumes that happiness is around the corner and through the gift shop. And the cost of our ballooned expectations and consumption is a degrading global ecosystem and a troubling rise in suicide.
While Harari is careful to offer possibilities rather than solutions, we may look to his own personal life in addition to his writing to find some hope. Collectively, we will continue our exponential problem-solving capacity through computer learning and bioengineer new ways to keep ourselves happy and, if we’re lucky, avoid environmental doomsday. New technology will extend the quality and length of our life while artificial intelligence will create new dimensions of the mind and consciousness. Individually, we will re-examine what it means to be happy and instead of hastening our pursuit of pleasure, we might restrain it.
Recently, I sat in silence for 8 days at the Southwest Vipassana Meditation Center about an hour’s drive outside of Dallas. This was my second long-term course at this center and the intensity of the experience has had a lasting effect on me.
Having already faced the discomfort yet ultimate benefit of a previous ten-day course last October, my ego struggled in the days leading up to my departure. As an old-student (old students are those that have sat a 10-day retreat) I was now allowed the privilege of sitting for as many days as I wanted – not the full ten, if I so chose. I justified skipping the first 3 days by telling myself that I was stressed from having houseguests for an extended weekend and that I could use a couple of days to accomplish some tasks around the house. Excuses, Excuses! My ego knew it was about to take a gut-punch and it scrambled all its forces to ensure its survival. It was wary of the unconscious elements that had been exposed during the first sitting.
My first 10-day retreat at the center had been both deeply unsettling and confidence building. The rules of the experience were strictly enforced: 10 hours of meditation from 4:30 AM to 9:00 PM with a few hours for meals and rest; no communication with any other participants except the teachers (no speaking, eye contact, writing notes); no outside materials allowed in (phones, books, journals, radios, etc.); and, no exercise or stretching other than walking a short loop trail. All these regulations were intended to let the deep material of the unconscious emerge over the course and to give the participants a fair idea of the benefits of the meditation technique.
The first 7 days were awful; I sat in terror as horrific behemoths emerged from my unconscious. I became aware that these same thoughts were the fabric of the depressive episode I’d had several years back. At that time, I attempted to escape from these thoughts – to reason and bargain with them to prove their falsity. But like quicksand, the more I fought against them the further I sunk. They dominated my head space, casting a dark shadow on everything. At the meditation center I feared I was slipping back into depression and, ultimately, madness.
The Assistant Teacher gave me guidance (once I finally asked for it) and he assured me that this was all perfectly normal material that comes up for students. “Stick to the simple principles of the technique and keep working at it. Nothing is permanent – including these thoughts and feelings,” assured the Assistant Teacher with a deep Texas accent. I cried and I practiced self-compassion while looking at myself in the mirror. I trudged through it all. Somewhere around Day 7, I began to feel confidence in my ability to sit with the discomfort of these contemplations. Yes, they were unpleasant in their nature and I would have preferred to think about milkshakes and cherubs, but they could not actually harm me. There were times when they ceased and I simply experienced the subtle sensations of my body.
The theory of the practice began to make sense; chasing our desire for pleasant thoughts and feelings creates misery. When we pursue ephemeral and transient phenomena we are left wanting more and more. Never satisfied, never complete and deeply discontent. We live our lives with reaction on top of reaction on top of reaction. Creating more and more tension in our lives. Vipassana seeks to gradually unwind the knots with a simple strategy. Sit in silence and without moving, keep your attention moving over the entire surface of the body and aware of the sensations present. Never linger for more than a few minutes in one area. No matter how pleasant or unpleasant the sensations, keep the attention moving. By keeping your attention impartial and balanced, you sew the seeds of non-reaction. This practice should extend into all areas of your life – do not expect miracles, but do expect benefits in your daily life. This isn’t blind faith, it is expected that your own direct experience with unbiased attention will leave you happier and more peaceful. I left the retreat after Day 10 feeling renewed enthusiasm and energy for all the domains of my life: partnership; family; work; and friendship. And I was committed to maintaining the recommended 2-hour practice in my daily life.
So it came as a surprise, when a full 8-months after my second sitting these same black thoughts emerged and were just as unpleasant as the first time I sat. I cried to myself in my room feeling sadness at what my mind had to offer me and that I had seemingly progressed so little. Again, I sought guidance from the teacher. “The mind-body structure is like a gong, when these unpleasant thoughts arise – they strike the gong and resonate throughout your whole body. Continue to use the Vipassana technique and work through these thoughts by turning your attention to the sensations in the body. Do not react with aversion to them and do not crave for your experience to be anything other than what it is. Keep working,” he reassured me. I cynically thought to myself, “That and a nickel will get me a nice cup of jack-squat! I’m suffering here Teach!” No miracle placing of hands, no liberation through a benevolent deity, no secret chants or texts. Just deliberate and endless repetitions of focusing the mind on the reality of the present moment as experienced through the body. Everyone has to fight their own battle for liberation. No one can do it for you.
I realized as I sat through the seemingly endless waterfall of thoughts that I had built much of my life around engaging with my own rambling contemplations rather than with the realities of the actual world. Yes, I had mostly maintained the practice for 8 months, but my meditation had become a ritual - not a practice. My meditation was mechanical and the rest of my life was still full of mindlessness. Constant multi-tasking, shoveling food while watching TV, incessant checking of my smartphone for mundane information and updates, chasing down every thought with a Google search. These were all the minor behaviors that kept me separated from my body’s experience of the moment and had kept me from addressing deeper issues: my irritability and quick temper at those that I most cherish; my frantic need to control my daily schedule (exercise, food, sleep, work); and my absolute terror when facing the thought patterns that led to my depressive episode. The ugly truth sat before me in plain sight and my hope dimmed.
Yet I kept working, I believe all my practice up to this point had, if nothing else, taught me persistence. To just keep at the goddamn thing. I took comfort in the evening discourses in which S.N. Goenka, the modern transmitter of this technique, delivered humorous and compassionate stories about the great miseries of life. The talks normalized the suffering that I was experiencing while inducing hope with the stories of other practitioners’ liberations. I reconnected with some of the wisdom I had acquired through my own life. The best way out is through.
Through these talks, I also gathered new insights about the psychology behind this technique. It is inspiring that this 2500 year-old technique conceptualizes the mind and psychology in a way that Western psychology and neuroscience is only beginning to accept. In essence, Vipassana believes that the roots of our problems are sankaras, which are deep reactions of craving and aversion that are stored in the body and the unconscious mind. By observing the sensations in the body and not reacting, we began to work through our deep store of sankaras and become happier. Like a bonfire of suffering, when we stop piling on more fuel, the flames gradually extinguish. This conceptualization fits nicely with modern trauma therapies (somatic experiencing, EMDR, yoga therapy) that conceptualize trauma be it combat, car accident, childhood neglect, or abuse as stored within the body and unconscious mind. Generally, because of the pain of the associated memories, we live our life in avoidance of certain feeling states and thoughts. Unfortunately, we can’t selectively turn-off emotions or thoughts. When we seek to numb or avoid fear, pain or negative thinking we also avoid joy, connection and love. Through their various modalities, these therapies allow the traumas of old to surface in a controlled and systematic method. By gradually facing the difficult memories and feelings, we widen our tolerance and live more dynamic and joyful lives.
To me, the deep reactions that are labeled sankaras by Vipassana could easily be substituted with the word traumas. The methodology is similar: sit through the unpleasantness without reaction and gradually become stronger and more tolerant.
It made me re-examine my own work as a therapist. Oftentimes, my work with clients is focused on the why? Why did my father treat me like that? Why do I drink so much? Why do I continue to destroy my relationships? Many times, the answer to the why fails to give adequate relief and it can feel as though therapy turns in circles on itself. Using the framework of Vipassana, the importance of the why is diminished. Thoughts, feelings, sensations are impersonal and transient. Chasing down an answer may be intellectually stimulating, but it fails to address the more important question of our lives: how will I be free from suffering? In my limited experience, Vipassana’s philosophy offers a simple and effective technique that may answer the how?
I concluded my second sitting slightly shaken-up, but with important realizations and goals. The solitary nature of the endeavor left me with gratitude and commitment to the people that are closest to me. The length and intensity of the work has given me more patience with myself and with others - the ability to sit through unpleasant emotions and thoughts without fueling them. And it has given me less anxiety in my daily life, instead of engaging in endless pleasure-seeking multi-tasks, I make an effort to do one thing at a time which gives me a greater sense of calmness.
Lastly, the fact that Vipassana centers are taught and run by volunteers, that there is no fee charged for these retreats (donations are accepted but not pushed), and that the attendees are from all walks of life and locations (India, China, Israel, Bhutan, Mexico, to name a few) leaves me feeling especially inspired. It has become evident to me that this technique has spread not because of a savvy-marketing team or a false promise to instantly lift suffering, but because it has genuinely helped people enough for them to want to give it to others.
I am not enlightened and I’ve only just begun to do the work, but I do feel that my experience with Vipassana has shown me a path to healing and happiness.
Psychiatrist Bessel Van Der Kolk’s book ’The Body Keeps the Score’ is an exploration into the mind-body connection of those suffering from the effects of trauma. Van Der Kolk has been working in the field of psychiatry since the Vietnam War and has tried a variety of different methods in helping those afflicted with the symptoms of PTSD. He brings a wealth of experiential knowledge into his writing.
Chapter 16 of the book details his work with yoga as a form of healing. Yoga has now become a mostly accepted form of exercise in the West and is synonymous with wellness and, for some, a form of spirituality. Van Der Kolk approaches the practice as a scientist would – with quantifiable data and research. The premise of his work is that trauma breaks the alarm system of the brain and body, a.k.a. the amygdala and associated limbic system. The limbic system is responsible for our fight, flight, or freeze response that helps us to escape bodily danger. It assesses threat without reason such as a jump away from a snake-like object or a quick reaction to a loud noise. It usually keeps us safe. However, for individuals with trauma it can lead to misinterpretation of daily situations as potentially life threatening and a constant state of ‘high alert’.
A real trauma has taught those of us with PTSD that the world is a dangerous place. Often, this waking state of extreme caution is unconscious to the day-to-day self, but our bodies are aware. Van Der Kolk asserts, if we are chronically scared or afraid our bodies will respond with chronic pain, headaches, and difficulty sleeping. In fact, many with mysterious physical illnesses may seek out treatment from physicians for issues that stem from a mostly psychological event. To help cope with the uncomfortable physical sensations, we may find ways to numb ourselves: drugs, alcohol, work, exercise, over or under-eating. Van der Kolk sought to better understand the physiology of PTSD and an over-active limbic system.
In order to assess our nervous system’s health, Van Der Kolk utilized heart rate variability (HRV) to evaluate the balance between the two branches of our autonomic nervous system, the sympathetic and parasympathetic. Broadly speaking, the sympathetic nervous system (SNS) branch uses adrenaline to thrust our system into action while the parasympathetic system (PNS) activates chemicals to assist with digestion, sleep, and healing.
When we inhale we activate the SNS and our heart rate slightly accelerates. When we exhale, our PNS takes over and our heart rate slightly decreases. The difference between our heart rate on an inhalation and exhalation is our heart rate variability. Healthy individuals show a wide difference in HRV correlated with the breath. Individuals with PTSD show rapid and shallow breaths that have little relationship with the heart rate. In short, individuals with PTSD have a much harder time regulating their nervous systems during both stimulating and relaxing times.
Van Der Kolk studied the effect of yoga on HRV and discovered that as little of eight weeks of regular yoga practice helped improve variability. However, it became clear to Van Der Kolk that the value of yoga was not its effect on HRV, but the bodily awareness it provided to those that practiced. The sequences of postures activating different muscle groups combined with awareness on deep or shallow breathing allowed practitioners to become more aware and comfortable with the relaxation and tension inherent in a yoga class. They understood that sensations came and went and they could tolerate them. This awareness clued them into the tension and relaxation present in their day-to-day lives. Many found themselves listening to their body more, and that it became easier to know what they needed moment-to-moment. Yoga taught many that their fear of certain feelings and sensations (anger, shame, sadness) was usually more detrimental than the feelings themselves. Yoga shows that like postures, feelings will peak then remit. Often the anxiety about the feelings is more de-stabilizing than the feelings themselves. Yoga harnesses the body to teach us these lessons which is an experiential form of learning that cannot be learned through reading, talking, or watching a film. We must experience to learn.
Van Der Kolk ‘The Body Keeps the Score’ is a fascinating and easy read that represents some of the most fascinating integrative work in psychology. His belief (backed up by modern neuroscience) that our psychological sense of self is rooted in our physical selves is a new idea to the West, but one that is fundamental to many Eastern philosophies.
“We don’t truly know ourselves unless we can feel and interpret our physical sensations; we need to register and act on these sensations to navigate safely through life,” (Van Der Kolk, The Body Keeps the Score, p. 272)
It is important to be aware of the choices present in life. To acknowledge our options when a moment or interaction goes somewhere we don’t it want it to go. For many men, anger is the most comfortable choice in responding to difficulty. ‘Manning up’ means going hard and doubling-down, attacking the problem. When something’s broke, not to mope – fix it with force. This logic has its upsides, but on an inter/intrapersonal level it sometimes leaves us feeling more isolated and full of rage than before. Moving through life with anger may keep us away from the acceptance and compassion available to us from others and ourselves.
2 to 3 days a week, I play pickup basketball with a group of men. Ambient testosterone levels are high and physical fights are known to happen with some regularity. The game of basketball is a team sport; it requires a group of 5 to work together. Respect the geometry and spacing, pass the ball, talk to each other on defense, have your teammates’ backs. There’s a sort of magic that happens when it all comes together properly. There’s a gratification in the unspoken harmony of the group. There’s also the potential for discord. Inevitably, a teammate errs. An easy layup is missed or a defensive gamble leads to an easy basket for the opposition. These are the moment that illuminate individuals’ characters and deepens or weakens bonds. The worst response to adversity is one in which teammates assign blame to each other, forgiveness is withheld, and superiority is established. Unquestionably, it is disappointing when a mistake is made. It makes sense to acknowledge the error and learn from it – make an effort not to repeat it. Usually, as individuals we are aware when we’ve made a mistake. Many of us have an internal critic that is harsher than anyone else’s criticism. However, there are some that find any mistakes by their teammates or partners in life so intolerable, their response is to become angry and assign fault. Rather than sit with disappointment, call out the other.
Unfortunately, most of us, including myself, do not respond well to judgment and criticism from others. It has a way of exacerbating the shame and guilt that we may already be feeling in response to our mistake. It also drives us away from seeking the support that others can offer us. Some feelings like shame and guilt are bigger than us and the people in our lives can help us manage them through their acceptance and compassion. Keeping this in the domain of basketball, this might look like telling our teammates ‘don’t sweat it’ or ‘keep shooting it’ or a friendly pat on the back when they mess up. Even the act of withholding criticism and playing through is an act of acceptance.
Relationally, when we assign fault and blame, we discourage risk-taking and vulnerability. Relationships become stunted and compartmentalized for fear of the negative feedback we receive unless we play if safe. Getting angry should not be confused with assigning blame. It is healthy for us to feel our emotions and not repress them. We can be angry, even enraged without it tearing down our relationships. Anger may be seen as a signal that something is unpleasant to us.
Occasionally, there are clear instances when anger and its charge are demanded – an physical attack on us or someone we love, a clear injustice on someone that is vulnerable and unable to defend themselves, etc. Though most of the time, anger keeps us out of touch of the grief that we are actually feeling. Grief that the moment didn’t go as we wanted, our partner said the wrong thing, or our boss didn’t recognize our achievement. When we are able to tap into grief, we are usually able to access compassion and care. This is healing for us and has the power to bring parts of ourselves into integration and to make our relationships deeper. Showing our soft side is good for those around us and for ourselves. Responding to grief with anger usually distances us from the support available within our selves and in our relationships. When we are angry with ourselves we may fall into shame and isolation.
The small moments and interactions of the day-to-day weave the networks that characterize the quality of our life. By choosing how we respond to difficulty in everyday life - be it at basketball, breakfast with our partner, or at work - we choose how our life feels. If we are able to stay with the disappointment and difficulty inherent to life without it making us angry and bitter, we may hope to forge new experiences and relationships that give us hope and happiness.
My heart was pounding and I found myself unable to follow the conversation of the other members of the group. My mind was racing in its attempt to answer the question ‘why are you feeling like this?’ Instead of internally deliberating on this question I blurted out to the group ‘I don’t know why, but I’m terrified.’ Kind faces and soothing words were offered to me from several group members. No one panicked or tried to deny my feelings. The leader of our group offered some insight. ‘Dave, you may be feeling what Tom is unable access within himself. You are holding the terror that is within him but that he avoids.’ This interpretation settled my mind a bit and diminished my panic. Tom stared at me with curious eyes and elaborated ‘this isolation I feel…it is so awful.’ Tears streamed from his face and the group shared a silence that honored the intensity of the emotion.
This was a recent scene from the American Group Psychotherapy Association Conference in Houston, TX. This annual week-long training is focused on improving the skills of process group leaders from around the world. Process groups are a form of psychotherapy that aim to improve the members’ interpersonal relationships and consequent feelings towards themselves. Generally, these groups are led by 1 or 2 psychotherapists, have 5-10 members and meet for 1-2 hours weekly. Rather than advice giving or turn-taking, group members are encouraged to keep things here-and-now, focused on their feelings and thoughts towards other group members. While this form of treatment was created out of necessity in the 40’s/50’s to treat a glut of shell-shocked GI’s, it is now widely accepted as legitimate treatment method for depression, anxiety, along with other more interpersonal issues. There are many views on the theory behind group therapy, but most psychotherapists would agree that our interpersonal relationships are a manifestation of our internal relationship with ourselves. So if we can understand and improve our relationships with others, we, as social creatures, will improve our relationship with ourselves.
‘I just feel so alone. I don’t feel like I have much of a life – if people really knew how I felt they would be repelled. It’s just so scary to let people in.’ I nodded along as Tom’s voice resonated within me, he was putting words to an experience I’d had. As Tom continued to explore his sense of aloneness, I felt tears just behind my eyes and my mind again wandered back to my own period of hardship. ‘I don’t want to go here,’ I thought to myself. ‘That period was so scary and difficult – I thought I was done with it,’ I continued to think to myself as the group conversed around me. I was scared of letting the other members see my vulnerability.
As a co-leader of weekly process group, the AGPA conference gave me firsthand experience of a variety of techniques and leadership styles while deepening my own understanding of myself and how I relate to others. As psychotherapists, we are expected to know the landscape of our own emotional and psychological world so that we may help our clients improve their own relationships with themselves. The trainings at the conference were all experiential, meaning that the learning was by doing rather than by lecture or presentation. In group, we are expected to get scared, be angry, feel sadness, and bubble with joy while doing our best to put our experiences into words so that others may understand us. The psychotherapists in my training groups emotionally held me in my grief and fear and shared moments of spontaneous humor and levity. The variety of experience and depth of intimacy was shocking and wonderful.
Finally I cried – I could no longer hold back. Tom’s words and display of emotion triggered my own experience of isolation and fear. I noticed how my mind spun, how I had unconsciously avoided feeling this sadness by busyness and structure. I noticed how scared I was of this feeling. But as I cried, relief washed over me and I felt closeness to the group – they had experienced a side of me that I rarely let anyone see. I realized how it was only by witnessing and being present to others pain and difficulty that I was able to make sense of my own. My eyes met with the leaders as he spoke, ‘You’re scared of this version of you, but that’s not you anymore. By experiencing this here and now, by putting it into words and sharing with us - you’ve changed it.’ This kernel of insight delivered me a cognitive understanding of my own emotional world. I left the group and the conference satiated with an renewed enthusiasm and faith in the goodness of people. As a psychotherapist and process group leader, I believe my increased mindfulness and widened tolerance for the spectrum of emotion will allow my clients improve their therapeutic work with me.
Note: Other than my own name and experience, names and identifying details in this blog have been altered to preserve confidentiality.
On my recent holiday vacation, my partner and I visited Germany for about 10 days. The trip allowed me to gain understanding of my partner’s deep German roots while benefitting from her fluency in the language and culture. I’ve found inspiration and vitality in traveling to other cultures and Germany proved to be especially moving. Their mix of social democracy has made them the Western leaders in renewable energy, allows everyone full health insurance, and makes them one of the leaders in accepting refugees from Syria. It amazed me that at no point on the (remarkably clean) Berlin subway did anyone or any machines actually check our tickets- we could have easily rode for free for our entire visit. On the autobahns (highways), drivers pass on the left at speeds nearing 110 mph then quickly move to the right to allow faster vehicles to overtake them.
There seems to be a collective trust that members of society will do their part and always think of others in their decisions. Conversations with Germans ranged in topic on how to shower more efficiently, the simplest and cheapest way to live, and how to balance the needs of the refugees with the needs of German citizens.
Germany has become the leader of the free world after being the center of nearly a century of global warfare and conflict. From the first battles of World War I in 1914, through Hitler’s rise and fall, and the nuclear tipped panic of the Cold War – Germany has known nothing but strife and hardship. Once the Berlin wall fell in 1989 and East and West Germany reunified there was a national urgency to make progress. Importantly, this progress has been made with a keen awareness of the stunning mistakes of the past.
Throughout the entirety of the country there is open acknowledgement and remembrance of the inconceivable atrocity of the Holocaust. In the very center of Berlin stands the eerie and massive Memorial to the Murdered Jews of Europe – a monument to collective guilt. Regarding the holocaust a German said ‘This is our strength – we learn from our mistakes.’ Germany is collectively guilty of the most heinous crime against humanity, but they do not hide this fact. They acknowledge it, debate it, and inform the next generation of the lessons they learned. All German school children are required to visit the camps – which are all free to the public (with one small exception).
Importantly, Germany has distinguished between guilt and shame – a lesson that can easily be applied to individuals and their own sense of personal history. Some will argue with me on this point, but I do not feel that shame is a helpful emotion. When we make a mistake and become ashamed we hide from others and ourselves. It is the hiding and the repression that generally amplifies our mistakes or makes us repeat them. If we do not realistically look at our problems we have little chance to solve them. On the other hand, guilt is felt when we make a mistake, acknowledge it, and vow to correct or not repeat it. Germany has chosen to embrace its guilt and has instilled a national value of self-examination – a value we may all hope to cultivate. While there is a right-wing movement alive within the country, there still seems be a collective ethos that allows Germany to effectively plan for the future well being of its citizens and the world.
Humans are imperfect – we make errors in judgment and belief. This fact should not be seen as an allowance or excuse for flagrant behavior, but as an opportunity for us to continually improve as individuals and as a species. Through honest self-examination and kindness towards others we may hope to live peacefully and happily.
In forming long-term relationships with clients, I’ve come to appreciate and utilize Attachment Theory. The theory purports that the childhood bonds formed with our caregivers shape how we relate to others and ourselves for the rest of our lives. In connection with others, we will either seek what is familiar to us or try to re-create accustomed patterns – this is our attachment style. For some of us, this is a helpful tendency. If our relationships were warm and attuned then we will seek out similar feeling relationships. Conversely, if our relationships with caregivers were conflict-ridden or inconsistent then we will unconsciously seek out others that will fulfill these expectations or create that same dynamic with partners.
Researcher Mary Ainsworth and her 'Strange Situation' study (done in the 1960’s-70’s) were crucial in understanding how our attachment style forms during our infancy. While previous generations of researchers and psychologists already placed value on early childhood development, Ainsworth's broad categorization of attachment styles helped adults more easily understand the effects of their childhood on their adult relationships. Through observing the reactions of young children and their primary caregiver, usually the mom, Ainsworth assessed the quality of the infant-parent relationship a.k.a. attachment style. The ‘Strange Situation’ study was conducted in a few systematic steps. First, a caregiver and infant would play in a room together for some minutes, then a stranger would enter and be present with the infant along with the parent. After a few minutes, the caregiver would leave the room then return shortly thereafter, all the while Ainsworth and her researchers observed through a two-way mirror.
Based on her observations, Ainsworth developed four categories of infant-parent attachment style: 1. Secure attachment 2. Insecure-anxious attachment 3. Insecure-avoidant attachment 4. Insecure-disorganized attachment. Attachment styles may be thought of as parts of a continuum with secure attachment at one end and disorganized attachment on the other end. Secure attached infants played and explored freely in the presence of their caregiver and showed little fear of the stranger. When their parent left, they became upset and upon their return, were happy and soothed by them. Secure attachment reflects a child’s belief that their parent is attuned and aware of them and will help in times of distress. This safe relationship instills in a person a belief that people are generally helpful and trustworthy. Conversely, insecurely attached children carry complicated beliefs that people are unhelpful, untrustworthy, or dis-regulating. The different variations of insecurely attached children reflect caregiver relationships that are inconsistent, absent, or at worst, another source of distress for the child. Anxiously attached children were wary of strangers (even in the presence of a parent), were highly distressed when the caregiver left, and upon return of the parent were either angry or displayed helplessness. These children had caregivers that were unpredictable in their care – alternating between presence and absence. Anxious children’s big displays of anger or helplessness were seen as cries for more steady contact. Avoidant attached children mirrored the behavior of a caregiver that snubbed or avoided the child’s bids for attention. These children explored little of their environment and ignored or tepidly approached their caregiver when they returned. While these children were clearly distressed by their caregivers’ absence - their belief that their needs would not be met prevented them from making an outward show of suffering. Why cry if no one is listening? Their silent protestations were a way to have some closeness with their caregiver, but not so close as to experience the painful rejection of an absent parent. Lastly, disorganized children were symbolic of a highly dysfunctional and un-attuned caregiver-infant relationship. Sadly, these children had parents that not only rejected or ignored their children’s requests for help but may have become enraged, upset or despondent by their child’s request for help. When their caregiver returned to the room the child displayed erratic behavior, they would approach their caregiver with irregular motion and display a flat affect while clearly being distraught. The infant was displaying the inner conflict of wanting care and attention but also a fear or wariness of their caregiver. Often, the parents in these relationships had recently experienced a major trauma or had serious depression.
This study has proven to be important because attachment style has proven to carry over into adulthood and emerge in our romantic relationships, close friendships, or in our own created families. For those of us with secure attachment, we have a belief that we can trust our feelings and those that are close to us. We probably don’t have much need for psychotherapy. For those of us with some insecure attachment, our relationship with others and ourselves is more complicated. We may notice troubling patterns and tendencies that emerge over time - different partner, same issues. Sometimes we might be unpleasantly reminded of how we felt as a child or notice that we’re responding to others as we responded to our parents. Anxiety and depression may be present. If we are an anxious (pre-occupied) type, our partners may give us feedback that we’re too needy or overwhelming. Jealousy and a fear of abandonment may drive our actions. If we are avoidantly attached, we may retreat if we feel hurt or angry – it may be safer to spend time alone rather than deal with issues. Perceptions that we are frequently distant are common. Disorganized attached individuals may have chaotic relationships with others, oscillating between rage and helplessness. Craving time with another while also being terrified of them.
Thankfully our attachment style is like our brain – malleable. Through therapy or even through relationship with other securely attached individuals, we can come to change the way we relate to people and ourselves. Kindness and empathy from others teach us to be kind to others and ourselves. We come to understand much of our feelings are by-products of the attachment style or schema laid during childhood, from ages 1-5. Some of us need to deepen our trust of our feelings while others may need to learn to ignore them! The more awareness we turn towards our inner workings the greater chance we have of choosing a healthy path and avoid repeating the same detrimental patterns.
There have been many important contributions and challenges to attachment theory since its inception in the 60's. We don’t all neatly fall into one of the categories – we all exhibit some streaks of each of these styles that manifest at different times. However, the essence of the theory remains important – that our early relationships are remarkably important to our long-term well-being.
My ongoing exploration into therapy related topics.