Avant-guard psychiatry

IMG_0193When I encounter people working in alternative energy or holistic health, I find a purity to their work born from having personal experience with their modality and a conviction in its importance.  There is a clarity in their words and a humility in their demeanor.

At the moment I have in mind a psychiatrist named Will Van Derveer whom I heard speak in Boulder, Colorado, last week.   Van Derveer is soft-spoken and articulate, a lean middle-aged man with clear skin and the centeredness that stems from meditation and wisdom.  He spoke on a holistic approach to psychiatry, one that takes into account gut health, neurotransmitter fluency, chemistry, genetics, attachment disruptions, ego structure, trauma, relationship, and spirituality.  As someone who has studied psychology but often finds something missing, I reveled in hearing a perspective that made sense to me on every level.

Van Derveer does prescribe medications, but he keeps his sights on the truth that it is still the relationship between therapist that is the heart of healing, as research has shown for decades now.  He also works with natural medicine to determine if someone has adrenal fatigue, candidiasis, gluten intolerance, lyme disease, or some other issue underlying mental dysfunction.  He may order neuropsych tests as well.  He works with somatic experiencing to address trauma, and he uses a natural supplement to help those who wish to come off meds.  It’s a very complex job he has, and his clientele is varied, their symptoms sometimes mysterious.  But he listens, seeks the advice of colleagues, and recommends a variety of treatments, including yoga, tai chi, and meditation.

Many MDs do not even recognize the validity of adrenal fatigue or candida, and Van Derveer acknowledges that these issues are more often the territory of naturopaths and sometimes of a few integrative medicine docs.  But he believes these disorders are real and much of his clientele does too. He follows studies and can describe case studies in which clearing up candida or adrenal issues clears up depression, lethargy, or anxiety.

When people are suffering, have tried a myriad of treatment approaches that have not helped enough, or are inclined to minimize medication use, they seek out Van Derveer’s.  They may have to make some real lifestyle changes, but this doc is patient and understanding.  He understands the importance of community and social support in making changes and recovering.  He understands the problems involved in an unbalanced brain and in addiction.  He has compassion, and he is open to learning from patients, colleagues, research.

Here is a man in touch with the realities of his time, the evolution of medicine, the suffering of his fellow creatures.  When someone in the audience asked him why he often prescribes medications for a person in acute distress, he said, “fear.”  Not a common confession from a physician, but an honest one.  Another listener noted that compassion is also involved in wanting to help someone suffering deeply and using the most powerful or best known remedy at hand.  At another point he spoke of the need to accept a condition and the ongoing struggles associated.   For me, the daughter of a doctor, I am most impressed by one admitting his fears, the limitations of medical knowledge, and this awareness of the complexity of humans, our environments and the food we eat.  At the same time I am reassured that he is attentive to the latest thinking and research as well as the experience of patients.

Other things he said let me know he is aware of his own psychological issues, that he eats well, lives well, and learns from mistakes.  Here is the art of medicine in full relief:  open to mystery, employing intellect and intuition, considering the natural world, practicing what one preaches, learning from mistakes and from patients and colleagues of all ranks.   I call him enlightened.

The trouble with Dr. Oz?

IMG_1356The New Yorker is my favorite magazine.  Every once in awhile, though, I encounter an article that really makes me scratch my head:  Actually a couple of these have been written by Michael Specter, including his recent “The Operator,” subtitle (in the contents), “The Trouble with Doctor Oz,” February 4, 2013.  (Specter is also the Author of Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives.)

I think Specter, along with some other Oz critics, is right to question the unbridled and hyped up promotion of herbs or foods, like raspberry ketones to burn fat, or green coffee beans for weight-loss, or red palm oil for Alzheimer’s disease, though I do think its helpful to bring attention to these things:  In my mind the hype and overemphasis is problem.

On the other hand, I strongly part ways with Specter when it comes to Oz’s showcasing of some “alternative” approaches to healing.  I am like Oz in not needing scientific proof that these approaches work.  If one thinks physicians should stick within the scientific, Specter’s argument is understandable.  But medicine is also an art.  In addition, science has shown us that sometimes placebos work as treatment.  Specter says that Oz’s practice of mixing “sensible” and scientifically proven information with unproven information is hard to understand—IS IT?  Science, after all, is sometimes used in specious ways to promote pharmaceutical drugs.

These are old questions representing two camps, the Western scientific and Eastern, the rationalist and the mystic, the chemical and surgical with the natural (the latter has not been studied as extensively).  Here’s where I come from.  The two major health conditions that have affected my wellbeing have been untreatable by modern medicine.  If they progress to cancer or blindness or an autoimmune condition, medicine will have an “answer” or treatment, but I have used alternative methods to reverse or stop the problem in their tracks.  These modalities, ayurveda, acupuncture, and herbal medicine, were off the radar of modern medicine, and science would not have given me reinforcement for pursuing them.

My experiences with keratoconus, an eye disorder, and candida/gluten intolerance, a digestive disorder, taught me how to address illness from a system, organic, natural, and energetic  angle.   Arresting of the keratoconus and resolving the candida issue involved processes that took quite a long time and a commitment to my health at emotional, spiritual, physical, social, and environmental levels.  I may not have healed had I not meditated, prayed, dropped unhealthy friendships, actually adjusted my way of exercising to a more gentle one focused on yoga and walking outdoors in the sunshine.   Without all these angles of approach, I would have become sicker and repeatedly visited my physician, who could only have given me temporary measures and helped me manage chronic illness.

Western science and medicine exist in one realm while some of the healing arts tap into another.  We have to acknowledge the limitations of our mechanistic medical sciences, to realize there is a realm of healing, of energy, that we do not understand with our rational minds.  We need a practice of mindfulness, of openness, of listening to the body, emotions, spirit, and chi, to old traumas and the need for radical self-care on all these levels.

This approach is not easy.  It requires time, energy, and an ability to go through upheaval and reorientation.  It demands an openness to uncertainty and to life changes.  It means loosening dependence on the rational, analytical intellect and paying attention to the body and its sensations.  I think the process also leads to examination of our culture, to a reengagement with our selves, and to a new relationship with the fruits of the earth, the herbs and natural foods. Not many of us will engage in such a process, particularly if we are working hard and are engaged with a profession of status, busy in our day-to-day lives.  It is easier to turn instead to the scientific, the prescription, the surgery.  Valid too, but sometimes not enough.

Specter quotes Oz:  “All I’m trying to do is put a couple of road signs out there.  I sit on that set every day, and that is what I am focusing on.  The road signs.”  Oz says he wants to erase barriers between patients and medicine, wants to raise issues that remain undiscussed, wants to walk the line that divides conventional medicine and alternative cures.   I am glad for his efforts.

Specter also says of Oz, “He describes modern medicine as a “civil war” waged between conventional physicians and those who are open to alternative cures for maladies ranging from anxiety to cancer; he considers it his mission to walk the line that divides them.  But more often his show seems to erase that line completely, with results that may be less benign than Oz and his many viewers realize.”

I tend to think the marriage of pharmaceutical companies and medicine is also less benign than many realize.  I for one think that Oz is doing important work inhabiting that zone between medicine and holistic health, between science and energy healing.  Many of us are grateful that he’s talking about these things, engaging with people out there seeking healing.  Medicine does not have all of the answers, and we need people like Oz to ask the questions and to present other sides so we might actively engage in our own healing in ways that involve our bodies, minds, and spirits.  I believe we need just such a wizard to catalyze a transformation.

Further adventures in yoga

I have so much faith in yoga to affect things physical or mental that I notice a need for it in many places.  Yoga for disabilities, yoga for kids in the justice system?  Amazing and effective in grounding, bringing more mobility and peace of mind: I have heard feedback from students corroborating my impression.  Now I have an opportunity to teach yoga, breathwork, and yoga nidra (deep relaxation) for veterans at a local clinic.

The prospect of working with vets traumatized by war is intimidating, but so was the prospect of teaching the other groups.  My friend Gina works at this vet center and is the one who invited me to teach; I ask her what it is like to work with these people, how they are affected by trauma the trauma of war and reentry into society.  She describes the anger, anxiety, and problems adjusting, and tells me it is challenging to work with this fallout of combat.  I get on the Give Back Yoga website and order CDs by folks who work with veterans:  They are on breathing and on yoga nidra, a practice for relaxing the body and even employing some hypnosis.  After years of my own practice and the influence of good teachers, I trust the ability of the yoga to do its magic, and I know how to incorporate feedback from the participants.   It’s a good starting point for challenging work.

We will meet once a week, equipped with mats, blankets, blocks, and bolsters.  My friend will be present, and that eases my mind.  Her experience dealing with the anxiety and anger that can erupt will be helpful to us all.  I will review all I have learned about dealing with trauma through the body and with mindlfulness.  With Gina there, and equipped with yoga and my own grounding through the practice, it may be doable.  It may be a healing experience.

There are now techniques for addressing trauma, whether from war, abuse, or accidents.  Yoga provides some that soothe the nervous system and rewire patterns in the muscles and nerves:  These other approaches, such as Somatic Experiencing, Sensorimotor Psychotherapy, or Eye Movement Desensitization Reprocessing, try to access traumatic memories and neuronal patternings and provide alternative experiences and a type of reprogramming.  My training in hakomi introduced me to basic presence and vocalizing with people re-experiencing trauma, and these other approaches go deeper in working directly with that trauma.

Twenty-three vet hospitals in the United States have yoga classes.  The Veterans Yoga Project is providing support and training to yoga teachers and centers introducing yoga to vets.  It’s pretty cool, really, to see an institution turn to yoga acknowledging the need and embracing the techniques and healing aspects of an ancient practice.  I am ready to jump into the pool and swim with the current on this one.

The Veterans Yoga Project’s mission “is to provide education and support for the mindful use of therapeutic yoga practices as an aid in the recovery process from post-traumatic stress and other psychological difficulties among US Veterans, their families, and their communities.”  The Project notes the following, information heeded by the vet hospitals around the country:  “Veterans coping with post-traumatic stress who practice yoga report better sleep, improved focus and concentration, less anger and irritability, and an overall greater ability to enjoy life in the present moment.” 

On the spectrum of disability

Before I worked at an independent living center I attended a workshop with Matthew Sanford, a yoga teacher paralyzed from the chest down.  In the workshop, he brought up the fears able-bodied people feel around disabilities as well as the commonalities among people in both conditions.  A gifted teacher, Sanford has provided helpful guidance to me and many others.  His intimacy with trauma, disability, and healing speaks deeply to me, as does his mission to change the perspective of the medical community and to educate on the mind-body relationship.

I think his teaching on yoga and healing is applicable to everyone.  Hasn’t each of us experienced some kind of trauma, some kind of search for healing or wholeness?  Whether we have a visible or invisible disability, or we simply have emotional wounds or limited beliefs about ourselves or limited social skills, we need to find our wholeness and self-respect.  We need to find our meaning and connection with others.

I share an office with a man who is quadriplegic, and each day when he arrives at work, I remove his hat and pull a file for him.  I consider these small tasks a privilege to perform because he is my friend and cohort.  And because they are a clear expression of our interrelation with each other.  I know this man as complex and normal as anyone, though I also think he’s a bit more evolved in having come to terms with his disability and valuing himself and his life.  He is bright, has a dry and deep sense of humor, a cool demeanor under stress, and an easy way of asking for and giving help.  His “boundaries” are strong but flexible, and his solid kindly presence is a comfort to me.

Another coworker is in a wheelchair and has a tracheotomy tube:  He cannot eat solid food, and he speaks with a whisper.  Yes, I feel sad for him, and I feel scared at the prospect of what life gives us to manage, and I wonder if he feels left out of social meals and gatherings, as I have from time to time.  At the same time, I am grounded by reality in his presence, sobered by our common human condition with all its vulnerability and tragedy.

My coworkers, both able and compromised physically, have taught me to take difficulty more in stride.  As a staff, we provide respect for anyone who comes in, from the special needs kids who help out twice a week with their teacher, to the man with schizophrenia who imagines people trying to tap into his computer and control his life, to the young man on parole trying to manage reduced vision.  The welcoming attitude demonstrates, or should I say embodies, the truth, that everyone has worth and value, that no one is lesser.  In fact, I barely see disability anymore.

I see my commonality with the state of disability when I encounter my psychological ruts or react, fight, say things from my childish self.  We are all limited in our humanity, even as we withdraw from others or grow angry and hurt them.  I think of my own introversion and lack of skill with boundaries, and I think of close friends with bipolar disorder, or people I know who are narcissistic and never seem to change, only to implode in their marriages or work lives as they age.   I often find myself wondering if might be possible for all of us to show up without hiding these things, and yet seek connection and resources and new learning about wellness and emotional freedom.

The challenges of love and loneliness, work and finances are held in common.  My coworkers who talk with me about disability, about growing up with cerebral palsy, managing MS, dealing with daily life, have taught me that our struggles are similar, if not varying in degrees.

Most profoundly, I am aware of the shared experience of losing physical function.  We seem to have a tendency to equate physical appearance with who one is, to make assumptions about personality or inner reality. And yet we also know, even if only on an unconscious level, that we will all experience disability, or death.  As a yoga teacher I am curious about what it means to be whole within an injured or deteriorating body.  I seek to learn how to experience more embodiment in such a state.  To help others yes, but also because I know we all will experience some disability at some point.  And because I seek to come to terms with my own eventual decline.

I see shared experience when I teach yoga at work while all of us sit in chairs.   A lesson in the fundamentals of yoga is absorbing in whatever physical form.  Someone’s practice is interesting to me whether it is a standing pose, a difficult arm balance, or aligning the spine and feeling through one’s torso while sitting.  Each of us struggles to be present, to let go, align, and breathe—to wake up to our experience.

Matthew has a DVD called “Beyond Disability.”  I believe the title refers to starting where we are, finding wholeness from there, and healing.   His personal experience with trauma and loss infuses his work as a yoga teacher dealing with injured bodies.  Yet he is so fully engaged in life that one sees how the term disabled becomes less relevant, and he inspires others to engage as well.

Truly this opportunity to work where I do has taken me beyond the concept of “normal” just as it has taken me beyond the concept of disability.  I barely see disability any more, and I am grateful to be less self conscious of what I perceive as my own shortcomings, such as my shyness and recurring boundary issues, to let go of more ego as well as its brother insecurity.   I feel cleansed, cleared to learn to show up as myself and to do my best given my own abilities and circumstances.

Over time, I have grown accustomed to a model in which we respect the state in which people find themselves, and it reminds me of the acceptance and loving-kindness we provide for ourselves in meditation.  At work we make things work for individuals or make a mutual decision to look for another environment.  Time is not wasted pounding a “square peg into a round hole.”  The respectful and welcoming attitude at work which seemed novel to me at first has become mundane in its constancy, and yet it is rare.  Might it be extended?   Can you imagine CEOs and CFOs, all the competitive high tech and financial and healthcare folks able to acknowledge their own disability or dysfunction and be more evenly respectful of others?

Each day I learn about our rights to live as fully as we are able, and I learn that if we claim these rights, there are supports for us.  If we get past the anger and our own ego/insecurity, we usually find aid, whether from God, humans, or nature.

Disability is more visible in some, but the challenge and aspiration is the same for all, and it is to live as fully as possible.  For society the gift of people with disabilities claiming their rights is great:  to see that life and love and heart are not dependent on fully functioning arms and legs.  That, even in a rupture between mind and body, body is alive in mind.  And sprit is alive regardless, reminding us of the mystery in our existence.

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